COVID-19 Benefit Period Waiver Coding Tip

The Centers for Medicare and Medicaid Services (CMS) last year provided updated clarifications to SNF Medicare Part A billing guidance when applying COVID-19 coverage waivers in MLN Matters Article SE20011. Since then, some providers have received denials that have been identified as provider data entry errors.   

Specifically, when a SNF is requesting a benefit period waiver for beneficiaries that qualify for the one-time additional benefit period without a 60-day break in spell of illness, CMS instructs providers to do the following: 

  • ​For ALL SNF benefit period waiver claims, include the following (within the same spell of illness): 
    • ​Condition code DR - Identifies the claims as related to the PHE. 
    • Condition code 57 (readmission) - This will bypass edits related to the 3-day stay being within 30 days. 
    • COVID100 in the remarks - This identifies the claim as a benefit period waiver request.     
CMS has identified that data entry errors in the remarks field not following the above guidance may create processing problems.  

AHCA Coding TIP: When entering “COVID100 in the remarks, provider billers must not insert any spaces between “COVID and “100” and must not add any additional information in the remarks field.   

Providers should forward this information to billing staff.