Special Billing and Payment Requirements Medicare Advantage (MA)

70.5 - Special Billing and Payment Requirements Medicare Advantage (MA) Beneficiaries (Rev. 261, Issued: 07-30-04, Effective: 10-01-04, Implementation: 10-04-04) CMS will make payment directly on a fee-for service basis for the routine costs of pancreatic islet cell transplants as well as transplantation and appropriate related items and services, for MA beneficiaries participating in an NIH-sponsored clinical trial. MA organizations will not be liable for payment for routine costs of this new clinical trial until MA payments can be appropriately adjusted to take into account the cost of this national coverage decision. Medicare contractors shall make payment on behalf of MA organizations directly to providers of these islet cell transplants in accordance with Medicare payment rules, except that beneficiaries are not responsible for the Part A and Part B deductibles. MA enrollees will be liable for any applicable coinsurance amounts MA organizations have in place for clinical trial benefits. E10.649 Type 1 diabetes mellitus with hypoglycemia without coma E10.8 Type 1 diabetes mellitus with unspecified complications