Description
Physical therapy, Occupational therapy, and/or Speech-Language pathology services, regardless of whether they are furnished by (or under the supervision of) a physician or other health care professional, are bundled into the SNF’s global per diem payment for a resident’s covered Part A stay. They are also subject to the SNF “Part B” consolidated billing requirement (for services furnished to SNF residents during noncovered stays) and must be billed by the SNF alone for its Part B residents on a 22x type of bill.
Affected Codes
Therapy CPT/HCPCS codes Included in File 4. SNF Part B Consolidated Billing files
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
2. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
3. Social Security Act (SSA) 1888(e)(2)(A)(ii)- Services excluded
4. 42 CFR §405.929- Post-Payment Review
5. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
6. 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
7. 42 CFR §405.986- Good Cause for Reopening
8. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
9. Medicare Claims Processing Manual, Chapter 6- SNF Inpatient Part A Billing, §10.3- Types of Services Subject to the Consolidated Billing Requirement for SNFs, §20.5- Therapy Services
10. Medicare Claims Processing Manual, Chapter 6-SNF Inpatient Part A Billing, §20.1.1-Physician’s Services and Other Professional Services Excluded From Part A PPS Payment and the Consolidated Billing Requirement
11. Medicare Claims Processing Manual, Chapter 7- SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule), §110- Carrier Claims Processing for Consolidated Billing for Physician and Non-Physician Practitioner Services Rendered to Beneficiaries in a Non-Covered SNF Stay
12. Medicare SNF Consolidated Billing- https://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling
13. AMA CPT Codebook
14. HCPCS Level II Codebook