Description
The Nursing Facility Services codes represent a “per day” service. As such, these codes may only be reported once per day, per Beneficiary, Provider and date of service.
Affected Code(s)
99304, 99305, 99306, 99307, 99308, 99309, 99310
Applicable Policy References
1. Social Security Act, Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
2. Social Security Act, Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A) - Exclusions from Coverage and Medicare as a Secondary Payer
3. 42 Code of Federal Regulations §405.929- Post-Payment Review
4. 42 Code of Federal Regulations §405.930- Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party.
6. 42 Code of Federal Regulations §405.986- Good Cause for Reopening
7. Medicare Claims Processing Manual, Chapter 12 Physicians/Nonphysician Practitioners, § 30.6.13 Nursing Facility Services, (B) Visits to Comply with Federal Regulations (42 CFR 483.40 (c) (1)) in the SNF and NF).
8. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
9. Novitas Local Coverage Determination: Evaluation and Management Services Provided in a Nursing Facility (L35068), Effective for services performed on or after 10/01/15, Retired 01/01/2023
10. Novitas Local Coverage Article: Billing and Coding: Evaluation and Management Services Provided in a Nursing Facility (A56712), Effective 07/25/19, Retired 01/01/2023
11. First Coast Local Coverage Determination: Evaluation and Management Services in a Nursing Facility (L36230), Effective for services performed on or after 11/15/15, Retired 01/01/2023
12. First Coast Local Coverage Article: Billing and Coding: Evaluation and Management Services in a Nursing Facility (A57724), Effective 10/03/2018, Retired 01/01/2023
13. AMA CPT Manual