Hospice Medicare Billing Codes Sheet Type of Bill (FL4) X=1 non hospital based ● X=2 hospital based Condition Code (FL 18-28) 8XA Notice of Election (NOE) 8X2 1st claim in series H2 Discharge for cause (i.e. patient/staff safety) 8XB Notice of Termination/Revocation (NOTR) 8X3 Continuing claim 52 Discharge for patient unavailability, inability to receive care, or out of service area 8XC Change of hospice 8X4 Discharge claim 8XD Cancel NOE/benefit period 8X7 Adjustment claim 8X0 Nonpayment claim 8X8 Cancel claim 8X1 Admit thru discharge Type of Admission (FL14) Emergency 3 Elective 2 Urgent 5 Trauma 9 Information not available CMS Pub. 100-04, Chapter 25, Section 75.1 Point of Origin (Source of Admission) (FL15) 1 Non-health care facility 2 Clinic or physician’s office 4 5 Claim Change Reason Code (CCRC) (FL 18-28) & Adjustment Reason Code (ARC) (FISS only) Description CMS Pub. 100-04, Chapter 11, Section 20.1.2 & 30.3 1 CMS Pub. 100-04, Chapter 11, Section 30.3 6 Transfer from Another Health Care Facility Transfer from hospital 8 Court/Law Enforcement Transfer from SNF or ICF 9 Information not available CMS Pub. 100-04, Chapter 25, Section 75.1 Patient Status (FL17) as of “To” date on claim 01 Discharged to home, revoked, or decertified 30 Still a patient (“To” date must be last day of month) 40 Expired at home (see occurrence code 55) 41 Expired at medical facility (see occurrence code 55) 42 Expired – place unknown (see occurrence code 55) 50 Discharged/transferred to hospice – home (routine or CHC) 51 Discharged/transferred to hospice – medical facility (respite or GIP) CMS Pub. 100-04, Chapter 11, Section 30.3 Website Reference - CMS Pub. 100: http://www.cms.gov/Regulations-and-Guidance/ Guidance/Manuals/Internet-Only-Manuals-IOMs.html CCRC ARC TOB Change in dates of service D0 RF 8X7 Change in charges D1 RG 8X7 Change in revenue/HCPCS code D2 RH 8X7 Cancel to correct provider #/HIC D5 RI 8X8 Cancel duplicate or OIG payment D6 RJ 8X8 Any other/multiple change(s) D9 RM 8X7 Change in patient status E0 RN 8X7 CMS Pub. 100-04, Chapter 1, Section 220.127.116.11 Occurrence Codes (FL 31-34) 27 Date of certification or recertification 42 Date of revocation (ONLY) 55 Date of death (when patient status = 40, 41 or 42) CMS Pub. 100-04, Chapter 11, Section 30.3 Occurrence Span Codes (FL 35-36) 77 Noncovered days due to untimely recertification OR Untimely NOE M2 Multiple respite stays, From/To dates of each stay CMS Pub. 100-04, Chapter 11, Section 30.3 NOTE: The codes listed on this billing codes sheet represent those most frequently submitted on hospice NOEs/claims. A complete listing of all codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual: http://www.nubc.org. H-016-09 • Page 1 of 4 • Revised January 29, 2015. © 2015 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited. Hospice Medicare Billing Codes Sheet MSP Value Codes (FL 39-41) Revenue Codes (FL 42), HCPCS Codes and Modifiers (FL 44) Description VC Description REV HCPCS, Modifiers Working aged 12 Total units/charges 0001 None ESRD 13 Physician services 0657 As appropriate, 26 (technical component) No Fault (no attorney involved) 14 Workers' Compensation 15 Public Health Svc/Other Federal 16 Disabled 43 Physical therapy 0421 G0151, PM Black Lung 41 Occupational therapy 0431 G0152, PM Liability (attorney involved) 47 Speech language pathology 0441 G0153, PM Skilled nursing 0551 G0154, PM Medical social service (visit) 0561 G0155, PM Medical social service (phone call) 0569 G0155, PM Home health aide 0571 G0156, PM As appropriate, GV (nurse practitioner is attending) Other Discipline Visit Description CMS Pub. 100-05, Chapter 3, Section 5 Allowed Place of Service (HCPCS) Codes for Levels of Care (Revenue) Codes Routine 0651 CHC 0652 