CMS Pub. 100-04, ch. 4, § 240

Medicare pays for hospital (including CAH) inpatient Part B services in the

circumstances provided in Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, § 10

(“Medical and Other Health Services Furnished to Inpatients of Participating Hospitals”).

Hospitals must bill Part B inpatient services on a 12x Type of Bill. This Part B inpatient

claim is subject to the statutory time limit for filing Part B claims described in chapter 1,

§70 of this manual.

Inpatient Part B services include inpatient ancillary services that do not require an

outpatient status and are not strictly provided in an outpatient setting. Services that

require an outpatient status and are provided only in an outpatient setting are not payable

inpatient Part B services, including Clinic Visits, Emergency Department Visits, and

Observation Services (this is not a complete listing).

Inpatient routine services in a hospital generally are those services included by the

provider in a daily service charge--sometimes referred to as the "Room and Board"

charge. They include the regular room, dietary and nursing services, minor medical and

surgical supplies, medical social services, psychiatric social services, and the use of

certain equipment and facilities for which a separate charge is not customarily made to

Medicare Part A. Many nursing services provided by the floor nurse (such as IV

infusions and injections, blood administration, and nebulizer treatments, etc.) may or may

not have a separate charge established depending upon the classification of an item or

service as routine or ancillary among providers of the same class in the same State. Some

provider’s customary charging practice has established separate charges for these services

following the PRM-1 instructions, however, in order for a provider’s customary charging

practice to be recognized it must be consistently followed for all patients and this must

not result in an inequitable apportionment of cost to the program. If the PRM-1

instructions have not been followed, a provider cannot bill these services as separate

charges. Additionally, it is important that the charges for service rendered and

documentation meet the definition of the HCPCS in order to separately bill.