Corporate

Hospice No-Pay Bills (Condition Code 21)

Condition code 21 indicates services are noncovered, but you are requesting a denial notice in order to bill another insurance or payer source. These claims are sometimes called "no-pay bills" because they are submitted with only noncovered charges on them. No-pay bills are submitted to Medicare for the sole purpose of obtaining a denial that can be passed to subsequent payers (e.g. room and board charges). For additional instructions on billing hospice room and board charges, refer to the "Hospice Room and Board" Web page.

Beneficiaries are assumed to be liable for services when a claim is submitted with condition code 21.

Condition code 21 should only be used in cases where an Advance Beneficiary Notice (ABN) was not required. If an ABN was required, a condition code 21 cannot be submitted.

In addition to all the usual claim information, include the following:

TOB

(FISS Page 01)

Enter a zero in the third-digit (810 or 820)
COND CODES

(FISS Page 01)

Enter condition code '21'
REV

(FISS Page 02)

Enter the appropriate revenue codes. Use 0659 if the denial is for room and board charges. FISS will also require a level of care (0651, 0652, 0655, or 0656) line. Submit this line with noncovered units and charges. A value of "1" unit and "1.00" charge may be used.
HCPC

(FISS Page 02)

Enter the HCPCS code if applicable. Use 'A9270' with modifier 'GY' if denial is for room and board.
NCOV CHARGE

(FISS Page 02)

Enter the amount of charges for which you are requesting a denial.
REMARKS

(FISS Page 04)

Enter a brief explanation of why you are requesting denial. Indicate if noncovered charges are for room and board.

As a reminder, no-pay claims must be submitted with only noncovered charges. Covered charges are not allowed on a no-pay claim, and must be submitted on a separate claim.

Reference: Medicare Claims Processing Manual (CMS. Pub. 100-04) Ch. 1, §60.1.3External PDF

Updated: 09.27.18

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