2010 Annual Update of HCPCS Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) for the Common Working File (CWF), A/B MACs, Medicare Carriers and Fiscal Intermediaries (FIs)
MLN Matters® Number: MM6619
Related Change Request (CR) #: 6619
Related CR Release Date: September 4, 2009
Effective Date: January 1, 2010
Related CR Transmittal #: R1814CP
Implementation Date: January 4, 2010
Provider Types Affected
This article is for physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, DME Medicare Administrative Contractors (DME MACs), Fiscal Intermediaries (FIs), and/or A/B Medicare Administrative Contractors (A/B MACs)) for services provided to Medicare beneficiaries who are in a Part A covered SNF stay.
Provider Action Needed
This article is based on Change Request (CR) 6619 which provides the 2010 annual update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility Consolidated Billing (SNF CB) that will be used in Medicare claims processing systems. Be sure billing staff are aware of these updates.
Background
Medicare’s claims processing systems currently have edits in place for claims received for beneficiaries in a Part A covered SNF stay as well as for beneficiaries in a non-covered stay. These edits only allow services that are excluded from SNF CB to be separately paid by Medicare contractors. The related policy is contained in the Medicare Claims Processing Manual (Chapter 6, Section 110.4.1 and Chapter 6, Section 20.6) which is available at www.cms.hhs.gov/manuals/downloads/clm104c06.pdf (PDF, 464 KB) on the Centers for Medicare & Medicaid Services (CMS) Web site.
Institutional providers should note that this site will include new Excel® and PDF format files. It is important and necessary for the provider community to view the 'General Explanation of the Major Categories' PDF file located at the bottom of each year’s FI update listed at www.cms.hhs.gov/SNFConsolidatedBilling/ on the CMS Web site in order to understand the Major Categories including additional exclusions not driven by HCPCS codes.
Additional Information
You can find information related to SNFs and Medicare on the CMS Skilled Nursing Facility Center at www.cms.hhs.gov/center/snf.asp on the CMS Web site.
If you have questions, please contact the Palmetto GBA Provider Contact Center at our toll-free number, (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2008 American Medical Association.