Hospice Billing

Hospice Visit Reporting

Table of Contents

[Return to Top]

Background

Effective on claims with dates of service on or after 7/1/2008, hospices must report the number of patient care visits that were provided to the beneficiary in the course of delivering hospice care. The total number of patient care visits is to be reported by the discipline (registered nurse, nurse practitioner, licensed nurse, home health aide [also known as a hospice aide], social worker, physician or nurse practitioner serving as the beneficiary’s attending physician) for each week at each location of service. If visits are provided in multiple sites, a separate line for each site and for each discipline will be required. Charges for the reported discipline visits will be reported on the appropriate level of care line. If patient care visits in a particular discipline are not provided under a given level of care or service location, do not report a line for the corresponding revenue code. The total number of visits does not imply the total number of activities or interventions provide.

[Return to Top]

Discipline Visits

To constitute a visit, the discipline, (as defined by the HCPCS code) must have provided care to the beneficiary. Services provided by a social worker to the beneficiary’s family or phone calls by the social worker also constitute a visit. Activities not related to the provisions of items or services to a beneficiary do not count towards a visit, for example, phone calls (other than a social worker), documentation in the medical/clinical record, interdisciplinary group meetings, obtaining physician orders, or rounds in a facility. In addition the visit must be reasonable and necessary for the palliation and management of the terminal illness and related conditions as described in the patient’s plan of care.

[Return to Top]

Reporting Visits in the Routine Home Care, Continuous Home Care and Inpatient Respite Care Levels of Care

For all RHC/CHC and inpatient respite care billing, report each visit performed by nurses, aides and social workers who are employed by the hospice and their associated time per visit in the number of 15-minute increments on a separate line. Do not report visit data for visits made by nonhospice staff providing respite care in contract facilities

Additionally, report each RHC/CHC and respite visit performed by physical therapists, occupational therapists and speech-language therapists, and their associated time per visit in the number of 15-minute increments on a separate line. The following tables provide the coding and timing requirements effective for claim dates of service on and after 1/1/2016.

Note: For claim dates of service prior to 1/1/2016 skilled nursing service for RNs, LPNs and LVNs are reported with a single HCPCS code G0154.

[Return to Top]

Discipline Revenue and HCPCS Coding

Discipline Revenue Code HCPCS Code
Physical Therapy 042X G0151
Occupational Therapy 043X G0152
Speech Language Therapy 044X G0153
Skilled Nursing Services by a registered nurse (RN) 055X G0299
Skilled Nursing Services by a licensed nurse (LPN or LVN) 055X G0300
Medical Social Services 056X G0155
Medical Social Services-Telephone Calls 0569 G0155
Aide Services 057X G0156

[Return to Top]

Required Detail for each Discipline

Units ‑ Time per visit (15 minute increments) *see time reporting chart

Charges ‑ Amount of charges for line item visit

Service Date ‑ Date the visit was provided

[Return to Top]

Time Reporting Chart

Unit(s) Time Unit(s) Time
1 < 23 minutes 6 = 83 minutes to < 98 minutes
2 = 23 minutes to < 38 minutes 7 = 98 minutes to < 113 minutes
3 = 38 minutes to < 53 minutes 8 = 113 minutes to < 128 minutes
4 = 53 minutes to < 68 minutes 9 = 128 minutes to < 143 minutes
5 = 68 minutes to < 83 minutes 10 = 143 minutes to < 158 minutes


Below is an example of the visit reporting for RHC, CHC, or inpatient respite care levels of care:

  • The beneficiary was admitted to the Medicare hospice benefit on 1/4/20XX and revoked the benefit on 1/7/20XX. The beneficiary was in the RHC level of care in a private residence until revocation.
Date (Day) Therapist Visits Skilled Nursing Visits by an RN Social Worker Visits/Phone Calls Aide Visits
1/4/20XX (M)   1 visit: 42 minutes    
1/5/20XX (TU) 1 PT visit: 75 minutes     1 visit: 22 minutes
1/6/20XX (W)       1 visit: 31 minutes
1/7/20XX (TH)   1 visit: 36 minutes 1 visit: 85 minutes  

