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Q. What is the proper billing procedure for an electronic claim for services paid under the Medicare Physician Fee Schedule (MPFS) and/or anesthesia services performed in different geographic areas?

Patient Financial Services Weekly Advisor, http://www.cms.hhs.gov/medlearnmattersarticles/downloads/SE0429.pdf, December 28, 2007

Q. What is the proper billing procedure for an electronic claim for services paid under the Medicare Physician Fee Schedule (MPFS) and/or anesthesia services performed in different geographic areas?

A. It is acceptable for claims to contain the code for place of service (POS) "home" and any number of additional POS codes according to the implementation guide of the 4010A1 version of the ASC X12N 837 electronic claims format. When different POS codes are used for services on the claim, a corresponding service facility location and address must be entered for each service at the line level if that location is different from the billing provider, the "pay-to" provider, or claim level service facility location.

You should refer to the current implementation guide of the ASC X12N 837 to determine how information must be entered on a claim.

The following information is based on the implementation guide:

• On version 4010A1 of the ASC X12N 837 electronic claim format the Billing Provider loop 2010AA is required and must always be entered. If the Pay-To Provider Name and Address loop 2010AB is the same as the Billing Provider, only the Billing Provider must be entered. If no Pay-To Provider Name and Address is entered in loop 2010AB and the Service Facility Location loop 2310D (claim level) or 2420C (line level) is the same as the Billing Provider, then only the Billing Provider must be entered.
• If the Pay-To Provider Name and Address loop 2010AB is not the same as the Billing Provider, both must be entered. If the Service Facility Location loop 2310D is not the same as the Billing Provider or the Pay-To Provider, the Service Facility Location loop 2310D (claim level) must be entered.
• When the same POS code and same service location address is applicable to each service line on the claim, the service facility location name and address must be entered at the claim level loop 2310D.
• If the POS code is the same for all services, but the services were provided at different addresses, each service must be submitted with line-level information. This will provide a zip code to price each service on the claim.

Source: The Centers for Medicare & Medicaid Services.

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