evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
NOTE:  Revenue Codes 0275 through 0278 are not used for Medicare billing on HH PPS claims.  042x  Physical Therapy   Required detail:  One of the physical therapy HCPCS codes defined below in the instructions for the HCPCS code field, the date of service, service units which represent the number of 15 minute increments that comprised the visit, and a charge amount.  043x  Occupational Therapy   Required detail:  One of the occupational therapy HCPCS codes defined below in the instructions for the HCPCS code field, the date of service, service units which represent the number of 15 minute increments that comprised the visit, and a charge amount.  044x  Speech -Language Pathology   Required detail:  One of the speech -language pathology HCPCS codes defined below in the instructions for the HCPCS code field, the date of service, service units which represent the number of 15 minute increments that comprised the visit, and a charge amount. 055x  Skilled Nursing   Required detail:  One of the skilled nursing HCPCS codes defined below in the instructions for the HCPCS code field, the date of service, service units which represent the number of 15 minute increments that comprised the visit, and a charge amount.  056x  Medical Social Services   Required detail:  The medical social services HCPCS code defined below in the instructions for the HCPCS code field, the date of service, service units which represent the number of 15 minute increments that comprised the visit, and a charge amount.  057x  Home Health Aide (Home Health)   Required detail:  The home health aide HCPCS code defined below in the instructions for the HCPCS code field, the date of service, service units which represent the number of 15 minute increments that comprised the visit, and a charge amount.   NOTE:  A/B MACs (HHH) will return claims to the provider if revenue codes 058x or 059x are submitted with covered charges on Medicare home health claims.  They also return to the provider if revenue code 0624, investigational devices is reported on HH claims   Revenue Codes for Optional Billing of DME
(Medicare Claims Processing Manual)
Revenue Codes for Optional Billing of DME   Billing of DME provided in the period of care is not required on the HH PPS claim.  Home health agencies retain the option to bill these services to their A/B MAC (HHH) processing home health claims or to have the services provided under arrangement with a  supplier that bills these services to the DME MAC.  Agencies that choose to bill DME services on their HH PPS claims must use the revenue codes below.  These services will be paid separately in addition to the HH PPS amount, based on the applicable Medica re fee schedule.  For additional instructions for billing DME services see chapter 20 of this manual.   0274  Prosthetic/Orthotic Devices   Required detail: The applicable HCPCS code for the item, a date of service, a number of service units, and a charge amount. 029x  Durable Medical Equipment (DME) (Other Than Renal)   Required detail:  The applicable HCPCS code for the item, a date of service indicating the purchase date or the beginning date of a monthly rental, a number of service units, and a charge amount.  Monthly rental items should be reported with a separate lin e for each months rental and service units of one.  Revenue code 0294 is used to bill drugs/supplies for the effective use of DME.  060x  Oxygen (Home Health)   Required detail:  The applicable HCPCS code for the item, a date of service, a number of service units, and a charge amount.  Revenue Code for Optional Reporting of Wound Care Supplies   0623  Medical/Surgical Supplies - Extension of 027x   Required detail:  Only service units and a charge must be reported with this revenue code.  If also reporting revenue code 027x to identify nonroutine supplies other than those used for wound care, the HHA must ensure that the charge amounts for the two re venue code lines are mutually exclusive.   HHAs may voluntarily report a separate revenue code line for charges for nonroutine wound care supplies, using revenue code 0623.  Notwithstanding the standard abbreviation surg dressings, HHAs use this code to report charges for ALL nonroutine wound car e supplies, including but not limited to surgical dressings.
(Medicare Claims Processing Manual)
Pub. 100- 02, Medicare Benefit Policy Manual, chapter 7, defines routine vs. nonroutine supplies.  HHAs use that definition to determine whether any wound care supply item should be reported in this line because it is nonroutine.  HHAs can assist Medicares future refinement of payment rates if they consistently and accurately report their charges for nonroutine wound care supplies under revenue center code 0623.  HHAs should ensure that charges reported under revenue code 027x for nonroutine supplies are also complete and accurate.  HCPCS/Accommodation Rates/HIPPS Rate Codes   Required -  On the 0023 revenue code line, the HHA may submit the HIPPS code they expect will be used for payment if they choose to run grouping software at their site for internal accounting purposes. If not, they may submit any valid HIPPS code in order to meet this requirement.   HHAs enter only one HIPPS code per claim in all cases.  Claims submitted with additional HIPPS codes will be returned to the provider.  Medicare will determine the appropriate HIPPS code for payment based on claims and OASIS data and will replace the provider -submitted HIPPS code as necessary.  If the HIPPS code further changes based on medical review or other processes, the code used for payment is recorded in the APC -HIPPS field of the electronic claim record.   For revenue code lines other than 0023, the HHA reports HCPCS codes as appropriate to that revenue code.  The G - and Q - HCPCS codes listed below are for use by HHAs on Type of Bill 032x only.  Claims with these HCPCS codes will be returned to the provider if submitted with Type of Bill 034x.   To report HH visits, the HHA reports one of the following HCPCS codes to represent a visit by each HH care discipline:   Physical Therapy (revenue code 042x)   G0151 Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes.   G0157 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 15 minutes.  G0159 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes.  G2168 Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes.
