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MIR-2006-8AB, August 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Use of 12X Type of Bill (TOB) for Billing Screening Mammography, Screening Pelvic Examinations, and Screening Pap Smears
Provider Types Affected
Providers who submit screening mammography, screening pelvic examinations, and screening Pap smear claims to Medicare fiscal intermediaries (FIs)
Background
Screening mammography, screening pelvic examinations, and screening Pap smears provided to inpatients of a hospital are covered under Part B, even though the patient has Part A coverage for the hospital stay, if applicable conditions of coverage are met and the applicable frequency limitations have not been exceeded by the patient.
Providers currently bill for these services using TOB 13X, since 12X TOB has not, up to this point, been valid for the billing of screening mammography, screening pelvic examinations, and screening Pap smears, when provided to hospital inpatients under Part B.
Key Points
Effective for claims submitted to FIs on or after July 1, 2006, providers must use 12X TOB in place of 13X TOB to bill for the following services provided to hospital inpatients:
- Screening mammography;
- Screening pelvic examinations; and
- Screening Pap smears.
TOBs used for billing of screening mammographies, screening pelvic examinations, and screening Pap smears, when provided to other than hospital inpatients under Part B, remain unchanged. These TOBs are 13X, 14X, 22X, 23X, and 85X.
For additional information about this policy, please refer to the revised Medicare Claims Processing Manual attachments to CR4243 (Publication 100-04, Chapter 18). The revised sections attached to CR4243 include the following:
- Section 20.4 – Billing Requirements – FI Claims;
- Section 20.4.1.2 – RHC/FQHC (Rural Health Center/Federally Qualified Health Center) Claims with Dates of Service on or after January 1, 2002;
- Section 30.7 – Type of Bill and Revenue Codes for the Centers for Medicare & Medicaid Services (CMS) Form CMS-1450; and
- Section 40.6 – Revenue Code and HCPCS (Healthcare Common Procedure Coding System) Codes for Billing.
Relevant Links
CR4243 is the official instruction issued to your FI (fiscal intermediary) regarding this change. CR4243 may be found at http://www.cms.hhs.gov/Transmittals/downloads/R827CP.pdf  on the CMS Web site.
Please refer to your local FI if you have questions about this issue. To find the FI’s toll-free phone number, go to http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf  on the CMS Web site.
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.
For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles. 
Pub. 100-4, Transmittal# R827CP4, CR# 4243
Medlearn Matters Number: MM4243
Related CR Release Date: February 1, 2006
Effective Date: July 1, 2006
Implementation Date: July 3, 2006
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