Q: I am confused by section 24 of the CMS 1500 form - specifically, sections 24B and 24C, which ask for place of service and type of service. I've heard that it should be "O" for office and "A" for acupuncture, but that seems incorrect, as I have had a claim denied for improper place and type of service indicators.Can you help?
A: Those sections are required on a standard CMS 1500 claim but, in fact, numbers are used, not letters. The use of letters you indicate is a common mistake, and it can be seen how they might be construed as correct, considering the assumption of what they seem to represent. Though you might have had claims accepted with incorrect indicators in the past, realize that insurers now are required under HIPAA regulations to have all sections of the claim complete and correct. Even when something as simple or mundane as those sections is incorrect, your claim can be rejected.
For section 24B, which asks for place of service, you must indicate the place with a two-digit number. Most commonly, the place of service is the doctor's office; that is represented by the number 11. If it's the patient's home, the number is 12. An inpatient hospital is 21, and an outpatient hospital is 22. The numeric codes for place of service are assigned up to 99 and begin with 11; numbers 00-10 are unassigned or not used. If the place of service is something other than those listed above, for acupuncture care, it's likely going to be number 99, which is used for an unlisted facility or location.
Type of service procedure codes in section 24C are single-digit numbers. For all medical care (including acupuncture services), the number is 1.
If you are performing a service other than what I have listed, you might see all of the possible type of service and place of service codes directly from the CMS Web site, as well as from most insurer Web sites, such as Blue Shield or Blue Cross.
Click here for more information about Samuel A. Collins.