CG-REHAB-08 Private Duty Nursing in the Home Setting

This policy addresses physician-prescribed Private Duty Nursing (PDN) in the home by a licensed RN or LPN/LVN for individuals with complex, chronic, or medically fragile conditions requiring continuous skilled care (e.g., ventilator/tracheostomy care, IV medications) beyond intermittent home health. PDN is medically necessary when services are skilled (not custodial), the attending physician certifies medical necessity and approves a goal-directed plan of care, and the care requires RN/LPN proficiency; LPN/LVN services must be under RN supervision. PDN is not covered when these criteria are unmet or when provided for convenience, stable conditions, family work/respite, or other custodial needs; services must be delivered by independent clinicians (not household/immediate family) and are authorized per hour/shift with duration (short- or long-term) based on documented medical necessity.

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