Medicare Claims Processing Manual

Medicare Claims Processing Manual Chapter 26 - Comple ting and Proce ssing form CMS- 1500 Data Set Table of Conte nts (Rev. 3881, 10-13-17) Transmittals for Chapter 26 10 - Health Insurance claim form CMS- 1500 - Claims That Are Incomplete or Contain Invalid Information - Items 1-11 - P atient and Insured Information - Items 11a - 13 - P atient and Insured Information - Items 14-33 - P rovider of Service or Supplier Information - Place of Service Codes (P OS) and Definitions - A/B Medicare Administrative Contractor (MAC) (B) Instructions for Place of Service (POS) Codes - Type of Service (TOS) - Requirements for Specialty Codes - Assigning Specialty Codes by A/B MACs (B) and DME MACs - P hysician Specialty Codes - Nonphysician P ractitioner, Supplier, and P rovider Specialty Codes - Miles/Times/Units/Services (MTUS) - Methodology for Coding Number of Services, MTUS Count and MTUS Indicator Fields 20 - Patient s Request for Medicare Payment form CMS-1490S 30 - P rinting Standards and P rint File Specifications form CMS- 1500 Exhibit 1 - form CMS- 1500 (08/05) User P rint File Specifications (Formerly Exhibit 2) 10 - Health Insurance claim form CMS- 1500 (Re v.)

Providers may use these instructions to complete this form. The CMS-1500 claim form has space for physicians and suppliers to provide information on other health insurance.

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