Medi-Cal Provider Manual, Part 2, Hospice Care, For All Status Changes

Though not required, hospice providers are requested to enter the admission date in the

Admission Date field (Box 12) and the appropriate status code in the Status field (Box 17) on

the outpatient UB-04 claim. Utilizing these fields will assist in providing accurate

reimbursement. Data values allowed for the Status field are:

Status Code Descriptions

Status Code Description

01 Discharged to home or self-care

30 Still a patient (for continuing hospice care for same Medi-Cal member)

40 Expired at home

41 Expired in a medical facility, such as a hospice, Nursing Facility Level A,

Nursing Facility Level B, or freestanding hospice

42 Expired, place unknown

50 Discharged/transferred to hospice, home

51 Discharged/transferred to hospice, medical facility

‹‹It is recommended that the Remarks field (Box 80), or an attachment to the claim, be

utilized to report previous discharge, decertification, revocation or transfer information for

this Medi-Cal member. Hospice providers should include the National Provider Indicator of

the facility from which Medi-Cal members were transferred, the admission dates and the

discharge date.››

It is also recommended that an occurrence code be entered in the Occurrence Code fields

(Boxes 31–34). The occurrence code works in tandem with the status code to clarify the

billing scenario. All occurrence code values are accessible in the National Uniform Billing

Committee (NUBC) UB-04 Data Specifications Manual. The following are examples of

scenarios in which occurrence codes are helpful:

Occurrence Code Descriptions

Occurrence

Code

Description Application

27 Date of hospice certification or

recertification

Could be used in conjunction with

status code 30 (still a patient) in a

claim scenario in which

Medi-Cal members get certified for

a new benefit period.

42 Date of discharge Could be used in conjunction with

status code 01 (discharged to home

or self-care) in a claim scenario

where Medi-Cal members are

determined to no longer be

terminally ill and discharged. Can

also be used if Medi-Cal members

choose to revoke the hospice

benefit.

55 Date of death Could be used in conjunction with

status code 20 (expired), 40

(expired at home), 41 (expired in a

medical facility) or 42 (expired in a

place unknown) in a claim scenario

in which Medi-Cal members pass

away.