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2015 Part B MAC Update

2015 Annual Part B MAC Update

The SNF consolidated billing files reflect new codes that have been developed for 2015 and codes that have been discontinued for 2015. 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 1/01/2015 unless otherwise noted.

NOTE: Certain Current Procedural Terminology (CPT) codes (33330, 33474, 61610 and 61870) were not included, and one code (34839) was incorrectly included in File 1 – Physician Services during the 2015 annual update to the SNF consolidated billing code editing lists, originally released in November 2014. A correction to the coding list in File 1 will be implemented in January, 2015. Please confirm you have downloaded the correct version of this file below.

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 MAC or Durable Medical Equipment MAC, 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 Part B MAC: 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 MAC 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 MAC 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 MAC 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.

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