US · guidance
CMS Pub. 100-01, ch. 3, § 20.4
Exceptions to Annual Deductible and Coinsurance
There is no deductible for screening mammography effective for services January 1, 1998
and later.
Neither the annual deductible nor the 20 percent coinsurance apply with respect to:
• Parts A and B home health services, except that there is a coinsurance of 20
percent of the payment amount for supplies, drugs, DME and prosthetics
/orthotics furnished as a home health benefit;
• Clinical diagnostic laboratory tests (including specimen collection fees)
performed or supervised by a physician, laboratory, or other entity paid on an
assigned basis;
• Pneumococcal vaccine and its administration;
• Influenza vaccine and its administration; and
• Services or items denied as medically unnecessary.
NOTE: Services which are not subject to the deductible cannot be used to satisfy the
deductible.
History
(Rev. 11, Issued: 10-22-04, Effective: 11-22-04, Implementation: 11-22-04)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
d367cf8688f589d1e56bad8387f8ccf99c49ee4a15ecfea7be2ca8b28ad0b1b3
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