Part B Deductible Amount

(1) EFFECTIVE WITH NCH VERSION I THE AMOUNT OF CASH DEDUCTIBLE THE BENEFICIARY PAID FOR THE LINE ITEM SERVICE. NOTE1: THIS FIELD IS POPULATED FOR THOSE CLAIMS THAT ARE REQUIRED TO PROCESS THROUGH OUTPATIENT PPS PRICER. THE TYPE OF BILLS (TOB) REQUIRED TO PROCESS THROUGH ARE: 12X, 13X, 14X (EXCEPT MARYLAND PROVIDERS, INDIAN HEALTH PROVIDERS, HOSPITALS LOCATED IN AMERICAN SAMOA, GUAM AND SAIPAN AND CRITICAL ACCESS HOSPITALS (CAH)); 76X; 75X AND 34X IF CERTAIN HCPCS ARE ON THE BILL; AND ANY OUTPATIENT TYPE OF BILL WITH A CONDITION CODE 07 AND CERTAIN HCPCS. THESE CLAIM TYPES COULD HAVE LINES THAT ARE NOT REQUIRED TO PRICE UNDER OPPS RULES SO THOSE LINES WOULD NOT HAVE DATA IN THIS FIELD. ADDITIONAL EXCEPTION: VIRGIN ISLAND HOSPITALS AND HOSPITALS THAT FURNISH ONLY INPATIENT PART B SERVICES WITH DATES OF SERVICE 1/1/02 AND FORWARD. NOTE2: IT HAS BEEN DISCOVERED THAT THIS FIELD MAY BE POPULATED WITH DATA ON CLAIMS WITH DATES OF SERVICE PRIOR TO 7/00 (IMPLEMENTATION OF CLAIM LINE EXPANSION OPPS/HHPPS). THE ORIGINAL UNDERSTANDING OF THE NEW REVENUE CENTER FIELDS WAS THAT DATA WOULD BE POPULATED ON CLAIMS WITH DATES OF SERVICE 7/00 AND FORWARD. DATA HAS BEEN FOUND IN CLAIMS WITH DATES OF SERVICE PRIOR TO 7/00 BECAUSE THE STANDARD SYSTEMS HAVE PROCESSED ANY CLAIM COMING IN 7/00 AND AFTER, MEETING THE ABOVE CRITERIA, THROUGH THE OUTPATIENT CODE EDITOR (OCE) REGARDLESS OF THE DATES OF SERVICE. [NCH] (2) THE AMOUNT OF MONEY FOR WHICH THE CARRIER HAS DETERMINED THAT THE BENEFICIARY IS LIABLE FOR THE PART B CASH DEDUCTIBLE FOR THE LINE ITEM SERVICE ON THE NONINSTITUTIONAL CLAIM. [NCH]

3.5