Medicare payment varies based on the type of service, site of service, and benefit covering the service.
For specific information about how Medicare pays for certain services related to Adenoscan, click here. For quarterly allowable for Adenoscan, click here.
| Site of Service | Payment Methodology |
| Hospital Inpatient | Medicare Severity Diagnosis Related Group (MS-DRG)
A classification system that groups
patient encounters according to diagnosis, type of treatment, age, and
other relevant criteria. Hospitals are paid one set fee for the patient,
encounter based on the MS-DRG, regardless of the actual cost of care
for the individual. |
| Skilled Nursing Facility | Resource Utilization Group (RUG)
Per diem payments for each admission are case-mix adjusted using
a resident classification system based on data from resident
assessments and relative weights developed from staff time data. |
| Hospital Outpatient | Ambulatory Payment Classification (APC)
Services in each APC are similar
clinically and in terms of the resources they require. A payment rate is
established for each APC. Depending on the services provided, hospitals
may be paid for more than one APC for an encounter. |
| Physician Office | Medicare Physician Fee Schedule based on Resource-Based Relative Value System (RBRVS)
A scale of national uniform relative
values for all physicians' services. The relative value for each service
includes physicians' work, practice expenses net of malpractice
expenses, and the cost of professional liability insurance. Medicare
multiplies the relative values by a conversion factor, and adjusts that
amount geographically to determine the fee schedule amount. |
Additional information about Medicare is available online at www.cms.hhs.gov or www.medicare.gov.
