HI 00610.450 Exceptions to Part B Deductible and Coinsurance

The 20 percent coinsurance (see HI 00610.440) does not have to be met with respect to Part B home health services furnished on and after January 1, 1973, and for used durable medical equipment (DME) purchased or rented on and after October 1, 1977, if the charge for the DME does not exceed 75 percent of the cost of new equipment (see HI 00610.190).

A. Nonapplicability of deductible/coinsurance

Neither the Part B cash deductible nor the 20 percent coinsurance apply with respect to:

  1. Radiology and pathology services furnished before July 1, 1981, to inpatients of qualified hospitals by physicians in the fields of radiology or pathology (see HI 00610.070);

  2. Radiology and pathology services furnished on and after July 1, 1981, to inpatients of qualified hospitals by physicians in the fields of radiology or pathology provided the physician agrees to accept assignment for all services furnished to inpatients; and

  3. Part B home health services (see HI 00610.390 ff.) furnished on and after July 1, 1981. (The deductible no longer has to be met with respect to Part B home health services furnished after that date.)

B. 1980 Legislative changes

Items A.2. and 3. above incorporate provisions of the Omnibus Reconciliation Act of 1980. Listed below are a number of other changes in the law affecting the application of the deductible and coinsurance. Policy instructions for implementing these changes have not been issued as of the date of this transmittal.

1. Preadmission diagnostic testing

Medicare Part B pays 100 percent of reasonable charges for certain preadmission diagnostic testing services of physicians and 100 percent of the reasonable costs of hospital outpatient preadmission diagnostic testing services (subject to the annual Part B cash deductible.)

2. Outpatient surgery

Medicare Part B pays 100 percent of physicians' reasonable charges for certain outpatient surgical procedures and an amount determined by the Secretary for facility services in connection with such outpatient surgical procedures.


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HI 00610.450 - Exceptions to Part B Deductible and Coinsurance - 04/03/2015
Batch run: 04/03/2015
Rev:04/03/2015