Medicare Claims Processing Manual - Centers for Medicare ...

1 Medicare Claims Processing Manual Chapter 18 - Preventive and Screening Services Table of Contents (Rev. 11092, 10-29-21) Transmittals for Chapter 18 1 - Medicare Preventive and Screening Services - Definition of Preventive Services - Table of Preventive and Screening Services - Waiver of Cost Sharing Requirements of Coinsurance, Copayment and Deductible for Furnished Preventive Services Available in Medicare 10 - pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines - Coverage Requirements - pneumococcal Vaccine - Influenza Virus Vaccine - Hepatitis B Vaccine - Billing Requirements - Healthcare Common Procedure Coding System (HCPCS)

2 And Diagnosis Codes - Claims Submitted to MACs Using Institutional Formats - Payment for pneumococcal Pneumonia Virus, Influenza Virus, and Hepatitis B Virus Vaccines and Their Administration on Institutional Claims - Special Instructions for Independent and Provider-Based Rural Health Clinics/Federally Qualified Health Center (RHCs/FQHCs) - Institutional Claims Submitted by Home Health Agencies and Hospices - Payment Procedures for Renal Dialysis Facilities (RDF) - Hepatitis B Vaccine Furnished to ESRD Patients - Claims Submitted to A/B MACs (B) - A/B MACs (B) Indicators for the Common Working File (CWF) - A/B MACs (B) Payment Requirements - Simplified Roster Claims for Mass Immunizers - Roster Claims Submitted to A/B MACs (B) for Mass immunization - Centralized Billing for Influenza Virus and pneumococcal Vaccines to A/B MACs (B) - Claims Submitted to A/B MACs (A) for Mass Immunizations of Influenza Virus and pneumococcal Vaccinations - Simplified Billing for Influenza Virus Vaccine and pneumococcal Vaccine Services by HHAs - Hospital Inpatient Roster Billing - Electronic Roster Claims - CWF Edits - CWF Edits on A/B MAC (A) Claims - CWF Edits on A/B MAC (B) Claims - CWF Crossover Edits for A/B MAC (B)

3 Claims - Medicare Summary Notice (MSN) 20 - Mammography Services (Screening and Diagnostic) - Certification of Mammography Facilities - Services Under Arrangements - FDA Certification Data - Using Certification Data in Claims Processing - HCPCS and Diagnosis Codes for Mammography Services Digital Breast Tomosynthesis - CAD Billing Charts - Digital Breast Tomosynthesis - claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages - Payment - Payment for Screening Mammography Services Provided On and After January 1, 2002 - Outpatient Hospital Mammography Payment Table - Critical Access Hospital Payment - CAH Screening Mammography Payment Table - SNF Mammography Payment Independent Diagnostic Testing Facility (IDTF) Mammography Payment - Payment for Screening Mammography Services Provided On or After January 1, 2002 - Outpatient Hospital Mammography Payment Table - Payment for Computer Add-On Diagnostic and Screening Mammograms for A/B MACs (A) and (B)

4 - Critical Access Hospital Payment - CAH Screening Mammography Payment Table - SNF Mammography Payment Table - Billing Requirements - A/B MAC (A) Claims - Rural Health Clinics and Federally Qualified Health Centers - RHC/FQHC Claims With Dates of Service Prior to January 1, 2002 - RHC/FQHC Claims With Dates of Service on or After January 1, 2002 - A/B MAC (A) Requirements for Nondigital Screening Mammographies - A/B MAC (A) Data for CWF and the Provider Statistical and Reimbursement Report (PS&R) - Billing Requirements-A/B MAC (B) Claims - A/B MAC (B) claim Record for CWF - A/B MAC (B) and CWF Edits - Transportation Costs for Mobile Units - Instructions When an Interpretation Results in Additional Films - Mammograms Performed With New Technologies - Beneficiary and Provider Notices - MSN Messages - Remittance Advice Messages 30 - Screening Pap Smears - Pap Smears From January 1, 1998, Through June 30 2001 - Pap Smears On and After July 1, 2001 - Screening for Cervical Cancer with Human Papillomavirus Testing - Deductible and Coinsurance - Payment Method - Payment Method for RHCs and FQHCs - Screening Pap Smears.

