MedicaidBilling CodesMedium impact
Clarification Regarding Initial 60-Day Higher Rate for Routine Home Care (RHC) and End of Life Service Intensity Add-On (SIA) Payment Split Between Two Calendar Months
Illinois Medicaid - HFS·IL · Palliative Care·Provider Notice
Effective date
Jan 1, 2016
We identified it
Jun 20, 2026
Summary
This policy clarifies hospice billing procedures for Illinois Medicaid, specifically addressing how the initial 60-day higher rate for Routine Home Care is calculated (looking back to elections before January 1, 2016) and the process for Service Intensity Add-on payments when they span multiple calendar months.
Action Required
Hospice billing teams in Illinois should ensure initial month claims are in payable status before billing final claims with patient death when SIA days cross calendar months. Monitor for Adjustment Reason Code 3566 on remittance advice for SIA adjustments. Bill revenue codes 0651, 055X, and 056X by individual service date when SIA days are involved.