evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Rev #  Issue Date  Subject  Impl Date  CR#  R2603CP  11/30/2012  Implementing the Claims -Based Data Collection Requirement for Outpatient Therapy Services --  Section 3005(g) of the Middle Clas s Tax Relief and Jobs Creation Act (MCTRJCA) of 2012  Rescinded and replaced by Transmittal 2622 01/07/2013 8005 R2537CP  08/31/2012  Expiration of 2012 Therapy Cap Revisions and User -Controlled Mechanism to Identify Legislative Effective Dates  01/07/2013 7881 R2532CP  08/24/2012  Implementing the Claims -Based Data Collection Requirement for Outpatient Therapy Services --  Section 3005(g) of the Middle Class Tax Relief and Jobs Creation Act (MCTRJCA) of 2012  Rescinded and replaced by Transmittal 2603 01/07/2013 8005 R2457CP  04/27/2012  Revisions of the Financial Limitation for Outpatient Therapy Services -Section 3005 of the Middle Class Tax Relief and Job Creation Act of 2012  Rescinded and replaced by Transmitta l 2615 10/01/2012 7785 R2328CP  10/27/2011  Claim Adjustment Reason Code (CARC) Used for Therapy Claims Subject to the Multiple Procedure Payment Reduction 04/02/2012 7564 R2160CP  02/18/2011  Correction to Manual References in Chapter 5, Section 20.2 05/19/2011 7315 R2121CP  12/17/2010  Reporting of Service Units With HCPCS  03/21/2011 7247 R2091CP  11/12/2010  Correct Reporting of Modifiers and Revenue Codes on Claims for Therapy Services  04/04/2011 7170 R2073CP  10/22/2010  Therapy Cap Values for Calendar Year (CY) 2011 01/03/2011 7107
(Medicare Claims Processing Manual)
Rev #  Issue Date  Subject  Impl Date  CR#  R2055CP  09/17/2010  Therapy Cap Values for Calendar Year (CY) 2011  Rescinded and replaced by Transmittal 2073 01/03/2011 7107 R2044CP  09/03/2010  Revisions and Re -issuance of Audiology Policies  09/30/2010 6447 R2007CP  07/23/2007  Revisions and Re -issuance of Audiology Policies  Rescinded and replaced by Transmittal 2044  08/11/2010 6447 R1985CP  06/11/2010  Clarifications and Updates of Therapy Services Policies  07/11/2010 6980 R1975CP  05/28/2010  Revisions and Re -issuance of Audiology Policies -  Rescinded and replaced by Transmittal 2007  07/28/2010 6447 R1951CP  04/27/2010  Removal of the Provider Reporting Requirement for Total Number of Therapy Visits U sing Value Codes 50- 53 10/04/2010 6899 R1921CP  02/19/2010  Billing for Services Related to Voluntary Uses of Advanced Beneficiary Notices of Noncoverage (ABNs)  04/05/2010 6563 R1894CP  01/15/2010  Billing for Services Related to Voluntary Uses of Advanced Beneficiary Notices of Noncoverage (ABNs)  Rescinded and replaced by Transmittal 1921 04/05/2010 6563 R1876CP  12/18/2009  Coverage of Kidney Disease Patient Education Services  04/05/2010 6557 R1860CP  11/20/2009  Therapy Cap Values for Calendar Year (CY) 2010 01/04/2010 6660 R1851CP  11/13/2009  Therapy Cap Values for Calendar Year (CY) 2010  Rescinded and replaced by Transmittal 1860 01/04/2010 6660
(Medicare Claims Processing Manual)
Rev #  Issue Date  Subject  Impl Date  CR#  R1850CP  11/13/2009  2010 Annual Update to the Therapy Code List  01/04/2010 6719 R1843CP  10/30/2009  Outpatient Mental Health Treatment Limitation  01/04/2010 6686 R1840CP  10/29/2009  Billing for Services Related to Voluntary Uses of Advanced Beneficiary Notices of Noncove rage (ABNs)  Rescinded and replaced by Transmittal 1894 04/05/2010 6563 R1733CP  05/08/2009  Manual Clarification for Skilled Nursing Facility (SNF) and Therapy Billing  04/27/2009 6407 R1717CP  04/24/2009  Speech -Language Pathology Practice Payment Policy  07/06/2009 6381 R1706CP  03/27/2009  Manual Clarification for Skilled Nursing Facility (SNF) and Therapy Billing  Rescinded and replaced by Transmittal 1733 04/27/2009 6407 R1678CP  02/13/2009  Outpatient Therapy Caps With Exceptions in CY 2009 04/06/2009 6321 R1631CP  11/07/2008  Extension of Therapy Cap Exception Process  12/08/2008 6222 R1593CP  09/12/2008  Smoking and Tobacco Use Cessation Counseling Billing Update for Comprehensive Outpatient Rehabilitation Facilities (CORFs) and Outpatient Physical Therapy Providers (OPTs) 12/12/2008 6163 R1472CP  03/06/2008  Update of Institutional Claims References  04/07/2008 5893 R1459CP  02/22/2008  Comprehensive Outpatient Rehabilitation Facility (CORF) Billing Requirement Updates for Fiscal Year (FY) 2008  07/07/2008 5898 R1421CP  01/25/2008  Update of Institutional Claims References -  Rescinded and Replaced by Transmittal 1472 04/07/2008 5893
