SNF excluded from CB provision HCPCS Code list

Change Request (CR) 9561 provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the consolidated billing (CB) provision of the SNF Prospective Payment System (PPS), effective January 1, 2016. Make sure your billing staffs are aware of these HCPCS code updates.


The Centers for Medicare & Medicaid Services (CMS) periodically updates the lists of HCPCS codes that are excluded from the CB provision of the SNF PPS.

You should be aware that providers other than SNFs may be paid for services that are excluded from SNF PPS and CB, even for those provided to beneficiaries in a SNF stay.

However, Medicare will only pay SNFs for claims for services that do not Additionally, SNF CB applies to non-therapy services only when furnished to a SNF resident during a covered Part A stay; however, it applies to physical and occupational therapies, and speech-language pathology services whenever they are furnished to a SNF  resident, regardless of whether Part A covers the stay. In order to assure proper payment in all settings, Medicare systems edit for services provided to SNF beneficiaries, both those that are included and those excluded from SNF CB


CR 9561 adds HCPCS Codes 93600, 93602, 93603, 93609, 93610, 93612, 93613, 93615, 93616, 93618-93624, 93631, 93640 - 93642, 93644, 93650, 93653, 93654, 93655, 93656,
93657, 93660, and 93662 to the Major Category 1.B Coding List for SNF Consolidated Billing, effective for dates of service on or after January 1, 2016.


Note: If you have claims with dates of service on or after January 1, 2016, that are impacted by these changes and that were denied/rejected prior to the implementation of CR9561, your MAC will re-open and re-process those claims that you bring to your MAC's attention.