Expiration of Medicare Processing of Certain Indian Health Service Part B Claims: Sunset of Section 630 of the Medicare Modernization Act of 2003 for Payment of Indian Health Services
MLN Matters® Number: SE0912
Related Change Request (CR) #: 3288
Related CR Release Date: N/A
Effective Date: N/A
Related CR Transmittal #: N/A
Implementation Date: N/A
Provider Types Affected
Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based) facilities submitting claims to Palmetto GBA.
Provider Action Needed
This special edition article is being issued by the Centers for Medicare & Medicaid Services (CMS) to notify affected Indian Health Service (IHS) physicians, IHS providers, and IHS suppliers that beginning January 1, 2010, IHS facilities can no longer bill Medicare for ‘other’ Part B services, including Durable Medical Equipment (DME), prosthetics, orthotics, therapeutic shoes, clinical laboratory services, surgical dressing, splints and casts, drugs (those processed by the DME/MACs and those processed by the A/B MACs and the Part B carrier) and ambulance services. As a result of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, coverage of these ‘other’ Part B items and services started January 1, 2005, for a five-year period which ends January 1, 2010. This article alerts affected providers that the five-year period expires as of January 1, 2010.
Background
Additionally, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA, Section 630) expanded the scope of items and services for which payment could be made to IHS facilities to include all ‘other’ Part B covered items and services for a 5 year period beginning January 1, 2005 and ending January 1, 2010. See Change Request (CR) 3288 at www.cms.hhs.gov/transmittals/downloads/R241CP.PDF (PDF, 210 KB). An MLN Matters® article related to that transmittal is available at www.cms.hhs.gov/MLNMattersArticles/downloads/MM3288.pdf (PDF, 67 KB).
This special edition article is being provided by CMS to notify affected IHS physicians, IHS providers, and IHS suppliers that beginning January 1, 2010; IHS facilities can no longer bill Medicare for the following Part B services:
- Durable medical equipment (DME)
- Prosthetics and orthotics
- Surgical dressings, Splints and Casts
- Therapeutic shoes
- Drugs (those processed by the DME/MACs and those processed by the A/B MACs and the Part B carrier)
- Clinical laboratory services and
- Ambulance services
Additional Information
If you have any questions, please contact our Provider Contact Center at (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.