Home health face-to-face encounter rules: timing, who can do it and what to document

Not clinically reviewed. Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.

To certify Medicare home health, the patient must have a face-to-face encounter related to the main reason for home care, no more than 90 days before or within 30 days after the start of care. A physician, nurse practitioner, clinical nurse specialist, physician assistant or certified nurse-midwife may perform it, and the certifier documents the date.

Key facts - The window is no more than 90 days before, or within 30 days after, the home health start of care (42 CFR 424.22(a)(1)(v), checked Nov. 5, 2026). - Five practitioner types may perform it, and it can happen by telehealth under Medicare's telehealth rules (42 CFR 424.22(a)(1)(v)(A)-(B)). - The CY 2026 final rule, effective Jan. 1, 2026, dropped the old limits on which physician could do the visit (CMS fact sheet, Nov. 28, 2025; 90 FR 55342). - Insufficient documentation caused 51.4% of home health improper payments in CMS's 2024 data (CMS MLN).

The face-to-face encounter is one of five things a physician or allowed practitioner has to certify before Medicare pays for home health. It's also one of the easiest to get wrong: the visit happens on someone else's calendar, often in a hospital or clinic, and the home health agency usually learns about it secondhand. If you're new to the benefit itself, start with our explainer on whether Medicare covers home health care.

What is the home health face-to-face encounter?

It's a visit with the patient, in person or by qualifying telehealth, that supports the certification that the patient is eligible for Medicare home health. Under 42 CFR 424.22(a)(1) (eCFR current text, checked Nov. 5, 2026), the certifier must attest that the patient needs intermittent skilled nursing, physical therapy or speech-language pathology; is confined to the home; has a plan of care; is under the care of a physician or allowed practitioner; and had a face-to-face encounter.

The encounter has to be "related to the primary reason the patient requires home health services," in the regulation's words. A routine visit for an unrelated problem doesn't satisfy it. Our story on the Nov. 2 manual change for NP and PA certifications walks through all five certification elements Medicare reviewers check.

When does the encounter have to happen?

No more than 90 days before the home health start of care, or within 30 days after it (42 CFR 424.22(a)(1)(v)). Together that's a window of up to 120 days around admission, most of it before care starts.

There's one wrinkle in CMS's Benefit Policy Manual, ch. 7, sec. 30.5.1.1 (checked Nov. 5, 2026). If home health is ordered for a new condition that wasn't evident at a visit in the 90 days before start of care, the patient needs to be seen again within 30 days after admission. In other words, an earlier visit only counts if it relates to the reason the patient is getting home health now.

Who can perform the face-to-face encounter?

The current regulation, 42 CFR 424.22(a)(1)(v)(A), lists five practitioner types:

Two limits still apply. First, under 42 CFR 424.22(d), a physician or allowed practitioner with a financial relationship with the home health agency (as defined at 42 CFR 411.354) can't conduct the encounter, certify or set up the plan of care unless the relationship fits a listed exception, and the same bar applies to nonphysician practitioners. Second, performing the encounter isn't the same as certifying: certification is done by a physician or allowed practitioner, which CMS's CY 2026 fact sheet describes as NPs, CNSs and PAs under the CARES Act.

What changed for 2026?

CMS's CY 2026 home health final rule (CMS-1828-F), issued Nov. 28, 2025, broadened the wording of 42 CFR 424.22(a)(1)(v) to align with section 3708 of the CARES Act, according to the CMS fact sheet. The fact sheet says physicians, NPs, CNSs and PAs can now perform the encounter "regardless of whether they are the certifying practitioner or whether they cared for the patient in the acute or post-acute facility" the patient came from. The rule was published Dec. 2, 2025 at 90 FR 55342 with an effective date of Jan. 1, 2026.

Watch for older guidance. As of Nov. 5, 2026, the manual section (Rev. 10438, issued Nov. 6, 2020) and the MLN compliance tip still describe the pre-2026 setup, where the physician had to be the certifier or the facility physician and NPs, CNSs, nurse-midwives and PAs worked in collaboration with or under supervision of one of them. The regulation is the current rule; if your intake checklist still asks "was this the certifying physician?", compare it with the eCFR text and ask your Medicare Administrative Contractor about anything unclear.

Can it be done by telehealth?

Yes, within Medicare's telehealth rules. 42 CFR 424.22(a)(1)(v)(B) says the encounter may occur through telehealth in compliance with section 1834(m) of the Social Security Act and the physician fee schedule's list of payable telehealth services. The manual's telehealth section describes originating-site requirements, such as rural location and approved site types. Those requirements depend on current Medicare telehealth policy, so check CMS's telehealth page, which links a telehealth FAQ updated Oct. 9, 2026, before relying on a video visit.

What has to be documented?

• The encounter date. The certifying physician or allowed practitioner must document it as part of the certification (42 CFR 424.22(a)(1)(v)).
• Records that support eligibility. Under 42 CFR 424.22(c), the certifier's medical record, or the hospital or post-acute facility's record if the patient was admitted straight from there, is the basis for certification. The MLN tip says those records must show the need for skilled services and homebound status.
• Agency documentation, with conditions. Home health agency records (like the plan of care or the patient assessment) can also support certification, but only if other entries in the certifier's or facility's record corroborate them and the certifier signs and dates them (42 CFR 424.22(c)(1)).

Documentation is where claims fail. CMS's MLN tip reports a 6.7% improper payment rate for home health in its 2024 data, with insufficient documentation behind 51.4% of those improper payments. Agencies in Illinois and the other Review Choice Demonstration states have extra reason to get this right before claims go out; see our Review Choice Demonstration explainer.

What if the patient dies before the encounter?

The Benefit Policy Manual treats it as an exceptional circumstance. When a patient dies shortly after admission and before the encounter, the certification is deemed complete if the contractor determines the agency made a good-faith effort to arrange the encounter and every other certification requirement is met.

Frequently asked questions

Can the home health face-to-face encounter be done by video? Yes, if it meets Medicare's telehealth rules. 42 CFR 424.22 says the encounter may occur through telehealth under section 1834(m) of the Social Security Act and the list of payable Medicare telehealth services, and CMS's MLN compliance tip also says it can occur through telehealth.

How long before the start of care can the encounter happen? No more than 90 days before the home health start of care, or within 30 days after it (42 CFR 424.22(a)(1)(v)).

What if the patient dies before the encounter happens? The Benefit Policy Manual (ch. 7, sec. 30.5.1.1) says the certification is deemed complete if the contractor finds the agency made a good-faith effort to arrange the encounter and every other certification requirement is met.

Who documents the encounter date? The certifying physician or certifying allowed practitioner, as part of the certification (42 CFR 424.22(a)(1)(v)).

Can a certified nurse-midwife certify home health? The regulation lets a certified nurse-midwife perform the face-to-face encounter as authorized by state law. Certification itself is done by a physician or allowed practitioner; CMS's fact sheet describes the CARES Act as letting NPs, CNSs and PAs order and certify home health.

For how home health differs from home care and hospice, see our guide to home health vs. home care vs. hospice.

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Sources were opened and checked Nov. 5, 2026. Rules and coverage can change; the linked primary sources control. Home Health Brief corrects errors under its published corrections policy.

This item has not been clinically reviewed. It is general information, not clinical, billing or legal advice.

Drafted with AI assistance from primary sources. Written and edited by the Home Health Brief newsroom under Monsaur Othman's editorial standards. Read how we use AI, our editorial policy and our corrections policy.