--- title: "PDGM Home Health Billing: Significant Change in Condition (SCIC)" description: PDGM home health billing for a Significant Change in Condition (SCIC) include completing a follow-up OASIS reflecting a new primary diagnosis. image: https://go.myhomecarebiz.com/hubfs/Non%20clinical%20images/image-billing-UB04.jpe --- [![PowerPath.ai](https://go.myhomecarebiz.com/hs-fs/hubfs/Power-Path-copy.ai_-2048x263.png?width=2000&height=256&name=Power-Path-copy.ai_-2048x263.png "PowerPath.ai")](https://powerpath.ai/) - [How It Works](https://powerpath.ai/how-it-works/) - [Tools for Growth](https://powerpath.ai/tools-for-growth/) - [Meet Pattii](https://powerpath.ai/meet-pattii/) - [Resources](https://powerpath.ai/resources/) - [Blog](https://go.myhomecarebiz.com/blog) - [About](https://powerpath.ai/about/) - [Contact](https://powerpath.ai/contact/) [My Account](https://secure.myhomecarebiz.com/) [Get Demo](https://melissa-myhomecarebiz.youcanbook.me/) ![BlogHeaderImg](https://go.myhomecarebiz.com/hs-fs/hubfs/BlogHeaderImg.png?width=2000&height=666&name=BlogHeaderImg.png "BlogHeaderImg") # Home Health Insights Stay informed with the latest news in home health. ## Browse by Topic - [Regulatory News for Home Health & Hospice (173)](https://go.myhomecarebiz.com/blog/topic/regulatory-news-for-home-health-hospice) - [Clinical Best Practices for Home Health & Hospice (22)](https://go.myhomecarebiz.com/blog/topic/clinical-best-practices-for-home-health-hospice) - [Home Health Billing & Coding (21)](https://go.myhomecarebiz.com/blog/topic/home-health-billing-coding) - [Home Health Marketing (18)](https://go.myhomecarebiz.com/blog/topic/home-health-marketing) ## PDGM Home Health Billing: Significant Change in Condition (SCIC) PDGM Home Health Billing: Significant Change in Condition (SCIC) Posted by Melissa Cott on Jun 27, 2023 # PDGM Home Health Billing: Significant Change in Condition (SCIC) Posted by [Melissa Cott](https://go.myhomecarebiz.com/blog/author/melissa-cott) on Jun 27, 2023 The home health conditions of participation (CoPs) require that agencies **update and revise** the current OASIS assessment under the following conditions: (1) The last 5 days of every 60 days if the patient is to be 're-certified', unless there is a beneficiary-elected transfer, **(2) a significant change in condition**, (3) patient discharge and return to the same HHA during the 60-day episode; (4) within 48 hours of the patient’s return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests; and (5) at discharge. [![Take the PDGM Billing Quiz!](https://no-cache.hubspot.com/cta/default/375308/37567a22-6ff2-44c3-9dd4-b1e2c21cd74b.png)](https://cta-redirect.hubspot.com/cta/redirect/375308/37567a22-6ff2-44c3-9dd4-b1e2c21cd74b) If, during a 30-day billing episode, a patient experiences a significant deterioration which changes the primary diagnosis, the claim for the FOLLOWING 30-day billing period (assuming the patient will receive another 30-day period of care) will reflect the change in diagnosis, the change in HIPPS code, and ultimately a change in payment. If the patient has a significant change after admission, providers would not change the claim for the first 30-day period. A follow-up assessment would be completed and submitted before the start of the second 30-day period to reflect the change in the functional level and the second 30-day claim would be grouped into its appropriate case-mix group. Accordingly, two 30-day periods would have two different case-mix groups to reflect any changes in patient condition. The case mix group cannot be adjusted within each 30-day period. Agencies must be sure to update the assessment completion date on the second 30-day claim if a follow-up assessment changes the case-mix group to ensure the claim can be matched to the follow-up assessment. HHAs can submit a claims adjustment if the assessment is received after the claim has been submitted, if the assessment items would change the payment grouping. Click here to learn how to get a [Prior Authorization](https://go.myhomecarebiz.com/blog/how-to-get-a-prior-authorization-for-home-health-billing). ## How to Manage a Patient's Significant Change in Condition Complete a Followup OASIS (Type 5) Before the Start of 2nd 30-Day Billing Period Before the start of the second 30-day billing period, a follow-up assessment (type 5) would be completed and submitted before the start of the second 30-day period to reflect the change in the diagnosis and functional level. The second 30-day claim would be grouped into its appropriate case-mix group accordingly. [A Beginner's Guide to Home Health Billing](https://go.myhomecarebiz.com/blog/a-beginners-guide-to-home-health-billing) [Medicare Home Health Billing: A RAP is Just a Loan](https://go.myhomecarebiz.com/blog/home-health-care-billing-a-rap-is-just-a-loan-2) [OASIS Guidance: M1600 UTI in the Past 14 Days?](https://go.myhomecarebiz.com/blog/oasis-guidance-m1600-uti-in-the-past-14-days) Tags: [Home Health Billing](https://go.myhomecarebiz.com/blog/topic/home-health-billing) [![you will make Medicare happy](https://no-cache.hubspot.com/cta/default/375308/98f7e1e7-1e9a-44ed-994f-96665cf71930.png)](https://cta-redirect.hubspot.com/cta/redirect/375308/98f7e1e7-1e9a-44ed-994f-96665cf71930) ### Topics - [Clinical Best Practices for Home Health & Hospice (22)](https://go.myhomecarebiz.com/blog/topic/clinical-best-practices-for-home-health-hospice) - [CMS News for Billing (6)](https://go.myhomecarebiz.com/blog/topic/cms-news-for-billing) - [Conditions of Participation (16)](https://go.myhomecarebiz.com/blog/topic/conditions-of-participation) - [COVID-19 (11)](https://go.myhomecarebiz.com/blog/topic/covid-19) - [DX Alzheimers/Dementia (3)](https://go.myhomecarebiz.com/blog/topic/dx-alzheimers-dementia) ### Recent Posts [![Power-Path-copy.ai_-2048x263](https://go.myhomecarebiz.com/hs-fs/hubfs/Power-Path-copy.ai_-2048x263.png?width=2000&height=256&name=Power-Path-copy.ai_-2048x263.png "Power-Path-copy.ai_-2048x263")](https://powerpath.ai/) ## AI-powered EMR and outcomes-based marketing tools that help home health agencies operate smarter, improve patient results, and grow referrals—all in one HIPAA-compliant platform. - [How It Works](https://powerpath.ai/how-it-works/) - [Tools for Growth](https://powerpath.ai/tools-for-growth/) - [Meet Pattii](https://powerpath.ai/meet-pattii/) - [Resources](https://powerpath.ai/resources/) - [Blog](https://go.myhomecarebiz.com/blog) - [About](https://powerpath.ai/about/) - [Contact](https://powerpath.ai/contact/) [Get Demo](https://melissa-myhomecarebiz.youcanbook.me/) ## © 2026 PowerPath.ai. 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