(Medicare Claims Processing Manual)

Social worker phone calls made to the patient or the patients family should be reported using revenue code 0569, and HCPCS G -code G0155 for the length of the call, with each call being a separate line item.  Only phone calls that are necessary for the pal liation and management of the terminal illness and related conditions as described in the patients plan of care (such as counseling or speaking with a patients family or arranging for a placement) should be reported.  Report only social worker phone call s related to providing and or coordinating care to the patient and family and documented as such in the clinical records.   When recording any visit or social worker phone call time, providers should sum the time for each visit or call, rounding to the nearest 15 minute increment.  Providers should not include travel time or documentation time in the time recorded for any visit or call.  Additionally, hospices may not include interdisciplinary group time in time and visit reporting.   For dates of service before October 1, 2018, Hospice agencies shall report injectable and non-injectable prescription drugs for the palliation and management of the terminal illness and related conditions on their claims.  Both injectable and non- injectable prescription drugs shall be reported on cla ims on a line -item basis per fill, based on the amount dispensed by the pharmacy.   When a facility (hospital, SNF, NF, or hospice inpatient facility) uses a medication management system where each administration of a hospice medication is considered a fill for hospice patients receiving care, the hospice shall report a monthly total for each drug (i.e., report a total for the period covered by the claim), along with the total dispensed.  Hospices shall report multi- ingredient compound prescription drugs (non -injectable) using revenue code 0250.  The hospice shall specify the same prescription number for each ingredient of a compound drug according to the 837i guidelines in loop 2410.  In addition, the hospice shall provide the NDC for each ingredient in the compound; the NDC qualifier represents the quantity of the drug filled (meaning the amount dispensed) and shall be reported as the unit measure.   When reporting prescription drugs in a comfort kit/pack, the hospice shall report the NDC of each prescription drug within the package, in accordance with the procedures for non-injectable prescriptions.   Hospice agencies shall report infusion pumps (a type of DME) on a line -item basis for each pump and for each medication fill and refill.  The hospice claim shall reflect the total charge for the infusion pump for the period covered by the claim, whether the hospice is billed for it daily, weekly, biweekly, with each medication refill, or in some other fashion.  The hospice shall include on the claim the infusion pump charges on whatever basis is easiest for its billing systems, so long as in total, the claim reflects the charges for the pump for the time period of that claim.  Effective for dates of service on and after 10/1/2018, hospices are no longer required to          report drugs using line item detail.  Hospices may report summary charges for drugs as shown in the table below.  Hospices must enter the following visit revenue codes, when applicable:   Revenue Code  Required HCPCS  Required Detail  0250 Non -injectable Prescription Drugs  N/A Required detail:  Report on a line -item basis per fill, using revenue code 0250 and the National Drug Code (NDC).  The NDC qualifier represents the quantity of the drug filled, and should be reported as the unit measure.  For dates of service on and after 10/1/2018: Report a monthly charge total for all drugs (i.e., report a total charge amount for the period covered by the claim) using revenue code 0250.  029X Infusion pumps  Applicable HCPCS    N/A  Required detail:  Report on the claim on a line -item basis per pump order and per medication refill, using revenue code 029X for the equipment and 0294 for the drugs along with the appropriate HCPCS.  For dates of service on and after 10/1/18: Report a monthly charge total for infusion DME (i.e., report a total charge amount for the period covered by the claim), including DME infusion drugs, using revenue center 029X for the infusion pumps and 0294 for DME infusion drugs.  042x Physical Therapy  G0151 or G0157 Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  043x Occupational Therapy  G0152 or G0158 Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  044x Speech Therapy  Language Pathology G0153  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  055x Skilled Nursing G0154  (before 01/01/2016))  G0299 or  G0300 (on or after 01/01/2016)  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  056x Medical Social Services  G0155  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the visit defined in the HCPCS description.  0569 Other Medical Social Services  G0155  Required detail:  Each social service phone call is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier for the total time of the call defined in the HCP CS description.  057x Aide  G0156  Required detail:  Each visit is identified on a separate line item with the appropriate line item date of service and a charge amount.  The units reported on the claim are the multiplier the total time of the visit defined in the HCPCS description.  0636 Injectable Drugs  Applicable HCPCS  Required detail: Report on a line item basis per fill with units representing the amount filled. (i.e., Q1234 Drug 100mg and the fill was for 200 mg, units reported = 2).  For dates of service on and after 10/1/2018: Revenue code 0636 is not required.    