MedicaidBilling CodesHigh impact
[Ohio] Hospice Per Diem Billing
CareSource·OH · Palliative Care·Claims & Billing
Effective date
Mar 1, 2026
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid updated hospice billing requirements effective March 1, 2026. Hospice per diem services must now be billed on UB-04 forms (not CMS-1500) with mandatory county codes and value codes in specific boxes; nursing facility room and board remains on CMS-1500. Incorrect form usage or missing required codes will result in claim denials.
Action Required
By March 1, 2026: (1) Billing team must configure billing software to route ALL hospice per diem claims (T2042, T2043, T2044, T2045) to UB-04 forms only, NOT CMS-1500; (2) Configure system to require county codes (per ODM Hospice Rates list) and value codes (61 for routine/continuous home care, G8 for inpatient/respite care) in Boxes 39-41 on all UB-04 hospice claims; (3) Ensure Type of Bill is 081X or 082X—any other Type of Bill will cause automatic denial; (4) For T2046 (nursing facility room and board), ONLY use CMS-1500 with facility name in Box 32 and facility NPI in Box 32a; (5) For ventilator/ventilator weaning claims (revenue codes 0410, 0419), ensure diagnosis code Z99.11 is included and facility name/NPI are documented in Box 80 (Remark Code); (6) Train billing staff on distinction between UB-04 and CMS-1500 to prevent rejections; (7) Update internal billing procedures and encounter templates. Failure to comply will result in claim denials and require adjusted claim resubmission. Contact CareSource Provider Services at 1-800-488-0134 with questions.