evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Enter either a 6 -digit (MM | DD | YY) or an 8 -digit (MM | DD | CCYY) x -ray date for chiropractor services (if an x -ray, rather than a physical examination was the method used to demonstrate the subluxation).  By entering an x -ray date and the initiation da te for course of chiropractic treatment in item 14, the chiropractor is certifying that all the relevant information requirements (including level of subluxation) of Pub. 100- 02, Medicare Benefit Policy Manual, chapter 15, is on file, along with the appropriate x -ray and all are available for A/B MAC (B) review.   Instructions for Not Otherwise Classified (NOC) Codes  Any unlisted services or procedure code.  Note: When reporting NOC codes, this field must be populated as specified below.   Enter the drug's name and dosage when submitting a claim for NOC drugs.   Enter a concise description of an "unlisted procedure code" or a NOC code if one can be given within the confines of this box.  Otherwise an attachment shall be submitted with the claim.     When billing for unlisted laboratory tests using a NOC code, this field MUST  include the specific name of the laboratory test(s) and/or a short descriptor of the test(s).  Claims for unlisted laboratory tests that are received without this information shall be treated according to the requirements found in Pub. 100- 04, Medicare Cl aims Processing Manual, Chapter 1, Section 80.3.2 and returned as unprocessable. Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA) requires reporting entities to report private payor payment rates for laboratory tests and the corresponding volumes of tests.   In compliance with PAMA, CMS must collect private payor data on unique tests currently being paid as a NOC code, Not Otherwise Specified (NOS) code, or unlisted service or procedure code.
(Medicare Claims Processing Manual)
Enter all applicable modifiers when modifier - 99 (multiple modifiers) is entered in item 24d.  If modifier - 99 is entered on multiple line items of a  single claim form, all applicable modifiers for each line item containing a - 99 modifier should be listed as follows: 1=(mod), where the number 1 represents the line item and "mod" represents all modifiers applicable to the referenced line item.   Enter the statement "Homebound" when an independent laboratory obtains a specimen from a homebound or institutionalized patient.  (See Pub. 100- 02, Medicare Benefit Policy Manual, Chapter 15, "Covered Medical and Other Health Services," and Pub. 100-04, Me dicare Claims Processing Manual, Chapter 16, "Laboratory Services, and Pub. 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5, "Definitions," respectively, for the definition of "homebound" and a more complete definition  of a medically necessary laboratory service to a homebound or an institutional patient.)   Enter the statement, "Patient refuses to assign benefits," when the beneficiary absolutely refuses to assign benefits to a non- participating physician/supplier who accepts assignment on a claim.  In this case, payment can only be made directly to the benef iciary.   Enter the statement, "Testing for hearing aid" when billing services involving the testing of a hearing aid(s) is used to obtain intentional denials when other payers are involved.   When dental examinations are billed, enter the specific surgery for which the exam is being performed.   Enter the specific name and dosage amount when low osmolar contrast material is billed, but only if HCPCS codes do not cover them.   Enter a 6 -digit (MM | DD | YY) or an 8- digit (MM | DD | CCYY) assumed and/or relinquished date for a global surgery claim when providers share post -operative care.   Enter demonstration ID number "30" for all national emphysema treatment trial claims.   Enter demonstration ID number 56 for all national Laboratory Affordable Care Act Section 113 Demonstration Claims.
(Medicare Claims Processing Manual)
Enter demonstration ID number "30" for all national emphysema treatment trial claims.   Enter demonstration ID number 56 for all national Laboratory Affordable Care Act Section 113 Demonstration Claims.   Enter the NPI of the physician who is performing the technical or professional component of a diagnostic test that is subject to the anti -markup payment limitation.  (See Pub. 100- 04, chapter 1, section 30.2.9 for additional information.)   NOTE:   Effective May 23, 2008, all provider identifiers submitted on the CMS -1500 claim form MUST be in the form of an NPI.   Method II suppliers shall enter the most current HCT value for the injection of Aranesp for ESRD beneficiaries on dialysis.  (See Pub. 100- 04, chapter 8, section 60.7.2.)   Individuals and entities who bill A/B MACs (B) for administrations of ESAs or Part B anti-anemia drugs not self -administered (other than ESAs) in the treatment of cancer must enter the most current hemoglobin or hematocrit test results.  The test results s hall be entered as follows: TR= test results (backslash), R1=hemoglobin, or R2=hematocrit (backslash), and the most current numeric test result figure up to 3 numerics and a decimal point [xx.x]).  Example for hemoglobin tests: TR/R1/9.0, Example for Hemat ocrit tests: TR/R2/27.0.  Item 20 -  Complete this item when billing for diagnostic tests subject to the anti- markup payment limitation.  Enter the acquisition price under charges if the "yes" block is checked.  A "yes" check indicates that an entity other than the entity billing for the service performed the diagnostic test.  A "no" check indicates "no anti -markup tests are included on the claim."  When "yes" is annotated, item 32 shall be completed.  When billing for multiple anti- markup tests, each test shall be submitted on a separate clai m form CMS -1500.  Multiple anti -markup tests may be submitted on the ASC X12 837 electronic format as long as appropriate line level information is submitted when services are rendered at different service facility locations.  See chapter 1.
