- 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
Hospice Site of Service Codes
Table of Contents
Hospice Site of Service Codes
Hospice agencies must report an HCPCS site of service location code along with each level of care revenue code to identify the type of service location where that level of care was provided.
If care is rendered at multiple locations, each location is to be identified on the claim with a corresponding HCPCS code. For example, routine home care may be provided for a portion of the billing period in the patient's residence and another portion in an assisted living facility. In this case, report one Revenue Code 651 (routine home care) line with HCPCS code Q5001 and the number of days of routine home care provided in the residence and another Revenue Code 651 (routine home care) line with HCPCS code Q5002 and the number of days of routine home care provided in the assisted living facility.
The HCPCS site of service location codes are listed in the table below.
HCPCS Codes
The HCPCS site of service location codes are listed in the table below.
| Code | Description |
|---|---|
| Q5001 | Hospice care provided in patient's home/residence |
| Q5002 | Hospice care provided in assisted living facility |
| Q5003 | Hospice care provided in nursing long term care facility (LTC) or non-skilled nursing facility (NF) |
| Q5004 | Hospice care provided in skilled nursing facility (SNF) |
| Q5005 | Hospice care provided in inpatient hospital |
| Q5006 | Hospice care provided in inpatient hospice facility |
| Q5007 | Hospice care provided in long term care hospital (LTCH) |
| Q5008 | Hospice care provided in inpatient psychiatric facility |
| Q5009 | Hospice care provided in place not otherwise specified (NOS) |
| Q5010 | Hospice home care provided in a hospice facility |
Site of Service Location Notes
Q5001 is reported for hospice care provided in a private residence (e.g., house, apartment, town house). Do not use Q5001 for congregate living situations (e.g., group home) (see Q5009). Do not use Q5001 for nursing facility residents (see Q5003/Q5004).
Q5002 is reported for hospice care provided in an assisted living facility. Do not report Q5002 for nursing facility residents (see Q5003/Q5004).
Q5003 is to be used for hospice patients in an unskilled NF or hospice patients in the NF portion of a dually certified nursing facility, who are receiving unskilled care from the facility staff. Do not report Q5003 for patients in a SNF or in a SNF portion of a dually certified nursing facility (see Q5004).
Q5004 is to be used for hospice patients in a SNF, or hospice patients in the SNF portion of a dually certified nursing facility. There are 4 situations where this would occur:
- If the beneficiary is receiving hospice care in a solely-certified SNF.
- If the beneficiary is receiving general inpatient care in the SNF.
- If the beneficiary is in a SNF receiving SNF care under the Medicare SNF benefit for a condition unrelated to the terminal illness and related conditions, and is receiving hospice routine home care; this is uncommon.
- If the beneficiary is receiving inpatient respite care in a SNF.
Do not report Q5004 for patients in an unskilled NF or patients in a NF portion of a dually certified nursing facility. If a beneficiary is in a NF but doesn’t meet the criteria above for Q5004, report Q5003, for a long term care nursing facility.
Note: Some facilities are dually certified as a SNF and a NF; the hospice will have to determine what level of care the facility staff is providing (skilled or unskilled) in deciding which type of bed the patient is in, and therefore which code to use. When a patient is in the NF portion of a dually certified nursing facility, and receiving only unskilled care from the facility staff, Q5003 should be reported. Note that GIP that is provided in a nursing facility can only be given in a SNF, because GIP requires a skilled level of care.
Q5005 is reported for the hospice care provided in the acute care hospital.
Q5006 is reported for the GIP or respite care provided in the inpatient hospice facility. Do not report Q5006 when RHC or CHC is provided at a hospice facility (see Q5010).
Q5007 is reported for hospice care provided in a long term care hospital.
Q5008 is reported for hospice care provided in an inpatient psychiatric facility.
Q5009 is reported for the hospice care provided in locations which are not already spelled out in one of the other site of service codes. For example, Q5009 would be used for patients in congregate living facilities (e.g., group home) or for those patients who are homeless.
Q5010 is reported for the when RHC or CHC is provided at a hospice residential facility or a hospice facility which is also certified to provide inpatient care. Do not report Q5010 when GIP or respite care is provided in the hospice facility (see Q5006).
Edits
Hospice claims submitted for services provided in non-covered settings will RTP. Claims will not be paid if the following level of care codes are reported with the site of service codes listed below.
GIP level of care (revenue code 0656): Claims for GIP days will RTP if the following HCPCS site of service location codes are reported on the same line:
- Q5001 (Patient's home/residence)
- Q5002 (Assisted living facility)
- Q5003 (Nursing LTC facility of non-SNF)
- Q5010 (Hospice home care)
Respite level of care (revenue code 0655): Claims for respite days will RTP if the following HCPCS site of service location codes are reported on the same line:
- Q5001 (Patient's home/residence)
- Q5002 (Assisted living facility)
- Q5010 (Hospice home care)
CHC level of care (revenue code 0652): Claims for CHC days will RTP if the following HCPCS site of service location codes are reported on the same line:
- Q5004 (Skilled nursing facility)
- Q5005 (Inpatient hospital)
- Q5006 (Inpatient hospice)
- Q5007 (LTC hospital)
- Q5008 (Inpatient psychiatric facility)
Related Content
- CR 8877: Hospice Manual Update for Diagnosis Reporting and Filing Hospice Notice of Election (NOE) and Termination or Revocation of Election. This CR rescinds and fully replaces CR 8777
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Coverage of Hospice Services Under Hospital Insurance
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims
Reviewed 5/20/2024