Payment Policy: Skilled Nursing Facility Leveling
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Govern reimbursement for reporting and paying SNF levels of care (levels 1–5) for facilities contracted with the health plan; applies to providers billing Arizona Complete Health (Centene-affiliated) health plans.
No material clinical or coverage changes in this revision.
SNF Level Payment Criteria
SNF level payment criteria
Reimbursement for a reported SNF level requires meeting the specified skilled nursing and/or skilled therapy hour thresholds and, for certain intensive levels, additional high-acuity criteria or administration of a listed high-cost drug.
ALL of the following
ANY of the following
ALL of the following
- Skilled nursing up to 4 hours per day, 7 days per week.
ALL of the following
- Skilled therapy 1 to 2 hours per day, at least 5 days per week.
ALL of the following
ANY of the following
ALL of the following
- Skilled nursing at least 4 hours per day, 7 days per week.
ALL of the following
- Skilled therapy at least 2 hours per day, at least 5 days per week.
ALL of the following
ALL of the following
- Skilled nursing for more than 4 hours per day, 7 days per week.
- Skilled therapy for at least 3 hours per day, at least 5 days per week.
ALL of the following
ALL of the following
- Skilled nursing for more than 4 hours per day, 7 days per week.
ANY of the following
ALL of the following
- Catastrophic multiple traumas; severe head injury or CVA; stabilized spinal cord injury; weanable and non-weanable ventilator-dependent patients.
- Administration of a high-cost drug listed in the policy's High-Cost Drug List.
ALL of the following
ANY of the following
ALL of the following
- Skilled nursing required for more than 4 hours per day, 7 days per week.
ALL of the following
- Administration of a high-cost drug listed in the policy's High-Cost Drug List.
Revenue Codes and Service Hour Thresholds
| Rev Code 191 | Level of Care 1 — Skilled Nursing Services |
| Rev Code 192 | Level of Care 2 — Comprehensive Care Services |
| Rev Code 193 | Level of Care 3 — Medical/Surgical / Complex |
| Rev Code 194 | Level of Care 4 — Intensive / Medically Complex |
| Rev Code 199 | Level of Care 5 — Intensive Care Services |
Reporting & Reimbursement Requirements for Providers
Report correct SNF level; payment depends on meeting nursing/therapy thresholds (and listed high‑cost drugs for levels 4–5)
Providers must report the SNF level of care that accurately reflects the services performed; reimbursement is contingent on meeting the specified skilled nursing and/or skilled therapy hour thresholds (and, for certain levels, administration of a listed high‑cost drug).
- Report the revenue code that corresponds to the level of care provided (Rev Code 191, 192, 193, 194, or 199) and ensure billed level meets the hours/criteria for that level.
- Levels 1–3 reimbursement requires meeting the nursing and/or therapy hour thresholds specified for each level (see Level 1: up to 4 hrs/day nursing OR 1–2 hrs/day therapy; Level 2: ≥4 hrs/day nursing OR ≥2 hrs/day therapy; Level 3: >4 hrs/day nursing AND ≥3 hrs/day therapy).
- Levels 4–5 require skilled nursing >4 hrs/day (7 days/week) and, for Level 4, a high‑acuity need (e.g., catastrophic trauma, severe head injury/CVA, stabilized spinal cord injury, ventilator dependence) or administration of a listed high‑cost drug; Level 5 is payable where adopted and may be supported by >4 hrs/day nursing or administration of a listed high‑cost drug.
Key Definitions
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