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Claim Page 02 – Entering a RAP or Claim

Claim Page 02 (Map 1712) contains revenue code information, charges and service dates.

Required fields for a RAP

Required fields for a RAP

Required fields for a claim

Required fields for a RAP

Key:

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

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Field Descriptions for Claim Page 02 – Maps 1712

The MID, TOB, S/LOC, and PROVIDER fields are system generated from Claim Page 01.

Field Name/Requirement

Description

REV

Required

Revenue code. All 32X bill types must include revenue code 0023 with the appropriate Health Insurance Prospective Payment System (HIPPS) code. This 5 position code is generated out of the Grouper softwareExternal Website based on the responses to the Outcome and Assessment Information Set (OASIS)External Website items.

RAPs – Enter the 0023 line with the HIPPS code in the HCPC field. Revenue code 0001 is entered on the second revenue code line. No other revenue code lines are required on a RAP. If additional revenue codes are submitted, FISS will ignore them.

Claims – Revenue code 0023 with a HIPPS code – where the first four positions match the HIPPS code billed on the RAP – must be present on all 329 type of bills. Services billed on 329 and 34X types of bill must be line item billed. Do not combine two visits that are performed on the same day as a single line item. Revenue code 0001 is entered on the last revenue code line of the claim.

  • This page will hold up to 14 revenue code lines. To enter additional revenue code lines, press F6 to scroll down. There are 33 revenue code pages and 450 total revenue code lines available.
  • The REV field is a four-position field. You may key a zero before the revenue code (e.g., 0420) or key the three-digit code (e.g., 420) and then use your TAB key to go to the next field.

HCPCS

Conditionally

Required

Key the appropriate HCPCS code that corresponds with the service(s) being billed and the HIPPS code on the 0023 revenue code line.

For episodes beginning on or after July 1, 2013, enter the appropriate HCPCS code (Q5001, Q5002 or Q5009) to identify the service location where the home health services occurred. See Medicare Learning Network (MLN) Matters® article, MM8136External PDF for additional information.

Appropriate HCPCS codes can be found in the CPT coding book. See the Home Health Revenue Code Listing or Home Health HCPCS Codes Listing below to determine the appropriate HCPCS used when billing therapies, skilled nursing, medical social services and home health aide visits on home health claims.

MODIFS

Conditionally Required

Modifiers. Use the appropriate modifier on home health outpatient therapy claims (type of bill 34X):

GN Services personally provided by a speech therapist

GO Services personally provided by an occupational therapist

GP Services personally provided by a physical therapist

KX Outpatient therapy service when the beneficiary is qualified for exception to the therapy caps.

See the Home Health Outpatient Therapy Billing Web page and Medicare Learning Network Matters® article, MM8005External PDF for information on required changes impacting Medicare claims with outpatient therapy services on and after July 1, 2013.

TOT UNIT

Required

Key the corresponding units for the services billed. Units can reflect the number of 15-minute increments, oxygen feet or pounds, units of service, DME items supplied per month, units of medication, visits, and drugs and biologicals.

For the Q code line, enter 1 unit.

When entering RAPs and claims in FISS, revenue code 0023 does not require units to be reported.

On a 34X type of bill, report the units as the number of times the procedure was performed.

COV UNIT

Required

Key the number of covered units for the services billed. Ensure the appropriate increment is reflected for the type of service or supply billed.

For the Q code line, enter 1 unit.

TOT CHARGE

Required

Key the total charge per revenue code. The decimal point is optional (i.e., $1500.00 can be keyed as 1500.00 or 150000). However, you must key two zeroes (00) for the cents amount.

For the Q code line, enter a nominal charge (example – $0.01)

NCOV CHARGE

Conditionally Required

Key any noncovered charges billed per revenue code.

SERV DATE

Required

Key the date the service was provided. Line item dates of service are required on all claims paid under the Home Health Prospective Payment System (HH PPS) and home health outpatient therapy claims (34X type of bill). These are entered in a month, day, year format (MMDDYY – example 061013 for June 10, 2013).

For the Q code line, the service date entered must match the date of the first visit date in the episode.

The service dates on the 0023 revenue code line for both the RAP and claim reflects the date of the first billable visit in the episode.

The service date reported must fall within the from and to date reported on the claim. Service dates billed for visits should reflect the date the visit occurred.

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Additional FISS Claim Pages

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Home Health Revenue Codes

Code

Description

0001

Total Units and/or Charges

0023

HIPPS Code

027X

Medical/Surgical Supplies

0 – General Classification

1 – Nonsterile Supply

2 – Sterile Supply

3 – Take Home Supply

4 – Prosthetic/Orthotic Devises

9 – Other Supplies/Devises

When reporting 027X, include units, charges, and a service date. If revenue code 0274 is billed, a HCPCS code is also required.

029X

Durable Medical Equipment (DME) Other Than Rental (used when billing DME on HH PPS claims)

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.

042X

Physical Therapy

0 – General Classification

1 – Visit Charge

On a 32X type of bill, report the date of service, the service units representing the number of 15-minute increments that comprised the visit, and a charge amount. You will also need to report one of the following HCPCS that reflects the service for which the clinician spent most of his/her time during the visit. Multiple HCPCS codes should not be billed for a single physical therapy visit.

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. NOTE: This code will be accepted in FISS when submitted after October 5, 2020, for dates of service on or after January 1, 2020. Valid on type of bill 032x other than 0322.

