A Medicare home health claim is built from a few sets of codes: a type of bill, one HIPPS code on revenue code 0023, a revenue code and G-code for each visit, a Q code for where care was given, and condition, occurrence and value codes. This guide lists what each means and where it goes, with the Medicare source linked. It is general education about Original Medicare.
What type of bill does a home health agency use?
Home health services under a plan of care use type of bill 032x. The fourth digit, the frequency code, says what the submission does. The field holds four digits, and Medicare ignores the leading zero (Claims Processing Manual, chapter 25).
| Type of bill | What it is | How it is used |
|---|---|---|
| 032A | Notice of admission | Sent once per admission. From, Through and Admission dates all equal the first visit. Add condition code 47 for a transfer from another agency. |
| 032D | Cancellation of a notice of admission | Cancels a notice of admission already sent. |
| 0329 | Final claim for a 30-day period | Every payment claim, sent once the period's services are done and the plan of care and later verbal orders are signed. |
| 0327 | Replacement of a prior claim | Corrects a paid claim, including adding services. Carries a claim change reason code and the original document control number. |
| 0328 | Void or cancel of a prior claim | Needed to change the Medicare number or provider number. A new 0329 is then sent for the period. |
| 0320 | No-payment bill | Used with condition code 21 to get a denial notice. Never used for a demand bill. |
Late charge bills (frequency code 5) are not accepted; add services to a paid period with a 0327 (Claims Processing Manual, chapter 10, sections 10.1.10.4, 10.1.11, 40.1, 40.2 and 60). Bill types for requests for anticipated payment in older guides no longer apply: notices of admission are required for periods beginning on or after January 1, 2022.
Type of bill 034x is for services paid outside the 30-day payment, such as care for a patient not under a home health plan of care. For a patient under a plan of care, it is used for a covered osteoporosis drug and for pneumococcal, influenza and hepatitis B vaccines (chapter 10, section 90). A 034x claim carrying the visit G-codes or Q codes below is returned. Type of bill 033x has not been valid since October 1, 2013 (CMS Transmittal 2694).
What is revenue code 0023 and the HIPPS code?
Revenue code 0023 is the line that carries the HIPPS code, a five-character code for one of the 432 payment groups under the Patient-Driven Groupings Model (PDGM). Each claim has exactly one 0023 line and one HIPPS code; a claim with more than one HIPPS code is returned (chapter 10, sections 10.1.8, 10.1.9 and 40.2).
| Position | What it shows | Values |
|---|---|---|
| 1 | Admission source and timing | 1 community early, 2 institutional early, 3 community late, 4 institutional late |
| 2 | Clinical group | A MMTA other, B neuro rehab, C wounds, D complex nursing interventions, E musculoskeletal rehab, F behavioral health, G MMTA surgical aftercare, H MMTA cardiac and circulatory, I MMTA endocrine, J MMTA GI/GU, K MMTA infectious disease, L MMTA respiratory |
| 3 | Functional level | A low, B medium, C high |
| 4 | Comorbidity adjustment | 1 none, 2 low, 3 high |
| 5 | Placeholder | 1 |
The manual's example, 4CC11, is a second period after an inpatient stay, in the wounds group, with a high functional level and no comorbidity adjustment. MMTA means medication management, teaching and assessment. The first 30-day period is early and later ones are late, until a gap of 60 days or more starts a new sequence. Source depends on the care setting in the 14 days before admission; a late period is institutional only after an acute hospital stay in those 14 days (CMS PDGM overview).
The agency may submit its own grouper's result or any valid HIPPS code. Medicare's grouper replaces it as needed, so a different code on the remittance is expected. Rules for the 0023 line (chapter 10, section 40.2):
- Total charges are zero, and units are above zero (Medicare disregards them).
- On an initial period, the service date is the first covered visit. If the Admission and From dates match and this date does not, the claim is returned.
- On later periods, the service date is the first visit, covered or not.
- If the notice of admission was late and the agency asks for an exception to the penalty, the KX modifier goes on this HIPPS code.
Which revenue codes are used for home health visits?
