§ 512.705 - CR/ICR services that count towards CR incentive payments.

§ 512.705 CR/ICR services that count towards CR incentive payments.

(a) Identification of CR/ICR services. CR/ICR services are identified by the HCPCS codes for CR/ICR services included in the CMS change request that implements the National Coverage Determination in the CR performance year.

(b) CR participant eligibility for CR incentive payment.

(1) For EPM-CR participants, CR/ICR services paid by Medicare under the OPPS or to any supplier reporting place of service code 11 on the PFS claim for AMI and CABG model beneficiaries during AMI and CABG model episodes result in eligibility for CR incentive payments.

(2) For FFS-CR participants, CR/ICR services paid by Medicare under the OPPS or to any supplier reporting place of service code 11 on the PFS claim for beneficiaries during AMI care periods and CABG care periods that would meet the requirements to be AMI and CABG model episodes in accordance with all provisions in subpart B if the FFS-CR participant were an EPM participant result in eligibility for CR incentive payments.

(c) Overlap between AMI care periods and CABG care periods with AMI and CABG model episodes.

(1) An AMI care period or CABG care period does not begin if the beneficiary is in an AMI or CABG model episode when the AMI care period or CABG care period would otherwise begin.

(2) An AMI care period or CABG care period is canceled if at any time during the AMI care period or CABG care period the beneficiary initiates an AMI or CABG model episode.

(d) CR incentive payment time period. All AMI and CABG model episodes and AMI care periods and CABG care periods begin on or after July 1, 2017 and end on or before December 31, 2021.