CMS Pub. 100-04, ch. 6, § 40.6.1

Where items and services are furnished which are more expensive or in excess of the

services covered by the program, the SNF will make the following entries in the Total

Charges and Noncovered fields on the bill:

• If the patient did not request such excess or more expensive services, the patient

may not be charged for them, and only the services covered by the program are

shown in total charges. No entry is made in noncovered charges in this situation.

(However, where all patients are routinely billed for such excess or more

expensive items, total charges may reflect the excess items or services as

discussed in total and noncovered charges, above.);

• If the patient did request such excess or more expensive services, the SNF may

charge the patient for them. In this case, the SNF show the line item total charge

(any customary charges covered by the program plus the excess charges). The

excess charges that will be billed to the patient are shown in noncovered charges.

• In the same situation as above, except that the SNF will not bill the patient for the

excess services. Instead the SNF will show only the customary charges for

covered services in total charges and make no entry in noncovered charges.