Author Topic: Services not covered by Medicare  (Read 1370 times)

MJ

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Services not covered by Medicare
« on: November 17, 2010, 11:49:55 AM »
Does anyone have a list of services not covered by Medicare.  This is a primary practice.  I would like one for our nursing staff so they can notify the patient prior to the work that Medicare will probably not pay for the service.  I would like to list the expected cost the patient will be responsible for.  We do have them sign the ABN.

Michele

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Re: Services not covered by Medicare
« Reply #1 on: November 18, 2010, 11:13:56 AM »
To have only one list of services not covered by Medicare would be too long.  You really need to just be aware what services are provided in your office that are not covered by Medicare and create a list.  Then you can include what the expected cost to the patient will be when you have them sign the ABN.

Michele
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tlewis

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Re: Services not covered by Medicare
« Reply #2 on: January 24, 2011, 05:54:58 PM »
Everything has the potential to be not covered if deemed unnecessary. But I would think that you should be able to look on the physcian fee schedule to see what CPT codes you perform and what the fee schedule is for that code. However if the DX doesn't support the service none of the services will be covered. You can cross reference the CPT codes with the LCD medicare coverage data base to see what DX code you would need for it to be considered necessary. Also it will give you any restrictions. I have only done ASC and LAB billing but certian procedures and test have time restrictions.