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More Eligibility Requirements
Home Health Medicare Rules & Regulations
Reasonable and Necessary
Path: Physician Certification of Care Plan <
  • To determine whether a service is reasonable and necessary, the Medicare home health benefit considers each beneficiary’s health status and medical needs.
  • Documentation of clinical evidence to show services are reasonable and necessary must be found in the medical record and on the Plan of Care (HCFA 485).
  • It is the home health agency’s responsibility to provide clear documentation of the patient’s progress or lack of progress, medical condition, functional losses and treatment goals to show services are reasonable and necessary.
  • The length of time services will be covered is determined by the needs of each patient.
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