For Providers & Clinics
Partnering to Support Your Patients at Home
Thank you for considering Mount Desert Nursing Association as a trusted partner in your patients' care. This page is designed to help providers and clinics navigate our referral process, understand eligibility requirements for Medicare home health services, and ensure a smooth transition of care to the home setting.
Who Qualifies for Home Health Services Under Medicare?
Medicare eligibility for home health requires:
A face-to-face visit with a Maine-based provider within the last 60 days
The patient must be homebound (see definition below)
A skilled need such as nursing, physical therapy, or occupational therapy
Services must be intermittent and medically necessary
Homebound Status – Medicare Definition: The patient requires assistance (from a person or device) to leave home, and absences from home are infrequent or short in duration (e.g., medical appointments, church).
Read more on Medicare.gov – Homebound Status
Useable Diagnoses for Medicare Home Health
Patients must have a skilled need tied to a medical diagnosis. Below are some common, usable diagnoses that support home health eligibility under Medicare:
✅ Examples:
Stroke (CVA)
Congestive Heart Failure (CHF)
Chronic Obstructive Pulmonary Disease (COPD)
Recent orthopedic surgery (e.g., hip or knee replacement)
Post-fall with injury or mobility decline
Wound care needs (e.g., diabetic ulcers)
Exacerbation of chronic conditions requiring skilled intervention
🚫 Not Typically Covered (Non-Examples):
Generalized fatigue without medical cause
Need for companion care only
Stable, non-skilled chronic conditions without recent change
Solely medication refills without skilled need
Weakness, generalized or unspecified
Malaise
Falls
Abnormality of gait and/or mobility
Low Back Pain
Unsteadiness on Feet
Repeated Falls
Difficulty walking not elsewhere classified
Unspecified Osteoarthritis
Encounter for other specified surgical aftercare
Wounds, unspecified
- Essentially, we need the primary diagnosis - not the symptoms. COPD is a useable primary diagnosis, which may have weakness as a symptom. Parkinson’s is a useable diagnosis with frequent falls as a possible symptom.
- If patient is suspected of a primary diagnosis (i.e. osteoarthritis) but waiting for imaging or labs to confirm, we do need the imaging/lab reports confirming before referral can be sent and accepted.
*This is not a complete list but primary examples. We are happy to check any code for viability if needed. Please do not hesitate to call us at 207-276-5184 with any questions.
Understanding Our Services
Our goal is to restore the patient's independence and reduce rehospitalizations.
Our home health care is intermittent, meaning care is provided for short durations, typically:
1-hour visits
Up to 3 times per week, depending on patient need
Focused on returning the patient to their prior level of function
We offer:
Skilled Nursing (CPT Code: G0299)
Physical Therapy (CPT Code: G0151)
Occupational Therapy (CPT Code: G0152)
Home Health vs. Caregivers: What’s the Difference?
Home Health (what we provide):
Licensed clinical services (nursing, PT, OT)
Ordered by a provider
Covered by Medicare/insurance when eligible
Time-limited, goal-directed care
Caregivers/Personal Support Workers:
Non-clinical assistance (bathing, meal prep, companionship)
Not covered by Medicare
Long-term support, often private pay or via long-term care insurance
How to Refer a Patient
We accept referrals from any Maine-licensed provider.
1. Submit a Referral
Download and complete our Referral & Intake Form (PDF)
Fax completed form to 206-276-5185
Ensure patient has been seen by their provider within the last 60 days
2. We’ll Take It From There
Our intake team will confirm eligibility and initiate services as appropriate.