CMS Pub. 100-04, ch. 6, § 20

by the SNF

(Rev. 2573, Issued: 10-26-12, Effective: 04-01-13, Implementation: 04-01-13)

For cost reporting periods beginning on and after July 1, 1998, SNF services paid under

Part A include posthospital SNF services for which benefits are provided under Part A,

and all items and services which, prior to July 1, 1998, had been paid under Part B but

furnished to SNF residents during a Part A covered stay regardless of source, except for

the exclusions listed in the annual SNF consolidated billing update files. Annual update

files, as well as subsequent quarterly updates to the annual update, for SNF consolidated

billing can be found at http://www.cms.hhs.gov/SNFConsolidatedBilling/. This file lists

services by HCPCS code, short descriptors, and the major category under which the

HCPCS falls. HCPCS added or removed by subsequent quarterly update transmittals will

be listed under the respective year’s annual update at the above link. The respective

year’s annual update file will be updated to add or remove the HCPCS listed in the

quarterly updates.

A general explanation of the five major categories can also be found at the above link.

NOTE: It is important for MACs/providers to understand the major categories for SNF

CB. Some major categories exclude services by revenue code (see section 20.1.2.2 for

emergency room exclusion) as well as bill types (see section 20.2.1.2 on coding for renal

dialysis facilities and 20.2.2 for hospice facilities).

Services paid under Part A cannot be billed under Part B. Any service paid under Part A

that is billed separately will not be paid separately, or payment will be recovered if

already paid at the time of the SNF billing. The following subsections list the types of

services that can be billed under Part B for SNF residents for whom Part A payment is

made.