Home Health PPS
Home Health Prospective Payment System
The CMS prospective payment system for home health services, based on 30-day periods of care under PDGM.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Acronym for
- Home Health Prospective Payment System
- Primary sources
- 1
- Workspace handoff
- ask d3 →
Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
CMS Home Health PPS uses the Patient-Driven Groupings Model (PDGM) to set 30-day period payments based on patient characteristics. OASIS assessments drive the case-mix categorization.
How it shows up in your practice
Home health agencies bill under HH PPS. Physicians billing for the home health certification and care plan oversight (CPO) bill professional under PFS.
Sources
- CMS — Home Health PPShttps://www.cms.gov/medicare/payment/prospective-payment-systems/home-health
Look up HH PPS rules in Ask D3
Open ask d3 →Related terms
- DocumentationOASISOutcome and Assessment Information Set — the CMS-required patient assessment for home health beneficiaries.
- DocumentationHome Health Face-to-FaceMedicare requirement that a physician or allowed practitioner document a face-to-face encounter related to the primary reason for home health within defined windows.
- BillingPhysician Fee Schedule (PFS)The CMS Medicare reimbursement schedule for physician and certain non-physician practitioner services, published annually.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryHome Health Face-to-FaceMedicare requirement that a physician or allowed practitioner document a face-to-face encounter related to the primary reason for home health within defined windows.
- GlossaryOASISOutcome and Assessment Information Set — the CMS-required patient assessment for home health beneficiaries.
- GlossaryPhysician Fee Schedule (PFS)The CMS Medicare reimbursement schedule for physician and certain non-physician practitioner services, published annually.
- ComplianceOIG LEIE Monthly Exclusion Screening: Process + Audit-Ready LogsMonthly OIG LEIE and SAM.gov exclusion screening for every workforce member and vendor: the workflow, the log fields auditors require, and the escalation path.
- CompliancePECOS Provider Enrollment Verification (2026) — Quarterly ChecklistQuarterly PECOS provider enrollment verification workflow: who to check, the exact lookup steps, the audit log columns, and the revalidation escalation path.
- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryACA Marketplace PlanHealth plans sold through the federal or state-based health insurance marketplaces under the Affordable Care Act.
- GlossaryAdvance Explanation of Benefits (AEOB)Under the No Surprises Act, the advance benefit statement that insurers must provide to insured patients before scheduled services (implementation deferred).
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.