Kentucky Medicaid identifies hospice services as Provider Type (44). To enroll in and bill Kentucky Medicaid, hospice providers must be:
Hospice services are available to beneficiaries who have a terminal diagnosis with a life expectancy of six months or less as certified by a physician. Hospice services provide care the beneficiary needs to live as fully and comfortably as possible. Hospice also provides assistance to a beneficiaries' families as they adjust to the patient's illness and death. Covered hospice services are available in home, in a nursing facility or in an intermediate care facility for individuals with intellectual disabilities.
Beneficiaries must elect to receive hospice coverage using the
MAP-374 - Election of Medicaid Hospice Benefit Form.
Beneficiaries who elect hospice will receive treatment for conditions related to their terminal illness by their hospice provider. Beneficiaries younger than 21 are eligible to receive curative treatment for their terminal illness concurrently with hospice services.
If an individual is eligible for Medicare as well as Medicaid (dual eligibility), the hospice benefit must be elected and revoked simultaneously under both programs.
Hospice benefits consist of two 90-day periods. An additional 60-days of hospice benefits are covered until revocation or termination for other reasons such as ineligibility or death. Recertification is required for each 60-day extension benefit period.
Send the MAP-374, MAP-375, MAP-376, MAP-378, and MAP-403 by fax to DMS at (502) 564-0039 or by
Mail or fax the MAP-377, MAP-383, MAP-384 and MAP-397 to:
9200 Shelbyville Road Suite 800
Louisville, KY 40222
Fax: 800-292-2392, Option 9
Hospice providers must meet the coverage provisions and requirements of
907 KAR 1:330 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or use the web-based KYHealth-Net System.
Hospice services are reimbursed per 907 KAR 1:340.
Duplication of Service
KY Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.
Some services may require prior authorization. Hospice services requiring prior authorization must contact
KY Medicaid currently contracts with
Gainwell Technologies to process fee-for-service (FFS) claims. Each MCO processes its own claims.
KY Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. KY Medicaid requires the use of CMS 1500 billing forms. Providers will need to bill Kentucky Medicaid using the correct CPT codes.
Appeal requests made on denied FFS claims must be submitted to
Gainwell Technologies. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO if appealing an MCO claim.
Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
Notice: Effective for dates of service Jan. 1, 2016, and later, hospice providers will be able to bill for service intensity add-on payments for routine home care services provided by a registered nurse or medical social worker during the last seven days of a patient's life. Billing for the service intensity add-on payment should be on a separate line and/or claim from your routine home care payment billing using revenue codes 551 or 561, as appropriate. Procedure code G0299 will be required with the use of revenue code 551 and G0155 will be required with the use of revenue code 561. Service intensity add-on payments must be billed in 15-minute increments (one unit is equal to 15 minutes) and billed on a claim with occurrence code 55 and an associated occurrence date that reflects the member's date of death. Revenue codes 551 and 561 must be billed as a single date of service per line (span-dating is not allowed). Please continue billing for your regular routine home care payments with revenue code 651 using the current billing guidelines and unit increment.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions - Gainwell Technologies - (800) 807-1232
General Provider Questions - (855) 824-5615
Prior Authorization - CareWise - 800-292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance - Gainwell Technologies - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (PAD) List - Pharmacy Branch - (502) 564-6890
Provider MCO Information
Anthem - (800) 205-5870
Aetna Better Health of KY - (855) 300-5528
Humana - (855) 852-7005
Passport Health Plan by Molina - (800) 578-0775
United Healthcare Community Plan - (866) 633-4449
WellCare of Kentucky - (877) 389-9457