Items and Services Not Covered Under Medicare

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services 

Items and Services Not Covered Under Medicare

 

ICN 906765  January 2017

PREFACE

This publication provides information on the four categories of items and services not covered under Medicare and applicable exceptions (items and services that may be covered). The discussion is not intended to provide an all-inclusive list of all items and services Medicare may or may not cover.

Please note: Any item or service furnished directly or indirectly by an individual or entity excluded by the Office of Inspector General from participating in all Federal health care programs is a non-covered item or service pursuant to Section 1862(e) of the Social Security Act.

When “you” is used in this publication, we are referring to Medicare providers and suppliers.

THE FOUR CATEGORIES OF ITEMS AND SERVICES NOT COVERED UNDER MEDICARE AND APPLICABLE EXCEPTIONS

Learn about these four categories of items and services not covered under Medicare:

  • Services and supplies that are not medically reasonable and necessary
  • Non-covered items and services
  • Services and supplies denied as bundled or included in the basic allowance of another service
  • Items and services reimbursable by other organizations or furnished without charge

Where applicable, this publication also provides information on exceptions (items and services that may be covered).

1) Services and Supplies That Are Not Medically Reasonable and Necessary

Services and supplies that are not medically reasonable and necessary to the overall diagnosis and treatment of the beneficiary’s condition are not covered. Some examples include:

  • Services furnished in a hospital that, based on the beneficiary’s condition, could have been furnished in a lower-cost setting (for example, the beneficiary’s home or a nursing home)
  • Hospital services that exceed Medicare length of stay limitations
  • Evaluation and management services that exceed those considered medically reasonable and necessary
  • Therapy or diagnostic procedures that exceed Medicare usage limits
  • Screening tests, examinations, and therapies for which the beneficiary has no symptoms or documented conditions, with the exception of certain screening tests, examinations, and therapies as described below under Exceptions (Items and Services That May Be Covered)
  • Services not warranted based on the diagnosis of the beneficiary (for example, acupuncture and transcendental meditation)
  • Items and services administered to a beneficiary for the purpose of causing or assisting in causing death (assisted suicide)

Services must meet specific medical necessity requirements contained in the statute, regulations, and manuals and specific medical necessity criteria defined by National Coverage Determinations and Local Coverage Determinations (if any exist for the service being reported). For every service billed, you must indicate the specific sign, symptom, or beneficiary complaint that makes the service reasonable and necessary.

Exceptions (Items and Services That May Be Covered)

These items and services may be covered:

  • Annual Wellness Visit
  • Initial Preventive Physical Examination (also known as the “Welcome to Medicare Preventive Visit”)
  • Colorectal cancer screening
  • Screening mammography
  • Clinical breast examinations
  • Screening Pap tests
  • Screening pelvic examinations
  • Prostate cancer screening
  • Cardiovascular disease screenings
  • Diabetes screening tests
  • Glaucoma screening
  • Human Immunodeficiency Virus (HIV) screening
  • Bone mass measurements
  • Medical nutrition therapy (for certain beneficiaries diagnosed with diabetes, renal disease, or who have received a kidney transplant within the last 3 years)
  • Diabetes Self-Management Training (for beneficiaries diagnosed with diabetes)
  • Vaccines
  • Ultrasound screening for abdominal aortic aneurysm
  • Intensive behavioral therapy for cardiovascular disease
  • Intensive behavioral therapy for obesity
  • Counseling to prevent tobacco use for asymptomatic beneficiaries
  • Screening for depression
  • Screening and behavioral counseling interventions in primary care to reduce alcohol misuse
  • Screening for sexually transmitted infections (STI) and high intensity behavioral counseling to prevent STIs
  • Screening for Hepatitis C virus
  • Screening for lung cancer
  • Transitional Care Management
  • Chronic Care Management
  • Advance Care Planning

Items and services administered for the purpose of alleviating pain or discomfort, even if such use may increase the risk of death, may be covered provided they are not furnished for the specific purpose of causing death.

