Can I Deliver a Prosthesis to a Patient in the SNF?
When a patient is in a skilled nursing facility (SNF), most services are included in the payment to the facility. This includes all orthotic devices used by the patient during the stay.
When a patient is in a skilled nursing facility (SNF), most services are included in the payment to the facility. This includes all orthotic devices used by the patient during the stay. However, most prosthetic devices are exempt from the payment to the SNF. In other words, prosthetic devices delivered to the patient in a SNF can usually be billed under the patient's Part B Medicare benefit. Submitting the claim to Medicare is the responsibility of the prosthetic supplier. Payment is made, by the appropriate MAC, directly to the prosthetic supplier.
CMS provides a comprehensive list of items, defined by HCPCS codes, which are excluded from the SNF payment.
What Does this Mean for You?
Check the HCPCS list here. Click on "2019 Part A MAC Update" and then "2019 Annual SNF Consolidated Billing HCPCS."
If an item is not listed, then it is considered to be a part of the SNF daily rate and is the financial responsibility of the SNF. You may submit an invoice to the SNF and request payment directly from the facility in this situation. The HCPCS codes listed on the spreadsheet are excluded from the SNF payment. In this situation, you may provide the product, document the medical necessity, and submit a claim directly to the MAC for your region.
The DME MAC websites each provide a DMEPOS Consolidated Billing tool which allows you to determine if a particular HCPCS code is billable to Medicare separately.