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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) 11876External PDF 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 NoticesExternal Website 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 PricerExternal Website for FY2021 article.

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