Can you please clarify the billing/payment regarding the difference between a semi-private and private room in a Skilled Nursing Facility (SNF)?
Medicare will not pay for a private room unless it is deemed medically necessary or if a semi-private room is not available. If the patient’s medical documentation supports the need for a private room Medicare will consider the claim for payment. If the patient elects to have a private room when a semi-private room is available, and the semi-private room is suitable for the patient’s medical needs, the patient will be responsible for the difference between the semi-private and private room charges. When billing for a medically necessary private room stay either condition code 38 or condition code 39 must be applied to the claim. The claim will be paid at the appropriate Resource Utilization Group (RUG) rate regardless of the semi-private or private room billed on the claim. The only instance the payment will change is if the patient chooses to have a private room when a semi-private room would suffice. In this situation, the patient will be responsible for the difference between the se
Related Questions
- Can you please clarify the billing/payment regarding the difference between a semi-private and private room in a Skilled Nursing Facility (SNF)?
- Do private insurers use the consolidated billing system for residents in skilled nursing facilities?
- What if someone is already in a skilled nursing facility?
