Emergency

Urgent

Elective

Newborn

Trauma center

Information not available

Non-health care facility (physician referral)

Clinic or physician's office

Transfer from hospital (different facility)

Transfer from skilled nursing facility (SNF), intermediate care facility (ICF), assisted living facility (ALF) or nursing facility (NF)

Transfer from another health care facility

Court/Law enforcement

Information not available

Discharged to home or self-care (routine discharge)

Discharged/transferred to a short-term general hospital for inpatient care

Discharged/transferred to SNF (Skilled Nursing Facility)

Discharged/transferred to a facility that provides custodial or supportive care

Discharged/transferred to home under care of organized home health service organization in anticipation of covered skilled care

Applies when a beneficiary:

• Discharges/transfers to a different HHA
• Discharges and readmits to the same HHA within a 60-day episode
• Enrolls in a Medicare Advantage plan during a HH PPS episode

Note: Always report this code when a partial episode payment (PEP) applies. Don't use this code for any other general discharge/transfer situation.

Left against medical advice or discontinued care

Expired (also report occurrence code 55 and the beneficiary's date of death)

Discharged/transferred to court/law enforcement

Still a patient (and services continue)

Discharged/transferred to a federal health care facility

Discharged/transferred for hospice services in the home

Discharged/transferred for hospice services in a medical facility

Discharged/transferred to an inpatient rehabilitation facility (IRF), including distinct part units of a hospital

Discharged/transferred to a long-term care hospital (LTCH)

Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital

Discharged/transferred to a critical access hospital (CAH)

Discharged/transferred to another type of health care institution not defined elsewhere in the code list

Treatment of a non-terminal condition for a hospice patient

Indicates the beneficiary elected hospice care, but the services aren't related to the terminal condition.

Beneficiary requested billing (demand denials)

See Demand Denials (Condition Code 20) for more information.

Billing for denial notice (no-pay bills)

See Home Health No-Payment Billing (Condition Code 21) for more information.

Transfer from another home health agency

See Beneficiary Elected Home Health Transfer for additional information.

No skilled HH visits in billing period. Policy exception documented at the HHA.

Indicates there are no skilled home health visits in the billing period, but a policy exception that allows billing for covered services is documented at the HHA.

Pneumococcal pneumonia and influenza vaccines paid at 100%

Only applies to claims with type of bill 034X and revenue code 0636. Note: Not required on roster bills submitted in FISS DDE.

Disaster related

Indicates specific payer policies related to a national or regional disaster impact the claim; mandatory for claims that require the presence of a formal waiver as a condition of Medicare payment.

Roster billed influenza virus vaccine or pneumococcal pneumonia vaccine (PPV)

Indicates the claim is a roster bill for a mass influenza or PPV vaccination program for multiple beneficiaries.
Note: Not required for roster bills submitted in FISS DDE.

QIO partial approval

Continue Medicare coverage only for a limited time (i.e., deny some services beyond the intended discharge date).

Occurrence Span Code (OSC) M0 (zero) and the approved stay dates from the QIO/QIC.

Services denied

Discharge the beneficiary from Medicare covered care (i.e., deny all services beyond the intended discharge date).

• OSC 76 and the dates of patient liability (if applicable).
• Appropriate patient discharge status code.

QIO extended authorization

Continue Medicare coverage (i.e., approve all services beyond the intended discharge date).

Change to service dates

*Use D9 to change a line-item date of service.

TOB 0327

Change to charges

*Use D9 to change units of service.

TOB 0327

Change to revenue/HCPCS/HIPPS codes

*Use D9 to add a revenue or HCPCS code.

TOB 0327

Cancel to correct Medicare beneficiary or provider number

TOB 0328

Cancel to repay a duplicate or OIG overpayment

TOB 0328

Any other change (no other code applies or multiple codes apply)

*Describe the change(s) in the Remarks field (required).

TOB 0327

Change to patient status

TOB 0327

Date of death (required with Patient Discharge Status Code 20 (expired))

For home health outpatient therapy claims (type of bill 34X):

Onset of symptoms/illness

Date outpatient occupational therapy (OT) plan established or last reviewed

Date outpatient physical therapy (PT) plan established or last reviewed

Date outpatient speech-language pathology (SLP) plan established or last reviewed

Date treatment started for PT

Date treatment started for OT

Date treatment started for SLP

Location where service is furnished

Report the Core-Based Statistical Area (CBSA) or special 500XX code that corresponds to the state and county where the beneficiary resides as of the claim "Through" date of service.

Enter the code number plus 2 zeros (e.g., XXXXX00 or XXXXX.00) in the amount field.

See Home Health Payment Rates to access code lists per calendar year.

85

County where service is rendered

Report the Federal Information Processing Standards (FIPS) code that corresponds to the state and county where the beneficiary resides as of the claim "Through" date of service.

Enter the code number plus 2 zeros (e.g., XXXXX00 or XXXXX.00) in the amount field.

See Home Health Payment Rates to access code lists per calendar year.

Total Units and/or Charges

HIPPS Code

Medical/Surgical Supplies

0 – General Classification

1 – Nonsterile Supply

2 – Sterile Supply

3 – Take Home Supply

4 – Prosthetic/Orthotic Devises

9 – Other Supplies/Devises

Units, charges, and a service date are required. Revenue code 0274 also requires a HCPCS code.

