Hospice Medicare Billing Codes Sheet
Type of Bill (FL4)
Type of Admission (FL14)
X=1 non hospital based X=2 hospital based
8XA Notice of Election (NOE)
8X2 1st claim in series
8XB Revocation/Termination
8X3 Continuing claim
8XC
8XD
8X0
8X1
8X4
8X5
8X7
8X8
Change of hospice
Cancel NOE/benefit period
Nonpayment claim
Admit thru discharge
Discharge claim
Late charges (phys/NP charges only)
Adjustment claim
Cancel claim
1
2
3
5
9
Emergency
Urgent
Elective
Trauma
Information not available
CR 7202,
www.cms.gov/Transmittals/downloads/R2090CP.pdf
CMS Pub. 100-04, Chapter 11, Section 20.1.2 & 30.3
Condition Code (FL 18-28)
H2
27
42
Discharge for cause (i.e. patient/staff safety)
Claim Change Reason Code (CCRC)
(FL 18-28) &
Adjustment Reason Code (ARC)
(FISS only)
Description
Change in dates of service
Change in charges
Change in revenue/HCPCS code
Cancel to correct provider #/HIC
Cancel duplicate or OIG payment
Any other/multiple change(s)
Change in patient status
CCRC
D0
D1
D2
D5
D6
D9
E0
ARC
RF
RG
RH
RI
RJ
RM
RN
CMS Pub. 100-04, Chapter 1, Section 130.1.2.1
Revenue Codes (FL42)
0001
0421
0431
0441
0551
0561
0569
Total units/charges
Physical therapy
Occupational therapy
Speech language path.
Skilled nursing visit
Medical social services visit
Medical social services
phone call
0571
0650
0651
0652
0655
0656
0657
0659
TOB
8X7
8X7
8X7
8X8
8X8
8X7
8X7
Home health aide visit
General (to request denial)
Routine home care
Continuous home care
Respite care
General inpatient care (GIP)
Physician services
Other (incl. room & board)
CMS Pub. 100-04, Chapter 11, Section 30.3
77
M2
MSP Value Codes (FL 39-41) &
Payer Codes (FISS only)
Date of certification or recertification
Date of discharge/revocation (not for transfers or death)
Occurrence Span Codes (FL 35-36)
Noncovered days due to untimely certification
Multiple respite stays, From/To dates of each stay
CMS Pub. 100-04, Chapter 11, Section 30.3
HCPCS Codes (FL 44)
For Discipline Lines (42X, 43X, 44X, 55X, 56X, 57X)
G0151 Physical therapy
G0152 Occupational therapy
G0153 Speech language pathology
G0154 Nursing services
G0155 Medical social services
G0156 Aide services
For Level of Care Lines (651, 652, 655, 656)
Q5001 Care provided in home
Q5002 Care provided in assisted living facility
Q5003 Care provided in LTC or non-skilled NF (receiving unskilled care)
Q5004 Care provided in skilled nursing facility (receiving skilled care)
Q5005 Care provided in inpatient hospital
Q5006 Care provided in inpatient hospice facility
Q5007 Care provided in long term care hospital
Q5008 Care provided in inpatient psychiatric facility
Q5009 Care provided in place not otherwise specified
Q5010 Care provided in a hospice facility (effective 10/1/10)
CMS Pub. 100-04, Chapter 11, Section 30.3
Web Site Reference - CMS Pub. 100
http://www.cms.gov/Manuals/IOM/list.asp
Discharged to home, revoked, or decertified
Still a patient
Expired at home
Expired at medical facility
Expired – place unknown
Discharged/transferred to hospice – home (routine or CHC)
Discharged/transferred to hospice – medical facility (respite or GIP)
CMS Pub. 100-04, Chapter 11, Section 30.3
Occurrence Codes (FL 31-34)
CMS Pub. 100-04, Chapter 11, Section 30.3
CMS Pub. 100-04, Chapter 11, Section 30.3
Patient Status (FL17) as of “To” date on claim
01
30
40
41
42
50
51
Description
Working aged
ESRD
No Fault (no attorney involved)
Workers' Compensation
Public Health Svc/Other Federal
Disabled
Black Lung
Veteran's Administration
Liability (attorney involved)
Conditional Payment
Medicare
VC
12
13
14
15
16
43
41
42
47
One of the above
CMS Pub. 100-05, Chapter 3, Section 5
Status/Location Codes (FISS only)
P B9996
P B9997
P O9998
R B9997
D B9997
T B9997
S B0100
S B6001
S M50MR
S B90XX
S M0XXX
Payment floor (claim approved for payment)
Processed NOE or paid claim (full or partial)
Archived claim (call CSR to access claim data)
Rejected claim (due to eligibility, duplicate or billing error)
Denied claim (full denial by Medical Review, may appeal)
Return to Provider (RTP) (available for 36 months)
Claim temporarily suspended, no provider action needed
ADR claim (submit medical documentation w/in 30 days)
Claim in medical review
Claim at Common Working File (CWF), XX=various #s
Suspended for Medicare staff intervention, XX=various #s
NOTE: The codes listed on this billing codes sheet represent those most frequently submitted on hospice NOEs/claims. A complete listing of all
codes is accessible from the Natiolnal Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual : www.nubc.org
 June 2011 • CGS Administrators, LLC •
PC
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
C
Z
H-016-01
Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited.
