Page 34 - Medicare Benefit Policy Manual

For SNF Part A inpatients, the following services are additional exceptions to this non
coverage rule and may be covered if provided by another authorized provider or supplier:

• Home dialysis supplies and equipment, self-care home dialysis support services,
and institutional dialysis services and supplies, including any related necessary
ambulance services;

• EPO;

• Hospice care related to a beneficiary’s terminal condition;

• Radioisotope services;

• Some customized prosthetic devices;

• Some chemotherapy and chemotherapy administration services;

• The following services which are considered beyond the scope of a SNF when
furnished in a Medicare participating Hospital or Critical Access Hospital. Note that this
exception does not apply if the service is furnished in an ASC. Specific coding is
described in the Medicare Claims Processing Manual.

º Cardiac catheterization;

º CT scans;

º MRIs;

º Ambulatory surgery involving the use of an operating room;

º Radiation therapy;

º Emergency services;

º Ambulance services related to the six services listed immediately above;
and ambulance transportation related to dialysis services.

180 - Services Related to and Required as a Result of Services Which
Are Not Covered Under Medicare
(Rev. 189, Issued: 06-27-14, Effective: 05-30-14, Implementation: 06-29-14)

Medical and hospital services are sometimes required to treat a condition that arises as a
result of services that are not covered because they are determined to be not reasonable
and necessary or because they are excluded from coverage for other reasons. Services
"related to" non-covered services (e.g., cosmetic surgery, non-covered organ transplants,
non-covered artificial organ implants, etc.), including services related to follow-up care