(Medicare Claims Processing Manual)
Rev #  Issue Date  Subject  Impl Date  CR#  R1414CP  01/17/2008  Outpatient Therapy Caps Without KX Modifier Exceptions Start January 1, 2008  01/07/2008 5871 R1407CP  01/10/2008  Outpatient Therapy Caps Without KX Modifier Exceptions Start January 1, 2008  Replaced by Transmittal 1414  01/07/2008 5871 R1377CP  11/23/2007  2008 Annual Update to the Therapy Code List  01/07/2008 5810 R1183CP  02/09/2007  Infrared Th erapy Devices  01/16/2007 5421 R1145CP  12/29/2006  Outpatient Therapy Cap Exceptions Process for Calendar Year (CY) 2007  01/29/2007 5478 R1127CP  12/15/2006  Infrared Therapy Devices  Replaced by Transmittal 1183  01/16/2007 5421 R1106CP  11/09/2006  Outpatient Therapy Cap Clarifications  12/09/2006 5271 R1019CP  08/03/2006  Outpatient Therapy - Additional DRA Mandated Service Edits  01/02/2007 5253 R1016CP  07/28/2006  Outpatient Therapy - Additional DRA Mandated Service Edit  01/02/2007 5253 R1000CP  07/19/2006  Common Working File (CWF) to the Medicare Beneficiary Database (MBD) Data Exchange Changes  10/02/2006 4300 R980CP  06/14/2006  Changes Conforming to CR 3648 Instructions for Therapy Services -  Replaces Rev. 941  10/02/2006 4014 R941CP  05/05/2006  Changes Conforming to CR 3648 Instructions for Therapy Services  10/02/2006 4014 R908CP  04/21/2006  Common Working File (CWF) to the Medicare Beneficiary Database (MBD) Data Exchange Changes  10/02/2006 4300
(Medicare Claims Processing Manual)
Rev #  Issue Date  Subject  Impl Date  CR#  R855CP  02/15/2006  Therapy Caps Exception Process  3/13/2006 4364 R853CP  02/13/2006  Therapy Caps Exception Process  3/13/2006 4364 R805CP  01/06/2006  Annual Update to the Therapy Code List  02/06/2006 4226 R771CP  12/02/2005  Revisions to Pub.100- 04, Medicare Claims Processing Manual in Preparation for the National Provider Identifier  01/03/2006 4181 R759CP  11/18/2005  Therapy Caps to be Effective January 1, 2006  01/03/2006 4115 R515CP  04/01/2005  Update to 100- 04 and Therapy Code Lists  07/05/2005 3647 R463CP  02/04/2005  Update to 100- 04 and Therapy Code Lists  07/05/2005 3647 R319CP  10/22/2004  CORF/OPT Edit for Billing Inappropriate Supplies  04/04/2005 3468 R042CP  12/08/2003  The Financial Limitation on Therapy Services  12/08/2003 3005 R030CP  11/14/2003  The Financial Limitation on Therapy Services  01/05/2004 2973 R001CP  10/01/2003  Initial Publication of Manual  NA NA Back to top of Chapter
(Medicare Claims Processing Manual Crosswalk)
Medicare Claims Processing Manual Chapter 5 - Part B Outpatient Rehabilitation and CORF Services Crosswalk New Chap. New Sect. Int.  Pub 13-3 Carrier Pub 14-3 OPT/CORF Pub 09 Hospital Pub 10 SNF Pub 12 PMs                                                        Description5 10 A3-3653 B3-2200 OPT-270 HO-241.1 SNF-532.F AB-98-63 Part B Outpatient Rehabilitation and CORF Services - General 5 10 A3-3147 B3-2215 OPT-271 AB-02-38 Part B Outpatient Rehabilitation and CORF Services - General 5 10   OPT-272    Part B Outp atient Rehabilitation and CORF Services - General 5 10.1      A-03-011 New Pay ment Requirem ents for Interm ediaries 5 10.2 A3-3653AB-03-018,  AB-03-057,  AB-03-097 The Financial Lim itation 5 20 A3-3653 SNF-532 AB-00- 39 HCPCS Coding Requirem ent  5 20.1 A3-3653 SNF-532G AB-00-01 Disci pline Specific Outpatient Rehabilitation Modifiers - All Claim s 5 20.2 A3-3653 SNF-532C AB-00-39 Reporti ng of Service Units With HCPCS  CMS 1500 and CMS-1450 5 20.3 A3-3653 SNF-532C AB-00-39 Dete rmining What Tim e Counts Towards 15 Minute Tim ed Codes - All Claim s
