Use of Healthcare Common Procedure Coding System (HCPCS)

HCPCS is required for reporting all SNF services paid under Part B, whether paid by Medicare fee schedules or by some other mechanism

The SNF should use the CPT-4 portion of HCPCS and/or Level II as directed by the manual sections applicable to the Part B service that is being billed. Currently, HCPCS codes are not applicable on SNF Part A inpatient claims.

For Part B claims, there are separate codes for the technical component, professional component, and/or complete procedure. Generally, SNFs bill for the technical component only, using the code that describes the procedure provided.

There may be specific rules for use of HCPCS codes for specific types of services (e.g., SNF's must bill global services for therapies). These will be described in the manual sections for the applicable service.

Revenue codes, HCPCS codes, line item dates of service, and units are required. Charges must be reported by HCPCS code. If the same revenue code applies to two or more HCPCS codes, the SNF should repeat the revenue code and show the line item date of service, units and charge for each HCPCS code on a separate line.

Billing Formats

The SNF must use the current ASC X12 837 institutional claim format or if permissible Form CMS-1450 to bill for covered Part B services

Frequency of Billing for Skilled Nursing Facilities (SNFs)

SNFs must bill repetitive Part B services on a single individual monthly bill (or at the conclusion of treatment). This avoids Medicare processing costs in holding such bills for monthly review and reduces bill processing costs for relatively small claims.

Other one-time Part B services must be billed upon completion of the services.

Guidelines for Submitting Corrected Bills 

When a SNF or intermediary discovers an error on an original bill, there are three methods for correcting the bill depending on the type of error. The SNF or intermediary may submit a late charge bill, an adjustment request, or maintain a log of charges.

 Billing Part B Rehabilitation Services 

Part B rehabilitation services other than audiology services must be billed by the SNF for Part A inpatients, for Part B residents (those not in a covered Part A stay) and for outpatients. Effective January 1, 1999, the MPFS is the payment basis for these services.