2) Non-Covered Items and Services

A) Items and Services Furnished Outside the U.S.

Most items and services furnished or delivered outside the U.S. are not covered, including when the beneficiary was within the U.S. when the contract to purchase the item was made or the item was purchased from an American firm. Payment will not be made for a medical service (or a portion of it) that was subcontracted to another provider or supplier located outside the U.S.

Medicare does not pay for provider professional services furnished outside the U.S., except for certain limited services as described below under Exceptions (Items and Services That May Be Covered). For Part A and Part B purposes, the Centers for Medicare & Medicaid Services (CMS) recognizes these jurisdictions as being within the U.S.:

  • The 50 States
  • The District of Columbia
  • The Commonwealth of Puerto Rico
  • The U.S. Virgin Islands
  • Guam
  • The Commonwealth of the Northern Mariana Islands
  • American Samoa
  • Territorial waters adjoining the land areas of the U.S. (for services furnished on board a ship)

A hospital is considered outside the U.S. if it is not physically located in one of the jurisdictions listed above, even if it is owned or operated by the

Exceptions (Items and Services That May Be Covered)

These services may be covered:

  • Emergency inpatient hospital services furnished at a foreign hospital provided the foreign hospital is closer to, or more accessible from, the place the emergency arose than the nearest U.S. hospital that is adequately equipped and available to deal with the emergency. One of these conditions must also exist:
  • The beneficiary was physically present in the U.S. at the time of the emergency.
  • The beneficiary was physically present in Canada when the emergency arose, and he or she was traveling by the most direct route without unreasonable delay between Alaska and another State.
  • Emergency or nonemergency inpatient hospital services furnished by a hospital located outside the S. provided the hospital is closer to, or substantially more accessible from, the beneficiary’s U.S. residence than the nearest participating U.S. hospital that is adequately equipped to deal with and available to treat the illness or injury.
  • Physician and ambulance services furnished in connection with covered foreign inpatient hospital services when these criteria are met:
    • The physician is legally authorized to practice in the country where he or she furnishes the services.
    • The ambulance supplier meets Medicare’s definition of an ambulance.

Payment will not be made for any other Part B outpatient, medical, and other health services furnished outside the U.S.

  • Services furnished on board a ship in a U.S. port or furnished within 6 hours of when the ship arrived at or departed from a U.S.

Services that do not meet this requirement are considered furnished outside U.S. territorial waters, even if the ship is of U.S. registry.

B) Items and Services Required as a Result of War

Items and services required as a result of war or an act of war and that occur after the effective date of the beneficiary’s current entitlement are not covered.

C) Personal Comfort Items and Services

Personal comfort items are not covered because these items do not meaningfully contribute to the treatment of a beneficiary’s illness or injury or the functioning of a malformed body member. Some examples of personal comfort items are:

  • Radios
  • Televisions
  • Beauty and barber services, except as described below under Exceptions (Items and Services That May Be Covered)

When a beneficiary requests a personal comfort item, you should inform him or her that there is a specified charge for the item. The specified charge may not exceed the customary charge, and future charges may not be more than the amount specified.

You cannot require the beneficiary to request non-covered items or services as a condition of admission or continued stay.

Exceptions (Items and Services That May Be Covered)

Certain basic personal services that residents in Skilled Nursing Facilities (SNFs) and general

psychiatric hospitals need and cannot perform for themselves may be covered. Some examples include:

  • Shaves
  • Haircuts
  • Shampoos
  • Simple hair sets

These services may be considered ordinary resident care and covered costs are reimbursable under Part A when they are:

  • Furnished by a long-stay institution
  • Included in the flat rate charge
  • Routinely furnished without charge to the beneficiary

D) Routine Physical Checkups; Certain Eye Examinations, Eyeglasses and Lenses; Hearing Aids and Examinations; and Certain Immunizations

