PalmettoGBA is reminding agencies to submit their claims with the correct Core-Based Statistical Area (CBSA) code.
 
Palmetto reminds providers:
  • Submit the CBSA code corresponding to the state and county of the beneficiary’s place of residence with value code 61 on home health claims. CBSA codes are not used on Notice of Admissions (NOAs).
  • Counties with different wage index values than the CBSA or rural area to which they are assigned after applying the 5% cap will use a wage index transition code. These codes will be five-digit codes starting with 50 and will only be used in specific counties to report with value code 61. The 50xxx codes are included in CMS’s annual HHPPS Wage Index files updates.
  • The billing period end/through date determines which calendar year CBSA code to apply to the claim. If a period starts in 2025, but ends in 2026, agencies should apply the 2026 code.
  • For periods of care in which the beneficiary’s site of service changes from one CBSA or county to another within the billing period, agencies should submit the CBSA code or state and county code corresponding to the site of service at the end of the period.
Read the full alert from Palmetto at https://palmettogba.com.