General Payment Rules and Application of Part B Deductible and

10.5 - General Payment Rules and Application of Part B Deductible and Coinsurance (Rev. 685, Issued: 09-23-05, Effective: 12-27-05, Implementation: 12-27-05) SNF-529.3 Section 1888(e)(9) of the Social Security Act (the Act) requires that the payment amount for Part B SNF services shall be the amount prescribed in the otherwise applicable fee schedule. Thus, where a fee schedule exists for the type of service, the fee amount will be paid. Where a fee does not exist on the Medicare Physician Fee Schedule (MPFS) the particular service is priced based on cost. This is also true for all “carrier-priced” codes on the MPFS, but not for services paid on the Clinical Diagnostic Laboratory Fee Schedule. All lab services missing fees are to be gap-filled. Some specific services continue to be paid on a cost basis and are specifically stated in the sections below where cost applies. Where payment is made under a fee schedule, the beneficiary's deductible and coinsurance are based on the approved amount. Where payment is made on a cost basis, deductible and coinsurance are based on charges for the service.