5FT10 and 5AT10: Documentation Does Not Support Homebound Status

The services billed were not covered because the medical records submitted for review did not support homebound status. 

A beneficiary is considered to be homebound if the following two criteria are met:

1. There exists a condition due to illness or injury that restricts the ability to leave the place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person; or if leaving home is medically contraindicated; and
2. There exists a normal inability to leave the home AND leaving the home requires a considerable and taxing effort

How to Prevent This Denial
Submit documentation that reflects 1) the need for supportive devices, the assistance of another person or that leaving the home is medically contraindicated, and 2) the normal inability to leave the home and that it is a taxing effort for the beneficiary to leave the home.

Resources

• 42 (CFR) Code of Federal Regulations Sections 409.42 and 424.22
• CMS Internet-Only Manuals (IOMs), Pub 100-02, Medicare Benefit Policy Manual, Chapter 7, Sections 30.1 and 30.1.1 (PDF)