Home Health Billing

Home Health Therapy Billing

Table of Contents

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Home Health Therapy Billing

This billing guide will assist HHAs in determining the proper information to submit on claims for PT, OT or SLP services provided under a home health POC on a 32X TOB or a therapy plan of care (when not under a home health POC) on a 34X TOB. Therapy services billed under the 34X TOB are paid under the MPFS.

The codes listed within this billing guide are only those most frequently applicable to home health therapy claims. For a complete list of codes, see the NUBC manual. The NUBC maintains the UB-04 data element specifications and revenue code tables. They may be contacted for subscription to the UB-04 on the NUBC website.

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32X TOB: Billing Therapy Under a Home Health Plan of Care

Discipline Revenue Codes (UB-04 FLs 42-43)

Code Description
042X Physical Therapy – identifies services by physical therapists.
043X Occupational Therapy – identifies services by occupational therapists.
044X Speech-Language Pathology – identifies services by speech language pathologists

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Discipline HCPCS Codes (UB-04 FL 44)

Code Description
G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes
G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes
G0153 Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes
G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes
G0158 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes
G0159 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes
G0160 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
G0161 Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes

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Service Units (UB-04 FL 46)

For HCPCs which have descriptions with time specifications, use the following chart to determine the number of units to report for the total amount of time.

Units Number of Minutes
1 ≥ 8 minutes through 22 minutes
2 ≥ 23 minutes through 37 minutes
3 ≥ 38 minutes through 52 minutes
4 ≥ 53 minutes through 67 minutes
5 ≥ 68 minutes through 82 minutes
6 ≥ 83 minutes through 97 minutes
7 ≥ 98 minutes through 112 minutes
8 ≥ 113 minutes through 127 minutes

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34X TOB: Billing Therapy Under a Therapy POC (patient not under HH POC)

Occurrence Codes and Dates (UB-04 FLs 31-34)

Code Description
17 Date the occupational therapy plan was either established or last reviewed
29 Date the physical therapy plan was either established or last reviewed
30 Date the speech-language pathology therapy plan was either established or last reviewed

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Discipline Revenue Codes (UB-04 FLs 42-43)

Code Description
042X Physical Therapy – identifies services by physical therapists.
043X Occupational Therapy – identifies services by occupational therapists.
044X Speech-Language Pathology – identifies services by speech language pathologists

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Discipline HCPCS Codes(UB-04 FL 44)

Applicable outpatient rehabilitation HCPCS codes reimbursed under MPFS can be found under the Therapy Services portal on the CMS website.

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HCPCS Modifiers (UB-04 FL 44)

Code Description
GN Services delivered under an outpatient speech-language pathology plan of care
GO Services delivered under an outpatient occupational therapy plan of care
GP Services delivered under an outpatient physical therapy plan of care
KX* Beneficiary has exceeded the therapy cap; however, the therapist attests that the services are reasonable and necessary and there is documentation of medical necessity in the beneficiary’s medical record
*Services billed on a 34X bill type for those beneficiaries who are not homebound or are not under a home health POC are subject to the therapy cap. For claims over the cap, therapy service providers may submit claims with the KX modifier, when an exception is appropriate, for services furnished through 12/31/2017.

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Service Units (UB-04 FL 46)

When reporting service units for HCPCS codes where the procedure is not defined by a specific timeframe (“untimed” HCPCS), the provider enters “1” in the field labeled units. For HCPCs which have descriptions with time specifications, use the following chart to determine the number of units to report for the total amount of time.

Units Number of Minutes
1 ≥ 8 minutes through 22 minutes
2 ≥ 23 minutes through 37 minutes
3 ≥ 38 minutes through 52 minutes
4 ≥ 53 minutes through 67 minutes
5 ≥ 68 minutes through 82 minutes
6 ≥ 83 minutes through 97 minutes
7 ≥ 98 minutes through 112 minutes
8 ≥ 113 minutes through 127 minutes

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Functional Reporting (UB-04 FL 44)

Functional reporting requires billing of certain G-codes that are used to report a beneficiary’s functional limitation being treated and whether the report is on the patient’s current status, projected goal status or discharge status.

Functional reporting required for certain DOS:

  • At the outset of a therapy episode of care, i.e., on the claim for the DOS of the initial therapy service;
  • At least once every 10 treatment days on the claim for services on the same DOS that the services related to the progress report are furnished;
  • On the DOS when an evaluative or re-evaluative procedure is furnished and billed;
  • At the time of discharge from the therapy episode of care, unless discharge data is unavailable, e.g., this may occur when the beneficiary discontinues therapy unexpectedly.

Each reported G-code must contain the following revenue line information:

  • Functional severity modifier
  • Therapy modifier indicating the related discipline (i.e., GO, GN or GP)
  • Date of the related therapy service
  • Nominal charge, e.g., a penny

A complete list of the Functional Reporting G-codes and Severity/Complexity Modifiers can be found on the Functional Reporting section of the CMS website.

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