Medi-Cal Provider Manual, Part 2, Hospice Care: General Billing Instructions, Special Physician Services

Hospice providers must use revenue code 0657 when billing for pain- and

symptom-management services related to a recipient’s terminal condition and provided by a

physician employed by, or under arrangement made by, the hospice.

Special physician services code 0657 may be billed only for physician services to manage

symptoms that cannot be remedied by the recipient’s attending physician because of one of

the following:

• Immediate need

• Attending physician does not have the required special skills

Claim Completion

Revenue code 0657 should be billed on a separate line for each date of service. Refer to the

UB-04 Completion: Outpatient Services section of this manual for additional billing

information.

Reimbursement

Reimbursement for revenue code 0657 is limited to once per day, per recipient, per provider.

The reimbursement rate is outlined in California Code of Regulations (CCR), Title 22,

Section 51503, 51509 or 51509.1, as applicable. Reimbursement is subject to the hospice

cap amount described in CCR, Title 22, Section 51544(d)(2).