tci Part B Insider - 2008 Issue 35

Part B Mythbuster: Calculate Fees Using Medicare's 'Carve Out' Rule

Applying this modifier alerts Medicare that you know the service.Myth: You can't collect for both a preventive and sick visit during the same encounter.Reality: To estimate what your practice should charge a Medicare patient when your doctor performs a preventive service as well as an E/M service at the same visit means applying the "carve out" rule. Depending on whether the patient's preventive exam is covered, your outcome will be very different.For Medicare beneficiaries, you should take your normal charge amount of the preventive service minus the charge amount for the sick visit. This will give...

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