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CMS-1403-FC
period. The public will have another opportunity to
comment on the NCD when the proposed decision is published.
After taking into consideration all of the public comments
and evidence, a final decision will be made public.
Development of a complete, formal request for an NCD can be
initiated either by an outside party or internally by CMS
staff.
We are establishing new §410.64, Additional Preventive
Services, to reflect these statutory requirements. To
conform the regulations to the statutory requirements of
the MIPPA, we are also adding new paragraph §411.15(k)(15)
for “additional preventive services.”
Payment of Co-Insurance
Section 101(a)(2) of the MIPPA establishes payment
rules under Part B if the Secretary makes a NCD for an
additional preventive service under section 1861(ddd) of
the Act. The amount of the Part B payment and the amount
of the beneficiary’s Part B coinsurance will depend on the
nature of the new preventive service. For instance, if the
additional preventive service is a clinical diagnostic
laboratory test, Medicare pays on a fee schedule basis and
the amount paid is 100 percent. There is no beneficiary
coinsurance. For all other additional preventive services,
Medicare will pay 80 percent of the lesser of the actual
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