Medicare Claims Processing Manual 
Chapter 6 - SNF Inpatient Part A Billing 
Crosswalk 
New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  10      SNF-515  A-02-016  CR-1666  Skilled Nursing Facility (SNF) Prospective Payment 
System (PPS) and Consolidated Billing Overview 
6  10.1            Consolidated Billing Requirement for SNFs 
6  10.2            Types of Facilities Subject to the Consolidated 
Billing Requirement for SNFs 
6  10.3            Types of Services Subject to the Consolidated Billing 
Requirement for SNFs 
6  20      SNF-515      Services Included in Part A PPS Payment Not 
Billable Separately by the SNF 
6  20.1      SNF-516      Services Beyond the Scope of the Part A SNF Benefit 
6  20.1.1      SNF-516,      Physicians Services and Other Professional Services 
SNF-516.1  Excluded From Part A PPS Payment and the 
Consolidated Billing Requirement 
6  20.1.1.1            Correct Place of Service (POS) Code for SNF Claims 
6  20.1.2      SNF-516.3      Other Excluded Services Beyond the Scope of a SNF 
Part A Benefit  New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  20.1.2.1      SNF-516.3      Cardiac Catheterization 
6  20.1.2.2      SNF-516.3      Computerized Axial Tomography (CT) Scans 
6  20.1.2.3      SNF-516.3      Magnetic Resonance Imaging (MRIs) 
6  20.1.2.4      SNF-516.3      Outpatient Surgery and Related Procedures 
Inclusion 
6  20.1.2.5      SNF-516.3      Radiation Therapy 
6  20.1.2.6      SNF-516.3      Angiography, Lymphatic, Venous, and Related 
Procedures 
6  20.1.2.7      SNF-516.3      Emergency Services 
6  20.2      SNF-516      Services Excluded from Part A PPS Payment and the 
Consolidated Billing Requirement on the Basis of 
Beneficiary Characteristics and Election 
6  20.2.1            Dialysis and Dialysis Related Services to a 
Beneficiary With  ESRD 
6  20.2.1.1      SNF-516.6  A-02-118    ESRD Services 
6  20.2.1.2            Coding Applicable to Services Provided in a Renal 
Dialysis Facility (RDF) 
6  20.2.1.3            Coding Applicable to Services Provided in a RDF or 
SNF as Home  New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  20.2.1.4      SNF-543      Coding Applicable to EPO Services 
6  20.2.2      SNF-515.1      Hospice Care for a Beneficiarys Terminal Illness 
6  20.3      SNF-515.1      Other Services Excluded from SNF PPS and 
Consolidated Billing 
6  20.3.1      SNF-516.2      Ambulance Services 
6  20.3.2      SNF-516.4      Chemotherapy, Chemotherapy Administration, and 
Radioisotope Services 
6  20.3.3      SNF-516.5      Certain Customized Prosthetic Devices 
6  20.4      SNF-515.7      Screening and Preventive Services 
6  30      SNF-515.3  A-01-056,    Billing SNF PPS Services 
A-02-016  CR-1666 
6  30.1            Health Insurance Prospective Payment System 
(HIPPS) Rate Code 
6  30.2        A-01-56,    Special Billing Requirements Where a Single 
A-01-124  CR-1655  OMRA, SCSA, or SCPA ARD is Set Within the 
Window of a Medicare-Required Assessment 
6  30.3            Special Billing Requirements Where There are 
Multiple Assessments (i.e., OMRA, SCSA, or SCPA) 
Within the Window of a Medicare-Required 
Assessment  New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  30.4            Coding PPS Bills for Ancillary Services 
6  30.5      SNF-515.5  A-00-46,  CR-1224  Adjustment to Health Insurance Prospective Payment 
A-01-121  System (HIPPS) Codes Resulting From Long Term 
Care Resident Assessment Instrument (RAI) 
Corrections 
6  30.5.1            Adjustment Requests 
6  40      SNF-517,      Special Inpatient Billing Instructions 
SNF-561 
6  40.1  A3-3603.2    SNF-517.13      Submit Bills in Sequence 
6  40.2  A3-3603.2    SNF-517.14      Reprocessing Inpatient Bills in Sequence 
6  40.3      SNF-515.4,      Determining Part A Admission Date, Discharge Date, 
SNF-515.4  and Utilization Days 
6  40.3.1            Date of Admission 
