CMS 1500 Items 25-33: Billing Information
Basics of CMS 1500
Most insurances allow you to send an electronic version of CMS 1500, called an 837 file. But, unfortunately, some paper-only payers are still hanging around, and they require that billers print and fill out the entire form. The bad news is that you can’t just look up a PDF of the CMS-1500 form, fill it out, and call it a day. If you want to obtain your own copies of the form, you have to find a vendor that sells them. You can contact the U.S. Government Printing Office (1-866-512-1800) and request the forms, you can also purchase the forms at office supply stores (e.g., Staples), printing companies, government websites, or even on Amazon. Just ensure that you’re using the most recent version of the form; you can do so by verifying that there’s a little (02/12) in the bottom right-hand portion of the document. CMS 1500 items 25-33 contain billing information such as federal tax ID number, total charge, billing provider information, service facility location information, and others. Let’s understand how to fill CMS 1500 items 25-33.
CMS 1500 Items 25-33
Item 25: Federal Tax ID Number
Enter the ‘Federal Tax ID Number’ (employer ID number or SSN) of the Billing Provider identified in Item Number 33. Enter an X in the appropriate box to indicate which number is being reported. Only one box can be marked. Do not enter hyphens with numbers. Enter numbers left justified in the field.
Item 26: Patient’s Account No.
Enter the patient’s account number assigned by the provider of service’s or supplier’s accounting system. While the patient’s account number is a required data element in the 837P claim transaction, it is not required on a paper claim.
Item 27: Accept Assignment?
The accept assignment indicates that the provider agrees to accept assignment under the terms of the payer’s program. Enter an X in the correct box. Only one box can be marked.
Item 28: Total Charge
The ‘Total Charge’ is the total billed amount for all services entered in 24F (lines 1–6). Enter the amount right justified in the dollar area of the field. Do not use commas when reporting dollar amounts. Negative dollar amounts are not allowed. Dollar signs should not be entered. Enter 00 in the cents area if the amount is a whole number.
Item 29: Amount Paid
The ’Amount Paid’ is the total amount the patient and/or other payers paid on the covered services only. Enter the amount right justified in the left-hand area of the field. Do not use commas when reporting dollar amounts. Negative dollar amounts are not allowed. Dollar signs should not be entered. Enter 00 in the right-hand area if the amount is a whole number.
Item 30: Reserved for NUCC Use
This field is reserved for NUCC use. The NUCC will provide instructions for any use of this field. This field was previously used to report ‘Balance Due.’ ‘Balance Due’ does not exist in 5010A1, so this field has been eliminated.
Item 31: Signature of Physician or Supplier Including Degrees or Credentials
Enter the legal signature of the practitioner or supplier, signature of the practitioner or supplier representative, ‘Signature on File,’ or ‘SOF.’ Enter either the 6-digit date (MM|DD|YY), 8-digit date (MM|DD|YYYY), or alphanumeric date (e.g., January 1, 2021) the form was signed.
Item 32: Service Facility Location Information
The name and address of facility where services were rendered identifies the site where service(s) were provided. Providers of service (namely physicians) must identify the supplier’s name, address, ZIP code, and NPI number when billing for purchased diagnostic tests. When more than one supplier is used, a separate 1500 Claim Form should be used to bill for each supplier.
If the ‘Service Facility Location’ is a component or subpart of the Billing Provider and they have their own NPI that is reported on the claim, then the subpart is reported as the Billing Provider and ‘Service Facility Location’ is not used. When reporting an NPI in the ‘Service Facility Location,’ the entity must be an external organization to the Billing Provider. Enter the name and address information in the following format:
- 1st Line – Name
- 2nd Line – Address
- 3rd Line – City, State and ZIP code
Do not use punctuation (i.e., commas, periods) or other symbols in the address (e.g., 123 N Main Street 101 instead of 123 N. Main Street, #101). Enter a space between town name and state code; do not include a comma. Report a 9-digit ZIP code. Enter the 9-digit ZIP code without the hyphen.
Item 32a: NPI#
Only report a Service Facility Location NPI when the NPI is different from the Billing Provider NPI.
Item 32b: Other ID#
The non-NPI ID number of the service facility is the payer assigned unique identifier of the facility. Enter the qualifier identifying the non-NPI number followed by the ID number. Do not enter a space, hyphen, or other separator between the qualifier and number. Following qualifiers can be used:
- 0B: State License Number
- G2: Provider Commercial Number
- LU: Location Number
Item 33: Billing Provider Info & Ph #
Enter the provider’s or supplier’s billing name, address, ZIP code, and phone number. The phone number is to be entered in the area to the right of the field title. Enter the name and address information in the following format:
- 1st Line – Name
- 2nd Line – Address
- 3rd Line – City, State and ZIP code
Do not use punctuation (i.e., commas, periods) or other symbols in the address (e.g., 123 N Main Street 101 instead of 123 N. Main Street, #101). Enter a space between town name and state code; do not include a comma. Report a 9-digit ZIP code. Enter the 9-digit ZIP code without the hyphen. Do not use a hyphen or space as a separator within the telephone number.
Item 33a: NPI#
Enter the NPI number of the billing provider in 33a.
Item 33b: Other ID#
Enter the qualifier identifying the non-NPI number followed by the ID number. Do not enter a space, hyphen, or other separator between the qualifier and number. Following qualifiers can be used:
- 0B: State License Number
- G2: Provider Commercial Number
- Provider Taxonomy (The qualifier in the 5010A1 for Provider Taxonomy is PXC, but ZZ will remain the qualifier for the 1500 Claim Form.)
The above list contains both provider identifiers, as well as the provider taxonomy code. The provider identifiers are assigned to the provider either by a specific payer or by a third party in order to uniquely identify the provider. The taxonomy code is designated by the provider in order to identify his/her provider grouping, classification, or area of specialization. Both, provider identifiers and provider taxonomy may be used in this field.
We hope that this article has given you a clear idea of how to fill CMS 1500 items 25-33. CMS 1500 items 25-33 contains crucial information for claim to get paid to right billing entity. The CMS-1500 form is definitely tough to master and it’s just one piece of a big thousand-piece billing puzzle! Don’t worry, simply contact E2E Medical Billing Services at 888-552-1290 / [email protected] and forget about your billing worries. We are one of the leading medical billing service providers for solo practitioners and small group practices. With our assistance, you can simply focus on your patients and you don’t have to worry about insurance reimbursements. We will handle it for you, cause that’s what we good at. See you soon.
Reference: https://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/1500
Do you have any doubts about accurate information to be entered in one of these fields? Let us know in the comment section below.
Additional CMS 1500 Resources
CMS 1500 items 1-7: Patient and Insured Information
CMS 1500 items 8-13: Patient and Insured Information
CMS 1500 items 14-23: Physician or Supplier Information
CMS 1500 item 24: Basics
CMS 1500: Supplemental Information in Item 24
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