Page 10 - Medicare Benefit Policy Manual

• Screening glaucoma services;

• Influenza, pneumococcal pneumonia, and hepatitis B vaccines;

• Colorectal screening;

• Bone mass measurements;

• Diabetes self-management services;

• Prostate screening; and

• Home health visits after all covered Part A visits have been used.

See §250 for provisions regarding supplementary medical insurance coverage of certain
of these services when furnished to hospital and SNF inpatients.

Payment may not be made under Part B for services furnished an individual if the
individual is entitled to have payment made for those services under Part A. An
individual is considered entitled to have payment made under Part A if the expenses
incurred were used to satisfy a Part A deductible or coinsurance amount, or if payment
would be made under Part A except for the lack of a request for payment or lack of a
physician certification.

Some medical services may be considered for coverage under more than one of the
above-enumerated categories. For example, electrocardiograms (EKGs) can be covered
as physician’s services or as other diagnostic tests. It is sufficient to determine that the
requirements for coverage under one category are met to permit payment.

Membership dues, subscription fees, charges for service policies, insurance premiums,
and other payments analogous to premiums which entitle enrollees to services or to
repairs or replacement of devices or equipment or parts thereof without charge or at a
reduced charge, are not considered expenses incurred for covered items or services
furnished under such contracts or undertakings. Examples of such arrangements are
memberships in ambulance companies, insurance for replacement of prosthetic lenses,
and service contracts for durable medical equipment.

20 - When Part B Expenses Are Incurred
(Rev. 1, 10-01-03)
B3-2005

Part B expenses for items and services other than expenses for surgery and childbirth (see
§20.1, below), are considered to have been incurred on the date the beneficiary received
the item or service, regardless of when it was paid for or ordered. Therefore, when an
individual orders an item prior to his or her entitlement to supplemental medical