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Friday Jun 08, 2018

Use this database to answer questions about Medicare noncoverage

If you treat Medicare patients, you probably know that if a beneficiary requests a service that you know or believe is not covered by Medicare, you must inform the patient of the situation with a form called an Advance Beneficiary Notice of Noncoverage (ABN). They have to fill out the form before you can bill them for the services.

But how do you know what the Medicare coverage rules are for specific circumstances? There’s actually an existing resource that many physicians apparently don’t know about.

The Centers for Medicare & Medicaid Services offers an online, searchable Medicare Coverage Database(www.cms.gov) that allows anyone to freely search both national and local Medicare coverage documents, which typically include associated ICD-10 codes. The database has both quick search and advanced search capabilities that permit users to tailor their search geographically, by Medicare contractor, and by key words, CPT codes, HCPCS codes, and ICD-10 codes.

The coverage database may not be the most efficient tool for learning what Medicare covers when, but it is transparent and readily accessible. So, the next time you wonder whether a service is covered by Medicare and whether you need to provide the patient with an ABN, consider giving the database a try.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 09:00AM Jun 08, 2018 by Kent Moore

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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