Home Health Medicare Billing Codes Sheet - CGS

Type of Bill (FL4) 

X=1 non hospital based X=2 hospital based 

8XA Notice of Election (NOE) 8X2 1 st claim in series 

8XB Revocation/Termination 

8XC Change of hospice 

Hospice Medicare Billing Codes Sheet 

8X3 Continuing claim 

8X4 Discharge claim 

8XD Cancel NOE/benefit period 8X5 Late charges (phys/NP charges only) 

8X0 Nonpayment claim 

8X7 Adjustment claim 

8X1 Admit thru discharge 8X8 Cancel claim 

CMS Pub. 100-04, Chapter 11, Section 20.1.2 & 30.3 

Condition Code (FL 18-28) 

H2 Discharge for cause (i.e. patient/staff safety) 

CMS Pub. 100-04, Chapter 11, Section 30.3 

Claim Change Reason Code (CCRC) 

(FL 18-28) & 

Adjustment Reason Code (ARC) 

(FISS only) 

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 #/HIC D5 RI 8X8 

Cancel duplicate or OIG payment D6 RJ 8X8 

Any other/multiple change(s) D9 RM 8X7 

Change in patient status E0 RN 8X7 

CMS Pub. 100-04, Chapter 1, Section 130.1.2.1 

Revenue Codes (FL42) 

0001 Total units/charges 0571 Home health aide visit 

0421 Physical therapy 0650 General (to request denial) 

0431 Occupational therapy 0651 Routine home care 

0441 Speech language path. 0652 Continuous home care 

0551 Skilled nursing visit 0655 Respite care 

0561 Medical social services visit 0656 General inpatient care (GIP) 

0569 Medical social services 0657 Physician services 

phone call 

0659 Other (incl. room & board) 


Type of Admission (FL14) 

1 Emergency 

2 Urgent 

3 Elective 

5 Trauma 

9 Information not available 

CR 7202, 

www.cms.gov/Transmittals/downloads/R2090CP.pdf 

Occurrence Codes (FL 31-34) 

27 Date of certification or recertification 

42 Date of discharge/revocation (not for transfers or death) 


Occurrence Span Codes (FL 35-36) 

77 Noncovered days due to untimely certification 

M2 Multiple respite stays, From/To dates of each stay 


HCPCS Codes (FL 44) 

For Discipline Lines (42X, 43X, 44X, 55X, 56X, 57X) 

G0151 Physical therapy 

G0152 Occupational therapy 

G0153 Speech language pathology G0154 Nursing services 

G0155 Medical social services G0156 Aide services 

For Level of Care Lines (651, 652, 655, 656) 

Q5001 Care provided in home 

Q5002 Care provided in assisted living facility 

Q5003 Care provided in LTC or non-skilled NF (receiving unskilled care) 

Q5004 Care provided in skilled nursing facility (receiving skilled care) 

Q5005 Care provided in inpatient hospital 

Q5006 Care provided in inpatient hospice facility 

Q5007 Care provided in long term care hospital 

Q5008 Care provided in inpatient psychiatric facility 

Q5009 Care provided in place not otherwise specified 

Q5010 Care provided in a hospice facility (effective 10/1/10) 


Web Site Reference - CMS Pub. 100 

http://www.cms.gov/Manuals/IOM/list.asp 

Patient Status (FL17) as of “To” date on claim 

01 Discharged to home, revoked, or decertified 

30 Still a patient 

40 Expired at home 

41 Expired at medical facility 

42 Expired – place unknown 

50 Discharged/transferred to hospice – home (routine or CHC) 

51 Discharged/transferred to hospice – medical facility (respite or GIP) 


MSP Value Codes (FL 39-41) & 

Payer Codes (FISS only) 

Description VC PC 

Working aged 12 N/A 

ESRD 13 N/A 

No Fault (no attorney involved) 14 N/A 

Workers' Compensation 15 N/A 

Public Health Svc/Other Federal 16 N/A 

Disabled 43 N/A 

Black Lung 41 N/A 

Veteran's Administration 42 N/A 

Liability (attorney involved) 47 N/A 

Conditional Payment One of the above C 

Medicare 

Z 

CMS Pub. 100-05, Chapter 3, Section 5 

Status/Location Codes (FISS only) 

P B9996 Payment floor (claim approved for payment) 

P B9997 Processed NOE or paid claim (full or partial) 

P O9998 Archived claim (call CSR to access claim data) 

R B9997 Rejected claim (due to eligibility, duplicate or billing error) 

D B9997 Denied claim (full denial by Medical Review, may appeal) 

T B9997 Return to Provider (RTP) (available for 36 months) 

S B0100 Claim temporarily suspended, no provider action needed 

S B6001 ADR claim (submit medical documentation w/in 30 days) 

S M50MR Claim in medical review 

S B90XX Claim at Common Working File (CWF), XX=various #s 

S M0XXX Suspended for Medicare staff intervention, XX=various #s 

NOTE: The codes listed on this billing codes sheet represent those most frequently submitted on hospice NOEs/claims. A complete listing of all 

codes is accessible from the Natiolnal Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual : www.nubc.org 

© June 2011 • CGS Administrators, LLC • H - 016- 01 

Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited.

