Skilled services

Some examples of direct skilled nursing services are:

• Intravenous or intramuscular injections and intravenous feeding;
  
• Enteral feeding that comprises at least 26 percent of daily calorie requirements and provides at least 501 milliliters of fluid per day;
  
• Naso-pharyngeal and tracheotomy aspiration;
  
• Insertion, sterile irrigation, and replacement of suprapubic catheters; Application of dressings involving prescription medications and aseptic techniques (see 30.5 for exception);
  
• Treatment of decubitus ulcers, of a severity rated at Stage 3 or worse, or a widespread skin disorder (see 30.5 for exception);
  
• Heat treatments which have been specifically ordered by a physician as part of active treatment and which require observation by skilled nursing personnel to evaluate the patient's progress adequately (see 30.5 for exception);
  
• Rehabilitation nursing procedures, including the related teaching and adaptive aspects of nursing, that are part of active treatment and require the presence of skilled nursing personnel; e.g., the institution and supervision of bowel and bladder training programs;
  
• Initial phases of a regimen involving administration of medical gases such as bronchodilator therapy; and
  
• Care of a colostomy during the early post-operative period in the presence of associated complications.
  
• The need for skilled nursing care during this period must be justified and documented in the patient's medical record.
  

I recommend reading the Medicare Benefit Policy Manual