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-484 | CMN | Oxygen |
| CMS-846 | CMN | Pneumatic compression devices |
| CMS-847 | CMN | Osteogenesis stimulators |
| 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 |