CMS Pub. 100-04, ch. 19, § 20.2

Section 630 of the MMA, indefinitely extended by §2902 of the ACA, extended to IHS

providers, suppliers, physicians and practitioners, independent ambulance suppliers,

hospital based ambulance providers and clinical laboratory service suppliers the ability to

bill for all Medicare Part B covered services and items which were not covered under

BIPA. This includes all screening and preventive services covered by Medicare. This

chapter contains the effective dates for services implemented under §630 of the MMA

and §2902 of the ACA.

Beginning January 1, 2005, IHS providers and suppliers may bill Medicare for the

following Medicare Part B services:

• DME;

• Prosthetics and orthotics;

• Prosthetic devices;

• Surgical dressings, splints and casts;

• Therapeutic shoes;

• Drugs (A/B MAC and DME MAC drugs);

• Clinical laboratory services;

• Ambulance services; and

• Screening and preventive services not already covered.

Payment is made on the AIR for IHS providers. Payment is made on the appropriate fee

schedule for IHS suppliers:

• The Medicare Physician Fee Schedule (MPFS);

• The Clinical Diagnostic Laboratory Fee Schedule;

• The Ambulance Fee Schedule;

• The DMEPOS Fee Schedule;

• The Anesthesia Fee Schedule; or

• DME MAC Drugs - based on the average sales price (ASP).

The nature of the provider or supplier, the location where the service is furnished and the

service being rendered determines which MAC shall be billed. Most services that are paid

under a fee schedule are billed to either the designated A/B MAC (B) or the (regional)

DME MAC. Some fee schedule paid services are billed to the designated A/B MAC (A).

For example, physical therapy may be billed to the designated A/B MAC (B) by an

independent practitioner, but is billed to the A/B MAC (A) when provided by a hospital

outpatient department or by a hospital-based facility.

Refer to §80.3 of this chapter for more information on the claims processing jurisdiction

for claims filed by IHS independent ambulance suppliers.

Refer to §80.7.1 of this chapter for more information on the claims processing

jurisdiction for claims filed by freestanding facilities for clinical laboratory services.

Refer to §90.2.1 of this chapter for more information on the services billed to DME

MAC.

Refer to §90.2.1.1 of this chapter for more information on the services billed to the A/B

MAC (A).

Refer to Chapter 1, §10.1.9 of Pub. 100-04, Medicare Claims Processing Manual, for

information on misdirected claims.