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
Dyspnea on minimal exertion that limits ambulation distance.
Oxygen dependence requiring portable oxygen and the assistance of another person.
Fatigue and low endurance from chronic lung disease, with the need for frequent rest.
Activity limited by oxygen desaturation with exertion.
Homebound paragraph — example
Patient remains homebound. Becomes dyspneic and desaturates with minimal exertion, ambulating only about 15 feet before needing to rest, and is dependent on continuous oxygen. Leaving the home requires portable oxygen, the assistance of a family member, and prolonged rest afterward; transport is exhausting and limited to medical appointments. Leaving home therefore requires a considerable and taxing effort.
