US · guidance
CMS Pub. 100-04, ch. 32, § 150.8
A/MAC Billing Requirements
The A/MAC billing requirements will pay for bariatric surgery only when the services are submitted on the
following type of bill (TOB): 11X. Type of facility and setting determines the basis of payment:
• For services performed in Indian Health Services inpatient hospitals, TOB 11X under the inpatient
prospective payment system (IPPS) is based on the diagnosis-related group (DRG).
• For services performed in inpatient hospitals, TOB 11X under IPPS is based on the DRG.
• For services performed in IHS critical access hospitals (CAHs), TOB 11X, payment is based on 101%
facility specific per diem rate.
• For services performed in CAH inpatient hospitals, TOB 11X, payment is based on 101% of reasonable
cost.
History
(Rev. 2841, Issued: 12-23-13, Effective: 09-24-13, Implementation: 12-17-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
687838ced60a7e58bc593b7292f13027c9e1d92a3db5ec44f17a6e60d79c9047
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.