Statutes, codes, and regulations
California Code Of Regulations
Title 22 - Social SecurityDivision 3 - Health Care ServicesSubdivision 1 - California Medical Assistance ProgramChapter 3 - Health Care Services
Article 7 - Payment for Services and Supplies
Section 51523 - Home Health Agency Services

Cal. Code Regs. tit. 22 § 51523

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Current through Register 2024 Notice Reg. No. 45, November 8, 2024
Section 51523 - Home Health Agency Services
(a) An approved home health agency shall be reimbursed in accordance with the maximum rates as shown below. However, in no case shall the service billed exceed charges made to the general public for the provision of similar services.

Procedure Code

Per Visit Allowance

Maximum Rates

Z6900Skilled Nursing Services....................................................$74.86
Z6902Home Health Aide Services....................................................$45.75
Z6904Physical Therapy Services....................................................$68.84
Z6906Occupational Therapy Services....................................................$71.36
Z6908Speech Therapy Services....................................................$78.43
Z6910Medical Social Services....................................................$96.22
Z6914Case Evaluation and Initial Treatment Plan....................................................$30.13
Z6916Monthly Case Evaluation Extension of Treatment Plan....................................................$15.19
Z6918Unlisted Services....................................................By Report
Z6920Early Discharge Visit....................................................$74.86

(b) Each "Per Visit Allowance" billed shall represent a minimum of one hour's service provided to the patient, with the exception of "Home Health Aide Services," which shall represent a minimum of two hours of service provided to the patient.
(c) "Unlisted Services" (Procedure Code Z6918) are payable only upon prior authorization of the Department and shall include:
(1) Services which are provided by the Home Health Agency staff but which are not shown in these rates, except that services rendered by interns or residents-in-training are not separately payable.
(2) Unusual transportation costs may be billed "By Report." All other travel expenses are included in the "Per Visit Allowance" rates.
(d) "Case Evaluation and Initial Treatment Plan" (Procedure Code Z6914) is for the purpose of evaluating and developing a patient's proposed treatment plan for approval by the patient's attending physician; and shall be billed one time only for each individual case. No service rendered prior to the development and signed approval by the attending physician of the "Case Evaluation and Initial Treatment Plan" is payable.
(e) A "Monthly Case Evaluation--Extension of Treatment Plan" (Procedure Code Z6916) may be allowed after "Case Evaluation and Initial Treatment Plan," provided such service is rendered no sooner than one full calendar month following the date of the attending physician's approval of the initial treatment plan, and no more frequently than monthly thereafter.
(f) Services provided during the Early Discharge Visit (Procedure code Z6920) shall be provided to both the mother and her newborn in accordance with Section 51327(b).

Cal. Code Regs. Tit. 22, § 51523

1. Amendment of subsection (a) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 81, No. 52.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment of subsection (a) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
4. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
5. Amendment filed 10-1-87; operative 10-31-87 (Register 87, No. 41).
6. Amendment of subsection (a) filed 5-9-88 as an emergency; operative 5-15-88 (Register 88, No. 20). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 9-12-88.
7. Certificate of Compliance transmitted to OAL 9-1-88 and filed 10-3-88 (Register 88, No. 42).
8. Amendment of subsections (a), (c), (d) and (e) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 9-25-92 order including amendment of subsection (a) transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
10. Amendment of subsection (a) and NOTE filed 12-22-94 as an emergency; operative 12-22-94 pursuant to Welfare and Institutions Code section 14105(a) (Register 94, No. 51). A Certificate of Compliance must be transmitted to OAL 4-21-95 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 12-22-94 order transmitted to OAL 4-21-95 and filed 6-1-95 (Register 95, No. 22).
12. Amendment of subsection (a) and NOTE refiled 10-16-95 as an emergency; operative 10-16-95 (Register 95, No. 42). A Certificate of Compliance must be transmitted to OAL by 2-13-96 or emergency language will be repealed by operation of law on the following day.
13. Amendment of subsection (a) and NOTE refiled 2-5-96 as an emergency; operative 2-5-96 (Register 96, No. 6). A Certificate of Compliance must be transmitted to OAL by 6-6-96 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 2-5-96 order transmitted to OAL 6-4-96 and filed 7-12-96 (Register 96, No. 28).
15. Amendment of subsection (a), new subsection (f) and amendment of NOTE filed 3-13-2000 as an emergency; operative 3-13-2000 (Register 2000, No. 11). A Certificate of Compliance must be transmitted to OAL by 7-11-2000 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 3-13-2000 order transmitted to OAL 7-5-2000 and filed 8-14-2000 (Register 2000, No. 33).
17. Amendment of subsection (a) and amendment of NOTE filed 11-17-2000 as an emergency; operative 11-17-2000 (Register 2000, No. 46). A Certificate of Compliance must be transmitted to OAL by 3-19-2001 or emergency language will be repealed by operation of law on the following day.
18. Certificate of Compliance as to 11-17-2000 order transmitted to OAL 3-8-2001 and filed 4-19-2001 (Register 2001, No. 16).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14105 and 14132.42, Welfare and Institutions Code; Statutes of 2000, Chapter 52, Items 4260-101-001 and 4260-101-0890; Section 433.123, Title 42, Code of Federal Regulations; and Coalition of Visiting Nurse Associations v. Department of Health Services, Los Angeles County Superior Court (Case No. BC 22501).

