Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA 02111
www.mass.gov/dma
MASSHEALTH
TRANSMITTAL LETTER HOS-12
December 2003

TO:      Hospice Providers Participating in MassHealth
FROM:      Beth Waldman, Acting Commissioner
RE:      Hospice Manual (Revisions to Service Codes and Descriptions)
This letter transmits revisions to service codes and descriptions in Subchapter 6 of the Hospice Manual. The Centers for Medicare and Medicaid Services (CMS) has revised the Healthcare Common Procedure Coding System (HCPCS) for 2004. In compliance with the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA), the Division of Medical Assistance (Division) has added national service codes to, and deleted MassHealth local service codes from, Subchapter 6. These revisions are effective for dates of service on or after January 1, 2004.
The attached Subchapter 6 contains the new national service codes and modifiers, where applicable.
Billing Instructions for HIPAA Electronic Claims
Hospice providers billing HIPAA-compliant electronic claims must use the 837 Institutional transaction (837I). Revenue codes are required on the 837I, in addition to the HCPCS service codes and applicable modifiers.

MASSHEALTH
TRANSMITTAL LETTER HOS-12 December 2003 Page 2
Billing Instructions for All Claims
Revenue codes are not to be used on the paper claim form no. 9, nor on the proprietary electronic media claims (EMC) format. The following is the listing of allowable revenue codes (for 837I transactions only), HCPCS codes, and HCPCS modifiers.

Obsolete	Revenue	New HCPCS code	Service Description	
Local	Code	- Modifier		
Code				
	837I only	All claims-paper 9, EMC, and 837I		
X2350	0651	T2042	
X2351	0652	T2043	
X2353	0655	T2044	
X2352	0656	T2045	
X2356	0658	T2046	
X2358	0651	T2042 TN	
X2359	0652	T2043 TN	
Hospice routine home care; per diem (within the
county in which the provider is located)
Hospice continuous home care; per hour (within the
county in which the provider is located)
Hospice inpatient respite care; per diem
Hospice general inpatient care; per diem
Hospice long term care, room and board only; per
diem
Hospice routine home care; per diem (outside the
county in which the provider is located)
Hospice continuous home care; per diem (outside the
county in which the provider is located)
If you have any questions about this transmittal letter, please contact MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Hospice Manual
Pages 6-1 and 6-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Hospice Manual
Pages 6-1 and 6-2 — transmitted by Transmittal Letter HOS-11

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
HOSPICE MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-1	

	TRANSMITTAL LETTER
HOS-12	DATE
01/01/04	
601  Service Codes and Descriptions
Service
Code-Modifier       Service Description
T2042	Hospice routine home care; per diem (within the county in which the provider is
located)
T2043	Hospice continuous home care; per hour (within the county in which the provider is
located)
T2044	Hospice inpatient respite care; per diem
T2045	Hospice general inpatient care; per diem
T2046	Hospice long term care, room and board only; per diem
T2042 TN	Hospice routine home care; per diem (outside the county in which the provider is
located)
T2043 TN	Hospice continuous home care; per hour (outside the county in which the provider
is located)

Commonwealth of Massachusetts
Division of Medical Assistance
Provider Manual Series
HOSPICE MANUAL	SUBCHAPTER NUMBER AND TITLE
6 SERVICE CODES AND DESCRIPTIONS	PAGE
6-2	

	TRANSMITTAL LETTER
HOS-12	DATE
01/01/04	
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