SNF Billing Guidelines
Last updated May 2026
Documentation essentials
Every Part B supply claim should be backed by: a physician order, a signed certification of medical necessity (when LCD-required), proof of delivery, and a clinical note linking the supply to the diagnosis being treated.
Common code categories
A-codes for ostomy and urological supplies, A-codes for surgical dressings, B-codes for enteral nutrition, J-codes for select drugs and immunosuppressives, E-codes for DME items dispensed under Part B.
Avoidable mistakes
Billing during a Part A stay, billing without a current physician order, billing the wrong unit count, and billing without an LCD-compliant diagnosis.
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Frequently asked questions
- No. This page summarizes how the rules apply in day-to-day SNF operations. The Medicare Claims Processing Manual, your MAC's LCDs, and current CMS transmittals are the controlling sources.
- Fee schedules update annually, and MAC coverage articles and edits can change mid-year. We review our guidance quarterly and re-verify against the applicable MAC policy before it affects claim preparation.
- The statute does not change, but the A/B MAC administering your jurisdiction publishes its own coverage articles and review targets, so documentation expectations can vary in practice.
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Read articleReviewed by Cara Hansen, Chief Operating Officer · August 2026. Guidance summarized here is re-verified quarterly against current CMS transmittals and MAC coverage articles.
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