Medicare Hospice Benefit · UB-04 / 837I

Hospice Medicare Billing Codes

Reference tables of the codes most frequently submitted on Medicare hospice NOEs and claims, organized by UB-04 form locator. Values are drawn from the CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 11.

Type of Bill (FL4)

Ch. 11 §20.1.2 & 30.3

TOB	Description
8XA	Notice of Election (NOE)
8XB	Notice of Termination / Revocation (NOTR)
8XC	Change of hospice provider
8XD	Cancel NOE / benefit period
8X0	Nonpayment / zero claim
8X1	Admit through discharge claim
8X2	First (interim) claim in a series
8X3	Continuing (interim) claim
8X4	Discharge / last claim
8X7	Adjustment / replacement claim
8X8	Cancel / void claim

The X (3rd position) identifies the facility type: X = 1 freestanding (non-hospital-based) hospice · X = 2 hospital-based hospice. On the paper form the type of bill is preceded by a leading zero (e.g. 0811).

Type of Admission (FL14) & Point of Origin (FL15)

Ch. 25 §75.1

Type of Admission · FL14

Code	Description
1	Emergency
2	Urgent
3	Elective
5	Trauma
9	Information not available

Point of Origin (Source of Admission) · FL15

Code	Description
1	Non-health care facility (e.g., home)
2	Clinic or physician's office
4	Transfer from a hospital
5	Transfer from a SNF or ICF
6	Transfer from another health care facility
8	Court / law enforcement
9	Information not available

Condition & Claim Change Reason Codes (FL18-28)

Ch. 11 §30.3 · Ch. 1 §130.1.2.1

Condition Codes · FL18-28

Code	Description
H2	Discharge for cause (e.g., patient/staff safety)
52	Discharge for patient unavailability, inability to receive care, or out of service area
85	Delayed recertification of terminal illness (claims received on/after 1/1/2017)

Claim Change Reason Code (CCRC) · FL18-28

CCRC	Description	ARC (FISS)	TOB
D0	Change in dates of service	RF	8X7
D1	Change in charges	RG	8X7
D2	Change in revenue / HCPCS code	RH	8X7
D5	Cancel to correct provider # / Medicare ID	RI	8X8
D6	Cancel duplicate or OIG payment	RJ	8X8
D9	Any other / multiple change(s)	RM	8X7
E0	Change in patient status	RN	8X7

ARC = Adjustment Reason Code (entered in FISS only). The CCRC is reported as a condition code on adjustment (8X7) and cancel (8X8) claims.

Occurrence, Span & MSP Value Codes

Ch. 11 §30.3 · Ch. 3 §5

Occurrence Codes · FL31-34

Code	Description
27	Date of certification or recertification
42	Date of revocation (only)
55	Date of death (when patient status = 40, 41, or 42)

Occurrence Span Codes · FL35-36

Code	Description
77	Non-covered days — untimely recertification or untimely NOE
M2	Multiple respite stays (from/to dates of each stay)

MSP Value Codes · FL39-41

Code	Description
12	Working aged
13	End-stage renal disease (ESRD)
14	No-fault (no attorney involved)
15	Workers' Compensation
16	Public Health Service / other federal
41	Black Lung
43	Disabled
47	Liability (attorney involved)

Also report location value codes with the CBSA code: value code 61 (+ CBSA) for revenue codes 0651/0652, and value code G8 (+ CBSA) for revenue codes 0655/0656.

