(Medicare Claims Processing Manual)

CarrierLocality/StateLocality Map   Carrier/Loc 1010200 =State Loc 01 (ALABAMA)  Carrier/Loc 0210201 =State Loc 02 (ALASKA)  Carrier/Loc 0310200 =State Loc 04 (ARIZONA)  Carrier/Loc 0710213 =State Loc 05 (ARKANSAS)  Carrier/Loc 0118218 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118226 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111252 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111207 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111205 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111206 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111209 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111251 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111253 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111254 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111255 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111256 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111257 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111258 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111259 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111260 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111261 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111262 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111263 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111264 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111265 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111266 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111267 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111268 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111269 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111270 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118271 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118272 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118273 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118274 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118217 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111275 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0411201 =State Loc 08 (COLORADO)  Carrier/Loc 1310200 =State Loc 09 (CONNECTICUT)  Carrier/Loc 1210201 =State Loc 10 (DELAWARE)  Carrier/Loc 1220201 =State Loc 11 (DISTRICT OF COLUMBIA)  Carrier/Loc 0910203 =State Loc 12 (FLORIDA)  Carrier/Loc 0910204 =State Loc 12 (FLORIDA)  Carrier/Loc 0910299 =State Loc 12 (FLORIDA)  Carrier/Loc 1020201 =State Loc 13 (GEORGIA)  Carrier/Loc 1020299 =State Loc 13 (GEORGIA)  Carrier/Loc 0121201 =State Loc 15 (HAWAII/GUAM)  Carrier/Loc 0220200 =State Loc 16 (IDAHO)  Carrier/Loc 0610216 =State Loc 17 (ILLINOIS)  Carrier/Loc 0610212 =State Loc 17 (ILLINOIS)  Carrier/Loc 0610215 =State Loc 17 (ILLINOIS)  Carrier/Loc 0610299 =State Loc 17 (ILLINOIS)  Carrier/Loc 0810200 =State Loc 18 (INDIANA)  Carrier/Loc 0510200 =State Loc 19 (IOWA)  Carrier/Loc 0520200 =State Loc 20 (KANSAS)  Carrier/Loc 1510200 =State Loc 21 (KENTUCKY)  Carrier/Loc 0720201 =State Loc 22 (LOUISIANA)  Carrier/Loc 0720299 =State Loc 22 (LOUISIANA)  Carrier/Loc 1411203 =State Loc 23 (MAINE)  Carrier/Loc 1411299 =State Loc 23 (MAINE)  Carrier/Loc 1230201 =State Loc 24 (MARYLAND)  Carrier/Loc 1230299 =State Loc 24 (MARYLAND)  Carrier/Loc 1421201 =State Loc 25 (MASSACHUSETTS)  Carrier/Loc 1421299 =State Loc 25 (MASSACHUSETTS)  Carrier/Loc 0820201 =State Loc 26 (MICHIGAN)  Carrier/Loc 0820299 =State Loc 26 (MICHIGAN)  Carrier/Loc 0620200 =State Loc 27 (MINNESOTA)  Carrier/Loc 0730200 =State Loc 28 (MISSISSIPPI)  Carrier/Loc 0530202 =State Loc 29 (MISSOURI)  Carrier/Loc 0530201 =State Loc 29 (MISSOURI)  Carrier/Loc 0530299 =State Loc 29 (MISSOURI)  Carrier/Loc 0320201 =State Loc 30 (MONTANA)  Carrier/Loc 0540200 =State Loc 31 (NEBRASKA)  Carrier/Loc 0131200 =State Loc 32 (NEVADA)  Carrier/Loc 1431240 =State Loc 33 (NEW HAMPSHIRE)  Carrier/Loc 1240201 =State Loc 34 (NEW JERSEY)  Carrier/Loc 1240299 =State Loc 34 (NEW JERSEY)  Carrier/Loc 0421205 =State Loc 35 (NEW MEXICO)  Carrier/Loc 1320201 =State Loc 36 (NEW YORK)  Carrier/Loc 1320202 =State Loc 36 (NEW YORK)  Carrier/Loc 1320203 =State Loc 36 (NEW YORK)  Carrier/Loc 1329204 =State Loc 36 (NEW YORK)  Carrier/Loc 1328299 =State Loc 36 (NEW YORK)  Carrier/Loc 1150200 =State Loc 37 (NORTH CAROLINA)  Carrier/Loc 0330201 =State Loc 38 (NORTH DAKOTA)  Carrier/Loc 1520200 =State Loc 39 (OHIO)  Carrier/Loc 0431200 =State Loc 40 (OKLAHOMA)  Carrier/Loc 0230201 =State Loc 41 (OREGON)  Carrier/Loc 0230299 =State Loc 41 (OREGON)  Carrier/Loc 1250201 =State Loc 42 (PENNSYLVANIA)  Carrier/Loc 1250299 =State Loc 42 (PENNSYLVANIA)  Carrier/Loc 0920220 =State Loc 72 (PUERTO RICO)  Carrier/Loc 1441201 =State Loc 44 (RHODE ISLAND)  Carrier/Loc 1120201 =State Loc 45 (SOUTH CAROLINA)  Carrier/Loc 0340202 =State Loc 46 (SOUTH DAKOTA)  Carrier/Loc 1030235 =State Loc 47 (TENNESSEE)  Carrier/Loc 0441231 =State Loc 48 (TEXAS)  Carrier/Loc 0441220 =State Loc 48 (TEXAS)  Carrier/Loc 0441209 =State Loc 48 (TEXAS)  Carrier/Loc 0441211 =State Loc 48 (TEXAS)  Carrier/Loc 0441228 =State Loc 48 (TEXAS)  Carrier/Loc 0441215 =State Loc 48 (TEXAS) Carrier/Loc 0441218 =State Loc 48 (TEXAS) Carrier/Loc 0441299 =State Loc 48 (TEXAS) Carrier/Loc 0350209 =State Loc 49 (UTAH) Carrier/Loc 1451250 =State Loc 50 (VERMONT) Carrier/Loc 0920250 =State Loc 78 (VIRGIN ISLANDS) Carrier/Loc 1130200 =State Loc 51 (VIRGINIA) Carrier/Loc 0240202 =State Loc 53 (WASHINGTON) Carrier/Loc 0240299 =State Loc 53 (WASHINGTON) Carrier/Loc 1140216 =State Loc 54 (WEST VIRGINIA) Carrier/Loc 0630200 =State Loc 55 (WISCONSIN) Carrier/Loc 0360221 =State Loc 56 (WYOMING)  50.5 - Jurisdiction of Laboratory Claims (Rev. 3071, Issued: 09- 19-14, Effective: 12-22-14, Implementation: 12-22-14)  Jurisdiction of payment requests for laboratory services furnished by an independent laboratory, except where indicated in 50.5.1 and 50.5.2, lies with the A/B MAC (B) serving the area in which the laboratory test is performed.  Jurisdiction is not affected by whether or not the independent laboratory uses a central billing office and whether or not the laboratory provides services to customer s outside its A/B MAC (B)s service area.  The location where the independent laboratory performed the test determines the 50.appropriate billing jurisdiction.  Therefore, even if the sample originates in a different jurisdiction from where the sample is being tested, the claim would still be filed in the jurisdiction where the test was performed.   Claims filing jurisdiction for the specimen collection fee and travel allowance is also determined by the location where the test was performed.  When billed by an independent lab, the specimen collection fee and travel allowance must be billed in conjunction with a covered lab test.  For more information about the specimen collection fee and travel allowance, see 60.1 and 60.2, respectively.  50.5.1 - Jurisdiction Of Referral Laboratory Services  (Rev. 85, 02-06-04)  Regardless of whether the laboratory that bills Medicare is the referring or reference laboratory, the laboratory that does the billing may bill only the A/B MAC (B) that services the jurisdiction in which the billing laboratory is physically located.  The location of the draw station, when a separate draw station is employed, never determines claims filing jurisdiction.   50.5.2 - Examples of Reference Laboratory Jurisdiction Rules  (Rev. 85, 02-06-04) B3-3102  EXAMPLE 1:   Scenario 1:   An independent laboratory located in Oregon performs laboratory services for physicians whose offices are located in several neighboring States.  A physician from Nevada sends specimens to the Oregon laboratory.   Jurisdiction:  The A/B MAC (B) in Oregon has jurisdiction.   EXAMPLE 2:   Scenario 2:  American Laboratories, Inc., is an independent laboratory company with branch laboratories located in Philadelphia, PA and Wilmington, DE, as well as regional laboratories located in Millville, NJ and Boston, MA.  The Philadelphia laboratory receives a blood sample from a patient whose physician ordered a complete blood count, a basic metabolic panel and a B12 and folate.  The Philadelphia laboratory performs the complete blood count, but the basic metabolic panel is performed at the Millville laboratory, while the B12 and folate is performed at the Boston Laboratory.   Jurisdiction:  The Pennsylvania A/B MAC (B) may retain jurisdiction for processing the claim for all of the services.  The A/B MAC (B) servicing Boston and/or Millville may have jurisdiction for processing their claims if those laboratories bill for the services they perform, but the Philadelphia laboratory is barred from bill ing for the services that Boston and Millville submit for payment.  EXAMPLE 3:   Scenario 3:  Same relationships as in Example 2.  American Laboratories, Inc., is an independent laboratory company with branch laboratories located in Philadelphia, PA and Wilmington, DE, as well as regional laboratories located in Millville, NJ and Boston, MA.  This time the Wilmington laboratory draws a blood specimen from a patient whose physician has ordered a blood culture.  The Wilmington laboratory then sends the specimen to the Boston laboratory, which performs the required test.   Jurisdiction:  The A/B MAC (B) processing claims for providers/suppliers located in Delaware may retain jurisdiction for processing the claim.  If the laboratory in Boston chooses to bill for the service to the Massachusetts A/B MAC (B), then the Wilmington laboratory may not bill for the service.   60 - Specimen Collection Fee and Travel Allowance  (Rev. 1, 10- 01-03) B3-5114.1