Medicare requires both prongs: the patient needs the aid of a supportive device or another person or has a condition that makes leaving home medically contraindicated, and leaving home requires a considerable and taxing effort. Document patient-specific evidence when homebound status is assessed, and ensure the longitudinal record continues to support both Medicare homebound criteria.
Evidence from this system that supports homebound status
Claudication or rest pain that limits ambulation.
Severe edema that limits mobility or footwear.
A non-healing ulcer requiring offloading or limited weight-bearing.
Activity limited by extremity pain or swelling, with associated fall risk.
Homebound paragraph — example
Patient remains homebound. Lower-extremity claudication and significant edema limit ambulation to about 25 feet before pain and require a walker and the assistance of a caregiver. A non-healing venous ulcer requires offloading and limits weight-bearing. Leaving the home requires assistance and prolonged rest afterward and is limited to medical appointments; leaving home therefore requires a considerable and taxing effort.