(Medicare Claims Processing Manual)
NOTE:  This is a required field when billing for diagnostic tests subject to the anti -markup payment limitation.   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.  Enter the diagnoses in priority order.  All narrative diagnoses for nonphysician specialties shall be submitted on an attachment.   Reminder:  Do not report ICD -10-CM codes for claims with dates of service prior to implementation of ICD -10-CM, on either the old or revised version of the CMS -1500 claim form.   For form version 08/05, report a valid ICD -9-CM code.  Enter up to four diagnosis codes.   For form version 02/12, it may be appropriate to report either ICD -9-CM or ICD -10-CM codes depending upon the dates of service (i.e., according to the effective dates of the given code set).    The ICD Indicator identifies the ICD code set being reported.  Enter the applicable ICD indicator according to the following:   Indicator  Code Set  9 ICD-9-CM diagnosis  0 ICD-10-CM diagnosis   Enter the indicator as a single digit between the vertical, dotted lines.   Do not report both ICD-9-CM and ICD -10-CM codes on the same claim form.  If there are services you wish to report that occurred on dates when ICD -9-CM codes were in effect, and others that occurred on dates when ICD -10-CM codes were in effect, then send separate claims such that you report only ICD -9-CM or only ICD -10-CM codes on the claim.  (See special considerations for spans of dates below.)    If you are submitting a claim with a span of dates for a service, use the from date to determine which ICD code set to use.    Enter up to 12 diagnosis codes.  Note that this information appears opposite lines with letters A -L.  Relate lines A - L to the lines of service in 24E by the letter of the line.  Use the highest level of specificity.  Do not provide narrative description in this field.
(Medicare Claims Processing Manual)
 Do not insert a period in the ICD -9-CM or ICD -10-CM code.   Item 22 -  Leave blank.  Not required by Medicare.  Item 23 -  Enter the Quality Improvement Organization (QIO) prior authorization number for those procedures requiring QIO prior approval.   Enter the Investigational Device Exemption (IDE) number when an investigational device is used in an FDA -approved clinical trial.  Post Market Approval number should also be placed here when applicable.   For physicians performing care plan oversight services, enter the NPI of the home health agency (HHA) or hospice when CPT code G0181 (HH) or G0182 (Hospice) is billed.  Enter the 10- digit Clinical Laboratory Improvement Act (CLIA) certification number for laboratory services billed by an entity performing CLIA covered procedures.  For ambulance claims, enter the ZIP code of the loaded ambulance trips point -of-pickup.   NOTE:   Item 23 can contain only one condition.  Any additional conditions should be reported on a separate CMS -1500 claim form.  Item 24 -  The six service lines in section 24 have been divided horizontally to accommodate submission of supplemental information to support the billed service.  The top portion in each of the six service lines is shaded and is the location for reporting supplemental information.  It is not intended to allow the billing of 12 service lines.  When required to submit NDC drug and quantity information for Medicaid rebates, submit the NDC code in the red shaded portion of the detail line item in positions 01 through position 13.  The NDC is to be preceded with the qualifier N4 and followed immedia tely by the 11 digit NDC code (e.g. N499999999999).  Report the NDC quantity in positions 17 through 24 of the same red shaded portion.  The quantity is to be preceded by the appropriate qualifier: UN (units), F2 (international units), GR (gram) or ML (milliliter).  There are six bytes available for quantity.  If the quantity is less than six bytes, left justify and space -fill the remaining positions (e.g., UN2 or F2999999).
(Medicare Claims Processing Manual)
Item 24A -  Enter a 6 -digit or 8 -digit (MMDDCCYY) date for each procedure, service, or supply.  When "from" and "to" dates are shown for a series of identical services, enter the number of days or units in column G.  This is a required field.  Return as unprocessable if a date of service extends more than 1 day, and a valid "to" date is not present.  Item 24B -  Enter the appropriate place of service code(s) from the list provided in section 10.5.  Identify the setting, using a place of service code, for each item used or service performed.  This is a required field.   NOTE:   When a service is rendered to a patient who is a registered inpatient or an outpatient (off campus or on campus) of a hospital, use the inpatient hospital POS code 21, Off Campus -Outpatient Hospital POS code 19, or On Campus -Outpatient Hospital POS code 22, respectively, as discussed in section 10.5 of this chapter.   Item 24C -  Medicare providers are not required to complete this item.   Item 24D -  Enter the procedures, services, or supplies using the CMS Healthcare Common Procedure Coding System (HCPCS) code.  When applicable, show HCPCS code modifiers with the HCPCS code.  The CMS -1500 claim form has the capacity to capture up to four modifiers.   Enter the specific procedure code without a narrative description.  However, when reporting an "unlisted procedure code" or a "not otherwise classified" (NOC) code, include a narrative description in item 19 if a coherent description can be given within the confines of that box.  Otherwise, an attachment shall be submitted with the claim.  This is a required field.   Return as unprocessable  if an "unlisted procedure code" or a NOC code is indicated in item 24d, but an accompanying narrative is not present in item 19 or on an attachment.   Item 24E -  This is a required field.  Enter the diagnosis code reference number or letter (as appropriate, per form version) as shown in item 21 to relate the date of service and the procedures performed to the primary diagnosis.  Enter only one reference number/lett er per line item.  When multiple services are performed, enter the primary reference number/letter for each service.
