Institutional Claims Submitted by Home Health Agencies and

10.2.3 - Institutional Claims Submitted by Home Health Agencies and Hospices (Rev. 11355; Issued:04-14-22; Effective:05-16-22; Implementation:05-16-22) The following provides billing instructions for Home Health Agencies (HHAs) in various situations: Where the sole purpose for an HHA visit is to administer a vaccine (influenza virus, pneumococcal, hepatitis B or COVID-19), Medicare will not pay for a skilled nursing visit by an HHA nurse under the HHA benefit. However, the vaccine and its administration are covered under the vaccine benefit. The administration should include charges only for the supplies being used and the cost of the injection. Medicare does not allow HHAs to charge for travel time or other expenses (e.g., gasoline). In this situation, the HHA bills under bill type 034x and reports revenue code 0636 along with the appropriate HCPCS code for the vaccine and revenue code 0771 along with the appropriate HCPCS code for the administration. NOTE: A separate bill is not allowed for the visit. If a vaccine (influenza virus, pneumococcal, hepatitis B, or COVID-19) is administered during the course of an otherwise covered home health visit (e.g., to perform wound care), the visit would be covered as normal but the HHA must not include the vaccine or its administration in their visit charge. In this case, the HHA is entitled to payment for the vaccine and its administration under the vaccine benefit. In this situation, the HHA bills under bill type 034x and reports revenue code 0636 along with the appropriate HCPCS code for the vaccine and revenue code 0771 along with the appropriate HCPCS code for the administration. NOTE: A separate bill is required for the visit Where a beneficiary does not meet the eligibility criteria for home health coverage, a home health nurse may be paid for the vaccine (influenza virus, pneumococcal, hepatitis B or COVID-19) and its administration. No skilled nursing visit charge is billable. Administration of the services should include charges only for the supplies being used and the cost of the injection. Medicare does not pay for travel time or other expenses (e.g., gasoline). In this situation, the HHA bills under bill type 034x and reports revenue code 0636 along with the appropriate HCPCS code for the vaccine and revenue code 0771 along with the appropriate HCPCS code for the administration. If a beneficiary meets the eligibility criteria for coverage, but his or her spouse does not, and the spouse wants an injection the same time as a nursing visit, HHAs bill in accordance with the last bullet point above. The following provides billing instructions for hospices: Hospices can provide the influenza virus, pneumococcal, hepatitis B and COVID-19 vaccines to those beneficiaries who request them, including those who have elected the hospice benefit. These services may be covered when furnished by the hospice. For dates of service before October 1, 2016, services for vaccines and their administration provided by a hospice should be billed on a professional claim to the local MAC. Payment is made using the same methodology as if they were a supplier. Hospices that do not have a supplier number should contact their MAC to obtain one in order to bill for these benefits. For dates of service on or after October 1, 2016, services for vaccines and their administration provided by a hospice may be billed on an institutional claim.