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Home Health Medicare Billing Codes Sheet

322 Request for Anticipated Payment 329 Final Claim for Episode (RAP) 327 Adjustment Claim 320 Nonpayment Claim 328 Void/Cancel Prior RAP/Claim 34X Outpatient Services 3XG or 3XI Contractor adjustment CMS Pub. 100-04, Chapter 10

* FISS will automatically change the 2nd digit of HH PPS TOBs from 2 to 3, if required. Example: 329 to 339

Type of Bill (TOB)* (FL 4)

1 2 3

Emergency Urgent Elective

Priority (Type) of Admission or Visit Codes (FL 14)

4 5 9 Newborn Trauma Information not available

Point of Origin (formerly Source of Admission Codes) (FL 15)

1 2 4 5 6 Non-Health Care Facility Point of Origin Clinic or Physician's Office Transfer from Hospital (Different Facility) Transfer from Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) Transfer from Another Health Care Facility 7 8 9 B C

Emergency Room (ER) (discontinued effective 07/01/2010) Court/Law Enforcement Information not available Transfer from Another HHA (cannot be submitted on home health RAPs/claims when "FROM" date is on/after 07/01/2010) Readmission to Same HHA (cannot be submitted on home health RAPs/claims when "FROM" date is on/after 07/01/2010)

Description

Claim Change Reason Codes (CCRC) (FL 18-28) & Adjustment Reason Codes (ARC) (FISS only)

CCRC D0 D1 D2 D5 D6 D7 D8 D9 E0 ARC RF RG RH RI RJ RK RL RM RN

TOB 3X7 3X7 3X7 3X8 3X8 3X7 3X7 3X7 3X7

Changes in Service Dates Changes to Charges Changes in revenue/HCPC/HIPPS codes Cancel to correct provider/HIC # Cancel duplicate or OIG payment Change to make Medicare secondary Change to make Medicare primary Any other/multiple change (s) Change in patient status

Description Working Aged ESRD No Fault (no attorney involved) Worker's Compensation

Medicare Secondary Payer (MSP) Value Codes (VC) (FL 39-41) & Payer Codes (PC) (FISS only)

VC 12 13 14 15 16 PC N/A N/A N/A N/A N/A Description Black Lung Disabled Veteran's Administration Conditional Payment Medicare

NOTE: RAPs cannot be adjusted. If information must be changed on a processed RAP, it must be cancelled and resubmitted to Medicare.

Public Health Svc/Other Federal CMS Pub. 100-05, Chapter 3

VC 41 43 42 Any of the above

PC N/A N/A N/A C Z

NOTE: Medicare does not make secondary payer payments on RAPs. Submit RAPs with Medicare as primary.

Core Based Statistical Area (CBSA) Value Code (FL 39-41)

61 CBSA code for where HH services were provided. CBSA codes are required on all 32X and 33X TOB. Place "61" in the first value code field locator and the CBSA code in the dollar amount column followed by two zeros. Other value codes may be required when Medicare is the secondary payer.

CMS Pub. 100-04, Chapter 10

Note: The codes listed on this billing codes sheet represent those most frequently submitted on home health RAPs/claims. A complete listing of all codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual - www.nubc.org

Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited.

CGS Administrators LLC

June 2011 · H-008-01

Home Health Medicare Billing Codes Sheet

01 02 03 04 05 06 Discharge to home or self-care (routine discharge) Discharge/transfer to short-term general hospital Discharge/transfer to SNF Discharge/transfer to ICF Discharge to designated cancer center or children's hospital Discharge/transfer to home care of another HHA OR discharge and readmit to the same HHA within a 60day episode Left against medical advice or discontinued care Expired Discharge/transfer to court/law enforcement Still a beneficiary. Services continue to be provided

Patient Status Codes (FL 17)

43 50 51 61 62 63

Discharge/transfer to federal hospital Discharge/transfer for hospice services in the home Discharge/transfer to hospice services in a medical facility Discharge/transfer to hospitalbased Medicare approved swing bed Discharge/transfer to IRF (inpatient rehabilitation facility) Discharge/transfer to long-term care hospital Discharge/transfer to Medicaid certified, but non-Medicare certified nursing facility Discharge/transfer to psychiatric hospital or psychiatric part unit of a hospital Discharge/transfer to Critical Access Hospital (CAH) Discharge/transfer to another type of health care institution not defined elsewhere in code list

Rev Code 0001 0023

Common Revenue Codes (FL 42) and HCPCS/Rates/HIPPS Rate Codes (FL 44)

Definition Total units/charges HIPPS code HCPCS N/A As assigned by Grouper software N/A unless 0274 Varied Varied Varied Varied G0155 G0156 N/A Comments No HCPCS required with revenue code See CMS Coding and Billing Information Web page for more information HCPCS required when submitting revenue code 0274 (Prosthetic/Orthotic devices) ­ See CPT coding book for appropriate HCPCs code. See Medicare Learning Network (MLN) article, MM7182 for more information. See Medicare Learning Network (MLN) article, MM7182 for more information. See Medicare Learning Network (MLN) article, MM7182 for more information. See Medicare Learning Network (MLN) article, MM7182 for more information. Optional Use: When HHAs choose to report additional breakdown for surgical/wound care dressings.

