Institutional Billing for National Coverage Determination (NCDs) services that are

66.1 – Institutional Billing for National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage (Rev. 10229, Issued: 07-21-20 Effective: 10-01-20, Implementation: 10-05-20) A. Institutional Inpatient Billing for National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage. The Medicare contractors shall allow Condition Code (CC) 78 on any inpatient institutional claims for Medicare Advantage beneficiaries when it is determined that certain services are being disallowed on MA plans that are considered a significant cost under section 422.109(a)(2) of title 42 of the Code of Federal Regulations. Any current editing that doesn’t allow this shall be updated to allow this scenario, unless there has been previous instructions excluding certain conditions. Note: Condition Code 78 = Newly covered Medicare service for which an HMO doesn't pay. B. Institutional Outpatient Billing for National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage The Medicare contractors shall allow Condition Code (CC) 78 on any outpatient institutional claims for Medicare Advantage beneficiaries when it is determined that certain services are being disallowed on MA plans that are considered a significant cost under section 422.109(a)(2) of title 42 of the Code of Federal Regulations. Any current editing that doesn’t allow this shall be updated to allow this scenario, unless there has been previous instructions excluding certain conditions. Note: Condition Code 78 = Newly covered Medicare service for which an HMO doesn't pay.