Hospice Medicare Billing Codes Sheet

1 Condition Code (FL 18-28)H2 Discharge for cause ( patient/staff safety)52 Discharge for patient unavailability, inability to receive care, or out of service area85 Delayed recertification of Hospice terminal illness (effective for claims received on or after 1/1/2017)CMS Pub. 100-04, chapter 11, Section Change Reason Code (CCRC) (FL 18-28) & Adjustment Reason Code (ARC) (FISS only)DescriptionCCRCARC TOBC hange in dates of serviceD0RF 8X7 Change in chargesD1RG 8X7 Change in revenue/HCPCS codeD2RH 8X7 Cancel to correct provider #/ Medicare ID numberD5RI 8X8 Cancel duplicate or OIG paymentD6RJ 8X8 Any other/multiple change(s)D9RM 8X7 Change in patient statusE0RN 8X7 CMS Pub. 100-04, chapter 1, Section Codes (FL 31-34)27 Date of certification or recertification42 Date of revocation (ONLY)55 Date of death (when patient status = 40, 41 or 42)CMS Pub.

2 100-04, chapter 11, Section Span Codes (FL 35-36)77 Noncovered days due to untimely recertification OR Untimely NOEM2 Multiple respite stays, From/To dates of each stayCMS Pub. 100-04, chapter 11, Section : 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: Value Codes (FL 39-41)DescriptionVCWorking aged12 Type of Bill (FL4) X=1 non hospital based X=2 hospital based8 XANotice of Election (NOE)8X21st claim in series8 XBNotice of Termination/Revocation (NOTR)8X3 Continuing claim8 XCChange of hospice8X4 Discharge claim8 XDCancel NOE/benefit period8X7 Adjustment claim8X0 Nonpayment claim8X8 Cancel claim8X1 Admit thru dischargeCMS Pub.

3 100-04, chapter 11, Section & of Admission (FL14)1 Emergency3 Elective9 Information not available2 Urgent5 TraumaCMS Pub. 100-04, chapter 25, Section of Origin (Source of Admission) ( FL15 )1 Non-health care facility6 Transfer from Another Health Care Facility2 Clinic or physician s office4 Transfer from hospital8 Court/Law Enforcement5 Transfer from SNF or ICF9 Information not availableCMS Pub. 100-04, chapter 25, Section Status (FL17) as of To date on claim01 Discharged to home, revoked, or decertified30 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.

4 100-04, chapter 11, Section Reference - CMS Pub. 100: 016-13 Page 1 of 4 Revised September 28, 2018. 2018 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal document. Reproduction of this material for profit is Medicare Billing Codes SheetH- 016-12 Page 2 of 4 Revised September 28, 2018. 2018 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal document. Reproduction of this material for profit is Medicare Billing Codes SheetRevenue Codes (FL 42), HCPCS Codes and Modifiers (FL 44)DescriptionREVHCPCS, ModifiersTotal units/charges0001 NonePhysician services0657As appropriate, 26 (technical component) As appropriate, GV (nurse practitioner is attending)Other 0659A9270, GY (room & board) report as non-coverd chargesDiscipline Visit DescriptionREVHCPCS, Modifiers (PM if post-mortem)Physical therapy0421G0151, PMOccupational therapy0431G0152, PMSpeech language pathology0441G0153, PMSkilled nursing0551G0154, PM (not valid for visits on/after 1/1/2016)G0299, PM (valid for RN visits on/after 1/1/2016)G0300, PM (valid for LPN visits on/after 1/1/2016)Medical social service (visit)0561G0155, PMMedical social service (phone call)

5 0569G0155, PMHome health aide0571G0156, PMLevels of Care DescriptionREVHCPCS (Place of Service)Routine home care (Q5001-Q5010)0651Q5001 HomeQ5002 Assisted living facilityQ5003 LTC or non-skilled NF (receiving unskilled care)Q5004 Skilled nursing facility (receiving skilled care)Q5005 Inpatient hospitalQ5006 Inpatient Hospice facilityQ5007 Long term care hospitalQ5008 Inpatient psychiatric facilityQ5009 Place not otherwise specifiedQ5010 Hospice residential facilityContinuous home care (Q5001-Q5003, Q5009-Q5010)0652 Respite care (Q5003-Q5009)0655 General inpatient care (Q5004-Q5009)0656 Drugs/Infusion Pumps DescriptionREVHCPCSNon-injectable drugs0250 None; NDC required for dates of service before 10/1/2018. See MM10573 Infusion pump equipment029 XAs appropriate to As appropriate; not required for dates of service on/after 10/1/2018.

