Coding of HH PPS Case-Mix Groups on HH PPS Claims:

10.1.8 - Coding of HH PPS Case-Mix Groups on HH PPS Claims: HHRGs and HIPPS Codes (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) Under the home health prospective payment system as refined by the Patient-Driven Groupings Model, a case-mix adjusted payment for a 30-day period of care is made using one of 432 HHRGs. On Medicare claims, these HHRGs are represented as Health Insurance Prospective Payment System (HIPPS) codes. HIPPS code rates represent specific characteristics (or case-mix) on which Medicare payment determinations are made. HIPPS codes are used in association with special revenue codes used on institutional claims submitted to A/B MACs (HHH). One revenue code is defined for every Medicare prospective payment system that uses HIPPS codes. For home health claims, this is revenue code 0023. HIPPS codes are placed in HCPCS/Accommodation Rates/HIPPS Rate Codes field of the claim.