Introduction
Comfort, dignity, and symptom control sit at the center of hospice care. Billing follows a different path as well. Revenue Code 0115 is used when a facility bills room and board for a private hospice inpatient room on the UB-04, but only when the payer’s policy allows it. This guide explains what 0115 covers, when to use it, how it differs from 0656, and how to complete the claim step by step.
What Revenue Code 0115 Means
Revenue code 0115 sits inside the 011X “Private Room & Board” group. Code 0115 tells the payer the patient was in a private room for hospice inpatient care, and you are billing daily room and board for that day on the facility claim.
Usually included with 0115
- Private room and bed
- Meals and dietary services
- Routine nursing tied to room/board
- Housekeeping, linens, basic comfort items
Usually not included
- Lab, imaging, therapy, or procedures (separate revenue lines if billable)
- Drugs for the terminal diagnosis (normally part of the hospice benefit)
- Physician professional fees (billed on the 1500/837P)
Where 0115 Fits vs. 0656
Hospice days under Medicare are billed by the hospice agency using 065X by level of care. For General Inpatient Care (GIP), the hospice bills 0656 (and includes the correct Q500x site-of-service code). In this case, the facility does not bill Medicare with 0115. Instead, the facility invoices the hospice agency for room and board under their contract (that invoice can list 0115).
For Medicaid or commercial plans, rules vary by policy and contract:
- Some follow the same pattern as Medicare (hospice sends 0656; facility invoices the hospice).
- Others allow the facility to bill 0115 directly to the plan for the private hospice room.
Always check the payer policy or your provider agreement before submitting the claim.
Quick Comparison Table
| Scenario | Revenue Code on Claim | Who Sends the Claim | Notes |
| Patient elected Medicare hospice; day is GIP | 0656 (hospice level of care) | Hospice → Medicare | The facility does not bill 0115 to Medicare; the facility invoices hospice per contract. |
| Plan follows hospice level-of-care billing | 0656 (or payer-defined equivalent) | Hospice → Payer | The facility typically sends a contract invoice to the hospice for room/board. |
| Plan allows facility billing of hospice room/board | 0115 (private hospice room) | Facility → Payer | Use payer policy and contract rate; confirm any required HCPCS. |
| Patient is in a non-hospice acute medical unit | 0111/0120/etc. | Facility → Payer | Use regular room/board code for the unit; do not use 0115. |
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How to Bill a Hospice Inpatient Day with 0115 (when payer allows)
1. Verify hospice status
- Hospice election is on file.
- Physician certification supports six months or less life expectancy.
- Notes show why an inpatient (GIP) level is needed (uncontrolled pain, severe nausea/vomiting, complex wounds, etc.).
2. Confirm the billing path
- Medicare hospice: Hospice bills 0656 to Medicare with the right Q500x site code. The facility bills the hospice under contract (not Medicare) for room/board.
- Medicaid or commercial: Follow the plan manual. If it allows facility billing for room/board, use 0115 on the UB-04.
3. Select the correct revenue code
- Use 0115 on the facility claim only if the payer permits hospice room/board billing by the facility.
- Use 0656 on the hospice claim to Medicare (or payer) when billing the hospice level of care.
4. Complete key UB-04 fields (facility using 0115)
- FL 42 (Revenue Code): 0115
- FL 46 (Units): number of covered hospice inpatient days
- FL 45 (Service Date): daily lines or a date span as allowed
- FL 6 (Statement Covers Period): matches your units/dates
- Diagnoses: Principal = terminal diagnosis; secondary = comorbid conditions that affect care
- TOB (for hospice claims): 081x (non-hospital-based) or 082x (hospital-based), with the 4th digit showing the claim frequency (1 = admit-through-discharge, 2 = first interim, 3 = continuing, 4 = last interim)
5. Send interim claims when needed
- Long stays should not wait until discharge. Use interim cycles allowed by the payer (monthly is common).
FY 2025 Payment Basics
Hospice payments are daily base rates adjusted by the local wage index and other policy rules. Four main levels of care apply: Routine Home Care (two tiers), Continuous Home Care, Inpatient Respite, and General Inpatient (GIP). For any GIP day billed to Medicare, the hospice uses 0656 (plus the correct site code). Your actual dollar amount depends on your location and any applicable adjustments. Always confirm current rates in your MAC guidance and CMS updates for FY 2025.
Common Errors and Simple Fixes
- Using 0115 on Medicare hospice claims
For Medicare hospice, the hospice claims the day with 0656. The facility sends room/board to the hospice under contract, not to Medicare. - Missing hospice election or certification
No election or no physician certification leads to denials. Keep both in the chart. - Wrong TOB or missing frequency digit
Use the correct hospice series (081x/082x) and the correct 4th digit (1, 2, 3, or 4) to show timing in the claim cycle. - Ignoring payer instructions on commercial plans
Some plans do not want 0115 line items for hospice room/board. Others allow it. Read the policy every time. - No interim billing on longer stays
Long waits slow cash flow. Use interim claims when allowed.
Real-Life Scenarios (Quick Checks)
Medicare hospice, inpatient GIP
- Hospice → Medicare with 0656 + Q500x
- Facility → Hospice with room/board (0115) on the invoice only
Commercial plan that allows facility billing
- Facility → Payer with 0115 under the contract
- Hospice-related drugs and services follow plan rules; do not double-bill
Non-hospice acute medical day
- Facility → Payer with the standard unit code (e.g., 0111 private, 0120 semi-private)
- Do not use 0115 unless the day is hospice inpatient and payer policy allows it
Hospice Billing Scenarios and Rate Overview (FY 2025)
| Level of Care | FY 2025 Note | Practical Tip |
| Routine Home Care (Days 1–60) | Daily base rate; wage indexed | Track the day 61+ tier switch. |
| Routine Home Care (Day 61+) | Lower daily base rate; wage indexed | Watch tier crossover in long stays. |
| General Inpatient (GIP) | Daily base rate; wage indexed | Hospice bills 0656; facility invoices hospice. |
| Inpatient Respite | Daily base rate; wage indexed | Confirm limits and documentation. |
| Continuous Home Care | Hourly, paid per 24 hours | Ensure hours and documentation match. |
Why Teams Choose RhinoMDs
Clear claims mean fewer denials and faster payments. RhinoMDs helps hospice and post-acute providers by:
- Picking the right code set (0115 vs. 0656) for the situation
- Filling UB-04 fields correctly and on time
- Matching documentation to the level of care and payer rules
- Reading contracts and manuals to avoid preventable write-offs
- Managing interim cycles to protect cash flow
Final Takeaway
Use 0115 only when a payer expects the facility to bill the private hospice room and board on the UB-04. For Medicare hospice, the hospice bills the day using 0656 and the correct site-of-service code, and the facility invoices the hospice under contract. Match the code to the level of care, follow the plan policy, and keep the documentation tight—your revenue will follow.