Ind. IHCP Hospice Services Provider Reference Module, Section 6, Service Intensity Add-On Payments

The service intensity add-on (SIA) payment is in addition to the routine home care per diem rate in both the

home and the nursing facility. The SIA payment is made for services provided by an RN or social worker

during the last seven days of a member’s life. The SIA payment amount is calculated using the continuous

home care hourly rate multiplied by the hours of nursing or social work provided on the date of service. The

SIA payment is also adjusted by the regional wage differences – using the wage index for the city or county

where the member resides (when delivered in the home) or where the hospice facility is located (when

delivered in a nursing facility).

The SIA payment is limited to 16 units or four hours per day. The SIA payment is applied only to routine

home hospice care level of service. These billing instructions should be followed:

• The following revenue codes must be billed for the SIA payment as appropriate:

➢ 551 for RN service intensity add-on payment

➢ 561 for social worker service intensity add-on payment

• The SIA revenue codes must be billed as detail line items on the claim when billing for routine

home hospice care services for the same dates of service.

• A procedure code is not required in conjunction with revenue codes 551 and 561.

• Claims with revenue codes 551 or 561 must include occurrence code 55 and the date of death in the

first open occurrence code field.

• The claim must include a patient status discharge code of 20, 40, 41 or 42 (field 17 of the UB-04

claim form).

The units billed for revenue codes 551 and 561 must reflect the time spent with the member in 15 -minute

increments, with no rounding up. The entire 15 minutes must be used rendering services to the member and

must be documented in the medical record.

The following examples show how to bill for the SIA payment.

Example 1:

RN spends 30 minutes with the member; revenue code 551 is billed for a total of two units.

Example 2:

Social worker spends 40 minutes with the member; revenue code 561 is billed for a total of two

units (rounded to the nearest 15-minute increment without rounding up).