These routine items and services are not covered:

  • Routine or annual physical checkups, except as described in the Exceptions (Items and Services That May Be Covered) Section under 1) Services and Supplies That Are Not Medically Reasonable and Necessary
  • Physical examinations performed without a specific sign, symptom, or beneficiary complaint necessitating the service or required by third parties (for example, insurance companies, business establishments, or Government agencies)
  • Eye examinations for the purpose of prescribing, fitting, or changing eyeglasses
  • Eye refractions furnished by all practitioners for any purpose
  • Eyeglasses and contact lenses
  • Examinations for hearing aids
  • Hearing aids
  • Immunizations, except as described in the Exceptions (Items and Services That May Be Covered) Section under 1) Services and Supplies That Are Not Medically Reasonable and Necessary

Exceptions (Items and Services That May Be Covered)

These items and services may be covered:

  • Physician services performed in conjunction with an eye disease (for example, glaucoma and cataracts)
  • Services performed “incident to” physician services in conjunction with an eye disease
  • One pair of eyeglasses or contact lenses after each cataract surgery with insertion of an intraocular lens
  • Vaccinations directly related to the treatment of an injury or direct exposure to a disease or condition (for example, antirabies treatment and immune globulin)
  • Vaccinations specifically covered by statute (for example, seasonal influenza virus, pneumococcal, and Hepatitis B)
  • A reasonable supply of antigens (not more than a 12-week supply prepared for a particular beneficiary) a doctor of medicine (MD) or a doctor of osteopathy (DO) prepares after examining the beneficiary and determining a plan of treatment and dosage regimen
  • Certain devices that produce perception of sound by replacing the function of the middle ear, cochlea, or auditory nerve and are indicated only when hearing aids are medically inappropriate or cannot be utilized due to:
    • Congenital malformations
    • Chronic disease
    • Severe sensorineural hearing loss
    • Surgery

These devices, which are payable as prosthetic devices, include:

  • Cochlear implants and auditory brainstem implants that replace the function of cochlear structures or the auditory nerve and provide electrical energy to auditory nerve fibers and other neural tissue via implanted electrode arrays
  • Osseointegrated implants that replace the function of the middle ear and provide mechanical energy to the cochlea via a mechanical transducer

E) Custodial Care

Custodial care furnished in the beneficiary’s home or an institution is not covered. Custodial care is personal care that does not require the continuing attention of trained medical or paramedical personnel and serves to assist an individual in the activities of daily living. These activities are considered custodial care:

  • Walking
  • Getting in and out of bed
  • Bathing
  • Dressing
  • Feeding
  • Using the toilet
  • Preparing a special diet
  • Supervising the administration of medication that can usually be self-administered

Exceptions (Items and Services That May Be Covered)

Individual reasonable and necessary services may be covered under Part B even though Part A denies coverage of a beneficiary’s overall hospital or SNF stay because it is determined to be custodial.

Care furnished to a beneficiary who has elected the hospice care option is considered custodial only if it is not reasonable and necessary for the palliation or management of the terminal illness and related conditions.

F) Cosmetic Surgery

Cosmetic surgery and expenses incurred in connection with cosmetic surgery are not covered. Cosmetic surgery includes any surgical procedure directed at improving the beneficiary’s appearance.

Exceptions (Items and Services That May Be Covered)

The prompt (as soon as medically feasible) repair of an accidental injury or the improvement of the functioning of a malformed body member may be covered. Some examples include:

  • Surgery performed in connection with the treatment of severe burns
  • Surgery to repair the face following a serious automobile accident
  • Surgery for therapeutic purposes that may coincidentally also serve some cosmetic purpose

G) Items and Services Furnished by the Beneficiary’s Immediate Relatives and Members of the Beneficiary’s Household

Payment for items and services furnished by the beneficiary’s immediate relatives and members of the beneficiary’s household will not be made since these items and services are ordinarily furnished gratuitously because of the relationship between the beneficiary and the provider or supplier.

