Reminder: Report numeric amounts in Medicare Advantage claims charge fields

The Centers for Medicare & Medicaid Services require a numeric amount in the charges field of both UB-04 and
CMS-1500 claims. Blue Cross Blue Shield of Michigan is not allowed to correct claims.

Home health and skilled nursing facility claims are, at times, submitted with blank charges. Zeros should be included when the forms are completed to initiate a procedure.

Below are links to information on the CMS website explaining each form’s guidelines:

• UB-04 – Field 47 overview of total charges required by Medicare: cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/ub04_fact_sheet.pdf*
• Medicare Claims Processing Manual, chapter 25, page 23, details field 47 specifically: cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c25.pdf*
• 1500 – Field 24F overview of total charges required by Medicare: cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/form_cms-1500_fact_sheet.pdf*
• Medicare Claims Processing Manual, chapter 26, page 14, details how Field 24F requires this charge for each listed service: cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c26.pdf*

CMS recently discovered that Medicare’s instruction regarding the total charges field report for home health is in conflict with the HIPAA standard 837 institutional claim format. This link below provides additional instructions and clarification: cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7660.pdf*. The 837 requires that the total charges filed (SV203) must always be reported. Zero is an acceptable value.

For skilled nursing facilities, total charges should be zero for revenue code 0022. This link provides additional guidance: cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c06.pdf *.

Thank you for your assistance. If you have any questions, please contact your provider consultant.

*BCBSM does not control this website or endorse its general content.