Add-on (Late Charges) Claim
For Dates of Service On/After April 1, 2012
Change Request 7556
discontinues the use of hospice late charge claims. For dates of service on/after April 1, 2012, hospice agencies must submit an adjustment claim (type of bill 8X7) to add physician charges to a previously processed claim.
For more information on how to submit an adjustment claim, refer to the Adjustments/Cancels web page or Chapter 5: Claims Correction
of the FISS Guide.
For Dates of Service Prior To April 1, 2012
An add-on claim (type of bill 815 or 825) can be submitted to add physician charges (revenue code 0657) only when the original claim did not include any physician charges. The "FROM" and "TO" dates submitted on the add-on claim must match the "FROM" and "TO" dates on the original claim.
If the original claim contained some physician charges, and you need to add additional physician charges, an adjustment claim (8X7) must be submitted; an add-on claim (8X5) cannot be submitted in this case.
The Fiscal Intermediary Standard System (FISS) allows only one add-on claim per original claim. Therefore, if an add-on claim has already processed and you need to add additional physician charges, the first add-on claim must be canceled (type of bill 8X8) and a new add-on claim with all the physician charges must be resubmitted.
Add-on claims are subject to timely filing requirements, and must be submitted within one year of the "TO" date. In addition to the usual claim information, include the following data on an add-on claim.
| TOB
(FISS Page 01) |
815 (non-hospital based) or 825 (hospital based) |
| STMT DATES FROM/TO
(FISS Page 01) |
Enter the FROM and TO date exactly as they appear on the original hospice claim. |
| REV
(FISS Page 02) |
Enter revenue code "0657" to
add-on physician charges.
Enter revenue code "0001" to total your charges. NOTE: No other revenue codes are allowed on an add-on claim. |
| HCPC
(FISS Page 02) |
Enter the HCPCS code for the add-on physician charges on the 0657 revenue code line. |
| MODIF
(FISS Page 02) |
Enter the modifier 'GV' if the services were provided by a nurse practitioner, serving as the patient's attending physician. |
| TOT UNIT
(FISS Page 02) |
Enter the total units for the add-on physician charges on the 0657 line. |
| COV UNIT
(FISS Page 02) |
Enter the total covered units for the add-on physician charges on the 0657 line. |
| TOT CHARGE
(FISS Page 02) |
Enter the total charge for the add-on physician
charges on the 0657 line.
Enter the total charges for the claim on the 0001 line. |
| SERV DATE
(FISS Page 02) |
Enter the date the physician provided the service on the 0657 line. |
Your add-on bill should not include the following:
- Occurrence code 42 (discharge/revocation)
- Any revenue codes or charges other than those for physician services.
- Only 0657 and 0001 revenue codes are permissible on add-on claims.
Reference: Medicare Claims Processing Manual (CMS Pub. 100-04), Ch. 11, §30.3![]()
Updated: 11.05.12

