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Skilled Nursing Facility (SNF) Billing Services
A Medicare Part A SNF stay is paid per day under the Patient Driven Payment Model (PDPM), but only when the claim carries the HIPPS code from an accepted MDS assessment, the dates of a 3-day qualifying inpatient stay, and every service the facility owes under consolidated billing. FY 2027 rates took effect on October 1, 2026, with a 2.4% update, and a stay that crosses that date is billed on separate claims for each fiscal year.
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Part A and Part B
What SNF billing includes
Facility claims under Part A and Part B, and the professional claims of the clinicians who round.
A covered Part A stay is billed on the institutional claim (UB-04 or 837I) as bill type 21X, or 18X for a hospital swing bed, with revenue code 0022 and one HIPPS code for each assessment period. Under PDPM the five characters of that code are the PT and OT group, the SLP group, the nursing group, the non-therapy ancillary (NTA) group, and the assessment indicator. Claims go out monthly and in order; a continuing-stay bill is returned until the previous one has processed.
When a resident is not in a covered Part A stay, the facility bills Part B services on bill type 22X, and after a discharge to a bed outside the Medicare-certified area, on 23X. Therapy stays with the facility under consolidated billing even then. Physicians, nurse practitioners, and physician assistants who see residents bill their own visits on the CMS-1500, with place of service 31 during a Part A stay and 32 otherwise.
What the SNF fee covers
- HIPPS codes checked against the MDS accepted in iQIES
- Occurrence span code 70 with the qualifying stay, or the condition code that replaces it
- Outside vendor invoices reconciled under consolidated billing
- Medicare Advantage authorizations and information-only claims tracked
What a Part A SNF claim must carry
From the Medicare SNF billing reference. A missing field returns or denies the claim.
| Field | What goes in it | When it is wrong |
|---|---|---|
| Type of bill (FL 04) | 21X for a SNF, 18X for a hospital swing bed | Rejected or processed under the wrong benefit |
| Revenue code 0022 (FL 42) | One line per HIPPS code and assessment period, with covered days as units | Days paid at the wrong group or not paid |
| HIPPS code (FL 44) | Five characters from the PDPM classification on the accepted MDS | A code that does not match the assessment in iQIES is rejected |
| Occurrence code 50 | The assessment reference date (ARD) for each assessment period | Returned for correction |
| Occurrence span code 70 (FL 35 and 36) | Dates of the 3-consecutive-day qualifying inpatient stay | A covered claim without it, or a condition code explaining why, is denied |
| Statement covers period (FL 06) | The admission date, or the day after the previous bill’s through date | Continuing-stay bill returned |
| Fiscal year split | Separate bills for days before and from October 1 | FY 2026 and FY 2027 days priced at one year’s rate |
The 3-day count starts on the day of inpatient admission and leaves out the day of discharge. Observation hours and emergency department time do not count, even overnight. The SNF admission generally has to follow within 30 days of the hospital discharge.
PDPM and Part A rules that move the payment
Most SNF underpayments come from timing and documentation, not rate disputes.
The 5-day assessment window
The ARD of the 5-day PPS assessment must fall on days 1 to 8 of the stay. When it is set late, the days out of compliance are billed at the default rate, HIPPS ZZZZZ, instead of the resident’s PDPM groups.
Variable per diem
The PT and OT components pay their full rate for days 1 to 20, then drop 2% every 7 days. The NTA component pays three times its rate for days 1 to 3, then the standard rate. A stay’s daily rate is not flat.
Interrupted stays
A resident who leaves and returns to the same SNF within the interruption window, the day of discharge plus the next 2 calendar days, continues the same stay: no new 5-day assessment and no reset of the variable per diem.
ICD-10 codes on the MDS
The primary reason for the stay, in MDS item I0020B, maps to a PDPM clinical category. A code that does not map, or comorbidities missing from section I, lowers the nursing and NTA groups.
Benefit days and exhaustion
Part A covers up to 100 days per benefit period: 20 days with no daily cost, then days 21 to 100 at a daily coinsurance of $217 in 2026. Claims continue monthly after benefits exhaust so Medicare can track the benefit period.
Quality reporting and value-based purchasing
A SNF that misses Quality Reporting Program data loses 2 percentage points of its annual update. The SNF Value-Based Purchasing Program withholds 2% of Part A payments and pays part of it back on performance.
Consolidated billing: who bills what
During a covered Part A stay, the SNF bills Medicare for most of what the resident receives, including care from outside suppliers.
