by Jared Staheli
June 25th, 2015
Effective for dates of service on or after July 1, 2005, IHS providers, including CAHs shall bill the designated A/B MAC for prosthetics and orthotics under revenue code 0274 (prosthetic/orthotic devices) on type of bill (TOB) 12X (hospital inpatient part B), 13X (hospital outpatient) or 85X (Critical Access Hospital (CAH). Medicare Part B payment may be made to IHS providers that furnish prosthetic devices which replace all or part of an internal body organ (including contiguous tissue), or replace all or part of the function of a permanently inoperative or malfunctioning internal body organ. Ostomy, tracheostomy, and urological supplies meet the definition of this benefit and are billed to the A/B MAC by IHS providers.
Effective for dates of service on or after July 1, 2005, IHS providers (including CAHs) shall bill the designated A/B MAC for surgical dressings under revenue code 0623 (surgical dressings) on TOB 12X, 13X or 85X. Splints and casts are included in the AIR for IHS providers.
Payment is made by the A/B MAC for pharmaceuticals when billed with a clinic visit. Payment is included in the AIR.
The prosthetics, orthotics and surgical dressings HCPCS codes are updated on a periodic basis and published in a “Recurring Update Notification.”