Payment for Critical Access Hospitals (CAHs) Ancillary Services Submitted on 12X Type of Bill (TOB) Claim
This change request instructs contractors to allow for CAH ancillary services at reasonable cost. The CAH ancillary service(s) TOB 12x should include the appropriate revenue codes. For facility services, not including physician or other practitioner services, payment will be based on 101 percent of the reasonable costs of the services. The only services for CAHs where the physician has reassigned their benefits are based off the MPFS services, on TOB 85x with the appropriate HCPCS code and revenue codes of 096x, 097x or 098x.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 07, 2022
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.