CurrentUnitedHealthcarePolicy CS137KY.11

Home Health Care Services (for Kentucky Only)

State-specific UnitedHealthcare medical policy governing medical necessity, limitations, and coding for home health agency services in Kentucky; applies to members covered under UnitedHealthcare Community Plan in Kentucky.

Policy Summary

PayerUnitedHealthcare

PolicyHome Health Care Services (for Kentucky Only)

Policy CodePolicy CS137KY.11

Change TypeAdministrative / Code maintenance

Effective DateJan 1, 2026

Next Review Date

Key ActionDocument that services meet Kentucky Administrative Regulations 907 KAR 1:030 and medical necessity per 907 KAR 3:130 and use InterQual LOC: Home Care Q&A to determine hours and clinical necessity for PT/OT/SLP and skilled nursing.

SourceLink

POLICY UPDATE CHANGES

Removed reference link to the Medical Policy titled Home Hemodialysis (for Kentucky Only) (retired Apr. 1, 2026).

Removed HCPCS codes S9339 and T1031 from Applicable Codes.

Archived previous policy version CS137KY.10.

100+HCPCS/CPT/S codes listed

Kentucky onlyPolicy jurisdiction

InterQualPrimary medical necessity criteria source

Medical Necessity and Coverage Determination

State-Specific Medical Necessity Determination (Kentucky Administrative Regulations)

Medical necessity, limitations, and exclusions for home health agency services in Kentucky are determined by state administrative regulations. Use the referenced KAR provisions to establish whether services meet state regulatory requirements.

ALL of the following

Services meet regulatory requirements per 907 KAR 1:030 (home health agency services) for medical necessity, limitations, and exclusions.
Services meet medical necessity and clinically appropriate determination basis per 907 KAR 3:130.

Non State-Specific Clinical Determination (InterQual LOC: Home Care Q&A)

After state-specific medical necessity is satisfied, clinical determination of hours and necessity for home care services uses InterQual LOC: Home Care Q&A.

ALL of the following

Physical therapy, occupational therapy, and speech therapy medical necessity must be determined using InterQual LOC: Home Care Q&A (Home Care Services, Adult or Pediatric).
Skilled nursing medical necessity is determined using InterQual LOC: Home Care Q&A (Home Care Services, Adult or Pediatric).

Procedure and Service Codes (Reference)

Listed Procedure/Service Codes (reference)mixed

99500	Home visit for prenatal monitoring and assessment
99501	Home visit for postnatal assessment and follow-up care
99502	Home visit for newborn care and assessment
99503	Home visit for respiratory therapy care
99504	Home visit for mechanical ventilation care
99505	Home visit for stoma care and maintenance
99506	Home visit for intramuscular injections
99507	Home visit for care and maintenance of catheter(s)
99511	Home visit for fecal impaction management and enema administration
99601	Home infusion/specialty drug administration, per visit (up to 2 hours)

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Documentation and Operational Requirements

Documentation Required

Use state regulations and InterQual criteria

Providers must document that services meet Kentucky Administrative Regulations 907 KAR 1:030 and medical necessity per 907 KAR 3:130; for PT/OT/SLP and skilled nursing determine hours and clinical necessity using InterQual LOC: Home Care Q&A (Adult or Pediatric).

InterQual LOC: Home Care Q & A to determine hours and clinical necessity for PT/OT/SLP and skilled nursing (Home Care Services, Adult or Pediatric).
Kentucky Administrative Regulations 907 KAR 1:030 (Home health agency services) and 907 KAR 3:130 (medical necessity and clinically appropriate determination basis).

Clinical and Administrative Context

Home health care services are short-term, intermittent skilled services delivered in the member's residence as prescribed by an appropriate practitioner (M.D., D.O., P.A., or N.P.). These services are intended to restore or maintain function after illness, injury, hospitalization, or surgery, or to manage chronic conditions with the goal of preventing unplanned hospitalization or prolonging a current hospitalization; they are provided in lieu of outpatient, acute, or sub-acute settings and must meet applicable state regulatory requirements for home health agency services in Kentucky.

Defined Terms

Definitions

InterQual LOC: Home Care Q&AProprietary clinical criteria used by UnitedHealthcare to determine level of care and hours for home care services (Adult and Pediatric modules referenced).

907 KAR 1:030Kentucky Administrative Regulation governing Home Health Agency Services (regulatory requirements, medical necessity criteria, limitations, and exclusions for home health agency services).

907 KAR 3:130Kentucky Administrative Regulation defining medical necessity and clinically appropriate determination basis used to determine covered services and clinical appropriateness.

Policy Changes and Versioning

2026-04-01removedLatest