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New Occurrence Span Code and Revenue Code for Acute Hospital Care at Home Program

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

In November 2020, the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home Program to provide hospitals expanded flexibility to care for patients in their homes.

The National Uniform Billing Committee (NUBC) recently released changes to the valid values acceptable on the Institutional Claim Form. The NUBC has approved two codes used in claims for the Acute Hospital Care at Home Program, which allows patients to obtain acute inpatient care at home. The codes are intended to be used to identify and track the inpatient claims for services provided under the Acute Hospital Care at Home Program.

The following codes are effective for claims received on or after July 1, 2022. The codes are as follows:

  • Occurrence span code 82: Hospital at home care dates
  • Revenue code 0161: Hospital at home, room and board (R&B)/Hospital at home

Occurrence span code 82 will be used to track the “from” and “through” dates of the hospital-at-home care delivered during an inpatient stay. Revenue code 0161 will be used to report the accommodation charges of the at-home care room and board.

On September 1, 2022, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual, Vol. 1, “Claims Filing,” section 6.6.3, “UB-04 CMS-1450 Instruction Table,” to reflect these changes.

Note: Any hospital permitted to have a hospital-at-home designation will bill for services using its facility license and National Provider Identifier (NPI). Claims are to be processed just as they would for regular hospital claims.

For additional information about the emergency rule, reference: GL 22-1000-A Emergency Rule for Hospitals Participating in the Centers for Medicare and Medicaid Services Acute Hospital Care at Home Program During the COVID-19 Pandemic [Amended] (texas.gov).

For more information, call the TMHP Contact Center at 800-925-9126.