Billing Details Overview | Medicare Billing: CMS-1500 & 837P

Review the following slides to understand key billing details, including diagnosis pointers, service charges, and total charges.

Loop 2400 SV107 / Item 24E

Table 42: Loop 2400 SV107 / Item 24E Fields
Diagnosis Pointer	Source
The reference to supply in 24E will be a letter from A to L. Enter the diagnosis code reference letter from item 21 to connect the date of service and the procedures performed to the primary diagnosis. Enter only 1 reference letter per line item. When you provide multiple services, enter the primary reference letter for each service. If you need 2 or more diagnoses for a procedure code, only reference 1 of the diagnoses in item 21.	Patient records

Loop 2400 SV102 / Item 24F

Table 43: Loop 2400 SV102 / Item 24F Fields
Charges	Source
Enter the charge for each listed service.	Health care professional or supplier’s records

Loop 2400 SV1 / Item 24G

Table 44: Loop 2400 SV1 / Item 24G Fields
Days or Units	Source
Enter the number of days or units. This field is most commonly used for multiple visits, units of supplies, anesthesia minutes, or oxygen volume. If you perform only 1 service, enter the numeral 1. Some services require that you clearly indicate the actual number or quantity billed on the claim form. When you furnish multiple services, enter the actual number provided. For anesthesia, show the elapsed time in minutes. Convert hours into minutes and enter the total minutes.	Patient records

Resource

Refer to Chapter 26 of the Medicare Claims Processing Manual for specific guidelines on billing anesthesia, oxygen, and ambulance claims.

Loop 2300 CLM02 / Item 28

Table 45: Loop 2300 CLM02 / Item 28 Fields
Total Charge	Source
Enter the total charges for the services, including all charges in item 24F Charges.	Health care professional or supplier’s records

Limiting Charge

The limiting charge is 115% of the CMS-approved fee schedule amount for non-participating health care professionals or suppliers. The fee schedule has the amount you can charge for each kind of service.