R 418.101005 Reimbursement for home health services.

Rule 1005. (1) Home health services are reimbursed "by report," requiring submission of a report with the charges on the UB-04 claim form. The carrier shall reimburse the home health agency according to each "by report" procedure listed on the UB-04, billed with the appropriate HCPCS code in accord with R 418.10909. (2) Home health services shall be reimbursed by the carrier at either the provider's usual and customary charge as defined by these rules or reasonable amount, whichever is less. (3) Services listed in the HCPCS Level II codebook, as adopted by reference in R 418.10107, as per diem shall be reimbursed per diem or per visit in accord with the description of the code. The per diem visit shall be either at the provider's usual and customary charge or reasonable amount, whichever is less. (4) Supplies and durable medical equipment (DME) shall be reimbursed pursuant to these rules.