Billing

60.1 - Billing (Rev. 3053, Issued: 08-28-14, Effective: ICD-10: Upon Implementation of ICD-10 ASC-X12: 01-01-12, Implementation ICD-10: Upon Implementation of ICD-10; ASC X12: 09-30-14) The SNF must bill the A/B MAC (A) for prosthetic/orthotic devices, supplies and surgical dressings using the ASC X12 837 institutional claim format or if permissible Form CMS-1450. Requirements for billing can be found in the Medicare Claims Processing Manual, Chapter 25, "Completing and Processing the CMS 1450 Data Set." The SNF must bill prosthetic and orthotic devices under revenue code 274, along with the appropriate HCPCS code. When billing for maintenance and servicing of these items, revenue code 274 along with the appropriate HCPCS code must be used. The SNF should report "Units of Service" on Form CMS-1450 the number of items billed to the SNF's A/B MAC (A) for orthotics and prosthetics. Supplies may be billed for SNF outpatients under revenue code 270. Payment is made based on a fee schedule. The SNF should bill the A/B MAC (A) for surgical dressings under revenue code 623. HCPCS codes for reporting surgical dressing are normally found in the Level II HCPCS codes in the A6000 series. The A/B MAC (A) makes payment based on the surgical dressing fee schedule. SNFs use 22X type of bill for orthotic and prosthetic devices and surgical dressings when billing for its Part B inpatients. Orthotic and prosthetic devices, surgical dressings, and supplies for outpatients are billed with 23X type of bill. (See the Medicare Benefit Policy Manual, Chapter 15, "Covered Medical and Other Health Service," §100 for coverage data.)