CLV IntelligenceReimbursement Policy Monitoring

Specialty intelligence

Home health Reimbursement Alerts

14 active CMS and MAC reimbursement alerts affect Home health billing teams (Critical-severity changes active) — most recent: Federal Register Final Rule: Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment Requirements, effective 2024-01-01. Monitored daily across CMS, all 16 MAC jurisdictions, and the Federal Register.

Daily CMS policy updates, MAC LCD revisions, and coding guidance for Home healthbilling teams. All alerts sourced directly from CMS — including the Medicare Coverage Database that carries every MAC’s LCDs — and the Federal Register.

Critical alerts active

Total alerts

14

Average signal

70/100

Sources monitored

9

Latest Home health alerts

14

Federal Register Final Rule: Medicare Program; Calendar Year (CY) 2024 Home Health (HH) Prospective Payment System Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin Items and Services; Hospice Informal Dispute Resolution and Special Focus Program Requirements, Certain Requirements for Durable Medical Equipment Prosthetics and Orthotics Supplies; and Provider and Supplier Enrollment Requirements

Home Health · Effective 2024-01-01

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MAC contractor coverage

Home health billing is subject to both national CMS policy and regional MAC contractor Local Coverage Determinations (LCDs). Coverage from all seven A/B contractors — Noridian, CGS, First Coast, NGS, Novitas, Palmetto GBA, and WPS — reaches us through the CMS Medicare Coverage Database, where they publish their LCDs and Billing & Coding Articles; we track it there for updates affecting Home health codes. Coverage criteria vary by contractor jurisdiction.

NoridianCGS AdministratorsFirst CoastNational Government ServicesNovitas SolutionsPalmetto GBAWPS

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Weekly digest of CMS and MAC policy changes for Home health billing teams.

Frequently asked questions

What MAC contractors issue LCDs for Home health billing?

Home health billing is subject to regional Local Coverage Determinations (LCDs) from the 7 A/B Medicare Administrative Contractors: Noridian, CGS Administrators, First Coast Service Options, National Government Services, Novitas Solutions, Palmetto GBA, and WPS Government Health Administrators. Between them they administer the 12 A/B MAC jurisdictions; a further 4 DME MAC jurisdictions are administered by Noridian and CGS. Coverage criteria and medical necessity requirements vary by jurisdiction. CLV Intelligence monitors all 16 MAC jurisdictions daily for LCD updates affecting Home health codes.

How often does CMS update Home health reimbursement policy?

CMS updates the Physician Fee Schedule annually, effective January 1, with proposed rules published in the summer and final rules in November. MAC contractors issue LCD updates on a rolling basis throughout the year with no fixed schedule. The Federal Register publishes proposed and final rules affecting Home health reimbursement on a continuous basis. CLV Intelligence monitors all three sources daily and surfaces updates by signal strength.

What is a Local Coverage Determination (LCD) and how does it affect Home health billing?

A Local Coverage Determination (LCD) is a decision by a Medicare Administrative Contractor specifying under what clinical circumstances a particular service is covered within its geographic jurisdiction. For Home health billing teams, LCDs define medical necessity criteria, covered diagnoses, and documentation requirements for specific procedures. Failure to comply with LCD requirements is among the most common causes of Medicare claim denial in Home health practices.

Codes we track for Home health

The CPT/HCPCS and ICD-10 codes most often affected by Home health policy changes we monitor. Each links to its reimbursement-alert history.

G0329hcpcs14254cptF00.9icd10P247icd1013004cpt21767cptG0299hcpcsG0300hcpcsG0539hcpcsG0540hcpcsG0151hcpcs95851cpt

Reimbursement guides & resources

Plain-language guides to the policy cycles that drive Home health reimbursement — the fee schedule, ICD-10, HCPCS, and Local Coverage Determinations.

2027 Fee Schedule Guide

How the CY2027 Medicare Physician Fee Schedule works and what to track.

ICD-10 Change Center

The FY2027 ICD-10-CM update cycle and the October 1 effective date.

HCPCS Quarterly Update

How HCPCS Level II changes every quarter — Jan, Apr, Jul, Oct.

Tracking LCD Changes

How LCDs change across every MAC jurisdiction and how to track them.

2027 Prep Checklist

A free, printable checklist for the CY2027 fee schedule cycle.

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