Medi-Cal Provider Manual, Part 2, Hospice Care: General Billing Instructions, Remittance Advice Details

The following Remittance Advice Details (RAD) codes and messages appear on the

Medi-Cal Remittance Advice Details for claims that are denied payment for the reasons

listed below.

“From-Through” or Billing for a Quantity Less Than Eight

Claims for hospice continuous home care (revenue code 0652) that are billed using the

“from-through” method or billed with a quantity less than “8” are denied with the following

denial message.

‹‹RAD Code Denial Message Table››

RAD Code Denial Message

166 Hospice continuous home care must be

billed a minimum of eight hours and cannot

be block (“from-through”) billed.

Same or Overlapping Dates of Service

Only one level of hospice care is allowed for any hospice recipient for the same day of

service. Claims for more than one type of hospice service billed for the same recipient on the

same or overlapping dates of service are denied with the following denial message.

RAD Code Denial Message Table

RAD Code Denial Message

168 More than one type of hospice care is not

payable for any recipient on the same or

overlapping dates of service.

Exception: In cases where one hospice discharges a recipient and another hospice admits

the same recipient on the same day, each hospice may bill for reimbursement

and each will be reimbursed at the appropriate level of care for its respective

day of discharge or admission.

Facility Type/Place of Service: Inappropriate

Claims submitted with an inappropriate facility type/Place of Service code are denied with

the following denial message.

RAD Code Denial Message Table

RAD Code Denial Message

9591 Revenue code 658 must be billed with

facility type codes “25,” “26,” “28,” “65,” “81”

or “86” on the UB-04 claim.

Billing Tip: ‹‹When performing an ASC X12N 837 v.5010 claim, revenue code 658 should

be entered on the claim line as a five-digit number with two leading zeros

(00658).››