CMS Pub. 100-04, ch. 18, § 110.3

If the screening is provided in a physician office, the service is billed to the A/B MAC (B) using the HCPCS code

identified in section 110.3.2 below. Payment is under the Medicare Physicians Fee Schedule (MPFS).

A/B MACs (A) shall pay for the AAA screening only when the services are performed in a hospital, including a

critical access hospital (CAH), Indian Health Service (IHS) Facility, Skilled Nursing Facility (SNF), Rural Health

Clinic (RHC), or Federally Qualified Health Center (FQHC) and submitted on one of the following types of bills

(TOBs): 12X, 13X, 22X, 23X, 71X, 73X, 85X.

The following describes the payment methodology for AAA Screening:

Facility Type of Bill Payment

Hospitals subject to OPPS 12X, 13X OPPS

Method I and Method II

Critical Access Hospitals

(CAHs)

12X and 85X 101% of reasonable cost

IHS providers 13X, revenue code 051X OMB-approved outpatient

per visit all inclusive rate

(AIR)

IHS providers 12X, revenue code 024X All-inclusive inpatient

ancillary per diem rate

IHS CAHs 85X, revenue code 051X 101% of the all-inclusive

facility specific per visit

rate

IHS CAHs 12X, revenue code 024X 101% of the all-inclusive

facility specific per diem

rate

SNFs ** 22X, 23X Non-facility rate on the

MPFS

RHCs* 71X, revenue code 052X All-inclusive encounter rate

FQHCs* 73X, revenue code 052X All-inclusive encounter rate

Maryland Hospitals under

jurisdiction of the Health

Services Cost Review

Commission (HSCRC)

12X, 13X 94% of provider submitted

charges or according to the

terms of the Maryland

Waiver

* If the screening is provided in an RHC or FQHC, the professional portion of the service is billed to the A/B MAC

(A) using TOBs 71X and 73X, respectively, and the appropriate site of service revenue code in the 052X revenue

code series.

If the screening is provided in an independent RHC or freestanding FQHC, the technical component of the service can

be billed by the practitioner to the A/B MAC (B) under the practitioner’s ID following instructions for submitting

practitioner claims to the Medicare A/B MAC (B).

If the screening is provided in a provider-based RHC/FQHC, the technical component of the service can be billed by

the base provider to the A/B MAC (A) under the base provider’s ID, following instructions for submitting claims to

the A/B MAC (A) from the base provider.

** The SNF consolidated billing provision allows separate part B payment for screening services for beneficiaries that

are in skilled Part A SNF stays, however, the SNF must submit these services on a 22X bill type. Screening services

provided by other provider types must be reimbursed by the SNF.