A beneficiary’s immediate relatives include the following degrees of relationship:

  • Husband or wife
  • Natural or adoptive parent, child, or sibling
  • Stepparent, stepchild, stepbrother, or stepsister
  • Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law
  • Grandparent or grandchild
  • Spouse of grandparent or grandchild

If the marriage upon which a step- or in-law relationship is based becomes terminated through divorce or death, the prohibited relationship will continue to exist.

Members of the beneficiary’s household include the following who share a common abode with him or her as part of a single family unit:

  • Individuals who are related by blood, marriage, or adoption
  • Domestic employees
  • Other individuals who live together as part of a single family unit (does not include roomers or boarders)

Payment will also not be made for these items and services:

  • Charges for services furnished by a physician or supplier with a prohibited relationship to the beneficiary submitted by an unrelated individual, partnership, or professional corporation
  • Those services furnished “incident to” a physician’s professional service when the ordering or supervising physician has a prohibited relationship to the beneficiary

A professional corporation is:

  • Completely owned by one or more physicians or is owned by other health care professionals as authorized by State law
  • Operated for the purpose of conducting the practice of medicine, osteopathy, dentistry, podiatry, optometry, or chiropractic

Any physician or group of physicians that is incorporated constitutes a professional corporation. Items and services furnished by non-physician suppliers that have a prohibited relationship with the beneficiary and are not incorporated will not be paid, regardless of whether the supplier is owned by a sole proprietor who is related to the beneficiary or owned by a partnership in which one of the partners is related to the beneficiary. This payment restriction does not apply to a corporation (other than a professional corporation), regardless of the beneficiary’s relationship to any of the stockholders, officers, or directors of the corporation or to the individual who furnished the service.

H) Dental Services

Items and services furnished in connection with the care, treatment, filling, removal, or replacement of teeth or the structures directly supporting the teeth are not covered. The structures that directly support the teeth are the periodontium, which includes:

  • The gingivae
  • The dentogingival junction
  • The periodontal membrane
  • The cementum
  • The alveolar process

Whether or not the beneficiary is hospitalized has no direct bearing on if payment will be made for a given dental procedure.

Exceptions (Items and Services That May Be Covered)

Some dental services may be covered depending upon whether the primary procedure that the dentist performs is covered. For example, these services may be covered:

  • An x-ray that is taken in connection with the reduction of a fracture of the jaw or facial bone
  • A tooth extraction that is performed to prepare the jaw for radiation treatments of neoplastic disease

I) Non-Physician Services Furnished to Hospital and Skilled Nursing Facility (SNF) Inpatients Not Provided Directly or Under Arrangement

In general, non-physician services furnished to Part A and Part B hospital inpatients and Part A SNF inpatients not provided directly or under arrangement are not covered.

Exceptions (Items and Services That May Be Covered)

These items and services may be covered:

  • Physician services furnished to hospital inpatients and SNF residents (with the exception of therapy in SNFs, which must be provided by the SNF itself, either directly or under arrangement, to both its Part A and Part B inpatients)
  • Physician assistant services
  • Nurse practitioner services
  • Clinical nurse specialist services
  • Certified nurse-midwife services
  • Qualified clinical psychologist services
  • Certified registered nurse anesthetist services

These Part A SNF inpatient services may be covered if they are not provided directly or under arrangement and are furnished by an authorized provider or supplier:

