Home Health Billing Codes: A Practical Guide for Home Health Organizations

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 codes 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 Codes

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:

1. HIPPS Codes (Health Insurance Prospective Payment System Codes)

2. HCPCS (Healthcare Common Procedure Coding System) Codes

3. Revenue Codes

4. Condition, Occurrence, and 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.¹

Based on OASIS assessments, these codes reflect a patient’s clinical group, functional impairment level, and comorbidity adjustment.² These codes are automatically assigned to Medicare Part A claims (types 32A and 32D) and determine payment under the Patient-Driven Groupings Model.¹

HIPPS Code Structure Under PDGM

Example HIPPS Code: 2AA11, indicating complex nursing intervention, low functional impairment, no comorbidity adjustment, and first 30-day billing period.

CMS recently recalibrated the PDGM for 2025, updating case-mix weights, functional impairment levels, and comorbidity adjustments to better reflect today’s patient populations.³ These changes make accurate OASIS assessments and coding even more critical to ensure agencies receive the correct payment for the care they provide.

Best Practices:

• Ensure OASIS assessments are completed accurately and promptly.

• Train coding staff on PDGM updates annually.

• Cross-verify HIPPS codes with patient records to catch scoring errors before submission.

2. HCPCS Codes for Home Health Services

HCPCS Level II codes are used to report specific services, procedures, and supplies provided in the home. These alphanumeric codes are critical for documenting the type of care delivered by each discipline.

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

In addition to core therapy and nursing codes, other HCPCS codes such as G0299 (RN direct skilled nursing) and G0493 (RN observation and assessment) may apply depending on the patient’s care plan. Regardless of the specific code, it’s essential to align the service documented with the clinician’s discipline.

While Medicare billing relies heavily on HIPPS codes to drive reimbursement under PDGM, HCPCS codes are still used to detail visit-level services and are required on claims for Medicaid, Medicare Advantage plans, and commercial insurers.¹

Best Practices:

• Confirm that the discipline providing the service matches the HCPCS code billed.

• Check payer-specific unit requirements (e.g., per 15 minutes vs. per visit).

• Use the latest HCPCS updates released each year to avoid outdated coding.

3. Revenue Codes

Revenue codes are three-digit numeric codes that indicate the department or type of service provided and are required on UB-04 institutional claims. In home health billing, revenue codes are used alongside HCPCS codes to provide a complete and accurate picture of each visit.

To ensure accurate billing and reimbursement, revenue codes must align with the clinician’s discipline and the specific service provided. For example, a visit billed under revenue code 042x (Physical Therapy) should also include a matching HCPCS code like G0151 to describe the service in detail. Revenue code 0023 is also used to report HIPPS codes under PDGM, and 027x series codes may be used for surgical supplies.²

Incorrect revenue-HCPCS pairings—or the use of overly general revenue codes—can trigger claim denials, downcoding, or audit flags. Consistency between codes, documentation, and actual services delivered is key to cleaner claims and faster payment cycles.

Best Practices:

• Build internal crosswalks linking HCPCS codes to the appropriate revenue codes.

• Always match the revenue code to the clinician discipline and service performed.

• Review revenue code selections quarterly to stay aligned with CMS and payer updates.

4. Condition, Occurrence, and Value Codes

In home health billing, Condition, Occurrence, and Value Codes provide essential context that can affect payment, eligibility, or the interpretation of a claim.

Condition Codes

Condition codes flag unique circumstances that impact billing or care delivery. Examples include:

• 21 – Billing for services after inpatient stay.

• 44 – Inpatient admission changed to outpatient status by the Utilization Review committee.

Condition codes may justify the use of certain services or payment timelines. For example, code 21 signals continuity of care from hospital to home health and may impact consolidated billing rules.

Occurrence Codes 

Occurrence codes document key dates or time-sensitive events that affect claim processing. Examples include:

• 11 – Date of onset of symptoms or illness.

• 27 – Date of hospice election.

These are especially important when establishing the timeline for coverage, coordination of benefits, or validating medical necessity.

Value Codes 

Value codes convey numerical or geographic data tied to reimbursement. Examples include:

• 61 – Number of home health visits in the billing period.

• 85 – County code where service was rendered (wage index use).

These codes are used to calculate payment adjustments—code 85, for example, ensures the correct geographic wage index is applied based on the patient’s service location.

Best Practices:

• Capture required condition, occurrence, and value codes at the time of admission and update throughout the episode as needed.

• Validate dates and county codes against the plan of care and patient admission data.

• Ensure value codes are updated annually based on changes to wage index and CBSA/FIPS codes.

• Train your billing team to cross-check these codes against documentation and OASIS data to ensure alignment across all parts of the claim.

