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Skilled Nursing Facility Consolidated Billing Services Reminder

For Medicare beneficiaries in a covered Part A stay, these separately payable, or excluded, services include select items or services in the following categories:

  • physician’s professional services;
  • certain dialysis-related services, including covered ambulance transportation to obtain the dialysis services;
  • certain ambulance services, including ambulance services that transport the beneficiary to the SNF initially, ambulance services that transport the beneficiary from the SNF at the end of the stay (other than in situations involving transfer to another SNF), and roundtrip ambulance services furnished during the stay that transport the beneficiary offsite temporarily in order to receive dialysis, or to receive certain types of intensive or emergency outpatient hospital services;
  • erythropoietin for certain dialysis patients;
  • certain chemotherapy drugs;
  • certain chemotherapy administration services;
  • radioisotope services; and
  • customized prosthetic devices.

When these situations exist, it is also important to remember the appropriate usage of place of service codes for different types of nursing facilities. For the proper guidance, use reference CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section 110.1 which states:  “Place of Service (POS) code 31 should be used with services for patients in a Part A covered stay and POS code 32 should be used with services for beneficiaries in a noncovered stay. A/B MACs (B) should adjust their prepayment procedure edits as appropriate.” 

Therefore, National Government Services will deny procedure codes billed with place of service 31 with MPFSDB PC/TC indicator of 1 for the global and technical component (the professional component is separately payable by Part B under SNF Consolidated Billing with place of service 31), PC/TC 3 (technical component only codes), PC/TC 4 (Global test only codes) and PC/TC 5 (incident to physician codes).  Services with the aforementioned PC/TC indicators: 1) if the beneficiary is in a covered Part A stay, these services should be submitted to Part A; 2) if the beneficiary is not in a covered Part A stay, then the provider should use place of service 32 and the claim should submitted to Part B. 

Posted 1/26/2022