The Home Health Face-to-Face Encounter

Medicare Part A and Part B pay for home health services only where a physician or allowed practitioner certifies, and later recertifies, the content set out at 42 CFR 424.22. The certification is not a cover sheet. It is a set of specific findings, and payment for the episode depends on all of them being supportable.

• The patient needs or needed intermittent skilled nursing care, or physical therapy or speech-language pathology services.
• The patient is or was confined to the home, except when receiving outpatient services.
• A plan for furnishing the services has been established and will be periodically reviewed by a physician or allowed practitioner.
• The services will be or were furnished while the patient was under the care of a physician or allowed practitioner.
• A face-to-face patient encounter occurred, related to the primary reason the patient requires home health services, within the window the regulation sets around the start of care.

The encounter is the fifth of those, at § 424.22(a)(1)(v). It must be related to the primary reason the patient requires home health services, and it must occur no more than 90 days before the home health start of care date or within 30 days after the start of care. The certifying practitioner must also document the date of the encounter as part of the certification. Those are the regulation's own figures rather than a contractor's interpretation of them, and they are the same for every beneficiary.

Until the end of 2025, the regulation did two things at once. It listed who could perform the encounter, wrapping each practitioner type in conditions about collaboration, supervision, or hospital privileges — and then, at paragraph (a)(1)(v)(C), it separately required that the encounter be performed by the certifying physician or allowed practitioner, unless it was performed by a certified nurse midwife or by a practitioner with privileges who had cared for the patient in the acute or post-acute facility from which the patient was directly admitted to home health.

The CY 2026 Home Health Prospective Payment System final rule replaced the first of those with a plain list and deleted the second outright. Its amendatory instruction is short enough to quote: section 424.22 is amended by revising paragraph (a)(1)(v)(A) and removing paragraph (a)(1)(v)(C).

CMS gave the reason plainly. Section 3708 of the CARES Act had already allowed nurse practitioners, clinical nurse specialists, and physician assistants to certify home health eligibility and establish the plan of care, and the regulation had not caught up — it still limited the encounter itself in ways the statute did not. The example CMS worked through is the ordinary one: a patient's primary care physician certifies eligibility and establishes the plan of care, while a different physician in the same practice, seeing the patient on a day the primary was unavailable, conducted the encounter. That was awkward under the old paragraph (C) and is unremarkable now.

Anyone tracking regulatory change by watching amendment dates will see § 424.22 carrying a version dated 5 August 2026 — more recent than the January change, and recent enough to look urgent. It is not a rulemaking, and nothing about a practice's obligations turns on it.

The Office of the Federal Register maintains a public register of corrections to the Code of Federal Regulations, which records for this section a single corrective action: paragraph (a)(2) reinstated. Paragraph (a)(2) is Timing and signature — the requirement that the certification be obtained when the plan of care is established or as soon as possible afterwards, and be signed and dated by the practitioner who establishes the plan. It had dropped out of the codified text when the December 2025 rule was applied to it, even though that rule's amendatory instructions changed only paragraphs (a)(1)(v)(A) and (a)(1)(v)(C). The August entry put it back.

The removed paragraph was about eligibility to perform the encounter and nothing else. Everything that made home health certification a documentation problem is still there.

The encounter has to be about the right thing

It must relate to the primary reason the patient requires home health services. CMS has been explicit that diagnosis codes are not required on the encounter documentation and do not have to match the primary home health diagnosis exactly — but the documentation does have to demonstrate the relationship. An encounter for an unrelated complaint does not satisfy the requirement no matter how well recorded.

The certification carries a date and a signature

The certifying practitioner documents the date of the encounter as part of the certification, and under paragraph (a)(2) the certification is obtained when the plan of care is established or as soon as possible afterwards and is signed and dated by the practitioner who establishes the plan.

Recertification is a recurring obligation

Where care continues, recertification is required at least every 60 days, timed to the review of the plan of care, unless the patient transfers or is discharged with goals met and no expectation of return. A new face-to-face encounter is not part of each recertification, but the continued-eligibility findings are.

Certain financial relationships disqualify the certifier

A practitioner with a financial relationship with the home health agency may not certify or recertify the need for its services, establish or review the plan of care, or perform the face-to-face encounter, unless the relationship meets one of the exceptions to the physician self-referral prohibition.

This is the part that produces denials on review, and it did not move. The basis for certifying eligibility must be documentation in the certifying practitioner's medical record, or in the medical record of the acute or post-acute facility from which the patient was directly admitted to home health, or both.

Documentation from the home health agency may also be used to support the certification, but only conditionally: it has to be corroborated by other entries in the certifying practitioner's record or the facility's record, so that the records together present a clinically consistent picture of eligibility, and the certifying practitioner has to sign and date the agency's documentation to show it was considered. Agency documentation on its own is not a basis for certification.

The regulation then states the consequence directly. The documentation must be provided on request to review entities or CMS, and where what was used as the basis for certification is not sufficient to demonstrate the patient was eligible, payment is not made for the home health services provided. There is no cure by supplementation after the fact — the question on review is what the certifying record supported at the time.

1. 01

   Stop refusing encounters performed by a colleague

   Where a practice previously turned away a home health referral because the encounter had been done by a partner rather than the certifying practitioner, that objection is gone as of 1 January 2026. The certifying practitioner still certifies; the encounter can have been someone else's.
2. 02

   Stop applying the acute or post-acute privileges test

   The old exception depended on whether the practitioner had privileges at the facility the patient came from. That condition no longer appears in the regulation, and a workflow still screening for it is rejecting encounters the rule now accepts.
3. 03

   Keep every documentation control exactly as it was

   The relationship to the primary reason for home health, the date on the certification, the signature, and the record basis are all unchanged. The flexibility is about who; nothing about what has to be shown moved.
4. 04

   Check the agency's requirements separately

   Medicare Advantage plans set their own coverage and authorization requirements for home health and do not necessarily follow this regulation. Commenters asked CMS to require alignment, and CMS did not. Where a patient is enrolled in a Medicare Advantage plan, the plan's rules are the ones to confirm.

When a home health claim is denied for insufficient face-to-face documentation, the appeal is largely an exercise in showing what the certifying record contained at the time of certification. That is a records problem before it is an argument, which is why the documentation a payer requests and the way the practice assembles it matter more here than the wording of the letter.