evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
10.8.2 - Physician Specialty Codes (Rev.  12231, Issued:  08-31-23, Effective: 01- 01-24, Implementation:  01-02-24)  Code  Physician Specialty  01 General Practice  02 General Surgery  03 Allergy/Immunology  04 Otolaryngology  05 Anesthesiology  06 Cardiology  07 Dermatology  08 Family Practice  09 Interventional Pain Management  10 Gastroenterology  11 Internal Medicine  12 Osteopathic Manipulative Medicine  13 Neurology  14 Neurosurgery  16 Obstetrics/Gynecology  17 Hospice and Palliative Care  18 Ophthalmology  19 Oral Surgery (dentists only)  20 Orthopedic Surgery  21 Cardiac Electrophysiology  22 Pathology  23 Sports Medicine  Code  Physician Specialty  24 Plastic and Reconstructive Surgery  25 Physical Medicine and Rehabilitation  26 Psychiatry  27 Geriatric Psychiatry  28 Colorectal Surgery (formerly proctology)  29 Pulmonary Disease  30 Diagnostic Radiology  33 Thoracic Surgery  34 Urology  35 Chiropractic  36 Nuclear Medicine  37 Pediatric Medicine  38 Geriatric Medicine  39 Nephrology  40 Hand Surgery  41 Optometry  44 Infectious Disease  46 Endocrinology  48 Podiatry  66 Rheumatology  70 Single or Multispecialty Clinic or Group Practice  72 Pain Management  76 Peripheral Vascular Disease  77 Vascular Surgery  78 Cardiac Surgery  79 Addiction Medicine  81 Critical Care (Intensivists)  82 Hematology  83 Hematology/Oncology  84 Preventive Medicine  85 Maxillofacial Surgery  86 Neuropsychiatry  90 Medical Oncology  91 Surgical Oncology  92 Radiation Oncology  93 Emergency Medicine  94 Interventional Radiology  98 Gynecological/Oncology  99 Unknown Physician Specialty  C0 Sleep Medicine  C3 Interventional Cardiology  C5 C6 C7 C8 Dentist  Hospitalist  Advanced Heart Failure and Transplant Cardiology Medical Toxicology  Code  Physician Specialty  C9 Hematopoietic Cell Transplantation and Cellular Therapy  D3 Medical Genetics and Genomics  D4 Undersea and Hyperbaric Medicine           D7          Micrographic Dermatologic Surgery           D8          Adult Congenital Heart Disease          E3          Dental Anesthesiology          E4          Dental Public Health                     E5          Endodontics                      E6          Oral and Maxillofacial Pathology                      E7          Oral and Maxillofacial Radiology                      E9          Oral Medicine                      F1          Orofacial Pain                     F2          Orthodontics and Dentofacial Orthopedics    F3          Pediatric Dentistry                      F4          Periodontics                      F5          Prosthodontics
(Medicare Claims Processing Manual)
10.8.3 - Nonphysician Practitioner, Supplier, and Provider Specialty Codes (Rev. 10124, Issued: 05- 08-2020, Effective: 10 -01-2020, Implementation:10- 05-2020)  The following list of 2- digit codes and narrative describe the kind of medicine non-physician practitioners or other healthcare providers/suppliers practice.  Code  Non-physician Practitioner/Supplier/Provider Specialty  15 Speech Language Pathologists  31 Intensive Cardiac Rehabilitation  32 Anesthesiologist Assistant  42 Certified Nurse Midwife (effective July 1, 1988)  43 Certified Registered Nurse Anesthetist (CRNA)  45 Mammography Screening Center  47 Independent Diagnostic Testing Facility (IDTF)  49 Ambulatory Surgical Center  50 Nurse Practitioner  51 Medical supply company with orthotic personnel certified by an accrediting organization  52 Medical supply company with prosthetic personnel certified by an accrediting organization  53 Medical supply company with prosthetic/orthotic personnel certified by an accrediting organization  54 Medical supply company not included in 51, 52, or 53  55 Individual orthotic personnel certified by an accrediting organization  56 Individual prosthetic personnel certified by an accrediting organization  57 Individual prosthetic/orthotic personnel certified by an accrediting organization  Code  Non-physician Practitioner/Supplier/Provider Specialty  58 Medical Supply Company with registered pharmacist  59 Ambulance Service Supplier, e.g., private ambulance companies, funeral homes  60 Public Health or Welfare Agencies (Federal, State, and local)  61 Voluntary Health or Charitable Agencies (e.g., National Cancer Society, National Heart Association, Catholic Charities)  62 Psychologist (Billing Independently)  63 Portable X -Ray Supplier (Billing Independently)  64 Audiologist (Billing Independently)  65 Physical Therapist in Private Practice  67 Occupational Therapist in Private Practice  68 Clinical Psychologist  69 Clinical Laboratory (Billing Independently)  71 Registered Dietician/Nutrition Professional  73 Mass Immunization Roster Billers (Mass Immunizers have to roster bill assigned claims and can only bill for immunizations)  74 Radiation Therapy Centers  75 Slide Preparation Facilities  80 Licensed Clinical Social Worker  87 All other suppliers, e.g., Drug Stores  88 Unknown Provider  89 Certified Clinical Nurse Specialist  95 Unknown Supplier  96 Optician  97 Physician Assistant  A0 Hospital  A1 Skilled Nursing Facility  A2 Intermediate Care Nursing Facility  A3 Nursing Facility, Other  A4 Home Health Agency  A5 Pharmacy  A6 Medical Supply Company with Respiratory Therapist  A7 Department Store  A8 Grocery Store  B1 Oxygen/Oxygen
