Ind. IHCP Hospice Services Provider Reference Module, Section 6, Revenue Codes

As indicated in Table 6 and Table 7, the IHCP reimbursement for hospice services is made at one of four

all-inclusive per diem rates, or levels of service, and one of two location types, for each day an IHCP

member is under the care of the hospice provider.

Hospice providers complete the UB-04 claim form and identify hospice service delivery according to one

of the following revenue codes:

• Revenue code 183 for nursing facility bed hold for hospice therapeutic leave days

• Revenue code 185 for nursing facility bed hold for hospitalization for services unrelated to the

terminal illness of the hospice member

• Revenue code 193 for SCU add-on payments for hospices with a member in a nursing facility that

qualifies as a provider of specialized SCU services

• Revenue code 199 for ventilator add-on payments for hospices with a member in a nursing facility

that qualifies as a provider of specialized ventilator services

• Revenue code 551 for RN service intensity add-on payment

• Revenue code 561 for social worker service intensity add-on payment

• Revenue code 650 for routine home hospice care delivered in a nursing facility

• Revenue code 651 for routine home hospice care delivered in the home

• Revenue code 652 for continuous home hospice care delivered in the home

Note: For revenue codes 651 and 652, “in the home” means any residential environment

other than a nursing facility. These codes are applicable for services delivered in a

private home, an ICF/IID or any other non-nursing-facility setting where the member

resides.

• Revenue code 655 for inpatient respite hospice care

• Revenue code 656 for general inpatient hospice care

Note: Inpatient facility is defined as a hospital, long-term care facility or the facility of a

hospice provider that provides care 24 hours a day as outlined in Code of Federal

Regulations 42 CFR 418.110.

• Revenue code 657 for hospice direct-care physician services

• Revenue code 658 for continuous home hospice care delivered in a nursing facility

• Revenue code 659 for room and board for dually eligible nursing facility hospice members only

Hospice revenue codes, along with the descriptions to be used when billing hospice services, are included

in Hospice Services Codes, accessible from the Code Sets page at in.gov/medicaid/providers.

Hospice providers must bill only one hospice-related revenue code per day. However, revenue codes 183,

185, 193, 199, 551, 561 and 657 can be billed on the same day as other hospice revenue codes. A detailed

description of each revenue code is provided as follows:

• Revenue code 183 for nursing facility bed hold for hospice therapeutic leave days

➢ The hospice provider receives 50% of the 95% nursing facility case-mix rate for the room-and-board rate associated with therapeutic leave of absence days.

➢ A total of 18 therapeutic leave of absence days are allowed per patient per calendar year.

➢ Revenue code 183 may be billed on the same day as other hospice revenue codes.

➢ One day equals one unit of service.

• Revenue code 185 for nursing facility bed-hold for hospitalization for services unrelated to the

terminal illness of the hospice member

➢ The hospice provider receives 50% of the 95% nursing facility case-mix rate associated with

each hospitalization up to 15 days per occurrence.

➢ Revenue code 185 may be billed on the same day as other hospice revenue codes.

➢ One day equals one unit of service.

• Revenue code 193 for SCU add-on payments for hospices with a member in a nursing facility that

qualifies as a provider of specialized SCU services

➢ The hospice provider receives 100% of the reimbursement the nursing facility would have

received ($12 per eligible Medicaid resident day)

➢ Revenue code 193 may be billed on the same day as other hospice revenue codes.

➢ One day equals one unit of service.

• Revenue code 199 for ventilator add-on payments for hospices with a member in a nursing facility

that qualifies as a provider of specialized ventilator services

➢ The hospice provider receives 100% of the reimbursement the nursing facility would have

received ($80 per eligible Medicaid resident day)

➢ Revenue code 199 may be billed on the same day as other hospice revenue codes.

➢ One day equals one unit of service.

• Revenue code 551 for RN service intensity add-on payment

➢ Must be billed with routine home hospice care revenue codes 650 or 651 on the same claim and

same date of service.

➢ The sum of revenue code 551 and/or 561 is limited to 16 units or four hours a day.

