CMS Pub. 100-04, ch. 12, § 20.5

B3-15054

A/B MACs (B) may not make adjustments in fee schedule amounts provided by CMS for:

• Inherent reasonableness;

• Comparability;

• Multiple visits to nursing homes (i.e., when more than one patient is seen during the

same trip);

• Refractions - If A/B MACs (B) receive a claim for a service that also indicates that a

refraction was done, A/B MACs (B) do not reduce payment for the service. The CMS

has already made the reduction in the fee for refractions provided to A/B MACs (B);

• HCPCS alpha-numeric modifiers AT (acute treatment), ET (emergency treatment), LT

(left side of body), RT (right side of body), and SF (second opinion ordered by PRO);

• CPT modifiers -23 (unusual anesthesia), -32 (mandated services), -47 (anesthesia by

surgeon), -76 (repeat procedure by same physician), and -90 (reference laboratory); and

• A/B MAC (B)-unique local modifiers (HCPCS Level 3 modifiers beginning with the

letters w through z).