Friday, July 16, 2010

Two-digit qualifiers in CMS1500 form


The shaded fields in boxes 17a, 24I, 24J, 32b and 33b should be used to report provider numbers other than the NPI as needed. Fields 17a and 24I include a separate space for a two-digit qualifier that describes the type of identifier entered. (See “Two-digit qualifiers” for a list.) Fields 32b and 33b do not have a separate area for the qualifiers, but the qualifier should still be the first two digits entered.

These two-digit qualifiers should be used as appropriate in fields 17a, 24I, 32b and 33b of the revised 1500 claim form.

0B State license number

1B Blue Shield provider number

1C Medicare provider number

1D Medicaid provider number

1G Provider UPIN

1H CHAMPUS identification number

EI Employer’s identification number

G2 Provider commercial number

LU Location number

N5 Provider plan network identification number

SY Social Security number (This may not be used for Medicare.)

X5 State industrial accident provider number

ZZ Provider taxonomy

The following identifiers are to be used when reporting services related to them.

ZZ Narrative description of unspecified code

N4 National Drug Codes (NDC)

VP Vendor product number Health Industry Business Communications Council (HIBCC) labeling standard

OZ Product number Health Care Uniform Code Council – Global Trade Item Number (GTIN)

CTR Contract rate

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