Page 258 - Medicare Benefit Policy Manual

• CORF - payment is made under the Medicare physician fee schedule;

• Hospital outpatient department - payment is made under outpatient prospective
payment system (OPPS);

• Hospital inpatient Part B - payment is made under OPPS;

• SNF outpatient - payment is made under the Medicare physician fee schedule
(MPFS); and

• SNF inpatient Part B - payment is made under MPFS.

Deductible and coinsurance apply.

E. Special Billing Instructions for RHCs and FQHCs

Screening glaucoma services are considered RHC/FQHC services. RHCs and FQHCs
bill the contractor under bill type 71X or 73X along with revenue code 770 and HCPCS
codes G0117 or G0118 and RHC/FQHC revenue code 520 or 521 to report the related
visit. Reporting of revenue code 770 and HCPCS codes G0117 and G0118 in addition to
revenue code 520 or 521 is required for this service in order for CWF to perform
frequency editing.

Payment should not be made for a screening glaucoma service unless the claim also
contains a visit code for the service. Therefore, the contractor installs an edit in its
system to assure payment is not made for revenue code 770 unless the claim also contains
a visit revenue code (520 or 521).

280.2 - Colorectal Cancer Screening
(Rev. 1, 10-01-03)
B3-4180

280.2.1 - Covered Services and HCPCS Codes
See Business Requirements at http://cms.hhs.gov/manuals/pm_trans/R3BP.pdf
(Rev. 3, 12-19-03)
B3-4180.1

Medicare covers colorectal cancer screening test/procedures for the early detection of
colorectal cancer for the HCPCS codes indicated.

A. Effective for Services Furnished On or After January 1, 1998:

G0107 - Colorectal cancer screening; fecal-Occult blood test, 1-3 simultaneous
determinations;