CMS Updated SNF PPS Consolidated Billing Code Exclusions List to be Posted in November

Medicare; CMS
The Centers for Medicare and Medicaid Services (CMS) recently published MLN Matters article MM11968 and an associated Change Request (CR) transmittal 11968 on September 11. The CR makes changes to HCPCS codes and Medicare Physician Fee Schedule (MPFS) designations that Medicare uses to revise its Common Working File (CWF) edits to allow Medicare Administrative Contractors (MACs) to make appropriate payments in accordance with policy for SNF Consolidated Billing (CB) requirements as described in the Medicare Claims Processing Manual, in Chapter 6, Section 110.4.1 and Section 20.6. Provider billing staff should review these changes once published in early November prior to billing SNF PPS claims for dates of service starting January 1, 2021.

Background: The CWF currently has edits in place for claims received for Medicare beneficiaries in a Part A covered SNF stay, as well as for beneficiaries in a non-covered stay. These edits allow only those services excluded from CB to be separately paid. Barring delays in the MPFS, the Centers for Medicare & Medicaid Services (CMS) will give the new code files to CWF by November 1, 2020. As soon as possible after the MPFS is released, CMS will post the new code files here​. It is important and necessary for the providers to view the “General Explanation of the Major Categories” file located at the bottom of each year’s update in order to understand the Major Categories, including additional exclusions not driven by HCPCS codes.