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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)
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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. |