Additional Billing Requirements Applicable to Claims Submitted to Fiscal

20.1 – Additional Billing Requirements Applicable to Claims Submitted to Fiscal Intermediaries (FIs) (Rev. 1876; Issued: 12-18-09; Effective Date: 01-01-10; Implementation Date: 04-05-10) The FI will reimburse for KDE services when services are rendered in a rural area and submitted on the following TOBs: 12X, 13X, 22X, 23X, 34X, 75X, 81X, 82X, and 85X. NOTE: FIs shall use the actual geographic location, core based statistical area (CBSA) to identify facilities located in rural areas. In addition, KDE services are covered when claims containing the above mentioned TOBs are received from section 401 hospitals. Revenue code 0942 should be reported when billing for KDE services in the following: SNFs, HHAs, CORFs, hospices, and CAHs. Hospital outpatient departments bill for this service under any valid/appropriate revenue code. They are not required to report revenue code 0942. Hospices report this service on a separate claim from any hospice services. Hospice claims billed for revenue code 0942 that contain any other services will be returned to the provider. In addition, hospices report value code 61 or G8 when billing for KDE services. NOTE: KDE services are not covered when services are submitted on TOB 72X.