Deductible and Coinsurance (Rev. 1, 10-01-03)

by  Jared Staheli
June 26th, 2015

Neither the Part B deductible nor coinsurance apply for services paid under the laboratory fee schedule. The Part B deductible for screening Pap smear and services paid for under the physician fee schedule is waived effective January 1, 1998. Coinsurance applies.

A. Carrier Action for Submitting Claim to CWF and CWF Edit 

When a carrier receives a claim for a screening Pap smear, performed on or after January 1, 1998, it must enter a deductible indicator of 1 (not subject to deductible) in field 67 of the HUBC record.

CWF will edit for screening pelvic examinations performed more frequently than allowed according to the presence of high risk factors.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 18