Payment of Bilateral Procedures in a Method II Critical Access Hospital (CAH)
Physicians and non-physician practitioners billing on type of bill (TOB) 85X for professional services rendered in a Method II CAH have the option of reassigning their billing rights to the CAH. When the billing rights are reassigned to the Method II CAH, payment is made to the CAH for professional services (revenue codes (RC) 96X, 97X or 98X). Bilateral procedures are procedures performed on both sides of the body during the same operative session. Medicare makes payment for bilateral procedures based on the lesser of the actual charges or 150 percent of the Medicare Physician Fee Schedule (MPFS) amount when the procedure is authorized as a bilateral procedure. This Change Request implements the 150 percent payment adjustment for bilateral procedures.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 24, 2009
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