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Medicare newbie

  1. #1
    Default Medicare newbie
    Medical Coding Books
    I am a relatively new coder, how do I find out what tests like a PSA or a V code type visit medicare will pay for?

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    You can start by reviewing your LMRP (local medical review policy)

    http://www.cms.hhs.gov/mcd/results_i...etter_range=4&

    At the top of this page, you can narrow your search by your state. Also,

    http://www.cms.hhs.gov/manuals/downloads/clm104c18.pdf

  3. #3
    Default
    http://www.cms.hhs.gov/MLNProducts/D...s_prevserv.pdf

    Heres an additonal link,

    Laura, CPC, CEMC

  4. #4
    Default
    I downloaded the 2009 medicare fee schedule, no tests are on there, like a lipid panel 80061, or for cholesterol screening, am i correct in assuming these are not paid by medicare if they are not in the fee schedule, what about hcpcs?

  5. #5
    Location
    North Carolina
    Posts
    3,126
    Default
    http://www.cms.hhs.gov/ClinicalLabFe...02_clinlab.asp

    Under "downloads", click on the first link and open up the excel spreadsheet. The columns are broken down by state.

  6. #6
    Location
    North Carolina
    Posts
    3,126
    Default
    Ohhh...you needed the DME fee schedule, too.

    http://www.cms.hhs.gov/DMEPOSFeeSche...=all&submit=Go

    The easiest way to navigate this link is to select "ALL" on your drop down key that's listed as "View items per page". The most current information is listed at the end of this list. (it may already default to the "All" list since I selected it prior to pasting this link)

  7. #7
    Default
    OMG, this is soooo helpful, one more question, the column for my state has an amount for a code, is that what medicare will pay or do i look under the first 3 columns, national limit and such?

  8. #8
    Location
    North Carolina
    Posts
    3,126
    Default
    If your state has an assigned fee schedule, I would use this fee as oppose to the national fee schedule. The fees can vary significantly from state to state.

  9. #9
    Default
    just to be clear, if my state column, has 19.57 in it for code 80061, i would be reimbursed 19.57 for that code, even if the first 3 columns (national etc.) of the spreadsheet say zero?

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