Effective Date: October 1, 2008

Implementation Date: October 6, 2008

In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare covered skilled nursing facility (SNF) stay be included in a bundled prospective payment made through the fiscal intermediary (FI) or A/B Medicare administrative contractor (MAC) to the SNF. These bundled services had to be billed by the SNF to the FI or A/B MAC in a consolidated bill.

The only change for October 1, 2008, is the addition of HCPCS code L5670 (Addition to lower extremity, below knee, molded supracondylar suspension [‘pts’ or similar]) to the File 1 coding list (Part A Stay – Physician Services). This code was inadvertently left off the SNF coding file as a separately payable code outside of consolidated billing.

Your Medicare contractor will reopen and reprocess affected claims brought to their attention, with dates of service on or after January 1, 2008.

Additional information is available on the CMS Web site at http://www.cms.hhs.gov/SNFConsolidatedBilling/01_Overview.asp#TopOfPage . Here is the link to the MLN Matters article MM6111 .