Reporting Federal Information Processing Standards State and County Codes on Home Health Claims Is Required

Published 05/09/2024

Change Request (CR) 10782 (PDF) changed the home health rural add-on payments effective January 1, 2019. The county-based increase applies to all periods and visits ending on or after January 1, 2019, through calendar years 2020, 2021 and 2022. Section 4137 of the Consolidated Appropriations Act of 2023 extended the rural add-on policy for CY 2023.

All home health claims, Type of Bill (TOB) 032x, received on or after January 1, 2019, for home health services furnished on or after January 1, 2019, shall contain the new coding as required by the Bipartisan Budget Act (BBA) of 2018. This includes non-rural home health agencies (HHAs) who are not affected by rural add-on payments. CR 10782 established value code (VC) 85 and an associated Federal Information Processing Standards (FIPS) state and county code for this requirement. VC 85 is defined as "County Where Service is Rendered."

CR 13543 (PDF), effective October 1, 2024, creates an edit in the Original Medicare systems to ensure VC 85 and a corresponding FIPS state and county code are reported on all home health claims processed on or after the CR’s effective date. Medicare shall return to the provider home health claims TOB 032x (other than 032A or 032D) if VC 85 and a corresponding FIPS state and county code are not present.

You can find the FIPS state and county codes using either of the following links:

HHAs should use the most recent list provided for the associated FIPS state and county codes. When entering the FIPS state and county code, the number would be keyed, followed by two zeros. For example, 19153 would be keyed as 1915300 or 19153.00. If the FIPS state and county code begins with a zero, do not enter the zero. Enter the four digits that follow the zero. For example, 08019 would be keyed as 801900 or 8019.00.

Prior to October 1, 2024, if the codes are missing on rural claims and/or adjustments, the claims will be returned to the provider. If the new codes are missing for non-rural HHAs, the claims would process without them. Whether the Medicare Claim Processing system edits for billing requirements or not, proper billing is still a requirement. 

Make sure your billing staff is aware of these changes.

Note: In addition to VC 85, the Core Based Statistical Area (CBSA) code reported with VC 61 continues to be required on all home health claims.

References


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