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MLN Product (Revised); Skilled Nursing Facility 3-Day Rule Billing

This revised Product comprises Subregulatory Guidance for the Skilled Nursing Facility 3-day rule billing requirement, and its content is based on publicly available content within the Social Security Act, Section 1861, Part E at, Electronic Code of Federal Regulations, Part 409 at, Social Security Act, Section 1812 at,, and Section 1870 at CMS policy or operation subject matter experts also reviewed/cleared this product. The fact sheet educates providers about the 3-day rule and how it affects payment and how hospitals should correctly communicate the number of inpatient days to skilled nursing facilities and patients (or their representatives). The 3-day rule requires the patient have a medically necessary 3-day-consective inpatient hospital stay to qualify for Skilled Nursing Facility (SNF) extended care services coverage. The 3-day-consecutive stay count doesn’t include the day of discharge, any pre-admission time spent in the emergency room or outpatient observation.
Revisions to this product include this 1 content update:
• We removed language related to the 3-day prior hospitalization waiver, which ended on May 11, 2023

The previous version of this product is available to the public and currently posted on the CMS website at

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: May 17, 2023

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.