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Skilled Nursing Facility Coding

Provider Administrative Policy

Claims Submission
Policy Date
July 2013
New/July 2013
Provider Type(s)
All Providers  


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Skilled Nursing Facility Coding

Skilled Nursing Facility provider should submit claims using a UB-04 claim form.

UB-04 Coding

Blue Cross of Idaho currently accepts four-digit revenue codes. Utilize the following revenue codes where appropriate for submitting claims for skilled nursing facility services.

Level I:  Custodial Care Revenue Code:  0190 or 0191
Level II:  Medium Level Skilled Nursing Care Revenue Code:  0192
Level III:  High Level Skilled Nursing Care Revenue Code:  0193
Level IV:  Complex Level Care Revenue Code:  0194
Level V:  Extraordinarily High Cost care Revenue Code:  0199

Please review to PAP357 for additional information on coverage provisions for the above noted levels of care.

Blue Cross of Idaho will consider benefits for certain pharmaceutical items provided by a skilled nursing facility. Claims should be submitted with codes specific for the type of pharmaceutical item provided. These pharmaceutical items may include, but are not limited to , certain antibiotics, anit-infectives, anti-virals, cell stimulation agents, growth factors, and TPN nutritional products.

Prior authorization of all skilled nursing facility services and pharmaceutical items is required.

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