  • Home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies (including related necessary ambulance services)
  • Epoetin Alfa (EPO) for certain dialysis patients
  • Hospice care related to a beneficiary’s terminal condition
  • Radioisotope services
  • Some customized prosthetic devices
  • Some chemotherapy and chemotherapy administration services
  • These categories of exceptionally intensive outpatient services (along with transportation from the SNF to the hospital and back when the resident’s medical condition requires the use of an ambulance) are beyond the typical scope of SNF care plans as to require the intensity of the hospital setting to be furnished safely and effectively (accordingly, this exception does not apply if these services are furnished in a freestanding [non-hospital] setting):
  • Cardiac catheterization
  • Computerized axial tomography scans
  • Magnetic resonance imaging
  • Ambulatory surgery that involves the use of an operating room or comparable setting
  • Radiation therapy services
  • Angiography
  • Certain lymphatic and venous procedures
  • Emergency services

J) Certain Foot Care Services and Supportive Devices for the Feet

These foot care services and devices are generally not covered, except as described below under Exceptions (Items and Services That May Be Covered):

  • Treatment of flat foot
  • Routine foot care, which includes
  • The cutting or removal of corns and calluses
  • The trimming, cutting, clipping, or debriding of nails
  • Other hygienic and preventive maintenance care (for example, cleaning and soaking the feet, use of skin creams to maintain skin tone of either ambulatory or bedridden patients, and any other service performed in the absence of localized illness, injury, or symptoms involving the foot)
  • Orthopedic shoes and other supportive devices for the feet

Exceptions (Items and Services That May Be Covered)

These devices and services may be covered:

  • Treatment of mycotic nails:
    • For an ambulatory beneficiary, the physician attending the mycotic condition must document that:
      • There is clinical evidence of mycosis of the toenail
      • The beneficiary has marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of the infected toenail plate
  • Treatment of warts on the foot (including plantar warts)
  • Services that are a necessary and integral part of an otherwise covered service (for example, the diagnosis and treatment of ulcers, wounds, or infections)
  • Therapeutic shoes furnished to diabetics
  • Orthopedic shoes that are an integral part of a leg brace
  • For a non-ambulatory beneficiary, the physician attending the beneficiary’s mycotic condition must document that:
    • There is clinical evidence of mycosis of the toenail
    • The beneficiary suffers from pain or secondary infection resulting from the thickening and dystrophy of the infected toenail plate
  • Presence of a systemic condition such as one of these metabolic, neurologic, and peripheral vascular diseases (this is not an all-inclusive list):
    • Diabetes mellitus*
    • Arteriosclerosis obliterans
    • Buerger’s disease
    • Chronic thrombophlebitis*
    • Peripheral neuropathies that involve the feet:
      • Associated with malnutrition and vitamin deficiency:*
        • Malnutrition (general, pellagra)
        • Alcoholism
        • Malabsorption (celiac disease, tropical sprue)
        • Pernicious anemia
      • Associated with carcinoma*
      • Associated with diabetes mellitus*
      • Associated with drugs and toxins*
      • Associated with multiple sclerosis*
      • Associated with uremia (chronic renal disease)*
      • Associated with traumatic injury
      • Associated with leprosy or neurosyphilis
      • Associated with hereditary disorders:
        • Hereditary sensory radicular neuropathy
        • Angiokeratoma corporis diffusum (Fabry’s)
        • Amyloid neuropathy

* For Medicare to cover routine procedures for this condition, the beneficiary must be under the active care of a MD or a DO who has documented the condition.

K) Investigational Devices

Category A devices, as categorized by the U.S. Food and Drug Administration, are considered not medically reasonable and necessary and are therefore not covered.

Category B devices may be covered if they are considered medically reasonable and necessary and all other applicable Medicare coverage requirements are met.

L) Services Related to and Required as a Result of Services That Are Not Covered

Medical and hospital services related to and required as a result of services that are not covered will not be paid. Some examples of these services are:

  • Cosmetic surgery
  • Non-covered organ transplants
  • Services related to follow-up care or complications that require treatment during a hospital stay in which a non-covered service is performed

Exceptions (Items and Services That May Be Covered)

When a beneficiary is hospitalized for a non-covered service and requires services not related to the non-covered service, the unrelated services may be covered. For example, if a beneficiary breaks a leg while he or she is in the hospital for a non-covered service, the services to treat the broken leg may be covered since they are not related to the non-covered service.

