Medical and Other Health Services Furnished to SNF Patients

70 - Medical and Other Health Services Furnished to SNF Patients (Rev. 228, Issued: 10-13-16, Effective: 10-18-16, Implementation: 10-18-16) The medical and other health services listed below are covered under Part B when furnished by a participating SNF either directly or under arrangements to inpatients who are not entitled to have payment made under Part A (e.g., benefits exhausted or 3-day prior-stay requirement not met). Services payable under Part B are: • Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests; • X-ray, radium, and radioactive isotope therapy, including materials and services of technicians; • Surgical dressings, and splints, casts, and other devices used for reduction of fractures and dislocations; • Prosthetic devices (other than dental) which replace all or part of an internal body organ (including contiguous tissue), or all or part of the function of a permanently inoperative or malfunctioning internal body organ, including replacement or repairs of such devices; • Leg, arm, back, and neck braces, trusses, and artificial legs, arms, and eyes including adjustments, repairs, and replacements required because of breakage, wear, loss, or a change in the patient’s physical condition; • Outpatient physical therapy, outpatient speech language pathology services, and outpatient occupational therapy (see Pub. 100-02, Medicare Benefit Policy Manual, Chapter 10, “Covered Medical and Other Health Services,” §220.1.4); • Screening mammography services; • Screening pap smears and pelvic exams; • Influenza, pneumococcal pneumonia, and hepatitis B vaccines; • Some colorectal screening; • Prostate screening; • Ambulance services; • Hemophilia clotting factors. • Epoetin Alfa (EPO) for ESRD beneficiaries when given in conjunction with dialysis. See Pub. 100-04, Medicare Claims Processing Manual chapter 6, for information on billing for these services. See §70.1 of this chapter for the conditions under which diagnostic services and radiological therapy furnished by SNFs are covered. For coverage of total parenteral nutrition (TPN) and enteral nutrition (EN) as a prosthetic device, see Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, “Hospital Services Covered Under Part B,” and the Medicare National Coverage Determinations Manual, chapter 1, Part 3, §180.2. Rental or purchase of durable medical equipment from SNFs for use in the patient’s home (other than a hospital or SNF, as discussed in Pub. 100-02, Medicare Benefit Policy Manual, chapter 15, §110.1.D) is covered under Part B in accordance with the provisions of Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, “Hospital Services Covered Under Part B,” §80 (also see Pub. 100-04, Medicare Claims Processing Manual, chapter 7, §60, for the related SNF billing instructions). DME rendered to Part A inpatients of a SNF is covered as part of the prospective payment system and is not separately payable. For coverage of provider ambulance services, see Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, “Hospital Services Covered Under Part B". Drugs, biologicals, and blood are not covered under Part B when furnished by a SNF.