Medical Coding, 2nd Edition

APPENDIX E

Payment System Reference

The payment methodology for Medicare claims is often followed by other payers soon after Medicare implementation. This appendix is intended to describe the payment methodologies used by different types of facilities or providers.

Type of Provider or Facility or Service	Payment Method and Rate
Ambulance	Ambulance fee schedule
Ambulatory Surgery Center (ASC)	Prospective payment—Ambulatory Payment Classification (APCs)
Cancer Hospital	Reasonable cost
Certified Nurse Midwife (CNM)	100% of physician fee schedule if billing independently
Clinical Nurse Specialist (CNS)	85% of physician fee schedule if billing independently
Clinical Psychologist (CP) or Independently Practicing Psychologist (IPP)	100% of ...