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Billing HH PPS Claims With Non-Routine Supplies (NRS)

Only non-routine supplies (NRS) are reported to Medicare on home health final claims. Revenue code 027X (Medical/Surgical Supplies) is used to identify NRS other than those used for wound care. The letters S, T, U, V, W, or X in the fifth position of the Health Insurance Prospective Payment System (HIPPS) code indicate that NRS were provided to the beneficiary during the episode. NRS supplies must be present on your final claim when a letter is submitted in the fifth position of the HIPPS code.

Home health agencies (HHAs) use revenue code 0623 (Medical/Surgical Supplies – Extension of 027X) to voluntarily report charges for all wound care supplies, including but not limited to surgical dressings. A complete listing of all revenue codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications ManualExternal Website.

See the screenprint of FISS Page 02 below which details the revenue information needed for billing NRS on home health claims. Note that all NRS may be reported as one line item on the final claim. It is not necessary to report each NRS on a separate revenue code line. When reporting revenue codes 0623 (Medical/Surgical Supplies - Extension of 027X) or 027X (Medical/Surgical Supplies) on the final claim, they must include:

Data Required? FISS DDE Field/FISS Page CMS-1450 Form Locator (FL) Data Entered
HCPCS code Only when billing revenue code 0274 (Prosthetic and Orthotic Devices) 'HCPC' /Page 02 FL 44 N/A unless billing revenue code 0274. Enter HCPCS code of prosthetic or orthotic device.
Service Unit Yes 'TOT UNIT' and 'COV UNIT' fields /Page 02 FL 46 # of units. HHAs may choose to use a default "1" in each of these fields.
Charges Yes 'TOT CHARGE' field/Page 02 FL 47 Dollar amount of NRS provided during the episode. Note: When reporting 0623 and 027X, charge amounts for the two revenue codes must be separate and distinct.
Service Date Yes 'SERV DATE' field /Page 02 FL 45 Date of service NRS were provided. Note: the date billed must fall within the "FROM" and "TO" date billed on the claim. CGS encourages you to use the first Medicare billable visit in the episode as the date of service submitted with NRS or surgical dressing/wound care supplies.

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Routine Versus Non-Routine Supplies

The Medicare Benefit Policy Manual (CMS Pub 100-02, Ch. 7, § 50.4.1External PDF) defines routine supplies versus NRS. Use this definition to determine whether a supply item is non-routine and is reported on the home health final claim. Documentation of all NRS provided to the beneficiary must be included in the patient's medical record.

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Additional Resources

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Updated: 06.24.15


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