CMS Pub. 100-04, ch. 23, § 80.4.1

B3-5021

A/B MAC (B) screens should include both dollars and cents. Rounding of customary and

prevailing charges should not normally take place with one exception.

Rounding is permitted in situations where the A/B MAC (B)’s customary charge

calculation is clearly erroneous and results in a peculiar or odd cent amount, e.g., $8.33. In

such an instance, rounding to the nearest l0 cents is permissible, pending the required

correction of the calculation, where the data result in a customary charge that is not in 25-cent or 75-cent units. For other than the 25-cent or 75-cent amounts, fractional amounts

ending in 5-cent increments should be rounded up to the nearest l0 cents. However, where

the A/B MAC (B) knows the odd cents in a customary charge calculation are correct, e.g.,

because a sales tax is involved in the charges made by a physician, then no rounding of the

odd cents should take place.

The above exception applies only to customary charge calculations, and not to prevailing

charges. The exception is permissible only as an interim measure to deal with an

immediate problem. The A/B MAC (B) should promptly identify the cause of the error and

take appropriate corrective action.

There should be no need for rounding initial prevailing charge calculations since actual

customary charges are used to establish these screens.