Program_Memos / 2003 / AB-03-134

Why This Topic Matters

The article helps readers identify the CMS policy update, understand the billing context for managed care versus fee-for-service claims, and recognize the code sets and administrative identifiers associated with the guidance.

Article Sections

1. General Information

   Overview of the program memorandum, its CMS context, and the policy area it addresses.

2. Background

   General coverage background and the relationship between the memorandum and the broader CMS coverage policy.

3. Scope

   The claim-processing and billing context for services furnished to managed care beneficiaries.

4. Business Requirements

   Administrative implementation requirements and internal processing references.

5. Supporting Information and Possible Design Considerations

   Supplemental implementation and systems-related information referenced by the memorandum.

6. Attachment 1: Provider Education Article

   CMS provider education material that expands on the coverage topic, billing context, and related implementation timing.

7. Background

   Summary of the coverage expansion context described in the attachment.

8. Coverage Guidelines

   High-level coverage guidance and eligibility-related policy background discussed in the provider education article.

9. Billing Instructions for Providers Who Render Services to Managed Care Patients

   Billing administration guidance for managed care settings and the timing of claim handling.

10. Billing Instructions for Providers Who Render Services to Fee-for-Service Patients

    Billing administration guidance for fee-for-service settings.

11. Attachment 2: Procedure Codes

    Referenced procedure coding identifiers associated with the article's billing guidance.