US · guidance
CMS Pub. 100-08, ch. 6, § 6.1.3
Bill Review Requirements
Medicare contractors must conduct review of SNF PPS claims in accordance with
these instructions and all applicable Pub. 100-08, Medicare Program Integrity Manual
sections, including but not limited to, Medicare contractor standard operating
procedures for soliciting additional documentation, time limitations for receipt of the
solicited documentation, claim adjudication, and recoupment of overpayment.
Minimum requirements of a valid SNF PPS claim are:
• Revenue Code 0022 must be on the claim. This is the code that designates
SNF PPS billing.
• A HIPPS code must also be on the claim. This is a five-character code. The first
character represents the patient’s physical therapy (PT) component and
occupational therapy (OT) component classification. The second character
represents the patient’s speech-language pathology (SLP) component
classification. The third character represents the patient’s nursing component
classification. The fourth character represents the patient’s non-therapy ancillary
(NTA) component classification. The fifth character represents the assessment
indicator (AI) code. See Pub. 100-04, chapter 6, §30.1 for valid codes and
assessment indicators.
History
(Rev. 924; Issued: 11-15-19; Effective: 10-01-19; Implementation: 12-17-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e3ee1751cad20907c8465acb14a0bf6363c9dc5ab4aacdf338432e2cc5b45787
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