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MIR-2006-9AB, September 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Correction to Skilled Nursing Facility (SNF) Consolidated Billing (CB) Coding File (MM5103)
Provider Types Affected
Physicians and providers billing Medicare carriers for SNF services to Medicare beneficiaries
What You Need to Know
Because claims for the procedure codes in Table 1 below have been processing incorrectly, carriers will begin to reopen and reprocess affected claims, when brought to their attention.
Background
The Centers for Medicare & Medicaid Services (CMS) has become aware that claims for the procedure codes listed below have not been processing correctly. In order to ensure that you receive payment for these procedure codes, CR 5103, from which this article is taken, instructs Medicare carriers to reopen and reprocess these claims, when brought to the carrier’s attention.
Table 1, shown below, displays the procedure codes (and applicable claim dates of service) subject to the overriding of the SNF consolidated billing edit. When brought to their attention, carriers will use the SNF consolidated billing override code to bypass the edits and adjust claims (claims with the dates of service as shown, and processed prior to July 3, 2006) to pay appropriately for these procedure codes.
Table 1
Procedure Codes Subject Reopening and Reprocessing* |
| Code
|
Date of Service |
54150
90471
90472 |
92977
93790 |
On or after April 1, 2001 |
0019T |
|
On or after January 1, 2002 |
90871
90918
90919 |
90920
90921
92617 |
On or after January 1, 2003 |
G0345
J9395
L6697
L6698
L7181 |
36818
44137
90467
90468 |
On or after January 1, 2005 |
G0375
G0376 |
|
On or after March 22, 2005 |
G0372 |
|
On or after October 25, 2005 |
*All processed prior to July 3, 2006
Additional Information
You can find more information about the correction to the skilled nursing facility (SNF) consolidated billing (CB) coding file by going to CR5103, located at http://www.cms.hhs.gov/Transmittals/downloads/R1032CP.pdf  on the CMS Web site.
If you have any questions, please contact your carrier at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  .
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5103
Pub. 100-4, Transmittal# R1032CP, CR# 5103
Related CR Release Date: August 18, 2006
Effective Date: April 1, 2001
Implementation Date: September 18, 2006
Attention Skilled Nursing Facilities!
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