billing thru the clinic to snf


Silt, CO
Best answers
Good Afternoon,
I was hoping I could get assistance on clarification. Our orthopedic office billed x-rays as global as they own the x-ray machine and do both the technical and professional component. I was advised a while back that when a patient is with a skilled nursing facility, that for medicare (no matter what) we would always bill the TC to the SNF and the 26 through the clinic; however, I am unable to locate documentation stating this and as stated above our office does global since they own the machine. Thank you for any clarification you may be able to provide


True Blue
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The Medicare SNF consolidated billing would require you to bill the technical component of most services to the SNF only if the patient is in a covered Part A stay in that facility (which is usually during the recovery period immediately following an inpatient hospital discharge). It would not apply to patients who are in a long-term stay in a nursing home for personal care needs beyond recovery from an illness or injury.

Here is the Medicare site's page about consolidated billing which will give you more information and also the listing of specific codes which would be covered by Medicare or which would have to be included in the SNF bill:

See the note under 'excluded services' at this link, which states that "Many physician services include both a professional and a technical component, and the technical component is subject to CB. The technical component of physician services must be billed to and reimbursed by the SNF."