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Does Medicare Cover Home Health Care for Respiratory Therapy?
Date Updated: December 13, 2024
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No, Medicare doesn’t cover home health care for respiratory therapy in most cases. While the government insurance program covers comprehensive pulmonary rehabilitation under Part B for qualifying individuals, such therapies don’t fall within the scope of home health services. People must obtain respiratory therapy outside of their residence.
Medicare-Covered Home Health Care Services
Medicare pays the full costs for a range of clinical and rehabilitative services in a person’s home. Agencies develop support plans tailored to meet an individual’s requirements, and trained professionals provide medically necessary care. Home health care teams include nurses and therapists, and common services include:
- In-home skilled nursing care, including pain management, catheter care and diabetes management
- Nutrition therapy
- Medical social services
- Physical therapy
- Speech-language therapy
- Occupational therapy
Additionally, those receiving doctor-prescribed skilled care may qualify for limited aide-delivered personal care, such as help with bathing and toileting. However, Medicare funding for home health care doesn’t typically include respiratory therapy.
Medicare Coverage of Respiratory Therapy
Public insurance subsidizes respiratory therapy for qualifying individuals — typically those with moderate-to-severe COPD — when a doctor orders services based on medical needs. However, CMS rules require individuals to undergo pulmonary rehabilitation in a clinical setting, such as a physician’s office or a hospital.
Medicare doesn’t cover the full costs of such care; people have a variable co-pay depending on the setting. A 20% copay applies for sessions in a doctor’s office, and differing copays apply for those receiving care in a hospital outpatient clinic. Medicare doesn’t usually fund services provided in a person’s private residence. Insurance limits coverage to up to 2 one-hour sessions each day for a maximum of 36 sessions over 36 weeks. Those requiring more intensive treatment must use other ways to pay for sessions.
Situations When Home Health Care Can Include Respiratory Therapy
In limited situations, individuals receiving Medicare Part A (hospital insurance) funding for home health care may receive respiratory therapy at home. If a respiratory therapist delivers training or consultations with home health staff and, by chance, provides therapy in a person's home, agencies may bill for those services.
Additionally, while home health care teams don't include specialized respiratory therapists, care plans may include respiratory therapy delivered by nurses or physical therapists, so long as that therapy classifies as skilled care.