Bundled to the SNF
Therapy, lab work, the technical component of X-rays and other diagnostic tests, drugs, supplies, and most services from outside suppliers. The supplier bills the SNF, not Medicare. Therapy stays bundled even in a Part B stay.
Billed by the practitioner
Professional services of physicians, nurse practitioners, physician assistants, clinical psychologists, and CRNAs. For a diagnostic test, only the professional component, with modifier 26, goes to Part B.
Excluded hospital services
Certain high-intensity outpatient hospital services are outside the bundle and billed by the hospital: for example CT, MRI, emergency care, outpatient surgery in an operating room, radiation therapy, and cardiac catheterization.
Other exclusions
Certain chemotherapy drugs and their administration, dialysis-related services for ESRD, customized prosthetic devices, and hospice care for the terminal condition. The annual CMS code list decides each HCPCS code.
Physician and NP visits to SNF residents
Professional claims for the clinicians who round in the facility.
| Code or rule | What it is | Billing note |
|---|---|---|
| 99304 to 99306 | Initial nursing facility visit | In a SNF, the federally required initial comprehensive visit is the physician’s |
| 99307 to 99310 | Subsequent nursing facility visit | Telehealth frequency limits on these codes were removed permanently in 2026 |
| 99315 and 99316 | Nursing facility discharge management | By total time on the day of the discharge visit: 30 minutes or less, or more than 30 minutes |
| G0317 | Prolonged nursing facility service, each 15 minutes | Medicare’s add-on to 99306 or 99310 when the visit is billed on time; Medicare does not pay CPT 99418 |
| POS 31 | SNF resident in a covered Part A stay | Paid at the facility rate |
| POS 32 | Nursing facility resident, or SNF resident without Part A coverage | Paid at the higher non-facility rate, so POS 32 on a Part A resident is an overpayment |
| Visit schedule | At least every 30 days for the first 90 days, then every 60 days (42 CFR 483.30) | After the initial visit, NPs, PAs, and clinical nurse specialists may alternate with the physician |
Clinicians who round in facilities: geriatrics · hospitalist · wound care · hospice.
Not inside the monthly fee
The monthly cycle bills claims that are already in the system. These are scoped on their own.
Written rate
The fee is a percentage of net collections (flat or per claim in New York). No setup fee on the monthly cycle. Month to month. The written rate follows volume, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
Separate work
MDS completion and submission stay with the facility’s MDS coordinator. Medicare cost reports, Medicaid rate filings, and responses to past ADR or targeted probe reviews are scoped on their own.
Audit a month of Part A claims
Send last month’s census with ARDs and HIPPS codes, outside vendor invoices, and the remittances. We report HIPPS mismatches, late assessments billed at the default rate, vendor invoices paid twice, and a written rate.
Written
Monthly rate
98%
Published NCR
50
US States
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Every Client
SNF billing questions
Straight answers for skilled nursing facilities and the clinicians who see their residents.
What is the 3-day rule for SNF coverage?
Original Medicare covers a SNF stay only after a medically necessary inpatient hospital stay of at least 3 consecutive days, counting the admission day but not the discharge day. Observation and emergency department time do not count. The SNF admission generally has to follow within 30 days of the hospital discharge. Medicare Advantage plans, and SNFs working with certain ACOs, can waive the rule.
What is consolidated billing in a SNF?
During a covered Part A stay, the SNF bills Medicare for nearly all services the resident receives, including those from outside suppliers, who bill the SNF instead. Professional services of physicians and certain practitioners, and a defined list of excluded services such as some high-intensity hospital outpatient services, are billed separately.
How many SNF days does Medicare cover?
Up to 100 days per benefit period: days 1 to 20 with no daily coinsurance, and days 21 to 100 with a daily coinsurance of $217 in 2026. A benefit period ends after 60 consecutive days without inpatient hospital or SNF care.
What changed for SNF billing on October 1, 2026?
FY 2027 SNF PPS rates took effect: a 2.4% update, from a 3.3% market basket less a 0.9 percentage point productivity adjustment. PDPM and its ICD-10 mappings did not change. A stay that spans October 1 is billed on separate claims for each fiscal year.
Which place of service do physicians use for SNF residents?
POS 31 when the resident is in a covered Part A SNF stay, and POS 32 when the resident is in a nursing facility or in a SNF without Part A coverage. POS 32 pays the non-facility rate, so using it during a Part A stay overpays the visit.
How is the fee set?
As a percentage of net collections (flat or per claim in New York) on the book you hand over. No setup fee on the monthly cycle, month to month, with 30 days’ written notice. The written rate follows volume, payer mix, and scope.