Condition Code 47: Home Health Transfer Billing

Condition code 47 tells Medicare that a patient is transferring to your agency from another home health agency whose admission period may still be open. It goes on the receiving agency's notice of admission and claim. This guide covers when to use it, what to document first, how each agency is paid, how disputes are settled and what happens when the code is missing. It is general education about Original Medicare.

What is condition code 47 on a home health claim?

Condition code 47 means a transfer from another home health agency. By law, patients must be able to transfer between agencies, and Medicare pro-rates payment when they do. The receiving agency shows the transfer by putting code 47 on its notice of admission when another agency's admission period may already be open (Claims Processing Manual, chapter 10, section 10.1.13).

Only one agency can be primary at a time. When an admission period is open, the MAC returns any other agency's notice unless it shows a transfer or a discharge and readmission (section 10.1.5.1). The choice is the patient's. A patient may transfer at any time, as often as they choose (CGS).

Where does condition code 47 go?

Code 47 goes in the condition code fields, form locators 18 through 28 on the UB-04 (CGS), on two submissions:

• The notice of admission, type of bill 032A (section 40.1).
• The period claim (section 40.2).

On the notice, the From date is the first visit in the admission, and the Through and admission dates must match it (section 40.1). For a transfer, submit based on the transfer date the two agencies agreed on (Wellpoint Federal).

When should you use condition code 47?

Use it when another agency has, or may have, an open admission period and the patient has chosen to move to you. That includes a patient the other agency has discharged when its discharge claim is not yet submitted or processed, so the period is still open (Wellpoint Federal; CGS).

Is a discharge and readmission the same as a transfer?

No. A transfer moves the patient between two agencies. A discharge and readmission stays within one. An agency that discharges a patient and readmits them within the same 30 days can open a new admission period when the CMS certification number matches the prior period (section 10.1.14).

An inpatient stay does not require a discharge. If an agency discharges anyway and the patient returns to it in the same period, Medicare does not recognize the discharge for payment (section 10.1.14), and a new notice is returned with reason code U537F (CGS). A transfer, or a discharge and readmission, within the 30-day period shortens the first period, and both are billed with patient status 06 (section 10.1.15).

What must the receiving agency do before using code 47?

CMS requires the receiving agency to document three things. It checked a Medicare inquiry system. It contacted the first agency on the effective date of transfer. It told the patient the first agency will no longer be paid by Medicare or provide Medicare-covered services after that date (section 10.1.13; Benefit Policy Manual, chapter 7, section 10.7.D). Billing code 47 without these steps is not appropriate (CGS).

1. Check Medicare's records. An eligibility inquiry shows whether the patient is in an admission period (section 30.1). An open period shows patient status 30, or no dates of earliest and latest billing activity (Wellpoint Federal; section 30.5).
2. Keep a screen print of the home health history dated at admission. Add a time and date stamp if it lacks one (CGS).
3. Allow for the lag. Responses are generally only as current as the previous day, so a notice or claim may still be in process (section 30.3).
4. Call the first agency. Confirm whether the patient is still on service or discharged, and agree on the transfer date (Wellpoint Federal). Record the patient's name and Medicare number, who you spoke with, and the date and time (CGS).
5. Tell the patient that two agencies cannot serve them at once and that the first agency stops after the transfer date. Document it (Wellpoint Federal).
6. Start a new admission with a start of care OASIS and a newly certified plan of care (42 CFR 484.235(b)).
7. Submit the notice of admission with code 47.

The first agency discharges the patient and documents the contact (CGS). It also keeps a copy of the transfer agreement with the agreed date (Wellpoint Federal).

What happens to the first agency's period of care?

When the notice with code 47 processes, Medicare closes the first agency's admission period as of the date services began at the new agency. The new period starts that day (section 10.1.13). The first agency cannot bill for services past the transfer date (section 30.11). Same-day transfers are allowed (section 30.6). The new agency takes over consolidated billing (section 20.1.1).

The first agency's last period gets a partial payment. It is the days from the first through the last billable visit, divided by 30, times the 30-day payment (42 CFR 484.235(b)). The remittance shows CARC B20 with RARC N120 (section 10.1.15).

