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Home health billing under PDGM, with every NOA on time
Billing for Medicare-certified home health agencies: notices of admission, 30-day PDGM periods, OASIS-driven HIPPS codes and more.
How home health billing works
Medicare pays home health under the Patient-Driven Groupings Model (PDGM) in 30-day periods. Each period’s payment group comes from the primary diagnosis, admission source, timing, functional score from OASIS and comorbidities, expressed as a HIPPS code on the claim.
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Agencies must file a Notice of Admission (NOA) within 5 calendar days of the start of care, or payment is reduced for each late day.
Codes we bill every day
| Code | What it covers |
|---|---|
| TOB 32x | Home health claims (institutional) |
| NOA | Notice of Admission, within 5 calendar days of start of care |
| HIPPS | PDGM payment group from OASIS and diagnoses |
| G0299 / G0300 | Skilled nursing visit codes (RN and LPN) |
| G0151 / G0152 / G0153 | PT, OT and speech-language visits |
Code descriptions are summarized. Payer coverage and documentation rules vary by plan and state.
Denials we prevent
- Late NOAs that reduce payment
- Primary diagnosis not accepted as a PDGM clinical group
- Face-to-face encounter or homebound status not documented
- Visits below the LUPA threshold billed as full periods
- Unsigned plans of care or physician orders
Payer rules to watch
Medicare requires a documented face-to-face encounter, a homebound patient and a signed plan of care. Medicare Advantage and Medicaid plans usually require prior authorization for visits and set their own visit limits.
Questions about home health billing
Do you track NOA deadlines?
Yes. NOAs are filed as soon as start of care is confirmed, and we track every period’s dates.
Do you bill Medicare Advantage home health?
Yes, with the authorizations and visit counts each plan requires.
Get a free home health billing audit
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.