31147

FISS Narrative
If non-routine supplies were provided, the charges must be added to the claim using the appropriate supply Revenue code, or if supplies were not provided, the HHA must indicate that on the claim by changing the 5th position of the HIPPS code to the appropriate numeric value in the range one through six.

Explanation and Suggestion
If non-routine supplies were provided, providers must report:

  • Supply revenue codes(s) 027X and/or 0623
  • Service units
  • Date of service (any date that falls within the episode date of service)
  • Charges for the non-routine supplies

If non-routine supplies were not provided during the episode, providers should change the 5th position of the HIPPS code to the corresponding numeric value of one through six.



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