RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Hospice – HIV Disease

A56677

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56677
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Hospice – HIV Disease
Article Type
Billing and Coding
Original Effective Date
07/04/2019
Revision Effective Date
11/16/2023
Revision Ending Date
05/20/2024
Retirement Date
05/20/2024

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

Title XVIII of the Social Security Act, §1813(a)(4)(A)(i) addresses drugs and biologicals provided in a hospice program.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 11, §30.2 Payment Rates, §30.2.2 Service Intensity Add-on (SIA) Payments, and §30.3 Data Required on the Institutional Claim to A/B MAC (HHH)

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 9, §80.2 Payment

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Hospice – HIV Disease L34566.

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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(1 Code)
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Group 1 Codes
Code Description
B20 Human immunodeficiency virus [HIV] disease
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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(6 Codes)
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Group 1 Codes
Code Description
R75 Inconclusive laboratory evidence of human immunodeficiency virus [HIV]
Z20.5 Contact with and (suspected) exposure to viral hepatitis
Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus [HIV]
Z20.822 Contact with and (suspected) exposure to COVID-19
Z20.828 Contact with and (suspected) exposure to other viral communicable diseases
Z21 Asymptomatic human immunodeficiency virus [HIV] infection status
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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
05/20/2024 R6

This article is being retired due to the information in the article is no longer needed.

11/16/2023 R5

Under CMS National Coverage Policy updated section headings for regulations. The following regulations were added: “Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.” and “Title XVIII of the Social Security Act, §1813(a)(4)(A)(i) addresses drugs and biologicals provided in a hospice program.” Punctuation corrections were made throughout article.

10/07/2021 R4

Under CMS National Coverage Policy added section headings to the regulations.

01/01/2021 R3

Under ICD-10 Codes that DO NOT Support Medical Necessity Group 1: Codes added Z20.822. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

10/10/2019 R2

This article is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Hospice - HIV Disease L34566 LCD and placed in this article.

07/04/2019 R1

All coding located in the Coding Information section has been removed from the related Hospice – HIV Disease L34566 LCD and added to this article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34566 - Hospice - HIV Disease
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
05/20/2024 11/16/2023 - 05/20/2024 Retired You are here
11/06/2023 11/16/2023 - N/A Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • HIV