Tax ID, Signatures, & Service Facility Locations
These slides cover how to enter the Tax ID, Signature, Service Facility Location, and NPI of the Service Facility for the CMS-1500 and 837P.
Loop 2010AA REF (Billing Provider Tax Identification Number) / Item 25
| Federal Tax ID Number | Source |
|---|---|
The federal tax ID is the Employer Identification Number or SSN of the health care professional or supplier who provided the service. Check the appropriate box. Enter the Billing Provider Tax ID in Loop 2010AA REF segment of the 837P. The Federal Tax ID Number can apply to a person or a group. | Health care professional or supplier’s records |
Source
When the Source column shows you can find the information in the health care professional or supplier’s records, this refers to the health care professional's or supplier's internal records.
Loop 2300 CLM06 / Item 31
| Signature of Physician or Supplier | Source |
|---|---|
On the CMS-1500, enter the signature of the health care professional or supplier who provided the service, or the signature of a representative of the health care professional and supplier, and either the 6-digit date (MMDDYY), 8-digit date (MMDDCCYY), or alpha-numeric date, like January 1, 2025, when the form was signed. Choose the Y (Yes) or N (No) indicator in the Provider or Supplier Signature Indicator 2300 CLM06 of the 837P. | Health care professional or supplier |
MM = 2-digit month
DD = 2-digit day
YY = 2-digit year
CCYY = 4-digit year
Date Field Format
Other than the birth date, fill all date fields with either the 6-digit or 8-digit format.
You can’t mix the 2 formats on the same claim form.
Note: The health care professional or supplier who furnished the service has to sign in Field Locator 31 (FL 31). Co-surgeons must sign their own operative reports.
Loop 2310C / Item 32 for DMEPOS Fields
| Service Facility Location Information | Source |
|---|---|
For DMEPOS, enter the name and address of the location where the supplier accepted the order. Complete this item whether the supplier’s employees do the work at the physician’s office or at another location. You must submit the location where you provided the service for all places of service, including a home. | Health care professional or supplier’s records |
Anti-Markup Payment Limitation
The anti-markup payment limitation applies to diagnostic tests (other than clinical diagnostic laboratory tests) ordered, performed, and billed by physicians and other suppliers, like physician organizations, who submit claims to MACs for the tests. Tests subject to the anti-markup payment limitation are sometimes referred to as "anti-markup tests."
For services payable under the physician fee schedule and anesthesia services, enter the name, address, and ZIP Code of the facility if you provided the services in a hospital, clinic, laboratory, or any facility other than the patient’s home or a physician’s office.
Loop 2310C NM109 / Item 32a
| NPI of the Service Facility | Source |
|---|---|
Enter the service facility's NPI. The NPI of the Service Facility can apply to a person or a group. | NPPES offers a searchable NPI Registry, or you can get the NPI from the ordering or referring health care professional. |