1. Amendment of subsection (a) filed 8-1-84 as an emergency; effective upon filing (Register 84, No. 31). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-84. For prior history, see Register 81, No. 52.
2. Certificate of Compliance transmitted to OAL 11-27-84 and filed 12-27-84 (Register 84, No. 52).
3. Amendment of subsection (a) filed 8-1-85 as an emergency; effective upon filing (Register 85, No. 32). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 11-29-85.
4. Certificate of Compliance transmitted to OAL 11-20-85 and filed 12-27-85 (Register 85, No. 52).
5. Amendment filed 10-1-87; operative 10-31-87 (Register 87, No. 41).
6. Amendment of subsection (a) filed 5-9-88 as an emergency; operative 5-15-88 (Register 88, No. 20). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 9-12-88.
7. Certificate of Compliance transmitted to OAL 9-1-88 and filed 10-3-88 (Register 88, No. 42).
8. Amendment of subsections (a), (c), (d) and (e) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 9-25-92 order including amendment of subsection (a) transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
10. Amendment of subsection (a) and Note filed 12-22-94 as an emergency; operative 12-22-94 pursuant to Welfare and Institutions Code section 14105(a) (Register 94, No. 51). A Certificate of Compliance must be transmitted to OAL 4-21-95 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 12-22-94 order transmitted to OAL 4-21-95 and filed 6-1-95 (Register 95, No. 22).
12. Amendment of subsection (a) and Note refiled 10-16-95 as an emergency; operative 10-16-95 (Register 95, No. 42). A Certificate of Compliance must be transmitted to OAL by 2-13-96 or emergency language will be repealed by operation of law on the following day.
13. Amendment of subsection (a) and Note refiled 2-5-96 as an emergency; operative 2-5-96 (Register 96, No. 6). A Certificate of Compliance must be transmitted to OAL by 6-6-96 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 2-5-96 order transmitted to OAL 6-4-96 and filed 7-12-96 (Register 96, No. 28).
15. Amendment of subsection (a), new subsection (f) and amendment of Note filed 3-13-2000 as an emergency; operative 3-13-2000 (Register 2000, No. 11). A Certificate of Compliance must be transmitted to OAL by 7-11-2000 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 3-13-2000 order transmitted to OAL 7-5-2000 and filed 8-14-2000 (Register 2000, No. 33).
17. Amendment of subsection (a) and amendment of Note filed 11-17-2000 as an emergency; operative 11-17-2000 (Register 2000, No. 46). A Certificate of Compliance must be transmitted to OAL by 3-19-2001 or emergency language will be repealed by operation of law on the following day.
18. Certificate of Compliance as to 11-17-2000 order transmitted to OAL 3-8-2001 and filed 4-19-2001 (Register 2001, No. 16).