(Medicare Claims Processing Manual)
Occupational Therapy (revenue code 043x)   G0152 Services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes.  G0158 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes.   G0160 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes.  G2169  Services  performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes.   Speech -Language Pathology (revenue code 044x)   G0153 Services performed by a qualified speech -language pathologist in the home health or hospice setting, each 15 minutes.  G0161 Services performed by a qualified speech -language pathologist, in the home health setting, in the establishment or delivery of a safe and effective speech- language pathology maintenance program, each 15 minutes.   Note that modifiers indicating services delivered under a therapy plan of care (modifiers GN, GO or GP) are not required on HH PPS claims.  Skilled Nursing (revenue code 055x)   General skilled nursing:   G0299  Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting  G0300  Direct skilled nursing of a licensed practical nurse (LPN) in the home health or hospice setting.  Care plan oversight:   G0162 Skilled services by a licensed nurse (RN only) for management and evaluation of the plan of care, each 15 minutes (the patients underlying condition or complication requires an RN to ensure that essential non- skilled care achieves its purpose in the home health o r hospice setting).  G0493 Skilled services of a registered nurse (RN) for the observation and assessment of the patients condition, each 15 minutes (the change in the patients condition requires skilled nursing personnel to identify and evaluate the patients need for possi ble modification of treatment in the home health or hospice setting).  G0494 Skilled services of a licensed practical nurse (LPN) for the observation and assessment of the patients condition, each 15 minutes (the change in the patients condition requires skilled nursing personnel to identify and evaluate the patients need for possible modification of treatment in the home health or hospice setting).   Training:
(Medicare Claims Processing Manual)
G0495 Skilled services of a registered nurse (RN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.  G0496 Skilled services of a licensed practical nurse (LPN), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes.   Medical Social Services (revenue code 056x)   G0155 Services of a clinical social worker under a home health plan of care, each 15 minutes.   Home Health Aide (revenue code 057x)   G0156 Services of a home health aide under a home health plan of care, each 15 minutes.  Regarding all skilled nursing and skilled therapy visits   In the course of a single visit, a nurse or qualified therapist may provide more than one of the nursing or therapy services reflected in the codes above.  HHAs must not report more than one G -code for each visit regardless of the variety of services provi ded during the visit.  In cases where more than one nursing or therapy service is provided in a visit, the HHA must report the G -code which reflects the service for which the clinician spent most of his/her time.   For instance, if direct skilled nursing services are provided, and the nurse also provides training/education of a patient or family member during that same visit, Medicare would expect the HHA to report the G -code which reflects the service for which most  of the time was spent during that visit.  Similarly, if a qualified therapist is performing a therapy service and also establishes a maintenance program during the same visit, the HHA should report the G -code that reflects the service for which most of the time was spent during that visit.  In all cases, however, the number of 15- minute increments reported for the visit should reflect the total time of the visit.   Telehealth Service Reporting   Beginning on or after January 1, 2023, HHAs may voluntarily report the use of telecommunications technology in the provision of home health services on claims. This information is required on home health claims beginning on July 1, 2023. HHAs shall submit the use of telecommunications technology when furnishing home health services, on the home health claim via three G -codes.   G0320: home health services furnished using synchronous telemedicine rendered via a real-time two -way audio and video telecommunications system
(Medicare Claims Processing Manual)
G0320: home health services furnished using synchronous telemedicine rendered via a real-time two -way audio and video telecommunications system   G0321: home health services furnished using synchronous telemedicine rendered via telephone or other real -time interactive audio -only telecommunications system  G0322: the collection of physiologic data digitally stored and/or transmitted by the patient to the home health agency (i.e., remote patient monitoring).   HHAs shall submit services furnished via telecommunications technology in line item detail and each service must be reported as a separately dated line under the appropriate revenue code for each discipline furnishing the service.  Two occurrences of G0320 or G0321 on the same day for the same revenue code shall be reported as separate line items.   The use of remote patient monitoring that spans a number of days shall be reported as a single G0322 line item reporting the beginning date of monitoring and the number of days of monitoring in the units field.   