Tools Series: Understanding Consolidated Billing (CB) for DMEPOS

Do you know if your beneficiary is in a Part A covered stay? If not, always ask the beneficiary or their family member/caregiver. It could also be beneficial to ask the ordering physician’s office. It’s always important to check eligibility in the Noridian Medicare Portal (NMP) but be aware Part A has a year to bill their claims so the stay may not be visible.

To help POS suppliers navigate CB, Noridian created a Consolidated Billing/SNF/Home Health/Hospice Lookup tool. A code can be entered in the tool to assist suppliers/providers with determining if a specific HCPCS is considered under consolidated billing for SNF, Home Health (HH), and Hospice. The tool provides information on the specific HCPCS code entered and whether the item is payable in each of the situations under CB (i.e., SNF, HH, or Hospice). The tool also provides guidance when an item is payable in a SNF after the Part A stay has ended. In this scenario some prosthetics, orthotics and supplies are covered when billing for a place of service (POS) 31 Skilled Nursing Facility or POS 32 Nursing Facility. Please visit our Consolidated Billing page on our website for more information.

            Last Updated Tue, 08 Nov 2022 19:00:27 +0000