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Physicians also cannot provide home services at their convenience (for example, visiting senior independent living facilities on a routine basis).

A home visit must be reasonable and necessary, not a convenience.If a beneficiary is receiving care under home health benefit, primary treating physician will be working in concert with home health agency.Based on Consolidative Billing Regulations, no service will be covered under Medicare Part B when performed only to provide supervision for a visiting nurse/home health agency visit(s).

These services cannot be duplicative or overlapping.There may be circumstances where home health services and services of physician/qualified non-physician practitioners (NPPs) are performed on same day.The service must be of such nature that it could not be provided by a Visiting Nurse/Home Health Services Agency under Home Health Benefit.To bill these codes, physician must be physically present in beneficiary's home. Home visits services (CPT codes 99341-99350) may only be billed when services are provided in beneficiary's private residence (POS 12).Training of domiciliary staff is not considered medically necessary.It is expected that frequency of visits for any given medical problem addressed in home setting will not exceed that of an office setting, except on rare occasion.Frequency of visits required to address any given clinical problem should be dictated by medical necessity rather than site of service.Service must be of equal quality to a similar service provided in an office.Service/visit must be medically reasonable and necessary and not for physician or qualified NPP convenience.Visit will be regarded as a social visit unless medical record clearly documents medical necessity for every visit.Medical necessity must exist for each individual visit.A payable diagnosis alone does not support medical necessity of ANY service.Chief complaint or a specific, reasonable, and medical necessity is required for each visit.The mere presence of inactive or chronic conditions does not constitute medical necessity for any setting (home, rest home, office etc.). Under provisions of the Balanced Budget Act of 1997, Physicians (MDs) and Qualified non-physicians Practitioners (NPPs) must be practicing within the scope of State law and may also bill for home and domiciliary visits. Beneficiaries seen may be disabled either physically or mentally making access to a traditional office visit very difficult, or may have limited support systems.There is no requirement that patient must be homebound.These visits are an extension of normal care.Services must meet need of medical necessity.

History, exam and medical decision making.

Services are covered only when the three key E/M components are met and documented in medical record and based on face-to-face time with patient.

Home and domiciliary visits require complex or multidisciplinary care modalities involving:

Services to Homebound patients under General Supervision.

Documentation which Supports Home Visits.

On this page, view the below information: This is not to be confused with home healthcare incident to services. A provider must be present and provide face to face services. This is to improve medical care in a home environment. Home and domiciliary visits are when a physician or qualified non-physician practitioner (NPPs) oversee or directly provide progressively more sophisticated evaluation and management (E/M) visits in a beneficiary's home.