by Jared Staheli
July 6th, 2015
If the screening is provided in a physician office, the service is billed to the carrier using the HCPCS code identified in section 110.3.2 below. Payment is under the Medicare Physicians Fee Schedule (MPFS).
Fiscal Intermediaries (FIs) shall pay for the AAA screening only when the services are performed in a hospital, including a critical access hospital (CAH), Indian Health Service (IHS) Facility, Skilled Nursing Facility (SNF), Rural Health Clinic (RHC), or Federally Qualified Health Center (FQHC) and submitted on one of the following types of bills (TOBs): 12X, 13X, 22X, 23X, 71X, 73X, 85X.
The following describes the payment methodology for AAA Screening:
|Facility||Type of Bill||Payment|
|Hospitals subject to OPPS||12X, 13X||OPPS|
|Method I and Method II Critical Access Hospitals (CAHs)||12X and 85X||101% of reasonable cost|
|IHS providers||13X, revenue code 051X||OMB-approved outpatient per visit all inclusive rate (AIR)|
|IHS providers||12X, revenue code 024X||All-inclusive inpatient ancillary per diem rate|
|IHS CAHs||85X, revenue code 051X||101% of the all-inclusive facility specific per visit rate|
|IHS CAHs||12X, revenue code 024X||101% of the all-inclusive facility specific per diem rate|
|SNFs **||22X, 23X||Non-facility rate on the MPFS|
|RHCs*||71X, revenue code 052X||All-inclusive encounter rate|
|FQHCs*||73X, revenue code 052X||All-inclusive encounter rate|
|Maryland Hospitals under jurisdiction of the Health Services Cost Review Commission (HSCRC)||12X, 13X||94% of provider submitted charges or according to the terms of the Maryland Waiver|
* If the screening is provided in an RHC or FQHC, the professional portion of the service is billed to the FI using TOBs 71X and 73X, respectively, and the appropriate site of service revenue code in the 052X revenue code series.
If the screening is provided in an independent RHC or freestanding FQHC, the technical component of the service can be billed by the practitioner to the carrier under the practitioner’s ID following instructions for submitting practitioner claims to the Medicare carrier.
If the screening is provided in a provider-based RHC/FQHC, the technical component of the service can be billed by the base provider to the FI under the base provider’s ID, following instructions for submitting claims to the FI from the base provider.
** The SNF consolidated billing provision allows separate part B payment for screening services for beneficiaries that are in skilled Part A SNF stays, however, the SNF must submit these services on a 22X bill type. Screening services provided by other provider types must be reimbursed by the SNF.