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CMS Pub. 100-04, ch. 19, § 100.5

A/B MAC (A) - Outpatient - Medicare Part B - Payment Policy

activein force · 2026-08-25 – presentas-observed

The IHS providers are paid for covered outpatient services based upon an all inclusive

outpatient per visit rate (AIR). The AIR is established by CMS and IHS based upon a

review of yearly cost reports prepared by IHS’s contractor. Upon completion of the

review, IHS submits the agreed upon rate to OMB for approval. Upon approval by OMB,

IHS publishes the approved rate in the Federal Register. The AIR is established for each

calendar year. The approved AIR is issued periodically in a Recurring Update

Notification.

Medicare Part B deductible and coinsurance amounts are applied to outpatient services,

but are waived by the IHS.

These rates are not all inclusive inpatient ancillary per diem rates and should not be

confused with the all-inclusive inpatient ancillary per diem rates paid to IHS providers

for services covered under Medicare Part B when coverage is no longer provided under

Medicare Part A. For more information on the all-inclusive inpatient ancillary per diem

rates, see §100.3.4 of this chapter.

History

(Rev. 1511; Issued: 05-23-08; Effective: 01-01-08; Implementation: 06-23-08)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
902d67f54e8af2e184784c6525c2c415c0ab0bace58b51faa3704aaa566e4122
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