Revenue Code 0115 Explained for Hospice Billing

Hospice billing can often feel like navigating a maze of codes, regulations, and payer requirements. Among the many codes used in hospice claims, Revenue Code 0115 holds a crucial place. Understanding what it represents and how to use it correctly is essential for accurate reimbursement and avoiding unnecessary denials. In this detailed guide, we’ll break down Revenue Code 0115, explain its role in hospice billing, and provide practical tips to ensure your claims are processed smoothly.

Whether you’re a biller, hospice provider, or healthcare administrator, this article will give you a clear, step-by-step explanation of Revenue Code 0115 and its connection to the broader hospice billing landscape.

What Is Revenue Code 0115?

Revenue Code 0115 falls under the revenue code series for room and board services. Specifically, it refers to:

0115 – Hospice – Room and Board (Routine Home Care)

Hospice agencies use this code to bill for routine home care provided in a nursing facility. Essentially, when a patient receives hospice services while residing in a skilled nursing facility (SNF) or other long-term care setting, the hospice agency must bill Medicare or other payers using Revenue Code 0115 for room and board charges.

This code allows hospices to receive payment for the daily rate of care provided in the facility, even though the hospice does not own or operate the facility itself. The hospice receives reimbursement and, in turn, pays the facility a contracted amount for room and board.

Why Revenue Code 0115 Matters in Hospice Billing

Revenue Code 0115 is more than just a billing number; it directly affects how Medicare and Medicaid reimburse hospice providers for services in nursing facilities. If this code is used incorrectly or omitted, it can lead to:

• Payment delays
• Claim denials
• Compliance issues
• Audit risks

Because hospice care often involves multiple payers and service settings, accurate use of revenue codes like 0115 ensures that claims are properly adjudicated. Payers look to revenue codes to determine the type of service delivered, so precision is essential.

Revenue Code 0115 and the Medicare Hospice Benefit

Under the Medicare Hospice Benefit, when a hospice patient resides in a nursing facility, the hospice is responsible for the professional management of care. While the facility provides room and board, the hospice agency oversees the plan of care, symptom management, and coordination with facility staff.

Medicare does not pay the facility directly for room and board in these cases. Instead:

1. The hospice agency bills Medicare using Revenue Code 0115 for the daily room and board rate.
2. Medicare reimburses the hospice.
3. The hospice then pays the nursing facility a contracted per diem amount.

This process makes 0115 billing a critical revenue stream for both the hospice and the facility, requiring accurate documentation and claim submission.

What Is the Revenue Code for Hospice?

Hospice billing uses a variety of revenue codes depending on the level of care provided:

• 0651 – Routine Home Care
• 0652 – Continuous Home Care
• 0655 – Inpatient Respite Care
• 0656 – General Inpatient Care
• 0657 – Physician Services

However, when hospice care is delivered in a nursing facility and involves routine home care, the correct revenue code is 0115.

This sometimes causes confusion among billers who may assume that hospice services should always use the 065X series. In reality, 0115 is specifically tied to room and board in a facility, while the 0651 revenue code applies to routine care provided in the patient’s home.

How Do You Bill Hospice Claims with Revenue Code 0115?

Billing hospice claims correctly requires understanding how revenue codes, HCPCS/CPT codes, and billing forms interact. Here’s a step-by-step outline for billing Revenue Code 0115:

Step 1: Determine Patient Setting

Confirm that the patient is receiving hospice services in a nursing facility or long-term care facility. If so, Revenue Code 0115 is applicable.

Step 2: Prepare the UB-04 Claim Form

Hospice claims are typically submitted on the UB-04 (CMS-1450) form. Revenue codes go in Form Locator 42, while charges and HCPCS codes align accordingly.

Step 3: Enter Revenue Code 0115

In the revenue code field, enter 0115 to indicate room and board in a facility.

Step 4: Include Charges

Report the daily room and board charge associated with the patient’s care. This should match your contract with the facility and reflect the days of service.

Step 5: Report Service Units and Dates

Accurately report the number of service units (days) and the corresponding dates of service. Any mismatch can lead to denials.

Step 6: Include Appropriate HCPCS Codes

While Revenue Code 0115 identifies the type of service, HCPCS codes may be required to indicate the level of hospice care. Ensure all fields are consistent.

Step 7: Submit to the Appropriate Payer

For Medicare beneficiaries, claims typically go through the Medicare Administrative Contractor (MAC). For Medicaid or commercial insurance, follow the payer’s submission rules.

