Direct answer: Home health billing and coding in 2026 requires accurate eligibility verification, certification, OASIS data, diagnosis coding, Notice of Admission submission, visit reporting, and final claims. Medicare uses 30-day payment periods under the Patient-Driven Groupings Model, while Medicaid, Medicare Advantage, and commercial plans may apply different rules.
Last reviewed: August 2026. This article provides general billing information and does not replace current CMS, Medicare Administrative Contractor, payer, coding, clinical, or legal guidance.
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What Is Home Health Billing and Coding?
Home health billing converts skilled services delivered in a patient’s residence into claims that meet the payer’s coverage, coding, documentation, and filing requirements. It can include skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, and home health aide services.
Medicare fee-for-service home health claims follow the Home Health Prospective Payment System. However, Medicare Advantage, Medicaid, and commercial payers may use different authorization requirements, rates, claim forms, visit limits, and deadlines.
Before applying any rule in this guide, confirm the patient’s payer and coverage arrangement.
Medicare Home Health Eligibility Requirements
Documentation must support the applicable Medicare home health benefit requirements. Generally, the record must establish that:
- The patient is confined to the home under Medicare’s homebound criteria.
- The patient needs intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy under the benefit rules.
- A physician or allowed practitioner established and periodically reviews the plan of care.
- The patient received the required face-to-face encounter.
- The services are provided by or under arrangements with a Medicare-certified home health agency.
The certification should be completed before the agency submits its claim. Documentation from the face-to-face encounter must support the patient’s eligibility and the need for skilled home health services.
Face-to-Face Encounter Requirements
The face-to-face encounter generally must occur within the 90 days before the start of home health care or within 30 days after the start of care. The encounter must relate to the primary reason the patient needs home health services.
Billing teams should verify that the record contains:
- The encounter date
- The identity and credentials of the practitioner
- Clinical findings supporting home health eligibility
- Information supporting homebound status
- The need for skilled services
- A valid certification and plan of care
A referral or signed form alone may not establish eligibility if the supporting medical record does not describe the patient’s clinical condition.
How Medicare Pays Home Health Claims Under PDGM
Medicare uses the Patient-Driven Groupings Model, or PDGM, to classify home health periods for payment. Medicare pays eligible home health services using 30-day periods rather than paying solely according to the number of therapy visits.
PDGM uses patient and claim information to place a 30-day period into a payment group. Its main components include:
- Admission source: community or institutional
- Timing: early or late
- Clinical group: the principal diagnosis and primary reason for home health care
- Functional impairment level: information supported by the OASIS assessment
- Comorbidity adjustment: qualifying secondary diagnoses
CMS categorizes 30-day periods into 432 case-mix groups. The home health grouper uses claim and OASIS information to assign the applicable HIPPS code.
Important 2026 Medicare Payment Changes
The 2026 Home Health Prospective Payment System final rule includes updated payment rates, PDGM case-mix weights, Low-Utilization Payment Adjustment thresholds, functional impairment levels, and comorbidity subgroups.
CMS estimated that the finalized policies would decrease aggregate Medicare payments to home health agencies by approximately 1.3% compared with 2025. The calculation includes:
- A 2.4% home health payment update
- A finalized permanent prospective adjustment of negative 1.023%
- A temporary adjustment of negative 3.0%
- An estimated reduction associated with the updated fixed-dollar-loss ratio
These percentages describe national policy estimates. They do not establish the exact payment for an individual claim. Actual payment depends on the case-mix group, wage adjustment, LUPA status, outlier eligibility, quality adjustments, and claim-specific information.
Notice of Admission: The Five-Day Rule
A Medicare home health agency must submit a one-time Notice of Admission, or NOA, for each admission. The NOA establishes that the patient is under a home health period of care and initiates Medicare consolidated-billing edits.
The agency can submit the NOA after it has:
- Obtained the required verbal or written order for the initial visit
- Completed the initial visit and admitted the patient to home health care
The Medicare Administrative Contractor must receive and accept the NOA within five calendar days after the admission date. For example, when the start of care is January 1, an NOA submitted and accepted by January 6 is considered timely.
What Happens When the NOA Is Late?
When an NOA is not timely, Medicare can reduce the applicable 30-day-period payment according to the number of days between admission and the date the NOA is submitted to and accepted by the MAC, divided by 30.
