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Linda Collins Blogger

Billing HCPCS for Services Delivered in a SNF

Posted by Linda Collins | January 08, 2018

The Centers for Medicare & Medicaid Services, CMS, have released the list of HPCPCS codes exempt from Skilled Nursing Facility (SNF) billing. In other words, the codes on the list may be billed to the DME MACs when a patient is in a SNF.

As in the past, orthotic codes are considered included in the SNF payment. So, any orthotics provided to patients in the SNF are to be paid by the SNF to the supplier. In this case, do not submit claims to the MACs. The only exception to this rule is when a patient has been in a SNF for 100 or more days and the SNF is now considered to be home for the patient.

Most prosthetic codes are exempt from SNF payments. This means you may bill the DME MAC for these products when delivered to a patient in a SNF. As in the past, L5987 ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON, is not considered for coverage when a patient is in the SNF.

What does this mean for you?

If you deliver an orthotic brace to a patient in a skilled nursing facility, you should expect payment from the SNF. If you deliver a prosthetic device to a SNF patient, you may bill the DME MAC for the service.

More information about Skilled Nursing Facility Consolidated Billing may be found here.

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