Institution

Under the Medicare program, a facility that meets Medicare’s definition of a long-term care facility such as a nursing home or skilled nursing facility. This does not include assisted or adult living facilities or residential homes.

Institutional providers

Hospitals, ambulatory surgical centers, nursing homes, day care centers, and alcohol and substance abuse centers that have a contractual agreement with an insurance plan to provide health care services to members of managed care plans and eligible Medicare beneficiaries. Institutional providers bill the insurance carrier or fiscal intermediary directly.

Instructional notes

Detailed descriptions about diagnostic code selection for the insurance biller that appear at the beginning of a heading, in parentheses before or after a code, or in parentheses as part of the code’s description. Also see inclusion note .