MHCP Provider Manual, Hospice Services, Hospice Care – Medical Services

Review the Hospices Services MN–ITS user manual for instructions for completing a hospice claim.

• Claim type: Use the 837I transaction set for hospice claims

• Bill type – use one of the following for type of bill:

• 811 Nonhospital-based hospice (817 for nonhospital-based hospice replacement claims)

• 821 Hospital-based hospice (827 for hospital-based hospice replacement claims)

• Revenue codes – When billing revenue codes 0651, 0652, 0655 and 0656, enter both of the following: value code for the service and the appropriate 5-digit Core Based Statistical Area (CBSA) code to identify the location where the hospice care was provided. The codes are the same for Medicare and MA.

HCPCS code (Q5001 – Q5010) for place of service, identifying the level of care can be used as separate service line; however, the service date on the separate service lines cannot overlap.

If the claim does not have a value code and the CBSA code for the location where the care was provided, DHS will deny the claim.

For home care, use one of the following revenue codes:

• 0651 Routine home care day (less than 8 hours):

• Enter the appropriate HCPCS code (Code range Q5001 - Q5010)

• Report units as days. (1 day = 1 unit; 30 days = 30 units)

• For Service Intensity Add-on Payments (in the last seven days of life):

• Use revenue code 0551 and HCPCS code G0299 Hospice RN services

• Use revenue code 0561 and HCPCS code G0155 Hospice LSW

• Report as units (1 unit = 15 minutes) with a max combined total of 16 units per day

• Report each SIA RN or social worker service on separate lines for each day of service

• Bill SIA claims on the same claim as the RHC claim, or bill separately if the last seven days of life cross over to the next month

• 0652 Continuous home care day, 8 or more hours of nursing care each day up to 24 hours per day:

• Enter the appropriate HCPCS code (Code range Q5001–Q5010)

• Report units in 15-minute increments. (8 hours = 32 units, 24 hours = 96 units)

For inpatient care use one of the following revenue codes:

• 0655 Inpatient respite day

• An inpatient respite care day is a day on which the individual who has elected hospice care receives care in an approved facility on a short-term basis for respite. For inpatient respite care day (0655) or general inpatient day the elected hospice and the facility would contract for the service. The facility would bill the elected hospice, the elected hospice would pay the facility and bill MHCP for the hospice care.

• 0656 General inpatient day

• A general inpatient care day is a day on which the hospice recipient receives general inpatient care in an inpatient facility for pain control or acute chronic symptom management which cannot be managed in other settings. The total number of general inpatient care days and inpatient respite care days must not exceed 20 percent of the total days provided to a hospice recipient.

For both inpatient respite and general inpatient days, billing may include date of admission but not date of discharge, unless discharge is due to member being deceased: Enter the appropriate HCPCS code (Code range Q5001–Q5010)