Skilled Nursing · Reference
SNF Consolidated Billing Checker
During a covered Part A stay the SNF is paid one bundled PDPM per diem. Pick the resident's stay status and a service category to see whether the service is included (the SNF bills; outside suppliers look to the SNF for payment) or excluded (separately billable to Medicare by the rendering provider).
Data statusReference Only
- Status
- Reference Only
- Data year / effective
- FY2026
- Last reviewed
- July 2026
- Last updated
- July 2026
- Primary source
- CMS SNF Consolidated Billing
- Known exclusions
- Category-level screen — HCPCS-level inclusion is set by the CMS files, updated during the year
- Managed-care (MA) plans may contract differently
- Verify specific codes with your MAC before billing or denying
Reference only — confirm code-level status against the current CMS consolidated billing files and your MAC.
Stay status
Service category
This is a category-level screen, not a code lookup. Inclusion is ultimately determined at the HCPCS level by the CMS consolidated-billing files, which change during the year — verify specific codes against the current CMS SNF consolidated billing files and your MAC before billing or denying.
Sources: Social Security Act §1862(a)(18) and §1888(e); CMS SNF Consolidated Billing; Medicare Claims Processing Manual, ch. 6.
How the bundle works
| Stay | What is bundled to the SNF |
|---|---|
| Part A | Nearly everything — room & board, nursing, therapy, most drugs, labs, imaging, supplies, DME — except the statutory exclusions. |
| Part B stay | Only outpatient therapy (PT / OT / SLP). All other services follow normal Part B rules. |
| Not a resident | Nothing. Consolidated billing does not apply. |
Excluded professional services are billed by the practitioner to the Part B carrier/MAC with place of service 31 (SNF). For bundled services from outside suppliers, payment flows supplier ← SNF “under arrangements,” not supplier ← Medicare.
FAQ
What is SNF consolidated billing?
During a covered Medicare Part A SNF stay, the SNF is paid one bundled PDPM per diem that covers nearly everything the resident receives. Outside suppliers generally cannot bill Medicare separately — they must look to the SNF for payment under an arrangement. A short list of services is excluded by statute and stays separately billable to Part B.
Which services are excluded from SNF consolidated billing?
The major exclusions are physician and other practitioner professional services; dialysis and ESRD-related drugs including erythropoietin; certain high-cost chemotherapy drugs and their administration; certain radioisotope services; customized prosthetic devices; preventive vaccines; certain intensive outpatient hospital services (emergency services, cardiac catheterization, CT and MRI, radiation therapy, angiography, ambulatory surgery involving an operating room); and most ambulance transports that begin or end a stay or take the resident to an excluded service. The exact code lists are published by CMS and updated through the year.
Does consolidated billing still apply when Part A days run out?
Partly. In a non-covered (Part B) stay, only outpatient therapy — PT, OT, and speech-language pathology — remains bundled to the SNF. Everything else follows normal Part B billing rules.
Who pays an outside supplier for a bundled service?
The SNF does, under an arrangement between the SNF and the supplier. Medicare will deny the supplier's separate claim for a bundled service furnished during a covered Part A stay, and the beneficiary cannot be billed for it.
