Medi-Cal Provider Manual, Part 2, Hospice Care, Residential Care Facilities for the Elderly (RCFE)

The following revenue codes are reimbursable when rendered in a RCFE.

RCFE Revenue Code Descriptions

Revenue Code Description

0552 Routine home care (service intensity add-on [SIA] rate)

0650 Routine home care (high rate)

0652 Continuous home care

0655 Inpatient respite care

0656* General inpatient care (no respite)/hospice general care

0657 Physician’s services

0659 Routine home care (low rate)

Note: Providers billing hospice care revenue codes 0552, 0650, 0652, 0655, 0656, 0657 or

0659 for Medi-Cal members who are entitled to Medicare, but not eligible for Part A

coverage on the date of service, may bill Medi-Cal directly. Medicare denial

documentation is not required with these claims.

Billing Instructions

Claims submitted for these services on the UB-04 claim require type of bill code with the first

two digits “86” and a third claim frequency digit as detailed in the National Uniform Billing

Data Element Specification manual. Refer to the UB-04 Completion: Outpatient Services

section in the appropriate Part 2 manual for additional information about Type of Bill field

(Box 4).

For information on documenting coexisting or additional diagnoses related to Medi-Cal

members’ terminal illness on hospice claims, refer to the Hospice Care: General Billing

Instructions section in the appropriate Part 2 manual.

Room and Board Not Reimbursable

Hospice providers rendering services in a RCFE may not be reimbursed for room and board

revenue code 0658.

Out of State Services

Medi-Cal does not cover or reimburse hospice providers for hospice services provided to

eligible Medi-Cal members outside the state of California.

Resources

Additional guidance and instructions may be found in the following resources:

• Medi-Cal Provider Portal

• Medi-Cal Hospice Program Election Notice (DHCS 8052)

• Patient Notification of Hospice Non-Covered Items, Services, and Drugs (DHCS 8053)

• DHCS’ Hospice Care website

• Medi-Cal Hospice Services Frequently Asked Questions (FAQ)

• Hospice Care Program Manual

For questions, email MCHospiceClerk@DHCS.ca.gov.