- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Notice of Election Termination/Revocation
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Tips to Facilitate the Change of Ownership Process
- Service Intensity Add-on Payment
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Avoiding Reason Code U5181: Appropriate Use of Occurrence Code 27/Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Appeal for Claims Rejected for an Untimely Hospice Notice of Election
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Correcting Hospice Claims Sequentially to Avoid Reason Code U5181
- Common Working File System Edit F5052 and M5052
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Filing an Electronic Notice of Termination-Revocation of Election (Type of Bill 8XB)
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Notice of Election: Timely Filing of Hospice Elections
- Hospice Claim Submission Job Aid
- Direct Mailing Notification to Hospice Providers Regarding the Hospice Benefit Component, VBID Model, Participating MAOs
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Hospice Prescription Drug and Infusion Pump Reporting
- Hospice Caps Job Aid
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Appropriate Use of Condition Code 85
- How to Correct/Avoid Reason Code U5150
- General Inpatient Check Off List
- Hospice Transfers Job Aid
- Medicare Two Tier Routine Home Care Payment Rate
- Canceling a Hospice Notice of Election
- Hospice Pricer Tool Quick Reference Tool
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Site of Service Codes for Continuous Home Care and General Inpatient Care Level of Service
- Hospice Payment Rates
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
Hospice Prescription Drug and Infusion Pump Reporting
With the implementation of CR 8358, hospices are required to report injectable, infusion pump, and noninjectable prescription drugs for the palliation and management of the terminal illness and related conditions on their claims. Both injectable and noninjectable prescription drugs shall be reported on claims on a line-item basis per fill, based on the amount dispensed by the pharmacy. OTC drugs shall not be reported. The reporting requirements are outlined below:
- Injectable drugs: Report on a line-item basis per fill, using revenue code 0636 and the appropriate HCPCS code, with units representing the amount filled (i.e. if HCPCS description states Q1234 Drug: 100 mg and the fill was for 200 mg, units reported = 2).
- Noninjectable prescriptions: Report on a line-item basis per fill (based on the amount dispensed by the pharmacy), using revenue code 0250 and the NDC. The NDC qualifier represents the quantity of the drug filled, and shall be reported as the unit measure.
- Infusion pumps/Infusion pump drugs: Report on the claim, on a line-item basis per pump order and per medication refill, using revenue code 029X for the equipment and 0294 for the drugs along with the appropriate HCPCS.
Reporting National Drug Codes
The NDC is a code set that identifies the vendor (manufacturer), product and package size of all drugs and biologics recognized by the FDA. The three segments of the 11-digit NDC identify the labeler, the product, and the commercial package size. The first set of numbers in the NDC identifies the labeler (manufacturer, repackager, or distributer). The second set of numbers is the product code, which identifies the specific strength, dosage form (e.g., capsule, tablet, liquid) and formulation of a drug for a specific manufacturer. Finally, the third set is the package code, which identifies package sizes and types.In addition to the actual NDC, you will also have to report the qualifier (electronic claims only), the quantity dispensed, and the unit qualifier.
The container label also displays the appropriate unit of measure for that drug. The unit of measure is by weight (grams: GR), volume (milliliter: ML) (milligram: ME) or count (unit: UN). Each dispensed dose must be converted into one of these, following the manufacturer’s unit of measure. International units (F2) must be converted to standard measurements (GR, ML, ME and UN). Examples of proper unit measures include:
- For drugs that come in a vial in powder form that needs to be reconstituted before administration, bill each vial (UN).
- For drugs that comes in a vial in liquid form, bill in milliliters (ML).
- For topical forms of medicine (e.g., cream, ointment, bulk powder in a jar), bill in grams (GR or ME).
Below is a chart with the NDC breakdown:
NDC breakdown for 5010 electronic claims Qualifier + NDC Code + UOM + Quantity |
NDC breakdown for FISS/DDE claims NDC Code + Quantity + UOM |
||
---|---|---|---|
Qualifier | N4 (always report N4) | NDC (NDC Field) | NDC format (5-4-2) |
NDC | NDC format (5-4-2) | Drug unit quantity (NDC Quantity field) | Dispensing quantity |
Drug UOM | Valid unit of measures are: F2 (international unit) GR (gram) ME (milligram) ML (milliliter) UN (unit) |
Drug UOM (Qualifier field) | Valid unit of measures are: F2 (international unit) GR (gram) ME (milligram) ML (milliliter) UN (unit) |
Drug unit quantity | Dispensing quantity |
Hospice Prescription Drug Reporting Table
When reporting prescription drugs on hospice claims, there are differences based on the type of administration. The table below provides information on how to report these drugs. Visit the Centers for Medicare & Medicaid Service for a list of HCPCS available codes. For a list of NDCs available in the FDA NDC directory, please visit the National Drug Code Directory.
