by Jared Staheli
June 29th, 2015
The Part B deductible for screening pelvic examinations is waived effective January 1, 1998. Coinsurance is applicable.
A. Action When Submitting Claims to CWF and CWF Edit
When a carrier receives a claim for a pelvic examination, performed on or after January 1, 1998, it must enter a deductible indicator of 1 (not subject to deductible) in field 65 of the HUBC record.
When an FI receives a claim for a screening pelvic examination (including a clinical breast examination), performed on or after January 1, 1998, it reports special override Code 1 in the “Special Action Code/Override Code” field of the CWF record for the line item, indicating the Part B deductible does not apply.
CWF edits for screening pelvic examinations performed more frequently than allowed according to the presence of high risk factors.