Billing

Billing Hospice Services

• Use the 837I claim for hospice claims
• Type of Bill:
  • 811 nonhospital-based hospice; 817 for nonhospital-based replacement claims
  • 821 hospital-based hospice; 827 for hospital-based replacement claims
• Revenue Codes:
  • 0651, 0652, 0655, 0656 enter:
    • Value code for the service and appropriate 5-digit Core Based Statistical Area (CBSA) code to identify the location where the hospice was provided
• For home care, use revenue codes:
  • 0651 – Routine home care day (less than 8 hours)
    • HCPCS code range Q5001-Q5010
    • Report units as days (1 day = 1 unit; 30 days = 30 units)
  • 0652 – Continuous home car day (8 or more hours of nursing care, up to 24 hours per day)
    • HCPCS code range Q5001-Q5010
    • Report units in 15-minute increments (8 hours = 32 units; 24 hours = 96 units)
• For inpatient care, use revenue codes:
  • 0655 - Inpatient respite day
    • A day on which the individual who has elected hospice care receives care in an approved facility on a short-term basis for respite. 
  • 0656 – General inpatient day
    • A day on which the hospice recipient receives general inpatient care in an inpatient facility for pain control or acute chronic symptom management which cannot be managed in other settings. The total number of days must not exceed 20 percent of the total days provided to a hospice recipient. 
• For both inpatient respite and general inpatient days, billing may include date of admission but not date of discharge, unless discharge is due to member being deceased. Use appropriate HCPCS range Q5001 – Q5010.
• For long-term care facility (LTCF), use revenue code:
  • 0658 – room and board for a member who resided in a long-term care facility before hospice election
  • PrimeWest Health does not pay for the discharge day, even upon death, when a member is residing in a LTC facility.
• For Pediatric Residential Hospice:
  • TOB: 89X
  • Revenue Code: 0679
  • Value Code: 61
  • Bill each date of service as a separate line up to 24 maximum units (1 unit equals 1 hour)

If the claim does not have a value code and the CBSA code for the location where the care was provided. PrimeWest Health will deny the claim.

Billing Hospice Physician Services

• Use the 837P claim form.
• Use appropriate Current Procedural Terminology (CPT)/HCPCS codes and any applicable modifiers.
• Enter the rendering physician’s individual NPI in the Rendering Provider field.
• Enter the NPI of the hospice provider in the Billing Provider section.
• The hospice payment for physician services is the PrimeWest Health physician payment rate and is included in the hospice cap amount.
  • Patient care services not related to the terminal illness rendered by an independent attending physician (a physician who is not considered employed or under contract with the hospice) must be billed using physician billing guidelines (refer to Physician and Professional Covered Services) and are not part of the hospice cap amount.
  • Do not submit denied Medicare physician payments that are related to the terminal illness.
  • Denied Medicare payments for physician services must have an attachment stating the reason(s) Medicare denied the services (services must not be related to the terminal illness).

Billing Medical Supplies and Equipment

Hospice services include medical supplies and equipment for the care and comfort of members when related to a terminal illness.

For medical supplies or equipment not related to a terminal illness, providers must bill Minnesota Health Care Programs (MHCP) using a diagnosis code related to the need for the item, not the terminal illness. Review the Equipment and Supplies section of the Minnesota Department of Human Services (DHS) Provider Manual for complete coverage criteria and billing information. Each claim must include a signed statement from the hospice physician indicating why the equipment or supply was not related to the terminal condition. It is the responsibility of the elected hospice provider to coordinate and provide this statement to the medical supplier when requested.

Cancellation of An Election

Hospices must use a cancellation notice when a member isn’t getting services from the hospice but the admission date has already been entered. The entered dates are voided because the member never participated with the hospice. A cancellation notice removes the hospice election period created by a Notice of Election (NOE). Cancellation notices may also be used to remove a transfer or for a change of ownership sent in error. When there’s been a transfer or change of ownership, the admittance date on the 8xD Type of Bill must match the corresponding transfer or change date to make sure those dates are removed correctly.

PW_11-19_555
Updated_06/12/2026