[Return to Top]

Claim Page 2 Level of Care/Visit Reporting

Claim Line Revenue Code HCPCS Code Units Service Date
1 0651 Q5001 4 0104XX
2 042X G0151 5 0104XX
4 055X G0299 3 0104XX
5 055X G0299 2 0107XX
7 056X G0155 6 0107XX
9 057X G0156 1 0105XX
10 057X G0156 2 0106XX

[Return to Top]

Reporting Visits in the GIP Level of Care

Reporting GIP Visits in SNFs and Hospitals

For GIP care provided to hospice patients in skilled nursing facilities (site of service HCPCS code Q5004) or in hospitals (site of service HCPCS codes Q5005, Q5007, Q5008), you will report each visit performed by hospice-employed nurses, aides, social workers, physical therapists, occupational therapists and speech-language therapists along with their associated time per visit in the number of 15-minute increments, on a separate line. This includes certain calls by hospice social workers (as described in CR 6440). For all visit/call reporting, only report visits/calls by the paid hospice staff; do not report visits by nonhospice staff.

The following table provides the coding and timing requirements.

[Return to Top]

Site of Service HCPCS Codes

HCPCS Code Description
Q5004 Hospice care provided in SNF
Q5005 Hospice care provided in inpatient hospital
Q5007 Hospice care provided in long term care hospital (LTCH)
Q5008 Hospice care provided in inpatient psychiatric facility

 

[Return to Top]

Discipline Revenue and HCPCS Coding

Discipline Revenue Code HCPCS Code
Physical Therapy 042X G0151
Occupational Therapy 043X G0152
Speech Language Therapy 044X G0153
Skilled Nursing Services by a RN, LPN or LVN *Note: for dates of service prior to 1/1/2016) 055X G0154
Skilled Nursing Services by a registered nurse (RN) *Note: for dates of service on or after 1/1/2016 055X G0299
Skilled Nursing Service by a licensed nurse (LPN or LVN) *Note: for dates of service on or after 1/1/2016 055X G0300
Medical Social Services 056X G0155
Medical Social Services ‑ Telephone Calls 0569 G0155
Aide Services 057X G0156

[Return to Top]

Required Detail for each Discipline

Units ‑ Time per visit (15 minute increments) *see time reporting chart

Charges ‑ Amount of charges for line item visit

Service Date ‑ Date the visit was provided

[Return to Top]

Time Reporting Chart

Unit(s) Time Unit(s) Time
1 < 23 minutes 6 = 83 minutes to < 98 minutes
2 = 23 minutes to < 38 minutes 7 = 98 minutes to < 113 minutes
3 = 38 minutes to < 53 minutes 8 = 113 minutes to < 128 minutes
4 = 53 minutes to < 68 minutes 9 = 128 minutes to < 143 minutes
5 = 68 minutes to < 83 minutes 10 = 143 minutes to < 158 minutes


Below is an example of the visit reporting for GIP provided in SNFs and hospitals:

  • The beneficiary was admitted to the GIP level of care at an acute hospital on 1/4/20XX and discharged on 1/5/20XX.

*Note: For claim dates of service prior to 1/1/2016 the skilled nursing visits by RNs, LPNs or LVNs are reported with G0154

Date (Day) Therapist Visits Skilled Nursing Visits by RN Social Worker Visits/Phone Calls Aide Visits
01/04/XX (M) 1 OT Visit: 45 minutes 1 visit: 42 minutes

1 visit: 75 minutes		 1 visit: 38 minutes 1 visit: 13 minutes

1 visit: 26 minutes

1 visit: 41 minutes

[Return to Top]

Claim Page 2 Level of Care/Visit Reporting

Claim Line Revenue Code HCPCS Code Units Service Date
1 0656 Q5005 1 0104XX
3 043X G0152 3 0104XX
4 055X G0299 3 0104XX
5 055X G0299 5 0104XX
9 056X G0155 3 0104XX
11 057X G0156 1 0104XX
12 057X G0156 2 0104XX
14 057X G0156 3 0104XX

[Return to Top]

Reporting GIP Visits in Hospice Inpatient Units

With the implementation of CR 8358, CMS did not change the existing GIP visit reporting requirements when the site of service is a hospice inpatient unit (site of service HCPCS code Q5006). You will continue to follow the instructions outlined in CR5567. Therefore, for GIP billing in hospice inpatient units, report the total number of visits performed by nurses, aides, and social workers who are employed by the hospice each week while in the GIP level of care. For each week, beginning on Sunday and ending on Saturday, you will indicate the number of services/visits provided by nurses (registered, licensed and/or nurse practitioner), aides, and social workers. The following tables provide the coding requirements.