(Medicare Claims Processing Manual Crosswalk)
New Chap. New Sect. Int.  Pub 13-3 Carrier Pub 14-3 OPT/CORF Pub 09 Hospital Pub 10 SNF Pub 12 PMs Description 5 20.4 A3-3653S     AB-00-39 Coding Guidance for Certain Phy sical Medicine CPT Codes - All Claim s 5 30       Special Claim s Processing Rules for Outpatient Rehabilitation Claim s - CMS-1500 5 30.1       Determ ining Pay ment Am ounts 5 30.2       Applicable Carrier CWF Ty pe of Service Codes 5 40       Special Claim s Processing Rules for Outpatient Rehabilitation Claim s-CMS-1450 5 40.1     SNF-532F AB-00-01 Determ ining Pay ment Am ounts - Interm ediaries 5 40.2 A3-3653B      Applicable Bill Ty pes - Interm ediaries 5                             40.3 A3-3653C SNF-532A A-98-63 Applicable Revenue Codes - Interm ediaries 5 40.4 A3-3653H SNF-532E Interm ediary Edit Requirem ents for Revenue Codes 5 40.5 A3-3653K SNF-532D Line Item Date of Service Reporting on CMS-1450 5 50 A3-3653P      CWF and PS&R Requirem ents - Interm ediaries 5 100       Special Rules for Com prehensive Outpatient Rehabilitation Facilities (CORFs)  5 100.1 A3-3370.1 B3-9300.1 General5 100.2     SNF-532F AB-00-01 Obtaining Fee Schedule Am ounts  New Chap. New Sect. Int.  Pub 13-3 Carrier Pub 14-3 OPT/CORF Pub 09 Hospital Pub 10 SNF Pub 12 PMs Description 5 100.3 A3-3653S      Proper Reporting of Code G0128 by  CORFs - Interm ediaries 5
(Medicare Claims Processing Manual Crosswalk)
100.4 A3-3653O Application of the Outpatient Mental Health Treatm ent Lim itation to CORF Claim s 5 100.5   OPT-403D    Off-Site CORF Services 5 100.6   OPT-410   A-01-77 Notify ing Patient of Service Denial  5 100.7 A3-3653N      Payment of Drugs, Biologicals, and Supplies in a CORF 5 100.8   OPT-412    Billing for DME,  Prosthetic and Orthotic Devices, and Surgical Dressings  5 100.9 OPT-412 Surgical Dressings5 100.10 A3-3653T B3-15302      Group Therapy  Services (Code 97150) 5 100.10.1 A3-3653U B3-15304 Therapy  Students
(Medicare Claims Processing Manual)
Medicare Claims Processing Manual  Chapter 6 - SNF Inpatient Part A Billing and SNF Consolidated Billing   Table of Contents  (Rev. 12283; Issued: 10-05-23)   Transmittals for Chapter 6
(Medicare Claims Processing Manual)
10 - Skilled Nursing Facility (SNF) Prospective Payment System (PPS) and Consolidated Billing Overview  10.1 - Consolidated Billing Requirement for SNFs 10.2 - Types of Facilities Subject to the Consolidated Billing Requirement for SNFs  10.3 - Types of Services Subject to the Consolidated Billing Requirement for SNFs  10.4 - Furnishing Services that are Subject to SNF Consolidated Billing Under an Arrangement with an Outside Entity  10.4.1 - Under Arrangements Relationships 10.4.2 - SNF and Supplier Responsibilities 20 - Services Included in Part A PPS Payment Not Billable Separately by the SNF  20.1 - Services Beyond the Scope of the Part A SNF Benefit 20.1.1 - Physicians Services and Other Professional Services Excluded From Part A PPS Payment and the Consolidated Billing Requirement 20.1.1.1 - Correct Place of Service (POS) Code for SNF Claims  20.1.1.2 - Hospitals Facility Charge in Connection with Clinic Services of a Physician  20.1.2 - Other Excluded Services Beyond the Scope of a SNF Part A Benefit  20.1.2.1 - Outpatient Surgery and Related Procedures- Inclusion 20.1.2.2 - Emergency Services  20.2 - Services Excluded from Part A PPS Payment and the Consolidated Billing Requirement on the Basis of Beneficiary Characteristics and Election  20.2.1 - Dialysis and Dialysis Related Services to a Beneficiary With ESRD  20.2.1.1 - ESRD Services  20.2.1.2 - Coding Applicable to Dialysis Services Provided in a Renal Dialysis Facility (RDF) or Home ) 20.2.2 - Hospice Care for a Beneficiarys Terminal Illness  20.3 -  Other Services Excluded from SNF PPS and Consolidated Billing  20.3.1 -  Ambulance Services  20.4 -  Screening and Preventive Services  20.5 -  Therapy Services  20.6 -  SNF CB Annual Update Proces for  A/B MACs (A)  30 - Billing SNF PPS Services  30.1 -  Health Insurance Prospective Payment System (HIPPS) Rate Code  30.2 -  Coding PPS Bills for Ancillary Services  30.3 -  Adjustment Request  30.4 -  SNF PPS Pricer Software  30.4.1 -  Input/Output Record Layout
