Home Health Qualifying Criteria
for Intermittent Care
Intermittent Care
1. Does the beneficiary receive Medicare covered physical therapy, speech
therapy, or continued occupational therapy?
Yes . . . Intermittent qualifying criteria is met. Refer to the “Part-time”
Definition for Skilled Nursing and Home Health Aide Web page at
https://www.cgsmedicare.com/hhh/coverage/HH_Coverage_
Guidelines/4C.html.
No . . . .Go to question 2.
2. Does the beneficiary receive a Medicare covered skilled nurse visit at least once
every 60-90 days?
Yes . . . Go to question 3.
No . . . .Beneficiary does not qualify for the home health Medicare benefit.
3. Does the beneficiary receive Medicare covered skilled nurse visits 7 days
per week?
Yes . . . Go to question 4.
No . . . .The intermittent qualifying criteria is met. Refer to the “Part-time”
Definition for Skilled Nursing and Home Health Aide web page at
https://www.cgsmedicare.com/hhh/coverage/HH_Coverage_
Guidelines/4C.html.
4. Is there a documented statement of predictable and finite endpoint to daily
skilled nurse visits?
Yes . . . Intermittent qualifying criteria is met.
No . . . .Beneficiary does not qualify for the Medicare benefit.
The one exception to the intermittent requirement is coverage of skilled nurse visits to
administer insulin. Documentation in the medical record must show that the beneficiary is
physically and/or mentally unable to self-inject and there is no willing and/or able caregiver
to administer the insulin.
Limitation of liability applies to services denied because the care provided did not meet the
intermittent criteria.
Reference: Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch.7, §40.1
(http://www.cms.gov/manuals/Downloads/bp102c07.pdf)
H-039-01 • Revised October 28, 2013.
© 2013 Copyright, CGS Administrators, LLC.
Disclaimer: This resource is not a legal document. Although every reasonable
effort has been made to assure accurate information, responsibility for correct
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