➢ A procedure code is not required.

➢ Claims must include occurrence code 55 and the date of death in the first open occurrence code

field.

➢ Claims must include the appropriate patient status code:

o Patient status code 20 – Expired

o Patient status code 40 – Expired at home

o Patient status code 41 – Expired in a medical facility, such as a hospital, skilled nursing

facility (SNF), intermediate care facility (ICF) or freestanding hospice

o Patient status code 42 – Expired – place unknown

• Revenue code 561 for social worker service intensity add-on payment

➢ Must be billed with routine home hospice care revenue codes 650 or 651 on the same claim and

same date of service.

➢ The sum of revenue code 551 and/or 561 is limited to 16 units or four hours a day.

➢ A procedure code is not required.

➢ Claims must include occurrence code 55 and the date of death in the first open occurrence code

field.

➢ Claims must include the appropriate patient status code:

o Patient status code 20 – Expired

o Patient status code 40 – Expired at home

o Patient status code 41 – Expired in a medical facility, such as a hospital, SNF, ICF or

freestanding hospice

o Patient status code 42 – Expired – place unknown

• Revenue code 650 for routine home hospice care delivered in a nursing facility.

➢ The IHCP pays the hospice provider at the routine home care rate for each day the member is in

a nursing facility under the care of the hospice provider and not receiving continuous home

hospice care.

➢ The IHCP pays this rate without regard to the volume or intensity of routine home hospice care

services on any given day.

➢ In addition, the IHCP pays the hospice provider 95% of the single nursing facility case-mix rate

to cover room-and-board costs incurred by the contracted nursing facility. The provider should

bill only normal and customary routine home care amounts as the billed amount; CoreMMIS

calculates 95% of the single nursing facility case-mix rate and pays accordingly.

➢ Nursing facility room and board are not billable for the date of death.

➢ Providers also cannot bill for nursing facility room and board for the date the member is

physically discharged from the facility.

➢ Claims must include the appropriate occurrence code and the date of death or discharge in the

first open occurrence code field:

o Occurrence code 42 for members discharged as live

o Occurrence code 55 for members discharged as deceased

➢ One day equals one unit of service.

• Revenue code 651 for routine home hospice care delivered in the home

➢ The IHCP pays the hospice at the routine home care rate for each day the member is at home,

under the care of the hospice provider, and not receiving continuous home hospice care.

➢ The IHCP pays this rate without regard to the volume or intensity of routine home hospice care

services on any given day.

➢ Claims must include the appropriate occurrence code and the date of death or discharge in the

first open occurrence code field:

o Occurrence code 42 for members discharged as live

o Occurrence code 55 for members discharged as deceased

➢ One day equals one unit of service.

Note: When a Medicaid-only hospice member is admitted to a nursing facility for treatment

of a nonterminal condition, the hospice provider must bill for hospice services using

revenue codes 650 or 658 while the hospice member is in the facility. When the

hospice patient has resumed residence in their home, the hospice provider must bill

the IHCP using hospice review codes 651 or 652 for those dates of service following

the discharge from the facility.

• Revenue code 652 for continuous home hospice care delivered in the home

➢ The provider gives continuous home hospice care only during a period of crisis.

➢ A period of crisis occurs when a patient requires continuous care, primarily nursing care, to

achieve palliation and management of acute medical symptoms.

➢ The provider must provide a minimum of eight hours of care during a 24-hour day that begins

and ends at midnight.

➢ A registered nurse (RN) or licensed practical nurse (LPN) must provide care for more than half

the total time. This care need not be continuous and uninterrupted.

➢ Less-skilled care needed continuously to enable the member to remain at home is covered as

routine home hospice care.

➢ Divide the continuous home care per diem rate by 24 hours to calculate an hourly rate. For every

hour or part of an hour of continuous care furnished, the IHCP reimburses the hourly rate to the

hospice provider, up to 24 hours a day.

➢ Claims must include the appropriate occurrence code and the date of death or discharge in the

first open occurrence code field:

o Occurrence code 42 for members discharged as live

o Occurrence code 55 for members discharged as deceased

➢ One hour equals one unit of service.

