Determining Payment and Patient Liability

60.2 - Determining Payment and Patient Liability (Rev. 1, 10-01-03) SNF-534.D, SNF-534.E There may be prosthetic and orthotic devices, for which the SNF would bill that are not included in the fee schedule. When fee schedule amounts are not available for a particular item, the intermediary will pay based on cost. To determine the SNF's Part B payment, the SNF subtracts any unmet Part B deductible from the lower of the actual charge or the fee schedule amount for the item or service and multiply the remainder by 80 percent. This is the final payment. The patient's liability is the remaining 20 percent plus any deductible remaining to be met.