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Medicare Claims Processing Manual



The Medicare Claims Processing Manual is a new manual that replaces current medicare claims processing instructions for Medicare providers and contractors. Corresponding sections within current manuals will be removed within a few weeks.

New instructions will be published in this manual. Manual transmitals through Revision Transmittal Number 1, dated October 1, 2003, are included in this update. As new transmittals are included they will be identified on this page. To review individual transmittals, view the CMS Transmittal Web site.

A crosswalk from the new manual to the source manual instruction is provided with each chapter. This crosswalk for the entire chapter may be accessed from the chapter table of contents. Also, the crosswalk for each section is shown immediately under the section heading.

You may either view the file in PDF or download a zipped MSWord file.


Table of Contents
Chapter Title IOM Manual PDF File Zipped Word File
1 General Billing Requirements Link to General Billing Requirements Adobe pdf file, 2351 KB2,351KB Link to General Billing Requirements Adobe pdf file, 300 KB300KB
2 Admission and Registration Requirements Link to Admission and Registration Requirements Adobe pdf file, 531 KB531KB Link to Admission and Registration Requirements zipped Word file, 62 KB62KB
3 Inpatient Part A Hospital Link to Inpatient Hospital Adobe pdf file, 3,955 KB3,955KB Link to Inpatient Hospital zipped Word file, 412 KB412KB
4 Part B Hospital (Including Inpatient Hospital Part B and OPPS) Link to Part B Hospital (Including Inpatient Hospital Part B and OPPS) Adobe pdf file, 1,273KB1,273KB Link to Part B Hospital (Including Inpatient Hospital Part B and OPPS)zipped Word file,147KB147KB
5 Part B Outpatient Rehabilitation and CORF Services Link to Part B Outpatient Rehabilitation and CORF Services Adobe pdf file, 245 KB245KB Link to Part B Outpatient Rehabilitation and CORF Services zipped Word file, 52 KB52KB
6 SNF Inpatient Part A Billing Link to Inpatient Part a SNF Adobe pdf file, 390 KB390KB Link to Inpatient Part a SNF zipped Word file, 82 KB82KB
7 SNF Part B (Including Inpatient Part B and Outpatient Fee Schedule) Link to SNF Part B Billing (Including Part B and Outpatient Fee Schedule) Adobe pdf file, 125 KB125KB Link to SNF Part B Billing (Including Part B and Outpatient Fee Schedule) zipped Word file, 30 KB30KB
8 Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims Link to Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims Adobe pdf file, 832 KB832KB Link to Outpatient ESRD (Hospital Based and Independent RDF Facilities) zipped Word file, 103 KB103KB
9 Rural Health Clinics and Federal Qualified Health Centers Link to Rural Health Clinics and Federal Qualified Health Centers Adobe pdf file, 267 KB267KB Link to Rural Health Clinics and Federal Qualified Health Centers zipped Word file, 51 KB51KB
10 Home Health Agency Billing Link to Home Health Adobe pdf file, 1031 KB1031KB Link to Home Health zipped Word file, 129 KB129KB
11 Hospice Link to Hospice Adobe pdf file, 323 KB323KB Link to Hospice zipped Word file, 63 KB63KB
12 Physician/Practitioner Billing Link to Physician/Practitioner Billing Word file, 1,070KB1,070KB Link to Physician/Practitioner Billing zipped Word file, 163KB163KB
13 Radiology Services Link to Radiology Adobe pdf file, 414 KB414KB Link to Radiology zipped Word file, 79 KB79KB
14 Ambulatory Surgical Centers Link to Ambulatory Surgical Centers Adobe pdf file, 124KB 124KB Link to Ambulatory Surgical zipped Word file, 25 KB25KB
15 Ambulance Link to Ambulance Adobe pdf file, 945KB945KB Link to Ambulance zipped Word file, 71KB71KB
16 Laboratory Services from Independent Labs, Physicians, and Providers Link to Laboratory Services from Independent Labs, Physicians, and Providers Adobe pdf file, 876 KB876KB Link to Laboratory Services from Independent Labs, Physicians, and Providers zipped Word file, 90 KB90KB
17 Drugs and Biologicals Link to Drugs and Biologicals Adobe pdf file, 831 KB831KB Link to Drugs and Biologicals zipped Word file, 72 KB72KB
18 Preventive and Screening Services Link to Preventive Services and Vaccines Adobe pdf file, 1,511 KB1,511KB Link to Preventive Services and Vaccines zipped Word file, 116 KB116KB
19 Indian Health Services
(Not yet available) 		   
20 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DME/POS), Parenteral and Enteral Link to Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DME/POS), Parenteral and Enteral Adobe pdf file, 1,075 KB1,075KB Link to Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DME/POS), Parenteral and Enteral zipped Word file, 166 KB166KB
21 Medicare Summary Notices Link to Medicare Summary Notices Adobe pdf file, 797 KB797KB Link to Medicare Summary Notices zipped Word file, 125 KB125KB
22 Remittance Notices to Providers Link to Remittance Notices to Providers Adobe pdf file, 763 KB763KB Link to Remittance Notices to Providers zipped Word file, 59 KB59KB
23 Fee Schedule Administration and Coding Requirements Link to Fee Schedule Administration and Coding Requirements Adobe pdf file, 2313 KB2313KB Link to Fee Schedule Administration and Coding Requirements zipped Word file, 171 KB171KB
24 EDI Support Requirements Link to EDI Support Requirements Adobe pdf file, 700 KB700KB Link to EDI Support Requirements zipped Word file, 94 KB94KB
25 Completing and Processing UB-92 (CMS-1450) Data Set Link to Completing and Processing UB-92 Data Set 5593 KB5593KB Link to Completing and Processing UB-92 Data Set zipped Word file 329 KB329KB
26 Completing and Processing Form CMS-1500 Data Set Link to Instructions for Completing Form CMS-1500 and NSF Format, 756 KB756KB Link to Instructions for Completing Form CMS-1500 and NSF Format Word file, 118 KB118
27 Contractor Instructions for CWF Link to Contractor Instructions for CWF Adobe pdf file, 4208 KB4208KB Link to CWF Procedures zipped Word file, 215 KB215KB
28 Coordination With Medigap, Medicaid, and Other Complementary Insurers Link to Coordination with Medigap, Medicaid, and Other Complementary Insurers Adobe pdf file, 324KB324KB Link to Coordination with Medigap, Medicaid, and Other Complementary Insurers zipped Word file, 43KB43KB
29 Appeals of Claims Decisions
Link to Appeals Adobe pdf file, 1,809 KB1,809KB Link to Appeals Zipped Word file, 268 KB268KB
30 Financial Liability Protections Financial Liability Protections Adobe pdf file, 1,384 KB1,384KB Financial Liability Protections zipped Word file, 217 KB217KB
31 ANSI X12N Formats Link to ANSI X12 Formats Other than Claims or Remittance Adobe pdf file, 526 KB526KB Link to ANSI X12 Formats Other than Claims or Remittance zipped Word file, 56 KB56KB
32 Billing Requirements for Special Services Link to Billing Requirements for Special Services Adobe pdf file, 118 KB118KB Link to Billing Requirements for Special Services zipped Word file, 33 KB33KB


Link to One Time Notifications Page One Time Notifications

Link to Business Requirements page Business Requirements




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Last Modified on Thursday, September 16, 2004  
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