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CodeMap® 08/14/2013: Medicare Coverage Edits

CodeMap® Compliance Briefing: August 14, 2013


Editor's Welcome:

Welcome to the first installment of a two-part CodeMap® Compliance Briefing concerning important Medicare Coverage Edits. As most of our subscribers know, Medicare only pays for tests and services that are medically reasonable and necessary. This coverage requirement was created by the Social Security Act, which states,

"no payment will be made under part A or part B (of Medicare) for any expenses incurred for items and services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." SSA §1862(a)(1)(A)

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* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



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