Medicare Claims Processing Manual

you can find guidance about coverage and billing for preventive and screening serves in Chapter 18 of the

Medicare Claims Processing Manual

Chapter 18 - Preventive and Screening Services
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf

Major Category IV: Excluded Preventive and Screening Services

Preventive and screening services are excluded from the Part A payment made under the SNF PPS, but are subject to SNF CB. As such, they are separately payable under Medicare Part B, but only to the SNF. The SNF must bill the services listed on the next page for beneficiaries in a Part A stay with Part B eligibility on TOB 22X.

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The first two files list codes that physicians, nonphysician practitioners, and suppliers (other than ambulance suppliers) can bill separately to the Part B MAC. If neither file lists the code for the service, the service is subject to SNF consolidated billing and the physician, nonphysician practitioner, or supplier must look to the SNF for payment of the service. The MAC will not pay for the service.
For more information and to access the files, visit http://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/FileExplanation.html

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Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

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Preliminary ICD-10-CM CMS HCC Mappings

The link below take you to the Preliminary ICD-10-CM Codes, CMS-HCC and RxHCC Models, Includes FY2014 preliminary list of ICD-10 codes HCC Mappings from CMS. Last modified 9/30/2014. Preliminary ICD-10-CM Mappings Diagnosis Code Description CMS-HCC PACE/ESRD Model Category V21 CMS-HCC Model Category V22 (clinically revised model implemented in 2014) RxHCC Model Category V04 CMS-HCC PACE/ESRD Model for 2015 Payment Year CMS-HCC Model for 2015 Payment Year RxHCC Model for 2015 Payment Year #HCC #ICD10 #CMS #ICD9 #RiskAdjustment #MedicalCoding #Mappings Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials.

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