The reduction is the provider’s liability and cannot be billed to the patient. Additionally, Medicare does not make LUPA per-visit payments for visits occurring before the late NOA is submitted.
CMS may allow an exception for qualifying circumstances outside the agency’s control. The agency must document the situation and follow its MAC’s current exception instructions.
Home Health Type of Bill Codes
| Type of Bill | Purpose |
|---|---|
| 32A | Notice of Admission |
| 329 | Original home health claim for a completed billing period |
| 327 | Adjustment of a previously processed home health claim |
| 328 | Void or cancellation of a previously processed claim |
Billing staff should confirm the appropriate frequency code and claim situation through the current Medicare Claims Processing Manual and MAC instructions.
OASIS Requirements in 2026
Beginning July 1, 2025, CMS requires OASIS data collection and submission for patients with any payer when they are not exempt and their OASIS start-of-care M0090 date is on or after that date.
The requirement can include the start of care and relevant subsequent assessments, such as:
- Resumption of care
- Recertification
- Other follow-up assessments
- Transfer
- Discharge
- Death at home
CMS identifies several exemptions, including certain patients under age 18, maternity-only patients, patients receiving only personal care or homemaker services, and other specifically excluded situations.
Do not describe OASIS as mandatory for every home health patient without exception. Agencies should consult the current OASIS manual when determining whether collection is required.
Diagnosis Coding Under PDGM
The principal diagnosis should represent the primary reason for skilled home health care. It also helps determine the PDGM clinical group.
Coding teams should:
- Review the referral and face-to-face encounter record.
- Confirm the plan of care and current clinical findings.
- Select the most specific supported ICD-10-CM code.
- Sequence secondary diagnoses that affect care when documentation supports them.
- Verify that the principal diagnosis maps to a valid PDGM clinical group.
- Resolve conflicting or incomplete documentation before billing.
Do not select diagnoses simply to obtain a more favorable clinical group or comorbidity adjustment. Every diagnosis must be supported by the patient’s record and current coding guidelines.
HIPPS Codes and Revenue Code 0023
The HIPPS code represents the payment group assigned through the home health grouper. It is reported with revenue code 0023 on the final claim.
The grouper uses claim data and OASIS information to determine the HIPPS code. Therefore, mismatches between the assessment, diagnosis coding, admission information, and final claim can delay processing or change payment.
Agencies should validate the HIPPS information before transmitting the final claim rather than manually selecting a payment group based on expected reimbursement.
Visit Reporting by Discipline
Claims must accurately identify the discipline and practitioner who furnished each service. Common home health reporting codes include:
| HCPCS code | Service or discipline |
|---|---|
| G0299 | Skilled nursing services furnished by a registered nurse |
| G0300 | Skilled nursing services furnished by an LPN or LVN |
| G0151 | Services performed by a qualified physical therapist |
| G0157 | Services performed by a physical therapist assistant |
| G0152 | Services performed by a qualified occupational therapist |
| G0158 | Services performed by an occupational therapy assistant |
| G0153 | Services performed by a qualified speech-language pathologist |
| G0155 | Services performed by a clinical social worker |
| G0156 | Services performed by a home health aide |
The claim, visit note, scheduling record, and staff credentials should agree. Never report an RN service when an LPN performed the visit or a therapist service when an assistant furnished it.
Telecommunications Technology Reporting
Medicare permits home health agencies to report certain telecommunications technology used under the plan of care. Relevant non-payable reporting codes include:
- G0320: synchronous audio-and-video telecommunications
- G0321: synchronous audio-only telecommunications
- G0322: collection of physiologic data digitally stored or transmitted by the patient
These services are non-payable reporting items under the home health benefit. They do not replace an in-person visit when an in-person visit is required. Report them only when they are part of the plan of care and meet current CMS claim instructions.
Low-Utilization Payment Adjustments
A Low-Utilization Payment Adjustment, or LUPA, applies when the number of visits in a 30-day period falls below the threshold assigned to the patient’s case-mix group. In that situation, Medicare pays using applicable per-visit rates instead of the full case-mix-adjusted period payment.
CMS recalibrated LUPA thresholds for 2026. Agencies should verify the threshold for each assigned case-mix group instead of relying on a general estimate or the prior year’s threshold.