(Medicare Claims Processing Manual)
97 Physician Assistant  A0 Hospital  A1 Skilled Nursing Facility  A2 Intermediate Care Nursing Facility  A3 Nursing Facility, Other  A4 Home Health Agency  A5 Pharmacy  A6 Medical Supply Company with Respiratory Therapist  A7 Department Store  A8 Grocery Store  B1 Oxygen/Oxygen Related Equipment  B2 Pedorthic Personnel  B3 Medical Supply Company with Pedorthic Personnel  B4 Rehabilitation Agency  B5 Ocularist  C1 Centralized Flu  C2 Indirect Payment Procedure  C4 Restricted Use  D1 Medicare Diabetes Preventive Program  D2 Restricted Use  Code  Non-physician Practitioner/Supplier/Provider Specialty  D5 Opioid Treatment Program  D6 Home Infusion Therapy Services  NOTE:  Specialty Code Use for Service in an Independent Laboratory .  For services performed in an independent laboratory, show the specialty code of the physician ordering the x- rays and requesting payment.  If the independent laboratory requests payment, use type of supplier code "69".
(Medicare Claims Processing Manual)
10.9 - Miles/Times/Units/Services (MTUS)  (Rev. 1970, Issued: 05- 21-10, Effective: 10 -01-2010, Implementation: 10 -04-10)  Miles/Times/Units/Services (MTUS) count and MTUS indicator fields are on Part B Physician/Supplier Claims.  These fields are documented in the CMS National Claims History Data Dictionary.   Shared systems are to put MTUS count and MTUS indicators on all claims at the line item level.   The purpose of the MTUS Count Field on the line item is to document additional information reflecting certain volumes related to indicators.  In most cases, the value in this field will be the same as in the Service Count Field on the line item; however, f or services such as anesthesia the field values will differ.  In this case, the service count field will likely contain a value of 1 for the occurrence of the surgery while the MTUS Count Field will contain the actual time units that the anesthesiologist s pent with the patient in 15 minute increments or a fraction thereof.   The purpose of the MTUS Indicator Field is to indicate what the value entered into the MTUS Count Field means.  There are 6 indicator values, as follows:   Indicator  Description  0 No allowed services  1 Ambulance transportation miles  2 Anesthesia Time Units  3 Services  4 Oxygen units  5 Units of Blood   Examples of how to code these fields are specified in 10.9.1 below.  10.9.1 - Methodology for Coding Number of Services, MTUS Count and MTUS Indicator Fields  (Rev. 1970, Issued: 05- 21-10, Effective: 10 -01-2010, Implementation: 10- 04-10)  The following instructions should be used as a guide for coding the number of services, MTUS Count and MTUS Indicator fields on the Part B Physician/Supplier Claim.  These fields are documented in the CMS National Claims History Data Dictionary as CWFB_SRVC_CNT, CWFB_MTUS_CNT, and CWFB_MTUS_IND_CD, respectively.  Services not falling into examples B, C, E, or F should be coded as shown in example D (services/pricing units).  A. No Allowed Services -  (CWFB_MTUS_IND_CD = 0)   For claims reporting no allowed services, the following example should be used to code the line item:
(Medicare Claims Processing Manual)
For claims reporting no allowed services, the following example should be used to code the line item:  A total of 2 visits was reported for HCPCS code 99211:  Office or other outpatient visit for the management of an established patient.  Both services were denied.   Number of services:  2 (furnished)  MTUS (services):  0 (allowed)  MTUS indicator:  0  B. Ambulance Miles  - (CWFB_MTUS_IND_CD = 1)   For claims reporting ambulance miles, the following example should be used to code the line item:   Mileage Reporting:  A total of 10 miles (1 trip) was reported for HCPCS code A0425: Ground mileage, per statute mile.   