Questions billers ask › What services can a SNF bill separately under Medicare Part B?
What services can a SNF bill separately under Medicare Part B?
The rule, word for word
“The following services may be billed separately under Part B by the rendering provider, supplier, or practitioner (other than the SNF that receives the Part A PPS payment) and paid to the entity that furnished the service. These services may be provided by any Medicare provider licensed to provide them, other than the SNF that receives the Part A PPS payment, and are excluded from Part A PPS payment and the requirement for consolidated billing, and are referred to as “Major Category III” for consolidated billing edits applied to claims submitted to A/B MACs (A). • A medically necessary ambulance trip (other than a transfer to another SNF) that transports a beneficiary to the SNF for the initial admission or from the SNF following a final discharge, or that occurs pursuant to the offsite provision of Part B dialysis services (see section 20.3.1 for additional situations involving ambulance transportation); • Certain chemotherapy (that is, anti-cancer) drugs. The chemotherapy exclusion applies solely to the particular chemotherapy codes designated under Major Category III.A of the SNF website’s A/B MAC (A) Annual Update. These same codes also appear on the list of exclusions in File 1 of the SNF website’s A/B MAC (B) Annual Update (though not displayed as a separate subcategory). The excluded chemotherapy codes serve to identify those high-intensity chemotherapy drugs that are [...]”
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What our AI found in the sources
When a beneficiary is in a Medicare Part A covered SNF stay, the SNF must consolidate billing for most services. However, certain services are excluded from the SNF Prospective Payment System and consolidated billing, and may be billed separately under Part B by the rendering provider or practitioner. These separately billable services include: physician services and services of certain non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, qualified psychologists, marriage and family therapists, mental health counselors, and certified registered nurse anesthetists); medically necessary ambulance trips (other than transfers to another SNF); certain high-intensity chemotherapy drugs and their administration services; certain radioisotope services; certain customized prosthetic devices; and blood clotting factors for hemophilia (effective October 1, 2021). Additionally, screening and preventive services (screening mammography, pap smears, pelvic exams, glaucoma screening, influenza/pneumococcal/hepatitis B vaccines, colorectal screening, bone mass measurements, and prostate screening) are not included in the SNF PPS amount but may be billed separately under Part B by the SNF itself for Part A patients who also have Part B coverage.
Also cited
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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.
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