CMS Pub. 100-04, ch. 18, § 20.3.1.2

Payment to a CAH for screening mammography is not subject to applicable Part B deductible, but

coinsurance does apply. Any deductible or coinsurance collected is deducted from the payment.

A. Under the Optional (All Inclusive) Method

Section 403(d) of the BBRA amended §1834(g) of the Act to permit a CAH to elect an optional

method of payment for outpatient services. This option is effective for cost reporting periods

beginning on or after October 1, 2001. A CAH may elect to be paid for outpatient services by

reasonable costs for facility services and §202 of BIPA allows an amount equal to 115 percent of

the allowed amount for professional component. (Costs related to professional services are

excluded from the cost payment.)

CAHs electing the optional method of reimbursement bill the A/B MAC (A) with type of bill 85X,

revenue code 0403 and HCPCS code 77067* (G0202*). They also include the professional

component on a separate line, with revenue code 96X, 97X, or 98X and HCPCS code 77067*

(G0202*).

B. Under the Standard Method

CAHs reimbursed on the standard method of payment bill the technical component of a screening

mammography to the A/B MAC (A) on type of bill 85X, revenue code 0403 and HCPCS code

77067* (G0202*).

Professional services are billed to the A/B MAC (B) and paid based on the fee schedule by the A/B

MAC (B).

For claims with dates of service on or after January 1, 2002, §104 of the Benefits Improvement and

Protection Act (BIPA) 2000, provides for payment of screening mammographies under the

Medicare physician fee schedule (MPFS) in CAHs not electing the optional method of payment for

outpatient services.