US · guidance
CMS Pub. 100-04, ch. 18, § 40.3
Deductible and Coinsurance
B3-4603.2.C, A3-3628.1.B.3
The Part B deductible for screening pelvic examinations is waived effective January 1, 1998.
Coinsurance is applicable.
A. Action When Submitting Claims to CWF and CWF Edit
B3-4603.4, B3-4603.6, A3-3628.1.C.1
When an A/B MAC (B) receives a claim for a pelvic examination, performed on or after January 1,
1998, it must enter a deductible indicator of 1 (not subject to deductible) in field 65 of the HUBC
record.
When an A/B MAC (A) receives a claim for a screening pelvic examination (including a clinical
breast examination), performed on or after January 1, 1998, it reports special override Code 1 in the
“Special Action Code/Override Code” field of the CWF record for the line item, indicating the Part
B deductible does not apply.
CWF edits for screening pelvic examinations performed more frequently than allowed according to
the presence of high risk factors.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
f500ba84c72fc09caf6380fa6967d3c63d4dc0789faddf01a36ccffd382396c6
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