CMS Pub. 100-02, ch. 7, § 90

Agencies

(Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)

Payment may be made by Medicare contractors to a home health agency which furnishes

either directly or under arrangements with others the following "medical and other health

services" to beneficiaries with Part B coverage in accordance with Part B billing and

payment rules other than when a home health plan of care is in effect.

1. Surgical dressings (for a patient who is not under a home health plan of care), and

splints, casts, and other devices used for reduction of fractures and dislocations;

2. Prosthetic (Except for items excluded from the term "orthotics and prosthetics" in

accordance with §1834(h)(4)(C) of the Act for patients who are under a home

health plan of care);

3. Leg, arm, back, and neck braces, trusses, and artificial legs, arms, and eyes and

adjustments to these items when ordered by a physician or allowed practitioner.

(See Pub 100-02, Medicare Benefit Policy Manual, Chapter 15);

4. Outpatient physical therapy, outpatient occupational therapy, and outpatient

speech-language pathology services (for a patient not under a home health plan of

care). (See Pub 100-02, Medicare Benefit Policy Manual, Chapter 15); and

5. Rental and purchase of durable medical equipment. (See Pub 100-02, Medicare

Benefit Policy Manual, Chapter 15.) If a beneficiary meets all of the criteria for

coverage of home health services and the HHA is providing home health care

under the Hospital Insurance Program (Part A), any DME provided and billed to

the Medicare contractor by the HHA to that patient must also be provided under

Part A. Where the patient meets the criteria for coverage of home health services

and the HHA is providing the home health care under the Supplementary Medical

Insurance Program (Part B) because the patient is not eligible for Part A, the

DME provided by the HHA may, at the beneficiary's option, be furnished under

the Part B home health benefit or as a medical and other health service.

Irrespective of how the DME is furnished, the beneficiary is responsible for a 20

percent coinsurance.

6. Ambulance service. (See Pub 100-02, Medicare Benefit Policy Manual, Chapter

10, Ambulance Services)

7. Hepatitis B Vaccine. Hepatitis B vaccine and its administration are covered under

Part B for patients who are at high or intermediate risk of contracting hepatitis B.

High risk groups currently identified include: end-stage renal disease (ESRD)

patients, hemophiliacs who receive factor VIII or IX concentrates, clients of

institutions for the mentally retarded, persons who live in the same household as a

hepatitis B virus carrier, homosexual men, illicit injectable drug users.

Intermediate risk groups currently identified include staff in institutions for the

mentally retarded, workers in health care professions who have frequent contact

with blood or blood-derived body fluids during routine work. Persons in the

above listed groups would not be considered at high or intermediate risk of

contracting hepatitis B, however, if there is laboratory evidence positive for

antibodies to hepatitis B. ESRD patients are routinely tested for hepatitis B

antibodies as part of their continuing monitoring and therapy. The vaccine may

be administered, upon the order of a doctor of medicine or osteopathy, by home

health agencies.

8. Hemophilia clotting factors. Blood clotting factors for hemophilia patients

competent to use such factors to control bleeding without medical or other

supervision and items related to the administration of such factors are covered

under Part B.

9. Pneumococcal and influenza vaccines. See Pub 100-02, Medicare Benefit Policy

Manual, Chapter 15, “Covered Medical and Other Health Services,” §50.4.2

“Immunizations.”

10. Splints, casts. See Pub 100-02, Medicare Benefit Policy Manual, Chapter 15,

“Covered Medical and Other Health Services.”

11. Antigens. See Pub 100-02, Medicare Benefit Policy Manual, Chapter 15,

“Covered Medical and Other Health Services.”