Corporate

Claim Page 02 – Entering a Hospice Claim

Claim Page 02 (Map 1712) contains revenue codes, HCPCS codes, units, charges, and service dates. Hospices must report the level(s) of care provided to the beneficiary during the billing period. If the level of care changes, or if the service location changes, a separate revenue code line is required. Separate lines should not be reported for the same level of care unless the site of service Q code changes. Refer to CMS Pub. 100.04, Ch. 11 §30.3External PDF for additional information. In addition, each nursing, aide, social worker, and therapy visit provided must be reported on a separate revenue code line. For additional information about hospice billing requirements, refer to the following resources.

Use the key and table below to determine what fields are required, and what information is required in each field.

Note: The codes listed on this page represent those most frequently submitted on hospice claims. A complete listing of all codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications ManualExternal Website.

screenshot

Key:

  • RED = Required field
  • BLUE = Optional field
  • GREEN = Conditional field, dependent on the type of claim
  • PURPLE = System generated field
  • BLACK = Not required field

Back to the Top of the Page Top

Field Descriptions for Claim Page 02 – Map 1712

The MID (Medicare ID), TOB, S/LOC and Provider fields are system generated from Claim Page 01.

Field Name/Requirement Description

REV
Required

FISS Page 02 will hold up to 14 revenue code lines per page. To enter additional revenue code lines, press F6 to scroll down to revenue code page (REV CD PAGE) 02. There are 33 revenue code pages and 450 total revenue code lines available.

The REV field is a four-position field. You may enter a zero before the revenue code (e.g. 0651) or enter the three-digit code (e.g. 651) and then use your TAB key to go to the next field.

Level of Care
Enter the appropriate revenue code(s) for the level of care provided (0651, 0652, 0655, 0656) (see descriptions below).

  • A separate revenue code line must be billed each time the level of care changes. However, separate lines should not be reported for the same level of care unless the site of service Q code changes.
  • Each day of continuous home care (revenue code 0652) must be billed on a separate revenue code line.

Discipline
Enter the appropriate revenue code for the discipline(s) provided (042X, 043X, 044X, 055X, 056X, 057X).

  • A separate revenue code line is required for each visit provided, with the following exceptions:
    • Visits provided under respite and/or GIP by non-hospice staff in a contracted facility are not reported.
    • Visits provided prior to January 1, 2014, under GIP by hospice-employed staff are reported weekly (Sun-Sat).
    • Visits provided between January 1 and April 1, 2014, under GIP by hospice-employed staff may be reported on a separate revenue code line for each visit.
    • Visits provided on/after April 1, 2014, under GIP by hospice-employed staff must be reported on a separate revenue code line for each visit.

Physician Services
Enter revenue code 0657 for physician services, when appropriate. Refer to the 'Billing Hospice Physician and Nurse Practitioner (NP) ServicesPDF' Web page for more information.

Room and Board
Enter revenue code 0659 only if you wish to receive a line item denial. See the Hospice Room and Board CGS Web page for details.

Non-injectable DrugsChange Request 8358External PDF
Enter revenue code 0250 when providing non-injectable provided on/after April 1, 2014.

  • For claims with dates of service before October 1, 2018, a separate revenue code line is required for each drug fill.
  • For claims with dates of service on or after October 1, 2018, report a monthly charge total for all drugs during the billing period.

Note: For claims with dates of service before October 1, 2018, in addition to revenue code 0250, hospices must also report the National Drug Code (NDC), quantity and the qualifier for each drug.  The NDC is reported in Loop 2410 of the 837 transaction. If you are entering your claim in FISS via DDE, press F11 from Page 02 to access the MAP171E screen to report the NDC. For claims with dates of service on or after October 1, 2018, hospices are no longer required to report a charge total and amount dispensed per drug. Refer to MM10573External PDF for additional information.

A list of current NDC codes can be accessed at http://www.fda.gov/drugs/informationondrugs/ucm142438.htmExternal Website

Infusion pump equipment
For claims with dates of service before October 1, 2018, enter the revenue code 029X (X=appropriate 4th digit) to report infusion pump equipment.

  • A separate revenue code line is required for each pump order.

Enter the revenue code 0294 to report infusion medications.

  • A separate revenue code line is required for medication fill.

Enter the revenue code 0636 to report injectable drugs.

  • A separate revenue code line is required for each drug fill.

For claims with dates of service on or after October 1, 2018, report a monthly charge total for infusion pump equipment with revenue code 029X (X=appropriate 4th digit), and infusion medications with revenue code 0294. Reporting injectable drugs using revenue code 0636 is no longer required. Refer to MM10573External PDF for additional information.

HCPC
Required

Level of Care
Enter the appropriate HCPCS code (Q5001-Q5010) on each level of care revenue code line (0651, 0652, 0655 or 0656) to identify the service location where that level of care was provided. Refer to the list of HCPCS codes below.

Discipline
Enter the appropriate HCPCS code on each discipline revenue code line (042X, 043X, 044X, 055X, 056X, 057X) that corresponds with the discipline provided. Refer to the list of HCPCS codes below.

