Ophthalmology and Optometry Coding Alert

Question: What is Medicare's billing policy for missed appointments?

Wisconsin Subscriber

Answer: MLN Matters article 5613 (http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5613.pdf) states that you may charge for missed appointments for Medicare patients, with a few caveats.

Caveat 1: Your no-show charge policy needs to apply equally to Medicare and non-Medicare patients. You must consistently charge all patients the same amount for missed appointments.

Caveat 2: You should not bill Medicare for the missed appointment. Instead, you'll bill the patient directly. Medicare will deny missed-appointment claims, citing reason code 204 (This service/equipment/drug is not covered under the patient's current benefit plan).

In most cases, if you bill for a hospital outpatient department, you'll be able to charge a beneficiary a missed-appointment charge. "In the event, however, that a hospital inpatient misses an appointment in the hospital outpatient department, it would violate 42 CFR 489.22 for the outpatient department to charge the beneficiary a missed-appointment fee," the MLN Matters article says.