When a beneficiary is discharged from a hospital stay in which he or she receives non-covered services and subsequently requires services to treat a condition or complication that arose as a result of the non-covered services, reasonable and necessary medical or hospital services may be covered. Some examples include:

  • Repair of complications after transsexual or cosmetic surgery
  • Treatment of an infection at the surgical site of a non-covered service

Any subsequent services that could be incorporated into a global fee are considered paid in the global fee and will not be paid again.

3) Services and Supplies Denied as Bundled or Included in the Basic Allowance of Another Service

These services and supplies denied as bundled or included in the basic allowance of another service will not be paid:

  • Fragmented services included in the basic allowance of the initial service
  • Prolonged care (indirect)
  • Physician standby services
  • Case management services (for example, telephone calls to and from the beneficiary)
  • Supplies included in the basic allowance of a procedure

4) Items and Services Reimbursable by Other Organizations or Furnished Without Charge

  1. Services Reimbursable Under Automobile, No-Fault, or Liability Insurance or Workers’ Compensation (WC) (the Medicare Secondary Payer Program)

Payment will not be made for items and services when payment has been made or can reasonably be expected to be paid promptly under:

  • Automobile insurance
  • No-fault insurance
  • Liability insurance
  • WC law or Plan of the U.S. or a State

Exceptions (Items and Services That May Be Covered)

Medicare may make payment if the primary payer denies the claim and documentation is provided indicating that the claim has been denied in the following situations:

  • The Group Health Plan denies payment for services because:
    • The beneficiary is not covered by the health plan
    • Benefits under the plan are exhausted for particular services
    • The services are not covered under the plan
    • A deductible applies
    • The beneficiary is not entitled to benefits
  • The no-fault or liability insurer denies payment or does not pay the bill because benefits have been exhausted
  • The WC Plan denies payment (for example, when it is not required to pay for certain medical conditions)
  • The Federal Black Lung Program does not pay the bill

In liability, no-fault, or WC situations, a conditional payment for covered services may be made to prevent beneficiary financial hardship when:

  • The claim is not expected to be paid promptly
  • A properly submitted claim was denied in whole or in part
  • A proper claim has not been filed with the primary insurer due to the beneficiary’s physical or mental incapacity

A conditional payment is made on the condition that the insurer and/or the beneficiary will reimburse Medicare to the extent that payment is subsequently made by the insurer.

B) Items and Services Authorized or Paid by a Government Entity

In general, payment will not be made for these items and services authorized or paid by a Government entity:

  • Those furnished by a Government or non-Government provider or other individual at public expense pursuant to an authorization issued by a Federal agency (for example, Veterans Administration authorized services).
  • Those furnished by a Federal provider or agency that generally provides services to the public as a community institution or agency (hospitals, SNFs, Home Health Agencies, and Comprehensive Outpatient Rehabilitation Facilities are not included in this category). Federal hospitals, like other nonparticipating hospitals, may be paid for emergency inpatient and outpatient hospital services.
  • Those that a Federal, State, or local Government entity directly or indirectly pays for or furnishes without expectation of payment from any source and without regard to the individual’s ability to pay.
  • Those that a non-Government provider or supplier furnishes and the charges are paid by a Government program other than Medicare or where the provider or supplier intends to look to another Government program for payment (unless the payment by the other program is limited to Medicare deductible and coinsurance amounts).

C) Items and Services for Which the Beneficiary, Another Individual, or an Organization Has No Legal Obligation to Pay For or Furnish

Payment will not be made when the beneficiary, another individual, or an organization has no legal obligation to pay for or furnish the items or services. Some examples include:

  • X-rays or immunizations gratuitously furnished to the beneficiary without regard to his or her ability to pay and without expectation of payment from any source.
  • An ambulance transport provided by a volunteer ambulance If the ambulance company asks but does not require a donation from the beneficiary to help offset the cost of the service, there is no enforceable legal obligation for the beneficiary or any other individual to pay for the service.