Physician Services
Enter the appropriate HCPCS code that corresponds to the physician service provided (0657).

The following additional data is to be reported for services on/after April 1, 2014.

When HCPCS Q5003, Q5004, Q5005, Q5007, or Q5008 are reported, the facility NPI must also be reported in the SERV FAC NPI field on FISS claim page 03, or in Loop 2310E.

Injectable drug, infusion pump, or infusion pump medication – Change Request 8358External PDF

Enter the appropriate HCPCS code for the injectable drug, infusion pump, or infusion pump medication. A list of HCPCS codes for drugs is available from the CMS website.

NOTE: For claims with dates of service on or after October 1, 2018, HCPCS code reporting is not required for infusion pumps, and infusion medications (revenue code 029X and 0294). Refer to Change Request 10573External PDF for additional information.

MODIFS
Conditionally Required

Modifiers. Use the appropriate modifier on hospice claims, when appropriate.

26 – Use modifier 26 to identify a physician's professional component of a technical service. The modifier may be reported when the patient's attending physician, or a physician who is contracted or employed by the hospice, has provided the professional component of an otherwise technical service. NOTE: When using the 26 modifier, include a brief remark in the "Remarks" field on FISS Claim Page 04 to indicate the service billed is for the professional component of a technical service.

GV – Report modifier GV when billing physician services (0657) performed by a nurse practitioner acting as the patient's attending physician.

PM – Report modifier PM when billing post-mortem visits provided on the date of death. Note: Per Change Request 8358External PDF, reporting of post-mortem is required for services on/after April 1, 2014.

KX – Report modifier KX to indicate you are requesting an exceptional circumstance for an untimely filed notice of election (NOE). Note: Per Change Request 8877External PDF, the KX modifier may be reported for dates of service on/after October 1, 2014.

TOT UNIT
Required

Enter the total units for each revenue code line.

  • For revenue codes 0651, 0655, or 0656, units = the number of consecutive days at that level of care.
  • For revenue code 0652, units = the number of 15-minute increments continuous care was provided.
  • For discipline revenue codes (042, 043X, 044X, 055X, 056X, 057X), units = the duration of the visit in 15-minute increments.
  • For 0657 (physician services), units = the number of procedures/services performed, as defined by the HCPCS code.

The following additional data is to be reported in accordance with Change Request 8358External PDF. This data is required for services on/after April 1, 2014, and before October 1, 2018.

For 0636 (injectable drugs), units = amount filled based on the HCPCS description.

For 0250, units = as appropriate.

For 029X, units = as appropriate.

For 0294, units = amount filled based on the HCPCS description.

For services provided on or after October 1, 2018, revenue code 0636 is no longer required. Hospices may choose to report the units as '1' or the number of drugs reported during the billing period. Refer to Change Request 10573External PDF for additional information.

COV UNIT
Required

Enter the number of covered units for the services billed.

For claims with dates of service on or after October 1, 2018, for revenue codes 0250 and 029X, hospices may choose to report the units as '1' or the number of drugs reported during the billing period. Refer to Change Request 10573External PDF for additional information.

TOT CHARGE
Required

Enter the total charge per revenue code. The decimal point is optional (i.e. $1500.00 can be entered as 1500.00 or 150000). However, you must enter the two digits for the cents.

For more information about determining charges, refer to the Medicare Claims Processing Manual (CMS Pub. 100-04) Ch. 25, §75.5External PDF and the Provider Reimbursement Manual, Part 1, Ch. 22 §§2202, 2203, and 2204External Website

NCOV CHARGE
Conditionally Required

Enter any noncovered charges billed per revenue code.

SERV DATE
Required

For each revenue code line, a service date is required.

  • For revenue code 0651, 0655, and 0656, service date = the earliest date that level of care began for that consecutive period.
  • For revenue code 0652, service date = the date continuous home care was provided.
  • For discipline revenue codes (042X, 043X, 044X, 055X, 056X, 057X), service date = the date of the visit. If the visit begins on one calendar day and spans into the next calendar day, report the date the visits ended.
  • Revenue code 0657 (physician services), service date = the date of the physician's service.

The following additional data is to be reported in accordance with Change Request 8358External PDF.

For revenue code 0250, 0294, and 0636, service date = date drug filled. Revenue code 0636 is not required on claims with dates of service on or after October 1, 2018. Refer to MM10573External PDF for additional information.

For revenue code 029X, service date = date pump ordered.

NOTE: The service date reported must fall within the FROM and TO date reported on the claim.

