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RFP-CMS-2007-0013
Categories of Benefits and Provider/Supplier Types for the MAC Contract
Covered Under the MAC Contract
The table below summarizes each provider type covered by the MAC contract. Refer to the language in the Social Security Act for more complete information about each benefit category and provider/supplier type. The law is available online at www.ssa.gov/OP_Home/ssact/title18/1861.htm.
| Provider/Supplier Type |
| Institutional |
| Professional |
| Both |
Ambulance providers and suppliers
| Chemotherapy Demonstration |
| ( |
Clinical diagnostic laboratories
| Centralized Billing for Mass Immunizers/ Part A Roster Billing |
| ( |
| Community Mental Health Centers |
| ( |
| Critical Access Hospitals |
| ( |
Independent Diagnostic Testing Facilities
Inpatient Non-Critical Access Hospital providers paid under Part A and Part B
| Institutional providers |
| ( |
Mammography providers
| Medicare Coordinated Care Demonstration |
| ( |
| Outpatient clinics (ORFs and CORFs) |
| ( |
| Outpatient hospitals paid under Part B |
| ( |
Outpatient rehabilitation services providers paid under Part B
| Pain management centers |
| ( |
Pharmacy providers
Physicians, non-physicians, practitioners, and limited license practitioners
Portable X-rays, EKGs, similar portable services, and radiology providers
Preventive and screening service providers
| Provider-Based Cost Reports (Home Health, Hospice, etc) |
| ( |
| Region VI Part A End Stage Renal Disease (ESRD) |
| ( |
Rural Health Clinics/Federally Qualified Health Centers
Shipboard/Foreign Travel Service
| Skilled Nursing Facilities |
| ( |
The table below summarizes each benefit category covered by the MAC contract. Refer to the language in the Social Security Act for more complete information about each benefit category and provider/supplier type. The law is available online at www.ssa.gov/OP_Home/ssact/title18/1861.htm.
Benefit Category
| Ambulance Service |
| Medical Nutrition Therapy Services |
| Ambulatory Surgical Center Facility Services |
| Nurse Practitioner Services |
| Antigens |
| Optometrist Services |
| Artificial Legs, Arms, and Eyes |
| Oral Anticancer Drugs |
| Audiology Services |
| Oral Antiemetic Drugs |
| Blood Clotting Factors and Administration for Hemophilia Patients |
| Osteoporosis Drug |
| Bone Mass Measurement |
| Outpatient Hospital Services Incident to a Physician's Service |
| Certified Nurse-Midwife Services |
| Outpatient Occupational Therapy Services |
| Certified Registered Nurse Anesthetist Services |
| Outpatient Physical Therapy Services |
| Chiropractor Services |
| Speech Language Pathology Services |
| Clinical Nurse Specialist Services |
| Partial Hospitalization Services |
| Clinical Social Worker Services |
| Physician Assistant Services |
| Colorectal Cancer Screening Tests |
| Physicians' Services |
| Comprehensive Outpatient Rehabilitation Facility (CORF) Services |
| Pneumococcal Vaccine and Administration |
| Critical Access Hospital Services |
| Podiatrist Services |
| Dentist Services |
| Post-Hospital Extended Care Services |
| Diabetes Outpatient Self-Management Training Services |
| Post-Institutional Home Health Services |
| Diagnostic Laboratory Tests |
| Prostate Cancer Screening Tests |
| Diagnostic Services in Outpatient Hospital |
| Qualified Psychologist Services |
| Diagnostic Tests (other) |
| Rural Health Clinic Services |
Diagnostic X-Ray Tests
Screening for Glaucoma
| Drugs and Biologicals |
| Screening Mammography |
| Erythropoietin and Administration for Dialysis Patients |
| Screening Pap Smear |
| Extended Care Services |
| Screening Pelvic Exam |
| Eyeglasses and Contact Lenses After Cataract Surgery |
| Self-Care Home Dialysis Support Services |
| Hepatitis B Vaccine and Administration |
| Shipboard/Foreign Travel |
| Indian Health Services |
| Shoes for Patients with Diabetes (Therapeutic Shoes) |
| Immunosuppressive Drugs |
| Splints, Casts, Other Devices Used for Reduction of Fractures and Dislocations |
| Services and Supplies Incident to a physician's professional Service |
| Surgical Dressings |
| Influenza Vaccine and Administration |
| Transplantation Services for ESRD-Entitled Beneficiaries |
| Inpatient Hospital Services |
| X-ray, Radium, and Radioactive Isotope Therapy |
| Inpatient Psychiatric Hospital Services |
| Coverage for ESRD Patients |
Institutional Dialysis Services and Supplies
Not Covered Under the MAC Contract
The table below summarizes each category and provider type not covered by the MAC contract.
Service Category
Durable Medical Equipment
Home Health Services
Hospice Care
Provider Types
DME DMEPOS
Home Health Agencies
Histocompatibility Labs
Organ Procurement Agencies
Religious Nonmedical Health Care Institutions
Beneficiaries with government entities eligibility, including Department of Veterans Affairs
Medicare Secondary Payer Post-Pay
� List is not all-inclusive.
Attachment J-2
