CMS Benefits Manual: Recertification Episodes

10.3 – Continuous 60-Day Episode Recertification (Rev. 1, 10-01-03) HH-201.3

Home health PPS permits continuous episode recertifications for patients who continue to be eligible for the home health benefit. Medicare does not limit the number of continuous episode recertifications for beneficiaries who continue to be eligible for the home health benefit.

10.4 – Counting 60-Day Episodes (Rev. 1, 10-01-03) HH-201.4

A. Initial Episodes

The “From” date for the initial certification must match the start of care (SOC) date, which is the first billable visit date for the 60-day episode. The “To” date is up to and including the last day of the episode which is not the first day of the subsequent episode. The “To” date can be up to, but never exceed a total of 60 days that includes the SOC date plus 59 days.

B. Subsequent Episodes

If a patient continues to be eligible for the home health benefit, the home health PPS permits continuous episode recertifications. At the end of the 60-day episode, a decision must be made whether or not to recertify the patient for a subsequent 60-day episode. An eligible beneficiary who qualifies for a subsequent 60-day episode would start the subsequent 60-day episode on day 61. The “From” date for the first subsequent episode is day 61 up to including day 120. The “To” date for the subsequent episode in this example can be up to, but never exceed a total of 60 days that includes day 61 plus 59 days.

Note that the certification or recertification visit can be done during a prior episode.

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