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
Profound fatigue or generalized weakness that limits the ability to leave home without assistance.
Deconditioning or functional decline requiring the assistance of another person for safe mobility.
An acute or subacute illness with constitutional symptoms making it medically unsafe to leave home.
The need for frequent skilled assessment of an unstable overall condition.
Homebound paragraph — example
Patient remains homebound. Generalized weakness and fatigue limit endurance, and the patient requires the assistance of another person and a device for safe ambulation; leaving the home is exhausting and requires assistance. The overall condition is being closely monitored for change. Leaving home therefore requires a considerable and taxing effort.
