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One-time Skilled Nurse

One-time Skilled Nurse visits , although not considered intermittent, can be billed if the answer is "yes" to either of the following:

Are there orders or intent to return?

Usually a one-time skilled nursing visit will not meet the intermittent criteria (when skilled nurse is the only qualifying skilled service). Occasionally a situation will occur when initially there appears to be a need for medically necessary, intermittent skilled nursing visits, but after the first visit the need for additional visits is not necessary (e.g., the beneficiary is institutionalized, dies, or requests no further services when the nurse attempts to return, etc.). In these situations, because the intent is to provide more than one visit, the one-time visit would be covered.

Was therapy involved or ordered at time of SN visit?

If the beneficiary requires skilled therapy services, and the therapy services qualify the beneficiary for the home health benefit, then a one-time skilled nursing visit would be payable under Medicare (when all other criteria are met).

Posted: 09.27.11

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