Loop Information Not Available/FL 43 | Medicare Billing: CMS-1450 & 837I

Required when line-level rendering provider is different from claim-level rendering provider on combined claims by Critical Access Hospitals (CAHs) billing under Method II, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs).

Table 38: Loop Information Not Available/FL 43 Field
Revenue Code Description/Investigational Device Exemption (IDE) Number/Medicaid Drug Rebate	Source
Medicare doesn’t typically require FL 43. Enter a narrative description or standard abbreviation for each revenue code shown in FL 42 on the adjacent line in FL 43.	NUBC

Combined claims require FL 43. If the rendering provider for the line item reported in FL 42 is different from the attending provider in FL 76 (claim level), FL 43 must include the rendering provider's NPI.

The Investigational Device Exemption (IDE) or procedure identifies a specific device used only for billing under revenue code 0624. The IDE will appear on the paper format of the CMS-1450 as follows: FDA IDE # A123456 (17 spaces).

Note: CMS allows only 1 IDE per claim.

Copyright © 2025, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA.