- 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
Billing Medicare for a Denial - Condition Code 21
Medicare will not pay for services excluded by statute. For claims submitted to Medicare, these excluded services that are not a Medicare benefit may be:
- Not submitted to Medicare at all
- Submitted as a noncovered line item, or
- Submitted on an entirely noncovered claim
To submit statutory exclusions as noncovered line items on claims with other covered services, modifier GY- can be appended on the noncovered line items. To submit statutory exclusions on entirely noncovered claims, use the condition code 21, a claim-level code, signifying that all charges that are submitted on the claim are noncovered charges.
Condition code 21 can also be used to indicate a no payment claim is being submitted at a beneficiary’s request, or other insurer’s request, to obtain a denial from Medicare in order to receive payment from another insurer. These no-payment claims are referred to as “billing for denial” when they are submitted with the condition code 21 (billing for denial notice).
Submit the condition code 21 claim as follows:
- All charges must be submitted as noncovered
- No modifiers that signify beneficiary/provider liability are necessary
- The 3rd position of the type of bill must be zero
- Total charges must be noncovered
- All basic required claim elements must be completed
Nocovered charges on these claims will be denied. The Medicare beneficiary will be liable for these claims.
Note that the no-payment bill that is submitted using the condition code 21 is only used for services that are not in dispute, as opposed to noncovered charges that are submitted on a demand bill (condition code 20).
Providers may reference the CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 60.1.3 for more information.