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Medicare Billing: CMS-1500 & 837P Code Sources

This Code Sources Job Aid gives billing information for the hardcopy claim CMS-1500 and the electronic claim 837P. It details what needs to be included on hardcopy forms and electronic submissions, along with Medicare's requirements.
Hardcopy ItemElectronic LoopMedicare RequirementCode Source and Location
Item 17 fields – Name of Referring Provider or Other Source2310A NM1 Name of Referring Provider or Other Source

2310D NM1 – Supervising Provider

2420E NM1 – Ordering Provider
Required if applicable

Refer to the Medicare Claims Processing Manual, Chapter 26, to decide when the claim requires this item.
National Plan and Provider Enumeration System (NPPES) nppes.cms.hhs.gov/#

Medicare Claims Processing Manual, Chapter 26
CMS.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c26pdf.pdf
Item 21 fields –
Diagnosis or Nature of Illness or Injury ICD Ind.
2300 HI01-HI12 – Claim InformationRequired

*Exception includes hardcopy claims submitted by ambulance suppliers.
ICD-10-CM
cdc.gov/nchs/icd/icd-10-cm/files.html
Item 23 – Prior Authorization Number2300 REF–
1. Quality Improvement Organization (QIO) prior authorization number
(2300)
Required if Applicable
1. Enter the QIO prior authorization number for those procedures requiring QIO prior approval.
1. Contact the QIO who gave the authorization to get the prior authorization number.
Item 23 – Prior Authorization Number
(continued)
2. Investigational Device Exemption (IDE) number (2300)2. Enter the IDE number when you use an investigational device in an FDA-approved clinical trial. You should also place the Post Market Approval number here when applicable.2. Contact the health care professional or supplier participating in the clinical trial for a copy of the FDA approval or clearance letter.
Item 23 – Prior Authorization Number
(continued)
3. NPI of the Home Health Agency (HHA) or hospice (2300)3. For physicians performing care plan oversight services, enter the NPI of the HHA or hospice when you bill CPT code G0181 (HH) or G0182 (Hospice).3. NPPES
nppes.cms.hhs.gov/#
Item 23 – Prior Authorization Number
(continued)
4. Clinical Laboratory Improvement Amendments (CLIA) certification number (2300 or 2400)4. Enter the 10-digit CLIA certification number for laboratory services when an entity performing CLIA covered procedures bills.4. State Agency
CMS.gov/medicare/quality/clinical-laboratory-improvement-amendments/apply
Item 23 – Prior Authorization Number
(continued)
5. ZIP Code5. For ambulance claims, enter the ZIP Code of the loaded ambulance trip’s point-of-pickup.5. U. S. Postal Service (USPS)
tools.usps.com/go/ZipLookupAction!input.action
Item 24B – Place of Service2300 CLM05 -01 or 2400 SV105 – Facility Code ValueRequiredMedicare Claims Processing Manual, Chapter 26
CMS.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c26pdf.pdf
Item 24D – Procedures, Services, or Supplies - CPT/ HCPCS2400 SV101-2– Product/Service IDRequiredLevel I: CPT codes maintained by the American Medical Association (AMA)
ama-assn.org

Level II: HCPCS codes maintained by CMS
CMS.gov/medicare/coding-billing/healthcare-common-procedure-system
Item 24D – Procedures, Services, or Supplies - Modifier2400 SV101-2 – SV101-6 – Procedure ModifierRequired if applicable

Refer to the CPT Manual or the HCPCS Book to decide when you need a modifier.
Level I: CPT codes maintained by the AMA
ama-assn.org

Level II: HCPCS codes maintained by CMS
CMS.gov/medicare/coding-billing/healthcare-common-procedure-system
Item 24J – Rendering Provider ID Number2310B NM109 or 2420A NM109 – Rendering Provider IdentifierRequiredNPPES
nppes.cms.hhs.gov/#
Item 26 – Patient Account NumberLoop 2300 CLM01 – Patient Control NumberSituationalProvider or supplier’s records
Item 32a – Service Facility NPI2310C NM109 – Laboratory or Facility Primary IdentifierRequiredNPPES
nppes.cms.hhs.gov/#
Item 33a – Billing Provider NPI2010AA NM109 – Billing Provider IdentifierRequiredNPPES
nppes.cms.hhs.gov/#

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