Inpatient Care in SNF - Revenue code 0191 - 0194

Type of bill (211-214)

Revenue code (0191-0194, 0199)

• Level 1 (Revenue Code 0191)

• Level 2 (Revenue Code 0192)

• Level 3 (Revenue Code 0193)

• Level 4 (Revenue Code 0194)

• Level 5 (Revenue Code 0199)

• All per diem rates will include, but may not be limited to the following services:

• Semi-private room

• Meals (including special dietary requirements)

• Skilled nursing care

• Case management

• Medication and pharmacy supplies

• Routine laboratory

• Routine radiology (except when excluded based on the terms of the agreement)

• Nutrition services (including enteral feedings)

• Administration of medications including intramuscular and intravenous services

• Medical supplies

• Discharge planning

• DME (excluding specialized/high cost DME*)

• Quality assessment and improvement programming

• Occupational, physical and speech therapy


All codes billed other than the per diem revenue codes (0191-0194, 0199) will be denied as included in the per diems rates. If the referenced per diem revenue codes are not submitted on the claim, the claim will be denied. Exceptions include outliers, instances where Blue Plan coverage is secondary to Medicare and other specific instances defined in the member’s contract.

Participating SNFs can coordinate select medications with one of the pharmacy providers that are part of the SNF select medication program. These pharmacy providers will bill and be reimbursed directly for these services. Please refer to the Skilled Nursing Facility Select Medication Program section program details. Any services not included in the per diem rate should be delivered and billed by participating providers outside the SNF. Contact Care Coordination for a list of participating providers for these services.

*Certain DME may be considered Custom DME due to its modification for use by a particular member. The term Custom DME shall mean equipment that is significantly altered or uniquely manufactured to meet the specific needs of an individual member according to the description and orders a physician or licensed practitioner whose license permits such practitioner to order Custom DME.