Skilled Nursing Facility Interrupted Stay Policy

Friday, July 10, 2020

TRICARE follows Medicare requirements for skilled nursing facility (SNF) admissions. For an SNF admission to be covered under TRICARE, the beneficiary must have a qualifying hospital stay of three consecutive days or more, not including the hospital discharge day, and the beneficiary must enter the SNF within 30 days of discharge from the hospital.

Retroactive to Oct. 1, 2019, TRICARE is adopting Medicare’s interrupted stay policy for SNF admissions. An interrupted SNF stay is one in where a patient is discharged from an SNF and subsequently readmitted to the same SNF within three days. 

The three-day interruption or leave of absence window begins on the first non-covered day following the SNF stay and ends at 11:59 p.m. on the third consecutive non-covered day. Follow Medicare guidelines when billing:

• Use revenue code 018x and occurrence span code 74,
• Indicate the interruption “from” and “through” dates and 
• Put the number of non-covered days as units.

The interrupted stay policy does not apply if:

• The patient is readmitted to the same SNF outside the three-day interruption window.
• The patient is admitted to a different SNF (regardless of the length of time between stays).

All SNF stays require prior approval. Beneficiaries who are dual-eligible for TRICARE and Medicare require an approval on day 101 when TRICARE becomes the primary payer. Requests for dual-eligible beneficiaries must be submitted to Wisconsin Physicians Services (WPS) – Military and Veterans Health. Visit the www.tricare4u.com for submission information.

Visit our Skilled Nursing Facility Care benefit details page and the TRICARE Reimbursement Manual, Chapter 8, Section 2 for additional information. 

Thank you for your continued partnership in caring for military service members, retirees and their families.