Consolidated Billing (CB) for SNF (Skilled Nursing Facilities) - Exceptions

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Aug 13th, 2014 - Reviewed/Updated May 6th

SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services listed below). CB for SNF resembles the bundling requirement for Inpatient Hospital Services, assigning the facility responsible for the entire package except for certain services that are specifically excluded. 

• Physicians' services furnished to SNF residents. These services are not subject to CB, and thus are still billed separately to the Part B carrier.
• Many physician services include both a professional and a technical component, and the technical component is subject to CB. The technical component of physician services must be billed to and reimbursed by the SNF.
• Section 1888(e)(2)(A)(ii) of the Social Security Act specifies that physical, occupational, and speech‑language therapy services are subject to CB, regardless of whether they are furnished by (or under the supervision of) a physician or other health care professional.
• Physician assistants working under a physician's supervision;
• Nurse practitioners and clinical nurse specialists working in collaboration with a physician;
• Certified nurse-midwives;
• Qualified psychologists;
• Certified registered nurse anesthetists;
• Services described in Section 1861(s)(2)(F) of the Social Security Act (i.e., Part B coverage of home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies);
• Services described in Section 1861(s)(2)(O) of the Social Security Act, i.e., Part B coverage of Epoetin Alfa (EPO, trade name Epogen) for certain dialysis patients. Note: Darbepoetin Alfa (DPA, trade name Aranesp) is now excluded on the same basis as EPO;
• Hospice care related to a resident's terminal condition;
• An ambulance trip that conveys a beneficiary to the SNF for the initial admission, or from the SNF following a final discharge