Services in Excess of Covered Services

40.6.1 - Services in Excess of Covered Services (Rev. 3220, Issued: 03-16-15, Effective: ICD-10: Upon Implementation of ICD-10, ASC-X12: 01-01-12, Implementation: 10-01-14, ICD-10: Upon Implementation of ICD-10 ASC X12: 09-16-14) Where items and services are furnished which are more expensive or in excess of the services covered by the program, the SNF will make the following entries in the Total Charges and Noncovered fields on the bill: • If the patient did not request such excess or more expensive services, the patient may not be charged for them, and only the services covered by the program are shown in total charges. No entry is made in noncovered charges in this situation. (However, where all patients are routinely billed for such excess or more expensive items, total charges may reflect the excess items or services as discussed in total and noncovered charges, above.); • If the patient did request such excess or more expensive services, the SNF may charge the patient for them. In this case, the SNF show the line item total charge (any customary charges covered by the program plus the excess charges). The excess charges that will be billed to the patient are shown in noncovered charges. • In the same situation as above, except that the SNF will not bill the patient for the excess services. Instead the SNF will show only the customary charges for covered services in total charges and make no entry in noncovered charges.