Question:

What is the Medicare policy related to payment for a cardiac device that the manufacturer supplies at no cost or reduced cost?

Answer:

When an implanted cardiac device is replaced at reduced or no cost to the hospital or with partial or full credit for the removed device, the Centers for Medicare & Medicaid Services (CMS) reduce Medicare payment. Hospitals receiving cardiac devices at no cost or with credit must use proper modifiers and/or condition codes when submitting inpatient or outpatient claims, so Medicare only reimburses the reasonable cost of the device and no overpayments occur.

Details about this policy are covered in a fact sheet that can be found at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/cardiacdevicecredits-ICN909368.pdf.

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