Questions billers ask › Can a SNF bill a Medicare resident for a day away at an overnight slee...
Can a SNF bill a Medicare resident for a day away at an overnight sleep study?
The rule, word for word
“A leave of absence for the purposes of this instruction is a situation where the patient is absent, but not discharged, for reasons other than admission to a hospital, other SNF, or nonparticipating portion of the same institution. If the absence exceeds 30 consecutive days, the 3-day prior stay and 30-day transfer requirements, as appropriate, must again be met to establish re-entitlement to SNF benefits. Leave of absence (LOA) days are shown on the bill with revenue code 018X and LOA days as units. However, charges for LOA days are shown as zero on the bill, and the SNF cannot bill the beneficiary for them except as specified in Chapter 1 of this manual at §30.1.1.1. Occurrence span code 74 is used to report the LOA from and through dates. Providers should review the RAI manual to clarify situations where an LOA is not appropriate, for example observation stays in a hospital lasting greater than 24 hours. 40.4 - Accommodation Charges Incurred in Different Accounting Years (Rev. 1, 10-01-03) SNF-517.1 The SNF must not put accommodation charges incurred in different accounting years on the same bill. (See §40.3.5.1 when billing for ancillary charges for services furnished on the day of discharge or death when it is also the day after the end of the accounting year.) At the end of the accounting year, the SNF must submit a bill that contains the charges for all services [...]”
Captured2026-05-24
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What our AI found in the sources
If the resident leaves the SNF for an overnight sleep study and that absence spans midnight (i.e., the resident is out of the building at the midnight census), the resident's "resident" status for consolidated billing purposes ends at the point of departure and doesn't resume until they're back at the SNF -- CMS specifically uses an overnight sleep study as its example of this scenario. That means the sleep study itself is not subject to SNF consolidated billing (the sleep study provider bills Medicare directly, not the SNF) and the day is treated as a leave-of-absence day. For a leave-of-absence day, the SNF reports it with revenue code 018X but must show the charge as zero -- the SNF cannot bill the beneficiary for that day's room-and-board, except that the resident may voluntarily agree in advance to pay an optional bed-hold charge under 42 CFR § 483.10(g)(17)-(18) to reserve the bed while away.
Also cited
Captured2026-05-24
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Captured2026-05-24
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If this comes up on one of your claims
The quoted paragraph above is what you would put in the appeal or the audit file, with its citation and dates. Verbatim does not tell you how to bill; it shows you the rule as published so the decision is yours and the proof is in writing.
Ask it your own question and get the same thing back: the governing rule, quoted, with a citation that still verifies later.
Ask Verbatim your question