027X 042X 043X 044X 055X 056X 057X 062X

Medical/Surgical Supplies Physical Therapy Occupational Therapy Speech Language Pathology Skilled Nursing Medical Social Services Home Health Aide Medical/Surgical Supplies

07 20 21 30*

64 65 66 70

* For revenue codes ending in an "X", sub-classifications exist. Use a "0" to indicate general classification when the subclassifications are not appropriate.

CMS Pub. 100-04, Chapter 10

* Required on RAPs

RC 31018 31755 38107

(When RAP/claim is in FISS status/location (S/LOC) T B9997 or R B9997) Resolution RC Resolution If 5th position of HIPPS code is a letter, non-routine supplies must be submitted on the If billing > 60 days, status code must be other than 30 31147 claim The service date of a visit must match the service date billed with 38157, Duplicate billing transaction; adjust or cancel claim or RAP instead of resubmitting revenue code 0023 38200 Re-bill RAP if auto-cancel AND ensure RAP is in P B9997 AND ensure "FROM" date, "ADMIT" date, first 4 position of HIPPS code, and 0023 U538I Enter condition code 47 to indicate transfer between HHAs date matches between RAP and claim for same episode

CGS Administrators LLC

Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited. June 2011 · H-008-01

Common Home Health Billing Errors by Reason Code (RC)

Home Health Medicare Billing Codes Sheet

FISS Fields and UB-04 Field Locators (FL) for Home Health Billing

R = required

FISS Pg 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2

1 2 4 5 6

C = conditional

RAP R R R1 O R R R R R R R R R R R2 R R R C N N R1 N R4 R5 R N N N N N R6 Claims R R R1 O R R R R R R R R R R R2 R R R C C C R1 C3 R4 R R C R R R C R

N = not required

FISS Pg 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 5 5 5 5 5 5 5 5

7 8

O = optional

UB FL 50 50 52 3b 67 76 76 76 76 77 77 77 77 77 77 77 77 80 58 N/A N/A 59 60 61 62 63 Data Entered Payer code Payer name Release of information Medical Record Number Diagnosis codes Primary care physician's NPI Primary physician's last name Primary physician's first name Primary physician's middle initial Operating physician's NPI Operating physician's last name Operating physician's first name Operating physician's middle initial Other physician's NPI Other physician's last name Other physician's first name Other physician's middle initial Remarks (adjustments, cancels, demand/no-pay bills, MSP) Insured's last name, first name Insured's sex code Insured's date of birth Patient's relationship Insured's ID/HIC# Insurance group name Insurance group number Claim-OASIS Matching Key code RAP R R R O R R R R O C C C O C C C O C N N N N N N N R Claims R R R O R R R R O C C C O C C C O C C7 C7 C7 C7 C7 C7 C7 R8

FISS Field Name HIC TOB NPI PAT. CNTL # STMT DATE FROM TO LAST FIRST DOB ADDR1 ADDR 2 ZIP SEX ADMIT DATE HR TYPE SRC STAT COND CODES OCC DCS/DATE SPAN CODES/DATES FAC ZIP DCN VALUE CODES REV HCPC MODIFS TOT UNIT COV UNIT TOT CHARGES NCOV CHARGES SERV DATE

UB FL 60 4 56 3a 6 6 8 8 10 9 9 9 11 12 13 14 15 17 18-28 31-34 35-36 1 64 39-41 42 44 44 46 46 47 48 45

Data Entered Medicare (HIC) number Type of Bill NPI number Patient Control Number From date of service To date of service Patient's last name Patient's first name Patient's date of birth Patient's address City State Zip code Gender (M or F) Date of admission Admission hour Admission type or visit Source of admission Patient status Condition codes Occurrence code(s)/date(s) Occurrence span code(s)/date(s) Zip code for provider or subpart Document control number Value codes Revenue codes HCPCS Modifiers Total Units Covered Units Total charges Noncovered charges Service Date

FISS Field Name CD PAYER RI MEDICAL RECORD NBR DIAG CODES ATT PHYS NPI LN FN MI OPR PHYS NPI LN FN MI OTH PHYS NPI LN FN MI REMARKS INSURED NAME SEX DOB REL CERT-SSN-HIC GROUP NAME GROUP NUMBER TREAT AUTH CODE

Required when Medicare is not the primary payer Enter the Claims-OASIS Matching Key code on the TREAT AUTH CODE line that reflects Medicare's payer status (primary, secondary or tertiary).

Web Site References

NPI & FAC ZIP required effective 1/1/2008. 3 Adjustments & cancels only Required for DDE Value code 61 and CBSA code required Rev codes 0023 and 0001 required on RAPs & final claim RAPs require the 1st covered, Medicare billable service date along with revenue code 0023 & the HIPPS code

Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited.

Internet Only Manuals ­ Pub. 100-02, Chapter 7 & Pub. 100-04, Chapter 10 www.cms.gov/Manuals/ Home Health Agency (HHA) Center www.cms.gov/center/hha.asp

CGS Administrators LLC

June 2011 · H-008-01

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