Key Fields in Loop 2300 | Medicare Billing: CMS-1500 & 837P

These slides cover key Loop 2300 fields, including Medicaid codes, patient disability dates, extra claim information, Not Otherwise Classified (NOC) code instructions, and the PWK (paperwork) segment.

Loop 2300 HI / Item 10d

Complete when the patient is entitled to Medicaid.

Table 34: Loop 2300 HI / Item 10d Fields
Claim Codes (Designated by NUCC)	Source
Use this item exclusively for Medicaid (MCD) information. If the patient is entitled to Medicaid, enter the patient’s Medicaid number with MCD in front of it. Medicare doesn't require this item. For the 837P, Loop 2300 HI is for reporting other Condition Codes.	Patient records

Resource

Beneficiaries Dually Eligible for Medicare & Medicaid fact sheet

Loop 2300 DTP / Item 16

Complete when the patient is employed but unable to work in their current occupation.

Table 35: Loop 2300 DTP / Item 16 Fields
Dates Patient Unable to Work in Current Occupation	Source
If the patient is employed but can't work, enter the date the patient is unable to work in an 8-digit (MMDDCCYY) or a 6-digit (MMDDYY) format. An entry in this field may indicate employment-related insurance coverage. For the 837P, use the 2300 DTP Disability From Date and Work Return Date.	Patient records

Loop 2300 DTP / Item 19

Complete when there’s narrative information to supplement what you submitted on the claim.

Table 36: Loop 2300 DTP / Item 19 Fields
Additional Claim Information (Designated by NUCC)	Source
When a physician provides routine foot care, enter either a 6-digit (MMDDYY) or an 8-digit (MMDDCCYY) date you last saw the patient (2300 DTP) and the NPI of their attending physician.	Health care professional or supplier’s records

Resource

Medicare Claims Processing Manual, Chapter 26

Billing Tips for Loop 2300 NTE / Item 19

Instructions for Not Otherwise Classified (NOC) Codes – Any unlisted services or procedure code.

When reporting Not Otherwise Classified (NOC) codes:

Enter the drug’s name and dosage when submitting a claim for NOC drugs.
If possible, enter a concise description of an unlisted procedure code or an NOC code in the box. Otherwise, submit the claim with an attachment. If you don’t include a description on the claim form, you must submit an attachment when you bill an NOC code.
Enter a 6-digit (MMDDYY) or an 8-digit (MMDDCCYY) x-ray date for chiropractor services if an x-ray, rather than a physical examination, was used to show the subluxation.

Loop 2300 / PWK Segment for X12N Version 5010

Electronic billers submit the paperwork (PWK) segment in the 837P to indicate unsolicited claim-related documentation is coming.

The PWK segment is the link that connects paper documentation to an electronic claim. Submit claims electronically with the PWK segment populated. Then, submit other documentation to the MAC at the same time or close to the same time as the electronic claim.

If the MAC doesn’t get the documentation or decides it isn't needed, the MAC will adjudicate the claim as it normally would have if you hadn’t submitted PWK documentation. Once you submit the PWK data electronically, the MAC expects to get the documentation as soon as possible. You must submit the documentation within 7 calendar days by fax or 10 calendar days by mail.

Medicare requires a specially designed cover sheet for PWK documentation submission. Contact your MAC for details on how to get the cover sheet and complete it correctly.

For more information, review the Medicare Claims Processing Manual, Chapter 24.