Use ZIP Codes to Zip Medicare Payment to You

If you provide services to Medicare patients at more than one office or practice location, you can submit all your Medicare claims through one office to TrailBlazer Health Enterprises, the Texas Medicare carrier. 

However, each claim must include the specific location where you provided services so Medicare will have the ZIP code and can determine the correct claims processing jurisdiction and apply the correct Medicare Physician Fee Schedule (MPFS). This requirement applies to all places of service except 12 (home).

Locations in certain areas of Texas (see table below), you must submit the nine-digit ZIP code with your Medicare claim. That's because some ZIP codes cover more than one payment locality under the MPFS; in some cases, while you actually may provide a medical service in one county, for payment purposes, it may be assigned into a different county based on the ZIP code.

Medicare will reject any claims lacking specific addresses as unprocessable; you will have to correct and refile the claim to get paid for your services.

For more information, read MLN Matters No. MM5208 (Revised) (PDF) from the Centers forMedicare & Medicaid Services. 

              ZIP code areas requiring the nine-digit code

75007
75019
75028
75044
75048
75050
75051
75052
75054
75067
75080
75082
75088
75089
75098

75104
75115
75125
75146
75148
75154
75159
75182
75248
75252
75287
75839
75844
75847

75851
75856
75862
76008
76020
76028
76036
76051
76052
76063
76065
76071
76092
76108
76126

76177
76262
77047
77053
77082
77083
77085
77099
77339
77357
77365
77381
77382
77426

77430
77444
77447
77450
77474
77477
77480
77484
77485
77489
77493
77494
77511
77520
77521

77532
77535
77539
77546
77550
77568
77581
77583
77622
77656
77665
77833
78610
78612

78613
78615
78617
78620
78621
78634
78641
78652
78654
78657
78663
78664
78669
78727
78728

78729
78734
78736
78737
78738
78750
78759
78933
78940
78950
78954
79835
79922
79932


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