MedicaidReimbursementHigh impact
MAB 061502 Hospice Two Tiered Routine Home Care and Service Intesity Add-On Payments
Pennsylvania Medicaid (DHS)·PA · Palliative Care·Provider Bulletin
Effective date
Jan 1, 2016
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid implements a two-tiered payment system for hospice routine home care services (higher rate for first 60 days, lower rate for days 61+) and adds new Service Intensity Add-On payments for RN/SW services during the last 7 days of life. This affects hospice billing procedures and requires specific modifiers and separate claim submissions.
Action Required
Immediately: Hospice billing teams must update systems to use modifier U9 for T2042 (routine home care days 1-60) and no modifier for T2042 (days 61+). Implement G0299 for RN services and G0155 for social worker services during last 7 days of life (up to 16 units/4 hours per day). Critical: Cannot span bill across days 60-61 - must submit separate claim lines or entire claim will be denied. Update billing software to track hospice day counts including pre-2016 days.