US · guidance
CMS Pub. 100-04, ch. 7, § 60.2
Determining Payment and Patient Liability
SNF-534.D, SNF-534.E
There may be prosthetic and orthotic devices, for which the SNF would bill that are not
included in the fee schedule. When fee schedule amounts are not available for a
particular item, the intermediary will pay based on cost.
To determine the SNF's Part B payment, the SNF subtracts any unmet Part B deductible
from the lower of the actual charge or the fee schedule amount for the item or service and
multiply the remainder by 80 percent. This is the final payment. The patient's liability is
the remaining 20 percent plus any deductible remaining to be met.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
0d5888eac4c11362e189610a604edc8731bf72e828577a5f664bc6d1400eb17f
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