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Home Health Medicare Billing Codes Sheet (Home Health ...

Home Health Medicare Billing Codes SheetH-008-13 Page 1 of 3 Revised April 2, 2019 2019 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal of this material for profit is of Bill (TOB)* (FL 4)322 Request for Anticipated Payment (RAP)327 Adjustment Claim328 Void/Cancel Prior RAP/Claim329 Final Claim for Episode320 Nonpayment Claim34 XOutpatient Services3 XQReopening3XG or 3 XIContractor adjustmentCMS Pub. 100-04, Chapter 10 (Type) of Admission or Visit Codes (FL 14)1 Emergency4 Newborn2 Urgent5 Trauma3 Elective9 Information not availablePoint of Origin (formerly Source of Admission Codes ) (FL 15)1 Non- Health Care Facility Point of Origin2 Clinic or Physician s Office4 Transfer from Hospital (Different Facility)5 Transfer from Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)6 Transfer from Another Health Care Facility8 Court/Law enforcement9 Information not availablePatient Status Codes (FL 17)01 Discharge to home or self-care (routine discharge)02 Discharge/transfer to short-term general hospital03 Discharge/transfer to SNF04 Discharge/transfer to ICF05 Discharge/transfer to a designated cancer center or children

Home Health Medicare Billing Codes Sheet Value Code (FL 39-41) 61 CBSA code for where HH services were provided. CBSA codes are required on all 32X TOB. Place “61” in the first value code field locator and the CBSA code in the dollar amount column

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Transcription of Home Health Medicare Billing Codes Sheet (Home Health ...

1 Home Health Medicare Billing Codes SheetH-008-13 Page 1 of 3 Revised April 2, 2019 2019 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal of this material for profit is of Bill (TOB)* (FL 4)322 Request for Anticipated Payment (RAP)327 Adjustment Claim328 Void/Cancel Prior RAP/Claim329 Final Claim for Episode320 Nonpayment Claim34 XOutpatient Services3 XQReopening3XG or 3 XIContractor adjustmentCMS Pub. 100-04, Chapter 10 (Type) of Admission or Visit Codes (FL 14)1 Emergency4 Newborn2 Urgent5 Trauma3 Elective9 Information not availablePoint of Origin (formerly Source of Admission Codes ) (FL 15)1 Non- Health Care Facility Point of Origin2 Clinic or Physician s Office4 Transfer from Hospital (Different Facility)5 Transfer from Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)6 Transfer from Another Health Care Facility8 Court/Law enforcement9 Information not availablePatient Status Codes (FL 17)01 Discharge to home or self-care (routine discharge)

2 02 Discharge/transfer to short-term general hospital03 Discharge/transfer to SNF04 Discharge/transfer to ICF05 Discharge/transfer to a designated cancer center or children s hospital06 Discharge/transfer to home care of another HHA OR discharge and readmit to the same HHA within a 60-day episode07 Left against medical advice or discontinued care20 Expired Occurrence code 55 also to court/law enforcement30 Still a patient. Services continue to be provided. (Required on RAPs.)43 Discharge/transfer to federal hospital50 Discharge/transfer for hospice services in the home51 Discharge/transfer to hospice services in a medical facility61 Discharge/transfer to hospital-based Medicare approved swing bed62 Discharge/transfer to IRF (inpatient rehabilitation facility)63 Discharge/transfer to long-term care hospital65 Discharge/transfer to psychiatric hospital or psychiatric part unit of a hospital66 Discharge/transfer to Critical Access Hospital (CAH)70 Discharge/transfer to another type of Health care institution not defined elsewhere in code listCondition Codes (CC) (FL 18-28)07 Treatment of nonterminal condition for hospice patient20 Beneficiary requested Billing (demand denial)21 Billing for denial notice (no-pay bill)

3 47 Transfer from another HHA54No skilled HH visits in Billing review partial approval of Medicare -covered servicesC4 Expedited review services deniedC7 Expedited review extended authorization of Medicare -covered servicesClaim Change Reason Codes (CCRC) (FL 18-28) & Adjustment Reason Codes (ARC) (FISS only)DescriptionCCRCARCTOBC hanges in Service DatesD0RF327 Changes to ChargesD1RG327 Changes in revenue/HCPC/HIPPS codesD2RH327 Cancel to correct provider/ Medicare ID numberD5RI328 Cancel duplicate or OIG paymentD6RJ328 Change to make Medicare the secondary payerD7TB327 Change to make Medicare the primary payerD8TB327 Any other/multiple change (s) (must include REMARKS, FISS pg 4)D9RM327 Change in patient statusE0RN327 NOTE: RAPs cannot be adjusted. If information must be changed on a processed RAP, it must be cancelled and resubmitted to Secondary Payer (MSP) Value Codes (VC) (FL 39-41) DescriptionVCWorking Aged12 ESRD13No Fault (no attorney involved)14 Worker s Compensation15 Public Health Svc/Other Federal16 Black Lung41 Disabled43 Obligated to Accept as Payment in Full (OTAF)44 Liability47 Conditional PaymentAny of the AboveMedicareNOTE: Medicare does not make secondary payer payments on RAPs.