Hospice Medicare Billing Codes Sheet 

FISS Fields and UB-04 Field Locators (FL) for Hospice Billing 

R = required C = conditional N = not required O = optional 

FISS Pg FISS Field Name UB FL Data Entered NOE Claim 

1 HIC 60 Medicare (HIC) number R R 

1 TOB 4 Type of Bill R R 

1 NPI 56 NPI number R R 

1 Pat.Cntl#: 3a Patient Control Number O O 

1 Stmt Date From 6 From date of service R R 

1 To 6 To date of service N R 

1 Last 8 Patient’s last name R R 

1 First 8 Patient’s first name R R 

1 DOB 10 Patient’s date of birth R R 

1 Addr 1 9 Patient’s address R R 

1 Addr 2 9 City State R R 

1 Zip 9 Zip R R 

1 Sex 11 Sex code (M or F) R R 

1 Admit Date 12 Date of admission R R 

1 Hr 13 Admission hour R 1 R 1 

1 Type 14 Type of Admission N R 

1 Stat 17 Patient status N R 

1 Cond Codes 18-28 Condition codes N C 

1 Occ Cds/Date 31-34 Occurrence code(s)/date(s) R C 2 

1 Span Codes/Dates 35-36 Occurrence span code(s)/date(s) N C 3 

1 DCN 64 Document control number N C 4 

1 Value Codes 39-41 Value codes N R 5 

2 Rev 42 Revenue codes N R 

2 HCPC 44 HCPCS N R 

2 Modifs 44 Modifier N C 

2 Tot Unit 46 Total units N R 

2 Cov Unit 46 Covered units N R 

1 

Required for DDE 

2 

OC 27 is required when certification/recertification overlaps the claim’s date of service. 

OC 42 is required when the patient has been discharged/revoked hospice. 

3 

OSC 77 is required when the recertification was not obtained timely. 

4 

Adjustments and cancels only 

5 

Value code 61 and CBSA code required for rev. code 0651 or 0652. Value code G8 and CBSA code 

required for rev. code 0655 or 0656. 

Common Hospice Billing Errors by Reason Code (RC) 

RC Problem Resolution RC Problem Resolution 

FISS Pg FISS Field Name UB FL Data Entered NOE Claim 

2 Tot Charges 47 Total charges N R 

2 Ncov Charge 48 Noncovered charges N C 

2 Serv Dt 45 Service date N R 

3 CD 50 Payer code R R 

3 Payer 50 Payer name R R 

3 RI 52 Release of information R R 

3 Medical Record Nbr 3b Medical Record Number O O 

3 Diagnosis codes 67 Diagnosis codes R R 

3 Att Phys NPI 76 Attending physician’s NPI R R 

3 LN 76 Attending physician’s last name R R 

3 FN 76 Attending physician’s first name R R 

3 MI 76 Attending physician’s middle initial O O 

3 Opr Phys NPI 77 Operating physician’s NPI N N 

3 LN 77 Operating physician’s last name N N 

3 FN 77 Operating physician’s first name N N 

3 MI 77 Operating physician’s middle initial N N 

3 Oth Phys NPI 78 Certifying physician’s NPI R R 

3 LN 78 Certifying physician’s last name R R 

3 FN 78 Certifying physician’s first name R R 

3 MI 78 Certifying physician’s middle initial O O 

4 Remarks 80 Remarks C C 

5 Insured name 58 Insured’s last name, first name N C 6 

5 Sex N/A Insured’s sex code N C 6 

5 DOB N/A Insured’s date of birth N C 6 

5 Rel 59 Patient’s relationship N C 6 

5 Cert-SSN-HIC 60 Insured’s ID/HIC# N C 6 

5 Group name 61 Insurance group name N C 6 

5 Ins Group Number 62 Insurance group number N C 6 

6 1 st Insurer Address 80 Insurer’s address N C 6 

6 City 80 Insurer’s city N C 6 

6 St 80 Insurer’s state N C 6 

6 Zip 80 Insurer’s zip N C 6 

6 

Required when Medicare is secondary. 

31428 HCPC error Corresponding HCPCS required on discipline rev code line. U5106 NOE w/in open episode Check ELGH for open hospice election. Contact other hospice if needed. 

Delete previously submitted batches. Check remittance 

38031 Duplicate claim 

U5150 No NOE on file NOE must be submitted & processed (P B9997) before submitting first claim. 

advice or use FISS Option 12 to check for paid claims. 

37402 Sequential billing 

Ensure prior claim is paid (P), denied (D) or rejected (R). 

Ensure no skip in days between prior and subsequent claim. 

U5181 Occurrence code 27 

© June 2011 • CGS Administrators, LLC • H - 016- 01 

Disclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited. 

Occ code 27 is required when a cert/recert is w/in the DOS. Check ELGH to 

verify OC 27 date matches first day of new benefit period.

Home Health Medicare Billing Codes Sheet - CGS

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