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December 22, 2016

New Condition Code for Delayed Recertification of Hospice Terminal Illness

Change Request 9590 implements the new condition code 85 for hospice providers to report when the recertification was not received within the required time.  Condition code 85, which is defined “Delayed recertification of hospice terminal illness” is effective for claims received on or after January 1, 2017. 

As a reminder, the Centers for Medicare & Medicaid Services (CMS) have published timely certification requirements in the CMS Publication 100-02, Chapter 9, Section 20.1External PDF.

This new condition code was created to serve as an indicator to differentiate two uses of occurrence span code 77, untimely recertification, and untimely notice of election.  When hospices report condition code 85, Medicare systems will ensure the occurrence code 27 date does not fall within the occurrence span code 77 dates.

For additional information, refer to the Medicare Learning Network (MLN) Matters® MM9590External PDF

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