In most pediatric practices, few patients have medical coverage through the Medicare program. This can make it difficult to know covered benefits and billing guidelines for services rendered when young patients are Medicare beneficiaries. Here are a few tips that may be helpful.

Medicare benefits are available to children with certain conditions and disabled adult children of persons who receive Social Security retirement or disability benefits. The criteria shown in the Table are used to determine Medicare eligibility for children and an adult disabled child.

Many patients who qualify for Medicare benefits under these circumstances will be dual eligible, meaning that Medicare is their primary coverage with Medicaid paying secondary benefits (usually limited to the Medicaid allowable amount). Medicare will typically be the secondary payer to a child who is also covered under a private payer plan or continuation of benefits. However, Medicare will be the primary payer for...

You do not currently have access to this content.