Medicare Claims Processing Manual (Pub. 100-04), Ch. 19 § 100.7.2
A/B MAC (A) - CAH Ancillary Services -Medicare Part B -
100.7.2 - A/B MAC (A) - CAH Ancillary Services -Medicare Part B -
Payment Policy
(Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06)
Certain inpatient CAH ancillary services are covered under Medicare Part B when
coverage is no longer provided under Medicare Part A due to benefits exhausted, the
beneficiary is determined to be receiving a non-covered level of care, or is not eligible for
Medicare Part A benefits. Chapter 4, §240 of Pub. 100-04, Medicare Claims Processing
Manual contains information on the physician services and the nonphysician medical and
other health services covered under Medicare Part B when furnished by a participating
IHS provider to an inpatient of the CAH, but only if payment for these services cannot be
made under Medicare Part A.
The IHS CAHs are paid for covered inpatient Medicare Part B ancillary services based
upon 101 percent of an all inclusive facility specific per diem rate that is established on a
yearly basis from prior year cost report information. Medicare Part B deductible and
coinsurance amounts are applied to inpatient Medicare Part B ancillary services, but are
waived by the IHS.