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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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Hospice Medicare Billing Codes Sheet

Type of Bill (FL4)

Type of Bill (FL4)
X=1 non-hospital based X=2 hospital based
8XA Notice of Election (NOE) 8X2 1st claim in series
8XB Revocation/Termination 8X3 Continuing claim
8XC Change of hospice 8X4 Discharge claim
8XD Cancel NOE/benefit period 8X5 Late charges (phys/NP charges only)
8X0 Nonpayment claim 8X7 Adjustment claim
8X1 Admit thru discharge 8X8 Cancel claim
CMS Pub. 100-04, Chapter 11, Section 20.1.2 & 30.3

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Condition Code (FL 18-28)

Condition Code (FL 18-28)
H2 Discharge for cause (i.e. patient/staff safety)
CMS Pub. 100-04, Chapter 11, Section 30.3

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

Claim Change Reason Code (CCRC) (FL 18-28) & Adjustment Reason Code (ARC) (FISS only)
Description CCRC ARC TOB
Change in dates of service D0 RF 8X7
Change in charges D1 RG 8X7
Change in revenue/HCPCS code D2 RH 8X7
Cancel to correct provider #/HIC D5 RI 8X8
Cancel duplicate or OIG payment D6 RJ 8X8
Any other/multiple change(s) D9 RM 8X7
Change in patient status E0 RN 8X7
CMS Pub. 100-04, Chapter 1, Section 130.1.2.1

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Revenue Codes (FL42)

Revenue Codes (FL42)
0001 Total units/charges 0571 Home health aide visit
0421 Physical therapy 0650 General (to request denial)
0431 Occupational therapy 0651 Routine home care
0441 Speech language path. 0652 Continuous home care
0551 Skilled nursing visit 0655 Respite care
0561 Medical social services visit 0656 General inpatient care (GIP)
0569 Medical social services phone call 0657 Physician services
0659 Other (incl. room & board)
CMS Pub. 100-04, Chapter 11, Section 30.3

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Type of Admission (FL14)

Type of Admission (FL14)
1 Emergency
2 Urgent
3 Elective
5 Trauma
9 Information not available
CR 7202, www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2090CP.pdfExternal PDF

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Occurrence Codes (FL 31-34)

Occurrence Codes (FL 31-34)
Occurrence Codes (FL 31-34)
27 Date of certification or recertification
42 Date of discharge/revocation (not for transfers or death)
CMS Pub. 100-04, Chapter 11, Section 30.3

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Occurrence Span Codes (FL 35-36)

Occurrence Span Codes (FL 35-36)
Occurrence Span Codes (FL 35-36)
77 Noncovered days due to untimely certification
M2 Multiple respite stays, From/To dates of each stay
CMS Pub. 100-04, Chapter 11, Section 30.3

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HCPCS Codes (FL 44)

HCPCS Codes (FL 44)
For Discipline Lines (42X, 43X, 44X, 55X, 56X, 57X)
G0151 Physical therapy G0152 Occupational therapy
G0153 Speech language pathology G0154 Nursing services
G0155 Medical social services G0156 Aide services
For Level of Care Lines (651, 652, 655, 656)
Q5001 Care provided in home
Q5002 Care provided in assisted living facility
Q5003 Care provided in LTC or non-skilled NF (receiving unskilled care)
Q5004 Care provided in skilled nursing facility (receiving skilled care)
Q5005 Care provided in inpatient hospital
Q5006 Care provided in inpatient hospice facility
Q5007 Care provided in long term care hospital
Q5008 Care provided in inpatient psychiatric facility
Q5009 Care provided in place not otherwise specified
Q5010 Care provided in a hospice facility (effective 10/1/10)
CMS Pub. 100-04, Chapter 11, Section 30.3

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Patient Status (FL17) as of "To" date on claim

Patient Status (FL17) as of "To" date on claim
01 Discharged to home, revoked, or decertified
30 Still a patient
40 Expired at home
41 Expired at medical facility
42 Expired – place unknown
50 Discharged/transferred to hospice – home (routine or CHC)
51 Discharged/transferred to hospice – medical facility (respite or GIP)
CMS Pub. 100-04, Chapter 11, Section 30.3

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MSP Value Codes (FL 39-41) & Payer Codes (FISS only)

MSP Value Codes (FL 39-41) & Payer Codes (FISS only)
Description VC PC
Working aged 12 N/A
ESRD 13 N/A
No Fault (no attorney involved) 14 N/A
Workers' Compensation 15 N/A
Public Health Svc/Other Federal 16 N/A
Disabled 43 N/A
Black Lung 41 N/A
Veteran's Administration 42 N/A
Liability (attorney involved) 47 N/A
Conditional Payment One of the above C
Medicare Z
CMS Pub. 100-05, Chapter 3, Section 5

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Status/Location Codes (FISS only)

Status/Location Codes (FISS only)
P B9996 Payment floor (claim approved for payment)
P B9997 Processed NOE or paid claim (full or partial)
P O9998 Archived claim (call CSR to access claim data)
R B9997 Rejected claim (due to eligibility, duplicate or billing error)
D B9997 Denied claim (full denial by Medical Review, may appeal)
T B9997 Return to Provider (RTP) (available for 36 months)
S B0100 Claim temporarily suspended, no provider action needed
S B6001 ADR claim (submit medical documentation w/in 30 days)
S M50MR Claim in medical review
S B90XX Claim at Common Working File (CWF), XX=various #s
S M0XXX Suspended for Medicare staff intervention, XX=various #s

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

R = required
C = conditional
N = not

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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