Back to the Top of the Page Top

Additional FISS Claim Pages

Hospice Revenue Codes

Code Description
0001 Total charges
0250 Pharmacy General Classification (required April 1, 2014)
029X Durable Medical Equipment (used to report Infusion Pumps/Medications) (required April 1, 2014)
0 – Durable medical equipment - General Classification
1 – Durable medical equipment - Med Equip/Rent
2 - Durable medical equipment - Med Equip/New
3 - Durable medical equipment - Med Equip/Used
4 – HHA/Supplies and drugs required for DME effectiveness
042X Physical Therapy
0 – General Classification
1 – Visit Charge
043X Occupational Therapy
0 – General Classification
1 – Visit Charge
044X Speech Language Pathology
0 – General Classification
1 – Visit Charge
055X Skilled Nursing
0 – General Classification
1 – Visit Charge
056X Medical Social Services
0 – General Classification
1 – Visit Charge
9 – Other (phone calls)
057X Hospice Aide
0 – General Classification
1 – Visit Charge
0636 Drugs Requiring Specific Identification (required April 1, 2014)

Revenue code 0636 is not required on claims with dates of service on or after October 1, 2018. Refer to MM10573External PDF for additional information.
0650 General Classification (Request for denials)
0651 Routine Home Care
0652 Continuous Home Care
0655 Respite Care
0656 General Inpatient Care
0657 Physician Services
0659 Other Hospice (use this code when billing noncovered room and board )

For definitions of each hospice level of care, refer to the Medicare Claims Processing Manual, (CMS Pub. 100-04), Ch. 11, §30.1 External PDF.

Back to the Top of the Page Top

Hospice HCPCS Codes

The following HCPCS are billed on the level of care revenue code lines to indicate the place where care was provided.

Hospice HCPCS Codes

Code Description
Q5001 Hospice care provided in patient's home/residence

Note: Q5001 cannot be billed with respite (0655) or GIP (0656).
Q5002 Hospice care provided in assisted living facility

Note: Change Request 6778External PDF Q5002 cannot be billed with respite (0655) or GIP (0656).
Q5003 Hospice care provided in nursing long term care (LTC) facility or non-skilled nursing facility (NF).

Change Request 8877External PDF clarifies the use of Q5003. If a beneficiary is in a nursing facility that does not meet the criteria as defined by Q5004 (see below), then Q5003 should be reported.

Note: Q5003 cannot be billed with GIP (0656). Per Change Request 8358 External PDF, the facility NPI must also be reported in Loop 2310E.
Q5004 Hospice care provided in skilled nursing facility (SNF).

Change Request 8877External PDF clarifies the Q5004 should be reported when the beneficiary is:
  • Receiving hospice care in a solely-certified SNF;
  • Received general inpatient care in the SNF;
  • In a SNF receiving SNF care under the Medicare SNF benefit for a condition unrelated to the terminal illness, and is receiving hospice routine home care (a rare occurrence); or
  • Receiving inpatient respite care in a SNF.

Note: Q5004 cannot be billed with continuous home care (0652). Per Change Request 8358 External PDF, the facility NPI must also be reported in Loop 2310E.

Q5005 Hospice care provided in inpatient hospital.

Note: Q5005 cannot be billed with continuous home care (0652). Per Change Request 8358 External PDF, the facility NPI must also be reported in Loop 2310E.
Q5006 Hospice care provided in inpatient hospice facility.

Note: Q5006 cannot be billed with continuous home care (0652).
Q5007 Hospice care provided in long term care facility (LTCH).

Note: Q5007 cannot be billed with continuous home care (0652). Per Change Request 8358 External PDF, the facility NPI must also be reported in Loop 2310E.
Q5008 Hospice care provided in inpatient psychiatric facility.

Note: Q5008 cannot be billed with continuous home care (0652). Per Change Request 8358 External PDF, the facility NPI must also be reported in Loop 2310E.
Q5009 Hospice care provided in place not otherwise specified (NOS)
Q5010 Hospice care provided in hospice facility. Used for hospice patients when routine home care or continuous home care is provided in:
  • A hospice residential facility; or
  • A hospice facility which is also certified to provide inpatient care.

Note: Q5010 cannot be billed with respite (0655) or GIP (0656).

The following HCPCS codes are required on the discipline revenue code lines (042X, 043X, 044X, 055X, 056X, 057X).

Code Description
G0151 Physical Therapy (042X)
G0152 Occupational Therapy (043X)
G0153 Speech Language Pathology (044X)
G0154 Skilled Nursing (055X)
NOTE: Not valid for visits on or after January 1, 2016
G0155 Medical Social Services (056X)
G0156 Hospice Aide (057X)
G0299 Skilled Nursing (055X)
Direct skilled nursing services of a registered nurse (RN) in home health or hospice setting, each 15 minutes. Effective for visits on or after January 1, 2016.
G0300 Skilled Nursing (055X)
Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes. Effective for visits on or after January 1, 2016.

Note: The above codes begin with a G and the number zero (G0); not G and the letter 'O'.

In accordance with Change Request 8358External PDF (required effective April 1, 2014), HCPCS code must be reported on revenue code lines 029X and 0636. A list of HCPCS for drugs is available from the CMS website. HCPCS codes for revenue code 029X is not required on claims with dates of service on or after October 1, 2018. Revenue code 0636 is not required on claims with dates of service on or after October 1, 2018. Refer to MM10573External PDF for additional information.

For additional guidance and resources, refer to the Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, §30.3 External PDF.

Back to the Top of the Page Top

Updated: 10.21.19

Was this page helpful? YES NO


Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved