HHAs: Ensure You Use the Proper Core-Based Statistical Areas (CBSAs) Code on Claims

Published 02/05/2021

This article is a reminder for home health agencies (HHAs) to use the correct Core-Based Statistical Areas (CBSAs) codes under the home health (HH) Prospective Payment System (PPS). Table 7 of MLN Matters: MM12017, HH PPS Rate Update for Calendar Year (CY) 2021 provides a list of counties that must use 50xxx codes for CY 2021 due to the wage index transition. In addition, some CBSAs that were applicable in 2020 are not used in 2021. HHAs are encountering underpayments by not using the correct code.

Please ensure you do the following:  

  • Submit the CBSA code or special wage index code corresponding to the state and county of the beneficiary’s place of residence in value code 61 on home health Request for Anticipated Payments RAPs and claims. Remember, value code 61 is optional on RAPs in 2021.   

  • Ensure when serving beneficiaries in areas where there is more than one unique CBSA due to the wage index transition, use the codes in range 50xxx (shown in the last column of the CY 2021 HH PPS wage index file) to report in value code 61

Please make sure your billing staff is aware of these updates.

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