myCGS

Eligibility

Deductibles/Caps

The "Deductibles/Caps" sub-tab provides information regarding the beneficiary's Part B deductibles, co-insurance, occupational/physical/speech therapy caps, and other services.

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The following tables provide information for the "Deductible/Caps" sub-tab fields:

Part B Deductible

Field Name Description

Start/End Date

The beginning and end dates for the annual deductible

Deductible Amount

The Medicare Part B deductible amount associated with the calendar year

Part B Remaining Deductible

Field Name Description

Start/End Date

The beginning and end dates for the annual deductible

Remaining Deductible

The Medicare Part B deductible amount remaining for the calendar year

Co-insurance Details

Field Name Description

Start/End Date

The beginning and end dates for the annual co-insurance

Co-insurance Amount

The percentage of the patient's financial responsibility for Medicare Part B services

Blood Deductible

Field Name Description

Calendar Year

The calendar year associated with the remaining deductible amount

Number of Units Remaining

The blood deductible units remaining associated with the calendar year indicated

Occupational Therapy Cap

Field Name Description

Calendar Year

The calendar year associated with the capitation limit

Amount Used

The amount of allowed occupational therapy services applied

Physical and Speech Therapy Cap

Field Name Description

Calendar Year

The calendar year associated with the capitation limit

Remaining Amount

The amount of allowed physical and speech-language pathology applied

Pulmonary Rehabilitation Services

Field Name Description

Calendar Year

The calendar year associated with the pulmonary rehabilitation services

Professional Sessions Remaining

The number of pulmonary rehabilitation sessions remaining for the professional component

Technical Sessions Remaining

The number of pulmonary rehabilitation sessions remaining for the technical component

Cardiac Rehabilitation Services

Field Name Description

Calendar Year

The calendar year associated with the cardiac rehabilitation services

Professional Sessions Used

The number of cardiac rehabilitation sessions used for the professional component

Technical Sessions Used

The number of cardiac rehabilitation sessions used for the technical component

Intensive Cardiac Rehabilitation Services

Field Name Description

Calendar Year

The calendar year associated with the cardiac rehabilitation services

Professional Sessions Used

The number of intensive cardiac rehabilitation sessions used for the professional component

Technical Sessions Used

The number of intensive cardiac rehabilitation sessions used for the technical component

Part B Free Services

Field Name Description

STC Codes

The Health Care Service Type Codes (STC) identify classifications of services or benefits. For definitions of the two-digit codes, view the link for "List of STC Codes."

Value

The patient's portion of responsibility for a benefit, represented as a percentage

Start/End Date

The start and end dates of the benefit period

Mental Health Co-insurance

Field Name Description

STC Codes

The Health Care Service Type Codes (STC) identify classifications of services or benefits. For definitions of the two-digit codes, view the link for "List of STC Codes." This section is specific to mental health.

Value

The patient's portion of responsibility for a benefit, represented as a percentage

Start/End Date

The start and end dates of the benefit period, typically the first day of the calendar year indicated

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