HCPCS code S9122: Home health aide or certified nurse assistant (CNA), per hour

Obtain a list of documentation and billing requirements for proper use and billing of HCPCS code S9122.

## **What is HCPCS code S9122?** HCPCS code S9122, which has a code description of "Home health aide or certified nurse assistant, providing care in the home; per hour", describes a home health aide or certified nurse assistant providing services in a patient's home, billed on a per-hour basis. It is a part of the "Temporary National Codes (Non-Medicare)" system, meaning it's primarily used by commercial payers, Medicaid, and other non-Medicare programs. The code is used when a patient requires in-home care, specifically, assistance with activities of daily living (ADLs), basic health monitoring, and other basic, personal care care due to a chronic illness, disability, or recovery from an injury or surgery. Do note that pain management is not necessarily offered unless it's to aid the patient's personal comfort.

## **HCPCS code S9122 documentation requirements** Detailed and accurate documentation is critical for proper billing and to demonstrate the medical necessity of the services provided. Documentation for S9122 should include: - **Authorization**: Evidence of a physician's order or a person-centered care plan that authorizes the services and specifies the number of hours per day or week. - **Service logs**: Detailed logs or progress notes for each visit that include the following: **Provider information**: Name and credentials of the home health aide or CNA. **Date of service**: The specific date the care was provided. **Time**: Start and end times of the visit. **Activities performed**: A clear description of the tasks performed, such as bathing, dressing, meal preparation, medication reminders, monitoring vital signs, wound care, or light housekeeping. **Patient validation**: The patient or a family member's signature to validate the services received. - **Medical necessity**: Clinical documentation that supports the need for the services, such as a patient's diagnosis (e.g., chronic illness, physical disability, cognitive impairment) and how it necessitates the home health aide's assistance.

## **S9122 billing requirements** Billing for S9122 generally follows these guidelines, though they can vary by payer. - **Unit of service**: One unit of S9122 equals one hour of service. - **Authorization**: Services must be authorized by the payer or a physician's order before being rendered. Billing for services not included in the authorization can lead to claim denials. - **Claim submission**: Claims are typically submitted on a CMS-1500 form. - **Maximum units**: Payer policies may specify a maximum number of units (hours) that can be billed per day or week. Some plans may cap the total hours or require a different per-diem code for services lasting 8 hours or more. - **Modifiers**: Specific modifiers may be required by certain payers. Always check the payer's policy for any necessary modifiers.

## **Other related codes** - **S9123**: Nursing care, in the home; by registered nurse, per hour. - **S9124**: Nursing care, in the home; by licensed practical nurse (LPN), per hour. - **T1021**: Home health aide or certified nurse assistant, per visit. This is often an alternative to S9122, used when services are billed per visit rather than per hour.

Frequently asked questions

No. S9122 is a temporary national code and is not recognized or reimbursed by Medicare. Medicare has its own set of codes (e.g., G0156) for home health aide services provided under a certified home health agency.

Check the payer's specific billing guidelines. Some payers allow billing for partial hours, often in 15-minute increments using a different code.

Yes, a physician's order is almost always required to establish medical necessity for home health services and to obtain authorization from the insurance provider.