(Medicare Claims Processing Manual)
Payment System (HIPPS) Rate Code  30.2 -  Coding PPS Bills for Ancillary Services  30.3 -  Adjustment Request  30.4 -  SNF PPS Pricer Software  30.4.1 -  Input/Output Record Layout  30.4.2 -  SNF PPS Rate Components  30.4.3 -  Decision Logic Used by the Pricer on Claims  30.5 -  Annual Updates to the SNF Pricer  40 - Special Inpatient Billing Instructions  40.1 -  Submit Bills in Sequence  40.2 -  Reprocessing Inpatient Bills in Sequence  40.3 -  Determining Part A Admission Date, Discharge Date, and Utilization Days  40.3.1 -  Date of Admission  40.3.2 -  Patient Readmitted Within 30 Days After Discharge  40.3.3 -  Same Day Transfer  40.3.4 -  Situations that Require a Discharge or Leave of Absence  40.3.5 -  Determine Utilization on Day of Discharge, Death, or Day Beginning a Leave of Absence  40.3.5.1 -  Day of Discharge or Death Is the Day Following the Close of the Accounting Year  40.3.5.2 -  Leave of Absence  40.4 -  Accommodation Charges Incurred in Different Accounting Years  40.5 -  Billing Procedures for Periodic Interim Payment (PIP) Method of Payment  40.6 -  Total and Noncovered Charges  40.6.1 -  Services in Excess of Covered Services  40.6.2 -  Showing Discounted Charges  40.6.3 -  Reporting Accommodations on the Claim  40.6.4 -  Bills with Covered and Noncovered Days  40.6.5 -  Notification of Limitation on Liability Decision  40.7 Ending a Benefit Period 40.8 -  Billing in Benefits Exhaust and No- Payment Situations  40.8.1 -  SNF Spell of Illness Quick Reference Chart  40.8.2 -  Billing When Qualifying Stay or Transfer Criteria are Not Met  40.9-  Other Billing Situations  50 - SNF Payment Bans, or Denial of Payment for New Admissions (DPNA)  50.1 -  Effect on Utilization Days and Benefit Period  50.2 -  Billing When Ban on Payment Is In Effect  50.2.1 -  Effect of an Appeal to a DPNA on Billing Requirements During the Period a SNF is Subject to a DPNA  50.2.2 -  Provider Liability Billing Instructions  50.2.3 -  Beneficiary Liability Billing Instructions  50.2.4 -  Part B
(Medicare Claims Processing Manual)
on Billing Requirements During the Period a SNF is Subject to a DPNA  50.2.2 -  Provider Liability Billing Instructions  50.2.3 -  Beneficiary Liability Billing Instructions  50.2.4 -  Part B Billing  50.3 -  Sanctions Lifted: Procedures for Beneficiaries Admitted During the Sanction Period 50.3.1 -  Tracking the Benefit Period 50.3.2 -  Determining Whether Transfer Requirements Have Been Met  50.4 -  Conducting Resident Assessments  50.5 -  Physician Certification  50.6 -  A/B MAC (A)  Responsibilities  50.7 -  Retroactive Removal of Sanctions  60 - Billing Procedures for a Composite SNF or a  Change in Provider Number  70 - Billing for Services After Termination of Provider Agreement, or After Payment is Denied for New Admissions  70.1 -  General Rules  70.2 -  Billing for Covered Services  70.3 -  Part B Billing  80 - Billing Related to Physicians Services  80.1 -  Reassignment Limitations  80.2 -  Payment to Employer of Physician  80.3 -  Information Necessary to Permit Payment to a Facility  80.4 -  Services Furnished Within the SNF  80.5 -  Billing Under Arrangements  80.6 -  Indirect Contractual Arrangement  80.7 -  Establishing That a SNF Qualifies to Receive Part B Payment on the Basis of Reassignment  90 - Medicare Advantage (MA) Beneficiaries  90.1 -  Beneficiary Disenrolled from MA Plans  90.2 -  Medicare Billing Requirements for Beneficiaries Enrolled in MA Plans  100 -  Part A SNF PPS for Hospital Swing Bed Facilities  100.1 -  Swing Bed Services