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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
0569	Medical social services phone call	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.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.