If more than one discipline is using the re mote monitoring information during the billing period, the HHA may choose which revenue code to report on the remote monitoring line item.   Claims with no billable visits are not submitted to Mediare, including claims for billing periods where only telehealth services are provided.   Site of Service Reporting   HHAs must report where home health services were provided.  The following codes are used for this reporting:   Q5001: Hospice or home health care provided in patients home/residence   Q5002: Hospice or home health care provided in assisted living facility   Q5009: Hospice or home health care provided in place not otherwise specified  The location where services were provided must always be reported along with the first visit reported on the claim.  In addition to reporting a visit line using the G codes as described above, HHAs must report an additional line item with the same revenue code and date of service, reporting one of the three Q codes (Q5001, Q5002, and Q5009), one unit and a nominal covered charge (e.g., a penny).  If the location where services were provided changes during the period of care, the new location should be repor ted with an additional line corresponding to the first visit provided in the new location.   Disposable Negative Pressure Wound Therapy Services
(Medicare Claims Processing Manual)
Disposable Negative Pressure Wound Therapy Services   Effective for claims with statement covers Through dates on or after January 1, 2024, Medicare makes a separate payment amount for a disposable negative pressure wound therapy (NPWT) device for a patient under a home health plan of care.  Payment is equal to the supply price used to determine the relative value for the service under the Medicare Physician Fee Schedule (as of January 1, 2022) for the applicable disposable device and updated by the consumer price index for all urban consumers minus the produc tivity adjustment for each future year.   Disposable NPWT services are billed using the following HCPCS code:     A9272 -  wound suction, disposable, includes dressing, all accessories and components, any type, each.    The HHA reports the HCPCS code with revenue code 027x (other than 0274), units representing the number of disposable devices provided during the billing period and a charge amount.  Since Medicare payment no longer includes the services of the practitioner  applying the device, revenue codes 042x, 043x or 0559 are not used for dNPWT HCPCS codes on Type of Bill 032x.   Modifiers   If the NOA that corresponds to a claim was filed late and the HHA is requesting an exception to the late -filing penalty (see section 10.1.10.3), append modifier KX to the HIPPS code reported on the revenue code 0023 line.    Service Date   Required -  For initial periods of care, the HHA reports on the 0023 revenue code line the date of the first covered visit provided during the period.  Claims and provider -submitted adjustments where the Admission Date and From Date match but the 0023 revenue code line date does not also match are returned to the provider.  Contractor -submitted adjustments are excluded from this edit.    For subsequent periods, the HHA reports on the 0023 revenue code the date of the first visit provided during the period, regardless of whether the visit was covered or non-covered.   For other line items detailing all services within the period, the HHA reports service dates as appropriate to that revenue code.  For service visits that begin in 1 calendar day and span into the next calendar day, report one visit using the date the visi t ended as the service date.
(Medicare Claims Processing Manual)
When the claim Admission Date matches the Statement Covers From Date, Medicare systems ensure that the Service Date on the 0023 revenue code line also matches these dates.   Service Units   Required -  Transaction standards require the reporting of a number greater than zero as the units on the 0023 revenue code line.  However, Medicare systems will disregard the submitted units in processing the claim.  For line items detailing all services w ithin the period, the HHA reports units of service as appropriate to that revenue code.  Coding detail for each revenue code under HH PPS is defined above under Revenue Codes.  For the revenue codes that represent home health visits (042x, 043x, 044x, 055x, 056x, and 057x), the HHA reports as service units a number of 15 minute increments that comprise the time spent treating the beneficiary.  Time spent completing the OASIS assessment in the home as part of an otherwise covered and billable visit and time spent updating medical records in the home as part of such a visit may also be reported.  Visits of any length are to be reported, rounding the time to the nearest 15- minute increment.  If any visits report over 96 units (over 24 hours) on a single line item, Medicare systems return the claim returned to the provider.   Covered and noncovered increments of the same visit must be reported on separate lines.  This is to ensure that only covered increments are included in the per -unit based calculation of outlier payments.   Telehealth services with HCPCS codes G0320 or G0321 are reported with units of 1.    Total Charges   Required -  The HHA must report zero charges on the 0023 revenue code line (the field must contain zero).   For line items detailing all services within the period of care, the HHA reports charges as appropriate to that revenue code.  Coding detail for each revenue code under HH PPS is defined above under Revenue Codes.  Charges may be reported in dollars and ce nts (i.e., charges are not required to be rounded to dollars and zero cents).  Medicare claims processing systems will not make any payments based upon submitted charge amounts.  Non-covered Charges   Required  The HHA reports the total non- covered charges pertaining to the related revenue code here.  Examples of non- covered charges on HH PPS claims may include:
