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Q: In the SNF setting, we have agreements with FEES providers that come to the SNF and conduct FEES studies (swallowing studies). The FEES provider charges the SNF a flat fee ($350) per study that the SNF pays to the FEES company.
Is this service billable by the SNF to Medicare Part B when provided in the SNF but to a contracted provider? Can we submit a Medicare part B claim for the FEES service?
We have different people with different experiences in doing this. Some say we have to bill the patient private pay. Some say we should bill Part B when it is available and by charging private pay we are not billing correctly.
A: The HCPCS code for FEES is 92616. This code is included in SNF consolidated billing, so the expenses for the test must be covered by your facility and not billed separately to Part B or privately to the resident (costs are rolled up in the resident’s Part A RUG rate). ). You can, on the other hand, be reimbursed by Medicare for your residents who have Part B and are not under a Part A stay. The amount to be reimbursed, as well as the supervision requirements for reimbursement vary based on your local coverage determination (for the Medicare fee schedule), so you will need to check with your local MAC.
As far as references, you may check the General Explanation of the Major Categories for SNF Consolidated Billing (Major Category V) and the HCPCS list. Click here for a reference tool from the American Speech-Language Hearing Association to help with a list of codes and information for SLP services.