Skilled Nursing Facility Consolidated Billing
During a covered Part A SNF stay, consolidated billing makes the SNF responsible for most services and supplies the resident receives, including wound care supplies. Physician and other practitioner professional services are excluded from consolidated billing and are billed by the provider to Part B.
Use place of service 31 for a resident in a Part A skilled stay and 32 for a nursing facility resident not in a Part A stay. Nursing facility E/M visits use the 99304 to 99310 code range.
What The Provider Can And Cannot Bill
- Billable by the provider: the professional service for debridement, E/M visits and the professional component of procedures
- Generally the facility's responsibility during a Part A stay: dressings, wound supplies and other items covered by consolidated billing
- Skin substitute products during a Part A stay should be coordinated with the facility before application
Home Health Periods Of Care
During a home health period of care, the home health agency is responsible for nursing, therapy and non-routine medical supplies. The physician's own visits and procedures remain billable under Part B, using place of service 12 and the home or residence E/M codes when the visit is in the home.
Coordination Prevents Denials
Most denials in these settings come from not knowing the patient's status. Before each visit, confirm whether the patient is in a Part A stay or an open home health period, and agree with the facility or agency on who supplies what.
Frequently Asked Questions
- Can a podiatrist bill routine foot care for a SNF resident?
- Yes, under the same Part B coverage rules that apply in the office, including the class findings needed for routine foot care, with the correct place of service.
- How do I find out if a patient is in a Part A stay?
- Ask the facility at each visit and verify through the MAC's eligibility tools, which show current inpatient, SNF and home health episodes.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.