MLN Product (Revised); Cardiac Device Credits: Medicare Billing
This revised Product comprises Subregulatory Guidance for Cardiac Device Credits: Medicare Billing and its content is based on publicly available content within https://www.ssa.gov/OP_Home/ssact/title18/1862.htm#act-1862-a-2, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf#page=172, https://www.govinfo.gov/content/pkg/FR-2020-12-29/pdf/2020-26819.pdf#page=152, https://www.ecfr.gov/cgi-bin/text-idx?SID=167ec6500f1e9dc33a4b3e0852bb2d9a&mc=true&node=pt42.2.412&rgn=div5#se42.2.412_189, https://www.ecfr.gov/cgi-bin/text-idx?SID=15ead62b89742e66b6404de74a45d66d&mc=true&node=pt42.3.419&rgn=div5#se42.3.419_145, https://www.ecfr.gov/cgi-bin/text-idx?SID=15ead62b89742e66b6404de74a45d66d&mc=true&node=pt42.3.419&rgn=div5#se42.3.419_145, and
https://www.ecfr.gov/cgi-bin/text-idx?SID=15ead62b89742e66b6404de74a45d66d&mc=true&node=pt42.3.419&rgn=div5#se42.3.419_166. CMS policy or operation subject matters experts also reviewed/cleared this product. The fact sheet educates providers about billing Medicare inpatient and outpatient cardiac devices and reducing overpayments. CMS reduces hospital payments when a patient gets a reduced or no cost implanted cardiac device or partial or full credit for the removed device. The reduced payment is consistent with https://www.ssa.gov/OP_Home/ssact/title18/1862.htm#act-1862-a-2 . It excludes Medicare coverage for an item or service the patient, or anyone on their behalf, must pay. Hospitals getting cardiac devices at no cost or with credit must use the correct billing modifiers and condition codes when submitting inpatient or outpatient claims so we only pay the reasonable cost of the device and don’t make overpayments. The revised product contains no substantive changes to the previous version dated
The previous version of this product is available to the public and currently posted on the CMS website at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/cardiacdevicecredits-ICN909368.pdf.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 17, 2023
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.