Carrier-Priced Procedures
For 2007, the Centers for Medicare & Medicaid Services (CMS) is changing many status "A" codes to status "C" (carrier-priced procedure) codes. What is a carrier-priced procedure?
Carrier-priced codes are those with a status code "C" on the Medicare Physician Fee Schedule Database (MPFSDB). Sometimes referred to as the Medicare Physician Fee Schedule Relative Value File, this database is available on the Centers for Medicare & Medicaid Services' Website at the following address:
http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp 
Other than category III "T" codes, CMS establishes no fees for carrier-priced procedures. WPS Medicare uses individual consideration when reviewing a carrier-priced procedure and may request medical records to assist in the evaluation and pricing. This occurs only after receipt of the claim. Therefore, providers that submit claims electronically should indicate that documentation is available upon request. For those providers that do not submit claims electronically, documentation must accompany the claim.
Providers should bill the amount to Medicare that accurately reflects all costs associated with providing the procedure for the beneficiary.
