Carriers (Medicare) pay for physicians’ services furnished on or after January 1, 1992, on the basis of a fee schedule. The Medicare allowed charge for such physicians’ services is the lower of
the actual charge or the fee schedule amount. The Medicare payment is 80 percent of the
allowed charge after the deductible is met.
Bundled Services/Supplies
A. Routinely Bundled
Separate payment is never made for routinely bundled services and supplies. The CMS has
provided RVUs for many of the bundled services/supplies. However, the RVUs are not for
Medicare payment use. Carriers may not establish their own relative values for these
services.
B. Injection Services
Injection services (codes 90782, 90783, 90784, 90788, and 90799) included in the fee
schedule are not paid for separately if the physician is paid for any other physician fee
schedule service rendered at the same time. Carriers must pay separately for those injection
services only if no other physician fee schedule service is being paid. In either case, the
drug is separately payable. If, for example, code 99211 is billed with an injection service,
pay only for code 99211 and the separately payable drug. (See section 30.6.7.D.) Injection
services that are immunizations with hepatitis B, pneumococcal, and influenza vaccines are
not included in the fee schedule and are paid under the drug pricing methodology .
C. Global Surgical Packages
The MPFSDB lists the global charge period applicable to surgical procedures.D. Intra-Operative and/or Duplicate ProceduresChapter 23 and §30 of this chapter describe the correct coding initiative (CCI) and policies to detect improper coding and duplicate procedures.
E. EKG Interpretations
For services provided between January 1, 1992, and December 31, 1993, carriers must not make separate payment for EKG interpretations performed or ordered as part of, or in conjunction
with, visit or consultation services. The EKG interpretation codes that are bundled in this
way are 93000, 93010, 93040, and 93042. Virtually, all EKGs are performed as part of or
ordered in conjunction with a visit, including a hospital visit.
If the global code is billed for, i.e., codes 93000 or 93040, carriers should assume that
the EKG interpretation was performed or ordered as part of a visit or consultation.
Therefore, they make separate payment for the tracing only portion of the service, i.e.,
code 93005 for 93000 and code 93041 for 93040. When the carrier makes this assumption in
processing a claim, they include a message to that effect on the Medicare Summary Notice
(MSN).
For services provided on or after January 1, 1994, carriers make separate payment for an EKG
interpretation.
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