Fee Schedules Used by Medicare A/B MACs (A) and (HHH) Processing

50 - Fee Schedules Used by Medicare A/B MACs (A) and (HHH) Processing Institutional Claims (Rev. 2643, Issued: 01-31-13, Effective: 07-01-13, Implementation: 07-01-13) A/B MACs (A) and (HHH) processing institutional claims retrieve multiple files from the CMS mainframe telecommunications system. The HCPCS data files include deleted codes for the upcoming year. A/B MACs (A) and (HHH) need to identify deleted codes using the HCPCS files because they are not identifiable solely from the fee schedules. HCPCS files are also obtained from CMS annually. New fee schedules are effective for dates of service on and after January 1 of each year. Quarterly and emergency updates to the fee schedules are also sometimes released. In that case, A/B MACs (A) and (HHH) implement them according to the instructions accompanying the release. Two HCPCS files are furnished by CMS. They are: • The annual HCPCS file update including procedure and modifier codes and deleted codes; and • A print file of the new year HCPCS codes. The following fee schedules are furnished by CMS for use in processing institutional claims: • Fees for hospice claims for Part B services provided by the hospice beneficiary’s attending physician; • Medicare Physician Fee Schedule; • Clinical Laboratory Fee Schedule discussed in §40.3 above; • Durable Medical Equipment, Prosthetics/Orthotics and Supplies (DMEPOS) Fee Schedule. A/B MACs (HHH) with home health workloads retrieve data from all categories on this file. All MACs retrieve data from categories prosthetic/orthotics and surgical dressings; • Outpatient Rehabilitation (Therapy) and CORF Services Fee Schedule Payment Amounts (Therapy/CORF Abstract File); • CORF, outpatient Critical Access Hospital (CAH and Indian Health Services not part of the Outpatient Rehabilitation (therapy) file; and • Skilled Nursing Facility (SNF) extract file for radiology, other diagnostic and other SNF services.