Free Home Health Billing Cheat Sheet Download

Home health organizations face ongoing challenges when it comes to billing compliance, reimbursement accuracy, and cash flow. With frequent regulatory updates and a complex mix of services delivered across various care settings, understanding home health billing cheat sheet is vital to maintaining operational efficiency and financial stability.

This article offers a practical overview of the key home health billing codes, structured guidance on how to apply them, and a downloadable home health billing cheat sheet tailored for clinical and billing leaders.

Home Health Billing Codes Cheat Sheet

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Understanding Home Health Billing Cheat Sheet

Home health billing codes are structured into several categories based on services provided, visit type, discipline, and the payer’s billing requirements. These codes are used to report home health services to Medicare, Medicaid, and private insurers. Proper coding is essential for compliant claims submission and timely reimbursement.

The core home health billing codes include:

• HIPPS Codes (Health Insurance Prospective Payment System Codes)

• HCPCS (Healthcare Common Procedure Coding System) Codes

• Revenue Codes

• Condition and Occurrence Codes

• Value Codes

Each plays a distinct role in aligning reimbursement with the patient’s acuity level, visit frequency, and clinical characteristics.

1. HIPPS Codes for Home Health

HIPPS codes are five-character codes that represent the patient’s clinical grouping, functional impairment level, and comorbidity adjustment. Under the Patient-Driven Groupings Model (PDGM), HIPPS codes are used by Medicare to determine payment rates.

HIPPS codes are generated by the Outcome and Assessment Information Set (OASIS) and represent:

• Clinical Group (based on the primary reason for home health services)

• Functional Impairment Level (low, medium, high)

• Comorbidity Adjustment (none, low, high)

A sample HIPPS code might be: 2AA11.

These codes are critical for claims processed under Medicare Part A and are found on claim types 32A and 32D.

2. HCPCS Codes for Home Health Services

HCPCS Level II codes are used to report specific services or equipment provided in the home. Common HCPCS codes used by home health organizations include:

• G0151 – Services of a physical therapist

• G0152 – Services of an occupational therapist

• G0153 – Services of a speech-language pathologist

• G0154 – Services of a skilled nurse

• G0156 – Services of a home health aide

• G0162 – Skilled services by a registered nurse for management and evaluation of a care plan

These codes should match the discipline and service rendered during each visit and are typically used for non-Medicare payers, Medicaid, and managed care plans.

3. Revenue Codes

Revenue codes reflect the department or type of service billed and are reported on UB-04 claims.

Revenue codes must align with the HCPCS code and discipline. Incorrect combinations may lead to denials or downcoding.

4. Condition, Occurrence, and Value Codes

Condition Codes indicate special circumstances that may impact billing or reimbursement. Common examples include:

• 21 – Billing for services after inpatient stay

• 44 – Inpatient admission changed to outpatient by UR committee

Occurrence Codes capture specific dates or events, such as:

• 11 – Date of onset of symptoms/illness

• 27 – Date of hospice election

Value Codes provide numerical information related to the claim:

• 61 – Number of service visits during the billing period

• 85 – County code where the service was rendered (used for wage index adjustment)

Accurate use of these codes supports cleaner claims and reduces audit risk.

5. Billing Scenarios by Payer

Different payers have different billing nuances. Below are examples of how billing codes are applied across Medicare, Medicaid, and commercial payers.

Medicare Billing

• HIPPS code required

• OASIS data must support the code

• Revenue code + appropriate HCPCS required on each line

Medicaid Billing

• Often requires visit-level HCPCS + modifier (e.g., U1-U9)

• Services may vary by state

• Time-based billing may apply (e.g., per 15-minute units)

Private Insurance / Managed Care

• Generally requires a mix of HCPCS and CPT codes

• May require authorization codes, plan-specific modifiers

• Often request clinical documentation to support services billed

Common Errors in Home Health Billing

1. Mismatch between HCPCS and revenue code

2. Incorrect HIPPS code sequencing

3. Missing or invalid condition/value codes

4. Failure to apply correct modifiers for visit types

5. Billing beyond allowed frequency or duration limits

Regular audits, staff training, and automated claim validation tools can reduce these errors and improve reimbursement outcomes.

The Value of a Home Health Billing Cheat Sheet

Given the complexity of home health billing, decision makers often look for reliable reference tools to support their staff. A well-structured billing cheat sheet can provide quick access to:

• Common HIPPS, HCPCS, and revenue code combinations

• State-specific Medicaid billing requirements

• Payer-specific modifiers and documentation needs

• Audit red flags and tips for cleaner claims

Download Medbridge’s free Home Health Billing Cheat Sheet to support your billing team with clear, up-to-date guidance on coding best practices.

Why Billing Accuracy Matters for Home Health Leaders

Inaccurate billing can delay cash flow, impact compliance audits, and lead to takebacks. As PDGM continues to shape reimbursement under Medicare, and Medicaid programs demand more granularity, organizations must have reliable processes and knowledgeable teams in place.

Billing codes do more than support reimbursement—they reflect the care delivered, and discrepancies can raise red flags. Using the right codes from the outset helps support timely payments, reduce denials, and improve margins.

Next Steps

Billing leadership at home health agencies can: To further support accurate billing and streamlined care delivery, MedBridge offers home health software that integrates documentation, coding support, and staff education in one unified platform.

• Use the downloadable cheat sheet as a training and operational resource

• Conduct quarterly internal billing audits

• Stay up to date with CMS and Medicaid updates

• Build a strong relationship with coders, therapists, and intake coordinators

Disclaimer

This article is intended for informational purposes only and does not constitute billing or legal advice. While the content reflects information sourced from CMS, CGS Medicare, and the National Uniform Billing Committee, readers are encouraged to verify all coding and billing details with official payer guidelines and regulatory updates. Medbridge recommends consulting appropriate resources or billing professionals to confirm the accuracy and applicability of any information presented.

References

1. Centers for Medicare & Medicaid Services. (n.d.). Medicare payment systems. U.S. Department of Health and Human Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/html/medicare-payment-systems.html

2. Centers for Medicare & Medicaid Services. (n.d.). Medicare Claims Processing Manual, Chapter 10 – Home Health Agency Billing. U.S. Department of Health and Human Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c10.pdf

3. Centers for Medicare & Medicaid Services. (2024, November 1). Calendar year (CY) 2025 Home Health Prospective Payment System final rule fact sheet (CMS-1803-F). https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-home-health-prospective-payment-system-final-rule-fact-sheet-cms-1803-f

4. SimiTree. (n.d.). Overview of home health billing codes. https://simitreehc.com/simitree-blog/overview-of-home-health-billing-codes/