Home Health Therapy Services

Revised: July 22, 2026

· Overview

· Eligible Providers

· Eligible Members

· Authorization Requirements

· Assessment Requirements

· Covered Services

· Noncovered Services

· Billing

· Legal References

Overview

Home health therapies improve or maintain the person’s functioning and include physical, occupational, speech-language pathology and respiratory therapies.

Eligible Providers

Only Medicare-certified home health agencies enrolled with Minnesota Health Care Programs (MHCP) can provide home health therapies.

Services may be provided by the following professionals:

· Certified occupational therapy assistant*

· Licensed physical therapist

· Physical therapy assistant*

· Registered occupational therapist

· Respiratory therapist (RT)

· Speech therapist (ST)

*Payment is 65 percent of the therapist rate when therapy assistant provides the service and the therapist is not on the premises.

Eligible Members

Members must be eligible under one of the following programs:

BB	MinnesotaCare state and federally funded coverage for adults age 19 years and older.
EH	Emergency Medical Assistance with an approved care plan certification
KK	MinnesotaCare - state funded coverage for children through the end of the month they turn 19 years old.
LL	MinnesotaCare - state and federally funded coverage for children through the month they turn 19 years old.
MA	Medical Assistance
NM	State-funded Medical Assistance (MA)
RM	Refugee Medical Assistance (MA)
Waiver Services Programs [excludes Elderly (EW) and Developmental Disabilities (DD) waivers]

To qualify for payment, services must be provided to an eligible member who is confined to the home or it takes “considerable effort” to depart. The functional status is expected to progress toward or achieve the goals specified in the member’s plan of care within a 60-day period.

Authorization Requirements

Authorization is not required for medically necessary home health therapies.

Assessment Requirements

The appropriate therapist(s) employed or contracted by a Medicare-certified home health agency must complete an assessment to determine the person’s need for services; and document it in the person’s record.

The assessment should indicate the following:

· Identifies the person’s needs

· Determines the outcome for the visit(s)

· Includes an individualized care or service plan.

All home health therapies must comply with the face-to-face visit requirement.

Providers are required to document the following in the member’s record:

· Documentation of the required face-to-face visit

· All evaluations

· Services provided including:

· Date, type and length of each service provided

· The name and title of the person(s) providing each service

· A statement every 30 days by the therapist indicating the nature, scope, duration and intensity of the therapy are appropriate to the medical condition

· Client progress

· Discharge plans

Covered Services

Home health therapy services are daily, per visit codes, with the exception of respiratory therapy which may be provided more than once per day, for services provided in the member’s home. All therapies must be specified in the member’s plan of care.

The following home health therapy services are not subject to the one-time rehabilitative service thresholds:

Code	Type of Therapy
S9129 TF	Certified Occupational Therapy Assistant (COTA) services
S9129	Occupational Therapy (OT)
S9131	Physical Therapy (PT)
S9131 TF	Physical Therapy Assistant (PTA) services
S5181	Respiratory Therapy (RT)
S9128	Speech Therapy (ST)

If the service is a Medicare covered service, and is provided to a member who is eligible for Medicare, the plan of care must be reviewed at the intervals required by Medicare.

Home health therapies are covered if they are classified as either a restorative or specialized maintenance therapy.

Restorative therapy is:

· Specified in the member’s plan of care

· Ordered by a physician, advanced practice registered nurse, or physician assistant

· Designed to restore the member’s functional status to a level consistent with the member’s physical or mental limitations

Specialized maintenance therapy is:

· Specified in the member’s plan of care

· Ordered by a physician, advanced practice registered nurse, or physician assistant

· Necessary for maintaining a member’s functional status at a level consistent with the member’s physical or mental limitations

· May include treatments in addition to rehabilitative nursing services

Noncovered Services

· Home health therapy services in the home when the member can reasonably access these services outside their residence, or to a member who can leave at will

· Home health therapy services provided to a child who could easily be transported, by a parent or guardian to a rehabilitation center

Billing

All provider types must follow general MHCP billing policies and guidelines in the Billing Policy Overview section under Provider Basics in the MHCP Provider Manual when submitting claims to MHCP.

Submit claims for reimbursement of Home Care (Non-PCA) Services using the (837I) Institutional transaction.

When services are provided by an assistant and the licensed or registered therapist is not on the premises, the services are billed with a modifier; and the payment will be at 65 percent of the therapist’s rate. The licensed PT or registered OT must provide in-person direction to the assistant at least every sixth visit.

When a home visit is made jointly by the therapist and assistant, the provider may bill only for the therapist’s visit. Providers may not bill for both the PT and PTA (or the OT and COTA) when a joint home visit is made.

Legal References

Minnesota Statutes, 256B.0625, subdivision 6a (Covered Services)
Minnesota Statutes, 256B.0651 (Home care services)
Minnesota Statutes, 256B.0653 (Home Health Agency Services)
Minnesota Rules, 9505.0295 (Home Health Services)