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Home Health Medicare Billing Codes Sheet

NOTE: The codes listed on this billing codes sheet represent those most frequently submitted on home health RAPs/claims. A complete listing of all codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual.External Website

Type of Bill (TOB)* (FL 4)

Type of Bill (TOB)* (FL 4)
3XG or 3XI Contractor adjustment

CMS Pub. 100-04, Chapter 10External PDF

* FISS will automatically change the 2nd digit of HH PPS TOBs from 2 to 3, if required. Example: 329 to 339
322 Request for Anticipated Payment (RAP) 329 Final Claim for Episode
327 Adjustment Claim 320 Nonpayment Claim
328 Void/Cancel Prior RAP/Claim 34X Outpatient Services

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Claim Change Reason Codes (CCRC) (FL 18-28) & Adjustment Reason Codes (ARC) (FISS only)

Claim Change Reason Codes (CCRC) (FL 18-28) & Adjustment Reason Codes (ARC) (FISS only)
Description CCRC ARC TOB
NOTE: RAPs cannot be adjusted. If information must be changed on a processed RAP, it must be cancelled and resubmitted to Medicare.
Changes in Service Dates D0 RF 3X7
Changes to Charges D1 RG 3X7
Changes in revenue/HCPC/HIPPS codes D2 RH 3X7
Cancel to correct provider/HIC # D5 RI 3X8
Cancel duplicate or OIG payment D6 RJ 3X8
Change to make Medicare secondary D7 RK 3X7
Change to make Medicare primary D8 RL 3X7
Any other/multiple change (s) D9 RM 3X7
Change in patient status E0 RN 3X7

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Core Based Statistical Area (CBSA) Value Code (FL 39-41)

Core Based Statistical Area (CBSA) Value Code (FL 39-41)
Other value codes may be required when Medicare is the secondary payer.

CMS Pub. 100-04, Chapter 10
61 CBSA code for where HH services were provided. CBSA codes are required on all 32X and 33X TOB.

Place "61" in the first value code field locator and the CBSA code in the dollar amount column followed by two zeros.

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Priority (Type) of Admission or Visit Codes (FL 14)

Priority (Type) of Admission or Visit Codes (FL 14)
1 Emergency 4 Newborn
2 Urgent 5 Trauma
3 Elective 9 Information not available

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Point of Origin (formerly Source of Admission Codes) (FL 15)

Point of Origin (formerly Source of Admission Codes) (FL 15)
1 Non-Health Care Facility Point of Origin 7 Emergency Room (ER) (discontinued effective 07/01/2010)
2 Clinic or Physician's Office 8 Court/Law Enforcement
4 Transfer from Hospital (Different Facility) 9 Information not available
5 Transfer from Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) B Transfer from Another HHA (cannot be submitted on home health RAPs/claims when "FROM" date is on/after 07/01/2010)
6 Transfer from Another Health Care Facility C Readmission to Same HHA (cannot be submitted on home health RAPs/claims when "FROM" date is on/after 07/01/2010)

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Medicare Secondary Payer (MSP) Value Codes (VC) (FL 39-41) & Payer Codes (PC) (FISS only)

Medicare Secondary Payer (MSP) Value Codes (VC) (FL 39-41) & Payer Codes (PC) (FISS only)
Description VC PC Description VC PC
NOTE: Medicare does not make secondary payer payments on RAPs. Submit RAPs with Medicare as primary.
CMS Pub. 100-05, Chapter 3External PDF
Working Aged 12 N/A Black Lung 41 N/A
ESRD 13 N/A Disabled 43 N/A
No Fault (no attorney involved) 14 N/A Veteran's Administration 42 N/A
Worker's Compensation 15 N/A Conditional Payment Any of the above C
Public Health Svc/Other Federal 16 N/A Medicare Z

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Patient Status Codes (FL 17)

Patient Status Codes (FL 17)
01 Discharge to home or self-care (routine discharge) 43 Discharge/transfer to federal hospital
02 Discharge/transfer to short-term general hospital 50 Discharge/transfer for hospice services in the home
03 Discharge/transfer to SNF 51 Discharge/transfer to hospice services in a medical facility
04 Discharge/transfer to ICF 61 Discharge/transfer to hospital-based Medicare approved swing bed
05 Discharge to designated cancer center or children's hospital 62 Discharge/transfer to IRF (inpatient rehabilitation facility)
06 Discharge/transfer to home care of another HHA OR discharge and readmit to the same HHA within a 60-day episode 63 Discharge/transfer to long-term care hospital
07 Left against medical advice or discontinued care 64 Discharge/transfer to Medicaid certified, but non-Medicare certified nursing facility
20 Expired 65 Discharge/transfer to psychiatric hospital or psychiatric part unit of a hospital
21 Discharge/transfer to court/law enforcement 66 Discharge/transfer to Critical Access Hospital (CAH)
30* Still a beneficiary. Services continue to be provided 70 Discharge/transfer to another type of health care institution not defined elsewhere in code list

* Required on RAPs

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Common Revenue Codes (FL 42) and HCPCS/Rates/HIPPS Rate Codes (FL 44)

Common Revenue Codes (FL 42) and HCPCS/Rates/HIPPS Rate Codes (FL 44)
Rev Code Definition HCPCS Comments

CMS Pub. 100-04, Chapter 10External PDF

* For revenue codes ending in an "X", sub-classifications exist. Use a "0" to indicate general classification when the sub-classifications are not appropriate.

