Day 3: Billing Codes
Home Health Medicare Billing Codes Sheet
Condition Codes (CC) (FL 18-28)
- 07 Treatment of nonterminal condition for hospice patient
- 20 Beneficiary requested billing (demand denial)
- 21 Billing for denial notice (no-pay bill)
- 47 Transfer from another HHA
- 54 No skilled HH visits in billing period.
- C3 Expedited review – partial approval of Medicare-covered services
- C4 Expedited review – services denied
- C7 Expedited review – extended authorization of Medicare-covered services
Claim Change Reason Codes (CCRC) (FL 18-28) & Adjustment Reason Codes (ARC) (FISS only)
NOTE: RAPs cannot be adjusted. If information must be changed on a processed RAP, it must be cancelled and resubmitted to Medicare.
Occurrence Codes (OC) (FL 31-34)
- 50 OASIS assessment completion date (OASIS item MO090) for start of care, resumption of care, recertification or other follow- up OASIS occurring most recently before the claim “From” date. Required on final claims with “From” dates of January 1, 2020.
- 61 The “Through” date of an acute care hospital discharge within 14 days prior to the “From” date of any home health claim. Optional on admission claims and continuing claims with “From” dates of January 1, 2020. (See Note below.)
- 62 The “Through” date of a SNF, IRF, LTCH, or IPF discharge within 14 days prior to the admission date of the first home health claim. Optional on admission claims with “From” dates of January 1, 2020. (See Note below.)
NOTE: If OC 61 and 62 are not present, Medicare systems will use inpatient claims history to assign Institutional payment groups based on the most current information.
Medicare Secondary Payer (MSP) Value Codes (VC) (FL 39-41)
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 – http://www.nubc.org.
Home Health Medicare Billing Codes Sheet
Value Code (FL 39-41)
- 61 CBSA code for where HH services were provided. CBSA codes are required on all 32X TOB.
Place “61” in the first value code field locator and the CBSA code in the dollar amount column followed by two zeros.
- 85 Federal Information Processing Standards (FIPS) State and County Code for what county the services were provided. FIPS codes are required on all 32X TOB.
Place “85” in the first value code field locator and the FIPS code in the dollar amount column followed by two zeros. The FIPS State and County codes are available at https://www.census.gov/geographies/reference-files/2017/demo/ popest/2017-fips.html.
Other value codes may be required when Medicare is the secondary payer. See the Medicare Secondary Payer (MSP) Web page for more information: https://www. cgsmedicare.com/hhh/education/materials/MSP.html
CMS Pub. 100-04, Chapter 10 http://www.cms.gov/Regulations-and-Guidance/ Guidance/Manuals/Downloads/clm104c10.pdf
* For revenue codes ending in an “X”, sub-classifications exist. Use a “0” to indicate general classification when the subclassifications are not appropriate.
FISS Fields and UB-04 Field Locators (FL) for Home Health Billing
1 Required for DDE
2 Adjustments & cancels only
3 Value code 61 and CBSA code required. Effective 1.1.2019 value code 85 and FIPS code required.
4 Rev codes 0023 & 0001 required on RAPs& final claims
5 Required when Medicare is not the primary payer
6 Enter the Claims-OASIS Matching Key code on the TREAT AUTH CODE line that reflects Medicare’s payer status (primary, secondary, or tertiary)
7 For episodes beginning on/after 7/1/14, if different than the ATT PHYS
Common Home Health Billing Errors by Reason Code (RC)
(When RAP/claim is in FISS status/location (S/LOC) T B9997 or R B9997)
- 31018 If billing > 60 days, status code must be other than 30 https://www.cgsmedicare.com/medicare_dynamic/j15/j15hhh_ reasoncodes/j15hhh_reasoncodes.aspx?31018
- 38107 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 date matches between RAP and claim for same episode https://www. cgsmedicare.com//medicare_dynamic/j15/j15hhh_reasoncodes/j15hhh_ reasoncodes.aspx?38107
38200 Duplicate billing transaction; adjust or cancel claim or RAP instead of resubmitting
- U538I Enter condition code 47 to indicate transfer between HHAs https://www.cgsmedicare.com/medicare_dynamic/j15/j15hhh_ reasoncodes/j15hhh_reasoncodes.aspx?U538i