HCPCS Code S9124: Nursing Care, in the Home; by Licensed Practical Nurse, Per Hour

## **HCPCS code S9124 documentation requirements** The documentation requirements for HCPCS Code S9124 (nursing care in the home by a licensed practical nurse, per hour) generally include: - Nurse progress notes detailing the care provided during each visit clearly identify the services provided. - Documentation that supports the medical necessity of the service, including treatment plans, the patient's condition, and individualized plan details. - Records such as medication administration logs, seizure logs, ventilator logs (if applicable), and other equipment use or monitoring documentation. - Specific information for each day billed, including start and end times of the nurse’s shift, the nurse’s name, initials, and title, and details of the care provided to the patient. - Updated treatment plans every 30 days if services continue beyond that period. - Additional documentation may be requested by the payer, cms, or plan for prior authorization, recertification, or service revision. These requirements help substantiate the hours billed and the complexity of care provided. They apply particularly in the context of private duty nursing, hospital discharge programs, or home health aide–supported home health plans that may request supporting documents beyond basic billing, ensuring compliance and authorization of the services rendered. Modifiers such as TG (for complex nursing services) and TE (for LPN/LVN services at a complex/high-tech level) might also be used in billing and require corresponding documentation.

## **HCPCS code S9124 billing requirements** HCPCS code S9124 billing requirements include the following key points: - When billing for complex nursing services using S9124, the HCPCS modifier TG must be applied to indicate complex nursing services. If these complex services are provided by a licensed practical nurse (LPN/LVN), modifier TE should also be included. If complex nursing services are provided to more than one patient in the same residence, modifier TT applies in addition. - Prior authorization is generally required for nursing services exceeding two hours per day. Home health agencies must request prior authorization from the relevant medical administrative services organization or payer before billing for more than two hours daily. - S9124 is billed per hour of nursing care provided by a licensed practical nurse in the home. Providers must document and bill actual hours accurately. Typically, providers bill the number of hours of care rendered each day, reflecting the nurse’s time spent with the patient. - To support the billed time, detailed documentation, including nurse notes, start and end times of nursing services, treatment plans, and logs of specific care interventions, should be maintained. - Reimbursement varies by payer, geographic location, and complexity, with typical average reimbursement ranging roughly between $20 and $46 per hour, depending on payer and modifiers used. - Claims should reflect the appropriate HCPCS code(s) and modifiers accurately to match the services performed and must comply with the billing requirements of the individual payer or plan. Claims that exceed benefit limits may be denied or adjusted.

## **Other relevant codes** Other relevant HCPCS codes related to S9124, which is "Nursing care, in the home; by licensed practical nurse, per hour," include: - **S9123**: Nursing care, in the home; by registered nurse (RN), per hour. This code is similar to S9124 but specifies RN care and is used for general nursing care. - **S9122**: Home health aide or certified nurse assistant, providing care in the home, per hour. This report aids-level services distinct from nursing care. - **S9125**: Respite care, in the home, per diem. This covers temporary relief care for primary caregivers at home. - **S9126**: Hospice care, in the home, per diem. This code is used for hospice services delivered at home. - **S9127**: Social work visit, in the home, per diem. For social worker visits in home care settings. - **S9128**: Speech therapy, in the home, per diem. - **S9129**: Occupational therapy, in the home, per diem. - **S9131**: Physical therapy, in the home, per diem.