Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Transmittal Letter HHA-41 December 2008 TO: Home Health Agencies Participating in MassHealth FROM: Tom Dehner, Medicaid Director RE: Revisions to Subchapter 6 (Service Codes and Descriptions) Skilled Nursing Visits for Members after 61 Consecutive Calendar Days Effective December 1, 2008, MassHealth has added a new billing requirement for skilled nursing visits for members who receive home health services from the same home health agency for 61 consecutive calendar days or longer. Home health agencies must use the Service Code and modifier G0154 UD when billing for skilled nursing visits provided to a member on or after the 61st consecutive calendar day of the first home health service, even if some or all of those services were paid by a third-party insurer other than MassHealth. For example, for a member who began to receive home health services on September 15, 2008, the home health agency must bill Service Code and modifier G1054 UD for dates of service on and after December 1. This is the case even though December 1 is the 77th day of service. For a member who began to receive home health services on November 22, 2008, the home health agency must bill Service Code and modifier G1054 UD for dates of service beginning January 21, 2009 (61 days from the initial date of service). If a member is discharged from an inpatient hospital or skilled-nursing facility, the home health agency bills for the following 60 consecutive calendar days at the skilled-nursing-visit rate, using Service Code G0154. This is applicable whether or not the home health agency provided services to the member before the admission to the hospital or skilled nursing facility. If the member continues services after 60 consecutive days, then the home health agency must bill for skilled nursing visits using Service Code and modifier G0154 UD. The Division of Health Care Finance and Policy (DHCFP) has established a new payment rate for G1054 UD, which can be viewed at their Web site (www.mass.gov/dhcfp). DHCFP has adopted this amendment to 114.3 CMR 50.00: Home Health Services, as an emergency regulation effective December 1, 2008, to implement budget reductions in accordance with M.G.L. c. 29, § 9C. Revenue Codes Revenue codes have been added to Subchapter 6 of the Home Health Agency Manual. The attached Subchapter 6 contains the revenue codes. If you have any questions about the information in this transmittal letter, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Home Health Agency Manual Pages 6-1 and 6-2 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Home Health Agency Manual Pages 6-1 and 6-2 — transmitted by Transmittal Letter HHA-38 Commonwealth of Massachusetts MassHealth Provider Manual Series Home Health Agency Manual Subchapter Number and Title 6. Service Codes and Descriptions Page 6-1 Transmittal Letter HHA-41 Date 12/01/08 601 Explanation of Abbreviation The abbreviation "PA" indicates that MassHealth prior authorization is required (see program regulations in Subchapter 4 of the Home Health Agency Manual). 602 Definitions Providers must use a service code and modifier that accurately reflect the nursing service provided. With nursing Service Codes T1002 and T1003, nursing services provided on a weekend or holiday will be automatically reimbursed in accordance with the applicable fee schedule of the Division of Health Care Finance and Policy (DHCFP). No additional service code or modifier is required to indicate weekend or holiday services. (A) Day – the hours from 7:00 A.M. to 2:59 P.M., Sunday through Saturday. (B) Night – the hours from 3:00 P.M. to 6:59 A.M., Sunday through Saturday. 603 Service Codes and Descriptions: Home Health Aide, Therapy, and Nursing Services Revenue Service Code Code-Modifier Service Description Nursing (for a Visit of Two Hours or Less) and Home Health Aide 0551 G0154 Services of skilled nurse in home health setting, each 15 minutes (PA for MassHealth Basic members not enrolled with a managed care organization and for complex-care members) 0551 G0154 TT Services of skilled nurse in a home health setting, each 15 minutes (use when billing for each subsequent member–not for the first member–when two or more members in the same household are receiving a nursing visit during the same time period.) (PA for MassHealth Basic members not enrolled with a managed care organization and for complex-care members) 0551 G0154 UD Services of skilled nurse in a home setting, each 15 minutes (use when billing for a member in home health services for 61 consecutive calendar days or longer) 0551 99058 Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service (use for emergency office services) 0572 G0156 Services of home health aide in home health setting, each 15 minutes (PA for complex-care members) Therapy 0421 G0151 Services of physical therapist in home health setting, each 15 minutes (PA after 20 visits) 0431 G0152 Services of occupational therapist in home health setting, each 15 minutes (PA after 20 visits) 0441 G0153 Services of speech and language pathologist in home health setting, each 15 minutes (PA after 35 visits) Commonwealth of Massachusetts MassHealth Provider Manual Series Home Health Agency Manual Subchapter Number and Title 6. Service Codes and Descriptions Page 6-2 Transmittal Letter HHA-41 Date 12/01/08 603 Service Codes and Descriptions: Home Health Aide, Therapy, and Nursing Services (cont.) Revenue Service Code Code-Modifier Service Description Continuous Skilled Nursing Services (More Than a Two-Hour Visit) Individual Patient Nursing The following service codes must be used for nursing care provided by one nurse to one member. 0552 T1002 RN services, up to 15 minutes (day) (PA) 0552 T1003 LPN/LVN services, up to 15 minutes (day) (PA) 0552 T1002 UJ RN services, up to 15 minutes (night) (PA) 0552 T1003 UJ LPN/LVN services, up to 15 minutes (night) (PA) Multiple-Patient Nursing The following service codes are to be used for nursing care provided by one nurse simultaneously to two members. 0552 T1002 TT RN services, up to 15 minutes (day) (each member) (PA) 0552 T1003 TT LPN/LVN services, up to 15 minutes (day) (each member) (PA) 0552 T1002 U1 RN services, up to 15 minutes (night) (each member) (PA) 0552 T1003 U1 LPN/LVN services, up to 15 minutes (night) (each member) (PA) The following service codes are to be used for nursing care provided by one nurse simultaneously to three members. 0552 T1002 U2 RN services, up to 15 minutes (day) (each member) (PA) 0552 T1003 U2 LPN/LVN services, up to 15 minutes (day) (each member) (PA) 0552 T1002 U3 RN services, up to 15 minutes (night) (each member) (PA) 0552 T1003 U3 LPN/LVN services, up to 15 minutes (night) (each member) (PA)