US · guidance
CMS Pub. 100-04, ch. 7, § 10.1.1
Editing of Skilled Nursing Facilities Part B Inpatient Services
Medicare pays under Part B for physicians’ services and for non-physician medical and
other health services listed below when furnished by a participating hospital to an
inpatient of the SNF when patients are not eligible or entitled to Part A benefits or the
patient has exhausted their Part A benefits.
The SSM shall edit to prevent payment on Type of Bill 22x for claims containing the
revenue codes listed in the table below.
010x 011x 012x 013x 014x 015x 016x 017x
018x 019x 020x 021x 022x 023x 024x 0250
0251 0252 0253 0256 0257 0258 0259 0261
0269 0270 0273 0277 0279 029x 0339 036x
0370 0374 041x 045x 0472 0479 049x 050x
051x 052x 053x 0541 0542 0543 0544 0546
0547 0548 0549 055x 057x 058x 059x 060x
0630 0631 0632 0633 0637 064x 065x 066x
067x 068x 072x 0762 078x 079x 093x 0940
0941 0943 0944 0945 0946 0947 0949 095x
0960 0961 0962 0969 097x 098x 099x 100x
210x 310x
The contractor shall use the following remittance advice messages and associated codes
when rejecting/denying claims under this policy. This CARC/RARC combination is
compliant with CAQH CORE Business Scenario Three.
Group Code: CO
CARC: 96
RARC: M28
MSN: 21.21
History
(Rev. 3481, Issued: 03-18-16. Effective: 06-20-16, Implementation: 06-20-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
fdbd8d27c06919ded6931560507f96fb4254297f8d48c4ee985dc99ec10ad1c7
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