- Avoiding Reason Code 38200
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Notice of Admission Questions and Answers
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Periods with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- 30-Day Home Health Therapy Reassessment Schedule
Reporting Site of Service Codes for Home Health Care
HH PPS claim payments are based on the site of the beneficiary’s care.
In order for Medicare to accurately capture where home health services are provided, HHAs are required to report the location of services on the period of care claim.
Provider Action Steps
HHAs should report one of the following three HCPCS site of service codes on every period of care claim: Q5001, Q5002 or Q5009.
The site of service Q-code needs to be reported with the first billable service on the home health claim. The revenue line with the Q-code should use the same revenue code and date of service as the first billable service, one unit, and a nominal charge (e.g., a penny). If the location where services were provided changes during the episode, the new location should be reported with an additional line corresponding to the first visit provided in the new location.
The table below lists the definitions of the Q-codes HHAs are required to report:
| HCPCS Code | Definition |
|---|---|
| Q5001 | Hospice or Home Health Care Provided in Patient's Home/Residence |
| Q5002 | Hospice Or Home Health Care Provided In Assisted Living Facility |
| Q5009 | Hospice Or Home Health Care Provided In Place Not Otherwise Specified (NOS) |
Example: Home health preiod begins 7/15/20XX. The first billable service in the period is a nursing visit at the patient’s home/residence. The site of service code is billed as follows:
| Revenue Code | HCPCS Code | Units | Total Charge | Service Date |
|---|---|---|---|---|
| 0551 | G0163 | 4 | 150.00 | 0715XX |
| 0551 | Q5001 | 1 | .01 | 0715XX |
Example with location change: Home health period begins 7/15/20XX. The first billable service in the period is a nursing visit in the patient’s home/residence. The patient moves to an assisted living facility and has a therapy visit on 8/7/20XX. The site of service code(s) are billed as follows:
| Revenue Code | HCPCS Code | Units | Total Charge | Service Date |
|---|---|---|---|---|
| 0551 | G0163 | 4 | 150.00 | 0715XX |
| 0551 | Q5001 | 1 | .01 | 0715XX |
| 0421 | G0157 | 3 | 125.00 | 0807XX |
| 0421 | Q5002 | 1 | .01 | 0807XX |
Notes on billing requirements:
- HCPCS site of service codes Q5001, Q5002, or Q5009 must be reported on HH PPS claims containing revenue code: 042X, 043X, 044X, 055X, 056X, or 057X or the claim will be returned to the provider.
- The line-item date of service of the line reporting Q5001, Q5002, or Q5009 must match the earliest dated HH visit line (revenue codes 042X, 043X, 044X, 055X, 056X, or 057X) on the claim or the claim will be returned to the provider.
- When more than one line on an HH PPS claim reports Q5001, Q5002, or Q5009, then the same HCPCS code must not be reported on consecutive dates or the claim will be returned to the provider.
- Claim lines reporting Q5001, Q5002, or Q5009 are not included in the visit counts passed to the HH Pricer, nor are they counted in medical policy parameters that count number of visits.
Revised 5/23/2024