6  40.3.2  A3-3630    SNF-517.5      Patient Readmitted Within 30 Days After Discharge 
6  40.3.3  A3-3610.5,    SNF-517.6      Same Day Transfer 
A3-3620 
6  40.3.4      SNF-517.6,      Day of Discharge, Death, or Leave of Absence 
SNF-515.4  
(transmittal 368)  New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  40.3.5  A3-3103.4    SNF-517.6.B      Determine Utilization on Day of Discharge, Death, or 
Day Beginning a Leave of Absence 
6  40.3.5.1      SNF-517.2      Day of Discharge or Death Is the Day Following the 
Close of the Accounting Year 
6  40.3.5.2  SNF-517.4          Leave of Absence 
6  40.4      SNF-517.1      Accommodation Charges Incurred in Different 
Accounting Years 
6  40.5      SNF-5l7.7      Billing Procedures for Periodic Interim Payment  
(PIP) Method of Payment 
6  40.6      SNF-517.9      Total and Noncovered Charges 
6  40.6.1      SNF-517.10      Services in Excess of Covered Services 
6  40.6.2      SNF-517.11      Showing Discounted Charges 
6  40.6.3      SNF-517.12      Reporting Accommodations on the Claim 
6  40.6.4  A3-3620    SNF-525      Bills with Covered and Noncovered Days 
6  40.6.5      SNF-517.8      Notification of Limitation on Liability Decision  New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  40.7  A3-3624,    SNF-517.3,    HO-411  Other Billing Situations 
A3-3630  SNF-526, 
A3-3630.1,  SNF-527, 
A3-3630.4,  SNF-527.1 
A3-3620,  
A3-3624.B 
6  50        AB-01-131    SNF Payment Bans, or Denial of Payment for New 
Admissions (DPNA) 
6  50.1        AB-01-131    Effect on Utilization Days and Benefit Period 
6  50.2        AB-01-131    Billing When Ban on Payment Is In Effect 
6  50.2.1        AB-01-131    Tracking Days to Calculate the Part A Benefit Period 
6  50.2.2        AB-01-131    Provider Liability Billing Instructions 
6  50.2.3        AB-01-131    Beneficiary Liability Billing Instructions 
6  50.2.4        AB-01-131    Part B Billing 
6  50.3        AB-01-131    Sanctions Lifted: Procedures for Beneficiaries 
Admitted During the Sanction Period 
6  50.3.1        AB-01-131    Tracking the Benefit Period 
6  50.3.2        AB-01-131    Determining Whether Transfer Requirements Have 
Been Met  New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  50.4        AB-01-131    Conducting Resident Assessments 
6  50.5        AB-01-131    Physician Certification 
6  50.6        AB-01-131    Intermediary Responsibilities 
6  50.7        AB-01-131    Retroactive Removal of Sanctions 
6  60  A3-3600.5    SNF-520      Billing Procedures for a Provider With Multiple 
Provider Numbers or a Change in Provider Number 
6  70      SNF-518      Billing for Services After Termination, Expiration, or 
Cancellation of Provider Agreement, or After 
Payment is Denied for New Admissions 
6  70.1      SNF-518.1      General Rules 
6  70.2      SNF-518.2      Billing for Covered Services 
6  70.3      SNF-518.3      Part B Billing 
6  80      SNF-502      Billing Related to Physicians Services 
updated with 
transmittal 368,
SNF-275 
6  80.1      SNF-507      Reassignment Limitations 
6  80.2      SNF-508,      Payment to Employer of Physician 
SNF-510  New  New  Int.  Carrier  SNF  PM  Other  Description 
Chap.  Sect.  Pub. 13  Pub. 14  Pub. 12 
6  80.3      SNF-510.1      Information Necessary to Permit Payment to a 
Facility 
6  80.4      SNF-510.2      Services Furnished Within the SNF 
6  80.5      SNF-510.2      Billing Under Arrangements 
6  80.6      SNF-510.3      Indirect Contractual Arrangement 
6  80.7      SNF-512      Establishing That a SNF Qualifies to Receive Part B 
Payment on the Basis of Reassignment 
6  90      SNF-500  AB-01-132    SNF Billing to HMO 
6  90.1        A-01-122,     Beneficiary Involuntarily Disenrolled from 
A-02-009  Terminated Medicare+Choice (M+C) Plans 
6  100        A-02-016    Part A SNF PPS for Hospital Swing Bed Facilities 
6  100.1        A-02-016    Swing Bed Services Not Included in the Part A PPS 
Rate