Idaho Medicaid Provider Handbook, Home Health and Hospice Services, Appendix B

a.

Revenue Codes

Covered Hospice Revenue Codes

Revenue

Code

Description

Notes

0651

Routine Care

Daily care provided for general hospice care.

0652

Continuous Care

Care rendered during crisis conditions. Requires a minimum

of eight (8) hours. Hours are counted from midnight to

midnight.

This procedure must be billed using units of time in fifteen

(15) minute increments. Partial blocks can be billed in fifteen

(15) minute increments.

Services must be provided by a registered or licensed

practical nurse.

0655

Inpatient Respite

Care

Respite care is limited to five (5) days per election period

(calendar month) for each participant in an approved

inpatient facility.

Respite care may only be rendered in a licensed freestanding

hospice or a qualified nursing facility.

0656

General Inpatient

Care

(Non-Respite)

Participant care must be rendered in an approved inpatient

hospital or freestanding hospice bed.

0657

Physician Care

Hospice-employed physician services must be billed with the

appropriate CPT® procedure codes on each line for each

service. When the physician billing for services is an

employee of the hospice, the UB-04 claim form must be used

with Revenue Code 0657.

0658

Room and Board

Care

Room and Board reimbursement for a hospice participant

only occurs when the participant has been approved for a

level of care in a long-term care facility.

Medicaid is always the primary payer of the hospice room

and board charge. Per diems are paid for Medicaid or dually

eligible hospice participants residing in a Medicare certified

nursing facility. The reimbursement rate will be ninety-five

percent (95%) percent of the nursing facility rate on file in

which the hospice participant is a resident. The nine (9) digit

Medicaid Nursing Home provider number must be submitted

on the claim in field 80 of the UB-04 claim form or in the

appropriate field of the electronic claim form.

Any participant liability will be withheld from the total hospice

payments. Prior Authorization is required.

b.

Bill Types

Covered Hospice Bill Types

Code

Description

0811

Hospice - Non-Hospital Based (Admit - Through - Discharge Claim)

0812

Hospice - Non-Hospital Based (Interim - First Claim)

0813

Hospice - Non-Hospital Based (Interim - Continuing Claim)

0814

Hospice - Non-Hospital Based (Interim - Last Claim)

0817

Hospice - Non-Hospital Based (Replacement of Prior Claim)

0818

Hospice - Non-Hospital Based (Void or Cancellation of Prior Claim)

0821

Hospice - Hospital Based (Admit - Through - Discharge Claim)

0822

Hospice - Hospital Based (Interim - First Claim)

0823

Hospice - Hospital Based (Interim - Continuing Claim)

0824

Hospice - Hospital Based (Interim - Last Claim)

0827

Hospice - Hospital Based (Replacement of Prior Claim)

0828

Hospice - Hospital Based (Void or Cancellation of Prior Claim)

c.

Patient Status Codes

Accepted Patient Status Codes (Field 17)

Code Description

01

Discharge to Home or self care

20

Death

30

Not Discharged, Still A Patient

d.

Occurrence Codes

Accepted Occurrence Codes (Fields 31-34)

Code Description

24

Date Insurance Denied

25

Date Benefits Terminated by Primary Carrier

42

Date of Discharge