Skip to Main Content

Print | Bookmark | Email | Font Size: + |

Part A Consolidated Billing Tool

Overview: The consolidated billing requirement gives SNF's the billing responsibility for the care that residents receive during a covered Part A SNF stay. SNF's are also responsible for billing Medicare for physical, occupational, and speech therapy services received during a non-covered stay. There are a limited number of services specifically excluded from consolidated billing, and therefore, separately payable.

The CMS SNF Annual Update FileExternal Website lists all HCPCS codes excluded from SNF Consolidated Billing for claims submitted to Part A MAC's. Minor surgery and Part B therapy codes included in Consolidated Billing are also listed in this file.

In addition, CMS divides services affected by SNF Consolidated Billing into Major Categories. The General Explanation of the Major CategoriesExternal Website provides a summary of each category, and describes the items and services excluded from Consolidated Billing.

How to use the Consolidated Billing Tool: Enter a CPT/HCPCS code in the space below and click Submit. The tool will show the Major Category for each code entered. It will also show the following information:

Inclusion: Service is subject to Skilled Nursing Facility (SNF) Consolidated Billing. The service must be included on the SNF claim.

Exclusion: Service is not subject to SNF Consolidated Billing. The rendering provider may bill Medicare directly for payment.

The HCPCS is NOT included in the Consolidated Billing Tool: This message means the HCPCS code is not listed in the CMS SNF Annual Update File and therefore is NOT excluded from SNF Consolidated Billing.

HCPCS:

NOTE: This tool lists CPT/HCPCS codes for the current billing year. For billing prior to 2024, please visit the CMS SNF Consolidated BillingExternal Website Web page.

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved