Payment Rules

40 - Payment Rules (Rev. 1502; Issued: 05-09-08; Effective/Implementation Date: 06-09-08) A single payment amount is established for each competitive bid item for each CBA based on the bids submitted and accepted for that item. All payment for competitive bidding items is made on an assignment related basis. The payment basis for an item is 80 percent of the applicable single payment amount for the CBA in which the beneficiary maintains a permanent residence, less any unmet Part B deductible described in §1833(b) of the Act. If an item that is included in a competitive bidding program is furnished to a beneficiary who does not maintain a permanent residence in a CBA, the payment basis for the item is 80 percent of the lesser of the actual charge of the item, or the applicable fee schedule amount for the item. The single payment amount calculated for each item under each competitive bidding program is paid for the duration of the competitive bidding program and will not be adjusted by any update factor. Payment for items or services furnished by a supplier under the Medicare Secondary Payer rules will be calculated in accordance with the established related payment rules.