§ 69.23. Applicable Medicare payment and codes.
(a) The applicable Medicare fee schedule shall include fees associated with all permissible procedure codes. If the Medicare fee schedule also includes a larger grouping of procedure codes and corresponding charges than are specifically reimbursed by Medicare, a provider may use these codes, and corresponding charges shall be paid by insurers. If a Medicare code exists for application to a specific provider specialty, that code shall be used.
(b) Medicare payments are updated periodically by HCFA and the carrier and intermediaries. Insurers and providers shall utilize the latest Medicare payments as updated and provided by HCFA. Medicare payments shall be utilized by insurers and providers within 30 days of their effective date or date of official publication by HCFA, whichever occurs later.
(c) Medicare procedure codes are updated periodically by HCFA and the carrier and intermediaries. The updated Medicare procedure codes shall be utilized by insurers and providers within 30 days of their effective date or date of official publication by HCFA, whichever occurs later.
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