Louisiana DHH Medicaid UB-92 Billing Instructions for Home Health s Release Name: Home Health Release Date: 12/08/2003 Revised: 11/14/2003 Prepared By: Shannon L. Clark, HIPAA Operations Team Lead Donna Copeland, HIPAA Analyst
For the Home Health HIPAA implementation, a number of local codes are being converted in order to bring the in compliance with the HIPAA standard code set guidelines. Since Home Health is moving from a HCFA-1500 based proprietary paper claim form (Unisys 101) to the UB-92 claim form, the local codes have also been cross walked to the appropriate revenue codes that will be billed with each procedure code. NOTE: For Procedure G0154 Medicaid defines 1 Unit = 1 Visit. NOTE: The HIPAA standard codes that are listed in this document must not be billed for any service dates prior to December 8, 2003. For prior dates of service, the local code must be billed. A X9900 Skilled Nursing Care-RN (Initial Visit) F X9901 Home Health Aide (Initial Visit) Cross-Reference HIPAA Nursing & Aid s 570, 571 B X9902 Skilled Nurse Hourly Charge or TE G0156** S9123* Health Setting, each 15 s of Home Health Aide in Registered Nurse (RN), per hour C X9903 Nurse Visits After Initial-RN- Multiple Visits D X9904 Aide Visits After Initial Visit 570, 571 M X9906 Skilled Nursing Care- RN/Multiple Recipients S9124* or TE G0156** and TT Licensed Practical Nurse (LPN), per hour s of Home Health Aide in Page 1
H X9907 Skilled Nursing Hourly Rate- Multiple-Recipients G X9910 Skilled Nursing Care-LPN (Initial Visit) I X9913 Nurse Visit After Initial- LPN-Multiple Visits K X9916 Skilled Nursing Care- LPN/Multiple Recipients J Y2602 Initial Sp/Lang/Hear 5 Y2609 Sp/Lang/Hear Therapy, 15 6 Y2611 Sp/Lang/Hear Therapy, 20 Cross-Reference HIPAA Therapies S9123* S9124* or TD or TD and TT Registered Nurse (RN), per hour Licensed Practical Nurse (LPN), per hour 444 92506 of Speech, Language, Voice, Communication, Auditory Processing, and/or Aural Rehabilitation Status G0153* s of Speech and Language Setting, each 15 Not mapped Non-payable L Y2612 Initial Hearing 440 92506 of Speech, Language, Voice, Communication, Auditory Processing, and/or Aural Rehabilitation Status 7 Y2613 Sp/Lang/Hear Therapy, 30 8 Y2614 Sp/Lang/Hear Therapy, 45 9 Y2615 Sp/Lang/Hear Therapy, 60 G0153* s of Speech and Language Setting, each 15 G0153* s of Speech and Language Setting, each 15 G0153* s of Speech and Language Setting, each 15 Page 2
O Y7000 Physical Therapy, One Mod, 30 Q Y7050 Physical Therapy, 2 or More, 45 Cross-Reference HIPAA T Y7100 Visit W/Procedure(s), 30 U Y7101 Visit W/Procedure(s), 45 V Y7102 Visit W/Procedure(s), 60 X Y7103 Visit W/Procedure(s), 75 Y Y7104 Visit W/Procedure(s), 90 S Y7105 Visit W/Procedure(s), 20 Not mapped Non-payable R Y7106 Ctr Visit One/More Mod W Y7202 Procedures and Mods, 60 P Y7702 Physical Therapy and Rehab Z Y7810 Occupational Therapy, 15 1 Y7811 Occupational Therapy, 20 E Y7812 Initial Occupational Therapy 2 Y7813 Occupational Therapy, 30 3 Y7814 Occupational Therapy, 45 424 97001 Physical Therapy G0152* s of Occupational each 15 Not mapped Non-payable 434 97003 Occupational Therapy G0152* s of Occupational each 15 G0152* s of Occupational each 15 Page 3
4 Y7815 Occupational Therapy, 60 Cross-Reference HIPAA N Y7902 Wheelchair Seating Eval 424 G0152* s of Occupational each 15 97001 Physical Therapy Modifier of UD 434 97003 Occupational Therapy Modifier of UD * Requires Prior Authorization ** Prior Authorization is only required for more than one service per day. Page 4