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Does Medicare Cover Home Health Care for Chronic Pain Management?
Date Updated: December 13, 2024
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
Yes, Medicare covers home health care for chronic pain management for eligible individuals. Pain management services fall under skilled nursing care or physical therapy, both of which count as qualifying services for home health care coverage. Agencies provide care for as long as a doctor deems it medically necessary.
Qualify for Medicare Home Health Care Coverage
Medicare-qualified individuals must fulfill extra requirements to benefit from home health care funding. They must meet medical need criteria, as certified by a doctor. Their physician must also certify that they satisfy homebound conditions, meaning that they can’t leave the home without difficulty or shouldn’t go out because of their condition.
Additionally, a doctor must prescribe in-home medical or therapeutic care and a Medicare-certified provider must deliver services. Initial orders last for 60 days, after which time a recipient must meet face-to-face with a medical professional who should then recertify that they continue to meet program criteria. The provider must repeat the recertification procedure every 60 days unless individuals change their home health agency or a doctor discharges them with no expectation of further necessary services.
Medicare Home Health Care for Pain Management
Various conditions cause chronic pain, including cancer, arthritis and some autoimmune issues. Diverse, progressive diseases and injuries also lead to ongoing pain. So long as doctors and agencies follow recertification processes, Medicare covers the full costs of home health care for as long as needed. This coverage means team members can deliver pain management on a temporary or ongoing basis. Medicare also pays partial costs for durable medical equipment, such as hospital beds and mobility devices, which can ease symptoms and make life easier.
Typical pain management measures include:
- Pain assessments
- Medication administration and management
- Physical therapy
- Occupational therapy
- Nutritional oversight
- Home health aide support with personal care, such as bathing and using the toilet (only for those also receiving skilled care at home)
- Medical social services