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Corporate

Part B Consolidated Billing Tool

Instructions for use: Enter a valid CPT/HCPCS code in the space below and click on submit. The tool will provide the following information for each CPT/HCPCS entered:

  • Physician Service Separately Payable - During a Part A Stay
  • Professional Component - Payable if submitted with 26 Modifier - During a Part A Stay
  • Physical, Occupational, or Speech Therapy Service- Subject to SNF CB - Not Separately Payable

Reminder: The consolidated billing requirement confers on the SNF the billing responsibility for the entire package of care that residents receive during a covered Part A SNF stay and physical, occupational, and speech therapy services received during a non-covered stay.

Under the consolidated billing requirements, the SNF must submit claims to Part A for services not payable by Part B, that are received by their residents. Providers must look to the SNF, rather than the beneficiary or Medicare Part B, for payment. Additional guidance is available via the SNF Consolidated Billing Job AidPDF.

HCPCS:

 



NOTE: This tool lists CPT/HCPCS codes for the current billing year. This tool does not include HCPCS code for ambulance transports. For billing prior to 2020, and ambulance transports, please visit the CMS SNF Consolidated BillingExternal Website Web page.

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