Effective Date: January 1, 2009

Implementation Date: January 5, 2009

The Medicare Benefits Policy Manual (chapter 2, section 10) includes implanted prosthetic devices in the list of designated services for which payment may be made under the OPPS for Medicare beneficiaries who are inpatients of a hospital but who are not covered under Medicare Part A at the time of implantation, but who do have Part B coverage, on the day that they receive an implanted prosthetic device. The processing of claims for these services is discussed in the Medicare Claims Processing Manual (chapter 4, section 240). Under the Medicare prospective payment systems, reimbursement for these items is packaged into payment for the procedure in which they are implanted.

Providers must submit these services on a type of bill 12x, reporting a new HCPCS C-code that will be effective for services furnished on and after January 1, 2009, when they furnish an implanted prosthetic device to a Medicare beneficiary who is a hospital inpatient, but who does not have Part A coverage of inpatient services on the date that the implanted prosthetic device is furnished.

By reporting the new HCPCS C-code, the hospital is reporting that all of the criteria for payment under Part B are met as specified in the chapter 6, section 10 of the Medicare Benefits Policy Manual.

Here is the link to the MLN Matters article MM6050 .