JAN 12, 2016
Medicare Coverages Rules for Patients in a Skilled Nursing Facility (SNF)
Question: We billed Medicare part B for HCPCS code J0178. Medicare paid and then later recouped their payment stating that the patient was in a skilled nursing facility (SNF) at the time of the injection.
Answer: There are different coverages rules for patients in a SNF. Injectable drugs, post-cataract glasses and the technical part of any test are not paid by Part B. And while you should bill the SNF, without prior knowledge or a contract with them, they may be very hesitant to pay. It is inappropriate to bill the patient directly.