Hospice Visit Reporting

Table of Contents

• Background
• Discipline Visits
• Reporting Visits in the Routine Home Care, Continuous Home Care and Inpatient Respite Care Levels of Care
  • Discipline Revenue and HCPCS Coding
  • Required Detail for each Discipline
  • Time Reporting Chart
  • Claim Page 2 Level of Care/Visit Reporting
• Reporting Visits in the GIP Level of Care
  • Site of Service HCPCS Codes
  • Discipline Revenue and HCPCS Coding
  • Required Detail for each Discipline
  • Time Reporting Chart
  • Claim Page 2 Level of Care/Visit Reporting
• Reporting GIP Visits in Hospice Inpatient Units
  • Site of Service HCPCS Codes
  • Discipline Revenue Coding
  • Required Detail for each Discipline
  • Claim Page 2 Level of Care/Visit Reporting
• Reporting Post Mortem Visits in All Levels of Care
• Related Content

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Background

Hospices are required to report the number of patient care visits provided to the beneficiary while delivering hospice care. The total number of patient care visits is to be reported by the discipline for each week at each location of service. These disciplines include registered nurse, nurse practitioner, licensed nurse, home health aide [also known as a hospice aide], social worker and physician or nurse practitioner serving as the beneficiary’s attending physician.  If visits are provided in multiple sites, a separate line for each site and for each discipline will be required. Charges for the reported discipline visits will be reported on the appropriate level of care line. If patient care visits in a particular discipline are not provided under a given level of care or service location, do not report a line for the corresponding revenue code. The total number of visits does not imply the total number of activities or interventions provide.

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Discipline Visits

To constitute a visit, the discipline, (as defined by the HCPCS code) must have provided care to the beneficiary. Services provided by a social worker to the beneficiary’s family or phone calls by the social worker also constitute a visit. Activities not related to the provisions of items or services to a beneficiary do not count towards a visit, for example, phone calls (other than a social worker), documentation in the medical/clinical record, interdisciplinary group meetings, obtaining physician orders, or rounds in a facility. In addition, the visit must be reasonable and necessary for the palliation and management of the terminal illness and related conditions as described in the patient’s plan of care.

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Reporting Visits in the Routine Home Care, Continuous Home Care and Inpatient Respite Care Levels of Care

For all RHC/CHC and inpatient respite care billing, report each visit performed by nurses, aides and social workers who are employed by the hospice and their associated time per visit in the number of 15-minute increments on a separate line. Do not report visit data for visits made by nonhospice staff providing respite care in contract facilities.

Additionally, report each RHC/CHC and respite visit performed by physical therapists, occupational therapists and speech-language therapists, and their associated time per visit in the number of 15-minute increments on a separate line. The following tables provide the coding and timing requirements.

Note: For claim dates of service prior to 1/1/2016 skilled nursing service for RNs, LPNs and LVNs are reported with a single HCPCS code G0154.

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Discipline Revenue and HCPCS Coding

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Required Detail for each Discipline

Units ‑ Time per visit (15-minute increments) *see time reporting chart

Charges ‑ Amount of charges for line item visit

Service Date ‑ Date the visit was provided

Note: When reporting physician services, the PHY SER field must be accompanied by a physician procedure code.

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Time Reporting Chart

Below is an example of the visit reporting for RHC, CHC, or inpatient respite care levels of care:

• The beneficiary was admitted to the Medicare hospice benefit on 1/4/20XX and revoked the benefit on 1/7/20XX. The beneficiary was in the RHC level of care in a private residence until revocation.

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Claim Page 2 Level of Care/Visit Reporting

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Reporting Visits in the GIP Level of Care

Reporting GIP Visits in SNFs and Hospitals

For GIP care provided to hospice patients in skilled nursing facilities (site of service HCPCS code Q5004) or in hospitals (site of service HCPCS codes Q5005, Q5007, Q5008), report each visit performed by hospice-employed nurses, aides, social workers, physical therapists, occupational therapists and speech-language therapists along with their associated time per visit in the number of 15-minute increments, on a separate line. This includes certain calls by hospice social workers. For all visit/call reporting, only report visits/calls by the paid hospice staff; do not report visits by nonhospice staff.

The following table provides the coding and timing requirements.

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Site of Service HCPCS Codes

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Discipline Revenue and HCPCS Coding

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Required Detail for each Discipline

Units ‑ Time per visit (15 minute increments) *see time reporting chart

Charges ‑ Amount of charges for line item visit

Service Date ‑ Date the visit was provided

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Time Reporting Chart

Below is an example of the visit reporting for GIP provided in SNFs and hospitals:

• The beneficiary was admitted to the GIP level of care at an acute hospital on 1/4/20XX and discharged on 1/5/20XX.

*Note: For claim dates of service prior to 1/1/2016 the skilled nursing visits by RNs, LPNs or LVNs are reported with G0154

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Claim Page 2 Level of Care/Visit Reporting

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Reporting GIP Visits in Hospice Inpatient Units

For GIP billing in hospice inpatient units, report the total number of visits performed by nurses, aides, and social workers who are employed by the hospice each week while in the GIP level of care. For each week, beginning on Sunday and ending on Saturday, indicate the number of services/visits provided by nurses (registered, licensed and/or nurse practitioner), aides, and social workers. The following tables provide the coding requirements.

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Site of Service HCPCS Codes

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Discipline Revenue Coding

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Required Detail for each Discipline

Units ‑ Total number of visits per week

Charges ‑ Amount of charges for visits per week

Service Date ‑ Earliest date visit was provided per week

Below is an example of the visit reporting for GIP provided in a hospice inpatient unit:

• The beneficiary was admitted to the GIP level of care at the hospice inpatient unit on 1/4/20XX and discharged on 1/6/20XX.

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Claim Page 2 Level of Care/Visit Reporting

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Reporting Postmortem Visits in All Levels of Care

Hospices must report visits and length of visits (rounded to the nearest 15-minute increment), for nurses, aides, social workers and therapists who are employed by the hospice, that occur on the date of death after the patient is pronounced, which is the official time of death as recorded on the pronouncement of death. The postmortem visits are reported with the PM modifier. This requirement is applicable for all levels of care (with the exception of GIP provided in a hospice inpatient facility*).

Due to system limitations with reporting services after the date of the death, postmortem visits occurring on a date subsequent to the date of death are not to be reported. For example, if the patient is pronounced at 11 p.m., only report postmortem visits that occur prior to 12 a.m. The reporting of postmortem visits on the date of death should occur regardless of the patient’s level of care or site of service.

If the patient passes away in the middle of the visit, the visit should be split to report the time of the visit prior to death and the time of the visit after death. For example, the nurse arrives at the home at 9 a.m. and leaves at 11 a.m. The patient is pronounced at 10 a.m. The time the patient was alive would be reported with four units (9 am – 10 am = 60 minutes) and the time after death would be reported with four units (10 a.m.‑11 a.m. = 60 minutes) along with the PM modifier.

*Note: Visit reporting for GIP in a hospice inpatient facility are reported by week and do not utilize the HCPCS G codes. Since line-item visit reporting is not applicable for GIP in a hospice inpatient facility (Q5006), post mortem visits cannot be reported.

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Related Content

• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims
• CMS IOM Publication 100-02, Medicare Claims Processing Manual, Chapter 9, Coverage of Hospice Services Under Hospital Insurance

Revised 6/11/2024