Hospice Care Services Code Conversion and Billing Instructions
Effective for dates of service on or after June 1, 2016, the current HCPCS Local Level III procedure codes for hospice care services will be discontinued. The codes will be replaced by five new Health Insurance Portability and Accountability Act (HIPPA) compliant national and/or revenue codes.
Every new Treatment Authorization Request (TAR) and electronic TAR (eTAR) submitted for dates of service on or after June 1, 2016, must include the appropriate HCPCS Level II procedure code described below. The Department of Health Care Services (DHCS) will provide direction at regular intervals, reminding providers to exhaust existing TARs and Service Authorization Requests (SARs).
Providers should review their inventory for previously approved TARs with hospice care services for dates of service on or after June 1, 2016. For those TARs, providers must submit a new TAR or eTAR with the appropriate HCPCS Level II procedure code to cover any remaining service period on or after June 1, 2016.
If a TAR is submitted for the purpose of updating codes in the same authorization period, it will not be reviewed for medical necessity.
The conversion is as follows:
|Current Billing||New Billing|
|HCPCS Code||Description||Authorization||Revenue Code/
|Z7100||Routine home care (per diem)||Medi-Cal recipients who are entitled to Medicare, but not eligible for Part A coverage on the date of service, may bill Medi-Cal directly. Medicare denial documentation is not required with these claims.||0651||Routine home care||TAR is not required.|
|Z7102||Continuous home care||0652||Continuous home care||TAR is not required.|
|Z7104||Respite care (per diem)||0655||Inpatient respite care||TAR is not required.|
|Z7106||General inpatient care||0656/
|General inpatient care (no respite)/
hospice general care
|TAR is required.|
|Z7108||Special physician services||0657||Physician's services||TAR is not required.|