Home Health Billing Services
Home health billing operates under the Patient-Driven Groupings Model (PDGM) with OASIS-based case-mix classification, 30-day billing periods, LUPA thresholds, and a value-based purchasing program that directly impacts reimbursement.
Why Home Health Billing Requires Specialty Expertise
Home health billing under PDGM classifies patients into 432 case-mix groups based on admission source, timing, clinical grouping, functional level, and comorbidity. OASIS assessment accuracy directly determines reimbursement. The shift from 60-day to 30-day billing periods doubled claim volume while LUPA (Low Utilization Payment Adjustment) thresholds penalize agencies that fail to deliver the minimum number of visits per period.
Common Home Health CPT Codes
Our coders handle these home health codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Home Health CPT Codes by State
Medicare reimbursement for home healthprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same home health CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 6 core home healthcodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Home Health Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 99347 | Home visit, established patient, low MDM | $49.25 | $45.94 | $47.41 | $49.70 | $46.15 | $46.92 | $44.83 | $45.72 | $44.63 | $45.75 |
| 99348 | Home visit, established patient, moderate MDM | $84.39 | $78.53 | $81.13 | $85.09 | $78.90 | $80.24 | $76.55 | $78.15 | $76.21 | $78.17 |
| 99349 | Home visit, established patient, high MDM | $141.07 | $131.63 | $137.48 | $143.30 | $132.44 | $135.89 | $128.36 | $131.35 | $127.29 | $131.67 |
| 99350 | Home visit, established patient, very high MDM | $205.57 | $192.14 | $200.86 | $209.13 | $193.37 | $198.59 | $187.48 | $191.83 | $185.82 | $192.37 |
| 99344 | Home visit, new patient, moderate MDM | $155.94 | $146.07 | $151.84 | $158.35 | $146.93 | $150.30 | $142.72 | $145.74 | $141.66 | $146.04 |
| 99345 | Home visit, new patient, high MDM | $224.14 | $209.09 | $218.24 | $227.58 | $210.36 | $215.72 | $203.88 | $208.61 | $202.24 | $209.09 |
Full Home Health fee detail by state
2026 Medicare allowables for home health CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 99347 | Home visit, established patient, low MDM | $49.25 | $49.25 |
| 99348 | Home visit, established patient, moderate MDM | $84.39 | $84.39 |
| 99349 | Home visit, established patient, high MDM | $141.07 | $141.07 |
| 99350 | Home visit, established patient, very high MDM | $205.57 | $205.57 |
| 99344 | Home visit, new patient, moderate MDM | $155.94 | $155.94 |
| 99345 | Home visit, new patient, high MDM | $224.14 | $224.14 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Home Health Billing Challenges We Solve
Common billing problems in home health and how our team handles them.
OASIS Assessment Accuracy
OASIS-E assessment items drive case-mix classification — inaccurate scoring directly reduces reimbursement by shifting patients to lower-paying groups.
LUPA Threshold Management
Each 30-day period has a LUPA visit threshold (typically 2-6 visits). Falling below it reduces payment from full episode to per-visit rates.
30-Day Period Billing
Doubled claim volume versus the former 60-day model creates more opportunities for timing and sequencing errors.
RAP Elimination Transition
The elimination of Request for Anticipated Payment requires agencies to manage cash flow without upfront partial payments.
Common Home Health Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Home Health Practices Miss
Payer-Specific Home Health Billing Tips
Home Health Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert Home Health Billing Support
Free billing assessment for your home health practice. See where revenue is leaking.
What We Handle for Home Health Practices
Why Choose Go Medical Billing for Home Health
Home health billing under PDGM demands clinical-coding integration that general billers lack. Our team reviews OASIS assessments for coding accuracy, monitors LUPA thresholds in real time, and optimizes case-mix classification to maximize appropriate reimbursement.
We serve home health practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Home Health Billing by State
We handle home health billing in all 50 states. The 2026 Medicare allowables for home health CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert Home Health Billing Support
Stop losing revenue to home health coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.