AHA Coding Clinic® for HCPCS - 2013 Issue 2; For Your Information

Medicare coverage determinations

CMS has published a reminder to the hospitals under OPPS regarding Medicare coverage determinations. The information published in Transmittal 2664 on March 1, 2013, states: The fact that a drug, device, procedure or service is assigned a HCPCS code and a payment rate under the OPPS does not imply coverage by the Medicare program, but indicates only how the product, procedure or service may be paid if covered by the program. Fiscal Intermediaries (FIs)/Medicare Administrative Contractors (MACs) determine whether a drug, device, procedure or other service meets all program requirements for coverage. For example, FIs/MACs determine that it is...

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