Federal (United States) · Agency guidance
Chapter 23
84 sections
84 sections
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 10Reporting ICD Diagnosis and Procedure Codes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 10.1General Rules for Diagnosis Codes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 10.2Inpatient Claim Diagnosis Reporting
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 10.3Outpatient Claim Diagnosis Reporting
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 10.4ICD Procedure Codes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 10.5Coding for Outpatient Services and Physician Offices
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 10.6Relationship of Diagnosis Codes and Date of Service
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20Description of Healthcare Common Procedure Coding System (HCPCS)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.1Use and Maintenance of CPT-4 in HCPCS
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.2RESERVEDReserved
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.3Use and Acceptance of HCPCS Codes and Modifiers
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.4Deleted HCPCS Codes/Modifiers
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.5The HCPCS Codes Training
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.6Professional/Public Relations for HCPCS
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.7Use of the American Medical Association’s (AMA’s) Physicians’ Current
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.8Payment, Utilization Review (UR), and Coverage Information on CMS Quarterly
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9National Correct Coding Initiative (NCCI)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.1.1Instructions for Codes With Modifiers (A/B MACs (B) Only)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.2Reserved for future use
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.3Appeals
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.3.1Procedure-to-Procedure (PTP) Edits
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.3.2Medically Unlikely Edits (MUEs)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.4Reserved for future use
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.4.1Reserved for future use
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.5Adjustments
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.6Correct Coding Edit (CCE) File Record Format
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 20.9.7National Correct Coding Initiative (NCCI) Edits Quarterly Updates
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30Services Paid Under the Medicare Physician’s Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.1Maintenance Process for the Medicare Physician Fee Schedule Database
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.2MPFSDB Record Layout
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.2.1Payment Concerns While Updating Codes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.2.2MPFSDB Status Indicators
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.3Furnishing Pricing Files
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.3.1RESERVED
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.3.2A/B MAC (A), (B), or (HHH) Furnishing Physician Fee Schedule Data for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.3.3Furnishing Other Fee Schedule, Prevailing Charge, and Conversion Factor
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.3.4Responsibility to Obtain and Implement Durable Medical Equipment,
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 30.3.5File Specifications
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 40Clinical Diagnostic Laboratory Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 40.1Access to Clinical Diagnostic Lab Fee Schedule Files
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 40.2A/B MAC (B) Record Layout for Clinical Laboratory Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 40.3Institutional Claim Record Layout for Clinical Laboratory Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 40.4Gap-Filled Fees Submitted to CMS by A/B MACs (B)
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 40.4.1A/B MACs (B) Forward HCPCS Gap Fill Amounts to A/B MACs (A) and
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50Fee Schedules Used by Medicare A/B MACs (A) and (HHH) Processing
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.1Institutional Claim Record Layout for Hospice, Radiology and Other Diagnostic
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.2Institutional Claim Record Layout for the Durable Medical Equipment,
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.3Institutional Claim Record Layout for the Outpatient Rehabilitation and CORF
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.4Institutional Claim Record Layout for the Skilled Nursing Facility Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.5RESERVED
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.6Physician Fee Schedule Payment Policy Indicator File Record Layout
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.7Institutional
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 50.8Institutional Claim Record Layout for the Ambulance Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 60Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS) Fee
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 60.1Record Layout for DMEPOS Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 60.2Quarterly Update Schedule for DMEPOS Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 60.3Gap-filling DMEPOS Fees
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 60.3.1Payment Concerns While Updating Codes
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 60.4Process for Submitting Revisions to DMEPOS Fee Schedule to
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 60.5Rural ZIP Code Claim Record Layout for Medicare Contractors
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 70Parenteral and Enteral Nutrition (PEN) Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 70.1Record Layout for PEN Fee Schedule
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80Reasonable Charges as Basis for A/B MAC (B)/DME MAC Payments
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.1Criteria for Determining Reasonable Charge
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.2Updating Customary and Prevailing Charges
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.3The Customary Charge
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.3.1Calculating Customary Charge
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.3.1.1Equity Adjustments in Customary Charge Screens
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.3.2Customary Charge Profile
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.4Prevailing Charge
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.4.1Rounding of Reasonable Charge Calculation
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.5Filling Gaps in A/B MAC (B) Reasonable Charge Screens
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.5.1Use of Relative Value Scale and Conversion Factors for
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.6Inflation Indexed Charge (IIC) for Nonphysician Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.7Determination of Comparable Circumstances
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.8Applying Criteria for Reasonable Charge Determinations
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 80.8.1Waiver of Deductible and Coinsurance
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 90Inherent Reasonableness Used for Payment of Nonphysician Services
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 100Competitive Bidding Durable Medical Equipment Prosthetics,
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 100.1Record Layout for Competitive Bidding HCPCS Category File
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 100.2Record Layout for Competitive Bidding Pricing File
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 100.3Record Layout for Competitive Bidding ZIP Code File
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 100.4Record Layout for Competitive Bidding Contract Supplier File
- Medicare Claims Processing Manual (Pub. 100-04), Ch. 23 § 100.5Adjustments to the Single Payment Amounts to Reflect Changes