T1030, Nursing care, in the home, by registered nurse, per diem
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Recommended (per ACOG guidance cited in the CPB) components of prenatal care that women considering home birth should be offered (not described as coverage documentation requirements): 'group B Strep screening and treatment, genetic screening, as well as HIV screening.'
- No specific documentation requirements are stated in this Clinical Policy Bulletin.
Key Coverage Criteria
- None — Aetna considers planned deliveries at home and associated services not medically appropriate.
- Coverage of home births will be considered when mandated by law under plans subject to state mandates.
- Note:To be eligible for wound care in the home setting, the individual must be confined to the home as defined in CG-MED-23 Home Health.
- Initial care for a chronic wound in the home or outpatient setting is consideredmedically necessarywhen:
- The wound care is prescribed by the attending physician, health care provider practicing within the scope of license, or the primary care physician in coordination with the attending physician as part of a written plan of care;and
- The wound care is so inherently complex that it can only be safely and effectively performed by or under the general supervision of a licensed medical professional (for example, but not limited to stage III or IV pressure ulcers, non-healing neuropathic ulcers, venous or arterial insufficiency related ulcers, persistent wounds);and
4 Active Policies
ANTHEM-CG-MED-71, CG-MED-71 Chronic Wound Care in the Home or Outpatient Setting
ANTHEM-CG-REHAB-08, CG-REHAB-08 Private Duty Nursing in the Home Setting
ANTHEM-CG-MED-23, CG-MED-23 Home Health
AETNA-CPB-0329, Home Births
Related Codes
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