Durable Medical Equipment (DME) Other Than Rental

0 – General Classification

1 – Rental

2 – Purchase of New Equipment

3 – Purchase of Used Equipment

4 – Supplies/Drugs for Effectiveness*

9 – Other Equipment

* Revenue code 0294 is used exclusively when medical documentation shows that a drug can safely be administered only through a pump.

Physical Therapy

0 – General Classification

1 – Visit Charge

Report type of bill 032X, one HCPCS code below that describes the service for which the clinician spent the most time during the visit, date of service, service units representing the number of 15-minute increments that comprised the visit, and a charge amount.

G0151: Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes

G0157: Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes

G0159: Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes

G2168: Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes

Occupational Therapy

0 – General Classification

1 – Visit Charge

Report type of bill 032X, one HCPCS code below that describes the service for which the clinician spent the most time during the visit, date of service, service units representing the number of 15-minute increments that comprised the visit, and a charge amount.

G0152: Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes

G0158: Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes

G0160: Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes

G2169: Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes

Speech-Language Pathology

0 – General Classification

1 – Visit Charge

Report type of bill 032X, one HCPCS code below that describes the service for which the clinician spent the most time during the visit, date of service, service units representing the number of 15-minute increments that comprised the visit, and a charge amount.

G0153: Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes

G0161: Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes

Skilled Nursing

0 – General Classification

1 – Visit Charge

Report type of bill 032X, one HCPCS code below that describes the service for which the clinician spent the most time during the visit, date of service, service units representing the number of 15-minute increments that comprised the visit, and a charge amount.

G0162: Skilled services by a licensed nurse (RN only) for management and evaluation of the plan of care, each 15 minutes (the patient's underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)

G0493: Skilled services of a registered nurse (RN) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)

G0494: Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the patient's condition, each 15 minutes (the change in a patient's condition requires skilled nursing personnel to identify and evaluate the patients need for possible modification of treatment in the home health or hospice setting)

G0495: Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes

G0496: Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes

G0299: Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting

G0300: Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting

This revenue code is not valid on a type of bill 034X claim.

Medical Social Services

0 – General Classification

1 – Visit Charge

Report type of bill 032X, HCPCS code G0155, date of service, service units representing the number of 15-minute increments that comprised the visit, and a charge amount.

This revenue code is not valid on a type of bill 034X claim.

Home Health Aide

0 – General Classification

1 – Visit Charge

9 – Other home health aide

Report type of bill 032X, HCPCS code G0156, date of service, service units representing the number of 15-minute increments that comprised the visit, and a charge amount.

This revenue code is not valid on a type of bill 034X claim.

Oxygen

0 – General Classification

1 – Oxygen – State or Portable Equip/Supply or Cont Over 1 LPM, but under 4 LPM

2 – Oxygen – Stat/Equip Under 1 LPM, Monthly payment reduced by 50%

3 – Oxygen – Stat/Equip Over 4 LPM, Monthly payment increased by 50%

4 – Oxygen – Stat/Equip/Portable Exceeds 4 LPM and portable oxygen prescribed

Medical/Surgical Supplies – Extension of 027X

Indicates charges for supply items required for patient care (when additional breakdown is needed).

3 – Surgical Dressings SURG DRESSING

Service units and a charge amount are also required.

HHAs may voluntarily report revenue code 0623 for non-routine wound care supply charges on a separate line (to assist Medicare's future refinement of payment rates). If also reporting 027X to identify non-routine supplies other than those used for wound care, ensure the charge amounts for the two revenue codes are mutually exclusive.

Drugs Requiring Specific Identification (type of bill 034X claims only)

Report a line-item date of service and applicable HCPCS code.

6 – Drugs Requiring Detailed Coding*

* Except radiopharmaceuticals reported with revenue codes 0343 and 0344

Preventive Care Services (type of bill 034X claims only)

0 – General classification

1 – Vaccine Administration

Other Therapeutic Services (type of bill 034X claims only)

2 – Education/Training (includes Diabetes-Related Dietary Therapy)

Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes

042X (Physical Therapy)

Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes

043X (Occupational Therapy)

Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes

044X (Speech-Language Pathology)

Services of clinical social worker under a home health plan of care, each 15 minutes

056X (Medical Social Services)

Services of home health aide under a home health plan of care, each 15 minutes

057X (Home Health Aide)

Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes

042X (Physical Therapy)

Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes

043X (Occupational Therapy)

Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes

042X (Physical Therapy)

Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes

043X (Occupational Therapy)

Services performed by a qualified speech-language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech-language pathology maintenance program, each 15 minutes

044X (Speech-Language Pathology)

Skilled services by a licensed nurse (RN only) for management and evaluation of the plan of care, each 15 minutes (the patient's underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)

055X (Skilled Nursing)

Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting

Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting

Home health services furnished using synchronous telemedicine rendered via a real-time two-way audio and video telecommunications system

For each discipline furnishing the service

Home health services furnished using synchronous telemedicine rendered via a real-time interactive audio-only telecommunications system

The collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring)

Skilled services of a registered nurse (RN) for the observation and assessment of the patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)

055X (Skilled Nursing)

Skilled services of a licensed practical nurse (LPN) for the observation and assessment of a patient's condition, each 15 minutes (the change in the patient's condition requires skilled nursing personnel to identify and evaluate the patient's need for possible modification of treatment in the home health or hospice setting)

Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes

Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes

Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes

042X (Physical Therapy)

Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes

043X (Occupational Therapy)

Hospice or home health care provided in patient's home/residence

Any home health discipline (therapy, nursing, aide, social worker)

Hospice or home health care provided in assisted living facility

Hospice or home health care provided in place not otherwise specified