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 ...

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