(Medicare Claims Processing Manual)
Required  The HHA reports the total non- covered charges pertaining to the related revenue code here.  Examples of non- covered charges on HH PPS claims may include:    Visits provided exclusively to perform OASIS assessments   Visits provided exclusively for supervisory or administrative purposes   Therapy visits provided prior to the required re -assessments   Payer Name   Required -  See chapter 25.   Release of Information Certification Indicator   Required -  See chapter 25.   National Provider Identifier  Billing Provider   Required -  The HHA enters their provider identifier.   Insureds Name   Required only if MSP involved.  See Pub. 100- 05, Medicare Secondary Payer Manual.   Patients Relationship To Insured   Required only if MSP involved.  See Pub. 100- 05, Medicare Secondary Payer Manual.   Insureds Unique Identifier   Required only if MSP involved.  See Pub. 100- 05, Medicare Secondary Payer Manual.   Insureds Group Name   Required only if MSP involved.  See Pub. 100- 05, Medicare Secondary Payer Manual.   Insureds Group Number   Required only if MSP involved.  See Pub. 100- 05, Medicare Secondary Payer Manual.   Treatment Authorization Code   Conditional -  Treatment authorization codes are not required on all claims.  The HHA submits a code in this field only if the period is subject to Pre -Claim Review.  In that case, the required tracking number is submitted in the first position of the field in all submission formats.   Document Control Number (DCN)   Required -  If submitting an adjustment (TOB 0327) to a previously paid HH PPS claim, the HHA enters the control number assigned to the original HH PPS claim here.   Employer Name   Required only if MSP involved.  See Pub. 100- 05, Medicare Secondary Payer Manual.   Principal Diagnosis Code   Required -  The HHA enters the ICD code for the principal diagnosis.  The code must be reported according to Official ICD Guidelines for Coding and Reporting, as required by the HIPAA.  The code must be the full diagnosis code, including all five digits for  ICD -9-CM or all seven digits for ICD -10 CM where applicable.  Where the proper code has fewer than the maximum number of digits, the HHA does not fill it with zeros.   Medicare systems may return claims to the provider when the principal diagnosis code is not sufficient to determine the HHRG assignment under the PDGM.
(Medicare Claims Processing Manual)
Medicare systems may return claims to the provider when the principal diagnosis code is not sufficient to determine the HHRG assignment under the PDGM.   The ICD code and principle diagnosis used for payment grouping is determined from claim coding rather than the OASIS assessment.  As a result, the claim and OASIS diagnosis codes are not expected to match in all cases.    Typically, the codes will match between the first claim in an admission and the start of care (Reason for Assessment RFA 01) assessment and claims corresponding to recertification (RFA 04) assessments.  Second 30- day claims in any 60- day period will not necessarily match the OASIS assessment.  When diagnosis codes change between one 30- day claim and the next, there is no absolute requirement for the HHA to complete an other follow -up (RFA 05) assessment to ensure that diagnosis coding on the claim matches to the assessment. However, the HHA would be required to complete an other follow -up (RFA 05) assessment when such a change would be considered a major decline or improvement in the patients health status.     Other Diagnosis Codes   Required -  The HHA enters the full diagnosis codes for additional conditions if they coexisted at the time of the establishment of the plan of care.  These codes may not duplicate the principal diagnosis as an additional or secondary diagnosis.   In listing the diagnoses, the HHA places them in order to best reflect the seriousness of the patients condition and to justify the disciplines and services provided in accordance with the Official ICD Guidelines for Coding and Reporting.  The sequence of  codes should follow ICD guidelines for reporting manifestation codes.  Medicare does not have any additional requirements regarding the reporting or sequence of the codes beyond those contained in ICD guidelines.  The claim and OASIS diagnosis codes may vary as described under Principal Diagnosis.   Diagnosis codes that reflect the patients condition as of the start of a period of care are reflected on the claim for the current period of care.   Diagnosis codes that reflect a change in the patients condition during a period of care should be reflect ed on the claim for the next period.     Attending Provider Name and Identifiers   Required - The HHA enters the name and national provider identifier (NPI) of the attending physician who signed the plan of care.   Other Provider (Individual) Names and Identifiers