Medicare Certified Facilities
- Participating Physician Groups (PPG)
In accordance with the Medicare Managed Care Manual (100-16), Chapter 6, Section 70, Institutional Provider and Supplier Certification, the Centers for Medicare and Medicaid Services (CMS) requires health plans to comply with all CMS requirements related to an approved benefit, and the use of approved Medicare-certified facilities for performing certain surgical procedures. This includes positron emission tomography (PET) scans in Medicare-specified studies.
The following procedures must be performed at Medicare-certified facilities:
- Carotid artery stenting
- Ventricular assist device (VAD) destination therapy
- Certain oncologic PET scans in Medicare-specified studies
- Lung-volume reduction surgery
When performing the above procedures, in addition to confirming the facility is Health Net participating, Health Net participating providers must refer to the CMS website at www.cms.gov to ensure the facility where the procedure is being performed is Medicare-certified. Once on the site, review the list in the left-hand menu bar for the applicable procedure.