CurrentUnitedHealthcarePolicy N/A

Home health services reimbursement (Place of Service 12)

Governs UnitedHealthcare reimbursement for home health services provided in the home (POS 12), including therapy, nursing, DME and related supplies; applies to providers submitting CMS-1500/UB04 claims for UnitedHealthcare patients.

Policy Summary

PayerUnitedHealthcare

PolicyHome health services reimbursement (Place of Service 12)

Policy CodePolicy N/A

Change TypeNon-material revisions and code list updates

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims on CMS-1500 or electronic equivalent; policy applies to participating and non-participating providers where out-of-network coverage exists.

SourceLink

POLICY UPDATE CHANGES

Overview, Reimbursement Guidelines, and Resources sections revised.

HCPCS code list corrected.

HCPCS code list updated.

Policy implemented by UnitedHealthcare Commercial and Individual Exchange.

POS 12Place of Service covered

CMS-1500 / UB04Claim forms this policy applies to

G0151, G0161, S9152, G2168Example HCPCS codes listed

5/1/2025Most recent policy change date

Coverage Criteria for Home Health (Place of Service 12)

Coverage criteria for home health (POS 12)

UnitedHealthcare covers home health services provided in the home (POS 12) with the following reimbursement rules and exceptions.

Services must be provided in the patient’s private residence and submitted with Place of Service (POS) 12.

This policy applies to claims submitted on CMS-1500 or UB04 by both participating and non-participating providers where out-of-network benefits exist.

Durable Medical Equipment (DME) and related supplies provided in the home are subject to this policy and the same reimbursement rules as other home health services.

If home health services and inpatient care are billed for the same dates of service, UnitedHealthcare will reimburse the inpatient care only and the home health services are not eligible for reimbursement.

Policy Summary

PayerUnitedHealthcare

PolicyHome health services reimbursement (Place of Service 12)

Policy CodePolicy N/A

Change TypeNon-material revisions and code list updates

Effective DateN/A

Next Review DateN/A

Key ActionSubmit accurate claims on CMS-1500 or electronic equivalent; policy applies to participating and non-participating providers where out-of-network coverage exists.

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.

HCPCS Codes and Status Indicators

Home health HCPCS codes with status indicator notesHCPCSCovered

G0151	Home health physical therapy (example mapping list)
G0161	Home health occupational therapy (example mapping list)
S9152	Home health nursing/therapy (example mapping list)
G2168	Home health codes (example mapping list)

Status indicator restriction notemixed

E	CMS status indicator E — not payable when billed by physicians/physician groups
I	CMS status indicator I — not payable when billed by physicians/physician groups
X	CMS status indicator X — not payable when billed by physicians/physician groups

Status indicator restriction — physician/physician group billing

RestrictionUnitedHealthcare will not consider for reimbursement home health HCPCS for physical therapy, occupational therapy, speech therapy and nursing home health when submitted by physicians or physician groups if the codes have a CMS status indicator of E, I, or X.

ExceptionThese home health HCPCS codes will continue to be considered for reimbursement when appropriately submitted by home health providers.

ExamplesExample codes listed with status indicators E, I or X include G0151, G0161, S9152, G2168 (and their mapped variants).

Claims Submission and Overlap Rules

Billing Rule

Claims submission responsibility and applicability

You are responsible for submission of accurate claims on the CMS-1500 (or its electronic equivalent). This policy applies to all products and to both network (participating) and non-network (non-participating) physicians and other qualified health care professionals. UnitedHealthcare uses CPT, CMS and other coding guidelines for definitional purposes; submission of the code(s) that correctly describe the services provided is the provider's responsibility.

Applicable claim form: CMS-1500 or electronic equivalent (and UB04 when specified elsewhere)
Applies to: all products, network and non-network providers, including non-network authorized and percent-of-charge contract providers

Denial Risk

Overlap with inpatient stay

When home health services (Place of Service 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 for those overlapping dates are not eligible for reimbursement. Exception: the inpatient admission and discharge dates — if home health services are provided on those specific dates, those days may still be eligible for reimbursement. Ensure home health services are submitted with POS 12 to indicate services were provided in a private residence.

Overlapping dates: inpatient care reimbursed; home health (POS 12) not reimbursed for same dates
Exception: admission and discharge dates may be reimbursed for home health if services provided on those dates
Submit home health claims with Place of Service 12

Billing Rule

HCPCS submission rules by provider type

UnitedHealthcare will not consider for reimbursement certain home health HCPCS codes for physical therapy, occupational therapy, speech therapy and nursing when those codes carry a CMS status indicator of E, I, or X if submitted by physicians or physician groups. Those HCPCS will continue to be considered for reimbursement when submitted appropriately by home health providers.

Do not submit HCPCS with CMS status indicator E, I, or X for home health therapy/nursing under physician or physician group billing — these will not be reimbursed
These codes remain payable when submitted by home health agencies/providers
Examples of affected HCPCS: G0151, G0152, G0153, G0155, G0156, G0157, G0158, G0159, G0160, G0161, G0162, S9122, S9123, S9124, S9127, S9128, S9129, S9131, S9152, G0299, G0300, G0490, G0493, G0494, G0495, G0496, G0529, G2168, G2169, S0274, T1002, T1003, T1021, T1030, T1031

Key Definitions

Durable Medical Equipment (DME) — definition and characteristics

DefinitionDurable Medical Equipment (DME): Medical equipment which can withstand repeated use, is not disposable, is used to serve a medical purpose, is generally not useful in the absence of sickness or injury, and is appropriate for use in the home.

CharacteristicsNot disposable; durable (reusable); serves a medical purpose; generally not useful without illness or injury; appropriate for home use.

Policy applicabilityDME with POS 12 is subject to this home health reimbursement policy and applies to billing that falls within inpatient claim dates (excluding admission and discharge dates).

Place of Service — definition and two-digit code explanation

DefinitionPlace of Service: A two-digit code used on health care professional claims to indicate the setting in which a service was provided.

UsagePOS codes are reported on professional claims to identify the service location (e.g., POS 12 for services provided in the patient's private residence).

Claim formsUsed on CMS-1500 (professional) claims to communicate the service setting for reimbursement determinations.