043X

Occupational Therapy

0 – General Classification

1 – Visit Charge

On a 32X type of bill, report the date of service, the service units representing the number of 15-minute increments that comprised the visit, and a charge amount. You will also need to report one of the following HCPCS that reflects the service for which the clinician spent most of his/her time during the visit. Multiple HCPCS codes should not be billed for a single occupational therapy visit.

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 therapy 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.  NOTE: This code will be accepted in FISS when submitted after October 5, 2020, for dates of service on or after January 1, 2020.  Valid on type of bill 032x other than 0322.

044X

Speech-Language Pathology

0 – General Classification

1 – Visit Charge

On a 32X type of bill, report the date of service, the service units representing the number of 15-minute increments that comprised the visit, and a charge amount. You will also need to report one of the following HCPCS that reflects the service for which the clinician spent most of his/her time during the visit. Multiple HCPCS codes should not be billed for a single speech-language pathology visit.

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.

055X

Skilled Nursing

0 – General Classification

1 – Visit Charge

On a 32X type of bill, report the date of service, the service units representing the number of 15-minute increments that comprised the visit, and a charge amount. You will also need to report one of the following HCPCS that reflects the service for which the clinician spent most of his/her time during the visit. Multiple HCPCS codes should not be billed for a single skilled nursing visit.

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).

G0299: 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: 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.

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). Valid for services provided on or after January 1, 2017.

G0494: Skilled services of a licensed practical nurse (LPN) for the observation and assessment of a 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). Valid for services provided on or after January 1, 2017.

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. Valid for services provided on or after January 1, 2017.

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. Valid for services provided on or after January 1, 2017.

This revenue code is not valid on a 34X type of bill.

056X

Medical Social Services

0 – General Classification

1 – Visit Charge

On a 32X type of bill, report HCPCS code G0155, the date of service, the 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 34X type of bill.

057X

Home Health Aide

0 – General Classification

1 – Visit Charge

9 – Other home health aide

On a 32X type of bill, report HCPCS code G0156, the date of service, the 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 34X type of bill.

060X

Oxygen (when including DME on HH PPS claims)

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

062X

Medical/Surgical Supplies – Extension of 027X

This code indicates charges for supply items required for patient care. The category is an extension of 027X for reporting additional breakdown where needed.

3 – Surgical Dressings SURG DRESSING

Also required with this revenue code: service units, a service date, and a charge amount.

HHAs may voluntarily report a separate revenue code line for charges for non-routine wound care supplies using revenue code 0623. We encourage HHAs to report this information so that it can be used to make refinements in the HH PPS case mix adjuster. If also reporting 027X to identify non-routine supplies other than those used for wound care, ensure that the charge amounts for the two revenue codes are mutually exclusive.

063X

Drugs Requiring Specific Identification (for use on 34X type of bills only)

Record drugs as line item date of service. Report the applicable HCPCS code

6 – Drugs Requiring Detailed Coding*

* Charges for drugs and biologicals (with the exception of radiopharmaceuticals, which are reported under revenue codes 0343 and 0344) requiring specific identifications as required by the payer.

077X

Preventive Care Services (for use on 34X type of bills only)

0 – General classification

1 – Vaccine Administration

094X

Other Therapeutic Services (for use on 34X type of bills only)

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

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Home Health HCPCS Codes

Code

Description

Used with Revenue Code

G0151

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

042X (Physical Therapy)

G0152

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

043X (Occupational Therapy)

G0153

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

044X (Speech-Language Pathology)

G0155

Services of clinical social worker in home health or hospice setting, each 15 minutes

056X (Medical Social Services)

G0156

Services of home health/hospice aide in home health or hospice settings, each 15 minutes

057X (Home Health Aide)

G0157

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

042X (Physical Therapy)

G0158

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

043X (Occupational Therapy)

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.

042X (Physical Therapy)

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

043X (Occupational Therapy)

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.

044X (Speech-Language Pathology)

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).

055X (Skilled Nursing)

G0299:

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:

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.

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). Valid for services provided on or after January 1, 2017.

G0494

Skilled services of a licensed practical nurse (LPN) for the observation and assessment of a 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). Valid for services provided on or after January 1, 2017.

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. Valid for services provided on or after January 1, 2017.

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. Valid for services provided on or after January 1, 2017.

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.

Valid on type of bill 032x other than 0322.

NOTE: This code will be accepted in FISS when submitted after October 5, 2020, for dates of service on or after January 1, 2020. See Medicare Learning Network (MLN) Matters® article, MM11721External PDF for additional information.

042X (Physical Therapy)

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.

Valid on type of bill 032x other than 0322.

NOTE: This code will be accepted in FISS when submitted after October 5, 2020, for dates of service on or after January 1, 2020. See Medicare Learning Network (MLN) Matters® article, MM11721External PDF for additional information.

043X (Occupational Therapy)

Q5001

Hospice or home health care provided in patient's home/residence. See Medicare Learning Network (MLN) Matters® article, MM8136External PDF for additional information.

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

Q5002

Hospice or home health care provided in assisted living facility. See Medicare Learning Network (MLN) Matters® article, MM8136External PDF for additional information.

Q5009

Hospice or home health care provided in place not otherwise specified (NO). See Medicare Learning Network (MLN) Matters® article, MM8136External PDF for additional information.

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Updated: 09.22.2020

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