100-04 Medicare Claims Processing Manual: Chapter 18 Crosswalk
us-cms-medicare-manuals-pub-100-04-clm104c18crosswalk100-04 Medicare Claims Processing Manual: Chapter 18 CrosswalkGuidance
Medicare Claims Processing Manual Chapter 18 - Preventive and Screening Services Crosswalk Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 10 A3-3660.7, A3-3110 (partial), A3-3157 (partial), A3- 3192 (partial), B3-4480 SNF-536.2, SNF-534.A, RHC-614, HSP-303.6.A, B, HO-435.A, HHA-473.A, B, HO-230.4.C, RHC-404 Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines 18 10.1 A3-3660.7, A3-A3-3110, A3-3157, A3-3192, B3-4480 SNF-536.2.A, SNF-534.A, RHC-614, HSP-303.6.A, B, HO-435.A, HHA-473.A, B, HO-230.4.C, RHC-404 Coverage Requirements 18 10.1.1 See Above See Above See Above Pneumococcal Pneumonia Vaccine (PPV) 18 10.1.2 See Above See Above See Above Influenza Virus Vaccine 18 10.1.3 See Above See Above See Above Hepatitis B Vaccine 18 10.2 A3-3660.7.B B3-4480.1, B3-2049.4 (partial), B3-4480.4.C SNF-536.2.B, RHC-614, RHC-504.1.B, HSP-303.6.C, HO-435.B, HHA-473.C, HHA 219, Billing Requirements 18 10.2.1 A3-3660.7, A3-3660. B3-4480.2, B3-4480.3, SNF-536.2.C, HSP-303.6.D, HO-435.C, HHA-473, 7, SNF-534.D, E, HO-435.D-F, HHA-473.E-G, SNF- 536.2.D, SNF-536.2.E Healthcare Common Procedural Coding System (HCPCS) and Diagnosis Codes
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 10.2.2 A3-3660.7.D, E, I Claims Submitted to Intermediaries 18 10.2.2.1 A3-3660.7 Intermediary Payment for Pneumococcal Pneumonia, Influenza Virus, and Hepatitis B Vaccines 18 10.2.2.2 A3-3660.7.G Special Instructions for Independent and Provider-Based RHCs/FQHCs 18 10.2.3 A3-3660.7.H Claims Submitted to Regional Home Health Intermediaries (RHHIs) 18 10.2.4 A3-3660.7.J, K Claims Submitted by Hospices and Payment Procedures for Renal Dialysis Facilities (RDF 18 10.2.4.1 PR 1 2711.4 Hepatitis B Vaccine Furnished to ESRD Patients 18 10.2.5 B3-4480.10 Claims Submitted to Carriers 18 10.2.5.1 Carrier Indicators and for the Common Working File (CWF) 18 10.2.5.2 B3-4480.6. B3-4480.7 Carrier Payment Requirements
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 10.3 A3-3660.7 B3-4480.8, B3 3001.1 (partial) B3-4480.9, B3-4481, B3-4480.6.A, B3-4480.6.C, B3-4480.9 SNF-534.F, G, HSP-303.6.D, HO-435.G, H, HHA-473.H, I, SNF-536.2.F, Simplified Roster Bills for Mass Immunizers 18 10.3.1 B3-4480.8.C Roster Bills Submitted to Carriers for Mass Immunization 18 10.3.1.1 B3-4481, B3-4481.C, B3-4481.D, B3-4481.E, B3-4481.F, B3-4481.G, B3-4481.H, B3-4481.I, B3-4481.J Centralized Billing for Flu and Pneumococcal (PPV) Vaccines to Medicare Carriers 18 10.3.2 A3-3660.7.L, A3-3660.7.N Claims Submitted to Intermediaries for Mass Immunizations of Influenza and PPV 18 10.3.2.1 A3-3660.7.M Simplified Billing for Influenza Virus Vaccine and PPV Services by HHAs 18 10.3.2.2 A3-3660.7.M Hospital Inpatient Roster Billing 18 10.3.2.3 A3-3660.7.N Electronic Roster Claims 18 10.4 AB-02-014 (CR1691), CWF Release Documentation for July 02 Common Working File (CWF) Edits
