HI 00601.230 Other Services

A. General

Other services which are necessary to the health of the patients are covered if the services are generally provided by Skilled Nursing Facilities (SNFs).

Items or services that would not be included as inpatient hospital services if furnished to an inpatient of a hospital are also excluded from coverage as extended care services.

The use of an operating room and any special equipment, supplies, or services would not constitute covered extended care services except when furnished to the facility by a hospital with which the facility has a transfer agreement, since operating rooms are not generally maintained by SNF's. However, supplies and nursing services connected with minor surgery performed in an SNF that does not require the use of an operating room or any special equipment or supplies associated with such a room would be covered extended care services and reimbursed as part of the cost of routine services.

B. Respiratory therapy

Since the provision of respiratory therapy by a respiratory therapist does not represent a service generally provided by SNF's, respiratory therapy furnished by a respiratory therapist is a covered extended care service only when furnished to the facility by a hospital with which the facility has a transfer agreement. (See HI 00601.050 for the definition and coverage criteria pertaining to respiratory therapy services.)

Although the services of a respiratory therapist are not covered extended care services, except as indicated above, respiratory therapy services performed by a nurse would constitute nursing services and would be covered as such under the extended care benefit. Moreover, oxygen which might be required in this service and the cost of nonroutine medications used are considered ancillary services and may be billed for separately. However, the use of any necessary equipment involved is considered part of the routine services furnished by the facility.

NOTE: See HI 00601.520 for information on Presumption of Coverage.


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HI 00601.230 - Other Services - 04/03/2015
Batch run: 04/03/2015
Rev:04/03/2015