CG-MED-23 Home Health

CG-MED-23 addresses home health services (skilled nursing, physical/occupational/speech therapy, licensed social work) delivered in the home. Coverage is medically necessary when all criteria are met: the individual is homebound (leaving home requires considerable and taxing effort, with only infrequent/short or treatment-related absences), requires intermittent skilled, medically necessary care under a physician-directed plan of care, and services are not duplicative; duration and clinician type are based on clinical response. Home health is not medically necessary when the physician’s plan does not demonstrate an ongoing need for skilled intervention or when plan-of-care goals have been met.

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