Number of services:  10 MTUS (miles):  10 MTUS indicator:  1  C. Anesthesia Time Units  - (CWFB_MTUS_IND_CD = 2)   For claims reporting anesthesia time units in 15 -minute periods or fractions of 15-minute periods, the following example should be used to code the line item:   A total of 1 allowed service is reported for HCPCS code 00142:  Anesthesia for procedures on eye; lens surgery.  The anesthesiologist attended the patient for 35 minutes.   Number of services:  1 MTUS (time units):  23 (one decimal point implied) * MTUS indicator:  2 *Two 15- minute periods + 1/3 of a 15- minute period equals 2.3   D. Services/Pricing Units  - (CWFB_MTUS_IND_CD = 3)   For claims reporting a service or pricing unit, the following examples should be used to code the line item:  Example 1:  A total of 2 visits was reported for HCPCS code 99211:  Office or other outpatient visit for the management of an established patient.   Number of services:  2 MTUS (services):  2 MTUS indicator:  3  Example 2:  A total of 500 milligrams was administered for HCPCS code J0120:  Injection, Tetracycline, up to 250 mg.  NOTE :  The number of milligrams should not be reported in the service or MTUS fields.  Instead, report the number of pricing units.  In this case, up to 250 mg equals 1 unit/service.  Thus, 500 mg equals 2 units/services.  Number of services:  2 MTUS (services):  2 MTUS indicator:  3
(Medicare Claims Processing Manual)
Example 3:  A total of 24 cans was purchased, each containing 300 calories for HCPCS code B4150:  Enteral Formulae, 100 calories.   NOTE :  Neither number of cans nor the number of calories should be reported in the services or MTUS fields.  Instead, report the number of pricing units.  In this case, 100 calories equals 1 unit/service.  Thus, 24 cans * 300 calories / 100 calories equals 72 uni ts/services.   Number of services:  72 MTUS (services):  72 MTUS indicator:  3  E. Oxygen Services  - (CWFB_MTUS_IND_CD = 4)   For claims reporting oxygen units, the following example should be used to code the line item:  A total of 2 allowed services was reported for HCPCS code E0441:  Oxygen contents, gaseous, 1 months supply = 1 unit.  The claim reported a 2 months supply of oxygen.  Number of services:  2 MTUS:  2 MTUS indicator:  4  F. Blood Services  - (CWFB_MTUS_IND_CD = 5)   For claims reporting blood units, the following example should be used to code the line item:  A total of 6 units of blood (services) was furnished for HCPCS code P9010:  Blood (whole), for transfusion, per unit.  Two units were denied .  Number of services:  6 (furnished)  MTUS (units):  4 (allowed)  MTUS indicator:  5  20 - Patients Request for Medica l Payment Form CMS -1490S  (Rev.: 4388; Issued: 09- 06-19; Effective: 10 -07-19; Implementation: 10 -07-19)
(Medicare Claims Processing Manual)
20 - Patients Request for Medica l Payment Form CMS -1490S  (Rev.: 4388; Issued: 09- 06-19; Effective: 10 -07-19; Implementation: 10 -07-19)  The CMS implemented a new version of the Form CMS -1490S effective January 1, 2019. The revised form is version 01/18, OMB control number 0938- 1197. The revised form will replace the previous version of the form 01/05, OMB control number 0938-0999.   The term, Form CMS -1490S refers to the form generically, independent of a given version. Medicare will conduct a dual -use period (January 1, 2019 through March 31, 2019) during which Beneficiaries (or their representatives) can send Medicare claims on either the old or the revised form. When the dual -use period is over, Medicare will accept beneficiary paper claims on only the revised Form CMS -1490S, version 01/18.   This form is used only by beneficiaries (or their representatives) who complete and file their own claims.  It contains the patients comparable items of data that are on the Form CMS -1500.  When the Form CMS -1490S is used, an itemized bill must be submitt ed with the claim.  Some enrollees may want to keep the original itemized physician and supplier bills for income tax or complementary insurance purposes.  Photocopies of itemized bills are acceptable for Medicare deductible and payment purposes if there i s no evidence of alteration.  Social Security offices use the Form CMS -1490S when assisting beneficiaries in filing Part B Medicare claims.   Although 1848(g)(4)  of the Act requires physicians and suppliers to submit Part B Medicare claims for services furnished on or after September 1, 1990, contractors continue to accept, process, and pay for covered services submitted by beneficiaries on a Form CMS -1490S if the re is no clear indication that the service provider intends to file a claim.  An itemized bill for services on or after September 1, 1990, which clearly indicates the physician or supplier intends to file a Part B claim for the patient, may be returned to the beneficiary.