Visits by registered nurses, licensed vocational nurses and nurse practitioners (unless the nurse practitioner is acting as the beneficiarys attending physician) are reported under revenue code 055x.   Charges associated with the reported visits are covered under the hospice bundled payment and reflected in the payment for the level of care billed on the claim.  No additional payment is made on the visit revenue lines.    The contractor shall use the following remittance advice messages and associated codes when bundling line items under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Four.  Group Code: CO  CARC: 97  RARC: N/A  MSN: N/A  Effective January 1, 2016, Medicare requires hospices to use G0299 for direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting and G0300 direct skilled nursing of a licensed practical nurse (LPN) in the home heal th or hospice setting. G0154 is retired as of 12/31/2015.  Hospices should report in the unit field on the line level the units as a multiplier of the visit time defined in the HCPCS description.    For information regarding the billing requirements for Coverage of Kidney Disease Patient Education Services under hospice see Chapter 32, 20.1).     HCPCS/Accommodation Rates/HIPPS Rate Codes   Hospices must report a HCPCS code along with each level of care revenue code (651, 652, 655 and 656) to identify the type of service location where that level of care was provided.  The following HCPCS codes will be used to report the type of service location for hospice services:   HCPCS Code  Definition  Q5001  HOSPICE CARE PROVIDED IN PATIENT'S HOME/RESIDENCE  Q5002  HOSPICE CARE PROVIDED IN ASSISTED LIVING FACILITY  Q5003  HOSPICE CARE PROVIDED IN NURSING LONG TERM CARE FACILITY (LTC) OR NON -SKILLED NURSING FACILITY (NF)  Q5004  HOSPICE CARE PROVIDED IN SKILLED NURSING FACILITY (SNF)  Q5005  HOSPICE CARE PROVIDED IN INPATIENT HOSPITAL  Q5006  HOSPICE CARE PROVIDED IN INPATIENT HOSPICE FACILITY  Q5007  HOSPICE CARE PROVIDED IN LONG TERM CARE HOSPITAL (LTCH)  Q5008  HOSPICE CARE PROVIDED IN INPATIENT PSYCHIATRIC FACILITY  Q5009  HOSPICE CARE PROVIDED IN PLACE NOT OTHERWISE SPECIFIED (NOS)  Q5010  Hospice home care provided in a hospice facility   If care is rendered at multiple locations, each location is to be identified on the claim with a corresponding HCPCS code.  For example, routine home care may be provided for a portion of the billing period in the patients residence and another portion in an assisted living facility.  In this case, report one revenue code 651 line with HCPCS code Q5001 and the number of days of routine home care provided in the residence and another revenue code 651 line with HCPCS code Q5002 and the number of days of routine  home care provided in the assisted living facility.   Q5004 shall be used for hospice patients in a skilled nursing facility (SNF), or hospice patients in the SNF portion of a dually- certified nursing facility. There are 4 situations where this would occur:   1) If the beneficiary is receiving hospice care in a solely -certified SNF.  2) If the beneficiary is receiving general inpatient care in the SNF.  3) If the beneficiary is in a SNF receiving SNF care under the Medicare SNF benefit for a condition unrelated to the terminal illness and related conditions, and is receiving hospice routine home care; this is uncommon. 4) If the beneficiary is receiving inpatient respite care in a SNF.   If a beneficiary is in a nursing facility but doesnt meet the criteria above for Q5004, the site shall be coded as Q5003, for a long term care nursing facility.  General inpatient care provided by hospice staff requires line item visit reporting in units of 15 minute increments when provided in the following sites of service:  Skilled Nursing Facility (Q5004), Inpatient Hospital (Q5005), Long Term Care Hospital (Q5007), Inpatient Psychiatric Facility (Q5008).  These service location HCPCS codes are not required on revenue code lines describing the visits provided under each level of care.   These lines report the HCPCS codes shown in the table under Revenue Codes.  Modifiers   The following modifier is required reporting for claims:  PM  Post -mortem visits.  Hospices shall report visits and length of visits (rounded to the nearest 15 minute increment), for nurses, aides, social workers, and therapists who are employed by the hospice, that occur on the date of death, after the patient has passed away.  Post mor tem visits occurring on a date subsequent to the date of death are not to be reported.  The reporting of post -mortem visits, on the date of death, should occur regardless of the patients level of care or site of service.  Date of  death is defined as the date of death reported on the death certificate.  Hospices shall report hospice visits that occur before death on a separate line from those which occur after death.   For example, assume that a nurse arrives at the home at 9 pm to provide routine home care (RHC) to a dying patient, and that the patient passes away at 11 pm.  The nurse stays with the family until 1:30 am.  The hospice should report a nursing visit with e ight 15-minute time units for the visit from 9 pm to 11 pm.  On a separate line, the hospice should report a nursing visit with a PM modifier with four 15- minute time units for the portion of the visit from 11 pm to midnight to account for the 1 hour post mortem visit.   If the patient passes away suddenly, and the hospice nurse does not arrive until after his death at 11:00 pm, and remains with the family until 1:30 am, then the hospice should report a line item nursing visit with a PM modifier and four 15- minute incremen ts of time as the units to account for the 1 hour post mortem visit from 11:00 pm to midnight.   The following modifier may be used to identify requests for an exception to the consequences of not filing the NOE timely: