(Medicare Claims Processing Manual)

Item 29 -  Enter the total amount the patient paid on the covered services only.  Item 30 -  Leave blank.  Not required by Medicare.  Item 31 -  Enter the signature of provider of service or supplier, or his/her representative, and either the 6 -digit date (MM | DD | YY), 8- digit date (MM | DD | CCYY), or alpha -numeric date (e.g., January 1, 1998) the form was signed.  In the case of a service that is provided incident to the service of a physician or non-physician practitioner, when the ordering physician or non- physician practitioner is directly supervising the service as in 42 CFR 410.32, the signature of the ordering physician or non- physician practitioner shall be entered in item 31.  When the ordering physician or non- physician practitioner is not supervising the service, then enter the signature of the physician or non- physician practitioner providing the direct supervision in item 31.   NOTE:  This is a required field; however, the claim can be processed if the following is true:  if a physician, supplier, or authorized person's signature is missing, but the signature is on file; or if any authorization is attached to the claim or if the signatu re field has "Signature on File" and/or a computer generated signature.   Item 32 -  For services payable under the physician fee schedule and anesthesia services, enter the name and address, and ZIP code of the facility if the services were furnished in a hospital, clinic, laboratory, or facility other than the patient's home or physician's office.  Effective for claims received on or after April 1, 2004, enter the name, address, and ZIP code of the service location for all services other than those furnished in place of service home -  12.  Effective for claims received on or aft er April 1, 2004, only one name, address and ZIP code may be entered in the block.  If additional entries are needed, separate claim forms shall be submitted.  Effective January 1, 2011, for claims processed on or after January 1, 2011, submission of the l ocation where the service was rendered will be required for all POS codes.   Providers of service (namely physicians) shall identify the supplier's name, address, and ZIP code when billing for anti -markup tests.  When more than one supplier is used, a separate CMS -1500 claim form shall be used to bill for each supplier.  (See Pub. 100- 04, chapter 1, 10.1.1.2 for more information on payment jurisdicti on for claims subject to the anti -markup limitation.)   For foreign claims, only the enrollee can file for Part B benefits rendered outside of the United States.  These claims will not include a valid ZIP code.  When a claim is received for these services on a beneficiary submitted Form CMS -1490S, before the cl aim is entered in the system, it should be determined if it is a foreign claim.  If it is a foreign claim, follow instructions in chapter 1 for disposition of the claim.  The A/B MAC (B) processing the foreign claim will have to make necessary accommodatio ns to verify that the claim is not returned as unprocessable due to the lack of a ZIP code.   For durable medical, orthotic, and prosthetic claims, the name and address of the location where the order was accepted must be entered (DME MAC only).  This field is required.  When more than one supplier is used, a separate CMS -1500 claim form shall be used to bill for each supplier.  This item is completed whether the supplier's personnel performs the work at the physician's office or at another location.  If the supplier is a certified mammography screening center, enter the 6 -digit FDA approved certification number.  Complete this item for all laboratory work performed outside a physician's office.  If an independent laboratory is billing, enter the place where the test was performed.  Item 32a -  If required by Medicare claims processing policy, enter the NPI of the service facility.   Effective for claims submitted with a receipt date on and after October 1, 2015, the billing physician or supplier must report the name, address, and NPI of the performing physician or supplier on the claim on reference laboratory claims, even if the perfo rming physician or supplier is enrolled in a different A/B MAC (B) jurisdiction.  See Pub. 100-04, Chapter 1, 10.1.1 for more information regarding claims filing jurisdiction.  Item 32b -  Effective May 23, 2008, Item 32b is not to be reported.   Item 33 -  Enter the provider of service/supplier's billing name, address, ZIP code, and telephone number.  This is a required field.   Item 33a -  Enter the NPI of the billing provider or group.  This is a required field.  Item 33b -  Item 33b is not generally reported.  However, for some Medicare policies you may be instructed to use this item; direction as to how to use this item will be in the instructions you received regarding the specific policy, if applicable.   10.5 - Place of Service Codes (POS) and Definitions  (Rev. 12411, Issued: 12- 14-23, Effective:  10-01-23, Implementation: 01- 02-24)  o HIPAA   o The Health Insurance Portability and Accountability Act of 1996 (HIPAA) became effective October 16, 2003, for all covered entities. Medicare is a covered entity under  HIPAA.   o The final rule, Health Insurance Reform: Standards for Electronic Transactions, published in the Federal Register, August 17, 2000, adopts the standards to be used under HIPAA and names the implementation guides to be used for these standards.  