(Medicare Claims Processing Manual)
For Medicare covered services received on or after September 1, 1990, the Form CMS -1490S is used by beneficiaries to submit Part B claims only if the service provider refuses to do so or if one of the following situations applies:    DME purchases from private sources;    Cases in which a physician/supplier does not possess information essential for filing an MSP claim.  Assume this is the case if the beneficiary files an MSP claim and encloses the primary insurer's payment determination notice and there is no indication that the service provider was asked to file but refused to do so;    Services paid under the indirect payment procedure;    Foreign claims;    Services furnished by sanctioned physicians and suppliers which are approved for payment to the beneficiary per the Program Integrity Manual (PIM); and    Other unusual or unique situations that are evaluated on a case -by-case basis.   If the contractor approves 11 or more Form CMS -1490S claims in a calendar month for services performed on or after September 1, 1990, by the same physician or supplier, monitor the provider's claims submissions and take appropriate action.  The contractor continues to stock Form CMS -1490S and, upon request, furnish beneficiaries with these forms. (Beneficiaries need these forms to file claims for services that physicians/suppliers are not required to submit (e.g., services prior to September 1, 1990), or refuse to submit to Part B on their behalf.)   30 - Printing Standards and Print File Specifications Form CMS -1500 (Rev. 899, Issued:  03- 31-06; Effective:  10 -01-06; Implementation:  10 -02-06)  The National Uniform Claims Committee (NUCC) has approved the printing standards for Form CMS -1500 (08- 05) paper claim.  These standards are as follows:   The Form CMS -1500 (08- 05) is designed to accommodate 10- pitch Pica type, 6 lines per inch vertical and 10 characters per inch (cpi) horizontal.  Once adjusted to the left and right, PICA Alignment blocks in the first print line and characters appear within form lines as shown in the print file matrix.   Also provided on the Form CMS -1500 (08- 05) is a position bar.  This is a thick horizontal line that is at the base of the PICA alignment Boxes.
(Medicare Claims Processing Manual)
Also provided on the Form CMS -1500 (08- 05) is a position bar.  This is a thick horizontal line that is at the base of the PICA alignment Boxes.   The Form CMS -1500 (08- 05) is used in four different styles.  Any one of these four styles may be printed from two negatives in concurrence with the layout that was approved by the NUCC.  The face/back negative furnished must be used for all parts.   Compliance with these standards is required to facilitate the use of image processing technology such as Optical Character Recognition (OCR), facsimile transmission, and image storing.  Cut Sheet:   Size -  8.5 by 11 inches (plus or minus .0625 inch) or 217mm by 279mm (plus or minus 2mm).   Print  - Face and back, head to head.   Margins  -   Face -  The top margin from the top edge of the form to the first print position is 1.33 inches or 34mm.  The left margin is 0.3 inches to the left end of the first print position.   Back -  0.25 inch head and foot, 0.25 inch left and right or 6.35 mm head and foot, 6.35 mm left and right.   Offset -  The X and Y offset for margins must not vary by more than +/ -0.1 inch or 2.54 mm from sheet to sheet.   The X  offset refers to the horizontal distance from the left edge of the paper to the beginning of the printing.  The Y  offset refers to the vertical distance between the top of the paper and the beginning of the printing.  Askewity -  The askewity of the printed image must be no greater than 0.15mm in 100mm.  Paper Stock  - Basis weight 20# recycled 30% postconsumer waste, White Environmental Paper Alliance (EPA) or approved paper stock.  Smoothness:  FS to be (140- 160), or equivalent stock.   Ink color  -   Face -  (OCR -Red Ink) must be in Flint J -6983 Red OCR dropout ink or an exact match, formerly known as Sinclair Valentine).  There is to be no contamination with Black ink or pigment.  Printer must maintain proper ink reflections limits of the OCR reader specified by the purchaser.   Back -  Same as face.
