Home Health Aides
Number: 0218
Table Of Contents
PolicyApplicable CPT / HCPCS / ICD-10 Codes
Background
References
Policy
Scope of Policy
This Clinical Policy Bulletin addresses home health aides.
-
Medical Necessity
-
Aetna considers the services of a home health aide medically necessary in selected cases when both of the following criteria are met:
- The services of a home health aide are rendered in conjunction with intermittent skilled home health care services provided by a licensed practical or registered nurse, occupational therapist, physical therapist, or speech therapist; and
- The services delivered by the home health aide directly support skilled home health care services. These may include:
- Assisting with a prescribed exercise regimen;
- Assisting with activities of daily living;
- Changing non-sterile dressings that do not require the skills of a licensed nurse;
- Routine care of prosthetic and orthotic devices;
- Supervising the individual's adherence to prescribed, self-administered medication and/or special diets;
- Taking blood pressure and other health monitoring activities.
A home health aide is a provider who assists a member with non-skilled care to meet activities of daily living, thereby maintaining the individual in his or her home environment. Generally, the following services are considered not medically necessary:
- Babysitting services
- House cleaning (except for maintaining the member's immediate area)
- Transportation.
-
In Aetna's Beginning Right℠ maternity program, there may be members at risk who require bed rest. In these cases, Aetna may consider home health services medically necessary to help with more routine household chores.
-
Code | Code Description |
---|---|
Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+": |
|
CPT codes covered if selection criteria are met: |
|
99509 | Home visit for assistance with activities of daily living and personal care |
Other CPT codes related to the CPB: |
|
92507 | Treatment of speech, language, voice communication, and/or auditory processing disorder; individual |
97010 - 97799 | Physical Medicine and Rehabilitation |
99500 - 99507, 99510 - 99600 | Home Health Procedures/Services |
99601 - 99602 | Home Infusion Procedures/Services |
HCPCS codes covered if selection criteria are met: |
|
G0156 | Services of home health aide in home health or hospice setting, each 15 minutes |
S9122 | Home health aide or certified nurse assistant, providing care in the home; per hour |
T1004 | Services of a qualified nursing aide, up to 15 minutes |
T1021 | Home health aid or certified nurse assistant, per visit |
Other HCPCS codes related to the CPB: |
|
G0068 | Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, and/or inotropic infusion drug(s) for each infusion drug administration calendar day in the individual's home, each 15 minutes |
G0151 - G0155 | Services of physical therapist, occupational therapist, speech and language pathologist, skilled nurse, or clinical social worker in home health or hospice setting, each 15 minutes |
S9128 - S9131 | Speech therapy, occupational therapy, or physical therapy, in the home, per diem |
S9208 - S9214 | Home management |
S9325 - S9379 | Home or home infusion therapy |
S9490 - S9810 | Home infusion therapy, routine venipuncture for collection of specimen(s), home therapy, home transfusion of blood products, home injectable therapy |
T1030, T1031 | Nursing care, in the home, by registered nurse or licensed practical nurse, per diem |
Background
A home health aide is a provider who assists a member with non-skilled care to meet activities of daily living, thereby maintaining the individual in his or her home environment. The services of a home health aide are rendered in conjunction with intermittent skilled home health care services provided by a registered or licensed practical nurse, physical therapist, occupational therapist, or speech therapist.
Glossary of Terms
Term | Definition |
---|---|
Home health aide | Provider who assists a member with non-skilled care to meet activities of daily living, thereby maintaining the individual in his or her home environment |
References
The above policy is based on the following references:
- Aalberts N. Training home care paraprofessionals. Areas for consideration. Caring. 1989;8(2):26-27.
- Boies AH. Role of the home health aide in the rehabilitation process. Home Health Nurse. 1987;5(6):44-45.
- Boland P. Making Managed Healthcare Work: A Practical Guide to Strategies and Solutions. New York, NY: McGraw Hill; 1991.
- Cayla JS. The nurse, the nurses' aide, the practical nurse and the home health aide. Soins. 1989;525:59-60.
- Cucinotta D, Savorani G, Piscaglia F, et al. The chronically ill elderly patients discharged from the hospital: Interim report from a controlled study of home care attendance. Arch Gerontol Geriatr Suppl. 2004;(9):103-108.
- Ferrell BR, Borneman T. Community implementation of home care palliative care education. Cancer Pract. 2002;10(1):20-27.
- Grieco AJ. Physician's guide to managing home care of older patients. Geriatrics. 1991;46(5):49-55, 59-60.
- Harris MD. The home health aide as a member of the home healthcare team. Home Healthc Nurse. 1997;15(11):773-775.
- Hays BJ, Willborn FH. Characteristics of clients who receive home health aide service. Public Health Nurs. 1996;13(1):58-64.
- Joseloff AW. The home health aide. A member of the hospice team. Caring. 1986;5(10):36-38.
- Kongstvedt P, The Managed Health Care Handbook. Gaithersburg, MD: Aspen; 1993.
- Marrelli TM, Handbook of Home Health Standards. St. Louis, MO: Mosby Year Book; 1991.
- Murashima S, Asahara K. The effectiveness of the around-the-clock in-home care system: Did it prevent the institutionalization of frail elderly? Public Health Nurs. 2003;20(1):13-24.
- Najera LK, Heavey BA. Nursing strategies for preventing home health aide abuse. Home Healthc Nurse. 1997;15(11):758-767; quiz 769-770.
- Najera LK. Enhancing home health aide training. Home Healthc Nurse. 1988;6(5):39-41.
- No authors listed. Medicare program; Medicare coverage of home health services, Medicare conditions of participation, and home health aide supervision--HCFA. Final rule. Fed Regist. 1994;59(243):65482-65498.
- Portnow J. Assistive technology in the home. Caring. 1994;13(9):58-61.
- Scharf JH, Lindner MK, Gordon J, et al. Making the relationship work. Management of a hospital-based home health agency and hospital for-profit home health aide service. Caring. 1990;9(4):62-65.
- U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). HCFA Publication No. 10969. Baltimore, MD: HCFA; updated December 10, 1996.