Part B Carrier Claim Record for CWF (Rev. 60, 01-09-04)

by  Jared Staheli
June 26th, 2015

Carriers complete the type of service field in the CWF Part B claim record with a “B” if the patient is a high risk screening mammography patient or a “C” if she is a low risk screening mammography patient for services prior to January 1, 1998.

For services on or after January 1, 1998, the type of service field on CWF must have a value of “1” for medical care (screening) or a “4” for diagnostic radiology (diagnostic). Fill in POS. Fill in deductible indicator field with a “1”; not subject to deductible if screening mammography. Submit the claim to the CWF host. Trailer 17 of the Part B Basic Reply record will give the date of the last screening mammography.

The CWF edits for age and frequency for screening mammography. There are no frequency limitations on diagnostic tests or CAD-diagnostic tests. When a screening CAD is billed in conjunction with a screening mammogram and the screening mammogram fails the age or frequency edits then both services will be rejected.

References:

Part B Carrier Claim Record for CWF (Rev. 60, 01-09-04). (2015, June 26). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/part-b-carrier-claim-record-for-cwf-rev-60-01-09-04-26943.html

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