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Hospice Room and Board

Under the Medicare hospice benefit, room and board charges are statutorily excluded and never covered by Medicare, except when provided under an inpatient level of care (inpatient respite or general inpatient care). Room and board charges should only be submitted to Medicare when a denial is necessary to bill another insurance (e.g., Medicaid).

Effective for claims submitted on/after July 1, 2012, Change Request 7677 states that hospice providers wishing to receive a line item denial for room and board charges may submit the charges as non-covered using revenue code 0659 with HCPCS A9270 and modifier 'GY' on an otherwise covered hospice claim.

Submitting Room and Board Charges on a Covered Hospice Claim

In addition to the usual hospice claim information (levels of care discipline visits, etc.), include the following data to indicate noncovered room and board charges:

REV  
(FISS Page 02)

Enter revenue code '0659' for room and board. Report other applicable revenue codes as usual.

HCPC
(FISS Page 02)

Enter the HCPC code 'A9270' on the 0659 revenue code line for room and board.

MODIFS
(FISS Page 02)

Enter the modifier 'GY' on the 0659 revenue code line for room and board.

TOT UNIT
(FISS Page 02)

Enter the units to reflect the number of room and board days being billed. 

COV UNIT
(FISS Page 02)

Leave this field blank.  

TOT CHARGE
(FISS Page 02)

Enter the total charge for the room and board on the 0659 revenue code line.

NCOV CHARGE
(FISS Page 02)

Enter the total noncovered charge for the room and board on the 0659 revenue code line.

SERV DATE
(FISS Page 02)

Enter the service date to reflect the first day of noncovered room and board.

REMARKS
(FISS Page 04)

Enter a brief remark indicating the noncovered charges are for room and board.

IMPORTANT REMINDERS:

  • Do not include a condition code 20 or 21 on your claim.
  • Ensure the 0659 revenue code line includes the HCPC 'A9270' and modifier 'GY'.
  • Ensure your claim includes REMARKS (FISS Page 04) to indicate the noncovered charges are for room and board.  Claims without remarks may be returned to you. 
  • If your original claim did not include room and board charges, an adjustment claim (type of bill 8X7) can be submitted to add the noncovered room and board charges. 

CMS Educational Resources

Updated: 10.30.12


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