Avoid These Common Paper CMS-1500 Medicare Claim Errors

Novitas Solutions, the Texas Medicare administrative contractor, says paper Medicare billers continue to make the errors described below. Expect Novitas to return such incorrectly billed claims as unprocessable.

Legacy provider identifier. Novitas says it receives CMS-1500 claim forms that report legacy numbers (i.e., provider identification number, unique physician identification number, or national clearinghouse number) in the following items. You should leave these items blank:

  • Item 17a (red shaded area) for the referring physician,
  • Item 24J (red shaded area) for the rendering physician, and
  • Item 33b for the billing physician or group.

You need to report only the National Provider Identifier (NPI) in the appropriate field designated for referring (17b), rendering (24J, unshaded area), and billing (33a) physicians. 

 Diagnosis codes reported in items 21 and 24E.

  • Item 21 Enter the patient's diagnosis/condition. This is a required field.
  • Enter up to 12 diagnosis codes in lines A-L.
  • Code to the highest level of specificity.
  • Enter the diagnoses in priority order from left to right.
  • Do not provide narrative description in this field; submit it on an attachment.
  • Item 24E/line diagnosis. This is a required field.
  • Enter the diagnosis code reference letter from item 21 to relate the date of service and the procedures performed to the primary diagnosis.
  • Enter the corresponding alpha diagnosis code pointer at the service line level (do not enter a numeric pointer in this field).
  • Enter only one reference letter per line item.
  • If you performed multiple services, enter the primary reference letter for each service.
  • If a situation arises where two or more diagnoses are required for a procedure code (e.g., pap smears), reference only one of the diagnoses in item 21.

Chapter 26 or the Medicare Claims Processing Manual contains instructions for completing the CMS-1500 claim form (PDF).

Published July 8, 2014

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