Home Health Agency and Home Nursing Agency Fee Schedule
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Sets fees, billing codes, prior-authorization requirements, and unit definitions for home health agency and home nursing agency services reimbursed by Illinois Department of Healthcare and Family Services.
No material clinical or coverage changes in this revision.
Coverage rules for home health and home nursing services
inv-01: Skilled nursing coverage rules
Covered when the specific timing, prior-approval, and billing-unit conditions below are met.
Timing and prior-approval variants
- Visit during the first 60 days following inpatient hospital discharge when care is initiated within 14 days from discharge; prior approval: No; rate: $72.00; reduced rate: $59.94.
- Hourly nursing assessment visit (definition for skilled nursing); prior approval: No; rate: $72.00; reduced rate: $59.94.
- Skilled nursing visit not following a hospital stay, or following the initial 60-day period; prior approval: Yes; rate: $72.00; reduced rate: $59.94.
Use modifier U2 when indicated for skilled nursing assessments as specified in the fee schedule
inv-02: Shift nursing and certified aide coverage
In-home shift nursing and certified staff services — billed per hour; prior approval required.
Rates by county and role
- Cook, DuPage, Kane: RN $35.03 per hour; LPN $31.14 per hour; reduced rates RN $29.16 / LPN $25.92.
- All other counties (including Will): RN $28.75 per hour; LPN $24.78 per hour; reduced rates RN $23.93 / LPN $20.63.
inv-03: Home health aide and therapy coverage
Home health aide and therapy services — coverage depends on timing relative to hospital discharge, with specified procedure codes, unit rules, rates, and prior-approval indicators.
Home Health Aide timing variants
- Visit during the first 60 days following inpatient hospital discharge when care is initiated within 14 days from discharge; prior approval: No; rate: $72.00; reduced rate: $59.94.
- Home health aide visit not following a hospital stay, or following the initial 60-day period, and multiple HHA visits on the same date of service; prior approval: Yes; listed rate contexts include $20.00 or $72.00 depending on circumstance; reduced rate: $59.94.
Procedure codes, rate applicability, and coding notes
Prior authorization and billing instructions for providers
Skilled nursing: when prior approval and U2 modifier apply
Skilled nursing visits use procedure code G0154. Prior approval is required for skilled nursing visits that do not follow a hospital stay or that occur after the initial 60‑day period; visits during the first 60 days after inpatient discharge (if care is initiated within 14 days of discharge) do not require prior approval. Use modifier U2 for skilled nursing assessment visits when specified.
- Procedure code: G0154 (skilled nursing visit)
- Prior approval: Yes for visits not following a hospital stay or after initial 60‑day period; No for visits during first 60 days if initiated within 14 days of discharge
- Modifier: G0154 with U2 for specified skilled nursing assessment visits
- Rate: $72.00 (standard); reduced rate $59.94 where applicable
Home health aide & in‑home shift certified: prior approval and billing notes
Home health aide and in‑home shift certified (nurses aid/CNA) services use procedure code G0156. Prior approval is required for HHA visits that do not follow a hospital stay or occur after the initial 60‑day period (and for multiple HHA visits on the same date); HHA visits during the first 60 days after inpatient discharge (if initiated within 14 days) do not require prior approval.
- Procedure code: G0156 (home health aide / nurses aid / shift certified)
- Prior approval: Yes for visits not following a hospital stay or after initial 60‑day period (and for multiple HHA visits same date); No for visits during first 60 days if initiated within 14 days of discharge
- Rate examples: $20.00 or $72.00 depending on context; reduced rate $59.94 where applicable
Therapy visits: U2 on evaluations and timing-based prior approval
Therapy visits (physical, occupational, speech) use G0151–G0153. Evaluations are marked with modifier U2 when specified; prior approval requirements vary by visit timing — visits not following a hospital stay or after the initial 60‑day period (and multiple visits on the same date) require prior approval, whereas some evaluation and early post‑discharge visits do not.
- Procedure codes: G0151 (PT), G0152 (OT), G0153 (ST)
- Evaluations: G0151 and G0152 evaluations flagged with U2 where specified
- Prior approval: Varies by timing — No for certain evaluations/first 60 days when initiated within 14 days of discharge; Yes for visits not following a hospital stay or after the initial 60‑day period (and multiple same‑date visits)
- Rate: $72.00 (standard); reduced rate $59.94 where applicable
Service definitions and unit descriptions
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