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February 7, 2019 - Updated 02.21.19

Home Health Rural Add-on Payments Based on County of Residence

This article is a collaboration between CGS, NGS, and Palmetto GBA. 

Change Request (CR) 10782, implemented January 7, 2019, changes the home health rural add-on payments effective January 1, 2019. The county-based increase applies to all episodes and visits ending on or after January 1, 2019.

All Requests for Anticipated Payment (RAPs) and home health claims, Types of Bill (TOBs) 032x, received on or after January 1, 2019, for home health services furnished on or after January 1, 2019, must contain the new coding as required by the Bipartisan Budget Act (BBA) of 2018. This includes non-rural home health agencies (HHAs) who are not affected by rural add-on payments.

The CR establishes value code (VC) 85 and an associated Federal Information Processing Standards (FIPS) State and County Code. The new VC 85 is defined as "County Where Service is Rendered." You can find the FIPS State and County Codes using either of the following links:

HHAs should use the most recent list provided for the associated FIPS State and County Codes. 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. If the FIPS State and County Code begins with a zero, do not enter the zero.  Enter the four digits that follow the zero.  For example, 08019 would be keyed as 801900 or 8019.00.

If the new codes are missing on rural HHAs' RAPs, final claims (end of episode) and/or adjustments, they will be returned to the provider. If the new codes are missing for non-rural HHAs, the claim will process without them. Whether the Medicare Claim Processing system edits for billing requirements or not, proper billing is still a requirement.

Make sure your billing staffs are aware of these changes.

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


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