Corporate

January 10, 2019

New Home Health Billing Requirement: Value Code 85

Change request (CR) 10782, implemented on January 7, 2019, requires home health rural add-on payments to vary based on the county in which the service was furnished.  As a result, CR 10782 established new value code (VC) 85, effective January 1, 2019.  VC 85 is defined as “County Where Service is Rendered.”  

On all Requests for Anticipated Payments (RAPs) and home health claims (type of bill 032X) with dates of service on or after January 1, 2019, providers must report VC 85 and the Federal Information Processing Standards (FIPS) State and County Code.

If the VC 85 and FIPS State and County Code are invalid or are missing from the billing transactions (RAP or claim), they will be moved to the Return to Provider (RTP) file (T B9997) with reason code 37257 for providers to correct.  When entering the FIPS State and County Code, the number would be keyed, followed by two zeros.  For example, 19153 would be keyed as 1915300 or 19153.00.

The most recent FIPS State and County Codes are located on the National Bureau of Economic ResearchExternal Website website, or on the United States Census BureauExternal Website website. 

Note: In addition to VC 85, the Core Based Statistical Area (CBSA) VC 61 continues to be required on home health RAPs and claims.

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