S9122 CPT Code – Home Health Aide (HHA) and CNA In-Home Care Billing

S9122 is a temporary HCPCS Level II code representing home health nursing services provided by a registered nurse (RN) in a patient’s residence. It covers skilled nursing care such as wound care, medication administration, or chronic disease management.

Use S9122 for time-based skilled nursing services in a home setting, including:

• Post-surgical care (e.g., dressing changes).
• Chronic condition monitoring (e.g., diabetes, heart failure).
• Patient/caregiver education.
  Note: Services must be ordered by a physician and part of a care plan.

It is a HCPCS Level II code, but often referred to as S9122 CPT code in billing contexts.

Reimbursement varies:

• Typically paid per 15-minute unit (1 unit = 15 minutes).
• Medicaid programs may have fixed rates (e.g., 25–25–50 per unit).
• Commercial payers often follow contract terms.

Some payers may require modifiers like:

• Modifier 59: For distinct services not bundled with other care.
• Modifier U1: State-specific Medicaid requirements.
  Confirm with individual payer guidelines.

Common reasons:

• No physician order or expired care plan.
• Incorrect time documentation (e.g., rounding errors).
• Payer does not recognize S9122 (e.g., Medicare).

No. S9122 applies only to in-person home health nursing. Telehealth services may use codes like 99421-99423 (online evaluation) or payer-specific virtual care codes.

Only qualified RNs employed by a home health agency or approved provider. Ensure your provider type is credentialed under the payer’s policy.

Key Tips

• Verify payer coverage: Medicaid plans vary by state; some commercial insurers exclude S9122.
• Track time meticulously: Use logs signed by the RN and patient/caregiver.
• Avoid Medicare: Use G0151 for Medicare patients instead.

Generally, up to 7 hours per day, unless more time is authorized by a claims examiner.

Yes, authorization is required to ensure services meet medical necessity and payer compliance.

• S9122: Hourly HHA/CNA care
• 99509: Broader home visits for ADLs and personal care