What goes in box 21 on a CMS 1500?
Item 21 – Enter the patient’s diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and nonphysician specialties (i.e., PA, NP, CNS, CRNA) use diagnosis codes to the highest level of specificity for the date of service.
What are preprinted in Block 21 of the CMS 1500 claim?
Item numbers 1 through 4 preprinted in Block 21 of the CMS-1500 claim. The act that regulates disclosure of confidential information. prohibts a payer from notifying the provider about payment or rejection of unassigned claims or payments sent directly to the patietn patient/policyholder.
What are value codes on a UB04?
Value Codes
| Code | Description | Addtional Description |
|---|---|---|
| 81 | Non-Covered Days | Effective 03/01/07 Hardcopy UB04 Claims |
| 82 | Coinsurance Days | Effective 03/01/07 Hardcopy UB04 Claims |
| 83 | Lifetime Reserve Days | Effective 03/01/07 Hardcopy UB04 Claims |
| 84-99 | Reserved for National Assignment |
What services are billed on a UB04?
Who Can Bill Claims Using the UB-04?
- Community mental health centers.
- Comprehensive outpatient rehabilitation facilities.
- Critical access hospitals.
- End-stage renal disease facilities.
- Federally qualified health centers.
- Histocompatibility laboratories.
- Home health agencies.
- Hospices.
What goes in box 32A on CMS 1500?
Claim submission reminder for service facility location information (HCFA 1500 Box 32A) Please remember to include the NPI of the servicing facility on your CMS-1500 form Box 32A. This will ensure your claim is processed to reflect the appropriate servicing facility where services were rendered.
What box does the CLIA number go in on a CMS 1500?
Clia number in CMS 1500 On each claim, the CLIA number of the laboratory that is actually performing the testing must be reported in item 23 on the CMS-1500 form. Referral laboratory claims are permitted only for independently billing clinical laboratories, specialty code 69.
What is the difference between a CMS 1500 form and UB 04 form?
The UB-04 (CMS-1450) form is the claim form for institutional facilities such as hospitals or outpatient facilities. This would include things like surgery, radiology, laboratory, or other facility services. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.
How many boxes are in a CMS 1500?
Only one box should be indicated; either M or F. Marking both or neither will cause the claim to be rejected as unprocessable. If Medicare is primary, leave blank. If there is insurance primary to Medicare, either through the patient’s or spouse’s employment or any other source, list the name of the insured here.
What box is discharge status on UB04?
Box 17 – Patient Discharge Status: (Required if applicable) This field indicates the discharge status of the patient when service is ended/complete.
What are value codes?
The code indicating a monetary condition which was used by the intermediary to process an institutional claim. The associated monetary value is in the claim value amount field (CLM_VAL_AMT).
What is the difference between the CMS 1500 and UB-04?
How many boxes does UB-04 have?
81 fields
There are 81 fields (or lines) on a UB-04 form. These are referred to as form locators or “FL.” Each form locator has a unique purpose for the insurance carrier and provider so that they can communicate. It’s important that each of the UB-04 fields is filled out correctly to ensure a smooth process.