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 10.4.1 See above See above CWF Edits on Intermediary Claims 18 10.4.2 See above See above CWF Edits on Carrier Claims 18 10.4.3 See above See above CWF A/B Crossover Edits for Intermediary and Carrier Claims 18 10.5 AB-01-155A Medicare Summary Notice (MSN) 18 20 A3-3660.10 A3-3660.19 B3-4601.1, B3-13027, B3-4601 SNF-537, HO-451.A, RHC-623.A, RHC-404, SNF-537, SNF-537.2, SNF-537.2.A Screening Mammography Services 18 20.1 A3-3660.16 B3-4601.2D, B3-4601.3, SNF-537.1, SNF-537.1.A, SNF-537.1.B, SNF-537.1.D, SNF-538, HO-454, RHC-641 Mammography Quality Standards Act (MQSA) 18 20.1.1 SNF-537.1.C Under Arrangements 18 20.2 A3-3660.16 B3-4601.2, B3-4601.2.C, B3-5266, B3-266B.1.c, B3-5266B.2.c, or 5266B.3.c, B3-5258 SNF-537.A-F, HO-451.B-F, RHC-623.B-E, HCPCS and Diagnosis Codes for Mammography Services 18 20.2.1 A3-3660.10.B, A3-3660.20 B3-4601.2.B, B3-4601.2.G, Computer-Aided Detection (CAD) Add-on Codes
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 20.3 A3-3660.10.B, B3-4601.2, B3-4601.2.E, B3-5266, B3-5266B.1.c, 5266B.2.c, or 5266B.3.c, B3 5258 SNF-537.A-F, SNF-537.2.B HO-451.B-F, RHC-623.B-E, SNF-537.2.E Payment 18 20.3.1 A3-3660.10.B, A3-3660.10.C B3-4601.2.E, Payment for Services Prior to January 1, 2002 18 20.3.2 A3-3660.10.B B3-4601.2.F, Payment for Services On and After January 1, 2002 18 20.3.2.1 See above See above Outpatient Hospital Mammography Payment Table 18 20.3.2.2 A3-3660.19, B3-4601.2.A Payment for Computer Add-on Diagnostic Mammograms 18 20.3.2.3 A3-3660.10B, A3-3610.22B2, A3-3660.10A Critical Access Hospital Payment 18 20.3.2.3. 1 See above CAH Mammography Payment Table 18 20.3.2.4 See above SNF Mammography Payment Table
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 20.4 A3-3610.22, A3-3660.10.D, B3-4601.2, B3-5266, B3-5266.B.1.c, 5266.B.2.c, or 5266.B.3.c, B3-5258, SNF-537.A-F, HO-451.B-F, RHC-623.B-E, SNF-537.2.C, Billing Requirements - Intermediary Claims 18 20.4.1 A3-3660.10.D Rural Health Clinics and Federally Qualified Health Centers 18 20.4.1.1 A3-3660.10.D RHC/FQHC Claims With Dates of Service Prior to January 1, 2002 18 20.4.1.2 A3-3660.10.D RHC/FQHC Claims With Dates of Service on or After January 1, 2002 18 20.4.2 A3-3660.10.E Intermediary Requirements for Nondigital Screening Mammographies 18 20.4.2.1 A3-3660.10.E, A3-3660.10.F Intermediary Data for CWF and Provider Statistical and Reimbursement Report (PS&R) 18 20.5 B3-4601.3, B3-4601.3.A Carrier Processing Requirements 18 20.5.1 B3-4601.3.B Part B Carrier Claim Record for CWF 18 20.5.2 B3-4601.2.J Transportation Costs for Mobile Units 18 20.6 A3-3660.10.G, A3-3660.10.H B3-4601.2.H, SNF-537.2.F Instructions When an Interpretation Results in Additional Films
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 20.7 A3-3660.20, A3-3660.20.A, A3-3660.20.B, A3-3660.20.C B3-4601.6.A B3-4601.6, B3-4602, Mammograms Performed With New Technologies 18 20.8 A3-3660.10I B3-4601.4 SNF-537.2.G Beneficiary and Provider Notices 18 20.8.1 A3-3660.10I B3-4601.4, MSN Messages 18 20.8.2 A3- 3660.10J B3-4601.5, SNF-537.I Remittance Advice Messages 18 30 A3-3628.1 B3-4603.1, B3-4603.1A, SNF-541.2 Screening Pap Smears 18 30.1 A3-3628.1A B3-4603.1A.1 B3-4603.1A.2 B3-4603.1A.3 Pap Smears from January 1, 1998, Through June 30 2001 18 30.2 A3-3628.1A1 B3-4603.1B Pap Smears On and After July 1, 2001 18 30.3 A3-3628.1A3 B3-4603.4, B3-4603.6, B3-4603.1.B Deductible and Coinsurance 18 30.4 B3-4603.1C1 and 2 Payment Method 18 30.4.1 A3-3628.1A3, A3-3628.1A4 Payment Method for RHCs and FQHCs 18 30.5 A3-3628.1.A.3 B3-4603.1.C.1 and 2 HCPCS Codes for Billing 18 30.6 B3-4603.3 AB-03-054 Diagnoses Codes