5 Healthcare Common Procedure Coding System HCPCS Codes for Billing - Screening Pap Smears: Diagnoses Codes - TOB and Revenue Codes for Form CMS-1450 - MSN Messages - Remittance Advice Codes 40 - Screening Pelvic Examinations - Screening Pelvic Examinations From January 1, 1998, Through June 30 2001 - Screening Pelvic Examinations on and After July 1, 2001 - Deductible and Coinsurance - Diagnosis Codes - Payment Method - Revenue Code and HCPCS Codes for Billing - MSN Messages - Remittance Advice Codes 50 - Prostate Cancer Screening Tests and Procedures - Definitions - Deductible and Coinsurance - Payment Method - A/B MACs (A) and (B) - Correct Coding Requirements for A/B MAC (B)

6 Claims - HCPCS, Revenue, and Type of Service Codes - Diagnosis Coding - Calculating Frequency - MSN Messages - Remittance Advice Notices 60 - Colorectal Cancer Screening - Payment - Deductible and Coinsurance - HCPCS Codes, Frequency Requirements, and Age Requirements (If Applicable) - Common Working Files (CWF) Edits - Ambulatory Surgical Center (ASC) Facility Fee - Determining High Risk for Developing Colorectal Cancer - D etermining Frequency Standards - Noncovered Services - Billing Requirements for Claims Submitted to A/B MACs (A) - Medicare Summary Notice (MSN) Messages - Remittance Advice Codes 70 - Glaucoma Screening Services - Claims Submission Requirements and Applicable HCPCS Codes - HCPCS and Diagnosis Coding - Additional Coding Applicable to Claims Submitted to A/B MACs (A) - Special Billing Instructions for RHCs and FQHCs - Edits - Payment Methodology - Determining the 11-Month Period - Remittance Advice Notices - MSN Messages 80 - Initial Preventive Physical Examination (IPPE) - Healthcare Common Procedure Coding System (HCPCS) Coding for the IPPE A/B Medicare Administrative Contractor (MAC) (B) Billing Requirements - A/B MAC (A)

7 Billing Requirements - Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC) Special Billing Instructions - Indian Health Services (IHS) Hospitals Special Billing Instructions - Outpatient Prospective Payment System (OPPS) Hospital Billing - Coinsurance and Deductible - Medicare Summary Notices (MSNs) - Remittance Advice Remark Codes - Claims Adjustment Reason Codes - Advance Beneficiary Notice (ABN) as Applied to the IPPE 90 - Diabetes Screening - HCPCS Coding for Diabetes Screening - A/B MAC (B) Billing Requirements - Modifier Requirements for Pre-diabetes - A/B MAC (A) Billing Requirements - Modifier Requirements for Pre-diabetes - Diagnosis Code Reporting - Medicare Summary Notices - Remittance Advice Remark Codes - Claims Adjustment Reason Codes 100 - Cardiovascular Disease Screening - HCPCS Coding for Cardiovascular Screening - A/B MAC (B) Billing Requirements - A/B MAC (A) Billing Requirements - Diagnosis Code Reporting - Medicare Summary Notices - Remittance Advice Remark Codes - Claims Adjustment Reason Codes 110 - Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

8 - Definitions - Coverage - Payment - Deductible and Coinsurance - HCPCS Code - Advanced Beneficiary Notice - RHCs/FQHCs Special Billing Instructions 120 - Diabetes Self Management Training (DSMT) Services - Coding and Payment of DSMT Services - Bill Processing Requirements - Special Processing Instructions for Billing Frequency Requirements - Advance Beneficiary Notice (ABN) Requirements - RHCs/FQHCs Special Billing Instructions - Duplicate Edits 130 - Human Immunodeficiency Virus (HIV) Screening Tests - Healthcare Common Procedure Coding System (HCPCS) for HIV Screening Tests - Billing Requirements - Payment Method - Types of Bill (TOBs) and Revenue Codes - Diagnosis Code Reporting - Medicare Summary Notice (MSN) and claim Adjustment Reason Codes (CARCs) 140 - Annual Wellness Visit (AWV) - Healthcare Common Procedure Coding System (HCPCS) Coding for the AWV - A/B MAC (B) Billing Requirements - A/B MAC (A) Billing Requirements - Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC) Special Billing Instructions - Coinsurance and Deductible - Common Working File (CWF) Edits - Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs)

9 , Claims Adjustment Reason Codes (CARCs), and Advance Beneficiary Notices (ABNs) - Advance Care Planning (ACP) as an Optional Element of an Annual Wellness Visit (AWV) 150 - Counseling to Prevent Tobacco Use - Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Coding - A/B MAC (B) Billing Requirements - A/B MAC (A) Billing Requirements - Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes - Common Working File (CWF) 160 - Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD) Furnished on or After November 8, 2011 - Coding Requirements for IBT for CVD Furnished on or After November 8, 2011 - Claims Processing Requirements for IBT for CVD Furnished on or After November 8, 2011 - Correct Place of Service (POS) Codes for IBT for CVD on Professional Claims - Provider Specialty Edits for IBT for CVD on Professional Claims Correct Types of Bill (TOB) for IBT for CVD on Institutional Claims Frequency Edits