ModifiedUnitedHealthcarePolicy CS137NE.W

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

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UnitedHealthcare Community Plan coverage considerations for home health, skilled nursing, hospice, infusion, therapy, aide, and custodial care services provided in Nebraska.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS137NE.W

Change TypeModified

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionSupport coverage requests with the applicable Nebraska Department of Health and Human Services home health and skilled nursing requirements under Code § 471-9.

SourceLink

POLICY UPDATE CHANGES

HCPCS code T1005 was removed from the applicable codes.

The policy added a reference link to the Medical Policy titled Chelation Therapy (for Nebraska Only).

The References section was updated to reflect the most current information.

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ModifiedUnitedHealthcarePolicy CS137NE.W

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

Customize your policy alerts

Sign up for UnitedHealthcare Policy CS137NE.W alerts

Get alerted when Policy CS137NE.W changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

UnitedHealthcare Community Plan coverage considerations for home health, skilled nursing, hospice, infusion, therapy, aide, and custodial care services provided in Nebraska.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS137NE.W

Change TypeModified

Effective DateOctober 1, 2026

Next Review DateN/A

Key ActionSupport coverage requests with the applicable Nebraska Department of Health and Human Services home health and skilled nursing requirements under Code § 471-9.

SourceLink

POLICY UPDATE CHANGES

HCPCS code T1005 was removed from the applicable codes.

The policy added a reference link to the Medical Policy titled Chelation Therapy (for Nebraska Only).

The References section was updated to reflect the most current information.

Nebraska Coverage Criteria

Home Health and Skilled Nursing Medical Necessity

For medical-necessity clinical coverage criteria, refer to the Nebraska Department of Health and Human Services, Code § 471-9: Home Health Agencies and Skilled Nursing Services.

Home health and skilled nursing services must meet the applicable medical-necessity criteria in Nebraska DHHS Code § 471-9.

Use of Authorized Hours Outside the Home

Authorized approved hours may be used outside of the home when the member's normal life activities take them out of the home during those authorized hours.

Use of authorized approved hours outside the home is permitted when the member's normal life activities take them out of the home during the authorized hours.

Applies only during authorized approved hours.

Applicable and Referenced Codes

CPT home visit and skilled service 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.

CPT home infusion and home care codesCPT

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).
99602	Home infusion/specialty drug administration, per visit (up to 2 hours); each additional hour.

HCPCS home health, hospice, therapy, nursing, and training codesHCPCS

G0152	Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes.
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.
G0160	Services performed by a qualified occupational therapist in the home health setting in the establishment or delivery of a safe and effective occupational 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 for management and evaluation of the plan of care; each 15 minutes.
G0299	Direct skilled nursing services of a registered nurse in the home health or hospice setting, each 15 minutes.

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HCPCS home infusion, catheter, wound, and phototherapy codesHCPCS

S5497	Home infusion therapy, catheter care/maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment.
S5498	Home infusion therapy, catheter care/maintenance, simple single-lumen; includes administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment.
S5501	Home infusion therapy, catheter care/maintenance, complex more than one lumen; includes administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment.
S5502	Home infusion therapy, catheter care/maintenance, implanted access device; includes administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment.
S5517	Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting.
S5518	Home infusion therapy, all supplies necessary for catheter repair.
S5520	Home infusion therapy, all supplies including catheter necessary for a peripherally inserted central venous catheter line insertion.
S5521	Home infusion therapy, all supplies including catheter necessary for a midline catheter insertion.
S5522	Home infusion therapy, insertion of peripherally inserted central venous catheter, nursing services only.
S5523	Home infusion therapy, insertion of midline venous catheter, nursing services only.

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HCPCS home nursing, therapy, obstetric management, and infusion codesHCPCS

S9122	Home health aide or certified nurse assistant, providing care in the home; per hour.
S9123	Nursing care in the home by registered nurse, per hour.
S9124	Nursing care in the home by licensed practical nurse, per hour.
S9127	Social work visit, in the home, per diem.
S9128	Speech therapy, in the home, per diem.
S9129	Occupational therapy, in the home, per diem.
S9131	Physical therapy in the home, per diem.
S9208	Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and necessary supplies or equipment, per diem.
S9209	Home management of preterm premature rupture of membranes, including administrative services, professional pharmacy services, care coordination, and necessary supplies or equipment, per diem.
S9211	Home management of gestational hypertension, including administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment, per diem.

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HCPCS enteral nutrition, infusion, injection, transfusion, and home therapy codesHCPCS

S9340	Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and necessary supplies and equipment, per diem.
S9341	Home therapy; enteral nutrition via gravity, per diem.
S9342	Home therapy; enteral nutrition via pump, per diem.
S9343	Home therapy; enteral nutrition via bolus, per diem.
S9345	Home infusion therapy, antihemophilic agent infusion therapy, per diem.
S9346	Home infusion therapy, alpha-1-proteinase inhibitor infusion therapy, per diem.
S9347	Home infusion therapy, uninterrupted long-term controlled-rate intravenous or subcutaneous infusion therapy, per diem.
S9348	Home infusion therapy, sympathomimetic/inotropic agent infusion therapy, per diem.
S9351	Home infusion therapy, continuous or intermittent antiemetic infusion therapy, per diem.
S9353	Home infusion therapy, continuous insulin infusion therapy, per diem.

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Applicable HCPCS CodesHCPCSCovered

S9474	Home infusion therapy, corticosteroid infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
S9490	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
S9503	Administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
S9504	Administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
S9537	Home therapy; hematopoietic hormone injection therapy (e.g., erythropoietin, G-CSF, GM-CSF); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
S9538	Home transfusion of blood product(s); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (blood products, drugs, and nursing visits coded separately), per diem.
S9542	Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
S9559	Home injectable therapy, interferon, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
S9560	Home injectable therapy; hormonal therapy (e.g., leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.
T1001	Nursing assessment/evaluation.

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Removed HCPCS CodeHCPCSNot Covered

T1005

HCPCS code removed from the applicable codes in the 2026-10-01 revision.

Provider Requirements

Documentation Required

Document Nebraska regulatory eligibility

Support each coverage request with the applicable Nebraska Department of Health and Human Services home health and skilled nursing requirements under Code § 471-9.

Denial Risk

Meet Nebraska home health medical-necessity criteria

Ensure that home health agency and skilled nursing services satisfy the medical-necessity clinical coverage criteria in Nebraska Department of Health and Human Services Code § 471-9. Coverage determinations follow these Nebraska requirements.

Policy Scope

This Nebraska-specific Medical Policy addresses home health, skilled nursing, hospice, infusion, therapy, aide, and custodial care services provided in the member’s home or other locations during authorized hours. Services may include skilled nursing and nursing assessments, physical, occupational, and speech therapy, hospice and home health aide services, home infusion and related catheter care, respiratory and wound care, enteral nutrition, and custodial or supportive care. Authorized approved hours may be used outside the home when the member’s normal life activities take the member out of the home; this does not increase the number of authorized hours. Medical-necessity determinations for home health agencies and skilled nursing services follow the applicable Nebraska Department of Health and Human Services requirements in Code § 471-9.