CMS Pub. 100-04, ch. 18, § 20.4.2.1

Reimbursement Report (PS&R)

(Rev. 3844, Issued: 08-18-17, Effective: 01-01-18, Implementation: 01-02-18)

The CWF records are annotated with the date of the first (technical) screening mammography

claim received. The record is updated based on the next covered (technical) claim received. A/B

MACs (A) and (B) assume the claim is the first received for the beneficiary where records do not

contain a date of last screening and process accordingly.

The A/B MACs (A) include revenue code, HCPCS code, units, and covered charges in the CWF

record fields with the same name. They report the payment amount for revenue code 0403 in the

CWF field named “Rate” and the billed charges in the field named “Charges” of the CWF record.

In addition, A/B MACs (A) report special override code 1 in the field named “Special Action” of

the CWF record to avoid application of the Part B deductible.

The A/B MACs (A) include in the financial data portion of the PS&R record, revenue code,

HCPCS code, units, charges, and rate (fee schedule amount).

The PS&R system will include screening mammographies on a separate report from cost-based

payments. See the PS&R guidelines for specific information.