March 4, 2015
Special CBSA Codes for Home Health Claims
Medicare pays for home health services furnished in 2015 using a transitional wage index. Due to the wage index transition, Home Health Agencies (HHAs) may serve beneficiaries in areas where there is more than one unique Core-Based Statistical Area (CBSA). In these cases, HHAs should use special CBSA codes in the range 50xxx on their claim. See MLN Matters Article MM8969 for details.
Some HHAs are not using these special CBSA codes, causing the claim to be paid incorrectly with 2014 wage index values. Soon, 2015 claims with invalid CBSA codes will be returned to the provider with reason code 7CBS1. HHAs should adjust any claims previously paid incorrectly.
To determine if you should submit a special CBSA code, refer to the "Home Health Payment Rates" Web page and select the "Calendar Year 2015 Rates By County" zip file. Refer to the last column of the CY 2015 Final wage index Excel file for the CBSA code that should be submitted on your claim.
The official instruction, Change Request 8969, is available on the CMS website.