Home Health Billing Codes

Type of Bill (TOB) (FL 4)

32A | Notice of Admission (NOA) • Start of Care (SOC) after 01.01.2022

32D | Cancellation of Admission • To cancel NOAs only

320 | Nonpayment Claim

327 | Adjustment Claim

328 | Void/Cancel Claim

329 | Final Claim for Period/Episode

34X | Outpatient Services

32Q | Reopening

32G, 32H, 32I | Contractor Adjustment

Type of Admission (FL 14)

1 | Emergency

2 | Urgent

3 | Elective

4 | Newborn

5 | Trauma

9 | Information Not Available

Point of Origin/Source of Admission (FL 15)

1 | Non-health Care Facility

2 | Clinic or Physician/Allowed Practitioner’s Office

4 | Transfer from Hospital (Different Facility)

5 | Transfer from Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF)

6 | Transfer from Another Health Care Facility

8 | Court/Law Enforcement

9 | Information Not Available

Patient Status (FL 17)

01 | Discharge to home or self-care (routine discharge)

02 | Discharge/transfer to short-term general hospital

03 | Discharge/transfer to SNF

04 | Discharge/transfer to ICF

05 | Discharge/transfer to designated cancer center or children's hospital

06 | Reported in all cases where the home health agency (HHA) is aware that the period of care will be paid a partial-period payment adjustment.

These are cases in which the HHA is aware that the beneficiary has transferred to another HHA within the 30-day period.

07 | Left against medical advice or discontinued care

20 | Expired (occurrence code 55 also required)

21 | Discharge/transfer to court or law enforcement

30 | Still a patient and services continue to be provided

43 | Discharge/transfer to federal hospital

50 | Discharge/transfer for hospice services in the home

51 | Discharge/transfer to hospice services in a medical facility

62 | Discharge/transfer to inpatient rehabilitation facility (IRF)

63 | Discharge/transfer to long-term care hospital (LTCH)

65 | Discharge/transfer to inpatient psychiatric hospital (IPH) or psychiatric unit of a hospital

66 | Discharge/transfer to Critical Access Hospital (CAH)

70 | Discharge/transfer to another type of health care institution not defined elsewhere in code list

Condition Code (FL 18-28)

07 | Treatment of non-terminal condition for hospice patient

20 | Beneficiary requested billing (demand denial)

21 | Billing for denial notice from Medicare (no-pay bill)

47 | Transfer from another HHA

54 | No skilled home health visits in billing period

C3 | Expedited review – partial approval of Medicare-covered services

C4 | Expedited review – services denied

C7 | Expedited review – extended authorization of Medicare-covered services

Claim Change Reason Code (CCRC) (FL 18-28) & Adjustment Reason Code (ARC)

Description CCRC |ARC | TOB

Change in Dates of Service (DOS) D0 |OT |327

Change in Charges D1 | OT | 327

Change in Revenue/HCPCS/HIPPS Codes D2 | QC | 327

Cancel to Correct Provider Number/Medicare ID Number D5 | PN | 328

Cancel Duplicate or Office of Inspector General (OIG) Payment D6 | 32 | 328

Change to make Medicare the secondary payer D7 | OT | 327

Change to make Medicare the primary payer D8 | OT | 327

Any Other/Multiple Change(s) (must include remarks) D9 | OT | 327

Change in Patient Status E0 | DS | 327

Occurrence Code (FL 31-34)

50 | OASIS assessment completion date (OASIS item M0090) for start of care, resumption of care, recertification or other follow-up OASIS occurring most recently before the claim "From" date. Required on final claims with "From" dates of January 1, 2020.

61 | The "Through" date of an acute care hospital discharge within 14 days prior to the "From" date of any home health claim. Optional on admission claims and continuing claims with "From" dates of January 1, 2020.

62 | The "Through" date of a SNF, IRF, LTCH or IPF discharge within 14 days prior to the admission date of the first home health claim. Optional on admission claims with "From" dates of January 1, 2020.

