The skilled nursing facility (SNF) consolidated billing (CB) file reflects new codes for 2018, as well as codes that are excluded from SNF CB for Medicare Part A claims payment.
The SNF annual update file contains a comprehensive list of codes involved in editing institutional claims submitted to A/B Medicare administrative contractors (MAC) for services subject to SNF CB. The Centers for Medicare & Medicaid Services (CMS) divides these codes into five major categories:
- Major Category I – Exclusion of services beyond the scope of a SNF
- Major Category II – Additional services excluded with rendered to specific beneficiaries
- Major Category III – Additional excluded services rendered by certified providers
- Major Category IV – Additional excluded preventive and screening services
- Major Category V – Part B services included in SNF CB
Major Category I. B. – Cardiac Catheterization:
Add – C9741 Right heart catheterization with implantation of wireless pressure sensor in the pulmonary artery, including any type of measurement, angiography, imaging supervision, interpretation, and report (effective Jan. 1, 2016)
Major Category II. A. – (Dialysis) Coding Applicable To EPO And Aranesp Services:
- Add – J0604Cinacalcet, oral, 1 mg, (for ESRD on dialysis)
- Add – J0606Injection, etelcalcetide, 0.1 mg
Major Category III. A. – Chemotherapy:
- Add – J9022Injection, atezolizumab, 10 mg
- Add – J9023 Injection, avelumab, 10 mg
- Add – J9203Injection, gemtuzumab ozogamicin, 0.1 mg
- Add – J9285 Injection, olaratumab, 10 mg
- Remove – J9300
Major Category III. C. – Radioisotopes And Their Administration:
- Add – A9606 Radium ra-223 dichloride, therapeutic, per microcurie (effective Jan. 1, 2016)
- Add – 77770(effective Jan. 1, 2016)
- Add – 77771(effective Jan. 1, 2016)
- Add – 77772(effective Jan. 1, 2016)
- Remove – 77785, 77786, 77787 (effective Dec. 31, 2015)
For more information: SNF Consolidated Billing Code Updates for 2018