Skilled Nursing Facility (SNF) pricing

TRICARE pays Skilled Nursing Facilities (SNF) using the Medicare PPS and consolidated billing. SNF PPS rates cover all routine, ancillary and capital costs of covered SNF services.

SNFs are required to perform resident assessments using the minimum data set. SNF admissions require authorizations when TRICARE is the primary payer. SNF admissions for children under age 10 and Critical Access Hospital (CAH) swing beds are exempt from SNF PPS and are reimbursed based on DRG or contracted rates.

For information about SNF PPS, refer to the TRICARE Reimbursement Manual, Chapter 8, Section 2