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Medicare Benefit Policy Manual-Chapter 7 30.1.1

MEDICALLY NECESSARY HOME VISIT

Attention All Ordering Providers:
The Medicare Benefit Policy Manual Chapter 7 30.1.1
Patient Confined to Home requires that Medicare beneficiaries
meet two sets of criteria before they be considered confined to the home (homebound):
1st Criteria:
The individual must either: Because of illness or injury, need the aid of
supportive devices such as crutches, canes, wheelchairs and walkers; the use
of special transportation; or the assistance of another person in order to
leave their place of residence
OR
Have a condition such that leaving his or her home is medically
contraindicated (should be avoided).
2nd Criteria:
Then, if one of the above criteria is met, the individual must meet two
additional requirements.
There must exist a normal inability to leave home;
AND
Leaving home must require a considerable and taxing effort.

However, if the patient does in fact leave the home, the patient
may still be considered homebound if the absences are infrequent and
for relatively short duration (i.e., attend religious services,
get a haircut, funeral, etc.) or are necessary in order to receive
health care treatment. An aged person who does not often travel from
home because of feebleness and insecurity brought on by advanced age
would not be considered homebound unless they meet the criterial outlined above.

*Apex will provide home laboratory services for patients who are deemed
homebound by their healthcare provider.
If the patient is not homebound, but would still like Apex Laboratory
to provide home laboratory services, a nominal fee will be collected for
the house call. The testing and draw fee (if applicable) will be billed to the patient's insurance.