March 31, 2025
The Centers for Medicare & Medicaid Services (CMS) has released a new MLN Matters aimed at enhancing payment accuracy for physician services provided in skilled nursing facilities (SNFs). Effective July 1, 2025, these measures will address common misclassifications of Place of Service (POS) codes that have led to overpayments.
CMS says that when using these POS codes, remember:
Use POS code 31 for services provided: (1) In SNFs for patients with Part A coverage, and (2) In mixed facilities (those containing both NF and SNF settings) unless the physician verifies no Part A payment will be made
Use POS code 32 for all services provided in NFs and for services provided in SNFs when patients have exhausted their Part A coverage
The Office of Inspector General identified that incorrect use of these codes has resulted in significant overpayments. CMS will implement system edits to reject claims with incorrect POS codes and adjust previously paid claims if discrepancies are detected. This initiative is part of CMS' ongoing efforts to ensure compliance and improve the accuracy of Medicare payments.
Affected providers, including physicians and SNFs, are advised to update their billing practices to align with these new guidelines.
For more information, view the full MLN Matters.
