Medicare Hospice Quick Reference Sheet
The codes listed below are only those most frequently applicable to hospice claims. For a complete list of codes, see the NUBC manual. The NUBC maintains the UB-04 data element specifications and revenue code tables. They may be contacted for subscription to the UB-04 at the NUBC website.
Table of Contents
- Type of Bill for Hospice (FL4)
- Claim Change Reason Code (FL 18-28) and Adjustment Reason Code
- Patient Status Codes (LF17) as of “To” date on claim
- Occurrence Codes (FL 31-34)
- Condition Codes (FL 18-28)
- Occurrence Span Codes (FL 35-36)
- Level of Care Revenue Codes (RCs) (UB-04 FLs 42-43)
- Visit (Discipline) HCPCS Code Reporting (UB-04 FL 44)
- Modifiers (UB-04 FL 44)
- Related Content
Type of Bill for Hospice (FL4)
| X=1 non hospital based | X=2 hospital based | ||
|---|---|---|---|
| 8XA | Notice of Election (NOE) | 8X3 | Continuing claim (interim) |
| 8XB | Notice of Termination/Revocation (NOTR) | 8X4 | Discharge claim (final) |
| 8XC | Change of hospice (transfer) | 8X7 | Adjustment claim |
| 8XD | Cancel NOE | 8X8 | Cancel claim |
| 8X0 | Nonpayment claim | ||
| 8X1 | Admit thru discharge (in the same month) | 8XH | CERT Adjusted Claim |
| 8X2 | First claim in the series (Interim) | ||
Claim Change Reason Code (FL 18-28) and Adjustment Reason Code
| Description | CCRC | ARC | TOB |
|---|---|---|---|
| Change in dates of service | D0 | RF | 8X7 |
| Change in charges | D1 | RG | 8X7 |
| Change in revenue HCPCS code | D2 | RH | 8X7 |
| Cancel to correct provider #/HICN | D5 | RI | 8X8 |
| Cancel duplicate or OIG payment | D6 | RJ | 8X8 |
| Any other multiple changes(s) | D9 | RM | 8X7 |
| Change in patient status | E0 | RN | 8X7 |
Patient Status Codes (LF17) as of “To” date on claim
| Code | Description |
|---|---|
| 01 | Discharged to home/self-care |
| 30 | Still a patient or exp. To return for OP services |
| 40 | Expired at home-hospice only |
| 41 | Expired in medical facility- hospice only |
| 42 | Expired place unknown- hospice only |
| 50 | Transferred to hospice home |
| 51 | Transferred to hospice medical facility |
Occurrence Codes (FL 31-34)
| Code | Description |
|---|---|
| 27 | Date of certification or recertification |
| 42 | Date of revocation (ONLY) |
| 55 | Date of death (when patient status = 40, 41, 42) |
Condition Codes (FL 18-28)
| Code | Description |
|---|---|
| H2 | Discharge for cause (i.e. patient/staff safety) |
| 52 | Discharge for patient unavailability, in ability to receive care, or out of service area |
| 85 | Effective for claims received on or after 1/1/2017. This code indicates the hospice received the recertification of terminal illness later than 2 days after the first day of a new benefit period. This code is reported with OSC 77, which reports the provider liable days associated with the untimely recertification. |
Occurrence Span Codes (FL 35-36)
| Code | Description |
|---|---|
| 77 | Noncovered days due to untimely recertification or untimely NOE |
| M2 | Multiple respite stays, From/To dates of each stay |
Level of Care Revenue Codes (RCs) (UB-04 FLs 42-43)
| Level of Care Reporting | HCPCS Place of Service | ||
|---|---|---|---|
| Level of Care | Revenue Code | Acceptable Site of Service Codes | Q5001 – Patient’s home/residence Q5002 - Assisted living Q5003 – LTC or nonskilled NF (receiving unskilled care) Q5004 – Skilled nursing facility (receiving skilled care) Q5005 – Inpatient hospital Q5006 – Inpatient hospice facility Q5007 – Long term care hospital Q5008 – Inpatient psychiatric facility Q5009 – Place not otherwise specified Q5010 – Hospice residential facility |
| Routine Home Care (RHC) | 0651 | Q5001-Q5010 | |
| Continuous Home Care | 0652 | Q5001-Q5003, Q5009, Q5010 | |
| Respite Care | 0655 | Q5003- Q5009 | |
| General Inpatient Care | 0656 | Q5004-Q5009 | |
Visit (Discipline) HCPCS Code Reporting (UB-04 FL 44)
| Discipline Visit Description | Revenue Code | HCPCS Codes | Description |
|---|---|---|---|
| Physical therapy | 042X | G0151 | Services of a physical therapist in home health or hospice settings, each 15 minutes |
| Occupational therapy | 043X | G0152 | Services of an occupational therapist in home health or hospice settings, each 15 minutes |
| Speech language pathology | 044X | G0153 | Services of a speech and language pathologist in home health or hospice settings, each 15 minutes |
| Skilled nursing | 055X | G0299 | Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes |
| Skilled nursing | 055X | G0300 | Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes |
| Medical social service (visit) | 056X | G0155 | Services of clinical social worker in home health or hospice setting, each 15 minutes |
| Medical social service (phone call) | 056X | G0155 | Services of clinical social worker in home health or hospice setting, each 15 minutes |
| Home health aide | 057X | G0156 | Services of home health/hospice aide in home health or hospice settings, each 15 minutes |
Modifiers (UB-04 FL 44)
| Modifier | Description | Reference |
|---|---|---|
| KX | Modifier is reported when requesting an exception to the Notice of Election (NOE) timely filing requirements | More information on appropriate use of the KX modifier can be found on our website in the Notice of Election: Timely Filing of Hospice Elections Job Aid. |
| PM | Modifier is reported with the visit HCPCS codes when visits occur on the date of death, after the patient has passed away. Post mortem visits occurring on a date subsequent to the date of death shall not be reported. | More information on the appropriate reporting of the post mortem modifier can be found on our website in the current version of the Hospice Change Request 8358 Questions and Answers. |
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims, Sections 20.1.2 and 30.3
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 9 Coverage of Hospice Services Under Hospital Insurance
Reviewed 5/20/2024