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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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