4 Submit RAPs with Medicare as Pub. 100-05, Chapter 3 : The Codes listed on this Billing Codes Sheet represent those most frequently submitted on home Health RAPs/claims. A complete listing of all Codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual - Health Medicare Billing Codes SheetValue code (FL 39-41)61 CBSA code for where HH services were provided. CBSA Codes are required on all 32X 61 in the first value code field locator and the CBSA code in the dollar amount column followed by two Information Processing Standards (FIPS) State and County code for what county the services were provided. FIPS Codes are required on all 32X TOB. Place 85 in the first value code field locator and the FIPS code in the dollar amount column followed by two zeros.

5 The FIPS State and County Codes are available at Other value Codes may be required when Medicare is the secondary payer. See the Medicare Secondary Payer (MSP) Web page for more information: Pub. 100-04, Chapter 10 Revenue Codes (FL 42) and HCPCS/Rates/HIPPS Rate Codes (FL 44)Rev CodeDefinitionHCPCSC omments0001 Total units/chargesN/ANo HCPCS required with revenue codeAs assigned by Grouper softwareSee CMS Coding and Billing information ( ) Web page for more SuppliesN/A unless 0274 HCPCS required when submitting revenue code 0274 (Prosthetic/Orthotic devices) See CPT coding book for appropriate HCPCS TherapyVariedRefer to the following link, section for further information: TherapyVaried044 XSpeech-Language PathologyVaried055 XSkilled NursingVaried056 XMedical Social ServicesG0155 For episodes beginning on/after 7/1/2013, see MLN article, MM8136 for additional Health AideG0156062 XMedical/Surgical SuppliesN/AOptional Use.

6 When HHAs choose to report additional breakdown for surgical/wound care Pub. 100-04, Chapter 10 * For revenue Codes ending in an X , sub-classifications exist. Use a 0 to indicate general classification when the subclassifications are not Page 2 of 3 Revised April 2, 2019 2019 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal of this material for profit is Rate Codes (FL44)HCPCSS ervices performed in 15-minute incrementsREV CodeG0151 Physical Therapy042X G0152 Occupational Therapy043X G0153 Speech-Language Pathology044XG0154 (see note)Direct skilled services of a licensed nurse (LPN or RN) NOTE: Not valid for visits made on or after 1/1/2016055XG0155 Clinical Social Worker 056X G0156 Home Health Aide 057XG0157PT assistant042X G0158OT assistant 043X G0159PT establish or deliver safe and effective PT maintenance program042X G0160OT establish or deliver safe and effective OT maintenance program043X G0161 SLP establish or deliver safe and effective SLP maintenance program044X G0162RN (only) for management and evaluation of POC NOTE.

7 Not valid for visits made on or after 1/1/2017055XG0163 (see note)LPN or RN for the observation and assessment of the patient's condition NOTE: Not valid for visits made on or after 1/1/2017G0164 (see note)LPN or RN training and/or education of patient or family member NOTE: Not valid for visits made on or after 1/1/2017G0299(see note)Direct skilled services of a licensed nurse (RN)NOTE: Valid for visits made on or after 1/1/2016055XG0300 (see note)Direct skilled services of a licensed nurse (LPN)NOTE: Valid for visits made on or after 1/1/2016055XG0493 (see note)RN for the observation and assessment of the patient s conditionNOTE: Valid for visits made on or after 1/1/2017055XG0494 (see note)LPN for the observation and assessment of the patient s conditionNOTE: Valid for visits made on or after 1/1/2017055XG0495 (see note)RN training and/or education of a patient or family memberNOTE: Valid for visits made on or after 1/1/2017055XG0496 (see note)LPN training and/or education of a patient or family memberNOTE: Valid for visits made on or after 1/1/2017055 XSee Medicare Learning Network (MLN) Matters article, MM7182 ( ) for additional home Health services were providedREV CodeQ5001 Care provided in patient s home/residence042X, 043X, 044X, 055X, 056X, or 057XQ5002 Care provided in assisted living facilityQ5009 Care provide in place not otherwise specified (NO)See Medicare Learning Network (MLN) Matters article, MM8136 ( ) for additional References: Internet Only Manuals Pub.

