Payment may be made for covered diagnostic and therapeutic services furnished by CSWs in a hospital outpatient setting. Carriers apply the limitation of 62.5 percent to the lesser of the actual charge or fee schedule amount. Diagnostic services are not subject to the limitation. These services are not billed to your intermediary. However, bill your intermediary for these services.
Payment is made on a reasonable cost basis.
MQSA requires the Secretary to ensure that all facilities that provide mammography services meet national quality standards. Your intermediary is responsible for determining that you have a certificate prior to payment. In addition, it is responsible for ensuring that payment is not made in situations where your certificate has expired, or it has been suspended or revoked or you have been issued a written notification by the FDA stating that you must cease conducting mammography examinations because you are not in compliance with certain critical FDA certification requirements. Such services are covered only when provided by order of a physician or another individual authorized by State licensure law and hospital bylaws to admit patients to the hospital or to order outpatient tests. Observation services usually do not exceed one day.