Hospice Medicare Billing Codes Sheet
FI SS Fields a nd UB-04 Field L oca tors (FL ) fo r Hos pice B illing
R = required
C = conditional
FISS Pg FISS Field Name
UB FL Data Entered
NOE
Claim
1
HIC
60
Medicare (HIC) number
R
R
1
TOB
4
Type of Bill
R
R
1
NPI
56
NPI number
R
R
1
Pat.Cntl#:
3a
Patient Control Number
O
O
1
Stmt Date From
6
From date of service
R
R
1
To
6
To date of service
N
R
1
Last
8
Patient’s last name
R
R
1
First
8
Patient’s first name
R
R
1
DOB
10
Patient’s date of birth
R
R
1
Addr 1
9
Patient’s address
R
R
1
Addr 2
9
City State
R
R
1
Zip
9
Zip
R
R
1
Sex
11
Sex code (M or F)
R
R
1
Admit Date
12
Date of admission
R
R
1
Hr
13
Admission hour
R1
R1
1
Type
14
Type of Admission
N
R
1
Stat
17
Patient status
N
R
1
Cond Codes
18-28 Condition codes
N
C
1
Occ Cds/Date
31-34 Occurrence code(s)/date(s)
R
C2
1
Span Codes/Dates
35-36 Occurrence span code(s)/date(s)
N
C3
1
DCN
64
Document control number
N
C4
1
Value Codes
39-41 Value codes
N
R5
2
Rev
42
Revenue codes
N
R
2
HCPC
44
HCPCS
N
R
2
Modifs
44
Modifier
N
C
2
Tot Unit
46
Total units
N
R
2
Cov Unit
46
Covered units
N
R
1 Required for DDE
2 OC 27 is required when certification/recertification overlaps the claim’s date of service.
OC 42 is required when the patient has been discharged/revoked hospice.
3 OSC 77 is required when the recertification was not obtained timely.
4 Adjustments and cancels only
5 Value code 61 and CBSA code required for rev. code 0651 or 0652. Value code G8 and CBSA code
required for rev. code 0655 or 0656.
RC
Problem
31428 HCPC error
38031
Duplicate claim
37402
Sequential billing
N = not required
O = optional
FISS Pg FISS Field Name
UB FL
2
Tot Charges
47
2
Ncov Charge
48
2
Serv Dt
45
3
CD
50
3
Payer
50
3
RI
52
3
Medical Record Nbr
3b
3
Diagnosis codes
67
3
Att Phys NPI
76
3
LN
76
3
FN
76
3
MI
76
3
Opr Phys NPI
77
3
LN
77
3
FN
77
3
MI
77
3
Oth Phys NPI
78
3
LN
78
3
FN
78
3
MI
78
4
Remarks
80
5
Insured name
58
5
Sex
N/A
5
DOB
N/A
5
Rel
59
5
Cert-SSN-HIC
60
5
Group name
61
5
Ins Group Number
62
6
1st Insurer Address
80
6
City
80
6
St
80
6
Zip
80
6 Required when Medicare is secondary.
Data Entered
Total charges
Noncovered charges
Service date
Payer code
Payer name
Release of information
Medical Record Number
Diagnosis codes
Attending physician’s NPI
Attending physician’s last name
Attending physician’s first name
Attending physician’s middle initial
Operating physician’s NPI
Operating physician’s last name
Operating physician’s first name
Operating physician’s middle initial
Certifying physician’s NPI
Certifying physician’s last name
Certifying physician’s first name
Certifying physician’s middle initial
Remarks
Insured’s last name, first name
Insured’s sex code
Insured’s date of birth
Patient’s relationship
Insured’s ID/HIC#
Insurance group name
Insurance group number
Insurer’s address
Insurer’s city
Insurer’s state
Insurer’s zip
NOE
N
N
N
R
R
R
O
R
R
R
R
O
N
N
N
N
R
R
R
O
C
N
N
N
N
N
N
N
N
N
N
N
Claim
R
C
R
R
R
R
O
R
R
R
R
O
N
N
N
N
R
R
R
O
C
C6
C6
C6
C6
C6
C6
C6
C6
C6
C6
C6
Common Hospice Billing Errors by Reason Code (RC)
Resolution
Corresponding HCPCS required on discipline rev code line.
Delete previously submitted batches. Check remittance
advice or use FISS Option 12 to check for paid claims.
Ensure prior claim is paid (P), denied (D) or rejected (R).
Ensure no skip in days between prior and subsequent claim.
RC
Problem
Resolution
U5106 NOE w/in open episode Check ELGH for open hospice election. Contact other hospice if needed.
U5150 No NOE on file
NOE must be submitted & processed (P B9997) before submitting first claim.
U5181 Occurrence code 27
Occ code 27 is required when a cert/recert is w/in the DOS. Check ELGH to
verify OC 27 date matches first day of new benefit period.
 June 2011 • CGS Administrators, LLC •
H-016-01
Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited.