Home Health Care Services
Skilled Home Health
Under CCN, skilled home health care includes skilled bundled, skilled unbundled and skilled expanded.
Skilled bundled care: Reimbursed via the Medicare Patient-Driven Groupings Model (PDGM), episodic method, clearly stated in the SEOC approved referral/authorization letter. It should be billed appropriately on a UB04.
Skilled unbundled care: Reimbursed on a fee-for-service basis and the VA issue orders regarding services and visits. The coding allowed is to accommodate billing per hour or per 15-minute increments. It should be billed appropriately on a CMS 1500.
Skilled expanded care: This is skilled private duty nursing for highly dependent Veterans. It will be reimbursed on a fee-for-service basis and VA will issue orders regarding services and visits/hours. The coding allowed is to accommodate billing per hour or per 15-minute increment. It should be billed appropriately on a CMS 1500.
For more specific information regarding home health care, refer to the Home Health Quick Reference Guide.
Unskilled Home Health
Homemaker, Home Health Aide or In-home Respite Care is available only through CCN. This care is included in the CCN Healthcare Benefit, and involves help with daily activities such as bathing, grooming, meal preparation and household tasks to enable independence and safety for the Veterans who are in need of it.
This care must be approved by VA, who chooses an appropriate SEOC. The SEOC indicates the number of hours the Veteran qualifies for per week. The specific amount of time that has been ordered by the VA physician is spelled out on the VA documentation.
For more specific information regarding unskilled home health care, refer to the Unskilled Home Health Quick Reference Guide.
Home and Other Infusion Therapy Services
Under the Department of Veterans Affairs (VA) Community Care Network (CCN), infusion therapy services includes: home infusion therapy (HIT), Ambulatory Infusion Suite (AIS), and IV Therapy Outpatient Infusion.
- Reimbursement provisions for home infusion therapy (HIT) drugs are based on ASP pricing.
- Reimbursement for services rendered cannot exceed the number of units authorized by the approved SEOC. If a provider requires additional units, they must request a new referral from VA.
- Compounding fees are not separately payable.
- Unlisted codes will follow the pricing hierarchy of:
- Medicare pricing methodology
- VA fee schedule
- Paid at billed (inclusive of any agreed contractual discount) not to exceed billed charges
For more information please reference the Infusion Therapy Services QRG.