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 CMS 1500 Software > Learning Center > Guide

CMS 1500 Form Revision History
 

April 1, 2010: Instructions have changed for Fields 17 and 17a. These fields are no longer required. EPSDT services are identified by EP or TS modifiers used in Field 24D. Rendering provider information is recorded in Field 24J.

December 29, 2008: Field 33b is now labeled as Conditional instead of Required. API users must complete this field, but it is required for NPI users only when they utilize a taxonomy code.

November 19, 2008: Instructions have changed for Field 24F. While most providers bill their usual and customary charge in this field, the Medicaid Services Manual (MSM) specifies that certain services must be billed based on other criteria (e.g., physician administered drugs must be billed at the Average Wholesale Price (AWP) and per MSM Chapter 300, radiopharmaceuticals must be billed at 100% of wholesale invoice price). It is important to be familiar with the MSM chapter(s) that apply to the services you provide.

The field requirement for Field 32 has changed from "Required" to "Conditional." Some services are provided in the recipient's home and therefore do not require a servicing facility address. The field requirement for Field 32a has been changed from "Required" to "Not Required" as this information is not required in order to process the claim.

November 1, 2007: Instructions have changed for Fields 17, 24A, 24D, 24H and 32a. Provider types 25, 38, 41, 48, 57 and 58 must complete Field 17 for EPSDT referrals. Fields 24A and 24D are affected by new National Drug Code (NDC) requirements. Field 24H is now marked “Conditional” as it applies to family planning service providers only. Field 32a is now marked “Recommended,” as the NPI of the service location is not required for claims processing.

Please send an e-mail to info@MedClaimSoftware.com with any comments or questions you might have.

 

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