American Speech-Language-Hearing Association

Medicare Part B Claims Checklist

Avoiding Simple Mistakes on the CMS-1500 Claim Form

The Patient Protection and Affordable Care Act and other legislation have modified the requirements for the Medicare Part B claim, which is filed using the CMS-1500 claim form [PDF]. Audiologists and speech-language pathologists can refer to the checklist below to make sure their claims are not returned or denied for simple errors.

Note: This checklist serves as a reminder for key items on the claim form and is not meant to be a step-by-step guide. For full instructions on completing and processing the CMS-1500 claim form, go to Chapter 26 of the Medicare Claims Processing Manual [PDF].

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Patient & Insurance Information

Fields 1-11

Most of the information in these fields is required. Double check the name, address, and insurance ID for accuracy before submitting the claim.

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Name & NPI of Referring Provider

Field 17

The name and National Provider Identifier (NPI) of the referring or certifying provider is required for all audiology and speech-language pathology services, even for purposes of a denial. The referring/certifying provider must be enrolled in the PECOS system and the name must be entered without titles or middle initials. Verify the referring/certifying provider information using the Medicare Ordering and Referring File.

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Diagnosis/Nature of Illness

Field 21 

The primary diagnosis represents the condition determined by the audiologist or speech-language pathologist or the reason why the patient was seen. Additional medical diagnoses can be included in the remaining spaces. Remember ICD-9 transitions to ICD-10 on October 1, 2015.

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Place of Service

Field 24.B 

The two-digit place of service (POS) must represent the setting where the beneficiary received the service. POS is very important to determine the appropriate payment rate and is monitored by the Office of the Inspector General. For more information and the list of POS codes, see the Medicare Learning Network's article on Revised and Clarified POS Coding Instructions [PDF].

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CPT Codes & Modifiers

Field 24.D

Ensure that the codes best represent the procedures that were performed for audiology or speech-language pathology services, and append any modifiers to further describe the services if necessary.

 Do CCI edits (audiology, SLP) or MUEs (audiology, SLP) apply?

 If reporting PQRS measures (audiology, SLP), are the appropriate G-codes entered?

 SLPs: The -GN modifier must be appended to all CPT codes.

SLPs: The G-codes for functional reporting must be reported at appropriate intervals.

SLPs: Are claims nearing the therapy cap? If so, append the -KX modifier.

SLPs: Are claims nearing the $3,700 threshold? Prepare for manual medical review.

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Total Charge

Field 28

Enter the total for all the charges entered in field 24.F. Include cents, but no decimals.

Amount Paid

Field 29

Do not include the amount paid by the primary insurance, co-insurance, deductibles, account balance, or payments on previous claims in this item.

Signature of Provider of Services

Field 31

This is a required field. Do not submit without completing this field. The signature and date must be completely within the confines of this box. Additional acceptable signatures include a signature stamp or a computer-generated signature.

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