Page 255 - Medicare Benefit Policy Manual

are Level II HCPCS and Category III CPT codes that crosswalk to or are clinically
similar to the Category I CPT codes in the range.

The surgical codes that are included on the ASC list of covered surgical procedures are
those that have been determined to pose no significant safety risk to Medicare
beneficiaries when furnished in ASCs and that are not expected to require active medical
monitoring at midnight of the day on which the surgical procedure is performed
(overnight stay).

Procedures that are included on the inpatient list used under Medicare’s hospital
outpatient prospective payment system and procedures that can only be reported by using
an unlisted Category I CPT code are deemed to pose significant safety risk to
beneficiaries in ASCs and are not eligible for designation and coverage as covered
surgical procedures.

260.5.3 - Rebundling of CPT Codes
(Rev. 1, 10-01-03)
B3-2266.3

Instructions regarding the Correct Coding Initiative apply to coverage of ASC facility
services.

270 - Telehealth Services
(Rev. 221, Issued: 03-11-16, Effective: 01-01-15, Effective: 04-11-16)

For information on telehealth services, see Pub. 100-04, Medicare Claims Processing
Manual, chapter 12, section 190.

280 – Preventive and Screening Services
(Rev. 93; Issued: 07-25-08; Effective Date: 04-28-08; Implementation Date: 08-25-
08)

See section 50.4.4.2 for coverage requirements for PPV, hepatitis B vaccine, and
Influenza Virus Vaccine.

See Pub. 100-04, Medicare Claims Processing Manual, Chapter 18, “Preventive and
Screening Services,” for coverage requirements for the following:

• §40 for screening pelvic examinations,

• §50 for prostate cancer screening test and procedures,

• §60 for colorectal cancer screening, and,

• §70.4 for glaucoma screening.