Home Health Aides

Number: 0218

Table Of Contents

Policy
Applicable CPT / HCPCS / ICD-10 Codes
Background
References

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Policy

Scope of Policy

This Clinical Policy Bulletin addresses home health aides.

1. Medical Necessity

   1. Aetna considers the services of a home health aide medically necessary in selected cases when both of the following criteria are met:

      1. 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
      2. The services delivered by the home health aide directly support skilled home health care services. These may include:
         
         
         1. Assisting with a prescribed exercise regimen;
         2. Assisting with activities of daily living;
         3. Changing non-sterile dressings that do not require the skills of a licensed nurse;
         4. Routine care of prosthetic and orthotic devices;
         5. Supervising the individual's adherence to prescribed, self-administered medication and/or special diets;
         6. 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:

      1. Babysitting services
      2. House cleaning (except for maintaining the member's immediate area)
      3. Transportation.
   2. Home Health Aide services are intended to be short-term. Note: The initial authorization should be for a period not longer than 3 months, with one extension of another 3 months permitted. After the member has been receiving intermittent home health aide services for a period of 6 months or more, or if the member is identified as having long-term needs for assistance in the home, other information should be provided to the participant and/or caregiver about other services (e.g., personal care, companion aide, etc.) that may be more appropriate to meet their needs. 

   3. In Aetna's Healthy Chapters 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.

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Table:

CPT Codes / HCPCS Codes / ICD-10 Codes

Code	Code Description
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 aide 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
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes
S5136	per diem
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
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)
T1020	Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)
T1030, T1031	Nursing care, in the home, by registered nurse or licensed practical nurse, per diem

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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.

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Glossary of Terms

Table: 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

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References