Re: opinion-Delivering a Custom Prosthetic to SNF Patient

Re: opinion-Delivering a Custom Prosthetic to SNF Patient

Elizabeth Roof

4/21/2021

Thanks for all the responses to my original question about billing a prosthetic to a SNF patient. The answers were for all over the country and varied. We have certainly got to remain knowledgeable and seek out the correct information and double check our codes on the Medicare Portal. Attached below is the information to check the codes against to see just exactly where they fall on the chart. We have also learned to ask the right questions when talking with someone from SNF facility. This has sure opened our eyes and the eyes of others of how inconsistent the information can be for the O & P providers.

There’s going to be a FREE webinar tomorrow by O & P Insight Live covering this very topic. Please see the information on this webinar that Lesleigh Sisson had previously posted and join to learn more so that we all are well informed and getting our patients taken care of.

Thanks again and hope this also helps everyone else out!

Liz Roof

Sent from Mail< <URL Redacted> > for Windows 10
Billing for O&P devices while a Medicare beneficiary is in a covered Part A stay can be confusing. During a covered Part A acute care stay, the hospital is responsible for all DMEPOS items ordered.
That is not to be confused with a covered Part A SNF. During a covered Part A SNF stay, the SNF is responsible for the provision of MOST DMEPOS devices with one exception being that of some prosthetic HCPCs.
The list below contains the prosthetic HCPCs that are NOT billable to the DME MAC when the patient is inpatient in a SNF:

[cid: <Email Address Redacted> ]
Learn more about consolidated billing:

<URL Redacted> < <URL Redacted> >

Both CGS and Noridian have some great tools to determine who is responsible for reimbursement of any HCPC code during a Part A SNF stay. The links are below.

https://urldefense.proofpoint.com/v2/url?u=https-3A__www.cgsmedicare.com_medicare-5Fdynamic_jc_consbill_consbill_index.aspx&d=DwIF-g&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=U7A9YxJn1gbNIz6k4SqxtZIqEZ_djv1fD0FdnH2uQ9s&s=buaWkVdp7l2m1Atz-GHgyklHTILaAiNf5o-L1l2F4N8&e= < https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttps-253A-252F-252Fwww.cgsmedicare.com-252Fmedicare-5Fdynamic-252Fjc-252Fconsbill-252Fconsbill-252Findex.aspx-26data-3D04-257C01-257C-257Ced299fd1a77b44494f2e08d9010a3e52-257C84df9e7fe9f640afb435aaaaaaaaaaaa-257C1-257C0-257C637541965767210085-257CUnknown-257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0-253D-257C1000-26sdata-3DF3QdC-252Bx-252FV4fSMiqRvQireLAA6vNaHG9sh6TE-252BO-252BpXZQ-253D-26reserved-3D0&d=DwIF-g&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=U7A9YxJn1gbNIz6k4SqxtZIqEZ_djv1fD0FdnH2uQ9s&s=30_IP9fL7rYKZ68l7ZuEkECZH4gpNKGMQFz6gqcPJo0&e= >

https://urldefense.proofpoint.com/v2/url?u=https-3A__med.noridianmedicare.com_web_jddme_claims-2Dappeals_billing-2Dsituations_consolidated-2Dbilling_consolidated-2Dbilling-2Dlookup&d=DwIF-g&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=U7A9YxJn1gbNIz6k4SqxtZIqEZ_djv1fD0FdnH2uQ9s&s=IQ6gD7Nginj5QmU-AFvOBNUhKu0HXeH_1EotaAuZMoY&e= < https://urldefense.proofpoint.com/v2/url?u=https-3A__na01.safelinks.protection.outlook.com_-3Furl-3Dhttps-253A-252F-252Fmed.noridianmedicare.com-252Fweb-252Fjddme-252Fclaims-2Dappeals-252Fbilling-2Dsituations-252Fconsolidated-2Dbilling-252Fconsolidated-2Dbilling-2Dlookup-26data-3D04-257C01-257C-257Ced299fd1a77b44494f2e08d9010a3e52-257C84df9e7fe9f640afb435aaaaaaaaaaaa-257C1-257C0-257C637541965767220083-257CUnknown-257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0-253D-257C1000-26sdata-3Dww4mu6aGZcAoPahNQ5Adq5zsD0U1HRiwVFBqjfQo0-252F0-253D-26reserved-3D0&d=DwIF-g&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=U7A9YxJn1gbNIz6k4SqxtZIqEZ_djv1fD0FdnH2uQ9s&s=qpdlD88DymB8PqkzsaYD7Q9Zw2w1GCkmIUCJEIPIKlE&e= >