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CMS Updates Several SNF CPT Codes

The Centers for Medicare and Medicaid Services (CMS) has issued an update to several CPT codes for services that are outside of consolidated billing. These changes are code corrections only- that is, the new updates occur because of changes to the coding system, not because of redefined services subject to SNF Consolidated billing (CB). More information on the change, which is effective Oct. 1, 2109, is available here.

Change Request 11381 alerts providers of incorrectly categorized CPT codes 29580, 29581, and 29584 and provides instructions to categorize these codes correctly on the SNF CB files. CMS periodically updates the lists of HCPCS codes excluded from the CB provision of the SNF PPS. There are services excluded from SNF PPS and CB paid to providers, other than SNFs, for beneficiaries, even when in a SNF stay. To assure proper payment in all settings, Medicare systems must edit for services provided to SNF beneficiaries both included and excluded from SNF CB. Note that the Medicare Adminstrative Contractor (MAC) will not search their files for incorrectly paid claims. They will reopen and reprocess claims when such claims are brought to their attention.

The updated lists for institutional and professional billing are available at https://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/index.html.

Contact:  Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841