Respite 0655 GIP 0656 Q5001 –Home Y Y N N Q5002 –Assisted living facility Y Y N N Q5003 –LTC or non-skilled NF (unskilled care) Y Y Y N Q5004 –Skilled nursing facility (skilled care) Y N Y Q5005 –Inpatient hospital Y N Q5006 –Inpatient hospice facility Y Q5007 –Long term care hospital Levels of Care Description 0659 REV HCPCS, Modifiers (PM if post-mortem) REV Routine home care (Q5001-Q5010) 0651 0652 Y Continuous home care (Q5001-Q5003, Q5009-Q5010) Y Y Respite care (Q5003-Q5009) 0655 N Y Y 0656 Y N Y Y General inpatient care (Q5004-Q5009) Q5008 –Inpatient psychiatric facility Y N Y Y Q5009 –Place not otherwise specified Y Y Y Y Q5010 –Hospice residential facility Y Y N N H-016-09 • Page 2 of 4 • Revised January 29, 2015. A9270, GY (room & board) HCPCS (Place of Service) Q5001 – Home Q5002 – Assisted living facility Q5003 – LTC or non-skilled NF (receiving unskilled care) Q5004 – Skilled nursing facility (receiving skilled care) Q5005 – Inpatient hospital Q5006 – Inpatient hospice facility Q5007 – Long term care hospital Q5008 – Inpatient psychiatric facility Q5009 – Place not otherwise specified Q5010 – Hospice residential facility Drugs/Infusion Pumps Description REV Non-injectable drugs 0250 None, however, NDC is required Infusion pump – equipment 029X As appropriate Infusion pump – drugs 0294 As appropriate Injectable drugs 0636 As appropriate CMS Pub. 100-04, Chapter 11, Section 30.3 © 2015 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited. HCPCS See: http://www.cms.gov/Medicare/ Coding/HCPCSReleaseCodeSets/ Downloads/2015-Table-of-Drugs-.pdf Hospice Medicare Billing Codes Sheet Reporting of Hospice Visits Medicare Claims Processing Manual (CMS Pub. 100-04) Ch. 11, §30.3 (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/ clm104c11.pdf). Reporting of hospice visits is based on the level of care the visit was provided under, and who provided the visit. To determine how to report a visit, find the appropriate column for the level of care provided. For Respite and GIP, find the column for who provided the visit. Level of Care Visit Provided Under Visit under Routine Home Care Discipline Skilled nurse Aide Social worker Each visit line item billed, 15-minute increments Visit under Continuous Home Care Each visit line item billed, 15-minute increments Visit under Respite Hospice employed staff Non-hospice staff Each visit line item billed, 15-minute increments Visits not reported Visit under General Inpatient Care (GIP) Hospice employed staff For all locations (except Q5006): Each visit line item billed in 15-min increments Non-hospice staff Visits not reported For Q5006: Visits reported weekly (Sunday-Saturday) except: • PT, SLP and OT visits are not reported • Social worker phone calls are not reported • Post-mortem visits are not reported Social worker (phone call) Physical therapy Speech-language pathology Occupational therapy Reporting of Hospice Discharges Medicare Claims Processing Manual (CMS Pub. 100-04) Ch. 11, §30.3 (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c11.pdf). To determine the data required on a hospice claim, use the table below. Discharge Reason Occurrence Code Condition Code Patient Status Code 42 None Appropriate code Patient transfers hospices None None 50 or 51 Patient no longer terminal None None Appropriate code Patient discharged for cause None H2 Appropriate code Patient moves out of service area None 52 Appropriate code 55 None 40, 41, or 42 None None Appropriate code Patient revokes Death Untimely FTF H-016-09 • Page 3 of 4 • Revised January 29, 2015. © 2015 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited. Hospice Medicare Billing Codes Sheet FISS Pg FISS Fields and UB-04 Field Locators (FL) for Hospice Billing R = required FISS Pg