Billing Code Overview

HCPCS Level II code S9124 describes nursing care in the home provided by a licensed practical nurse, billed per hour. This service falls under Miscellaneous Supplies and Services and is typically furnished in the home (Place of Service 12). The code denotes one-on-one nursing care delivered in a patient’s residence and is used to document and bill hourly licensed practical nurse services in the home setting.

Clinical Context

A homebound adult patient with limited mobility and ongoing nursing needs receives hourly licensed practical nurse (LPN) visits for skilled nursing tasks. Typical reasons include wound care, medication administration or monitoring (including therapeutic drug level checks), assistance with activities of daily living related to bed confinement or wheelchair dependence, and transitional aftercare following hospital discharge. The LPN documents visit start and stop times, tasks performed (e.g., medication administration, vital signs, skin/wound assessment), communication with the supervising provider or home health agency, and any changes in patient status that require escalation to a registered nurse or physician. Services are delivered in the patient’s residence (Place of Service 12).

Coding Specifications

• Modifier TT: Use when an individualized service is provided to more than one patient in the same setting. Apply to indicate that the billed unit reflects that circumstance.

• Modifier 59: Use to indicate a Distinct Procedural Service when a separately identifiable service or procedure is performed in addition to another service on the same day.

• Associated provider taxonomies and specialties:

Related Diagnoses

• Z74.01 — Bed confinement status

  Relevance: Bed confinement indicates limited mobility and increased need for in-home nursing support for repositioning, skin care, and monitoring.

• Z48.89 — Encounter for other specified aftercare

  Relevance: Aftercare encounters following procedures or hospital discharge may require home nursing visits for wound checks, medication management, and care coordination.

• Z51.81 — Encounter for therapeutic drug level monitoring

  Relevance: Patients requiring medication level monitoring may need LPN visits to obtain specimens, administer medications, or report levels to the supervising clinician.

• Z79.01 — Long term (current) use of anticoagulants

  Relevance: Long-term anticoagulation increases the need for nursing oversight for medication administration, bleeding surveillance, and patient education during home visits.

• Z99.3 — Dependence on wheelchair

  Relevance: Wheelchair dependence is associated with mobility limitations that often necessitate routine home nursing assistance for transfers, skin integrity checks, and ADL support.

Related Codes

• S9123 is a direct parallel service delivered by a registered nurse (RN) rather than an LPN; it may be used instead of S9124 when RN-level skills are required.

• 99503 and 99504 are home visit services for respiratory support and mechanical ventilation; these may be used in the same home-care episode when respiratory therapy or ventilator management is needed in addition to nursing care.

• 99509 covers home visits for assistance with activities of daily living and personal care and can be used alongside S9124 when personal care support is provided in the same episode; it may be billed as a separate service when the activity meets payor criteria for distinct services.

Across national payers, Medicare and BUCA (average commercial) mean rates for HCPCS Level II code S9124 are similar in magnitude, with Medicare at $25.27 and BUCA at $29.38. Blue Cross Blue Shield reports the highest mean at $41.77, while Cigna Health reports the lowest mean at $15.04. The distribution medians align with many of the means, but some payers show notable gaps between mean and median.

Rate dispersion (P75 − P25) is widest for Blue Cross Blue Shield (55 − 26 = 29) and UnitedHealthcare/Medicare (45 − 0 = 45), indicating greater variability in paid amounts. Cigna Health is the tightest with no dispersion (11 − 11 = 0), followed by Aetna with effectively no spread (30 − 30 = 0). The table and chart below present the full breakdown.