MSP Value Code (FL 39-41)

12 | Working Aged

13 | ESRD

14 | No Fault (No Attorney Involved)

15 | Workers’ Compensation

16 | Public Health Service/Other Federal

41 | Black Lung

43 | Disabled

44 | Obligated to Accept as Payment in Full (OTAF)

47 | Liability

Any of the above | Conditional Payment

Medicare

Non-MSP Value Code (FL 39-41)

61 | Core-Based Statistical Area (CBSA) code for where home health services

were provided. CBSA codes are required on all 329 TOBs, optional on 322

TOBs after 01.01.2021 and not required on 32A TOBs. Place "61" in the frst

value code field locator and the CBSA code in the dollar amount column

followed by two zeros.

85 | Federal Information Processing Standards (FIPS) state and county code

to designate where services were provided. FIPS codes are required on all

329 TOBs, optional on 322 TOBs after January 1, 2021 and not required

on 32A TOBs. Place "85" in the frst value code feld locator and the FIPS

code in the dollar amount column followed by two zeros. Select this link

for more information on FIPS state and county codes.

Revenue Code (FL 42), HCPCS/Rates/HIPPS Rate Codes (FL 44)

REV | Description | HCPCS

0001 | Total Units or Charges | N/A

0023 | HIPPS Code As assigned by Grouper software

027X | Medical/Surgical Supplies N/A unless 0274

042X | Physical Therapy | Varied

043X | Occupational Therapy | Varied

044X | Speech-language Pathology | Varied

055X | Skilled Nursing | Varied

056X | Medical Social Services | G0155

057X | Home Health Aide | G0156

062X | Medical/Surgical Supplies | N/A

HCPCS/Rates/HIPPS Rate Codes (FL 44)

HCPCS Services Performed in 15-minute Increments | REV

G0151 | Physical Therapy | 042X

G0152 | Occupational Therapy | 043X

G0153 | Speech-language Pathology | 044X

G0155 | Clinical Social Worker | 056X

G0156 | Home Health Aide | 057X

G0157 | Physical Therapist Assistant | 042X

G0158 | Occupational Therapist Assistant | 043X

G0159 | Physical therapy establish or deliver safe and effective physical therapy maintenance program | 042X

G0160 | Occupational therapy establish or deliver safe and effective occupational therapy maintenance program | 043X

G0161 | Speech-language pathology establish or deliver safe and effective speech-language pathology maintenance program | 044X

G0162 | Registered nurse (only) for management and evaluation of plan of care (POC) | 055X

G0299 | Direct skilled services of a registered nurse | 055X

G0300 | Direct skilled services of a licensed practical nurse | 055X

G0493 | Registered nurse for the observation and assessment of patient's condition | 055X

G0494 | Licensed practical nurse for the observation and assessment of patient's condition | 055X

G0495 | Registered nurse training and/or education of a patient or family member | 055X

G0496 | Licensed practical nurse training and/or education of a patient or family member | 055X

G2168 | Services performed by a physical therapy assistant, each 15 minutes (Valid for claims submitted after October 5, 2020, for services on or after January 1, 2020. TOB 032X other than 0322. Select this link for more information.) | 042X

G2169 | Services performed by an occupational therapy assistant, each 15 minutes (Valid for claims submitted after October 5, 2020, for services on or after January 1, 2020. TOB 032X other than 0322. Select this link for more information.) | 043X

HCPCS/Rates/HIPPS Rate Codes (FL 44)

HCPCS | Where Home Health Services Were Provided

Q5001 | Care provided in patient's home or residence

Q5002 Care provided in assisted living facility

Q5009 Care provided in place not otherwise specified (NO)

HCPCS | Telehealth Coding

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 (for example, remote patient monitoring). Report the use of remote patient monitoring that spans a number of days as a single line item showing the start date of monitoring and the number of days of monitoring in the Units field.

