Home Health Care Billing Requirements

WSI billing requirements for home health care include both a per hour and/or a per visit reimbursement rate. To ensure correct reimbursement, a provider should bill for services based on a per hour or per visit bases, regardless of the time units given by the HCPC code description. The following outlines the different billing options and requirements for each.

Per Visit

• Requires prior authorization from the claims adjuster
• Includes codes G0151-G0153, G0155-G0162, G0299-G0300 and G0493-G0496

Per Hour

• Requires prior authorization from the claims adjuster with specific approval of an hourly reimbursement rate
• Considered if, on average, the length of visit is greater than 3 hours
• Includes codes S9122-S9124 and 99601-99602

For more detailed information on the reimbursement rate of a home health care service, a provider may review WSI’s Home Health Care Fee Schedule.

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