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Hospice Care Services Code Conversion and Billing Instructions

May 6, 2016

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/
HCPCS Code
Description Authorization
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/
T2045
General inpatient care (no respite)/
hospice general care
TAR is required.
Z7108 Special physician services 0657 Physician's services TAR is not required.