Inpatient Hospital or SNF Services Not Delivered Directly or

170 - Inpatient Hospital or SNF Services Not Delivered Directly or Under Arrangement by the Provider (Rev. 1, 10-01-03) A3-3164, HO-260.15, B3-2390, PM A 00-88 Nonphysician services provided to a Part A inpatient or Part B inpatient of a hospital or to a Part A inpatient of a SNF which are not provided directly by the hospital/SNF or under arrangement generally are excluded from coverage under Medicare. This coverage exclusion does not apply to the following types of services: • Physicians’ services for hospital inpatients or physician’s services other than therapy for SNF inpatients (i.e., therapy provided by physicians is not covered for any SNF Part A and Part B inpatient unless provided by the SNF, but other physician services may be covered. Any normally-covered service may be provided by a physician to a hospital inpatient); • Physician assistant services; • Nurse practitioners and clinical nurse specialists; • Certified nurse-midwife services; • Qualified clinical psychologist services; • Certified registered nurse anesthetist; and • Services of an anesthetist employed by a physician that were furnished during cost reporting periods beginning on or after October 1, 1984, through any part of a cost reporting period occurring before January 1, 1989. The A/B MAC (B) may make direct payment on Part B bills for these services, if they are medically necessary, even though they are not furnished directly or arranged for by the hospital/SNF. For SNF Part A inpatients, the following services are additional exceptions to this non coverage rule and may be covered if provided by another authorized provider or supplier: • Home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies, including any related necessary ambulance services; • EPO; • Hospice care related to a beneficiary’s terminal condition; • Radioisotope services; • Some customized prosthetic devices; • Some chemotherapy and chemotherapy administration services; • The following services which are considered beyond the scope of a SNF when furnished in a Medicare participating Hospital or Critical Access Hospital. Note that this exception does not apply if the service is furnished in an ASC. Specific coding is described in the Medicare Claims Processing Manual. º Cardiac catheterization; º CT scans; º MRIs; º Ambulatory surgery involving the use of an operating room; º Radiation therapy; º Emergency services; º Ambulance services related to the six services listed immediately above; and ambulance transportation related to dialysis services.