Which residents qualify?
Residents with a practitioner order for a splint or orthotic to support, protect, or restore function, who have active Part B and are not in a covered Part A stay.
What documentation does each claim need?
- A practitioner order for the specific device
- Medical record documentation of the functional need
- Device-specific LCD criteria where one applies
- Proof the device was provided to the resident
Frequently asked questions
Can a SNF bill Part B for splints and braces?
Yes, for residents not in a covered Part A stay, when the device is ordered and medically necessary. Durable medical equipment like wheelchairs is a different benefit and is not included.
Do we have to change suppliers?
No. CareComply replaces the Part B supply vendor that bills Medicare under its own NPI today. Your facility keeps ordering from its regular supplier, now for all residents, and CareComply bills the Part B–eligible usage under your facility’s NPI.
Does this apply to residents in a Medicare Part A stay?
No. During a covered Part A stay, consolidated billing applies and supplies are part of the Part A payment. Part B supply billing applies to residents who are not in a covered Part A stay and have active Medicare Part B on the date of service.
Sources
- Social Security Act §1861(s): medical and other health services
- CMS Medicare Coverage Database
- CMS Medicare Claims Processing Manual, Pub. 100-04, Chapter 7 (SNF Part B billing)
- Article A55426: Standard Documentation Requirements for All Claims Submitted to DME MACs
Review status: Pending compliance review