The first agency reports patient status 06 when it knows of the transfer. If it does not, Medicare changes the status to 06 itself. If the transfer comes in a new period before any visits in it, the agency should not report 06. It reports 01 on the last period with visits instead (section 40.2).

Agencies with common ownership are the exception. There is no partial payment adjustment. The care is treated as furnished under arrangement for the first agency for the rest of the 30-day period, unless the patient moved to a different MSA or non-MSA area (42 CFR 484.235(b)(2); Benefit Policy Manual, section 10.7.C).

Does the 5-day notice of admission rule apply to a transfer?

Yes. A transfer opens a new admission period (section 10.1.13). A notice of admission is timely only if it is submitted to and accepted by the MAC within 5 calendar days after the admission date, and that rule sets no separate timeline for transfers (section 10.1.10.3).

A notice returned for an overlap still has to be fixed and accepted inside that window. So do the inquiry and the call on the transfer date. For how the days are counted and how the penalty works, see our notice of admission guide and its section on late notices.

What happens if the two agencies disagree about a transfer?

The agencies must try to settle it themselves first. The first agency makes at least three contacts, each logged with the date, time and person (CGS). Wellpoint Federal wants at least one of them in writing (Wellpoint Federal).

If that fails, the first agency sends its MAC's dispute form with the admission records. CGS will not open a case without both (CGS). The MAC works with both agencies, and the outcome turns on the receiving agency's records (section 10.7.D; Wellpoint Federal):

• If the receiving agency can show it informed the patient and contacted the first agency on the transfer date, the first agency is not paid for the overlap and also takes the partial payment adjustment.
• If it cannot, the receiving agency's submissions are cancelled and the first agency gets the full period payment.

CGS calls the dated screen print and a signed, dated patient consent form among the most important records. No dispute exists if the first agency had discharged the patient, with a status other than 30, and no dates overlap. The process can be lengthy (CGS). Wellpoint Federal acts only on claims still within timely filing (Wellpoint Federal).

What happens if condition code 47 is missing or used wrongly?

Without code 47, a notice from a different agency inside an open admission period is returned (section 30.6). The reason code is U537F: the From date falls within an existing home health admission period (Wellpoint Federal). It is first on the CGS list of top home health claim submission errors (CGS).

U537F can also mean a duplicate notice, a same-agency readmission in the same period (CGS), or a CMS certification number that does not match the prior period (Wellpoint Federal). Do not resubmit with code 47 until the transfer steps are done (Wellpoint Federal).

Misuse has a cost. Improper transfers can close the first agency's period, and if a dispute finds the steps were skipped, the receiving agency's notice and claims are cancelled (Wellpoint Federal).

The first agency can get returns too. A claim with a visit date inside a period another agency opened is returned with reason code U538F. If no one disputes those dates, remove them from the claim. If you dispute them, use the transfer dispute process first (CGS).

Condition code 47 checklist

1. At admission, run an eligibility inquiry and save a dated screen print.
2. If another agency has an open period, call it, agree on the transfer date and log each contact.
3. Document what the patient was told and keep the signed, dated consent.
4. Complete a start of care OASIS and get the new plan of care certified.
5. Submit the 032A with code 47 and get it accepted within 5 calendar days.
6. Put code 47 on the period claim too.
7. If the notice comes back with U537F, find the cause before you resubmit.
8. As the first agency, keep the transfer agreement and bill status 06, or 01 if no visits happened in the new period.

A billing company can run the eligibility check, add code 47 when the transfer records are in place, and trace a returned notice to its cause. The agency still has to call the first agency, inform the patient and keep the signed records.

Related guides

For the 5-day deadline and the late penalty, read the home health notice of admission guide. Other condition and patient status codes are in home health billing codes. See Medicare home health billing for how periods fit together, and why home health claims come back for other returned claims. If you are starting out or weighing outside help, read billing for a new home health agency and choosing a home health billing company. For what LMNS covers, see home health billing services. The home health billing cheat sheet puts the deadlines and codes on one page.

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