Not Included in the Part A PPS Rate  110 -  A/B MAC (B)/DME MAC  Claims Processing for Consolidated Billing for Physician and Non- Physician Practitioner Services Rendered to Beneficiaries in a SNF Part A Stay  110.1 -  Correct Place of Service (POS) Code for SNF Claims  110.2 -  CWF Edits  110.2.1 -  Reject and Unsolicited Response Edits  110.2.2 -  A/B Crossover Edit s 110.2.3 -  Duplicate Edits  110.2.4 -  Edit for Ambulance Services  110.2.5 -  Edit for Clinical Social Workers ( CSWs ) 110.2.6 -  Edit for Therapy Services Separately Payable When Furnished by a Physician 110.2.7 -  Edit to Prevent Payment of Facility Fees for
(Medicare Claims Processing Manual)
for Ambulance Services  110.2.5 -  Edit for Clinical Social Workers ( CSWs ) 110.2.6 -  Edit for Therapy Services Separately Payable When Furnished by a Physician 110.2.7 -  Edit to Prevent Payment of Facility Fees for Services Billed by an Ambulatory Surgical Center (ASC) when Rendered to a Beneficiary in a Part A Stay  110.3 -  CWF Override Codes  110.4 -  Coding Files and Updates  110.4.1 -  Annual Update Process
(Medicare Claims Processing Manual)
120-  Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)   120.1 -  HIPPS Updates and Structure Changes   120.2 -  Interrupted Stay Policy   120.3 -  Variable Per Diem (VPD) Adjustment   120.4 -  AIDS Adjustments   120.5 -  Transition Claims   120.6 -  Default Billing   10 - Skilled Nursing Facility (SNF) Prospective Payment System (PPS) and Consolidated Billing Overview  (Rev.4163, Issued: 11- 02-18, Effective: 12-04-18, Implementation: 12-04-18)
(Medicare Claims Processing Manual)
All SNF Part A inpatient services are paid under a prospective payment system (PPS).  Under SNF PPS, beneficiaries must meet the regular eligibility requirements for a SNF stay.  That is, the beneficiary must have been an inpatient of a hospital for a medically necessary stay of at least three consecutive calendar days.  In addition, the be neficiary must have been transferred to a participating SNF within 30 days after discharge from the hospital, unless the patients condition makes it medically inappropriate to begin an active course of treatment in an SNF within 30 days after hospital discharge, and it is medically predictable at the time of the hospital discharge that the beneficiary will require covered care within a predetermined time period.  (See the Medicare Benefit Policy Manual, Chapter 8, Coverage of Extended Care Services Under Hospital Insurance, 20.2, for further information on the 30-day transfer requirement and exception.)  To be covered, the extended care services must be needed for a condition which was treated during the patients qualifying hospital stay, or for a condition which arose while in the SNF for treatment of a condition for which the beneficiary was previously treated in a hospital. Also under SNF PPS all Medicare covered Part A services that are considered within the scope or capability of SNFs are considered paid in the PPS rate.  In some cases this means that the SNF must obtain some services that it does not provide directly.  Nei ther the SNF nor another provider or practitioner may bill the program for the services under Part B, except for services specifically excluded from PPS payment and associated consolidated billing requirements. Any DME or oxygen furnished to inpatients in a covered Part A stay is included in the SNF PPS rate.  The definition of DME in 1861(n)
(Medicare Claims Processing Manual)
