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License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

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  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
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  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

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Transferring Beneficiary From/To Another Hospice Agency

Once in each benefit period, a hospice beneficiary may change the designation of the hospice he/she wishes to receive care from. You can check to see if the beneficiary has already transferred once within the current benefit period by:

  • Asking the beneficiary if they have received hospice care from another hospice agency, and when;
  • Asking the hospice agency that the beneficiary is transferring from when they admitted the patient and if they received the patient on transfer from another hospice;
  • Review ELGH Page 19 to determine if the provider number of the hospice the patient is transferring from appears in the PROVIDER NO field. If so, this indicates the patient has not transferred previously in this benefit period. (See sample screenprint below.)

    Screenshot

Note: To look up the name and address of the hospice agency that appears in the PROVIDER NO field on ELGH Page 19, go to https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/Hospice-1984-2014-formExternal Website. Click on the link 'Hospice 14 Reports' and open the Excel file titled "HOSPC_PRVDR_ID_INFO".

When a hospice patient transfers to another hospice agency, the beneficiary must file a signed statement with the transferring hospice (Hospice #1) and the receiving hospice (Hospice #2). The statement must include the name of the prior hospice, the name of the 'new' hospice, and the date the transfer is effective.

In addition, the Hospice Conditions of Participation, 42 Part 418 §418.104External Website, state that "if the care of a patient is transferred to another Medicare/Medicaid-certified facility, the hospice must forward to the receiving facility, a copy of the hospice discharge summary, and the patient's clinical record, if requested".

The table below provides billing instructions for hospices when a patient is transferring either to or from your agency.

Patient Transferring FROM Your Agency

Patient Transferring TO Your Agency

Submit your final claim promptly to allow the agency receiving the transferring beneficiary to submit their Notice of Change (NOC). Both the transferring and receiving hospice agencies may bill for the day of transfer.

In addition to the usual claim information, report the following on your final claim indicating the transfer:

  • Type of Bill (TOB) =
    • 8X1 – if this is the only claim you are submitting for the patient; or
    • 8X4 – if you have previously submitted a hospice claim for this patient
  • Patient Status (STAT) =
    • 50 – if the patient is transferring under routine or continuous home care
    • 51 – if the beneficiary is transferring under respite or general inpatient care
  • Remarks = Enter the name, address and provider number of the receiving hospice agency.

Note: Do not use occurrence code 42 on a hospice claim when the patient is transferring to another hospice.

Submit a Notice of Change (NOC), prior to submitting your first claim. This indicates that the admission is a continuation of the current benefit period. The NOC must be submitted after the transferring hospice agency has submitted their final claim.

To submit the NOC, enter the same information as you would for a notice of election, except for the following:

  • Type of Bill (TOB) = 81C or 82C
  • From date (STMT FROM DATE) = the date your agency started hospice care
  • Admission date (ADMIT DATE) = the date your agency admitted the transferring beneficiary
  • Remarks = Enter the name, address and provider number of the hospice agency the patient transferred from

NOTE: The NOC (81C or 82C) must process before your agency may submit your first claim.

When you bill your first claim, an occurrence code 27 must be reported. The date used with OC 27 is based on which benefit period the claim falls within or overlaps.

  • If a patient is in the first certification period when they transfer, the receiving hospice would report OC 27 with the same certification date as the previous hospice.
  • If a patient is in the next certification period when they transfer, the receiving hospice would report OC 27 with the with the next certification period date. For example, the first benefit period was from 5/25 to 8/22. The next benefit period begins on 8/23 and the patient was transferred to your agency on 9/5. Therefore, the receiving hospice would report OC 27 with the date of 8/23.

Reference: Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9§20.2External PDF

Updated: 12.14.20

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