Tex. HHSC Medicaid Hospice Provider Manual § 5200

Revision 06-2; Effective December 12, 2006

The Medicaid program pays one of four per diem rates. Rates are paid for any particular hospice day based on the hospice care setting (of a Medicaid only recipient) applicable to the type and intensity of the hospice services provided for that day. The four Medicaid per diem rates are:

routine home care,

continuous home care,

inpatient respite care, and

general inpatient care.

HHSC pays one of the per diem rates for each day an individual on Medicaid hospice qualifies for the Medicaid Hospice Program, regardless of the volume of services provided on any given day.

The following table identifies the services that can be billed for individuals on HHSC Medicaid hospice based on their eligibility type and residence.

Service Medicaid Bill Code Medicaid Home Medicaid Nursing Facility Medicaid and Medicare Home Medicaid and Medicare Nursing Facility

One of the following: - - - - -

Routine Home Care T0100 X X - -

Continuous Home Care T0200 X X - -

Inpatient Respite Care* T0300 X X - -

General Inpatient Care T0301 X X - -

*Limit to 5 consecutive days - - - - -

- - - - - -

Physician Direct Care T0302 X X - -

- - - - - -

Nursing Facility Room and Board T0201 to T0212 - X - X

- - - - - -

Medicare Pharmacy Coinsurance T0400 - - X X

- - - - - -

Medicare Respite Coinsurance T0401 - - X X

Conversion Table from Old to New Service Codes

Service Old Texas LTC Local Bill Code Service Code HCPC Code

Routine Home Care T0100 1 T2042

Continuous Home Care T0200 1 T2043

Inpatient Respite Care T0300 1 T2044

General Inpatient Care T0301 1 T2045

- - - -

Physician Direct Care T0302 30 See TMHP crosswalk

Medicare Pharmacy Coinsurance T0400 32 T0400

Medicare Respite Coinsurance T0401 33 T0401

- - - -

Nursing Facility and ICF/MR Room and Board N0201/ N0212 31 T2046