Hospice Billing

Hospice Billing Codes Chart

Table of Contents

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Hospice Billing Codes Chart

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 on the NUBC website.

Note: This chart does not include MSP codes. Additional information on MSP codes can be found in the Medicare Secondary Payer section on our website.

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Condition Codes (CC) (UB-04 FL 18-28)

Code Title Description
20 Beneficiary Requested Billing Code indicates the provider realizes the services on this bill are at a noncovered level of care or otherwise excluded from coverage, but the beneficiary has requested a formal determination.
21 Billing for Denial Notice Code indicates the provider realizes services are at a noncovered level of care or excluded, but requests a denial notice from Medicare in order to bill Medicaid or other insurers.
52 Out of Hospice Service Area Code indicates the patient is discharged for moving out of the hospice service area. This can include patients who relocate or who go on vacation outside of the hospice’s service area, or patients who are admitted to a hospital or SNF that does not have contractual arrangements with the hospice.
85 Delayed Recertification of Hospice Terminal Illness Effective for claims received on or after 1/1/2017, and is defined "Delayed recertification of hospice terminal illness. Must use with OSC 77 when the physician recertification is untimely. This code is not used with OSC 77 when used to indicate an untimely NOE.
H2 Discharge by a Hospice Provider for Cause Used by the provider to indicate the patient meets the hospice’s documented policy addressing discharges for cause. Results only in the discharge from the provider’s care, not from the hospice benefit.

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Occurrence Codes (OC) and Dates (UB-04 FLs 31-34)

Code Title Description
27* Date of Hospice Certification or Re-Certification Code indicates the date of certification or re-certification of the hospice benefit period, beginning with the first 2 initial benefit periods of 90 days each and the subsequent 60-day benefit periods. This code is reported on the claim for the billing period in which the certification or re-certification was obtained.
42 Date of Termination of Hospice Benefit Code indicates the date on which the beneficiary terminated his/her election to receive hospice benefits. This code can be used only when the beneficiary has revoked the benefit.
55 Date of death Code and date of death is required when the patient discharge status code indicates death (40-expired at home, 41-expired at medical facility, or 42-expired place unknown).
* *More information on the appropriate reporting of OC 27 can be found on our website under U5181 in the Top Claim Errors and in the Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 job aid.

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Occurrence Span Code and Date (UB-04 FLs 35-36)

Code Title Description
77* Provider Liability –Utilization Charged Code indicates From/Through dates for a period of non-covered hospice care for which the provider accepts payment liability (other than for medical necessity or custodial care).
M2** Dates of Inpatient Respite Care Code indicates From/Through dates of a period of inpatient respite care for hospice patients to differentiate separate respite periods of less than five days each. M2 is used when respite care is provided more than once during a billing period.
*More information on the appropriate reporting of OSC 77 can be found on our website under U5181 in the Top Claim Errors and in the Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77 job aid.
**More information on the appropriate reporting of OSC M2 can be found on our website in the Hospice Levels of Care: Inpatient Respite Care Job Aid.

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Value Codes (VCs) and CBSA (UB-04 FLs 39-41)

Code Title Description
61 Place of Residence where Service is Furnished (Routine Home Care and Continuous Home Care)
  • Core-based Statistical Area (CBSA) number of the location where the hospice service is delivered
  • Hospices must report value code 61 when billing revenue codes 0651 and 0652
G8 Facility where Inpatient Hospice Service is Delivered (General Inpatient and Inpatient Respite Care)
  • CBSA number of the facility where inpatient hospice services are delivered
  • Hospices must report value code G8 when billing revenue codes 0655 and 0656

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Level of Care Revenue Codes (RCs) UB-04 FLs 42-43)

Code Title Description
0651 Routine Home Care (RHC) The hospice is paid the routine home care rate for each day the patient is under the care of the hospice and not receiving one of the other categories of hospice care. This rate is paid without regard to the volume or intensity of routine home care services provided on any given day, and is also paid when the patient is receiving outpatient hospital care for a condition unrelated to the terminal condition.
0652 Continuous Home Care (CHC) Continuous home care is to be provided only during periods of crisis to maintain the beneficiary at home. A period of crisis is a period of time when the beneficiary requires the higher level of “continuous care” for at least eight hours in a 24-hour period (midnight to midnight) to achieve palliation or management of acute medical symptoms. The care does not have to be “continuous” to qualify, but must total eight hours or more of care within the 24 hour period. The care can be provided by a RN, LPN and home health aide. However, more than 50 percent of the total care provided must be provided by a nurse.
0655 Inpatient Respite Care The hospice is paid at the inpatient respite care rate for each day on which the beneficiary is in an approved inpatient facility and is receiving respite care. Payment for respite care may be made for a maximum of five continuous days at a time including the date of admission but not counting the date of discharge. Payment for the sixth and any subsequent days is to be made at the routine home care rate. More than one respite period (of no more than five days each) is allowable in a single billing period. If the beneficiary dies under inpatient respite care, the day of death is paid at the inpatient respite care rate.
0656 General Inpatient Care (GIP) Payment at the inpatient rate is made when general inpatient care is provided. General inpatient care is provided when hospice beneficiaries are in need of pain control or symptom management that cannot be provided in any other setting.

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Prescription Drug/Infusion Pump Revenue Codes (RCs) (UB-04 FLs 42-43)

Code Title Description
0250 Noninjectable Prescription Drug Report on a line-item basis per fill, along with NDC.
029X Infusion Pump Report on the claim on a line-item basis per pump order for the equipment.
0294 Infusion Pump Drug Report on the claim on a line-item basis per medication fill for the drugs along with the appropriate HCPCS code.
0636 Injectable Prescription Drug Report on a line-item basis per fill along with the appropriate HCPCS code.

 

Revised 5/23/2024