Skilled Home Health & Fall Prevention • Medical Necessity & Prior Authorization
Home Health & In-Home Neuromuscular Rehab — Medical Necessity Checklist
Billing & Coverage Codes: HCPCS G0151 (Home Health PT), G0152 (Home Health OT), G0153 (Home Health Speech Therapy), G0299 (Home Health RN) • CPT 99349
Important Policy Notice — Not a Guarantee of Approval: Clinical coverage criteria change periodically and your health plan's official Evidence of Coverage and clinical policy determination are final. This checklist summarizes published CMS and commercial payer policies for educational preparation and is never a guarantee of approval.
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Plain-English Clinical Documentation Checklist
What Your Neurologist / Care Team Must Document in the Chart Note
Medicare Part A/B covers intermittent skilled Home Health Physical, Occupational, and Speech Therapy at a $0 patient copay — but ONLY if the patient meets Medicare's two-part 'Homebound' and 'Skilled Need' criteria:
1Face-to-Face Encounter: A documented in-person or telehealth visit with the certifying physician or NP/PA within 90 days before (or 30 days after) the start of home health care, specifically addressing the Parkinson's deficit requiring home health.
2Homebound Criterion #1: Because of Parkinson's disease (freezing of gait, severe postural instability, orthostatic hypotension, or fall risk), leaving the home requires a considerable and taxing effort AND the assistance of another person or a mobility device (walker, cane, wheelchair).
3Homebound Criterion #2: The patient leaves home infrequently and only for short durations (attending medical appointments, dialysis, adult day health care, or religious services is explicitly permitted without losing homebound status).
4Intermittent Skilled Need: The patient requires skilled physical therapy (home gait/transfer training, fall-hazard modification), occupational therapy (bathroom/ADL safety), speech therapy (home dysphagia/voice therapy), or intermittent skilled nursing.
5Care is provided by a Medicare-certified Home Health Agency (HHA) under a physician-signed 60-day episode Plan of Care.
Published Clinical Policy Citations
CMS Medicare & Major Commercial Payer Policies
Medicare (Original Medicare & Medicare Advantage)Verified Oct 2026
CMS Medicare Benefit Policy Manual (MBPM) Chapter 7 — Home Health Services (§ 30 Conditions Patient Must Meet)
$0 copay for intermittent skilled nursing, PT, OT, and speech-language pathology when the beneficiary is confined to the home ('homebound') and under a physician's plan of care. Maintenance therapy is covered under Jimmo v. Sebelius.
View Official Source Policy (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c07.pdf)