Friday, 26 July 2013

Place of Service Codes (CMS1500 box 24b) Part 3


49Independent Clinic
A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only. (effective 10/1/03)
50Federally Qualified Health CenterA facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician.
51Inpatient Psychiatric FacilityA facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician.
52Psychiatric Facility-Partial HospitalizationA facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.

Thursday, 25 July 2013

Place of Service Codes (CMS1500 box 24b) Part 2


14Group Home *A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).
15Mobile UnitA facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.

Special Considerations
When services are furnished in a mobile unit, they are often provided to serve an entity for which another POS code exists. For example, a mobile unit may be sent to a physician's office or a skilled nursing facility. If the mobile unit is serving an entity for which another POS code already exists, providers should use the POS code for that entity. However, if the mobile unit is not serving an entity which could be described by an existing POS code, the providers are to use the Mobile Unit POS code 15. Apply the nonfacility rate to payments for services designated as being furnished in POS code 15; apply the appropriate facility or nonfacility rate for the POS code designated when a code other than the mobile unit code is indicated.
16Temporary LodgingA short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. (effective 4/1/08)

Wednesday, 24 July 2013

Place of Service Codes (CMS1500 box 24b) Part 1

Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry.

This code set is required for use in the implementation guide adopted as the national standard for electronic transmission of professional health care claims under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA directed the Secretary of HHS to adopt national standards for electronic transactions. These standard transactions require all health plans and providers to use standard code sets to populate data elements in each transaction. The Transaction and Code Set Rule adopted the ASC X12N-837 Health Care Claim: Professional, volumes 1 and 2, version 4010, as the standard for electronic submission of professional claims. This standard names the POS code set currently maintained by CMS as the code set to be used for describing sites of service in such claims. POS information is often needed to determine the acceptability of direct billing of Medicare, Medicaid and private insurance services provided by a given provider.

List of Place of Service Codes

List (updated March 17, 2011 )

Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. If you would like to comment on a code(s) or description(s), please send your request to posinfo@cms.hhs.gov.

Code(s)Place of Service NamePlace of Service Description
01Pharmacy**A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. (effective 10/1/05)
02UnassignedN/A

Tuesday, 23 July 2013

CMS 1500 claim form billing instruction Part 6

BLOCK 23 PRIOR AUTHORIZATION NUMBER
Enter the Professional Review Organization (PRO) prior authorization number for those procedures requiring PRO prior approval.
Enter the Investigational Device Exemption (IDE) number for those clinical trial procedures requiring IDE approval.
For paper claims only, enter the ten - digit Clinical Laboratory Improvement Act (CLIA) certification number for laboratory services. Only one CLIA number may be reported per claim.
Completion of this field is conditional the situations above

CMS 1500 - BLOCK 24A DATES OF SERVICE

CMS 1500 claim form billing instruction Part 5

BLOCK 14 DATE OF CURRENT ILLNESS

the six - digit date (MMDDYY) of current illness, injury, or pregnancy. For chiropractic services, enter the six - digit date (MMDDYY) of the initiation of the course of treatment and enter the six - digit date (MMDDYY) x-ray date in block 19
.Note: Effective for dates of service January 1, 2000 and after, the x-ray date is no longer required for chiropractic services.Completion of this field is required for all chiropractic services; conditional for other services.

BLOCK 15 IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS

CMS 1500 claim form billing instruction Part 4

BLOCK 11A INSURED'S DATE OF BIRTH

Enter the insured's birth date (MMDDCCYY) and sex, if different from block 3.
BLOCK 11B EMPLOYER'S NAME OR SCHOOL NAME
Enter the employer's name, if applicable. If there is a change in the insured's insurance status, e.g., retired, enter the six - digit retirement date (MMDDYY) preceded by the word "RETIRED."
Completion of this field is conditional when the beneficiary has insurance primary to Medicare. 

BLOCK 11C INSURANCE PLAN NAME OR PROGRAM NAME

CMS 1500 claim form billing instruction Part 3

HCFA BOX BLOCK 9 OTHER INSURED'S NAME


Enter the last name, first name, and middle initial of the enrollee in a Medigap policy, if it is different from that shown in block 2. Otherwise, enter the word "SAME". If no Medigap benefits are assigned, leave blank. 

BLOCK 9A OTHER INSURED'S POLICY OR GROUP NUMBER
Enter the policy and/or group number of the Medigap insured preceded by MEDIGAP, MG or MGAP. 

BLOCK 9B OTHER INSURED'S DATE OF BIRTH

Enter the Medigap enrollee's birth date (MMDDCCYY) and sex. 

BLOCK 9C EMPLOYER'S NAME OR SCHOOL NAME

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