6 See MM10573 Infusion pump drugs0294As appropriate to As appropriate; not required for dates of service on/after 10/1/2018. See MM10573 Injectable drugs0636As appropriate to not required on claims with dates of service on/after 10/1/2018 CMS Pub. 100-04, chapter 11, Section See: for current Drug Code list. See MM10573 at Value Codes (FL 39-41)DescriptionVCESRD13No Fault (no attorney involved)14 Workers' Compensation15 Public Health Svc/Other Federal16 Disabled43 Black Lung41 Liability (attorney involved)47 CMS Pub. 100-05, chapter 3, Section 5 Allowed Place of Service (HCPCS) Codes for Levels of Care (Revenue) CodesRoutine 0651 CHC 0652 Respite 0655 GIP 0656Q5001 HomeYYNNQ5002 Assisted living facilityYYNNQ5003 LTC or non-skilled NF (unskilled care)YYYNQ5004 Skilled nursing facility (skilled care)

7 YNYYQ5005 Inpatient hospitalYNYYQ5006 Inpatient Hospice facilityYNYYQ5007 Long term care hospitalYNYYQ5008 Inpatient psychiatric facilityYNYYQ5009 Place not otherwise specifiedYYYYQ5010 Hospice residential facility YYNNR eporting of Hospice Visits Hospice Medicare Billing Codes SheetDisciplineLevel of Care Visit Provided UnderVisit under Routine Home CareVisit under Continuous Home CareVisit under RespiteVisit under General Inpatient Care (GIP) Hospice employed staffNon- Hospice staffHospice employed staffNon- Hospice staffSkilled nurseAideSocial workerSocial worker (phone call)Physical therapySpeech-language pathologyOccupational therapyEach visit line item billed, 15-minute incrementsEach visit line item billed, 15-minute incrementsEach visit line item billed, 15-minute incrementsVisits not reportedFor all locations (except Q5006): Each visit line item billed in 15-min incrementsFor 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 reportedVisits not reportedReporting of Hospice Discharges Medicare Claims Processing Manual (CMS Pub.)

8 100-04) Ch. 11, ( ). To determine the data required on a Hospice claim , use the table ReasonOccurrence CodeCondition CodePatient Status CodePatient revokes42 NoneAppropriate codePatient transfers hospicesNoneNone50 or 51 Patient no longer terminalNoneNoneAppropriate codePatient discharged for causeNoneH2 Appropriate codePatient moves out of service areaNone52 Appropriate codeDeath55 None40, 41, or 42 Untimely FTFNoneNoneAppropriate codeMedicare Claims Processing Manual (CMS Pub. 100-04) Ch. 11, ( l m10 4 d f). H- 016-12 Page 3 of 4 Revised September 28, 2018. 2018 Copyright, CGS Administrators, LLC. Disclaimer: This resource is not a legal document. Reproduction of this material for profit is of Hospice visits is based on the level of care the visit was provided under, and who provided the visit.

9 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. R = required C = conditional N = not required O = optionalFISS PgFISS Field NameUB FLData EnteredNOEC laim1 MID60 Medicare ID numberRR1 TOB4 Type of BillRR1 NPI56 NPI #:3aPatient Control NumberOO1 Stmt Date From6 From date of serviceRR1To6To date of serviceNR1 Last8 Patient s last nameRR1 First8 Patient s first nameRR1 DOB10 Patient s date of birthRR1 Addr 19 Patient s addressRR1 Addr 29 City StateRR1 Zip9 ZipRR1 Sex11 Sex code (M or F)RR1 Admit Date12 Date of admissionRR1Hr13 Admission hourNR11Ty p e14 Type of AdmissionNR1 Src15 Source of admissionNR1 Stat17 Patient statusNR1 Cond Codes18-28 Condition codesNC31 Occ Cds/Date31-34 Occurrence code(s)/date(s)RC21 Span Codes /Dates35-36 Occurrence span code(s)/date(s)

10 Zip codeRR1 DCN64 Document control numberNC41 Value Codes39- 41 Value codesNR52 Rev42 Revenue codesNR2 HCPC44 HCPCSNR2 Modifs44 ModifierNC2 Tot Unit46 Total unitsNR2 Cov Unit46 Covered unitsNR2 Tot Charge47 Total chargesNR2 Ncov Charge48 Noncovered chargesNC2 Serv Date45 Service dateNR3CD 50 Payer code RR3 Payer50 Payer nameRR3RI52 Release of informationRR3 SERV FAC NPIN/ANPI of FacilityNC73 Medical Record Nbr3bMedical Record NumberOO3 Diag Codes67 Diagnosis codesRR3 Att Phys NPI76 Attending physician s NPIRR3L76 Attending physician s last nameRR3F76 Attending physician s first nameRRFISS PgFISS Field NameUB FLData EnteredNOEC laim3M76 Attending physician s middle initialOO3 Opr Phys NPI77 Operating physician s NPINN3L77 Operating physician s last nameNN3F77 Operating physician s first nameNN3M77 Operating physician s middle initialNN3 Ref Phys NPI78 Certifying physician s NPI C6 C6 3 L 78 Certifying physician s last name C6C6 3 F 78 Certifying physician s first name C6 C6 3 M 78 Certifying physician s middle initial O O 4 Remarks 80 Remarks C C Note: For information on Billing Medicare Secondary Payer (MSP) claims, refer to the MSP Billing and Adjustments quick resource tool ( )1 Required for DDE2OC 27 is required when certification/recertification overlaps the claim s date of 42 is required only when the patient revokes Hospice .