N.H. Medicaid Hospice Provider Manual, Vol. II, § 11, Diagnosis & Procedure Codes

All NH Medicaid services must be billed using the appropriate industry-standard diagnosis and

procedure codes. One procedure code must be provided for each charge billed.

For medical services, the NH Medicaid Program requires the Health Care Financing Administration

Common Procedure Coding System (HCPCS) codes and modifiers.

ICD-9-CM diagnosis codes are required for all services billed on institutional claim forms (UB-04).

Claims without the required diagnosis or procedure codes will be denied.

Before submitting a claim, the hospice provider must submit, as applicable, 282 A “ Medicaid Hospice

Care Notification Form,” which can be found on the NH MMIS Health Enterprise portal at

www.nhmmis.nh.gov, to the Office Of Medicaid Business and Policy (OMBP) by either mail or fax, as

follows:

Mail to:

Department of Health and Human Services

129 Pleasant Street

Office of Medicaid Business and Policy

Brown Building

Concord, NH 03301

Attention: Patricia Dean

Fax to:

(603) 271-8194

Attention: Patricia Dean

Claims for hospice services should be submitted on a UB 04 claim form. Hospice providers must report

the level of hospice care and details of the visits provided with appropriate revenue and HCPCS codes.