Each visit goes on its own line under its discipline's revenue code, with one G-code, the date, units and a charge (chapter 10, section 40.2).
| Revenue code | Service | Line detail |
|---|---|---|
| 042x | Physical therapy | G-code, date, units, charge |
| 043x | Occupational therapy | G-code, date, units, charge |
| 044x | Speech-language pathology | G-code, date, units, charge |
| 055x | Skilled nursing | G-code, date, units, charge |
| 056x | Medical social services | G0155, date, units, charge |
| 057x | Home health aide | G0156, date, units, charge |
| 027x | Nonroutine supplies | Units and charge; 0274 (prosthetics and orthotics) also needs a HCPCS code and date. 0275 to 0278 are not used. |
| 0623 | Nonroutine wound care supplies (optional) | Units and charge, kept separate from 027x charges |
| 029x, 060x | Equipment and oxygen (optional) | HCPCS code, date, units, charge; paid on top of the period payment |
| 0001 | Total charges | Claim total (CGS) |
Visit units are 15-minute increments covering the whole visit, rounded to the nearest increment. OASIS time during an otherwise billable visit counts. Over 96 units on one line sends the claim back. Covered and noncovered time go on separate lines, and a visit past midnight uses the date it ended. A 0329 with no visit charges is returned, as is a claim with covered 058x or 059x charges or revenue code 0624.
Which G-codes are used for home health visits in 2026?
These are the visit codes in chapter 10, section 40.2, revision 13089 (February 21, 2025), still current in November 2026 (chapter 10). Descriptions are shortened; the manual has the full wording.
| G-code | Service | Revenue code |
|---|---|---|
| G0151 | Physical therapist | 042x |
| G0157 | Physical therapist assistant | 042x |
| G0159 | Physical therapist, maintenance program | 042x |
| G2168 | Physical therapist assistant, maintenance program | 042x |
| G0152 | Occupational therapist | 043x |
| G0158 | Occupational therapist assistant | 043x |
| G0160 | Occupational therapist, maintenance program | 043x |
| G2169 | Occupational therapist assistant, maintenance program | 043x |
| G0153 | Speech-language pathologist | 044x |
| G0161 | Speech-language pathologist, maintenance program | 044x |
| G0299 | Direct skilled nursing, registered nurse | 055x |
| G0300 | Direct skilled nursing, licensed practical nurse | 055x |
| G0162 | Registered nurse managing and evaluating the plan of care | 055x |
| G0493 | Registered nurse observation and assessment | 055x |
| G0494 | Licensed practical nurse observation and assessment | 055x |
| G0495 | Registered nurse training or education | 055x |
| G0496 | Licensed practical nurse training or education | 055x |
| G0155 | Clinical social worker | 056x |
| G0156 | Home health aide | 057x |
Report one G-code per visit: the service that took most of the time, with units for the whole visit. Modifiers GN, GO and GP are not required.
Since July 1, 2023, care given by telecommunications must also be reported, on separately dated lines under the discipline's revenue code with covered charges: G0320 for audio and video and G0321 for audio only (1 unit each), and G0322 for remote patient monitoring (one line, start date, days as units). A period with only telehealth services is not billed.
What are the Q codes for home health location?
Every claim reports where care was given with one of three Q codes, required for episodes beginning on or after July 1, 2013 (CMS Transmittal 2680, CR 8136; chapter 10, section 40.2).
| Q code | Where care was given |
|---|---|
| Q5001 | The patient's home or residence |
| Q5002 | An assisted living facility |
| Q5009 | A place not otherwise specified |
The Q code goes on an extra line with the same revenue code and date as the first visit on the claim, 1 unit and a nominal covered charge, such as a penny. If the place of care changes, add another Q line dated with the first visit at the new place. Chapter 10 lists only these three for home health.
Which condition codes go on a home health claim?
Codes 47, 54, DR, 20 and 21 are in chapter 10; D4 and E0 are in chapter 1, section 130.5; the claim change codes are on the CGS code list.
| Code | Meaning |
|---|---|
| 47 | Transfer from another home health agency, on the notice of admission and claim |
| 54 | No skilled visits in the period, with a policy exception documented at the agency |
| DR | Disaster related; under an OASIS waiver, lets a claim go without occurrence code 50 |
| 20 | Demand bill requested by the beneficiary, on 0329 |
| 21 | Billing for a denial notice, on 0320 only |
| D0 | 0327 changing service dates (D9 for a line-item date) |
| D1 | 0327 changing charges (D9 for units) |
| D2 | 0327 changing revenue, HCPCS or HIPPS codes (D9 to add a code) |
| D4 | 0327 correcting diagnosis codes that applied on the From date |
| D9 | 0327 for any other change, or several changes |
| E0 | 0327 changing patient status, such as a discharge after a still-a-patient claim |
| D5 | 0328 to correct the Medicare number or provider number |
| D6 | 0328 to repay a duplicate or OIG overpayment |
Remarks are required with D9, with a HIPPS change under D2 and on every cancel. An adjustment or cancel without a claim change reason code is returned; CGS lists this as reason code 30949 (CGS reason codes).
