Deductibles/Caps
The "Deductibles/Caps" sub-tab provides information regarding the beneficiary's Part B deductibles, co-insurance, occupational/physical/speech therapy caps, and other services.
The following tables provide information for the "Deductible/Caps" sub-tab fields:
Part B Deductible
Field Name | Description |
---|---|
Start/End Date |
The beginning and end dates for the annual deductible |
Deductible Amount |
The Medicare Part B deductible amount associated with the calendar year |
Part B Remaining Deductible
Field Name | Description |
---|---|
Start/End Date |
The beginning and end dates for the annual deductible |
Remaining Deductible |
The Medicare Part B deductible amount remaining for the calendar year |
Co-insurance Details
Field Name | Description |
---|---|
Start/End Date |
The beginning and end dates for the annual co-insurance |
Co-insurance Amount |
The percentage of the patient's financial responsibility for Medicare Part B services |
Blood Deductible
Field Name | Description |
---|---|
Calendar Year |
The calendar year associated with the remaining deductible amount |
Number of Units Remaining |
The blood deductible units remaining associated with the calendar year indicated |
Occupational Therapy Cap
Field Name | Description |
---|---|
Calendar Year |
The calendar year associated with the capitation limit |
Amount Used |
The amount of allowed occupational therapy services applied |
Physical and Speech Therapy Cap
Field Name | Description |
---|---|
Calendar Year |
The calendar year associated with the capitation limit |
Remaining Amount |
The amount of allowed physical and speech-language pathology applied |
Pulmonary Rehabilitation Services
Field Name | Description |
---|---|
Calendar Year |
The calendar year associated with the pulmonary rehabilitation services |
Professional Sessions Remaining |
The number of pulmonary rehabilitation sessions remaining for the professional component |
Technical Sessions Remaining |
The number of pulmonary rehabilitation sessions remaining for the technical component |
Cardiac Rehabilitation Services
Field Name | Description |
---|---|
Calendar Year |
The calendar year associated with the cardiac rehabilitation services |
Professional Sessions Used |
The number of cardiac rehabilitation sessions used for the professional component |
Technical Sessions Used |
The number of cardiac rehabilitation sessions used for the technical component |
Intensive Cardiac Rehabilitation Services
Field Name | Description |
---|---|
Calendar Year |
The calendar year associated with the cardiac rehabilitation services |
Professional Sessions Used |
The number of intensive cardiac rehabilitation sessions used for the professional component |
Technical Sessions Used |
The number of intensive cardiac rehabilitation sessions used for the technical component |
Part B Free Services
Field Name | Description |
---|---|
STC Codes |
The Health Care Service Type Codes (STC) identify classifications of services or benefits. For definitions of the two-digit codes, view the link for "List of STC Codes." |
Value |
The patient's portion of responsibility for a benefit, represented as a percentage |
Start/End Date |
The start and end dates of the benefit period |
Mental Health Co-insurance
Field Name | Description |
---|---|
STC Codes |
The Health Care Service Type Codes (STC) identify classifications of services or benefits. For definitions of the two-digit codes, view the link for "List of STC Codes." This section is specific to mental health. |
Value |
The patient's portion of responsibility for a benefit, represented as a percentage |
Start/End Date |
The start and end dates of the benefit period, typically the first day of the calendar year indicated |