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Ambulance Transports Included in SNF Consolidated Billing

Transport Description Medical Necessity Met Ambulance Billing Modifiers and Other Considerations Who is Responsible for Payment? Reference(s)
SNF to SNF

Note: The day of departure from SNF 1 is a covered Part A day (to which consolidated billing would apply) only if the beneficiary’s admission to SNF 2 occurs by midnight of the day of departure.
YES The first character (origin) of any HCPCS ambulance modifier is N (SNF), the second character (destination) of the HCPCS ambulance modifier is N (SNF) and the patient status is 03.

An ambulance trip that is medically necessary to effect this type of SNF-to-SNF transfer would be bundled back to SNF 1, as in this specific situation the beneficiary would continue to be considered a “resident” of SNF 1 for CB purposes up until the actual point of admission to SNF 2.

For example, a SNF-to-SNF transfer would be considered reasonable and necessary in a situation where needed care is unavailable at the originating SNF, thus necessitating a transfer to the receiving SNF in order to obtain that care.
SNF 1-Transferring SNF
SNF to SNF

Note: The day of departure from SNF 1 is a covered Part A day (to which consolidated billing would apply) only if the beneficiary’s admission to SNF 2 occurs by midnight of the day of departure.
NO The first character (origin) of any HCPCS ambulance modifier is N (SNF), the second character (destination) of the HCPCS ambulance modifier is N (SNF) and the patient status is 03.

A SNF-to-SNF transfer that is prompted by non-medical considerations (such as a patient’s personal preference to be placed in the receiving SNF) is not considered reasonable and necessary for diagnosing or treating the patient’s condition and, thus, would not be bundled back to the originating SNF.
Beneficiary CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services (500 KB)
Ambulance transports to or from a diagnostic or therapeutic site other than a hospital or renal dialysis facility (e.g., an independent diagnostic testing facility (IDTF), cancer treatment center, radiation therapy center, wound care center, etc.) YES The ambulance transport is included in the SNF PPS rate if the first or second character (origin or destination) of any HCPCS code ambulance modifier is “D” (diagnostic or therapeutic site other than “P” or “H”), and the other modifier (origin or destination) is “N” (SNF). SNF CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services (500 KB)
SNF Part A resident to a physician’s office (round trip) YES First or second character (origin or destination) of any HCPCS code ambulance modifier is “P” (physician’s office), and the other modifier (origin or destination) is “N” (SNF) SNF
SNF Part A resident to a physician’s office (round trip) NO First or second character (origin or destination) of any HCPCS code ambulance modifier is “P” (physician’s office), and the other modifier (origin or destination) is “N” (SNF) Note:  Medicare does not provide any coverage at all under Part A or Part B for any non-ambulance forms of transportation, such as ambulette, wheelchair van, or litter van. In order for the Part A SNF benefit to cover transportation via ambulance, the regulations at 42 CFR 409.27(c) specify that the ambulance transportation must be medically necessary--that is, the patient’s condition is such that transportation by any means other than ambulance would be medically contraindicated. Beneficiary CMS IOM Publication 100-04, Claims Processing Manual, Chapter 6 Section 20.3.1 - Ambulance Services (500 KB)
Ambulance Transports Included in SNF Consolidated Billing
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