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Consolidated Billing: New HCPCS Codes for SNFs

New HCPCS codes related to consolidated billing for Skilled Nursing Facilities goes into effect, Oct. 1, 2021.

CMS states that this will impact any SNF that “bill Medicare Administrative Contractors (MACs) for services provided to Medicare patients in a covered Part A stay in a SNF.” The full list of code changes are included below to assist your organization when reviewing referrals and completing month-end billing.

Overview of Consolidated Billing for Skilled Nursing Facilities 

In 1997, Congress passed the Balanced Budget Act of 1997, which created the consolidated billing requirements for Skilled Nursing Facilities. This means that for the services their residents receive during a Part A Medicare Stay, SNF have to submit all Medicare claims.

The goal was to help reduce billing the same service more than once per resident. Very few services are excluded from this consolidated billing requirement due to the specialization or cost.

For more information on consolidated billing visit CMS’s webpage.

HCPCS Code Changes

On June 29, 2021, CMS released the October Quarterly Update to 2021 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility Consolidated Billing Enforcement.

The following HCPCS codes were added to the exclusion list effective October 1, 2021. These are certain blood clotting factors and treatments for hemophilia/bleeding disorders put in place by Section 134 of the Consolidated Appropriations Act, 2021.

J7170 INJ., EMICIZUMAB-KXWH 0.5 MG
J7175 INJ, FACTOR X, (HUMAN), 1IU
J7179 VONVENDI INJ 1 IU VWF:RCO
J7180 FACTOR XIII ANTI-HEM FACTOR
J7181 FACTOR XIII RECOMB A-SUBUNIT
J7182 FACTOR VIII RECOMB NOVOEIGHT
J7183 WILATE INJECTION
J7185 XYNTHA INJ
J7186 ANTIHEMOPHILIC VIII/VWF COMP
J7187 HUMATE-P, INJ
J7188 FACTOR VIII RECOMB OBIZUR
J7189 FACTOR VIIA RECOMB NOVOSEVEN
J7190 FACTOR VIII
J7191 FACTOR VIII (PORCINE)
J7192 FACTOR VIII RECOMBINANT NOS
J7193 FACTOR IX NON-RECOMBINANT
J7194 FACTOR IX COMPLEX
J7195 FACTOR IX RECOMBINANT NOS
J7196 ANTITHROMBIN RECOMBINANT
J7197 ANTITHROMBIN III INJECTION
J7198 ANTI-INHIBITOR
J7199 HEMOPHILIA CLOT FACTOR NOC
J7200 FACTOR IX RECOMBINAN RIXUBIS
J7201 FACTOR IX ALPROLIX RECOMB
J7202 FACTOR IX IDELVION INJ
J7203 FACTOR IX RECOMB GLY REBINYN
J7204 INJ.,FACTOR VIII, ANTIHEMOPHILIC FACTOR (RECOMBINANT), (ESPEROCT), GLYCOPEGYLATED-EXEI
J7205 FACTOR VIII FC FUSION RECOMB
J7207 FACTOR VIII PEGYLATED RECOMB
J7209 FACTOR VIII NUWIQ RECOMB 1IU
J7210 INJ, AFSTYLA, 1 I.U.
J7211 INJ, KOVALTRY, 1 I.U.
J7212 FACTOR VIIA RECOMB SEVENFACT

CMS also added the following HCPCS chemotherapy code to the appropriate edits to exclude it from SNF Consolidated billing effective for claims with dates of service on or after July 1, 2021.

Q5123 INJECTION, RITUXIMAB-ARRX, BIOSIMILAR, (RIABNI), 10 MG

Contact Us

At Blue & Co., we understand the the new exclusions to consolidated billing for Skilled Nursing Facilities can be a lot of information to understand. Reach out to a member of our Post Acute Care team or contact your local advisor to learn how we can help.

Landon Hackett, Director
317.713.7929

Stephanie Fey, Manager
502.992.2582

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