Medication Form (method of administration) | Revenue Code | HCPCS | Revenue Code Units |
NDC | NDC Quantity | NDC Unit of Measure | NDC Example |
---|---|---|---|---|---|---|---|
Non-injectable (solution, liquid, suspension) | 0250 | N/A | 1* | Required | Quantity of solution, liquid, suspension | ML | 3 ml bottle of Albuterol 0.083% inhalation solution, NDC qty= 3 0.5 ml of Morphine Sulfate 20 mg/ml oral solution, NDC qty= 0.5 |
Non-injectable (Cream, Ointment or Lotion) |
0250 | N/A | 1* | Required | Quantity of cream, ointment or lotion | GR or ME | 5 gm tube of cream, NDC qty= 5 60 ml bottle of 1% lotion, NDC qty = 60 |
Non-injectable (powder packet) | 0250 | N/A | 1* | Required | # of vials/bottles | UN (administered in powder form) | One bottle of Zmax 2gm oral suspension, NDC qty= 1 |
Non-injectable (powder – requires reconstitution) | 0250 | N/A | 1* | Required | Quantity of powder | ML | 150 ml bottle of Amoxacillin (powder for reconstitution) 250mg/ml, NDC qty= 150 |
Non-injectable (tablet, capsule) |
0250 | N/A | 1* | Required | # of tablets, capsules per fill | UN | Two Cephalexin 500mg oral capsules, NDC qty= 2 One Lorazepam 0.5mg oral tablet, NDC qty= 1 |
Non-injectable (suppository) | 0250 | N/A | 1* | Required | # of suppositories per fill | UN | One 25 mg suppository, NDC qty = 1 |
Non-injectable (Transdermal Patches) |
0250 | N/A | 1* | Required | # of patches | UN | One Duragesic 50mcg/hr patch, NDC qty = 1 |
Injectable | 0636 | Required | Amount filled based on HCPCS definition (ex. HCPCS=100 mg, fill=200, units reported as 2) | N/A | N/A | N/A | N/A |
Infusion pump drug | 0294 | Required | Amount filled based on HCPCS definition (ex. HCPCS=100 mg, fill=200, units reported as 2) | N/A | N/A | N/A | N/A |
* The 0250 revenue code line only requires a valid value (i.e., whole number) because the actual units (quantity) are reported in the NDC field. Providers can report a unit of “1” or any other value that may assist them internally. |
Tips/Notes on Drug Reporting
- To determine the appropriate “Medication Form” select the form that reflects the method by which the medication is administered (e.g. an injectable medication that is administered via inhalation is reported as a non-injectable).
- Solutions or diluents used to mix with prescription drugs (including those used in an infusion pump) are not to be reported. These “fillers” are not prescription drugs.
- You will have to convert micrograms to a reportable measure (i.e., milligrams or grams) when reporting the NDC.For example, 1 microgram (mcg) is 1000th of a milligram:
- 1 mcg= 0.001 mg
- 10 mcg =0.01mg
- 100 mcg = 0.1 mg
- 1000 mcg = 1.0 mg
- For comfort kit/pack, report each prescription drug in the package as indicated above.
- Do NOT report OTC drugs on the claim. This would include OTC drugs ordered by a physician. Only prescription drugs should be reported on the claim. Per the FDA's Prescription Drugs and Over-the-Counter (OTC) Drugs: Questions and Answers article, prescription drugs are prescribed by a doctor and only obtained through a pharmacy. OTC drugs are drugs that do not require a doctor's prescription and can be bought off-the-shelf in stores.
- Do not report “S” HCPCS codes as these are non-Medicare codes and should not be on hospice claims.
- Do not report pass-through item HCPCS codes (C1300-C9899).These codes are for the Outpatient Prospective Payment System (OPPS) only for possible pass-through payments and should not be on hospice claims.
- The “Q” HCPCS codes (Q0035-Q4116 and Q9951-Q9968) are mostly DMEsupply type codes.There are a couple drugs listed within these Q code sets but please check with your Medicare coder before using any of these codes.
Related Content
- CR 8358: Additional Data Reporting Requirements for Hospice Claims
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 9, Coverage of Hospice Services Under Hospital Insurance
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims
- FDA's Prescription Drugs and Over-the-Counter (OTC) Drugs: Questions and Answers
- Hospice Change Request 8358: Additional Data Reporting Questions and Answers