Deductible Application

50.2 - Deductible Application (Rev. 1, 10-03-03) A-03-066 Pricer determines the deductible for OPPS services on a claim, and the A/B MAC (A) determines the deductible for other services on the same claim. Pricer will automatically apply the deductible to the APC line item with the largest national unadjusted coinsurance as a percent of the APC payment. Pricer then goes to the next largest coinsurance as a percent of the APC payment and so on until the deductible is met or no other payments can be used to satisfy the deductible. This method of applying the deductible is the most advantageous for the beneficiary. If less than $100, or less than the beneficiary’s remaining deductible amount is applied, an additional deductible amount from other services, if applicable, is applied to the claim for other types of payments on the same claim before submitting to CWF. The deductible does not apply to the influenza virus vaccines, pneumococcal pneumonia vaccine, clinical diagnostic laboratory services (which include screening pap smears), screening mammographies, screening pelvic examinations, and screening prostate examinations. Only influenza virus vaccine, pneumococcal pneumonia vaccine, screening pelvic examinations and screening prostate examinations are subject to OPPS.