0001 Total units/charges N/A No HCPCS required with revenue code
0023 HIPPS code As assigned by Grouper software See CMS Coding and Billing Information Web page for more information
027X Medical/Surgical Supplies N/A unless 0274 HCPCS required when submitting revenue code 0274 (Prosthetic/Orthotic devices) – See CPT coding book for appropriate HCPCs code.
042X Physical Therapy Varied See Medicare Learning Network (MLN) article MM7182 for more information.
043X Occupational Therapy Varied See Medicare Learning Network (MLN) article MM7182 for more information.
044X Speech Language Pathology Varied See Medicare Learning Network (MLN) article MM7182 for more information.
055X Skilled Nursing Varied See Medicare Learning Network (MLN) article MM7182 for more information.
056X Medical Social Services G0155
057X Home Health Aide G0156
062X Medical/Surgical Supplies N/A Optional Use: When HHAs choose to report additional breakdown for surgical/wound care dressings.

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Common Home Health Billing Errors by Reason Code (RC) (When RAP/claim is in FISS status/location (S/LOC) T B9997 or R B9997)

Common Home Health Billing Errors by Reason Code (RC) (When RAP/claim is in FISS status/location (S/LOC) T B9997 or R B9997)
RC Resolution RC Resolution
31018 If billing > 60 days, status code must be other than 30 31147 If 5th position of HIPPS code is a letter, non-routine supplies must be submitted on the claim
31755 The service date of a visit must match the service date billed with revenue code 0023 38157, 38200 Duplicate billing transaction; adjust or cancel claim or RAP instead of resubmitting
38107 Re-bill RAP if auto-cancel AND ensure RAP is in P B9997 AND ensure "FROM" date, "ADMIT" date, first 4 position of HIPPS code, and 0023 date matches between RAP and claim for same episode U538I Enter condition code 47 to indicate transfer between HHAs

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FISS Fields and UB-04 Field Locators (FL) for Hospice Billing

R = required
C = conditional
N = not required
O = optional

FISS Fields and UB-04 Field Locators (FL) for Hospice Billing
FISS Pg FISS Field Name UB FL Data Entered NOE Claim
1 HIC 60 Medicare (HIC) number R R
1 TOB 4 Type of Bill R R
1 NPI 56 NPI number R R
1 Pat.Cntl#: 3a Patient Control Number O O
1 Stmt Date From 6 From date of service R R
1 To 6 To date of service N R
1 Last 8 Patient's last name R R
1 First 8 Patient's first name R R
1 DOB 10 Patient's date of birth R R
1 Addr 1 9 Patient's address R R
1 Addr 2 9 City State R R
1 Zip 9 Zip R R
1 Sex 11 Sex code (M or F) R R
1 Admit Date 12 Date of admission R R
1 Hr 13 Admission hour R 1 R 1
1 Type 14 Type of Admission N R
1 Stat 17 Patient status N R
1 Cond Codes 18-28 Condition codes N C
1 Occ Cds/Date 31-34 Occurrence code(s)/date(s) R C 2
1 Span Codes/Dates 35-36 Occurrence span code(s)/date(s) N C 3
1 DCN 64 Document control number N C 4
1 Value Codes 39-41 Value codes N R 5
2 Rev 42 Revenue codes N R
2 HCPC 44 HCPCS N R
2 Modifs 44 Modifier N C
2 Tot Unit 46 Total units N R
2 Cov Unit 46 Covered units N R
2 Tot Charges 47 Total charges N R
2 Ncov Charge 48 Noncovered charges N C
2 Serv Dt 45 Service date N R
3 CD 50 Payer code R R
3 Payer 50 Payer name R R
3 RI 52 Release of information R R
3 Medical Record Nbr 3b Medical Record Number O O
3 Diagnosis codes 67 Diagnosis codes R R
3 Att Phys NPI 76 Attending physician's NPI R R
3 LN 76 Attending physician's last name R R
3 FN 76 Attending physician's first name R R
3 MI 76 Attending physician's middle initial O O
3 Opr Phys NPI 77 Operating physician's NPI N N
3 LN 77 Operating physician's last name N N
3 FN 77 Operating physician's first name N N
3 MI 77 Operating physician's middle initial N N
3 Oth Phys NPI 78 Certifying physician's NPI R R
3 LN 78 Certifying physician's last name R R
3 FN 78 Certifying physician's first name R R
3 MI 78 Certifying physician's middle initial O O
4 Remarks 80 Remarks C C
5 Insured name 58 Insured's last name, first name N C 6
5 Sex N/A Insured's sex code N C 6
5 DOB N/A Insured's date of birth N C 6
5 Rel 59 Patient's relationship N C 6
5 Cert-SSN-HIC 60 Insured's ID/HIC# N C 6
5 Group name 61 Insurance group name N C 6
5 Ins Group Number 62 Insurance group number N C 6
6 1st Insurer Address 80 Insurer's address N C 6
6 City 80 Insurer's city N C 6
6 St 80 Insurer's state N C 6
6 Zip 80 Insurer's zip N C 6
1 Required for DDE
2 OC 27 is required when certification/recertification overlaps the claim's date of service.

OC 42 is required when the patient has been discharged/revoked hospice.
3 OSC 77 is required when the recertification was not obtained timely.
4 Adjustments and cancels only
5 Value code 61 and CBSA code required for rev. code 0651 or 0652. Value code G8 and CBSA code required for rev. code 0655 or 0656.
6 Required when Medicare is secondary.

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