Questions billers ask › What services are included in SNF consolidated billing under Medicare?
What services are included in SNF consolidated billing under Medicare?
The rule, word for word
“As previously discussed, the consolidated billing requirement applies to all services furnished to a SNF resident in a covered Part A stay (other than the excluded service categories described below) and for physical therapy, occupational therapy, and/or speech-language pathology services provided to residents and paid under Part B. Examples of services that are subject to consolidated billing include: • Physical therapy, occupational therapy, and/or speech-language pathology services, regardless of whether they are furnished by (or under the supervision of) a physician or other health care professional (see §1888(e)(2)(A)(ii) of the Act). Physical therapy, occupational therapy, and/or speech-language pathology services (other than audiology services, which are considered diagnostic tests rather than therapy services) furnished to a SNF resident during a noncovered stay must still be billed by the SNF itself. This is known as “Part B” consolidated billing (see §20.5 of this chapter). • Psychological and other services furnished by a clinical social worker; and • Services furnished as an “incident to” the professional services of a physician or other excluded category of health care professional described in §20.1.1 below.”
Captured2026-05-24
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What our AI found in the sources
SNF consolidated billing requires the SNF to bill Medicare for almost all services a resident receives during a covered Part A stay, with a few statutory exclusions. Services subject to consolidated billing include physical therapy, occupational therapy, and speech-language pathology services (regardless of who furnishes them); psychological and other services furnished by a clinical social worker; and services furnished "incident to" the professional services of a physician or other excluded practitioner. During a noncovered stay, only therapy services (PT, OT, and speech-language pathology) are subject to consolidated billing; all other covered services are separately billable.
Also cited
Published2018-05-08 Captured2018-05-08
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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.
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