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US · guidance

CMS Pub. 100-01, ch. 3, § 20.4

Exceptions to Annual Deductible and Coinsurance

activein force · 2026-08-25 – presentas-observed

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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