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
Pain that limits ambulation distance or the ability to leave home without assistance.
Functional limitation in transfers or activities of daily living attributable to pain.
Sedation or fall risk from the analgesic regimen that makes leaving home unsafe without assistance.
The need for frequent skilled assessment and regimen adjustment.
Homebound paragraph — example
Patient remains homebound. Pain limits ambulation to a short distance with a device and the assistance of another person, and pain with transfers restricts independent mobility. The analgesic regimen contributes to sedation and fall risk, and leaving the home requires assistance and considerable effort. Leaving home therefore requires a considerable and taxing effort.
