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Last Modified: 7/1/2020 Location: FL, PR, USVI Business: Part A, Part B

MM10550 changes for skilled nursing facility (SNF) ambulance transport billing

Q. What changes have been made relating to consolidated billing for ambulance transportation for skilled nursing facility (SNF) residents according to transmittal MM10550?
A. Based on Medicare Learning Network (MLN®) Matters® (MM) 10550 external pdf file, CMS is revising the Medicare Benefit Policy Manual and Medicare Claims Processing Manual to clarify that a medically necessary ambulance transport from a SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a resident (including the return trip) may be covered under Part B. This applies to beneficiaries who are in a SNF stay not covered by Part A, but who have Part B benefits.
To address questions relating to this change, the points below have been highlighted:
If the beneficiary is a resident of a SNF and must be transported by ambulance to receive dialysis or certain high-end outpatient hospital services, the ambulance transport may be separately payable under Part B.
If the beneficiary is a SNF resident and not in a Part A covered stay and must be transported by ambulance to the nearest supplier of medically necessary services not available at the SNF, the ambulance transport, including the return trip, may be covered under Part B.
When billing for ambulance transports of SNF residents, suppliers should indicate whether the transport was part of a SNF Part A covered stay, using the appropriate origin/destination modifier.
The following may be billed as Part B services:
The ambulance trip is to or from a hospital based or non-hospital based ESRD facility (either one of any Healthcare Common Procedure Coding System-HCPCS code ambulance modifiers is G [Hospital based dialysis facility] or J [Non-hospital based dialysis facility] and the other modifier is N [SNF]).
An ambulance transport from a SNF to the nearest supplier of medically necessary services not available at the SNF where the beneficiary is a resident and not in a covered Part A stay, including the return trip, is covered under Part B provided that the ambulance transportation was medically reasonable and necessary and all other coverage requirements are met.
Other coverage guidelines and requirements relating to billing for ambulance transports of SNF residents remain unchanged and can be found in Chapter 15 of the Medicare Claims Processing Manual.
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