Deductible and Coinsurance

40.3 - Deductible and Coinsurance (Rev. 1, 10-01-03) B3-4603.2.C, A3-3628.1.B.3 The Part B deductible for screening pelvic examinations is waived effective January 1, 1998. Coinsurance is applicable. A. Action When Submitting Claims to CWF and CWF Edit B3-4603.4, B3-4603.6, A3-3628.1.C.1 When an A/B MAC (B) receives a claim for a pelvic examination, performed on or after January 1, 1998, it must enter a deductible indicator of 1 (not subject to deductible) in field 65 of the HUBC record. When an A/B MAC (A) receives a claim for a screening pelvic examination (including a clinical breast examination), performed on or after January 1, 1998, it reports special override Code 1 in the “Special Action Code/Override Code” field of the CWF record for the line item, indicating the Part B deductible does not apply. CWF edits for screening pelvic examinations performed more frequently than allowed according to the presence of high risk factors.