FISS Field & UB-04 FL

FISS Pg | FISS Field Name | UB FL | Data Entered Claim

1 | MID | 60 | Medicare ID Number | Required

1 | TOB | 4 | Type of Bill | Required

1 | NPI | 56 | NPI Number | Required

1 | Pat.Cntl #|3a | Patient Control Number | Optional

1 Stmt Date From | 6 From DOS | Required

1 To | 6 To DOS | Required

1 Last | 8 | Patient’s Last Name | Required

1 First | 8 | Patient’s First Name | Required

1 DOB | 10 | Patient’s Date of Birth | Required

1 Addr 1 |9 | Patient’s Address | Required

1 Addr 2 | 9 |City, State | Required

1 ZIP | 9 |ZIP Code | Required

1 | Sex | 11 | Sex Code (M or F) | Required

1 Admit Date | 12 | Date of Admission | Required

1 Hr | 13 | Admission Hour | Required1

1 Type | 14 | Type of Admission | Required

1 Src | 15 | Point of Origin | Required

1 Stat | 17 | Patient Status | Required

1 Cond Codes | 18-28 | Condition Code | Conditional

1 Occ Cds/Date | 31-34 | Occurrence Code/Date | Conditional

1 Fac.ZIP | 1 | ZIP Code for Provider or Subpart | Required1

1 DCN | 64 | Document Control Number | Conditional2

1 Value Codes | 39-41 | Value Codes | Required3

2 | Rev | 42 | Revenue Codes | Required4

2 | HCPC | 44 HCPCS | Required

2 | Modifs | 44 | Modifiers Conditional

2 | Tot Unit | 46 | Total Units | Required

2 | Cov Unit | 46 Covered Units | Required

2 | Tot Charge | 47 Total Charges | Required

2 | Ncov Charge | 48 | Non-covered Charges | Conditional

2 | Serv Date | 45 | Service Date | Required

3 | CD | 50 | Payer Code | Required

3 | Payer | 50 | Payer Name | Required

3 | RI | 52 Release of Information | Required

3 | Medical Record Nbr | 3b | Medical Record Number | Optional

3 | Diag Codes | 67 | Diagnosis Codes | Required

3 | Att Phys NPI | 76 | Physician/Allowed Practitioner NPI Who Signed POC | Required

3 | L | 76 | Last Name of Physician/Allowed Practitioner Who Signed POC | Required

3 | F | 76 | First Name of Physician/Allowed Practitioner Who Signed POC | Required

3 | M | 76 | Middle Initial of Physician/Allowed Practitioner Who Signed POC | Optional

3 | Ref Phys | 78 | Physician/Allowed Practitioner NPI Who Certified/Recertified Eligibility | Required

3 | L | 78 | Last Name of Physician/Allowed Practitioner Who Certified/Recertified Eligibility | Required

3 | F | 78 | First Name of Physician/Allowed Practitioner Who Certified/Recertified Eligibility | Required

3 | M | 78 | Middle Initial of Physician Who Certified/Recertified Eligibility | Optional

4 | Remarks | 80 | remarks (adjustments, cancels, MSP, etc.) | Conditional

5 | Insured Name | 58 | Insured's Last Name, First Name | Conditional

5 | Sex | N/A | Insured's Sex Code | Conditional

5 | DOB | N/A | Insured's Date of Birth | Conditional

5 | REL | 59 | Patient's Relationship to Insured | Conditional

5 | CERT-SSN-MID | 60 | Insured's ID/Medicare ID Number| Conditional

5 | Group Name | 61 | Insurance Group Name | Conditional

5 | Group Number | 62 | Insurance Group Number | Conditional

5 | Treat Auth Code | 63 | 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 for the HH Review Choice Demonstration. In that case, the required tracking number is submitted in the first position of the field in all submission formats. | Required