Guidelines for the Federal Employee Program states that home nursing care is limited to two (2) hours per day, up to 25 visits per calendar year. Any home nursing care that exceeds the member benefit limitation is considered non-covered and is the patient's responsibility.
Using the correct bill type ensures correct payment to your facility. The bill types that should be used when filing claims are:
- 331 – admit through discharge claim
- 332* - interim – first claim
- 333* - interim – continuing claim
- 334* - interim – final claim
- 337 – replacement claim
- 338 – cancelled claim
*Interim billing is accepted but not required.
Use revenue code 0551 and HCPCS code G0154 (services of skilled nurse in home health setting, each 15 minutes).
Provider was approved for and billed two (2) home nursing visits in one day.
The total number of units billed under code G0154 was 10.
The total charge billed for the 2 visits (or 10 units) was $150.
The total charge of $150 will be divided by the number of units billed ($150/10 = $15 per unit).
8 units (2 hr) are allowed and subject to the maximum allowable payment. These units are applied to the member's benefits.
The other 2 units are non-covered and are the patient's responsibility.
Services for this day will accumulate as 1 visit and applied toward the 25 visits per calendar year limitation.
Complete FEP benefit information is available at
FEP eligibility and claim status information is available by calling the BCBSKS FEP customer service center at 785-291-4181 or 1-800-432-0379.