Skilled Nursing Facility Billing Cheat Sheet (2026)
Three things decide an SNF professional claim: the visit type, the level the documentation supports, and whether the visit was federally required or medically necessary. Get any of the three wrong and the visit is downcoded or denied.
Quick reference for skilled nursing facility billers. Last updated .
Top Skilled Nursing Facility CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 99304 | SNF initial care visit, F1 (low complexity) | $81.16 | $71.14 | 2.43 |
| 99305 | SNF initial care visit, F2 (moderate complexity) | $140.95 | $119.91 | 4.22 |
| 99306 | SNF initial care visit, F3 (high complexity) | $193.06 | $163.33 | 5.78 |
| 99307 | SNF subsequent care, problem focused | $42.09 | $37.07 | 1.26 |
| 99308 | SNF subsequent care, expanded problem focused | $78.83 | $67.80 | 2.36 |
| 99309 | SNF subsequent care, detailed | $114.57 | $98.53 | 3.43 |
| 99310 | SNF subsequent care, comprehensive | $163.33 | $140.28 | 4.89 |
| 99315 | SNF discharge management, 30 minutes or less | $85.84 | $73.15 | 2.57 |
| 99316 | SNF discharge management, more than 30 minutes | $138.28 | $117.57 | 4.14 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Skilled Nursing Facility billing services page.
Modifiers That Prevent Skilled Nursing Facility Denials
A significant, separately identifiable E/M on the same day as another reported procedure in the facility.
The principal physician of record on the initial SNF visit, distinguishing it from consultants.
A distinct service separate from the visit that NCCI would otherwise bundle.
Substitute physician arrangements (reciprocal or fee-for-time) covering the visit.
A service performed in part by a resident under teaching physician rules where applicable.
A SNF visit furnished via telehealth where the payer and facility policy allow it.
Top Skilled Nursing Facility Denials → Quick Fix
Only the principal physician of record appends AI on the initial comprehensive visit (99304 to 99306). Consultants bill subsequent or other codes. A mismatch denies.
99304 to 99310 are leveled by MDM or time. Document the elements; defaulting every subsequent visit to one level is a coding-accuracy denial.
Federally required visits have a defined schedule; additional visits must be medically necessary and documented as such. Routine over-frequency without necessity is denied.
Use the correct SNF place of service (31 or 32 as applicable). A mismatched POS reprices or denies the professional claim.
99315 and 99316 are time-based discharge codes. Document the time spent on the discharge day to support the code billed.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 99304 | 0362T | Misuse of Column Two code with Column One code |
| 99304 | 0373T | Misuse of Column Two code with Column One code |
| 99305 | 0362T | Misuse of Column Two code with Column One code |
| 99305 | 0373T | Misuse of Column Two code with Column One code |
| 99306 | 0362T | Misuse of Column Two code with Column One code |
| 99306 | 0373T | Misuse of Column Two code with Column One code |
| 99307 | 0362T | Misuse of Column Two code with Column One code |
| 99307 | 0373T | Misuse of Column Two code with Column One code |
Documentation That Holds Up on Appeal
That the billing provider is the principal physician of record (AI) and the comprehensive visit elements.
MDM or total time supporting the level, and the clinical reason for the visit.
Whether the visit was federally required or medically necessary, with the necessity documented for additional visits.
The time spent on the discharge day, since the code is time-based.
The correct SNF POS for the patient's stay type.
Revenue Skilled Nursing Facility Practices Leave on the Table
Down-leveling every subsequent visit out of habit instead of coding the MDM or time documented.
Frequency denials because extra visits were not documented as medically necessary.
POS errors that reprice the professional claim.
Missing the higher discharge-management code because the discharge-day time was not recorded.
Skilled Nursing Facility Billing FAQ
Who bills the initial SNF visit?
The principal physician of record, appending modifier AI on the initial comprehensive visit (99304 to 99306). Consultants and other physicians bill subsequent or other appropriate codes; billing initial without being the principal denies.
How is visit frequency handled?
Federally required visits follow a defined schedule. Visits beyond that must be medically necessary and documented as such. Routine over-frequency without documented necessity is denied as CO-151.
How are subsequent visits leveled?
99307 to 99310 by medical decision-making or total time. The note has to support the level; defaulting all visits to one level fails on audit.
How is discharge day billed?
99315 for 30 minutes or less and 99316 for more than 30 minutes of discharge-day management. The time spent has to be documented to support the code.
Stop Losing Skilled Nursing Facility Revenue to Preventable Denials
Our AAPC-certified skilled nursing facility coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.