September 14, 2020
Hospices Wage Index and Counties That Must Use 50xxx Code CBSA for Fiscal Year (FY) 2021
The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 11876 providing the payment rates for hospice care, the hospice cap amount and the hospice wage index for FY 2021. This CR incorporates revisions to the FY 2021 hospice wage index resulting in some counties having to use a special 50xxx Core Based Statistical Areas (CBSA) number.
Background
On September 14, 2018, the Office of Management and Budget (OMB) issued OMB Bulletin No. 18-04, announcing revisions to the delineation of Metropolitan Statistical Areas (MSAs), Micropolitan Statistical Areas, and Combined Statistical Areas, and guidance on uses of the delineation in these areas. These revisions will be incorporated into the hospice wage index for FY 2021.
For FY 2021 as a transition to help mitigate any significant negative impacts that hospices may experience due to our proposal to adopt the revised OMB delineations, a 5 percent cap was applied on any decrease in a geographic area’s wage index value from FY 2020 to FY 2021. Due to the way that the transition wage index is calculated, some CBSAs and statewide rural areas will have more than one wage index value associated with that CBSA or rural area. For example, some counties that change OMB designations will have a wage index value that is different than the wage index value associated with the CBSA or rural area they are moving to because of the transition. However, each county will have only one wage index value. For counties that correspond to a different transition wage index value, the CBSA number will not be able to be used for FY 2021 claims. These counties are listed below. In these cases, a number other than the CBSA number will be needed to identify the appropriate wage index value for claims for hospice care provided in FY 2021. These numbers are five digits in length and begin with “50”. These special 50xxx codes are shown in the last column of the FY 2021 hospice wage index file located on the CMS Hospice Regulations and Notices webpage. For counties located in CBSAs and rural areas that do not correspond to a different transition wage index value, the CBSA number will still be used.
As a reminder, CBSAs are reported with value code 61 when billing routine and/or continuous home care (revenue codes 0651 and 0652).
List of counties that must use 50xxx Codes for FY 2021 due to the wage index transition.
FIPS County Code |
COUNTY NAME |
CBSA FY 2020 |
CBSA Name FY 2020 |
Alternative ID |
CBSA NAME FY 2021 |
---|---|---|---|---|---|
17039 |
DE WITT |
14010 |
Bloomington, IL |
50001 |
ILLINOIS |
18143 |
SCOTT |
31140 |
Louisville/Jefferson County, KY-IN |
50002 |
INDIANA |
20149 |
POTTAWATOMIE |
31740 |
Manhattan, KS |
50003 |
Manhattan, KS |
20161 |
RILEY |
31740 |
Manhattan, KS |
50003 |
Manhattan, KS |
20095 |
KINGMAN |
48620 |
Wichita, KS |
50004 |
KANSAS |
21223 |
TRIMBLE |
31140 |
Louisville/Jefferson County, KY-IN |
50005 |
KENTUCKY |
25011 |
FRANKLIN |
99922 |
MASSACHUSETTS |
50006 |
Springfield, MA |
26159 |
VAN BUREN |
28020 |
Kalamazoo-Portage, MI |
50007 |
MICHIGAN |
27143 |
SIBLEY |
33460 |
Minneapolis-St. Paul-Bloomington, MN-W |
50008 |
MINNESOTA |
28009 |
BENTON |
32820 |
Memphis, TN-MS-AR |
50009 |
MISSISSIPPI |
30037 |
GOLDEN VALLEY |
13740 |
Billings, MT |
50010 |
MONTANA |
31081 |
HAMILTON |
24260 |
Grand Island, NE |
50011 |
NEBRASKA |
34023 |
MIDDLESEX |
35614 |
New York-Jersey City-White Plains, NY- |
50012 |
New Brunswick-Lakewood, NJ |
34025 |
MONMOUTH |
35614 |
New York-Jersey City-White Plains, NY- |
50012 |
New Brunswick-Lakewood, NJ |
34029 |
OCEAN |
35614 |
New York-Jersey City-White Plains, NY- |
50012 |
New Brunswick-Lakewood, NJ |
36071 |
ORANGE |
35614 |
New York-Jersey City-White Plains, NY- |
50013 |
Poughkeepsie-Newburgh-Middletown, NY |
37051 |
CUMBERLAND |
22180 |
Fayetteville, NC |
50014 |
Fayetteville, NC |
37093 |
HOKE |
22180 |
Fayetteville, NC |
50014 |
Fayetteville, NC |
45087 |
UNION |
43900 |
Spartanburg, SC |
50015 |
SOUTH CAROLINA |
46033 |
CUSTER |
39660 |
Rapid City, SD |
50016 |
SOUTH DAKOTA |
47081 |
HICKMAN |
34980 |
Nashville-Davidson--Murfreesboro—Fran |
50017 |
TENNESSEE |
48007 |
ARANSAS |
18580 |
Corpus Christi, TX |
50018 |
TEXAS |
48221 |
HOOD |
23104 |
Fort Worth-Arlington, TX |
50019 |
TEXAS |
48425 |
SOMERVELL |
23104 |
Fort Worth-Arlington, TX |
50019 |
TEXAS |
51029 |
BUCKINGHAM |
16820 |
Charlottesville, VA |
50020 |
VIRGINIA |
51033 |
CAROLINE |
40060 |
Richmond, VA |
50021 |
VIRGINIA |
51063 |
FLOYD |
13980 |
Blacksburg-Christiansburg-Radford, VA |
50022 |
VIRGINIA |
53051 |
PEND OREILLE |
44060 |
Spokane-Spokane Valley, WA |
50023 |
WASHINGTON |
54003 |
BERKELEY |
25180 |
Hagerstown-Martinsburg, MD-WV |
50024 |
Hagerstown-Martinsburg, MD-WV |
24043 |
WASHINGTON |
25180 |
Hagerstown-Martinsburg, MD-WV |
50024 |
Hagerstown-Martinsburg, MD-WV |
72083 |
LAS MARIAS |
99940 |
PUERTO RICO |
50025 |
Mayaguez, PR |
For additional information, refer to the MM11876, Update to Hospice Payment Rats, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY2021 article.