WI · guidance
Wis. ForwardHealth Online Handbook, Hospice, Topic #1147
Revenue Codes
Revenue codes are required on all claims submitted using the UB-04 or 837I (837 Health Care Claim: Institutional). Claims or
adjustment requests for hospice services without revenue codes are denied. Allowable revenue codes and their descriptions for
hospice services are listed below.
Hospice Revenue
Code
Corresponding Hospice
HCPCS Code Description of HCPCS Code
055X G0299 Hospice routine home care service intensity add-on, services provided by
RNs (registered nurses); per quarter hour
0562 G0155 Hospice routine home care service intensity add-on, services provided by
social workers; per quarter hour
0651 T2042 Hospice routine home care; per diem
0652 T2043 Hospice continuous home care; per hour
0655 T2044 Hospice inpatient respite care; per diem
0656 T2045 Hospice general inpatient care; per diem
0169 T2046 Hospice long term care, room and board only; per diem
National Revenue
Code Description
0169 Room and board — Other (for skilled nursing facility)
055X Hospice services — Routine home care service intensity add-on, services provided by RNs (registered
Provenance
- Source
- www.forwardhealth.wi.gov
- Retrieved
- 2026-10-02
- Edition
- forwardhealth-hospice-2026-10-01
- Content hash
c2c3fbb850e3957b3c400daea2d3c8f91e5df9e98d5d23dc24332e7c55c5c7c8
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