No Adjustments in Fee Schedule Amounts

20.5 - No Adjustments in Fee Schedule Amounts (Rev. 1, 10-01-03) B3-15054 A/B MACs (B) may not make adjustments in fee schedule amounts provided by CMS for: • Inherent reasonableness; • Comparability; • Multiple visits to nursing homes (i.e., when more than one patient is seen during the same trip); • Refractions - If A/B MACs (B) receive a claim for a service that also indicates that a refraction was done, A/B MACs (B) do not reduce payment for the service. The CMS has already made the reduction in the fee for refractions provided to A/B MACs (B); • HCPCS alpha-numeric modifiers AT (acute treatment), ET (emergency treatment), LT (left side of body), RT (right side of body), and SF (second opinion ordered by PRO); • CPT modifiers -23 (unusual anesthesia), -32 (mandated services), -47 (anesthesia by surgeon), -76 (repeat procedure by same physician), and -90 (reference laboratory); and • A/B MAC (B)-unique local modifiers (HCPCS Level 3 modifiers beginning with the letters w through z).