Use standard Medicare claim formats
- Electronic submitters: ANSI 837
- Billers submitting paper claims for professional services: CMS-1500 (02/12)
- Billers submitting paper claims for services by facilities and institutions: UB-04
Apply original Medicare coding rules
- Paper claims – use your national provider identifier and federal tax ID as appropriate.
- Electronic submitters – use NPI only.
- Quantify facility services by revenue code categories, or, if reporting HCPCS codes, the number of units equal to the number of times the service or procedure is being reported.
- Use Medicare CPT codes and defined modifiers.
- Bill diagnosis codes to the highest level of specificity.
- Include physician's or supplier's signature. Include date, degrees or credentials. "Signature on file" is not acceptable.
- Use CMS-approved HCPCS code modifiers.
Some services require a Certificate of Medical Necessity, a durable medical equipment information form, a prescription or other documentation with the first-month supply claim, a first-month rental equipment claim, or a claim for a one-time equipment purchase. We will deny claims that require, but do not include, appropriate documentation.
|CMS form||Type of form||Service description|
|CMS-846||CMN||Pneumatic compression devices|
|CMS-848||CMN||Transcutaneous electrical nerve stimulators|
|CMS-849||CMN||Seat lift mechanisms|
|CMS-854||CMN||Section C continuation form|
|CMS-10125||DIF||External infusion pumps|
|CMS-10126||DIF||Enteral and parenteral nutrition|
|CMS-10269||CMN||Positive Airway Pressure (PAP) devices for obstruction sleep apnea|