When a provider or supplier furnishes items or services without charge to indigent Medicare beneficiaries and without charge to non-Medicare indigent individuals (because of both groups’ inability to pay), this payment exclusion does not apply if the provider or supplier bills its other (non-indigent) individuals.

D) Defective Equipment or Medical Devices Covered Under Warranty

No payment will be made under cost reimbursement for defective medical equipment or medical devices under warranty if they are replaced free of charge by the warrantor or if an acceptable replacement could have been obtained free of charge under the warranty, but it was purchased instead.

Exceptions (Items and Services That May Be Covered)

When defective equipment or medical devices are replaced under warranty, hospital or other provider services furnished by parties other than the warrantor may be covered despite the warrantor’s liability.

Payment may be made for defective equipment or medical devices as follows:

  • When a replacement from another manufacturer is substituted because the replacement offered under the warranty is not acceptable to the beneficiary or to the beneficiary’s physician
  • Partial payment, if defective equipment or medical devices are supplied by the warrantor and a charge or a pro rata payment is imposed
  • Payment is limited to the amount that would have been paid under the warranty if an acceptable replacement could have been purchased at a reduced price under a warranty, but the full price was paid to the original manufacturer or a new replacement was purchased from a different manufacturer or other source

ADVANCE BENEFICIARY NOTICES (ABNS)

You must give written notice to a Fee-For-Service Medicare beneficiary before furnishing items or services that are usually covered by Medicare but are not expected to be paid in a specific instance, for certain reasons, such as lack of medical necessity.

RESOURCES

This chart provides resource information related to this publication.

Resource Information

For More Information About… Resource
Services Not Covered Under Medicare and Medicare-Covered Services

Chapters 1, 6, 8, 9, 15, and 16 of Medicare Benefit Policy

Manual (Publication 100-02)

Medicare National Coverage Determinations (NCD) Manual (Publication 100-03)

Medicare Secondary Payer Medicare Secondary Payer Manual (Publication 100-05)
Claims Processing Procedures for Non-Covered Services Medicare Claims Processing Manual (Publication 100-04)
Preventive Services

Preventive Services

Chapter 15 of the Medicare Benefit Policy Manual

(Publication 100-02)

ABNs

Chapter 30 of the Medicare Claims Processing Manual (Publication 100-04)

Beneficiary Notices Initiative (BNI)

All Available Medicare Learning Network® (MLN) Products MLN Catalog
Provider-Specific Medicare Information

MLN Guided Pathways: Provider Specific Medicare

Resources

Medicare Information for Beneficiaries Medicare.gov

Hyperlink Table

 

Embedded Hyperlink Complete URL
Medicare Benefit Policy Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673. html
Medicare National Coverage Determinations (NCD) Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Internet-Only-Manuals-IOMs-Items/CMS014961. html
Medicare Secondary Payer Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Internet-Only-Manuals-IOMs-Items/CMS019017. html
Medicare Claims Processing Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912. html
Preventive Services https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo
Chapter 15 of the Medicare Benefit Policy Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Downloads/bp102c15.pdf
Chapter 30 of the Medicare Claims Processing Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Downloads/clm104c30.pdf
Beneficiary Notices Initiative (BNI)

https://www.cms.gov/Medicare/Medicare-General-

Information/BNI

MLN Catalog https://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network-MLN/MLNProducts/Downloads/MLN Catalog.pdf

MLN Guided Pathways: Provider Specific Medicare

Resources

https://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network-MLN/MLNEdWebGuide/Downloads/ Guided_Pathways_Provider_Specific_Booklet.pdf

 

 

Medicare Learning Network® Product Disclaimer

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).

Source: The Centers for Medicare and Medicaid Services

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