- Avoiding Reason Code 38200
- Correcting Reason Code 37253
- Reason Code 39929
- Influenza and Pneumonia Vaccinations in the Home Health and/or Hospice Setting
- Certification or Recertification of Medicare Covered Home Health Services
- Billing the Home Health Period of Care Claim - PDGM
- Disposable Negative Pressure Wound Therapy Services Under Home Health
- MLN Matters® 11855 Request for Anticipated Payment Submission Frequently Asked Questions
- Home Health Prospective Payment System Booklet
- Home Health Third Party Liability Demand Billing
- Home Health Demand Billing
- Counting 60-Day Episodes
- Notice of Admission Questions and Answers
- Home Health Patient-Driven Groupings Model (PDGM) FAQs
- Billing the Home Health Notice of Admission Electronically
- Billing the Home Health Notice of Admission via DDE
- Home Health Requests for Anticipated Payment
- Home Health Transfers
- Home Health Agency Transfer and Dispute Protocol
- Late Notice of Admission - The Exception Process
- Reporting Home Health Episodes with No Skilled Visits
- Telehealth Home Health Services: New G-Codes
- Reporting Site of Service Codes for Home Health Care
- PDGM Resources
- Billing G-Codes for Therapy and Skilled Nursing Services
- Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment
- Correcting and Avoiding Reason Code C7080: Inpatient Overlap
- Completing the Advance Beneficiary Notice for Home Health Agency Demand Claims
- Correcting and Avoiding Reason Code C7010: Overlap With a Hospice Election Period
- The Medicare Home Infusion Therapy Benefit and Home Health Agencies
- Home Health Therapy Billing
- Home Health Billing When a New MBI is Assigned
- Correcting and Avoiding Overlap Reason Codes
- 30-Day Home Health Therapy Reassessment Schedule
Reporting Site of Service Codes for Home Health Care
HH PPS claims are paid a standardized 60-day episode rate that includes delivery of service under six home health disciplines: home health aides, medical social services, occupational therapy, physical therapy, skilled nursing care and speech-language pathology.
In order for Medicare to accurately capture where home health services are provided, HHAs are required to report the location of services on the final episode claim for episodes beginning on or after 7/1/2013.
Provider Action Steps
HHAs should report one of the following three HCPCS site of service codes on every final episode claim: Q5001, Q5002 or Q5009.
The site of service Q-code needs to be reported with the first billable service on the home health final episode claim. The revenue line with the Q-code should use the same revenue code and date of service as the first billable service, one unit, and a nominal charge (e.g., a penny). If the location where services were provided changes during the episode, the new location should be reported with an additional line corresponding to the first visit provided in the new location.
The table below lists the definitions of the Q-codes HHAs are required to report:
| HCPCS Code | Definition |
|---|---|
| Q5001 | Hospice or Home Health Care Provided in Patient's Home/Residence |
| Q5002 | Hospice Or Home Health Care Provided In Assisted LivingFacility |
| Q5009 | Hospice Or Home Health Care Provided In Place Not Otherwise Specified (NOS) |
Example: Home health episode begins 7/15/2013. The first billable service in the episode is a nursing visit at the patient’s home/residence. The site of service code is billed as follows:
| Revenue Code | HCPCS Code | Units | Total Charge | Service Date |
|---|---|---|---|---|
| 0551 | G0163 | 4 | 150.00 | 071513 |
| 0551 | Q5001 | 1 | .01 | 071513 |
Example with location change: Home health episode begins 7/15/2013. The first billable service in the episode is a nursing visit in the patient’s home/residence. The patient moves to an assisted living facility and has a therapy visit on 8/17/2013. The site of service code(s) are billed as follows:
| Revenue Code | HCPCS Code | Units | Total Charge | Service Date |
|---|---|---|---|---|
| 0551 | G0163 | 4 | 150.00 | 071513 |
| 0551 | Q5001 | 1 | .01 | 071513 |
| 0421 | G0157 | 3 | 125.00 | 081713 |
| 0421 | Q5002 | 1 | .01 | 081713 |
Notes on billing requirements:
- HCPCS site of service codes Q5001, Q5002, or Q5009 must be reported on HH PPS claims containing revenue code: 042X, 043X, 044X, 055X, 056X, or 057X or the claim will be returned to the provider.
- The line item date of service of the line reporting Q5001, Q5002, or Q5009 must match the earliest dated HH visit line (revenue codes 042X, 043X, 044X, 055X, 056X, or 057X) on the claim or the claim will be returned to the provider.
- When more than one line on an HH PPS claim reports Q5001, Q5002, or Q5009, then the same HCPCS code must not be reported on consecutive dates or the claim will be returned to the provider.
- Claim lines reporting Q5001, Q5002, or Q5009 are not included in the visit counts passed to the HH Pricer, nor are they counted in medical policy parameters that count number of visits.