Scheduling should follow the patient’s clinical needs. Agencies should not add unnecessary visits merely to avoid a LUPA. However, missed or canceled medically necessary visits should be identified promptly so the clinical team can determine the appropriate response.
Home Health Value-Based Purchasing in 2026
The expanded Home Health Value-Based Purchasing Model applies to Medicare-certified home health agencies in all 50 states, the District of Columbia, and U.S. territories.
For the 2026 payment year, CMS applies an adjustment of up to 5% upward or downward to applicable Medicare fee-for-service payments based on the agency’s 2024 performance. The measures include information from OASIS, Medicare claims, and patient-experience reporting.
Accurate OASIS submission, complete documentation, care coordination, hospitalization reduction, and patient outcomes therefore affect both compliance and future reimbursement.
Consolidated Billing Risks
Under Medicare home health consolidated billing, the primary home health agency may be responsible for billing certain covered services and supplies furnished during an active home health period.
Agencies should:
- Verify whether a service or supply falls under consolidated billing.
- Coordinate with outside providers and suppliers.
- Confirm active home health periods before arranging outside services.
- Review the current CMS Home Health Consolidated Billing Master Code List.
- Reconcile vendor invoices with the plan of care and patient record.
Rules for Medicare Advantage, Medicaid, and Commercial Claims
Fee-for-service Medicare requirements should not automatically be applied to every payer. Medicare Advantage plans, state Medicaid programs, Medicaid managed-care organizations, and commercial insurers may establish their own:
- Authorization requirements
- Covered service definitions
- Visit limits
- Electronic visit verification requirements
- Claim forms and code combinations
- Rates and payment methodologies
- Timely filing limits
- Appeal procedures
Create a payer-specific billing matrix rather than relying on one Medicare checklist for every claim.
Common Home Health Claim Denials
- Missing or late Notice of Admission
- Eligibility or payer-selection errors
- Missing face-to-face encounter documentation
- Incomplete certification or plan of care
- Unsupported homebound status
- Invalid or unsupported principal diagnosis
- OASIS and claim inconsistencies
- Incorrect discipline or visit code
- Missing authorization
- Overlapping institutional stays
- Consolidated-billing conflicts
- Claims filed after the payer’s deadline
For additional guidance, read our articles about reducing denials through eligibility verification and using medical billing modifiers correctly.
Final Home Health Claim Checklist
- Verify eligibility and identify the correct payer.
- Confirm the order, certification, face-to-face encounter, and plan of care.
- Submit the NOA and verify that the MAC accepted it.
- Complete and submit required OASIS assessments.
- Validate the principal and secondary diagnoses.
- Confirm the PDGM group and HIPPS information.
- Match every visit code to the rendering discipline and documentation.
- Review LUPA status and missed medically necessary visits.
- Check institutional overlaps and consolidated-billing issues.
- Review claim acceptance reports and remittance advice.
Frequently Asked Questions
How long is a Medicare home health payment period?
Medicare uses 30-day payment periods under PDGM. The certification period and clinical-plan requirements should not be confused with the payment period.
How soon must a home health agency submit an NOA?
The Medicare Administrative Contractor must receive and accept the NOA within five calendar days after the admission date.
Is OASIS required for every payer?
Beginning July 1, 2025, OASIS collection and submission apply to patients with any payer when the patient is not exempt and meets the applicable start-of-care requirements. CMS maintains specific exemptions.
Are home health telehealth codes separately payable?
G0320, G0321, and G0322 are non-payable reporting codes under the Medicare home health benefit. They document qualifying telecommunications technology used under the plan of care.
What causes a home health LUPA?
A LUPA applies when the number of visits during a 30-day period falls below the threshold for the assigned case-mix group.
Official CMS Resources
- 2026 Home Health PPS Final Rule Fact Sheet
- Home Health Patient-Driven Groupings Model
- Medicare Claims Processing Manual, Chapter 10
- Medicare Benefit Policy Manual, Chapter 7
- Home Health Quality Reporting Requirements
Improve Your Home Health Revenue Cycle
Successful home health billing requires coordination between intake, clinicians, OASIS reviewers, coders, schedulers, authorization staff, and billers. A breakdown at any stage can delay payment or create audit exposure.
Med Billing and Transcription supports eligibility verification, coding, claim submission, denial management, and accounts receivable follow-up for healthcare organizations. Contact our team to discuss support for your agency.
