UB04 Type of Bill Code 0811: Specialty Facility - Hospice (Non-Hospital Based) - Admit through Discharge Claim

Overview

Type of Bill (TOB) code 0811 identifies a claim submitted by a Specialty Facility – Hospice (Non-Hospital Based) for an Admit through Discharge episode. The code structure follows the CMS four‑digit system: the third digit (1) indicates “Hospice non‑hospital (Special)”; and the fourth digit (1) signifies a claim that covers the entire period from admission to discharge ^[1]. The leading zero is ignored by CMS. The claim must reflect all services furnished between the patient’s hospice election date (admission) and the date of discharge (death or revocation). Unlike interim or continuation bills, code 0811 is a single, final bill for the entire hospice stay ^[1]. The MassHealth UB‑04 Billing Guide confirms that the UB‑04 form is required for all paper claims from specialty facilities, including hospice providers, though electronic submission is now mandated unless a waiver is granted ^[2].

When to Use

Use TOB 0811 when submitting a claim for a non‑hospital‑based hospice that is billing a complete episode from admission (or election of the hospice benefit) through discharge. The “1” in the fourth digit (frequency) explicitly means “Admit Through Discharge,” so the claim must include all services provided during the entire hospice stay. This code is not appropriate for interim billing (first, continuing, or last claim) or for late charges ^[1]. Providers should ensure the facility type is correctly identified as “8” (Special facility). If the hospice is hospital‑based, the third digit should be “2” (Hospice hospital), yielding code 0821 for an admit‑through‑discharge claim. Use 0811 only for freestanding, community‑based hospice programs. The claim should be submitted after the patient has been discharged – either due to death, revocation of the hospice benefit, or transfer to another facility. The MassHealth guide notes that all MassHealth claims must be submitted electronically unless a waiver is obtained, but the UB‑04 paper form remains the standard for providers with approved waivers ^[2].

Step-by-Step Claim Example

Assume a patient named Jane Doe is admitted to “Hope Hospice House,” a non‑hospital‑based hospice facility, on January 1, 2025, and dies on January 20, 2025. The hospice submits a single claim for the entire 20‑day stay.

1. Provider Information – Enter the hospice’s name, address, and National Provider Identifier (NPI) as registered with Medicare and MassHealth (per general UB‑04 instructions) ^[2].
2. Field 4 – Type of Bill – Enter 0811. The leading zero is ignored; the “8” confirms a Special facility, “1” confirms non‑hospital hospice care, and the final “1” indicates admit through discharge ^[1].
3. Field 6 – Statement Covers Period – Enter “20250101” through “20250120” reflecting the full stay.
4. Field 8 – Patient Name – “Doe, Jane”.
5. Field 11 – Patient Control Number – Use the hospice’s internal account number.
6. Field 12 – Medical/Health Record Number – Internal record number.
7. Field 17 – Admission Date – “20250101”.
8. Field 18 – Discharge Hour – Enter the hour of death (e.g., “14” for 2:00 p.m.).
9. Field 42 – Revenue Codes – List applicable hospice revenue codes (e.g., 0651 for hospice routine home care, 0652 for continuous home care, etc.). Each revenue code line must be accompanied by the appropriate service units and charges.
10. Field 50 – Payer Information – Identify primary payer (e.g., Medicare Part A, MassHealth, or other) and include the patient’s health insurance claim number.
11. Field 67 – Diagnosis Codes – Enter the principal diagnosis and any secondary diagnoses that support the need for hospice care.
12. Field 84 – Remarks – Optionally include remarks if required by the payer (e.g., death certificate number).

After completion, the claim is submitted electronically (or on paper if a waiver has been approved) ^[2]. The payer processes the claim under the frequency “1” and expects that no further claims will be submitted for this patient for the period covered.

Common Mistakes & Audit Red Flags

• Using 0821 for a non‑hospital‑based hospice. The third digit “2” is reserved for hospice care provided in a hospital setting. Billing 0821 for a freestanding hospice is a code error and will likely result in denial ^[1].
• Submitting 0811 for an active patient. The “1” frequency means the stay is complete. If the patient is still alive and receiving hospice services, the correct frequency is “2” (interim – first claim) or “3” (interim – continuing). Using 0811 prematurely may trigger overpayment demands if additional claims are later submitted ^[1].
• Omitting required hospice election or revocation notices. When a patient elects hospice, a separate notice using frequency “A” (Admission/Election Notice) may be required. Similarly, a termination/revocation uses frequency “B”. Relying solely on the 0811 claim without these notices can cause audit flags for incomplete documentation ^[1].
• Incorrect statement dates. The statement covers period must exactly match the admit‑through‑discharge dates. Any discrepancy (e.g., missing days) will be considered a billing error.
• Failure to adhere to electronic submission mandates. MassHealth requires electronic claims; paper claims with code 0811 will be rejected unless a waiver is on file ^[2].

Auditors may cross‑reference death records, hospice election dates, and the frequency code to ensure the claim truly represents a final, complete episode.

Related Codes/Fields

Code / Field	Description	Source
0821	Specialty Facility – Hospice (Hospital Based) – Admit through Discharge	[1]
0812	Non‑hospital‑based hospice – Interim First Claim	[1]
0813	Non‑hospital‑based hospice – Interim Continuing Claim	[1]
0814	Non‑hospital‑based hospice – Interim Last Claim	[1]
081A	Non‑hospital‑based hospice – Admission/Election Notice	[1]
081B	Non‑hospital‑based hospice – Termination/Revocation Notice	[1]
081C	Non‑hospital‑based hospice – Change of Provider Notice	[1]
Field 4	Type of Bill (code placement on UB‑04)	[2]
Field 6	Statement Covers Period (must match admit/discharge)	[2]
Revenue Codes 065x	Hospice service revenue codes (e.g., 0651, 0652) – used on the claim lines	[1] (inferred from hospice care category)

---END---

---

References

[1] Noridian Bill Types — https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types

[2] MassHealth UB-04 Guide — https://www.mass.gov/doc/ub-04-billing-guide-0/download