8 100-02, Chapter 7 & Pub. 100-04, Chapter 10: Health Agency (HHA) Center: PgFISS Field NameUB FLData EnteredRAPC laims3 ATT PHYS NPI76 NPI of physician who signed POCRR3L76 Last name of physician who signed POCRR3F76 First name of physician who signed POCRR3M76 Middle initial of physician who signed POCOO3 REF PHYS78 NPI of physician who cert/recert eligibilityRR73L78 Last name of physician who cert/recert eligibilityRR73F78 First name of physician who cert/recert eligibilityRR73M78 Middle initial of physician who cert/recert eligibilityOO74 REMARKS80 Remarks (adjustments, cancels, demand/no-pay bills, MSP)CC5 INSURED NAME58 Insured s last name, first nameNC55 SEXN/AInsured s sex codeNC55 DOBN/AInsured s date of birthNC55 REL59 Patient s relationship to insuredNC55 CERT-SSN-MID60 Insured s ID/ Medicare ID numberNC55 GROUP NAME61 Insurance group nameNC55 GROUP NUMBER62 Insurance group Matching Key codeRR61 Required for DDE 2 Adjustments & cancels only 3 Value code 61 and CBSA code required.

9 Effective value code 85 and FIPS code Rev Codes 0023 & 0001 required on RAPs& final claims 5 Required when Medicare is not the primary payer6 Enter the Claims-OASIS Matching Key code on theTREAT AUTH code line that reflects Medicare spayer status (primary, secondary, or tertiary)7 For episodes beginning on/after 7/1/14, if different than the ATT PHYSC ommon Home Health Billing Errors by Reason code (RC) (When RAP/claim is in FISS status/location (S/LOC) T B9997 or R B9997)RCResolution31018If Billing > 60 days, status code must be other than 30 31790 Must report HCPCS Q5001, Q5002, or Q5009 to indicate location of where services were provided. RAP if auto-cancel AND ensure RAP is in P B9997 AND ensure FROM date, ADMIT date, first 4 position of HIPPS code , and 0023 date matches between RAP and claim for same episode 3 815 7, 38200 Duplicate Billing transaction; adjust or cancel claim or RAP instead of resubmitting U538 IEnter condition code 47 to indicate transfer between HHAs Health Medicare Billing Codes Sheet FISS Fields and UB-04 Field Locators (FL) for Home Health BillingH-008-15 Page 3 of 3 Revised April 2, 2019 2019 Copyright, CGS Administrators, LLC.

10 Disclaimer: This resource is not a legal of this material for profit is PgFISS Field NameUB FLData EnteredRAPC laims1 MID60 Medicare ID numberRR1 TOB4 Type of BillRR1 NPI56 NPI numberRR1 PAT. CNTL #3aPatient Control NumberOO1 STMT DATES FROM6 From date of serviceRR1TO6To date of serviceRR1 LAST8 Patient s last nameRR1 FIRST8 Patient s first nameRR1 DOB10 Patient s date of birthRR1 ADDR19 Patient s addressRR1 ADDR 29 City StateRR1 ZIP9 Zip codeRR1 SEX11 Gender (M or F)RR1 ADMIT DATE12 Date of admissionRR1HR13 Admission hourR1R11 TYPE14 Admission type or visitRR1 SRC15 Point of Origin (formerly Source of Admission Codes )RR1 STAT17 Patient statusRR1 COND CODES18-28 Condition codesCC1 OCC CDS/DATE31-34 Occurrence code (s)/date(s) code for provider or subpartR1R11 DCN64 Document control numberNC21 VALUE CODES39-41 Value codesR3R32 REV42 Revenue codesR4R42 HCPC44 HCPCSRR2 MODIFS44 ModifiersNC2 TOT UNIT46 Total UnitsNR2 COV UNIT46 Covered UnitsNR2 TOT CHARGE47 Total chargesNR2 NCOV CHARGE48 Noncovered chargesNC2 SERV DATE45 Service DateRR3CD50 Payer codeRR3 PAYER50 Payer nameRR3RI52 Release of informationRR3 MEDICAL RECORD NBR3bMedical Record NumberOO3 DIAG CODES67 Diagnosis codesRRR = required C = conditional N = not required O = optional


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