CurrentUnitedHealthcarePolicy N/A

Home health services reimbursement (POS 12)

Governs UnitedHealthcare reimbursement for home health services provided in the home (Place of Service 12), including therapy, nursing, aides, DME and supplies; applies to claims submitted by providers for UnitedHealthcare enrollees.

Policy Summary

PayerUnitedHealthcare

PolicyHome health services reimbursement (POS 12)

Policy CodePolicy N/A

Change TypeHCPCS list update and corrections

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims with appropriate codes and use POS 12 for home health services; do not submit certain HCPCS (status indicator E/I/X) when billing as a physician or physician group.

SourceLink

POLICY UPDATE CHANGES

HCPCS code list updated.

HCPCS code list corrected.

Overview, Reimbursement Guidelines, and Resources sections were revised.

POS 12Place of Service this policy applies to

PT/OT/SLP/nursing/aide/DMEService types covered

No coverageInpatient overlap rule

May reimburseAdmission/discharge exception

Physician submissionsHCPCS E/I/X billing restriction

Home Health Coverage Criteria

Home health reimbursement criteria

UnitedHealthcare covers home health services provided in the home (POS 12) subject to the following reimbursement rules and billing restrictions.

Services are provided in the home (Place of Service 12) and include part-time or intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology, home health aide services, medical social services, durable medical equipment (DME), and/or medical supplies.

Claims for home health services must be submitted with Place of Service code 12 to indicate services were provided in a private residence.

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

Exception: Home health services provided on the dates of inpatient admission or discharge may still be eligible for reimbursement.

Policy Summary

PayerUnitedHealthcare

PolicyHome health services reimbursement (POS 12)

Policy CodePolicy N/A

Change TypeHCPCS list update and corrections

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims with appropriate codes and use POS 12 for home health services; do not submit certain HCPCS (status indicator E/I/X) when billing as a physician or physician group.

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.

Provider Responsibilities & Billing Rules

Documentation Required

Claim submission responsibilities

You are responsible for submitting accurate claims that reflect the services actually provided. UnitedHealthcare reimbursement policies use CPT, CMS and other coding guidelines for definitional purposes; references do not guarantee reimbursement. This policy applies to services billed on CMS 1500 and, when specified, UB04 forms. Coding methodology, industry reimbursement logic, regulatory requirements, benefits design and other factors are considered when applying this policy. UnitedHealthcare may use reasonable discretion in interpreting and applying this policy and may modify the policy at any time by publishing a new version.

Submit claims with the code(s) that correctly describe the health care services provided.
Ensure claims are submitted on the correct form (CMS 1500 or UB04 as applicable).
Accurate Place of Service (POS) coding is required — home health services should be submitted with POS 12 when provided in a private residence.

Billing Rule

Inpatient overlap billing rule

If home health services (POS 12) and inpatient care are billed for the same dates of service, UnitedHealthcare follows CMS alignment and will reimburse the inpatient care only; home health services are not eligible for reimbursement on overlapping inpatient dates. Exception: services provided on the inpatient admission and discharge dates may still be eligible for reimbursement when home health services occur on those specific dates.

Do not bill home health POS 12 for dates that are within an inpatient stay — these services will be denied.
Home health services provided on the inpatient admission or discharge date may be reimbursed; document those dates clearly.
Ensure inpatient admission and discharge dates are accurate on the inpatient claim to permit appropriate consideration of home health services on those dates.

Denial Risk

HCPCS submission restrictions

UnitedHealthcare will not consider for reimbursement certain home health HCPCS codes (status indicator E, I, or X) when submitted by physicians or physician groups. Those codes will be considered for reimbursement only when appropriately submitted by home health providers.

Do not submit status indicator E, I, or X home health HCPCS codes (examples include G0151 series, G0161 series, S9152 series, G2168 series and others listed in policy) on physician or physician group claims — these will not be reimbursed.
Submit these HCPCS codes on claims from home health agencies or other appropriate home health providers for consideration.
Verify the submitter/provider Taxonomy and provider type on the claim to reflect a home health provider when billing these HCPCS.

Key Definitions

Durable Medical Equipment (DME)

DefinitionDurable Medical Equipment (DME): Medical equipment that can withstand repeated use, is not disposable, is used to serve a medical purpose, is generally not useful without sickness or injury, and is appropriate for home use.

Inpatient overlap ruleDME with POS 12 is subject to the same inpatient overlap rule — not reimbursed during inpatient stay dates except admission and discharge dates.

ApplicabilityPolicy applies to DME billed with Place of Service 12 (private residence).

Place of Service (POS)

DefinitionPlace of Service (POS): A two-digit code used on health care professional claims to indicate the setting in which a service was provided; POS 12 = private residence.

Billing requirementHome health services must be submitted with POS 12 to indicate services were provided in the home.

Overlap guidanceHome health services provided on inpatient admission and discharge dates remain eligible for reimbursement; services billed during inpatient stay dates (other than admission/discharge) are not reimbursed.

G0151	Physical therapy, per 15 minutes
G0152	Physical therapy, other
G0153	Physical therapy, other
G0155	Physical therapy, other
G0156	Physical therapy, other
G0157	Physical therapy, other
G0158	Physical therapy, other
G0159	Physical therapy, other
G0160	Occupational therapy, per 15 minutes
G0161	Occupational therapy, other

OpenPayer

Home health services reimbursement (POS 12)

Home Health Coverage Criteria

HCPCS / CPT Coding Guidance

Provider Responsibilities & Billing Rules

Key Definitions