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Fee-for-Service Hospice Rates Effective Oct. 1, 2026
Effective date
Oct 1, 2026
Identified
Oct 2, 2026
Summary
Oregon Medicaid updated hospice fee-for-service rates effective October 1, 2026, introducing a critical billing distinction: revenue code 651 applies to routine home care (RHC) days 1-60, while new revenue code 650 applies to RHC days 61 and beyond. Providers must track hospice election days carefully for readmissions and ensure compliance with federal quality reporting requirements to receive full Medicaid rates; non-compliant providers will receive lower reimbursement.
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What to do
Action · 8 steps
01Before October 1, 2026.
02Billing team must update all billing system software to enforce the new revenue code logic: use revenue code 651 for RHC services during days 1-60 of hospice election and revenue code 650 for RHC services on day 61 or later.
03Implement day-counting logic in the billing system to track hospice election days across readmissions: if patient is readmitted within 60 days of discharge, prior hospice days count toward the 60-day threshold; if readmitted more than 60 days after discharge, reset the count and begin a new 60-day window.
04If a patient transfers to a different hospice provider, only reset the day count if there is a break in hospice services exceeding 60 days.
05Verify that your hospice provider has submitted required federal quality reporting data to CMS Hospice Quality Reporting website—do not bill services on or after October 1, 2026 if this requirement is not met, as non-compliant providers receive reduced Medicaid rates.
06Update encounter templates and billing instructions to remind providers to document registered nurse and social worker services provided in the last seven days of patient life for future service-intensity add-on (SIA) billing.
07Ensure billing staff and providers understand the geographic CBSA codes and corresponding rate tables for each service location (Albany 10540, Bend 13460, Corvallis 18700, Eugene/Springfield 21660, Grants Pass 24420, Medford 32780, Portland-Beaverton 38900, Salem 41420, and all other areas 99938).
08Enter CBSA code as a value code (61) followed by dollar amount in the Value Code field on institutional claims.
If missed: Failure to use correct revenue codes and day counts will result in claim denials or underpayment; non-compliance with quality reporting requirements will trigger reduced reimbursement rates.
Original notice
Fee-for-Service Hospice Rates Effective Oct. 1, 2026
oregon.gov · Always check the source before changing claims.
Related changes
See all Oregon Health Plan changes →Fee-for-service hospice rates effective April 1, 2020 through June 30, 2020LowEffective Apr 1, 2020 · ProviderFee-for-service hospice NF rates effective July 1, 2020 – June 30, 2021LowEffective Jul 1, 2020 · ProviderFee-for-service nursing facility rates effective July 1, 2026HighEffective Jul 1, 2026 · ProviderFee-for-service hospice rates effective April 1, 2020 through June 30, 2020HighEffective Apr 1, 2020 · ProviderBrowse every Oregon Health Plan change in the policy list