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Revised HCPCS codes Q5001, Q5002 and Q5009 for Home Health Services


Medicare is planning to capture data to show where Home Health services were provided by requiring Home Health Agencies (HHAs) to report the location on the claim.

Generally, Original Medicare makes payment under the HH PPS (Home Health Prospective Payment System) on the basis of a national standardized 60-day episode payment rate that is adjusted for the applicable case-mix and wage index. The national standardized 60-day episode rate pays for the delivery of home health services, which includes the six home health disciplines (skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy, and medical social services). Claims must report all home health services provided to the beneficiary within the episode.

Healthcare Common Procedure Coding System (HCPCS) codes Q5001 through Q5009 currently describe where hospice services were provided (in the patient’s home, assisted living facility, etc). These codes have been reported on hospice claims since 2007.  Medicare is planning to capture data to show where home health services were provided by requiring Home Health Agencies (HHAs) to report the location on the claim.

Effective for HH episodes beginning on or after July 1, 2013, HHAs are to use the HCPCS codes Q5001, Q5002, and Q5009 on home health claims to report where home health services were provided.

The following table lists the definitions of the Q codes Q5001, Q5002, and Q5009, which were revised effective April 1, 2013:

Q5001 Hospice or home health care provided in patient’s home/residence

Q5002 Hospice or home health care provided in assisted living facility

Q5009 Hospice or home health care provided in place not otherwise specified (NO)

The patient’s residence is wherever he or she makes his or her home. This may be his or her own dwelling, an apartment, a relative’s home, a home for the aged, or some other type of institution. Q code Q5002 should be used to indicate that home health services were provided at an assisted living facility (as defined by the State in which the beneficiary is located). Conversely, Q code Q5001 should be used to indicate that home health services provided at a patient’s residence except in the cases where the services are provided at an assisted living facility. Finally, Q code Q5009 may be reported in the rare instance an HHA believes the definitions of Q5001 and Q5002 do not accurately describe the location where services are provided.


Reference: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8136.pdf
 

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