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Home Health Rural Add-on Payments Based on County of Residence

CR10782 and MM10782, implemented 1/7/2019, changes the home health rural add-on payments effective 1/1/2019. The county-based increase applies to all episodes and visits ending on or after 1/1/2019.

All RAPs and home health claims, TOBs 032x, received on or after 1/1/2019, for home health services furnished on or after 1/1/2019, must contain the new coding as required by the BBA of 2018. This includes nonrural HHAs who are not affected by rural add-on payments.

The CR establishes VC 85 and an associated FIPS State and County Code. The new VC 85 is defined as "County Where Service is Rendered." You can find the FIPS State and County Codes using either of the following links:

HHAs should use the most recent list provided for the associated FIPS State and County Codes. When entering the FIPS State and County Code, the number would be keyed, followed by two zeros. For example, 19153 would be keyed as 1915300 or 19153.00.

If the new codes are missing on rural HHA's RAPs, final claims (end of episode) and/or adjustments, they will be returned to the provider. If the new codes are missing for nonrural HHAs, the claim will process without them. Whether the Medicare claim processing system edits for billing requirements or not, proper billing is still a requirement.

Make sure your billing staffs are aware of these changes.

Note: In addition to VC 85, the CBSA code reported with VC 61 continues to be required on all home health RAPs and claims.

Posted 2/11/2019

Last Modified: 2/11/19
Home Health Rural Add-on Payments Based on County of Residence
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