Common Errors When Billing Revenue Code 0115

Incorrect use of Revenue Code 0115 is a frequent cause of hospice claim denials. Some common mistakes include:

• Using 0651 instead of 0115 for patients in nursing facilities.
• Missing or incorrect service dates.
• Mismatched service units between revenue code and line item detail.
• Incorrect payer sequencing (e.g., billing Medicaid before Medicare).
• Failing to include necessary documentation supporting the stay.

Each of these errors can trigger claim rejection or payment delays, increasing administrative workload and impacting cash flow.

What Is the Denial Code for Hospice?

When claims involving Revenue Code 0115 are denied, payers often assign denial codes that point to the underlying issue. Common denial codes for hospice claims include:

• 5 Denial Code: Claim not covered under patient’s hospice benefit.
• 176 Denial Code: Invalid or missing revenue code.
• 198 Denial Code: Patient eligibility issue or coverage terminated.
• M76/M77 Remark Codes: Missing or incomplete information.

For example, if a hospice claim uses 0651 for a nursing facility patient, the claim might be denied with a 176 denial code, indicating an invalid revenue code. This highlights why understanding and correctly applying Revenue Code 0115 is so important.

Tips to Avoid Denials and Ensure Compliance

To maintain clean claims and avoid disruptions in revenue cycle management, follow these best practices:

1. Train billing staff regularly on hospice revenue codes and payer requirements.
2. Establish clear contracts with nursing facilities that outline room and board charges.
3. Perform internal audits of hospice claims to identify patterns of error.
4. Use claim scrubbers or billing software that flags missing or incorrect codes.
5. Stay updated on CMS regulations, as hospice billing rules can evolve.

Accurate billing is not just about getting paid it’s about ensuring compliance with federal regulations and avoiding costly audits.

Real-World Example: Correct Use of Revenue Code 0115

Let’s consider a scenario:

• Patient: Mrs. J
• Setting: Skilled Nursing Facility
• Payer: Medicare Part A
• Service Dates: 10/01/2025 – 10/07/2025

The hospice agency provides routine home care in the nursing facility. For each day, the hospice bills Medicare using:

• Revenue Code: 0115
• Units: 7
• Total Charges: 7 × $250/day = $1,750

Medicare processes the claim, reimburses the hospice at the contracted rate, and the hospice pays the facility per their agreement. Because the revenue code, units, and charges were consistent and accurate, the claim was paid without denial.

Why Partner with A2Z Billings for Hospice Revenue Code Accuracy

Hospice billing is intricate, and even small coding mistakes can lead to significant revenue loss. At A2Z Billings, we specialize in hospice and home health billing, ensuring:

• Accurate use of revenue codes like 0115
• Timely claim submission and follow-up
• Denial management and appeals support
• Compliance with Medicare and Medicaid guidelines

Our experienced team understands the nuances of hospice billing, so your agency can focus on providing compassionate care not chasing claims.

For more insights, explore our guide on How to Bill Outpatient Observation Services Correctly.

Conclusion

Revenue Code 0115 plays a pivotal role in hospice billing, particularly for patients receiving routine home care in nursing facilities. Understanding what this code represents, when to use it, and how to bill it correctly can prevent denials, streamline reimbursement, and strengthen your agency’s financial health.

By mastering the use of Revenue Code 0115 and staying informed on hospice billing regulations, hospice providers can maintain compliance, optimize revenue, and continue delivering exceptional care to patients at the end of life.

FAQs

1. What is Revenue Code 0115 in hospice billing?
   Revenue Code 0115 is used to bill room and board charges for hospice patients residing in a nursing facility. It represents “Routine Home Care – Room and Board” and is essential for proper reimbursement under the Medicare Hospice Benefit.
2. When should hospice providers use Revenue Code 0115?
   Hospice providers should use Revenue Code 0115 when a patient receives routine hospice care in a skilled nursing facility or long-term care setting. This code is not used for home-based care or general inpatient services.
3. How do you bill Medicare for Revenue Code 0115?
   To bill Medicare for Revenue Code 0115, hospices must use the UB-04 claim form, enter 0115 in the revenue code field, include the daily room and board charges, accurately report service units and dates, and submit the claim to the appropriate Medicare Administrative Contractor (MAC)
4. What are common denial reasons for Revenue Code 0115 claims?
   Common denial reasons include:

• Using the wrong revenue code (e.g., 0651 instead of 0115)
• Missing or mismatched service dates
• Incorrect payer sequencing
• Incomplete documentation

These errors often result in 176 denial codes for invalid revenue codes or M76 remark codes for missing information.

5. What is the difference between Revenue Code 0115 and 0651?
   The key difference lies in the care setting:

• 0115 is used for routine home care provided in a nursing facility (room and board billing).
• 0651 is used for routine home care provided in the patient’s private residence.
  Using the correct code ensures accurate reimbursement and avoids claim denials.