AHA Coding Clinic® for HCPCS - 2004 Issue 3; FOR your INFORMATION

Is it covered or NOT?

Have you ever wondered whether a service was covered or not? Someone may have told you it wasn’t or you may have read somewhere that if it has a payment rate under OPPS or a HCPCS code that it’s covered, but the bill was returned Rejected. Well, CMS recently released a clarification on this particular issue of coverage determinations. This clarification can be found at www.cms.hhs.gov Publication 100-04, Transmittal 195. “The fact that a drug, device, procedure, or service has a HCPCS code and a payment rate under the OPPS does not imply...

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