Updated SNF Billing Codes

Updates have been made to Healthcare Common Procedural Coding System (HCPCS) codes that are subject to consolidated billing (CB) provisions of the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), which includes revisions to Part B SNF CB files for 2021, 2020, 2019, and 2017. SNF billing staff should be aware that changes to the HCPCS codes will be used to revise Common Working File (CWF) edits, which allow Medicare Administrative Contractors (MAC) to make appropriate payments in accordance with policy for SNF CB.

Updated coding is used to describe the same services subject to SNF PPS payment by law and does not add any additional services. For non-therapy services, SNF CB applies only when you furnish the services to a SNF resident during a covered Part A stay. Keep in mind that SNF CB applies to physical and occupational therapies and speech-language pathology services whenever you provide them to a SNF resident, regardless of whether Part A covers the stay. To ensure proper payment in all settings, Medicare systems must edit for services provided to SNF beneficiaries both included and excluded from SNF CB.

An overview of SNF CB can be found here. To view the Medicare Learning Network April 2021 Quarterly Billing Update, which includes the updated billing codes, click here.

Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820