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2018 New CPT codes

00731  Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified ...

What is Liability insurance and No-Fault Insurance?


Liability insurance is coverage that protects against claims based on negligence, inappropriate action, or inaction that results in bodily injury or damage to property. Liability insurance includes but is not limited to:

Homeowners’ liability insurance.

Automobile liability insurance.

Product liability insurance.

Malpractice liability insurance.

Uninsured motorist liability insurance.

Underinsured motorist liability insurance.

Medicare does not make payment for covered items or services to the extent that payment has been made, or can reasonably be expected to be made under a liability insurance policy or plan. Under certain circumstances, Medicare may make conditional payments if the liability insurance will not pay or will not pay promptly. Conditional payments are conditioned upon reimbursement to the Medicare program to the extent that payment with respect to the same items or services has been made, or could be made, under a liability insurance policy or plan (including self-insured plan). Medicare’s right to recover its benefits from liability insurers and from those who have been paid by liability insurers takes precedence over the claims of any other party.

What is No-Fault Insurance?

Insurance that pays for medical expenses for injuries sustained on the property or premises of the insured, or in the use, occupancy or operation of an automobile, regardless of who may have been responsible for causing the accident. This insurance includes but is not limited to automobile, homeowners’ and commercial plans. It includes “medical payments coverage,” “personal injury protection” or “medical expense coverage.” Examples of no-fault insurance include homeowners’ and commercial medical payments insurance, commonly referred to as Med-Pay coverage.

Med-Pay – A payment made by an insurer intended specifically to pay for medical expenses without regard to the fault of any party to the accident. Med-Pay is a form of no-fault insurance.

Prompt or Promptly – With regard to liability insurance, means payment within 120 days after the earliest of the following:

The date a claim is filed with an insurer or a lien is filed against a potential liability settlement. Or,

The date the service was furnished or, in the case of inpatient hospital services, the date of discharge.

With regard to no-fault and workers’ compensation insurance, “prompt” or “promptly” means payment within 120 days after receipt of the claim.

* Medicare does not pay as the primary insurer for medical services covered by no-fault policies. Therefore, all no-fault claims should be filed to the no-fault insurance company first.

* Medicare pays as the primary insurer if the entire primary insurer allowance on the automobile insurance claim is applied to the deductible, regardless of the deductible amount.

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