(Medicare Claims Processing Manual)
When using form version 08/05, this reference will be either a 1, or a 2, or a 3, or a 4.   When using form version 02/12, the reference to supply in 24E will be a letter from A -L.  Otherwise, the instructions above apply.   If a situation arises where two or more diagnoses are required for a procedure code (e.g., pap smears), the provider shall reference only one of the diagnoses in item 21.  Item 24F - Enter the charge for each listed service.   Item 24G -  Enter the number of days or units.  This field is most commonly used for multiple visits, units of supplies, anesthesia minutes, or oxygen volume.  If only one service is performed, the numeral 1 must be entered.  Some services require that the actual number or quantity billed be clearly indicated on the claim form (e.g., multiple ostomy or urinary supplies, medication dosages, or allergy testing procedures).  When multiple services are provided, enter the actual nu mber provided.  For anesthesia, show the elapsed time (minutes) in item 24g.  Convert hours into minutes and enter the total minutes required for this procedure.   For instructions on submitting units for oxygen claims, see chapter 20, section 130.6 of this manual.   Beginning with dates of service on and after January 1, 2011, for ambulance mileage, enter the number of loaded miles traveled rounded up to the nearest tenth of a mile up to 100 miles.  For mileage totaling 100 miles and greater, enter the number of cover ed miles rounded up to the nearest whole number miles.  If the total mileage is less than 1 whole mile, enter a 0 before the decimal (e.g. 0.9).  See Pub. 100- 04, chapter 15, 20.2 for more information on loaded mileage and 30.1.2 for more information on reporting fractional mileage.   NOTE:  This field should contain an appropriate numerical value.  The A/B MAC (B) should program their system to automatically default "1" unit when the information in this field is missing to avoid returning as unprocessable, except on claims for ambulance milea ge.  For ambulance mileage claims, contractors shall automatically default 0.1 unit when total mileage units are missing in this field.
(Medicare Claims Processing Manual)
Item 24H  - Leave blank.  Not required by Medicare.   Item 24I -  Leave Blank. Not required by Medicare.   Item 24J -  Enter the rendering providers NPI number in the lower unshaded portion.  In the case of a service provided incident to the service of a physician or non- physician practitioner, when the person who ordered the service is not supervising, enter the NPI of the supervisor in the lower unshaded portion.  This unprocessable instruction does not apply to influenza virus and pneumococcal vaccine claims submitted on roster bills as they do not require a rendering provider NPI.   NOTE:   Effective May 23, 2008, the shaded portion of 24J is not to be reported.  Item 25 -  Enter the provider of service or supplier Federal Tax ID (Employer Identification Number or Social Security Number) and check the appropriate check box. Medicare providers are not required to complete this item for crossover purposes since the Medicare con tractor will retrieve the tax identification information from their internal provider file for inclusion on the COB outbound claim.  However, tax identification information is used in the determination of accurate National Provider Identifier reimbursement.  Reimbursement of claims submitted without tax identification information will/may be delayed.   Item 26 -  Enter the patient's account number assigned by the provider's of service or supplier's accounting system.  This field is optional to assist the provider in patient identification.  As a service, any account numbers entered here will be returned to the provider.   Item 27 -  Check the appropriate block to indicate whether the provider of service or supplier accepts assignment of Medicare benefits.  If Medigap is indicated in item 9 and Medigap payment authorization is given in item 13, the provider of service or supplier shall  also be a Medicare participating provider of service or supplier and accept assignment of Medicare benefits for all covered charges for all patients.   The following providers of service/suppliers and claims can only be paid on an assignment basis:    Clinical diagnostic laboratory services;    Physician services to individuals dually entitled to Medicare and Medicaid;    Participating physician/supplier services;    Services of physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, certified registered nurse anesthetists, clinical psychologists, and clinical social workers;    Ambulatory surgical center services for covered ASC procedures;    Home dialysis supplies and equipment paid under Method II;    Ambulance services;    Drugs and biologicals; and
(Medicare Claims Processing Manual)
 Ambulatory surgical center services for covered ASC procedures;    Home dialysis supplies and equipment paid under Method II;    Ambulance services;    Drugs and biologicals; and   Simplified Billing Roster for influenza virus vaccine and pneumococcal vaccine.   Item 28 -  Enter total charges for the services (i.e., total of all charges in item 24f).  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.
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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.