Skip to Main Content

2013 Part B MAC Update

2013 Annual Carrier Update

The SNF consolidated billing files reflect new codes that have been developed for 2013 and codes that have been discontinued for 2013. In addition, the files reflect any additions and deletions to categories of services excluded from consolidated billing. These files are effective for claims with dates of service on or after 1/01/2013 unless otherwise noted.

File 1 - Part A Stay - Physician Services (see file below)

Services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part A covered stay. They should be submitted to the Part B Medicare carrier or Durable Medical Equipment Regional Carrier, as appropriate, for payment consideration.

The following codes when billed globally, or as a separate technical component or professional component billed with a TC or 26 modifier, are excluded from consolidated billing and may be paid separately by the Medicare Part B contractor: 78804, 79200, 79300, 79403, and 79440. These codes therefore appear on both File 1 and File 2.

File 2 - Part A Stay - Professional Components of Services to be Submitted with a 26 Modifier (see file below)

Note: The professional component of the services represented by these codes are not subject to skilled nursing facility (SNF) consolidated billing and will be considered for payment by the Part B Medicare carrier for Medicare beneficiaries in a SNF Part A stay. These codes must be submitted with a modifier of 26 to indicate "professional component".

File 3 - Part A Stay - Ambulance (see file below)

Note: These are ambulance codes that will always be denied by the Part B Medicare carrier for Medicare beneficiaries in a skilled nursing facility Part A covered stay when submitted with an NN modifier. Effective 10/4/04, per Transmittal 163, these ambulance codes will also be denied when submitted with modifiers ND or DN.

File 4 - Part B Stay Only - Therapy Services (see file below)

Note: Services represented by these codes are the only services subject to skilled nursing facility (SNF) consolidated billing for Medicare beneficiaries in a SNF Part B stay. The file includes codes for physical, occupational and speech therapy. The Part B Medicare carrier will always deny these codes for Medicare beneficiaries in a SNF Part B stay. Therapy services must be provided and billed under arrangement with the SNF.  For 2013, this file also includes the therapy claims based data reporting codes.