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Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial im...

HCPCS code

Name of the Procedure:

Physician Certification for Medicare-Covered Home Health Services under a Home Health Plan of Care (Patient Not Present)


This is a necessary administrative procedure where a physician provides certification that a patient qualifies for Medicare-covered home health services. It entails reviewing the patient's medical records and communicating with the home health agency to ensure the patient receives appropriate care at home.


The main purpose is to allow the patient to receive necessary home health care services covered by Medicare. This includes ensuring the services are medically required and meet specific federal criteria.


  • Patients with chronic illnesses or conditions that require nursing care or therapy at home.
  • Post-operative patients needing continued medical supervision and assistance with daily activities.
  • Elderly or disabled individuals who find it challenging to visit healthcare facilities.


No specific preparation is required for the patient.

Procedure Description

  1. Review Medical Records: The physician reviews the patient’s medical records, including recent hospital discharge reports if applicable.
  2. Communicate with Home Health Agency: The physician may contact the home health agency to discuss the patient's status and required care.
  3. Certification: The physician certifies that the patient is homebound and requires medical care or therapy services at home. This involves filling out specific certification forms that detail the patient’s condition, required services, and the plan of care.
  4. Ongoing Review: Regular follow-up and updates with the home health agency to review progress and need for continued home health services.


Typically, the certification and communication process can take a few hours spread over several days depending on the complexity of the patient’s condition and the coordination required.


The procedure is conducted in the physician's office or clinic. The patient is not physically present.


  • Primary Care Physician
  • Home Health Agency Staff

Risks and Complications

  • Administrative errors: Potential delays in service provision due to mistakes in the paperwork.
  • Miscommunication: Misunderstandings between the physician and home health agency that could affect the quality of patient care.


  • Ensures that patients receive necessary, Medicare-covered home health services.
  • Allows patients to receive medical care in the comfort of their own homes.
  • Facilitates better management of chronic conditions and promotes faster recovery post-surgery.


N/A as it is an administrative process.


  • Direct inpatient or outpatient treatment: May be more costly and less comfortable for the patient.
  • Private payment for home health services without Medicare certification: Often financially burdensome for the patient.

Patient Experience

Since the patient is not directly involved in this procedure, there should be minimal to no discomfort or inconvenience. The benefits are primarily realized through the continued receipt of necessary home healthcare services.

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