Which occurrence codes are required?
Occurrence code 50, dated with the OASIS completion date (M0090), is required on every claim and adjustment. Without it the claim is returned unless condition code DR is present (chapter 10, section 40.2).
| Code | Meaning |
|---|---|
| 50 | OASIS assessment completion date (M0090) |
| 61 | Through date of a hospital stay ending within 14 days before the From date; any period |
| 62 | Through date of a skilled nursing, inpatient rehabilitation, long-term care hospital or inpatient psychiatric stay ending within 14 days before admission; initial periods only |
| 55 | Date of death, with patient status 20 (CGS) |
To count the 14 days, the day before the From date is day 1: for a From date of January 20, the window is January 6 through 19, and a discharge on January 20 itself also counts. Report only the most recent discharge; more than one 61 or 62 sends the claim back.
Which value codes does the agency report?
Every claim carries two value codes for where the patient received care, using the location at the end of the period if it changed (chapter 10, section 40.2):
- 61: the CBSA code (or rural state code), entered as dollars with two zeros as cents.
- 85: the FIPS state and county code, enforced on claims processed from October 1, 2024 (CMS Transmittal 12577).
Medicare adds other value codes in processing, and agencies never submit them: 17 (outlier), 62 to 65 (Part A and Part B visits and dollars), QF (the cut for a notice of admission filed more than 5 days after the From date) and QV (value-based purchasing adjustment).
Which patient status codes matter most?
Patient status describes the patient as of the Through date (chapter 10, section 40.2):
- 30: still a patient.
- 01: discharged home. If the discharge falls in a next period with no billable visits, use 01 on the last period with visits so the admission closes.
- 06: partial period payment, such as a transfer, a discharge and readmission in one period, or a known move to Medicare Advantage.
- 20: expired. The Through date is the date of death.
How does the claim connect to the OASIS assessment?
Medicare matches each claim to an accepted OASIS assessment using three items: the agency's CMS Certification Number (M0010), the Medicare number (M0063) and the completion date (M0090, the occurrence code 50 date). It then combines the OASIS answers with claim data (period timing, inpatient discharge, diagnoses) to set the HIPPS code. If any item differs, including a Medicare number that changed after the assessment was sent, the claim is returned until the claim or assessment is corrected (chapter 10). Grouping diagnoses come from the claim, so they need not match the assessment exactly.
Where do these codes go on the UB-04?
These are the UB-04 form locators (chapter 25). An 837I carries the same data.
| Form locator | Field |
|---|---|
| 4 | Type of bill |
| 6 | Statement period; a full period ends 29 days after the From date |
| 12, 15, 17 | Admission date, point of origin, patient status |
| 18 to 28 | Condition codes |
| 31 to 34 | Occurrence codes and dates |
| 39 to 41 | Value codes and amounts |
| 42, 44 | Revenue code; HCPCS or HIPPS code |
| 45 to 48 | Service date, units, total and noncovered charges |
| 64 | Original document control number, on a 0327 |
| 67, 76, 80 | Principal diagnosis; attending physician who signed the plan of care; Remarks |
What should you check before you submit?
- The type of bill fits the action, and the notice of admission was accepted.
- One 0023 line, one HIPPS code, zero charges and the right service date.
- Each visit on its own line with one G-code, a date, 15-minute units and a charge.
- A Q code line with the first visit, and with the first visit at any new place of care.
- Occurrence code 50 carries the M0090 date of an accepted assessment.
- Any inpatient discharge in the prior 14 days is reported once, with 61 or 62.
- Value codes 61 and 85 are present, and patient status fits the Through date.
- An adjustment or cancel has its reason code, Remarks and, on a 0327, the original document control number.
A billing company can run these checks on each claim before it goes out. The agency still supplies the records the codes come from.
Related guides
See Medicare home health billing for periods and deadlines, and why home health claims come back for returns and reason codes. If you are weighing outside help, read choosing a home health billing company. For what LMNS covers, see home health billing services. More guides: the home health notice of admission for the 5-day rule and late penalty, and billing for a new home health agency for the path from license to first Medicare claim.