Exceptions to Annual Deductible and Coinsurance

There is no deductible for screening mammography effective for services January 1, 1998 and later.

Neither the annual deductible nor the 20 percent coinsurance apply with respect to:
 
• Parts A and B home health services, except that there is a coinsurance of 20 percent of the payment amount for supplies, drugs, DME and prosthetics /orthotics furnished as a home health benefit;
 
• Clinical diagnostic laboratory tests (including specimen collection fees) performed or supervised by a physician, laboratory, or other entity paid on an assigned basis;
 
• Pneumococcal vaccine and its administration;
 
• Influenza vaccine and its administration; and
 
• Services or items denied as medically unnecessary.
 
NOTE: Services which are not subject to the deductible cannot be used to satisfy the deductible.

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