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Bill Types

This three-digit alphanumeric code gives three specific pieces of information.

The first digit identifies the type of facility. The second classifies the type of care. The third indicates the
sequence of this bill in this particular episode of care. It is referred to as a "frequency" code.

First Digit Identifies Type of Facility

  • 1 Hospital
  • 2 Skilled Nursing Facility
  • 3 Home Health
  • 4 Religious Nonmedical (Hospital)
  • 5 Religious Nonmedical (Extended Care) discontinued 10/1/05
  • 6 Intermediate Care
  • 7 Clinic or Hospital based ESRD facility (requires Special second digit)
  • 8 Special facility or hospital (CAH) (ASC) surgery (requires special second digit)
  • 9 Reserved for National Assignment

Second Digit (Except Clinics & Special Facilities) - Bill Classification

  • 1 Inpatient Part A
  • 2 Inpatient Part B (includes Part B plan of treatment)
  • 3 Outpatient (includes Part B plan of treatment)
  • 4 Other (Part B) (includes HHA medical and other health services not under a plan of treatment, hospital and SNF for diagnostic clinical laboratory services for "non-patients" and referenced diagnostic services.
  • 5 Intermediate Care - Level I
  • 6 Intermediate Care - Level II
  • 7 Subacute Inpatient (Revenue Code 019X required) 17X, 27X discontinued 10/1/05
  • 8 Swing Beds
  • 9 Reserved for National Assignment

Second Digit (Clinics only) - Bill Classification

  • 1 Rural Health Center (RHC)
  • 2 Hospital based or Independent Renal Dialysis Center
  • 3 Other Rehabilitation Facility (ORF)
  • 4 Comprehensive Outpatient Rehabilitation Facility (CORF)
  • 5 Community Mental Health Center (CMHC)
  • 6 Free Standing/Provider-based Federally Qualified Health Center (FQHC)
  • 7 Reserved for National Assignment
  • 8 Other

Second Digit (Special Facilities only) - Bill Classification

  • 1 Hospice (non-hospital based)
  • 2 Hospice (hospital based)
  • 4 Free Standing Birthing Center
  • 5 Critical Access Hospital (CAH) 6-8. Reserved for National Assignment
  • 9 Other

Initial Bill Third Digit – Frequencies

Digit

Action

Details

0

Non-payment/Zero Claim

Provider uses this code when it does not anticipate payment from the payer for the bill, but is informing the payer about a period of non- payable confinement or termination of care. The "Through" date of this bill (FL 6) is the discharge date for this confinement, or termination of the plan of care.

1

Admit Through Discharge

The provider uses this code for a bill encompassing an entire inpatient confinement or course of outpatient treatment for which it expects payment from the payer or which will update deductible for inpatient or Part B claims when Medicare is secondary to an EGHP.

2

Interim - First Claim

Used for the first of an expected series of bills for which utilization is chargeable or which will update inpatient deductible for the same confinement of course of treatment. For HHAs, used for the submission of original or replacement RAPs.

3

Interim-Continuing Claims (Not valid for PPS Bills)

Use this code when a bill for which utilization is chargeable for the same confinement or course of treatment had already been submitted and further bills are expected to be submitted later.

4

Interim - Last Claim (Not valid for PPS Bills)

This code is used for a bill for which utilization is chargeable, and which is the last of a series for this confinement or course of treatment.

5

Late Charge Only (Outpatient claims only)

When the provider submits late charges on bills to the FI as bill type XX5, these bills contain only additional charges.

7

Replacement of Prior Claim (See adjustment third digit)

This is used to correct a previously submitted bill. The provider applies this code to the corrected or "new" bill.

8

Void/Cancel of Prior Claim (See adjustment third digit)

The provider uses this code to indicate this bill is an exact duplicate of an incorrect bill previously submitted. A code "7" (Replacement of Prior Claim) is being submitted showing corrected information.

9

Final claim for a Home Health PPS Episode

 

A

Admission/Election Notice for Hospice

Used when the hospice or Religious Non-medical Health Care Institution is submitting Form CMS-1450 as an Admission Notice.

B

Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Termination/ Revocation Notice

Used when the Form CMS-1450 is used as a notice of termination/revocation for a previously posted Hospice/Medicare Coordinated Care Demonstration/Religious Non-medical Health Care Institution election.

C

Hospice Change of Provider Notice

Used when CMS Form-1450 is being used as a Notice of Change to the Hospice provider.

D

Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Void/Cancel

Used when Form CMS-1450 is used as a Notice of a Void/Cancel of Hospice/Medicare Coordinated Care Demonstration/Religious Non- medical Health Care Institution election.

E

Hospice Change of Ownership

Used when Form CMS-1450 is used as a Notice of Change in Ownership for the hospice.

F

Beneficiary Initiated Adjustment Claim

Used to identify adjustments initiated by the beneficiary. For FI use only.

G

CWF Initiated Adjustment Claim

Used to identify adjustments initiated by CWF. For FI use only.

H

CMS Initiated Adjustment Claim

Used to identify adjustments initiated by CMS. For FI use only.

I

FI Adjustment Claim (Other than QIO or Provider)

Used to identify adjustments initiated by the FI. For FI use only.

J

Initiated Adjustment Claim--Other

Used to identify adjustments initiated by other entities. For FI use only.

K

OIG Initiated Adjustment Claim

Used to identify adjustments initiated by the OIG. For FI use only.

M

MSP Initiated Adjustment Claim

Used to identify adjustments initiated by MSP. For FI use only. Note: MSP takes precedence for other adjustment sources.

P

QIO Adjustment Claim

Used to identify adjustments initiated by the QIO. For FI use only.

 

Last Updated Apr 30, 2015