Posted: 04/29/2025

HAP-Home Health Consolidated Billing

Home Health Consolidated Billing

Effective July 1, 2025, HAP will follow The Centers for Medicare and Medicaid Services (CMS) Home Health Consolidated Billing policy for claims paid using Medicare Home Health Prospective Payment System.

CMS requires consolidated billing of all home health services while a beneficiary is under a home health plan of care authorized by a physician. Separately billed services documented on the CMS Home Health Consolidated Billing Code list will not be separately reimbursed from the payment of the home health episode.

During a postpay review, we will deny claims where we find the member received care from a home health facility, and in the same date range, received non-routine supplies from another provider that should have been consolidated into the home health episode bill. Some examples of non-routine supplies include bandages, dressings, catheters, wound pouch, etc. While these services may be payable, they must be obtained and billed by the home health agency. We will deny separate billing of these services by a different provider, such as a durable medical equipment carrier. The provider must work with the home health agency to obtain their payment.