HH PPS Claims With Non-Routine Supplies (NRS)

Only non-routine supplies (NRS) are reported to Medicare on home health final claims. Revenue code 027X (Medical/Surgical Supplies) is used to identify non-routine supplies other than those used for wound care. The letters S, T, U, V, W, or X in the fifth position of the Health Insurance Prospective Payment System (HIPPS) code indicate that NRS were provided to the beneficiary during the episode. NRS supplies must be present on your final claim when a letter is submitted in the fifth position of the HIPPS code.

Home health agencies (HHAs) use revenue code 0623 (Medical/Surgical Supplies – Extension of 027X) to voluntarily report charges for all non-routine wound care supplies, including but not limited to surgical dressings.

When reporting revenue codes 0623 or 027X on the final claim, they must include:

HCPCS code — Required only for revenue code 0274 (Prosthetic and Orthotic Devices). Enter this information when required into the “HCPC” field via direct data entry (DDE) on Fiscal Intermediary Standard System (FISS) page 02, which corresponds with form locator (FL) 44 on the CMS-1450 paper claim form.
Service units (required) — Units must be reported in both the TOT UNIT and COV UNIT fields on the FISS page 02. These fields correspond to form locator (FL) 46 on the CMS-1450 claim form. HHAs may choose to use a default “1” in each of these fields.
Charges (required) — When reporting 0623 and 027X, charge amounts for the two revenue codes must be separate and distinct. Charges are keyed into the “TOT CHARGE” field on FISS page 02, which corresponds to FL 47 on the CMS-1450 claim form.
Dates of Service (required) — The line item date of service must fall within the “FROM” and “TO” date of the claim. This information is entered into the “SERV DT” field on FISS page 02, which corresponds to FL 45 on the CMS-1450 claim form.
- Cahaba encourages you to use the first Medicare billable visit in the episode as the date of service submitted with non-routine or surgical dressing/wound care supplies.

All NRS may be reported on one line item on the final claim. Documentation of all NRS provided to the beneficiary must be included in the patient’s medical record.

Routine Versus Non-Routine Supplies

The Medicare Benefit Policy Manual (CMS Pub 100-02, Ch. 7, § 50.4.1) defines routine versus non-routine supplies. Use this definition to determine whether a supply item is non-routine and must be reported separately.