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.


Medicare coding rules breakdown
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


CMS documentation forms