of the Social Security Act (the Act) provides that DME is covered by Part B only when intended for use in the home, which explicitly does not include a SNF.  This definition applies to oxygen also.  (See the Medicare Benefit Policy Manual, Chapter 15, Covered Medical and Other Health Service, 110.) Most prosthetics and all orthotic devices are included in the Part A PPS rate.  An exception involves certain designated customized prosthetic devices that are specifically identified as being outside the rate (see the regulations at 42 CFR 411.15(p)(2)(xvi) and Major Category III.D of the SNF consolidated billing editing).  Those customized prosthetic devices that are considered outside the PPS rate are billed by the qualified outside entity that furnished the service.  That entity bills its normal MAC.  Services that are not considered to be furnished within SNF PPS are identified in sections 20.1 - 20.4.  These may be billed separately under Part B.  Some services must be billed by the SNF.  (This is referred to as consolidated billing.)  Some services must be billed by the rendering provider (SNF or otherwise).  These are discussed further in 20.1 - 20.4.  10.1 - Consolidated Billing Requirement for SNFs  (Rev.4163, Issued: 11- 02-18, Effective: 12-04-18, Implementation: 12-04-18)
(Medicare Claims Processing Manual)
Section 4432 (b) of the Balanced Budget Act (BBA) requires consolidated billing (CB) for SNFs.  Under the CB requirement, the SNF must submit ALL Medicare claims for ALL the services that its residents receive under Part A, except  for certain excluded services described in 20.1 - 20.3, and  for all physical, occupational and speech-language pathology services received by residents under Part B (see 20.5).  A SNF resident is defined as a beneficiary who is admitted to a Medicare participating SNF or the participating, Medicare- certified, distinct part unit (DPU) of a larger institution.  Under the regulations at 42 CFR 411.15(p)(3)(i)- (iv), if  such a beneficiary leaves the facility (or the DPU), the beneficiarys status as a SNF resident for CB purposes (along with the SNFs responsibility  to furnish or make arrangements for needed services) ends when any one of the following events occurs:   The beneficiary is admitted as an inpatient to a Medicare-participating hospital or critical access hospital (CAH), or as a resident to another SNF;   The beneficiary receives services from a Medicare -participating home health agency under a plan of care;   The beneficiary receives one of the types of outpatient hospital services that CMS has designated as being exceptionally intensive (see 20.1.2); or   The beneficiary is formally discharged (or otherwise departs) from the SNF or DPU, unless the beneficiary is readmitted (or returns) to that or another SNF before the following midnight. This provision is sometimes referred to as the midnight rule (see Pub. 100-02, Medicare Benefit Policy Manual, chapter 3, 20.1, which specifies that an inpatient day . . . begins at midnight and ends 24 hours later).  A discharge from the Medicare- certified DPU includes situations in which the beneficiary is moved from the DPU to a Medicare non -certified area within the same institution.
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When a beneficiary is absent from the SNF overnight (i.e., the absence from the SNF spans midnight), the beneficiarys status as a SNF resident for CB purposes would end upon the point of departure from the SNF (per the above-described midnight rule), and would not resume until the actual point of arrival back at the SNF the next day. Accordingly, that beneficiary would not be considered a SNF resident for CB purposes between those two points, so that any offsite services furnished during the interim (such as an overnight sleep study) would not be subject to CB.  It should be noted that the scenarios described in the first three clauses above would become relevant only if a beneficiary leaves the SNF but then arrives back in that or another SNF before the following midnight.  This is because under the midnight rule discussed in the fourth clause, whenever a beneficiary leaves the SNF but does not arrive back in that or another SNF later on that same day, the beneficiarys resident  status for CB purposes would end immediately upon departure --before any of the other events described in the first three clauses could even occur.