Updated billing guidance for hospice billing for nursing facility room and board (HCPC T2046) and ventilator/ventilator‑weaning services

Hospice nursing facility room and board (HCPC T2046)

Hospice providers billing for nursing facility room and board must submit claims using the HCFA (CMS-1500) form. The name of the nursing facility in which the services were delivered must be placed in Box 32, and the National Provider Identifier (NPI) related to the nursing facility must be placed in 32a.

Private room add‑on payment — effective for dates of service on or after December 18, 2024

If a hospice provider is billing for room and board in a skilled nursing facility (SNF), and the member was placed in a private room where the SNF is approved by ODM as a Category 1 or Category 2 private room service provider, the hospice provider is eligible for 95% of the Category 1 add‑on payment of $30 and of the Category 2 add‑on payment of $20 (as applicable).

Hospice providers should bill using the following code/modifier combinations to receive this add‑on payment. Category 1 and Category 2 should be billed on individual claim lines. Do not bill both modifiers on the same claim line.

Example 1: Member transitioned from a Category 1 room to Category 2 room midmonth

Example 2: Member remained in the Category 1 room for the entire month

Example 3: Member remained in the Category 2 room for the entire month

Exceptions: SNFs that are receiving the enhanced ventilator rate are excluded from this program. If the SNF’s NPI is not recognized by ODM as having the appropriate specialty code of 86A (Category 1) and/or 86B (Category 2), the add‑on payment is subject to postpayment review/recoupment. These services are add‑on payments and will not be reimbursed if the nursing facility stay is not approved.

Hospice ventilator and ventilator‑weaning claims

Ventilator‑dependent and ventilator‑weaning (0410 and 0419) claims must be billed using the UB-04 institutional form.

Type of bill — 81X/081X: If the claim is billed with the incorrect type of bill, the claim will not be eligible for reimbursement.

When billing ventilator‑dependent and ventilator‑weaning claims, the hospice provider is required to include the name and NPI of the nursing facility in which the services were delivered in Box 80 (Remark code). In addition, when billing for ventilator and/or ventilator‑weaning services, the diagnosis code Z99.11 must be included.

Any claims for nursing facility room and board or ventilator/ventilator‑weaning that do not meet the instructions in this guidance may not be eligible for reimbursement and will require an adjusted claim submission. Nursing facility hospice (T2046) and ventilator/ventilator‑weaning services are not billable on the same date of service.

Note: The current list of facilities with Medicaid IDs (ohio.gov) can be found on the ODM website under Nursing Facility Rates. This information will allow claims to be properly priced and will avoid backend work and delay.

If you have any questions, write to ohmedicaidencpesupport@elevancehealth.com.