The ASC X12N 837 professional is the standard to be used for transmitting health care claims electronically, and its impleme ntation guide requires the use of POS codes from the National POS code set, currently maintained by CMS.   o As a covered entity, Medicare must use the POS codes from the National POS code set for processing its electronically submitted claims. Medicare must also recognize as valid POS codes from the POS code set when  these codes appear on such a claim.   o Medicare must recognize and accept POS codes from the national POS code set in terms of HIPAA compliance. Note special considerations for Homeless Shelter (code 04), Indian Health Service (codes 05, 06), Tribal 638 (codes 07, 08), and 09 Prison/Correctional Facility settings,  describe below. Where there is no national policy for a given POS code, local contractors may work with their medical directors to develop local policy regarding the services payable in a given setting, and this could include creating a crosswalk to an exi sting setting if d esired. However, local contractors must pay for the services at either the facility or the nonfacility rate as designated below. In addition, local contractors, when developing policy, must ensure that they continue to pay appropriate rates for services rendered in the new setting; if they choose to create a crosswalk from one setting to another, they must crosswalk a facility rate des ignated code to another facility rate designated code, and a nonfacility rate designated code to another nonfacility rate de signated code. For previously issued POS codes for which a crosswalk was mandated, and for which no other national Medicare directive has been issued, local contractors may elect to continue to use the crosswalk or develop local policy regarding the servic es payable in the setting, including another crosswalk, if  appropriate. If a local contractor develops local policy for these settings, but later receives specific national instructions for these codes, the local contractors shall defer to and comply with the newer instructions. ( Note : While, effective January 1, 2003, codes 03 School, 04 Homeless Shelter, and 20 Urgent Care became part of the National POS code set and were to be crosswalked to 11 Office, this mandate to crosswalk has since been lifted, as indicated  above).  o National policy in the form of Special Considerations for Off Campus - Outpatient Hospital (POS 19), Inpatient Hospital (POS code 21), On Campus -Outpatient Hospital (POS code 22), Ambulatory Surgical  Center (POS code 24) and Hospice (POS code 34) are included  below.    The National POS Code Set and Instructions for Using It  The following is the current national POS code set, with facility and nonfacility designations noted for Medicare payment for services on the Physician Fee Schedule. As a new POS code is established, the health care industry is permitted to use this code f rom the date that it is posted on the Medicare Place of Service Code Set Web page at http://www.cms.gov/Medicare/Coding/place -of-service - codes/Place_of_Service_Code_Set.html which is typically expected to be some months ahead of the final effective date for Medicare use.   The code set is annotated with the effective dates for this  and all other codes added on and after January 1, 2003. Codes without effective dates annotated are long -standing and in effect on and before January 1, 2003.   POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 01 Pharmacy (October 1, 2005)    A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. NF 02 Telehealth Provided Other than in Patients Home  (January 1, 2017)   The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.   (See Special Considerations below.)  F POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 03 School (January 1, 2003)   A facility whose primary purpose is education. NF 04 Homeless Shelter (January 1, 2003)   A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters).   (See Special Considerations below.)  NF 05 Indian Health Service Free -standing Facility (January 1, 2003)   A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization.   (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  06 Indian Health Service Provider -based Facility (January 1, 2003)   A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients.  (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  07 Tribal 638 Free -Standing Facility (January 1, 2003)   A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members who do not require hospitalization.   (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  POS Code and Name (effective date)  Description  Payment Rate Facility=F Nonfacility=NF 08 Tribal 638 Provider -Based Facility (January 1, 2003)   A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.  (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  09 Prison/Correctional Facility (July 1, 2006)   A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.   (See Special Considerations below.)  NF 10 Telehealth Provided in Patients Home  (January 1, 2022)   The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence)  when receiving health services or health related services through telecommunication technology.   (See Special Considerations below.)  Not applicable for adjudication of Medicare claims; systems must recognize for HIPAA  11 Office   Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examina tions, diagnosis, and treatment of illness or injury on an ambulatory basis. NF 12 Home