by Jared Staheli
June 29th, 2015
Pelvic examinations are paid under the MPFS, whether billed to the FI or carrier except:
• Hospital outpatient services are paid under OPPS;
• See §40.5.B of this chapter for proper billing by RHC/FQHCs for the professional and technical components of a screening pelvic examination. RHCs/FQHCs are paid under the all-inclusive rate for the professional component; or based on the provider’s payment method for the technical component;
• CAH payment is under reasonable cost.
NOTE: SNFs are paid under the MPFS and bill the FI. Physicians and other individual practitioners bill the carrier.