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Physician Regulatory Issues Team (PRIT)

Past PRIT Issues


  Details for Billing for CPT code 96400 in a SNF Part A stay
  

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Issue Name Billing for CPT code 96400 in a SNF Part A stay
Issue Can a physician be paid by Medicare for providing CPT 96400 to a patient in a SNF Part A stay?
Status See below.
Date Issue Created 01/01/2004

This issue was brought to the PRIT by the Wisconsin Medical society.

June 10: The Balanced Budget Reform Act of 1999 unbundled certain "high cost, low probability'" services from the SNF bundled rate. By statute, some chemotherapy codes (such as 96400) were intentionally left as a bundled service and therefore part of the SNF's global PPS per diem Part A payment, therefore CMS does not have the authority to allow separate payment for this service.

 


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Last Modified Date : 05/08/2006
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