US · guidance
CMS Pub. 100-04, ch. 18, § 50.3
Payment Method - A/B MACs (A) and (B)
Screening PSA tests (G0103) are paid under the clinical diagnostic lab fee schedule.
Screening PSA tests (Effective 01/01/23 (0359U)) new codes are contractor-priced (where
applicable) until they are nationally priced and undergo the CLFS annual payment determination
process.
Screening rectal examinations (G0102) are paid under the MPFS except for the following bill types
identified (A/B MAC (A) only). Bill types not identified are paid under the MPFS.
12X = Outpatient Prospective Payment System
13X = Outpatient Prospective Payment System
14X-=Outpatient Prospective Payment System
71X = Included in All Inclusive Rate
73X = Included in All Inclusive Rate
85X = Cost (Payment should be consistent with amounts paid for code 84153 or code 86316.)
Effective 4/1/06 the type of bill 14X is for non-patient laboratory specimens.
The RHCs and FQHCs should include the charges on the claims for future inclusion in encounter
rate calculations.
History
(Rev. 11902; Issued:03-16-23; Effective: 04-17-23; Implementation: 04-17-23)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
56f4d2c0d2a95d549dd1f780747c2f80e5529b2da361e6d50cf124fef1bca697
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