New Payment Requirement for A/B MACs (A)

10.1 - New Payment Requirement for A/B MACs (A) (Rev. 1, 10-01-03) Effective with claims with dates of service on or after July 1, 2003, OPTs/outpatient rehabilitation facilities (ORFs), (74X and 75X bill type) are required to report all their services utilizing HCPCS. A/B MACs (A) are required to make payment for these services under the MPFS unless the item or service is currently being paid under the orthotic fee schedule or the item is a drug, biological, supply or vaccine (see below for an explanation of these services). The CMS currently provides A/B MACs (A) with a CORF supplemental file that contains all physician fee schedule services and their related prices. A/B MACs (A) use this file to price and pay OPT claims. The format of the record layout is provided in Attachment E of PM A-02-090, dated September 27, 2002. This is located in Chapter 23, section 50.3. A/B MACs (A) will be notified in a one-time instruction of updates to this file and when it will be available for retrieval. If an A/B MAC (A) receives a claim for one of the above HCPCS codes with dates of service on or after July 1, 2003, that does not appear on the CORF supplemental file it currently uses to pay the CORF claims, it contacts its local A/B MAC (B) to obtain the price in order to pay the claim. When requesting the pricing data, it advises the A/B MAC (B) to provide it with the nonfacility fee.