Page 23 - Medicare Benefit Policy Manual

becomes supportive rather than corrective in nature, the treatment is then considered
maintenance therapy. For information on how to indicate on a claim a treatment is or is
not maintenance, see §240.1.3.

30.6 - Indian Health Service (IHS) Physician and Nonphysician Services
(Rev. 86, Issued: 04-18-08, Effective: 09-11-06, Implementation: 05-19-08)

This information can also be found in the Medicare Claims Processing Manual,
Publication 100-04, chapter 19.

Section 1880 of Title XVIII of the Social Security Act (the Act) provides an exception
for Indian Health Service to the general prohibition of payment to Federal Agencies.

The following facilities, which were unable to bill for practitioner services prior to BIPA,
may now be paid:

• Outpatient departments of IHS operated hospitals that meet the definition of
provider-based in 42 CFR 413.65; and

• Outpatient clinics (freestanding) operated by the IHS.

The following facilities, which were limited by §1880 of the Act, may be paid for
services under BIPA or may be paid under another authority under which it qualifies.

• Outpatient departments of tribally operated hospitals that are operated by a tribe
or tribal organization; and

• Other outpatient facilities that are tribally operated regardless of ownership.

See the Medicare Claims Processing Manual chapter 19 for a description of billing
procedures, physician and non-physician services and other Part B services.

30.6.1 - Payment for Medicare Part B Services Furnished by Certain
IHS Hospitals and Clinics
(Rev. 86, Issued: 04-18-08, Effective: 09-11-06, Implementation: 05-19-08)

Section 1880 of the Act, as amended by §630 of the Medicare Modernization Act of 2003
(MMA), expands the scope of items and services for which payment may be made to IHS
facilities, providers and suppliers to include all Part B covered items and services for
which payment may be made under Part B, subject to certain limitations as specified in
§1880(e)(1)(A) of the Act, for a 5-year period beginning January 1, 2005.

Specifically, for the 5-year period beginning January 1, 2005, IHS facilities, providers
and suppliers may bill Medicare for the following Part B services:

• Durable medical equipment