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.
Cardiovascular evidence that supports homebound status
Exertional dyspnea or angina that limits ambulation distance.
Fatigue and activity intolerance from heart failure or low cardiac output.
Orthostatic instability or fall risk from antihypertensive or diuretic therapy.
The need to rest after minimal exertion; oxygen dependence.
Severe edema that limits mobility or footwear.
Homebound paragraph — cardiovascular
Patient remains homebound. Becomes dyspneic with minimal exertion and can ambulate only about 20 feet with a walker before needing to rest. Leaving the home requires the assistance of his wife and approximately 30 minutes of rest after dressing; transfer into a vehicle requires a two-person assist. The last unaccompanied outing was more than three months ago for a medical appointment, after which he reported exhaustion for the remainder of the day. Leaving home therefore requires a considerable and taxing effort.
