ModifiedUnitedHealthcarePolicy CS137NJ.X

Home Health, Skilled, and Custodial Care Services (for New Jersey Only)

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This UnitedHealthcare Community Plan medical policy governs home health, skilled nursing, hospice, infusion, therapy, aide, custodial, and related home-based services for Medicaid members in New Jersey. Medical necessity criteria refer to New Jersey Administrative Code § 10:60: Home Care Services.

Policy Summary

PayerUnitedHealthcare

PolicyHome Health, Skilled, and Custodial Care Services (for New Jersey Only)

Policy CodePolicy CS137NJ.X

Change TypeModified

Effective DateSeptember 1, 2026

Next Review DateN/A

Key ActionDo not rely on the code listing alone to establish coverage, reimbursement, or claim payment.

SourceLink

POLICY UPDATE CHANGES

CPT/HCPCS codes 99512 and T1005 were removed from the applicable codes.

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ModifiedUnitedHealthcarePolicy CS137NJ.X

Home Health, Skilled, and Custodial Care Services (for New Jersey Only)

Customize your policy alerts

Sign up for UnitedHealthcare Policy CS137NJ.X alerts

Get alerted when Policy CS137NJ.X changes without checking for updates manually.

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Policy Summary

PayerUnitedHealthcare

PolicyHome Health, Skilled, and Custodial Care Services (for New Jersey Only)

Policy CodePolicy CS137NJ.X

Change TypeModified

Effective DateSeptember 1, 2026

Next Review DateN/A

Key ActionDo not rely on the code listing alone to establish coverage, reimbursement, or claim payment.

SourceLink

POLICY UPDATE CHANGES

CPT/HCPCS codes 99512 and T1005 were removed from the applicable codes.

New Jersey Home Care Medical Necessity

New Jersey home care medical necessity criteria

For medical necessity clinical coverage criteria, refer to the New Jersey Administrative Code § 10:60: Home Care Services.

Referenced regulatory criteria: Apply the medical necessity clinical coverage criteria in New Jersey Administrative Code § 10:60: Home Care Services.

The policy does not reproduce the criteria in this document.

Applicable and Removed Codes

CPT Home Visit and Infusion CodesCPT

99500	Home visit for prenatal monitoring and assessment to include fetal heart rate, non-stress test, uterine monitoring, and gestational diabetes monitoring.
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 (e.g., bronchodilator, oxygen therapy, respiratory assessment, apnea evaluation).
99504	Home visit for mechanical ventilation care.
99505	Home visit for stoma care and maintenance including colostomy and cystostomy.
99506	Home visit for intramuscular injections.
99507	Home visit for care and maintenance of catheter(s) (e.g., urinary, drainage, and enteral).
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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HCPCS Skilled, Therapy, Aide, and Prenatal Home ServicesHCPCS

G0153	Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes.
G0155	Services of clinical social worker in home health or hospice settings, each 15 minutes.
G0156	Services of home health/hospice aide in home health or hospice settings, each 15 minutes.
G0158	Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes.
G0159	Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes.
G0161	Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes.
G0162	Skilled services by a registered nurse (RN) for management and evaluation of the plan of care; each 15 minutes.
G0299	Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes.
G0496	Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.
G2168	Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes.

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HCPCS Home Care, Infusion, Therapy, Prenatal, Nutrition, and Related ServicesHCPCS

S5035	Home infusion therapy, routine service of infusion device (e.g., pump maintenance).
S5036	Home infusion therapy, repair of infusion device (e.g., pump repair).
S5108	Home care training to home care client, per 15 minutes.
S5109	Home care training to home care client, per session.
S5110	Home care training, family; per 15 minutes.
S5111	Home care training, family; per session.
S5115	Home care training, nonfamily; per 15 minutes.
S5116	Home care training, nonfamily; per session.
S5181	Home health respiratory therapy, NOS, per diem.
S5497	Home infusion therapy, catheter care/maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.

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Applicable CPT/HCPCS CodesHCPCSCovered

S9353	Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9355	Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9365	Home infusion therapy, total parenteral nutrition (TPN); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula
S9366	Home infusion therapy, total parenteral nutrition (TPN); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula
S9367	Home infusion therapy, total parenteral nutrition (TPN); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula
S9368	Home infusion therapy, total parenteral nutrition (TPN); more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard TPN formula
S9370	Home therapy, intermittent antiemetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9372	Home therapy; intermittent anticoagulant injection therapy (e.g., Heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9373	Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
S9374	Home infusion therapy, hydration therapy; 1 liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

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Removed CPT/HCPCS CodesHCPCSNot Covered

99512	Applicable CPT/HCPCS code removed
T1005	Applicable CPT/HCPCS code removed

TPN volume scales

S9366One liter per day

S9367More than two liters but no more than three liters per day

S9368More than three liters per day

Hydration therapy volume scales

S93741 liter per day

S9375More than 1 liter but no more than 2 liters per day

S9376More than 2 liters but no more than 3 liters per day

S9377More than 3 liters per day

Coverage and Billing Rules

Denial Risk

Code listing does not guarantee coverage

Do not treat a code’s inclusion in this policy as confirmation that the service is covered or non-covered. Benefit coverage is determined by federal, state, or contractual requirements and applicable laws; code listing alone does not imply a right to reimbursement or guarantee claim payment.

Policy Scope

This New Jersey-only policy addresses home-based clinical and supportive services for UnitedHealthcare Community Plan members, including skilled nursing, hospice, therapy, home health aide, custodial care, infusion, respiratory, catheter, wound, prenatal, nutrition, and related services. Services may include professional care, care coordination, necessary supplies and equipment, and patient or family training, as applicable to the service.

Medical necessity for covered home care services is determined under New Jersey Administrative Code § 10:60: Home Care Services. The policy’s applicable-code listings include home visits, nursing and aide services, therapy, hospice services, infusion and injectable therapies, enteral nutrition, hydration, TPN, and home management of certain prenatal and maternal conditions.