Due to a number of inquiries about HIPPS code requirements, Medicare Administrative Contractor CGS is reminding providers of a change under PDGM that has impacted no-pay RAPS and final claims in 2021.
The issue is a HIPPS code required for the RAP. It can be any valid HIPPS code, but the code used on the RAP must match the code used on the final claim.
CGS stresses that the HIPPS code can be any valid HIPPS code — the code used for payment will be determined by the MAC’s system and not determined by the code listed on the RAP/final claim.