January 1, 2019
New Value Code 85 Required on Home Health Claims
Change Request 10782 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 Bureau Web page or the CMS' SSA to FIPS State and County Crosswalk 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.
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:
- MLN Matters® MM10782
Please share this information with your billing staff.