skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 5/28/2019 Location: FL, PR, USVI Business: Part A, Part B

Guidelines for billing acute inpatient noncovered days

Billing acute inpatient noncovered provider-liable days

If an acute care hospital determines the entire admission is noncovered and the provider is liable, bill as follows:
Type of bill (TOB) - 11x (Full provider-liable claim)
Admit date - Date the patient was actually admitted (not the deemed date) 
From and through dates - This span of dates should include all days
Noncovered days - The entire length of stay should be entered as noncovered
Occurrence span code M1 - The first provider-liable day through the last provider-liable day (do not include the discharge date)
Revenue code - Room & board revenue code line report as follows: 
Total units should equal the total number of days
Noncovered units should equal the total days
Total charge should equal the rate times the total number of units
Noncovered charge should equal the rate times the number of noncovered days
Remarks - Include remarks to indicate why the noncovered days are provider liable.

Billing acute partial inpatient noncovered provider-liable days

If an acute care hospital determines a portion of the admission is noncovered and the provider is liable, bill as follows:
Type of bill (TOB) - 11X
Admit date - Date the patient was actually admitted (not the deemed date) 
From and through dates - This span of dates should include all days, both covered and noncovered
Covered days - The portion of the stay in which the patient received medically necessary services
Noncovered days – The portion of the stay in which the provider is liable due to the services rendered were not medically necessary
Occurrence span code M1 - The first provider-liable day through the last provider-liable day (do not include the discharge date)
Revenue code - Room & board revenue code line report as follows: 
Total units should equal the total number of days
Covered units should equal the total days minus the noncovered days (Provider-liable days)
Total charge should equal the rate times the total number of units
Noncovered charge should equal the rate times the number of noncovered days
Remarks - Include remarks to indicate why the noncovered days are provider liable.

Billing acute inpatient noncovered beneficiary-liable days

If an acute care hospital determines that a portion of the admission, or the entire admission, is noncovered and the beneficiary is liable, bill as follows:
Type of bill (TOB) - 11X
Admit date - Date the patient was actually admitted (not the deemed date)
From and through dates - This span of dates should include all days, both covered and noncovered
Covered days - Report only days the patient was at a covered level of care. If the entire stay is noncovered, report zero covered days.
Noncovered days - Report all the days that are noncovered for the duration of the stay
Occurrence span code 76 - The first beneficiary liable day through the last beneficiary liable day
Occurrence code 31 - The date the facility provided notice to the beneficiary
Value code 31 - The amount charged to the beneficiary for noncovered services
Revenue code - Room & board revenue code line report as follows:
Total units should equal the total number of days
Covered units should equal the total days minus the noncovered days
Total charge should equal the rate times the total number of units
Noncovered charges should equal the rate times the number of noncovered days
Remarks - Include remarks to indicate why the noncovered level of care is beneficiary liable.
These instructions do not apply to benefits exhaust billing. Please refer to the Centers for Medicare & Medicaid Services (CMS) claims processing manual, publication 100-04, chapter 3 external pdf file, sections 20.7.4 (acute care hospital), 140 (IRF - inpatient rehabilitation facilities), 190 (LTCH - long term care hospitals).
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.