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Issue Number - Name
0109-Skilled Nursing Facility (SNF) Consolidated Billing Part B (Full)
Review Type
Automated
Claim Type
Physician/Non-Physician Services
Region and State
RAC 1-4
All States
Date Approved
09/11/2018

Description

Payment for the majority of Skilled Nursing Facility (SNF) services provided to beneficiaries in a Medicare covered Part A stay are included in a bundled prospective payment made through the fiscal intermediary (FI) A/B Medicare Administrative Contractor (MAC) to the SNF. These bundled services are to be billed by the SNF to the FI A/B MAC in a consolidated bill. The consolidated billing requirements confers on the SNF the billing responsibility for the entire package of care that residents receive during a covered Part A SNF stay.

Affected Code(s)

All CPT/HCPCS codes excluding those service codes listed on the CMS File 1 (Part A Stay-Physician Services) CPT/HCPCS code listed on the CMS File 2 billed with modifier TC (Part A Stay-Professional Components of Services)

Applicable Policy References

Social Security Act, Section 1833(e)
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 6, Section 20.1.1
SNF Consolidated Billing - Part B Medicare Administrative Contractor (MAC) File Explanation - https://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/2018-Part-B-MAC-Update.html