HCPCS Q5001 & HCPCS Q5002 | Descriptions & Billing Guidelines

Hospice or home health services can be billed with HCPCS Q5001 if provided in a home setting and HCPCS Q5002 if provided in an assisted living facility. 

1. What Is Hospice Care?

Hospice care refers to palliative care to help terminally ill individuals live their remaining days comfortably. A trained professional team provides medical, psychological, and spiritual support to a patient and his family.

A hospice care program combines pain control and symptom management with emotional support. Hospice care is usually provided in the patient’s home. However, it also can be made available at a special hospice residence or another facility.

Home health care includes a wide range of medical services provided to patients at their homes for illness or injury.

Licensed and trained professional caregivers give home health care services. A home health program may include personal care, homemaking, and medical services.

2. What Is HCPCS Code Q5001?

HCPCS Q5001 represents the location of hospice or home health care services. Report this code for a home or residence location.

2.1 Description

The official description of Q5001 is defined by HCPCS as follows: “Hospice or home health care provided in patient’s home/residence.”

2.2 Code Explanation

Report HCPCS code Q5001 for hospice or home health care services provided in a home or residence location.

2.3 Billing Guidelines

You can use HCPCS code Q5001 to indicate that the home health services were provided at the patient’s residence.

A patient’s home can be;

• their apartment;
•  a home for the aged;
•  a relative’s house;
•  their dwelling; or
•  any other type of institution that they use as their home.

The only exception is an assisted living facility. Report Q5002 instead of Q5001 in that case.

3. What Is HCPCS Code Q5002?

Q5002 represents the location of hospice or home health care services. Report this code for an assisted living facility location.

3.1 Description

HCPCS describes the Q5002 code as: “Hospice or home health care provided in an assisted living facility.”

3.2 Code Explanation

HCPCS code Q5002 can be used for hospice or home health care services in an assisted living facility.

In this place, trained professionals administer or supervise medication and personal care to people with disabilities to assist them in their activities of daily living.

3.3 Billing Guidelines

Bill Q5002 only if the home health services or hospice care is performed in an assisted living facility. The state defines the location of the beneficiary.

References

https://understandhospice.org/can-i-receive-hospice-services-at-home/

https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r2680cp.pdf

https://www.cms.gov/files/document/r11502cp.pdf