(Medicare Claims Processing Manual)
Back -  Same as face.   Titles -  Color of any titles if applicable:  Are to be in the same ink as the form, Flint J6983 OCR Red dropout ink.  Symbol -  The identifiable 1500 in a rectangle located in the upper left front of the form above the PICA boxes is to be in black ink.  Two Part Snap -set:  Size -  Dimensions are same as Cut Sheet (detached 8.5 by 11 inches), plus top stub (.5 to .75 inches).   Print  -   Part 1 -  Face and back - head to head.   Part 2 -  Face and back - head to head.   Margins  - Same as Cut Sheet.   Askewity  - Same as Cut Sheet.   Stock  -   Part 1 -  Carbonless, 20 CB -  Recycled White   Part 2 -  Any color that will not interfere with scanning of Part 1 sheet.   Ink Color  -  Part 1 -  (OCR -Red Ink) must be in Flint J -6983 Red OCR dropout ink or an exact match.   Part 2 -  Any color that will not interfere with scanning of Part 1 sheet.   Titles -  Color of any titles if applicable:  Are to be in the same ink as the form, Flint J6983 OCR Red dropout ink.  Symbol -  The identifiable 1500 in a rectangle located in the upper left front of the form above the PICA boxes is to be in black ink.  Perforations  - Perforate top stub for disassembly of parts.   One Part Marginally Punched Continuous Form:   Size -  Same dimensions as for Cut Sheet, plus 0.5 inch left and right, (overall: 9.5 by 11 inches, detached: 8.5 by 11 inches).   Print  - Face and back, head to head.   Margins  - On detached sheet, same as for Cut Sheet.   Askewity  - On detached sheet, same as for Cut Sheet.   Paper Stock  - Same as for Cut Sheet.   Ink Color  - Same as for Cut Sheet (OCR -Red Ink) must be in Flint J -6983 Red OCR dropout ink or an exact match.
(Medicare Claims Processing Manual)
Paper Stock  - Same as for Cut Sheet.   Ink Color  - Same as for Cut Sheet (OCR -Red Ink) must be in Flint J -6983 Red OCR dropout ink or an exact match.  Titles -  Color of any titles if applicable: Are to be in the same ink as the form, Flint J6983 OCR Red dropout ink.  Symbol -  The identifiable 1500 in a rectangle located in the upper left front of the form above the PICA boxes is to be in black ink.  Perforations  - Marginally 0.5 inch left and right, tear line horizontally every 11 inches.   Two Part Marginally Punched Continuous Forms:   Size -  Same dimensions as for Cut Sheet, plus 0.5 inch left and right, (overall: 9.5 by 11 inches, detached: 8.5 by 11 inches).   Print  -   Part 1 - Face and back, head to head.   Part 2 - Face and back, head to head.   Margins  - On detached sheet, same as for Cut Sheet.   Askewity  - On detached sheet, same as for Cut Sheet.   Paper Stock -    Part 1 -  Carbonless, 20 CB -  Recycled White   Part 2 -  Any color or weight that does not interfere with scanning of part 1 sheet. Suggest the following sequence:   Paper Weight:   1st part is 20 CB -  OCR Bond   2nd part is 14 CFB (if not last part)   Last part is 15CF   CB = Coated Back (Carbonless black print)   CFB = Coated Front and Back (Carbonless black print)   CF = Coated Front (Carbonless black print)   Ink color  -  Part 1 -  Same as for cut sheet, (OCR -Red Ink) must be in Flint J -6983 Red OCR dropout ink or an exact match.  Part 2 -  Any color that will not interfere with scanning of the part 1 sheet.   Titles -  Color of any titles if applicable: Are to be in the same ink as the form, Flint J6983 OCR Red dropout ink.  Symbol -  The identifiable 1500 in a rectangle located in the upper left front of the form above the PICA boxes is to be in black ink.  Joining -  Crimp left and right.   Perforations  - Marginally 0.5 inch left and right, tear line horizontally every 11.
(Medicare Claims Processing Manual)
Perforations  - Marginally 0.5 inch left and right, tear line horizontally every 11.  NOTE:  Users may determine the number of parts that are applicable to their needs.  Up to four total parts are feasible on some printers; some other printers may limit the readability of multiple plies.  Color of any titles if applicable:  Are to be in the same ink as the form, Flint J6983 OCR Red dropout ink.  Symbol:  NUCC requires the use of an approved Form CMS -1500 in the formats provided displaying the 1500 symbol as approved by the NUCC.  All printing of Form CMS -1500 must occur in accordance with the NUCC requirements.  Form Name -  CMS -1500 Health Insurance Paper Claim Form, Approved by the National Uniform Claims Committee (NUCC).   Form Identification :  The lower right -hand margin contains the approved OMB numbers and should be consistent throughout.  No modification is to be made to the Form CMS -1500 (08- 05) without prior approval from the NUCC and CMS.  Exhibit  1 (Rev. 1970,  05-21-10)  Form CMS -1500 (08/05)  User Print  File Specifications  (Formerly  Exhibit  2)