- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Claim Reporting Requirements for Attending and Certifying Physicians
- 17729 Hospice Claim Edit for Certifying Physicians
- Billing Hospice Transfers
- Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Hospice Claim Submission Job Aid
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Canceling a Hospice Notice of Election
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
Medicare Hospice Quick Reference Sheet
The codes listed below are only those most frequently applicable to hospice claims. For a complete list of codes, see the NUBC manual. The NUBC maintains the UB-04 data element specifications and revenue code tables. They may be contacted for subscription to the UB-04 at the NUBC website.
Table of Contents
- Type of Bill for Hospice (FL4)
- Claim Change Reason Code (FL 18-28) and Adjustment Reason Code
- Patient Status Codes (LF17) as of “To” date on claim
- Occurrence Codes (FL 31-34)
- Condition Codes (FL 18-28)
- Occurrence Span Codes (FL 35-36)
- Level of Care Revenue Codes (RCs) (UB-04 FLs 42-43)
- Visit (Discipline) HCPCS Code Reporting (UB-04 FL 44)
- Modifiers (UB-04 FL 44)
- Related Content
Type of Bill for Hospice (FL4)
| X=1 non hospital based | X=2 hospital based | ||
|---|---|---|---|
| 8XA | Notice of Election (NOE) | 8X3 | Continuing claim (interim) |
| 8XB | Notice of Termination/Revocation (NOTR) | 8X4 | Discharge claim (final) |
| 8XC | Change of hospice (transfer) | 8X7 | Adjustment claim |
| 8XD | Cancel NOE | 8X8 | Cancel claim |
| 8X0 | Nonpayment claim | ||
| 8X1 | Admit thru discharge (in the same month) | 8XH | CERT Adjusted Claim |
| 8X2 | First claim in the series (Interim) | ||
Claim Change Reason Code (FL 18-28) and Adjustment Reason Code
| Description | CCRC | ARC | TOB |
|---|---|---|---|
| Change in dates of service | D0 | RF | 8X7 |
| Change in charges | D1 | RG | 8X7 |
| Change in revenue HCPCS code | D2 | RH | 8X7 |
| Cancel to correct provider #/HICN | D5 | RI | 8X8 |
| Cancel duplicate or OIG payment | D6 | RJ | 8X8 |
| Any other multiple changes(s) | D9 | RM | 8X7 |
| Change in patient status | E0 | RN | 8X7 |
Patient Status Codes (LF17) as of “To” date on claim
| Code | Description |
|---|---|
| 01 | Discharged to home/self-care |
| 30 | Still a patient or exp. To return for OP services |
| 40 | Expired at home-hospice only |
| 41 | Expired in medical facility- hospice only |
| 42 | Expired place unknown- hospice only |
| 50 | Transferred to hospice home |
| 51 | Transferred to hospice medical facility |
Occurrence Codes (FL 31-34)
| Code | Description |
|---|---|
| 27 | Date of certification or recertification |
| 42 | Date of revocation (ONLY) |
| 55 | Date of death (when patient status = 40, 41, 42) |
Condition Codes (FL 18-28)
| Code | Description |
|---|---|
| H2 | Discharge for cause (i.e. patient/staff safety) |
| 52 | Discharge for patient unavailability, in ability to receive care, or out of service area |
| 85 | Effective for claims received on or after 1/1/2017. This code indicates the hospice received the recertification of terminal illness later than 2 days after the first day of a new benefit period. This code is reported with OSC 77, which reports the provider liable days associated with the untimely recertification. |
Occurrence Span Codes (FL 35-36)
| Code | Description |
|---|---|
| 77 | Noncovered days due to untimely recertification or untimely NOE |
| M2 | Multiple respite stays, From/To dates of each stay |
Level of Care Revenue Codes (RCs) (UB-04 FLs 42-43)
| Level of Care Reporting | HCPCS Place of Service | ||
|---|---|---|---|
| Level of Care | Revenue Code | Acceptable Site of Service Codes | Q5001 – Patient’s home/residence Q5002 - Assisted living Q5003 – LTC or nonskilled NF (receiving unskilled care) Q5004 – Skilled nursing facility (receiving skilled care) Q5005 – Inpatient hospital Q5006 – Inpatient hospice facility Q5007 – Long term care hospital Q5008 – Inpatient psychiatric facility Q5009 – Place not otherwise specified Q5010 – Hospice residential facility |
| Routine Home Care (RHC) | 0651 | Q5001-Q5010 | |
| Continuous Home Care | 0652 | Q5001-Q5003, Q5009, Q5010 | |
| Respite Care | 0655 | Q5003- Q5009 | |
| General Inpatient Care | 0656 | Q5004-Q5009 | |
Visit (Discipline) HCPCS Code Reporting (UB-04 FL 44)
| Discipline Visit Description | Revenue Code | HCPCS Codes | Description |
|---|---|---|---|
| Physical therapy | 042X | G0151 | Services of a physical therapist in home health or hospice settings, each 15 minutes |
| Occupational therapy | 043X | G0152 | Services of an occupational therapist in home health or hospice settings, each 15 minutes |
| Speech language pathology | 044X | G0153 | Services of a speech and language pathologist in home health or hospice settings, each 15 minutes |
| Skilled nursing | 055X | G0299 | Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes |
| Skilled nursing | 055X | G0300 | Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes |
| Medical social service (visit) | 056X | G0155 | Services of clinical social worker in home health or hospice setting, each 15 minutes |
| Medical social service (phone call) | 056X | G0155 | Services of clinical social worker in home health or hospice setting, each 15 minutes |
| Home health aide | 057X | G0156 | Services of home health/hospice aide in home health or hospice settings, each 15 minutes |
Modifiers (UB-04 FL 44)
| Modifier | Description | Reference |
|---|---|---|
| KX | Modifier is reported when requesting an exception to the Notice of Election (NOE) timely filing requirements | More information on appropriate use of the KX modifier can be found on our website in the Notice of Election: Timely Filing of Hospice Elections Job Aid. |
| PM | Modifier is reported with the visit HCPCS codes when visits occur on the date of death, after the patient has passed away. Post mortem visits occurring on a date subsequent to the date of death shall not be reported. | More information on the appropriate reporting of the post mortem modifier can be found on our website in the current version of the Hospice Change Request 8358 Questions and Answers. |
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims, Sections 20.1.2 and 30.3
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 9 Coverage of Hospice Services Under Hospital Insurance
Reviewed 5/20/2024