Medi-Cal Provider Manual, Part 2, Hospice Care: General Billing Instructions, Home and Respite Care: Authorization Not Required

The following hospice services do not require authorization:

• Routine home care

• Continuous home care

• Inpatient respite care

• Physician’s services

Claims for services that do not require authorization are billed directly to Medi-Cal.

Continuous and Respite Home Care

When billing for continuous home care (revenue code 0652) or respite care (revenue code

0655), medical justification must be entered in the Remarks field of the claim.

If medical justification is not included or is not adequate, reimbursement will be reduced to

the rate for 0659 (routine home care, low rate). An appeal may be submitted for

reconsideration of payment by including additional documentation of the medical necessity

for the increased level of care.