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 |
2,351KB |
300KB |
2 |
Admission and Registration Requirements |
531KB |
62KB |
3 |
Inpatient Part A Hospital |
3,955KB |
412KB |
4 |
Part B Hospital (Including Inpatient Hospital Part B and OPPS) |
1,273KB |
147KB |
5 |
Part B Outpatient Rehabilitation and CORF Services |
245KB |
52KB |
6 |
SNF Inpatient Part A Billing |
390KB |
82KB |
7 |
SNF Part B (Including Inpatient Part B and Outpatient Fee Schedule) |
125KB |
30KB |
8 |
Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims |
832KB |
103KB |
9 |
Rural Health Clinics and Federal Qualified Health Centers |
267KB |
51KB |
10 |
Home Health Agency Billing |
1031KB |
129KB |
11 |
Hospice |
323KB |
63KB |
12 |
Physician/Practitioner Billing |
1,070KB |
163KB |
13 |
Radiology Services |
414KB |
79KB |
14 |
Ambulatory Surgical Centers |
124KB |
25KB |
15 |
Ambulance |
945KB |
71KB |
16 |
Laboratory Services from Independent Labs, Physicians, and Providers |
876KB |
90KB |
17 |
Drugs and Biologicals |
831KB |
72KB |
18 |
Preventive and Screening Services |
1,511KB |
116KB |
19 |
Indian Health Services
(Not yet available)
|
|
|
20 |
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DME/POS), Parenteral and Enteral |
1,075KB |
166KB |
21 |
Medicare Summary Notices |
797KB |
125KB |
22 |
Remittance Notices to Providers |
763KB |
59KB |
23 |
Fee Schedule Administration and Coding Requirements |
2313KB |
171KB |
24 |
EDI Support Requirements |
700KB |
94KB |
25 |
Completing and Processing UB-92 (CMS-1450) Data Set |
5593KB |
329KB |
26 |
Completing and Processing Form CMS-1500 Data Set |
756KB |
118 |
27 |
Contractor Instructions for CWF |
4208KB |
215KB |
28 |
Coordination With Medigap, Medicaid, and Other Complementary Insurers |
324KB |
43KB |
29 |
Appeals of Claims Decisions
|
1,809KB |
268KB |
30 |
Financial Liability Protections
|
1,384KB |
217KB |
31 |
ANSI X12N Formats |
526KB |
56KB |
32 |
Billing Requirements for Special Services |
118KB |
33KB |
One Time Notifications
Business Requirements
Go to top of Manual Table of Contents
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Last Modified on Thursday, September 16, 2004
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