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 30.7 See Above See Above See Above Type of Bill and Revenue Codes for Form CMS-1450 18 30.8 See Above See Above See Above MSN Messages 18 30.9 See Above See Above See Above Remittance Advice Codes 18 40 A3-3, 3628.1B B3-4603.2 Screening Pelvic Examinations 18 40.1 A3-3628.1.B.1 B3-4603.2.A, B3-4603.5 Screening Pelvic Examinations From January 1, 1998, Through June 30 2001 18 40.2 A3-3628.1.B.1 B3-4603.2.B, C Screening Pelvic Examinations on and After July 1, 2001 18 40.3 A3-3628.1.B.3, A3-3628.1.C.1 B3-4603.2C, B3-4603.4, B3-4603.6 Deductible and Coinsurance 18 40.4 A3-3628.1.B.3 B3-4603.2.C Payment Method 18 40.5 A3-3628.1B4 B3-4603.4 Revenue Code and HCPCS Codes for Billing 18 40.6 A3-3628.1.C.2 B3-4603.7 MSN Messages 18 40.7 A3-3628.1.C.3 B3-4603.8 Remittance Advice Codes 18 50 A3-3 3616 B3-4182 Prostate Cancer Screening Tests and Procedures 18 50.1 A3-3616.A.1,2 Definitions 18 50.2 B3-4182.3 Deductible and Coinsurance
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 50.3 A3-3616.C B3-4182.3 Payment Method - Intermediaries and Carriers 18 50.3.1 B3-4182.6 Correct Coding Requirements for Carrier Claims 18 50.4 See above HCPCS, Revenue, and Type of Service Codes 18 50.5 B3-4182.7 Diagnosis Coding 18 50.6 A3-3616D, E B3-4182.4, B3-4182.5 Calculating Frequency 18 50.7 A3-3616.F B3-4182.8B MSN Messages 18 50.8 A3-3616.G B3-4182.8 Remittance Advice Notices 18 60 A3-3660.17 B3-4180, B3-4180.6 Colorectal Cancer Screening 18 60.1 See above See above Payment 18 60.2 A3-3660.17.A B3-4180.2 AB-03-114 HCPCS Codes, Frequency Requirements, and Age Requirements (If Applicable) 18 60.2.1 A3-3660.17.H B3-4180.7 Common Working Files (CWF) Edits 18 60.2.2 A3-3660.17.K B3-4180.10 Ambulatory Surgical Center (ASC) Facility Fee 18 60.3 A3-3660.17 B3-4180.3, HO-456.B Determining High Risk for Developing Colorectal Cancer 18 60.4 A3-3660.17D B3-4180.4 HO-456.D Determining Frequency Standards
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 60.5 A3-3660.17 B3-4180.5 HO-456.C Noncovered Services 18 60.6 A3-3660.17 E and G Billing Requirements for Claims Submitted to Intermediaries 18 60.7 A3-3660.17I B3-4180.8 HO-456.I MSN Messages 18 60.8 A3-3660.17.J B3-4180.9 HO-456.J Remittance Advice Notices 18 70 B3-4184 Glaucoma Screening Services 18 70.1 B3-4184.2 A-01-105 (CR 1783), B-01-46 (CR 1717), A-01-132(CR 1914) Claims Submission Requirements and Applicable HCPCS Codes 18 70.1.1 B3-4184.2 A-01-105 (CR 1783), B-01-46 (CR 1717), A-01-132(CR 1914) HCPCS and Diagnosis Coding 18 70.1.1.1 A-01- 132 (CR 1914), A-01-105 (CR 1783), B-01-46 (CR 1717) Additional Coding Applicable to Claims Submitted to Intermediaries 18 70.1.1.2 A-01- 132(CR 1914) Special Billing Instructions for RHCs and FQHCs
Chap. Sect. Int. Pub 13 Carrier Pub. 14 PMs Other Description 18 70.1.2 B3-4184.4, B3-4184.5 A-01-132 (CR 1914), Edits 18 70.2 B3-4184.7 A-01-132 (CR 1914), A-01-105(CR 1783), B-01-46 (CR 1717) Payment Methodology 18 70.3 B3-4184.3 A-01-132 (CR 1914), Determining the 11-Month Period 18 70.4 B3-4184.8 A-01-132 (CR 1914) Remittance Advice Notices 18 70.5 B3-4184.9 A-01-132 (CR 1914) MSN Messages
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