Total and Noncovered Charges

40.6 - Total and Noncovered Charges (Rev. 10569, Issued: 01-14-21, Effective: 04-01-21, Implementation: 04-05-21) ASC X12 837 Institutional Claim See the related implementation guide on the official Washington Publishing Company website. Form CMS -1450 For each cost center for which a separate charge is billed (type of accommodation or ancillary), a revenue code is assigned and is entered on the claim with the related charges. On Form CMS-1450 the appropriate numeric revenue code is entered in FL 42 to explain each charge in FL 47. Additionally, there is no fixed “Total” line in the charge area. Instead, revenue code “0001” is always entered last in FL 42. Thus, the adjacent charge entry, in FL 47, is the sum of charges billed. This is also the same line on which noncovered charges, if any, in FL 48, are summed. The total charge for all services, covered and noncovered, will generally be shown. See §40.6.1 below, for certain exceptions. In the “noncovered charges” column (FL48) enter the amount of any noncovered charge except where: • The A/B MAC (A) has notified the SNF that payment can be made under the limitation of liability provisions; and • A payer primary to Medicare is involved. (See the Medicare Secondary Payer [MSP] Manual, Chapter 3, “MSP Provider Billing Requirements,” and Chapter 4, “Contractor Prepayment Processing Requirements.”) Where a bill is submitted for a period including both covered and noncovered days (e.g., days submitted for noncovered level of care), the SNF must list the charges for noncovered days under noncovered charges. Refer to the Medicare Claims Processing Manual, Chapter 25 for further information about completing the claim. For claims that contain both covered days and noncovered days, and those noncovered days are the responsibility of the beneficiary (e.g., days submitted for noncovered level of care), the provider should append span code 76 to indicate the days the beneficiary is liable.