Tuesday, September 12, 2017

CMS Updates SNF Consolidated Billing HCPCS Code List for CY 2018

Dan Ciolek

The Centers for Medicare and Medicaid Services (CMS) published a MLN Matters article titled 2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update. The article indicates that Change Request (CR) 10262 makes changes to Healthcare Common Procedure Coding System (HCPCS) codes and Medicare Physician Fee Schedule designations that will be used to revise Common Working File (CWF) edits to allow A/B MACs to make appropriate payments in accordance with policy for SNF CB in Chapter 6, Section 110.4.1 and Chapter 6, Section 20.6 in the “Medicare Claims Processing Manual.”

The Common Working File (CWF) currently has edits in place for claims received for beneficiaries in a Part A covered SNF stay as well as for beneficiaries in a non-covered stay. These edits allow only those services that are excluded from consolidated billing to be separately paid. Barring any delay in the Medicare Physician Fee Schedule, the new code files will be provided to CWF by November 1, 2017.

By the first week in December 2017, new code files will be posted at http://www.cms.gov/SNFConsolidatedBilling/. The files will be applicable to claims with dates of service on or after January 1, 2018, through December 31, 2018. It is important and necessary for the SNF billers to view the “General Explanation of the Major Categories” file located at the bottom of each year’s update in order to understand the Major Categories including additional exclusions not driven by HCPCS codes.

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