Wis. ForwardHealth Online Handbook, Hospice, Topic #1131

Hospice providers submitting claims to ForwardHealth under the following national revenue codes are required to indicate their

usual and customary charge for the services provided:

• 0651: Hospice services — Routine home care

• 055X: Hospice services — Routine home care service intensity add-on — services provided by an RN (registered nurse)

• 0562: Hospice services — Routine home care service intensity add-on — services provided by a social worker

• 0652: Hospice services — Continuous home care

• 0655: Hospice services — Inpatient respite care

• 0656: Hospice services — General inpatient care

• 0169: Room and board — Other (for skilled nursing facility)

Hospice services are reimbursed at the per diem or hourly amounts allowed by the federal CMS (Centers for Medicare &

Medicaid Services). Hospice providers may be reimbursed for services rendered up to midnight on the date the member revokes

their enrollment in the hospice benefit. Wisconsin Medicaid will reimburse only one of the four categories of hospice care (routine

home care, continuous home care, inpatient respite care, or general inpatient care) on a single DOS (date of service). In addition

to routine home care reimbursement, a service intensity add-on payment is reimbursable for services provided by a social worker

or an RN during the last seven days of a member's life.

Wisconsin Medicaid reimburses the hospice directly; the hospice is then responsible for paying the nursing home or hospital.