Allowed Place of Service (HCPCS) by Level of Care

Revenue codes 0651/0652/0655/0656

HCPCS — Place of Service	Routine 0651	CHC 0652	Respite 0655	GIP 0656
Q5001 — Home	Y	Y	N	N
Q5002 — Assisted living facility	Y	Y	N	N
Q5003 — LTC or non-skilled NF (unskilled care)	Y	Y	Y	N
Q5004 — Skilled nursing facility (skilled care)	Y	N	Y	Y
Q5005 — Inpatient hospital	Y	N	Y	Y
Q5006 — Inpatient hospice facility	Y	N	Y	Y
Q5007 — Long term care hospital	Y	N	Y	Y
Q5008 — Inpatient psychiatric facility	Y	N	Y	Y
Q5009 — Place not otherwise specified	Y	Y	Y	Y
Q5010 — Hospice residential facility	Y	Y	N	N

Y = HCPCS place-of-service code allowed with that level-of-care revenue code; N = not allowed. A service-facility NPI is required when billing Q5003, Q5004, Q5005, Q5007, or Q5008.

Revenue Codes (FL42), HCPCS & Modifiers (FL44)

Ch. 11 §30.3

Levels of Care & Claim Totals

Rev	Description	HCPCS & Modifiers
0001	Total units / charges	None
0651	Routine home care (RHC)	Q5001–Q5010 (place of service)
0652	Continuous home care (CHC)	Q5001–Q5003, Q5009–Q5010
0655	Inpatient respite care (IRC)	Q5003–Q5009
0656	General inpatient care (GIP)	Q5004–Q5009
0657	Physician services	26 (prof. component) as appropriate; GV when NP/PA is attending
0659	Other	A9270 + GY (room & board, reported as non-covered)

Discipline Visits (add PM for post-mortem visits)

Rev	Discipline / Visit	HCPCS & Modifiers
0421	Physical therapy	G0151 (PM)
0431	Occupational therapy	G0152 (PM)
0441	Speech-language pathology	G0153 (PM)
0551	Skilled nursing	G0299 RN / G0300 LPN (on/after 1/1/2016); G0154 before (PM)
0561	Medical social services (visit)	G0155 (PM)
0569	Medical social services (phone call)	G0155 (PM)
0571	Home health aide	G0156 (PM)

Drugs & Infusion Pumps

Rev	Description	HCPCS & Modifiers
0250	Non-injectable drugs	None (NDC required for DOS before 10/1/2018)
029X	Infusion pump — equipment	As appropriate (not required on/after 10/1/2018)
0294	Infusion pump — drugs	As appropriate (not required on/after 10/1/2018)
0636	Injectable drugs	As appropriate (not required on/after 10/1/2018)

Key hospice modifiers: GV attending physician not employed/paid by the hospice · GW service not related to the terminal condition · PM post-mortem visit · 26 professional component · GY item/service statutorily excluded (e.g., room & board).

Reporting of Hospice Discharges

Ch. 11 §30.3

Discharge Reason	Occurrence Code	Condition Code	Patient Status Code
Patient revokes the benefit	42	—	Appropriate status code
Patient transfers to another hospice	—	—	50 or 51
Patient no longer terminally ill	—	—	Appropriate status code
Patient discharged for cause	—	H2	Appropriate status code
Patient moves out of the service area	—	52	Appropriate status code
Death	55	—	40, 41, or 42
Untimely face-to-face (FTF) encounter	—	—	Appropriate status code

Patient Status (FL17) — reference

Code	Description (as of the claim "Through" date)
01	Discharged to home, revoked, or decertified
30	Still a patient (the "Through" date must be the last day of the month)
40	Expired at home (use occurrence code 55)
41	Expired in a medical facility (use occurrence code 55)
42	Expired — place unknown (use occurrence code 55)
50	Discharged / transferred to hospice — home (routine or CHC)
51	Discharged / transferred to hospice — medical facility (respite or GIP)

Scope & sources. These tables list the codes most frequently submitted on Medicare hospice NOEs and claims; they are not a complete code set. Values and citations are based on the CMS Medicare Claims Processing Manual (Pub. 100-04), Chapters 1, 3, 11, and 25, and the National Uniform Billing Committee (NUBC) UB-04 Data Specifications. Code descriptions are simplified summaries for reference. Always confirm against the current CMS manuals, your MAC's guidance, and the official NUBC UB-04 manual before submitting claims, as codes and effective dates change.