Questions billers ask › Can a SNF bill a Medicare resident privately for a leave of absence da...
Can a SNF bill a Medicare resident privately for a leave of absence day?
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
sha256:5745c7e1…2efe65e0 · Source
What our AI found in the sources
If a resident leaves the SNF and does not return by midnight (i.e., is absent at the midnight census), that day becomes a leave-of-absence (LOA) day -- reported with revenue code 018x -- and the SNF must show the charge for that day as zero. The SNF cannot bill the beneficiary privately for an LOA day except as a bed-hold payment, and even then only if the resident affirmatively elected in advance to pay for bed-hold under 42 CFR 483.10(g)(17)-(18) and was told the bed-hold charge amount beforehand. So: no private "midnight absence" charge is allowed unless it's a properly elected, per-diem bed-hold payment -- the SNF cannot simply assess a fixed fee at departure or bill the resident after the fact without that prior election.
Also cited
Captured2026-05-24
sha256:1ee358b6…15f32bf5 · Source
Captured2026-05-24
sha256:5745c7e1…2efe65e0 · Source
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