Preparing for 2021 SNF Billing

Thoughtware Alert Published: Jan 29, 2021
Long-term-care provider speaking with senior

As skilled nursing facilities (SNF) prepare for their first billing cycle in the new year, it’s important to ensure billing staff are aware of the following changes.

Part B

Changes to the Physician Fee Schedule were a roller coaster ride heading into the new year. SNFs were faced with multiple cuts to Part B rates affecting therapy services, including the geographic practice cost index (GPCI) floor minimum of 1.0 expiring and the Physician Fee Schedule Final Rule, which included cuts estimated to decrease payments by 9 percent. Luckily, the passing of the 2021 Consolidated Appropriations Act helped mitigate the effect of these cuts, which are now estimated to be 2 percent to 3 percent for therapy services in 2021. This was a combination of multiple items, including delaying payment changes for certain evaluation and management codes, which allocated more funds to payment for other Part B services, and extending the GPCI floor minimum of 1.0 through 2023. Updated Part B rates can be downloaded from

The Part B KX modifier threshold (previously called the therapy cap) increased to $2,110 for 2021. As in prior years, the threshold calculation is combined for both physical therapy and speech-language pathology services, while occupational therapy is calculated separately. The Part B threshold for targeted medical review remains at $3,000 for 2021.

Part A

The SNF coinsurance rate for 2021 is $185.50.


Providers have a reprieve in the 2 percent sequestration through March 2021. Billing staff should review if software will need to be updated in April to correctly reduce Medicare payments by 2 percent after that time.

COVID-19 Waivers

As the public health emergency continues into 2021, so does the extension of 1135 waivers, which waive certain requirements including the three-day prior hospitalization for SNF Part A stays and allow for extending SNF benefits beyond 100 days for skilled stays related to the emergency. Since these waivers have multiple clinical and billing implications, it’s important for staff to understand when waivers should be used and how claims should be billed.

For more information, reach out to your BKD Trusted Advisor™ or submit the Contact Us form below.

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