Corporate

January 1, 2019

New Value Code 85 Required on Home Health Claims

Change Request 10782External PDF implements recent legislation that requires home health rural add-on payments to vary, based on the county in which the service was furnished.  As a result, home health claims (type of bill 032X) submitted with services furnished on or after January 1, 2019, should report the new value code 85 and an associated Federal Information Processing Standards (FIPS) State and County Code.  Value code 85 is defined as “County Where Service is Rendered.”

NOTE: As a reminder, value code 61 and the Core Based Statistical Area (CBSA) are also required on home health claims (type of bill 032X). 

Refer to the United States Census BureauExternal Website Web page or the CMS' SSA to FIPS State and County CrosswalkExternal Website to access the FIPS State and County Code.

When entering a value code that represents a number rather than a monetary amount, enter the number followed by two zeros.  For example, FIPS code 19153 would be entered as 1915300 or 19153.00.

Screen Shot

If the value code 85 and FIPS code is missing or is invalid, the claim will go to the Return to Provider (RTP) file with reason code 37257 for you to add/correct.

Resources:

Please share this information with your billing staff.

Was this page helpful? YES NO


Two Vantage Way, Nashville, TN 37228 © CGS Administrators, LLC. All Rights Reserved