Hospice Room and Board
Medicare Benefit Policy Manual (CMS Pub. 100-02), Ch. 9 §20.3)
Under the Medicare hospice benefit, room and board charges are statutorily excluded and never covered by Medicare, except when provided in an inpatient setting (inpatient respite or general inpatient care). Room and board charges should only be submitted to Medicare when a denial is necessary to bill another insurance (e.g., Medicaid).
Noncovered hospice room and board charges should be billed separately
whenever possible. If it is not possible, the charges may be billed
with the covered charges for the daily levels of care. Billing processes
for each method can be found in the Medicare
Claims Processing Manual (CMS Pub. 100-04), Ch.1 §60 
and
are summarized below.
Only Room and Board Charges
In addition to all the usual claim information, include the following:
TOB field on the Fiscal Intermediary Standard System (FISS) Claim Page 01 |
Enter a zero in the third-digit (810 or 820). |
STMT DATES FROM / TO field on the FISS Claim Page 01 |
Enter the same dates of service as submitted on the covered claim. |
COND CODES field on the FISS Claim Page 01 |
Enter condition code 21. |
REV field on the FISS Claim Page 02 |
Enter revenue codes 0659. |
HCPC on the FISS Claim Page 02 |
Enter the HCPC code A9270. |
MODIFS field on the FISS Claim Page 02 |
Enter the Modifier GY. |
NCOV CHARGE on the FISS Claim Page 02 |
Enter the amount of charges for which you are requesting a denial. |
REMARKS on the FISS Claim Page 04 |
Enter a brief remark indicating that the noncovered charges are for room and board. |
Room and Board Charges Submitted with Covered Charges
In addition to all the usual claim information, include the following:
REV field on the FISS Claim Page 02 |
Enter revenue codes 0659 for room and board. Report other applicable revenue codes as usual. |
HCPC on the FISS Claim Page 02 |
Enter the HCPC code A9270 for room and board. |
MODIFS field on the FISS Claim Page 02 |
Enter the Modifier GY for room and board. |
NCOV CHARGE on the FISS Claim Page 02 |
Enter the room and board charges (0659) as noncovered charges. |
REMARKS on the FISS Claim Page 04 |
Enter a brief remark indicating that the noncovered charges are for room and board. |
Page last updated: March 31, 2008
