Skilled Nursing Facilities (SNF) – Ancillary Billing Guidance
| Date: | August 23, 2023 |
| To: | Health Plan of San Joaquin (HPSJ) Contracted Providers & Facilities |
| From: | Health Plan of San Joaquin (HPSJ) |
| Type: | Informational |
| Subject: | Skilled Nursing Facilities (SNF) – Ancillary Billing Guidance |
| Business: | Medi-Cal Managed Care |
Health Plan of San Joaquin (HPSJ) would like to remind Skilled Nursing Facilities
(SNF)/Long Term Care (LTC) providers of the proper billing guidance for ancillary services (i.e., physical, occupational and speech therapies).
To ensure you receive proper reimbursement for ancillary services after the initial 45 days of an authorized admission, please include the appropriate revenue code and current procedural terminology (CPT)/healthcare common procedural coding system (HCPCS) codes in your claim’s submissions. This will help indicate the level of care or any identified excluded service, along with the room and board charges. Please note the following example:
| 42 Rev. Co | 43 Description | 44 HCPCS/Rate/HIPPS CODE | 45 SERV. DATE | 46. SERV. UNITS |
|---|---|---|---|---|
| 101 | ALL INCL R&B | 1/1/23 | 8 | |
| 270 | MED-SUR SUPPLIES | 1/1/23 | 1 | |
| 0420 | PHYSICAL THERAPY | X3900 | 1/1/23 | 10 |
| 0424 | PHYS THERP/EVAL | X3924 | 1/1/23 | 1 |
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.