Deductible and Coinsurance for Screening Pelvic Examinations (Rev. 1541, 09-23-08)

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.

References:

Deductible and Coinsurance for Screening Pelvic Examinations (Rev. 1541, 09-23-08). (2015, June 29). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/deductible-and-coinsurance-for-screening-pelvic-examinations-rev-1541-09-23-08-26962.html

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