The following table provides the coding requirements.

[Return to Top]

Site of Service HCPCS Codes

HCPCS Code Description
Q5006 Hospice care provided in inpatient hospice facility

[Return to Top]

Discipline Revenue Coding

Discipline Revenue Code
Skilled Nursing Services 055X
Medical Social Services 056X
Aide Services 057X

[Return to Top]

Required Detail for each Discipline

Units ‑ Total number of visits per week

Charges ‑ Amount of charges for visits per week

Service Date ‑ Earliest date visit was provided per week

Below is an example of the visit reporting for GIP provided in a hospice inpatient unit:

  • The beneficiary was admitted to the GIP level of care at the hospice inpatient unit on 1/4/20XX and discharged on 1/6/20XX.
Date (Day) Skilled Nursing Visits Social Worker Visits Aide Visits
1/4/20XX (M) 3 visits 1 visit 5 visits
1/5/20XX (T) 4 visits 1 visit 3 visits

[Return to Top]

Claim Page 2 Level of Care/Visit Reporting

Claim Line Revenue Code HCPCS Code Units Service Date
1 0656 Q5006 2 0104XX
2 055X   7 0104XX
3 056X   2 0104XX
4 057X   8 0104XX

Below is a chart to assist with the appropriate reporting rules for GIP visits based on service location for dates of service on or after 4/1/2014:

HCPCS Definition CR Visit Reporting Description
Q5004 Hospice care provided in SNF 8358 Report each visit with associated HCPCS G-code
Q5005 Hospice care provided in inpatient hospital 8358 Report each visit with associated HCPCS G-code
Q5006 Hospice care provided in inpatient hospice facility 5567 Report total number of visits per week (no HCPCS G-code)
Q5007 Hospice care provided in long term care hospital (LTCH) 8358 Report each visit with associated HCPCS G-code
Q5008 Hospice care provided in inpatient psychiatric facility 8358 Report each visit with associated HCPCS G-code

[Return to Top]

Reporting Post Mortem Visits in All Levels of Care

For dates of service on or after 4/1/2014, hospices must report visits and length of visits (rounded to the nearest 15-minute increment), for nurses, aides, social workers and therapists who are employed by the hospice, that occur on the date of death after the patient is pronounced, which is the official time of death as recorded on the pronouncement of death. The post mortem visits are reported with the PM modifier, which is the post mortem modifier. This requirement is applicable for all levels of care (with the exception of GIP provided in a hospice inpatient facility*).

Due to system limitations with reporting services after the date of the death, post mortem visits occurring on a date subsequent to the date of death are not to be reported. For example, if the patient is pronounced at 11 p.m., only report post mortem visits that occur prior to 12 a.m. The reporting of post-mortem visits, on the date of death, should occur regardless of the patient’s level of care or site of service.

If the patient passes away in the middle of the visit, the visit should be split to report the time of the visit prior to death and the time of the visit after death. For example, the nurse arrives at the home at 9 a.m. and leaves at 11 a.m. The patient is pronounced at 10 a.m. The time the patient was alive would be reported with four units (9 am – 10 am = 60 minutes) and the time after death would be reported with four units (10 a.m.‑11 a.m. = 60 minutes) along with the PM modifier.

*Note: Visit reporting for GIP in a hospice inpatient facility still follows the instructions in CR5567. These visits are reported by week and do not utilize the HCPCS G codes. Since line item visit reporting is not applicable for GIP in a hospice inpatient facility (Q5006), post mortem visits cannot be reported.

[Return to Top]

Related Content