[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-573135-105":3,"detail-sidebar-cat-1-en-105":74,"doc-detail-573135-en":120},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":67,"head_meta":69,"extra_data":71,"updated_unix":73},105,"en","hospice-medicare-billing-codes-sheet-hospice-noesclaims","Hospice Medicare Billing Codes Sheet - Hospice NOEs/Claims","","Hospice Medicare billing codes sheet compiling frequently submitted code values used in hospice notices of election (NOE) and hospice claims. The sheet maps billing and admission-related fields such as type of bill, type of admission, point of origin, patient status, condition codes, claim change/adjustment reason codes, occurrence codes, and occurrence span codes. It also lists MSP value codes, allowed place-of-service HCPCS for levels of care, and revenue code categories paired with HCPCS and modifiers for common discipline and service visits, referencing CMS Pub. 100 documentation.",{"@graph":14,"@context":66},[15,34,49],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/invoices/","Invoices",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/hospice-medicare-billing-codes-sheet-hospice-noesclaims/573135/",4,{"url":32,"name":10,"@type":35,"author":36,"headline":10,"publisher":39,"fileFormat":42,"inLanguage":8,"description":12,"dateModified":43,"datePublished":43,"encodingFormat":42,"isAccessibleForFree":44,"interactionStatistic":45},"DigitalDocument",{"name":37,"@type":38},"Guten tag","Person",{"url":19,"name":40,"@type":41},"DocShare","Organization","application/pdf","2026-10-13",true,{"@type":46,"interactionType":47,"userInteractionCount":4},"InteractionCounter",{"@type":48},"ViewAction",{"@type":50,"mainEntity":51},"FAQPage",[52,58,62],{"name":53,"@type":54,"acceptedAnswer":55},"What is covered under Type of Bill (FL4) codes on the sheet?","Question",{"text":56,"@type":57},"The sheet lists hospice-related Type of Bill values indicating non-hospital vs hospital based bills, and claim actions such as first claim in series, continuing claim, discharge claim, adjustment claim, and cancel/ nonpayment variants.","Answer",{"name":59,"@type":54,"acceptedAnswer":60},"How do Condition Code (FL 18-28) and occurrence codes work together?",{"text":61,"@type":57},"Condition codes on the sheet include discharge-for-cause and discharge/unavailability scenarios, while occurrence codes provide specific dates like certification/recertification and dates of revocation or death when patient status requires it.",{"name":63,"@type":54,"acceptedAnswer":64},"Which sections provide HCPCS and modifiers for services?",{"text":65,"@type":57},"The sheet includes a portion for allowed place-of-service HCPCS by levels of care and a section for revenue codes (FL 42) with corresponding HCPCS codes and modifiers (FL 44), including discipline visit descriptions such as therapy and skilled nursing.","https://schema.org",{"og:url":32,"og:type":68,"og:title":10,"og:site_name":40,"og:description":12},"article",{"robots":70,"canonical":32},"index,follow",{"doc_id":72,"site_id":7},573135,1791932960,{"code":4,"msg":75,"data":76},"success",[77,82,87,91,96,101,106,111,116],{"id":78,"doc_module":22,"doc_module_name":25,"category_name":79,"show_sort_weight":80,"slug":81},11,"Presentations",90,"presentations",{"id":83,"doc_module":22,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},12,"Resumes",80,"resumes",{"id":88,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":89,"slug":90},14,70,"invoices",{"id":92,"doc_module":22,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},15,"Posters",60,"posters",{"id":97,"doc_module":22,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},16,"Social Media",50,"social-media",{"id":102,"doc_module":22,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},17,"Forms",40,"forms",{"id":107,"doc_module":22,"doc_module_name":25,"category_name":108,"show_sort_weight":109,"slug":110},18,"Letters",30,"letters",{"id":112,"doc_module":22,"doc_module_name":25,"category_name":113,"show_sort_weight":114,"slug":115},21,"Paper Templates",5,"papers-templates",{"id":117,"doc_module":22,"doc_module_name":25,"category_name":118,"show_sort_weight":4,"slug":119},158,"General","general-158",{"code":4,"msg":75,"data":121},{"doc_id":72,"user_id":122,"nickname":37,"user_avatar":123,"doc_module":22,"category_id":88,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":124,"file_id":125,"file_url":126,"file_type":127,"file_size":128,"view_count":4,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":129,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":130,"faqs":131,"seo_title":132,"seo_description":12,"update_tm":73,"read_time":26},687212321768,"https://ap-avatar.wpscdn.com/avatar/a0010bdbe886d2fe77?x-image-process=image/resize,m_fixed,w_180,h_180&k=1789897067658708522","| Type of Bill (FL4) X=1 non hospital based ● X=2 hospital based |  |  |  |\n| --- | --- | --- | --- |\n| 8XA | Notice of Election (NOE) | 8X2 | 1st claim in series |\n| 8XB | Notice of Termination/Revocation (NOTR) | 8X3 | Continuing claim |\n| 8XC | Change of hospice | 8X4 | Discharge claim |\n| 8XD | Cancel NOE/benefit period | 8X7 | Adjustment claim |\n| 8X0 | Nonpayment claim | 8X8 | Cancel claim |\n| 8X1 | Admit thru discharge |  |  |\n| CMS Pub. 100-04, Chapter 11, Section 20.1.2 & 30.3 |  |  |  |\n\n\n| Type of Admission (FL14) |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| 1 | Emergency | 3 | Elective | 9 | Information not available |\n| 2 | Urgent | 5 | Trauma |  |  |\n| CMS Pub. 100-04, Chapter 25, Section 75.1 |  |  |  |  |  |\n\n\n| Point of Origin (Source of Admission) (FL15) |  |  |  |\n| --- | --- | --- | --- |\n| 1 | Non-health care facility | 6 | Transfer from Another Health Care Facility |\n| 2 | Clinic or physician’s office |  |  |\n| 4 | Transfer from hospital | 8 | Court/Law Enforcement |\n| 5 | Transfer from SNF or ICF | 9 | Information not available |\n| CMS Pub. 100-04, Chapter 25, Section 75.1 |  |  |  |\n\n\n| Patient Status (FL17) as of “To” date on claim |  |\n| --- | --- |\n| 01 | Discharged to home, revoked, or decertified |\n| 30 | Still a patient (“To” date must be last day of month) |\n| 40 | Expired at home (see occurrence code 55) |\n| 41 | Expired at medical facility (see occurrence code 55) |\n| 42 | Expired – place unknown (see occurrence code 55) |\n| 50 | Discharged/transferred to hospice – home (routine or CHC) |\n| 51 | Discharged/transferred to hospice – medical facility (respite or GIP) |\n| CMS Pub. 100-04, Chapter 11, Section 30.3 |  |\n\n\n| Condition Code (FL 18-28) |  |\n| --- | --- |\n| H2 | Discharge for cause (i.e. patient/staff safety) |\n| 52 | Discharge for patient unavailability, inability to receive care, or out of service area |\n| 85 | Delayed recertification of hospice terminal illness (effective for claims received on or after 1/1/2017) |\n| CMS Pub. 100-04, Chapter 11, Section 30.3 |  |\n\n\n| Claim Change Reason Code (CCRC) (FL 18-28) & Adjustment Reason Code (ARC) (FISS only) |  |  |  |\n| --- | --- | --- | --- |\n| Description | CCRC | ARC | TOB |\n| Change in dates of service | D0 | RF | 8X7 |\n| Change in charges | D1 | RG | 8X7 |\n| Change in revenue/HCPCS code | D2 | RH | 8X7 |\n| Cancel to correct provider \\#/Medicare ID number | D5 | RI | 8X8 |\n| Cancel duplicate or OIG payment | D6 | RJ | 8X8 |\n| Any other/multiple change(s) | D9 | RM | 8X7 |\n| Change in patient status | E0 | RN | 8X7 |\n| CMS Pub. 100-04, Chapter 1, Section [130.1.2.1](130.1.2.1) |  |  |  |\n\n\n| Occurrence Codes (FL 31-34) |  |\n| --- | --- |\n| 27 | Date of certification or recertification |\n| 42 | Date of revocation (ONLY) |\n| 55 | Date of death (when patient status = 40, 41 or 42) |\n| CMS Pub. 100-04, Chapter 11, Section 30.3 |  |\n\n\n| Occurrence Span Codes (FL 35-36) |  |\n| --- | --- |\n| 77 | Noncovered days due to untimely recertification OR Untimely NOE |\n| M2 | Multiple respite stays, From/To dates of each stay |\n| CMS Pub. 100-04, Chapter 11, Section 30.3 |  |\n\nNOTE: The codes listed on this billing codes sheet represent those most frequently submitted on hospice NOEs/claims. A complete listing of all codes is accessible from the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual: [http://www.nubc.org](http://www.nubc.org).  \nWebsite Reference-CMS Pub. 100: [http://www.cms.gov/Regulations-and](http://www.cms.gov/Regulations-and)Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs. html  \n\n| MSP Value Codes (FL 39-41) |  |\n| --- | --- |\n| Description | VC |\n| Working aged | 12 |\n\nH-016-13 • Page 1 of 4 • Revised September 28, 2018.  \n© 2018 Copyright, CGS Administrators, LLC.  \nDisclaimer: This resource is not a legal document. Reproduction of this material for profit is prohibited.  \n| MSP Value Codes (FL 39-41) |  |\n| --- | --- |\n| Description | VC |\n| ESRD | 13 |\n| No Fault (no attorney inv","cbCaivMgEHCuj6Af","https://ap.wps.com/l/cbCaivMgEHCuj6Af","pdf",252295,"English","# Type of Bill (FL4)\n# Type of Admission (FL14)\n# Point of Origin (FL15)\n# Patient Status (FL17)\n# Condition Code (FL 18-28)\n# Claim Change/Adjustment Reason Codes (FL 18-28)\n# Occurrence Codes (FL 31-34)\n# Occurrence Span Codes (FL 35-36)\n# MSP Value Codes (FL 39-41)\n# Allowed Place of Service (HCPCS) by Levels of Care (Revenue)\n# Revenue Codes (FL 42) and HCPCS/Modifiers (FL 44)","[{\"question\":\"What is covered under Type of Bill (FL4) codes on the sheet?\",\"answer\":\"The sheet lists hospice-related Type of Bill values indicating non-hospital vs hospital based bills, and claim actions such as first claim in series, continuing claim, discharge claim, adjustment claim, and cancel/ nonpayment variants.\"},{\"question\":\"How do Condition Code (FL 18-28) and occurrence codes work together?\",\"answer\":\"Condition codes on the sheet include discharge-for-cause and discharge/unavailability scenarios, while occurrence codes provide specific dates like certification/recertification and dates of revocation or death when patient status requires it.\"},{\"question\":\"Which sections provide HCPCS and modifiers for services?\",\"answer\":\"The sheet includes a portion for allowed place-of-service HCPCS by levels of care and a section for revenue codes (FL 42) with corresponding HCPCS codes and modifiers (FL 44), including discipline visit descriptions such as therapy and skilled nursing.\"}]","Hospice Medicare Billing Codes Sheet - Hospice NOEs/Claims | PDF"]