CurrentColorado Rocky Mountain Health PlansPolicy N/A

Reimbursement for home health services during inpatient stay

Governance of reimbursement when home health services (Place of Service 12) and inpatient care are billed for the same patient and same date(s); applies to UnitedHealthcare Community Plan Medicaid products and providers submitting CMS-1500 or electronic equivalent.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement for home health services during inpatient stay

Policy CodePolicy N/A

Change TypeState exception updates

Effective DateN/A

Next Review DateN/A

Key ActionWhen home health (POS 12) and inpatient care are billed for the same dates, reimburse the inpatient claim; home health may be eligible only on admission and discharge dates or per listed state exceptions.

SourceLink

POLICY UPDATE CHANGES

State Exceptions updated multiple times with additions and removals (examples: Massachusetts added 2026-01-25; Washington D.C. added 2025-08-17; Indiana added 2025-05-18; Rhode Island updates on multiple dates; Arizona and New Jersey removed 2025-09-01).

POS 12Place of Service code governed by policy

Medicaid productsApplies to

CMS-1500Claim form type

AllowedAdmission/discharge exception

MultipleState exceptions

Home Health and Inpatient Overlap — Coverage Criteria

Home health during inpatient stay — coverage criteria

Reimbursement stance when home health services overlap with inpatient care:

When home health services (Place of Service 12) and inpatient care are billed for the same patient and same dates of service, UnitedHealthcare will reimburse the inpatient care and the home health services will not be eligible for reimbursement.

Exceptions

Home health services provided on the dates of inpatient admission and discharge may still be eligible for reimbursement.
State-specific exceptions: certain states permit billing of specific HCPCS or DME codes during the inpatient date span (examples include Indiana: S5161, S5165, S5170, T1028; Massachusetts: S5140U6, S5140U7, S5140TGU6, S5140TGU7; Rhode Island: E0602, E0603, E0604, H2000, H2021, S5161, T1023; Washington D.C.: T1023, S5161, T2040).

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement for home health services during inpatient stay

Policy CodePolicy N/A

Change TypeState exception updates

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

HCPCS / POS Coding and Same-Date Rule

State-exception HCPCS codes mentionedHCPCS

S5161	Example HCPCS referenced in state exceptions
S5165	Example HCPCS referenced in state exceptions
S5170	Example HCPCS referenced in state exceptions
T1028	Example HCPCS referenced in state exceptions
S5140U6	Massachusetts-specific HCPCS allowed
E0602	Rhode Island-specific HCPCS allowed
S5140U7	Massachusetts-specific HCPCS allowed
S5140TGU6	Massachusetts-specific HCPCS allowed
S5140TGU7	Massachusetts-specific HCPCS allowed
E0603	Rhode Island-specific HCPCS allowed

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Same-date reimbursement rule

Reimbursement priorityWhen home health services (POS 12) and inpatient care are billed for the same dates of service, UnitedHealthcare will reimburse the inpatient care; home health services are not eligible for reimbursement for those overlapping dates.

Admission/discharge exceptionHome health services provided on the dates of inpatient admission and discharge may still be eligible for reimbursement.

Submission requirementHome health services must be submitted with Place of Service 12 indicating services were provided in a private residence (not a hospital or other facility).

State exceptions existCertain states permit specific HCPCS to be billed during the inpatient date span; see state-specific HCPCS allowances and exemptions.

Billing Prioritization and Provider Billing Actions

Billing Rule

Prioritization of inpatient reimbursement over home health for same dates

If both inpatient care and home health services (Place of Service 12) are billed for the same dates of service, inpatient reimbursement takes priority and the home health services will not be reimbursed for those overlapping dates. Exceptions: the inpatient admission and discharge dates may still be eligible for home health reimbursement if services were provided on those specific dates. Home health services must be submitted with POS 12 to indicate services were provided in a private residence (not a hospital or other facility).

Prioritize inpatient reimbursement when inpatient and home health (POS 12) cover the same dates — home health denied for overlapping dates
Admission and discharge dates: home health provided on these dates may still be eligible
Ensure home health claims use POS 12 for private residence billing
Durable Medical Equipment (DME) billed with POS 12 is subject to this rule when within the inpatient claim date span (admission/discharge dates excluded)
State exceptions may allow certain HCPCS/DME codes to be billed during inpatient date spans — verify local state rules

Definitions

Durable Medical Equipment (DME)

DefinitionDurable Medical Equipment (DME): Medical equipment which can withstand repeated use, is not disposable, serves a medical purpose, is generally not useful in the absence of sickness or injury, and is appropriate for use in the home.

Applicability to policyDME billed with POS 12 that falls within the dates of an inpatient claim is subject to this policy (except admission/discharge dates).

Typical characteristicsDME is reusable, non-disposable, and intended for home use to address a medical condition.

Place of Service

DefinitionPlace of Service: A two-digit code used on health care professional claims to indicate the setting in which a service was provided.

POS code governed by this policyPOS 12 (home/private residence) — home health services must be submitted with POS 12.

Implication for facility careServices provided in a facility or hospital are not appropriately billed with POS 12 under this policy.