C = conditional FISS Field Name N = not required UB FL O = optional Data Entered FISS Field Name UB FL Data Entered NOE Claim 3 M 76 Attending physician’s middle initial O O 3 Opr Phys NPI 77 Operating physician’s NPI N N 3 L 77 Operating physician’s last name N N N NOE Claim 3 F 77 Operating physician’s first name N 1 HIC 60 Medicare (HIC) number R R 3 M 77 Operating physician’s middle initial N N 1 TOB 4 Type of Bill R R 3 Ref Phys NPI 78 Certifying physician’s NPI C6 C6 1 NPI 56 NPI number R R 3 L 78 Certifying physician’s last name C6 C6 F 78 Certifying physician’s first name C6 C6 1 Pat.Cntl#: 3a Patient Control Number O O 3 1 Stmt Date From 6 From date of service R R 3 M 78 Certifying physician’s middle initial O O 1 To 6 To date of service N R 4 Remarks 80 Remarks C C 1 Last 8 Patient’s last name R R 1 First 8 Patient’s first name R R 1 DOB 10 Patient’s date of birth R R 1 Addr 1 9 Patient’s address R R 1 Addr 2 9 City State R R 1 Zip 9 Zip R R 1 Sex 11 Sex code (M or F) R R 1 Admit Date 12 Date of admission R R 1 Hr 13 Admission hour N R1 1 Type 14 Type of Admission N R 1 Src 15 Source of admission N R 1 Stat 17 Patient status N R 1 Cond Codes 18-28 Condition codes N C 1 Occ Cds/Date 31-34 Occurrence code(s)/date(s) R C2 1 Span Codes/Dates 35-36 Occurrence span code(s)/date(s) N C3 1 Fac.zip 1 Facility zip code R R 1 DCN 64 Document control number N C4 1 Value Codes Value codes N R5 2 Rev 42 Revenue codes N R 2 HCPC 44 HCPCS N R 2 Modifs 44 Modifier N C 2 Tot Unit 46 Total units N R 2 Cov Unit 46 Covered units N R 2 Tot Charge 47 Total charges N R 2 Ncov Charge 48 Noncovered charges N C 2 Serv Date 45 Service date N R 3 CD 50 Payer code R R 3 Payer 50 Payer name R R 3 RI 52 Release of information R R 3 SERV FAC NPI N/A NPI of Facility N C7 3 Medical Record Nbr 3b Medical Record Number O O 3 Diag Codes 67 Diagnosis codes R R 3 Att Phys NPI 76 Attending physician’s NPI R R 3 L 76 Attending physician’s last name R R 3 F 76 Attending physician’s first name R R 39-41 Note: For information on billing Medicare Secondary Payer (MSP) claims, refer to the MSP Billing and Adjustments quick resource tool (http://www.cgsmedicare.com/hhh/education/ materials/pdf/MSP_Billing.pdf) 1 2 3 4 5 6 7 Required for DDE OC 27 is required when certification/recertification overlaps the claim’s date of service. OC 42 is required only when the patient revokes hospice. OC 55 is required to report the patient’s date of death. OSC 77 is required when the NOE or recertification was untimely. OSC M2 is required when multiple respite stays in billing period. Adjustments and cancels only. Value code 61 and CBSA code required for rev. code 0651 or 0652. Value code G8 and CBSA code required for rev. code 0655 or 0656. The certifying physician’s information is only completed if different than the attending physician. Required when patient in nursing facility, hospital, hospice inpatient facility. Common Hospice Billing Errors by Reason Code (RC) RC Problem Resolution 34952 SERV FAC NPI missing A service facility NPI must be reported when billing Q5003, Q5004, Q5005, Q5007 or Q5008 37402 Sequential billing Ensure prior claim has paid (P), denied (D), or rejected (R). Ensure no skip in days between prior and subsequent claim. 38200 Duplicate claim Delete previously submitted batches. Check remittance advice or use FISS Option 12 to check for paid claims. U5106 NOE w/in open episode Check the patient’s eligibility for open hospice election. Contact other hospice if needed. U5194 Untimely NOE and no OSC 77 If NOE is untimely, report OSC 77 and noncovered dates H-016-09 • Page 4 of 4 • Revised January 29, 2015. © 2015 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited.
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