With best practices in place, agencies can improve billing accuracy and reduce administrative burden.

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:^1,2

Medicare Billing

Medicare billing follows the Patient-Driven Groupings Model and requires structured, episode-based coding:

• HIPPS code required for 30-day payment periods

• OASIS data must support the assigned HIPPS code

• Revenue code plus appropriate HCPCS required on each line item of the claim

Medicaid Billing

Medicaid billing requirements vary by state and often involve more granular, visit-based coding:

• Visit-level HCPCS codes often required with state-specific modifiers (e.g., U1–U9)

• Some states require time-based billing (e.g., units per 15 minutes of care)

• Coverage rules and allowable services may differ by state program

Private Insurance / Managed Care

These payers typically combine CMS standards with plan-specific guidelines:

• Mix of HCPCS and CPT codes often required

• May require prior authorization, payer-specific modifiers, or billing templates

• Frequently request documentation or clinical notes to support medical necessity

Common Errors in Home Health Billing and How to Avoid Them

Even small coding or documentation mistakes can have a big impact—delaying reimbursement, triggering audits, or causing claim denials. The following are some of the most common billing errors in home health care, along with practical tips for avoiding them:⁴

Mismatch between HCPCS and revenue code

When the HCPCS code used doesn’t match the associated revenue code on the claim, the payer may deny or downcode the claim. For example, submitting a physical therapy service (G0151) under a skilled nursing revenue code (055x) would trigger a mismatch error.

How to Avoid: Always verify that the HCPCS service matches the correct revenue code based on the discipline providing care.

Incorrect HIPPS code sequencing

Under PDGM, each 30-day billing period is classified as early or late based on episode timing. Submitting an "early" HIPPS code for a second or third payment period can cause underpayment or claim rejection.

How to Avoid: Carefully monitor certification periods and OASIS assessments to sequence HIPPS codes accurately.²

Missing or invalid condition/value codes

Condition and value codes provide important context about service timelines, visit volume, and geography that affect reimbursement. Missing or incorrect codes can delay claims or result in inaccurate wage index or visit-based payment calculations.

How to Avoid: Keep billing software updated with the latest code sets, and audit claims to ensure all required condition and value codes are complete and correct.

Failure to apply correct modifiers for visit types

Some payers—especially Medicaid and managed care plans—require visit-specific modifiers (like U1–U9) to indicate service complexity or extended duration. Missing these modifiers can cause claim rejections or partial payments.

How to Avoid: Confirm required visit modifiers for each payer and incorporate them into both clinical documentation and claim workflows.

Billing beyond allowed frequency or duration limits

Many payers cap the number of visits or hours that can be billed during a certification period or week. Submitting claims beyond those limits without authorization or medical necessity documentation often results in denials.

How to Avoid: Review payer-specific frequency and duration limits during plan of care development and track visit counts throughout the episode.

The Value of a Home Health Billing Cheat Sheet

Given the complexity of home health billing, decision makers often look for practical tools that can help streamline processes and reduce errors. A well-structured billing cheat sheet serves as a quick reference guide for staff, promoting greater accuracy and efficiency during claims submission.

A strong home health billing cheat sheet should include:

• Common HIPPS, HCPCS, and revenue code combinations.

• State-specific Medicaid billing requirements and modifiers.

• Payer-specific guidelines and documentation needs.

• Common audit triggers and tips for submitting cleaner claims.

Having a centralized, easy-to-access reference helps teams quickly verify billing details, reduce avoidable mistakes, and support compliance with Medicare, Medicaid, and private payer rules.

Thinking about that need, we’ve created a free, downloadable Home Health Billing Cheat Sheet that you can use to give your billing team clear, up-to-date guidance on coding best practices and claim preparation. With the right tools in place, your organization can submit cleaner claims, minimize denials, and keep revenue flowing smoothly.

Strengthening Billing Accuracy for Long-Term Success

Inaccurate billing not only delays cash flow and compliance audits but also raises red flags when codes do not accurately reflect the care delivered. Using the right codes from the outset helps support timely payments, reduce denials, and improve margins.

Billing leadership at home health agencies can take key steps to strengthen billing accuracy and streamline care delivery. To further support accurate billing and operational success, we offer home health software that integrates documentation, coding support, and staff education in one unified platform.

A few smart moves now can set your agency up for cleaner claims and fewer denials—here’s where to begin:

1. Use the downloadable Home Health Billing Cheat Sheet as a training and operational resource

2. Conduct quarterly internal billing audits

3. Stay up to date with CMS and Medicaid updates

4. Build a strong relationship with coders, therapists, and intake coordinators

5. Explore how Medbridge’s integrated home health software can support your team—request a demo today.

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/