• Revenue code 655 for inpatient respite hospice care

➢ The IHCP pays the hospice provider at the inpatient respite care rate for each day the member is

in an approved inpatient facility and is receiving respite care.

➢ Respite care is short-term inpatient care provided to the member only when necessary to relieve

the family members or other people caring for the member. Respite care may be provided only

on an occasional basis.

➢ The IHCP pays for respite care for a maximum of five consecutive days at a time, including the

date of admission but not counting the day of discharge.

➢ The IHCP pays for the sixth and any subsequent days at the routine home care rate.

➢ This service applies only to members who normally reside in private homes.

➢ The additional amount for room and board is not available for members receiving respite care.

➢ One day equals one unit of service.

➢ According to 405 IAC 1-16-2(i), when a member is receiving general inpatient or inpatient

respite care, the applicable inpatient rate (general or respite) is paid for the date of admission and

all subsequent inpatient days except the day on which the patient is discharged. For the day of

discharge, the appropriate home care rate is paid unless the patient dies as an inpatient. In the

case where the member is discharged deceased, the applicable inpatient rate (general or respite)

is paid for the date of discharge.

• Revenue code 656 for general inpatient hospice care

➢ The IHCP pays the hospice provider at the general inpatient hospice rate for each day the

member is in an approved inpatient hospice facility and is receiving general inpatient hospice

care for pain control, or acute or chronic symptom management, that cannot be managed in

other settings.

➢ The additional amount for room and board is not available for members receiving respite care.

➢ One day equals one unit of service.

➢ According to 405 IAC 1-16-2(i), when a member is receiving general inpatient or inpatient

respite care, the applicable inpatient rate (general or respite) is paid for the date of admission and

all subsequent inpatient days except the day on which the patient is discharged. For the day of

discharge, the appropriate home care rate is paid unless the patient dies as an inpatient. In the

case where the member is discharged deceased, the applicable inpatient rate (general or respite)

is paid for the date of discharge.

• Revenue code 657 for hospice direct care physician services

➢ The IHCP reimburses on a fee-for-service basis for physician services provided by a physician

who is an employee of the hospice provider or subcontracted by the hospice. The hospice

provider bills for these services under the hospice National Provider Identifier (NPI).

➢ Providers can bill this revenue code on the same day as other hospice revenue codes.

➢ One day equals one unit of service.

• Revenue code 658 for continuous home hospice care delivered in a nursing facility

➢ Divide the continuous home care rate by 24 hours to calculate an hourly rate. For every hour or

part of an hour of continuous care furnished, the IHCP reimburses the hourly rate to the hospice

provider, up to 24 hours a day.

➢ All limitations listed for the home setting also apply in the nursing facility setting.

➢ In addition, the IHCP pays the hospice provider 95% of the single nursing facility case-mix rate

to cover room-and-board costs incurred by the contracted nursing facility.

➢ Providers cannot bill for nursing facility room and board for the date of death.

➢ Providers also cannot bill for nursing facility room and board for the date the member is

physically discharged from the nursing facility.

➢ Claims must include the appropriate occurrence code and the date of death or discharge in the

first open occurrence code field:

o Occurrence code 42 for members discharged as live

o Occurrence code 55 for members discharged as deceased

➢ One hour equals one unit of service.

• Revenue code 659 for room and board for dually eligible nursing facility hospice members only

➢ Use this revenue code for dually eligible members residing in a nursing facility.

➢ This code represents the room-and-board portion of the hospice per diem.

➢ In addition, the IHCP pays the hospice provider 95% of the single nursing facility case-mix rate

to cover room-and-board costs incurred by the contracted nursing facility.

➢ Revenue code 659 must not be billed with the following hospice-related revenue codes: 650,

651, 652, 655, 656 and 658.

➢ Providers cannot bill for nursing facility room and board for the date of death.

➢ Providers also cannot bill for nursing facility room and board for the date the member is

physically discharged from the nursing facility.

➢ One day equals one unit of service.