Tuesday, September 22, 2015

CMS 1500 box 24a, 24b and 24c Detailed view

24a  Dates of Service-unshaded NDC number-shaded (required when billing CPT/HCPCS codes for a drug)

Unshaded area: Enter date of service in the block, MMDDYY.

Shaded area: Drug codes require NDC. See www.wvdhhr/bms.org for the Drug Code List for procedure codes that require NDC codes. Enter the NDC qualifier of N4, followed by an 11-digit NDC number. Do not enter a space between the qualifier and NDC. Do not enter hyphens or spaces within the NDC number. The NDC number submitted to Medicaid must be the actual NDC number on the package or container from which the medication was administered.

24b Place of Service
Enter the appropriate 2-digit code for place of service. Valid values are: 01 & 02 = Unassigned 03 = School 04 = Homeless Shelter 05 = Native American Health Service, Free Standing Clinic 06 = Native American Health Service, Provider Based Facility 07 = Tribal 638 Free Standing Facility 08 = Tribal 638 Provider Based Facility 09 & 10 = Unassigned 11 = Office 12 = Patient’s Home 13 = Assisted Living Facility 14 = Group Home 15 = Mobile Unit 16 – 19 = Unassigned 20 = Urgent Care Facility 21 = Inpatient Hospital 22 = Outpatient Hospital 23 = Emergency Room - Hospital 24 = Ambulatory Surgical Center 25 = Birthing Center 26 = Military Treatment Facility 27 – 30 = Unassigned 31 = Skilled Nursing Facility 32 = Nursing Facility 33 = Custodial Care Facility 34 = Hospice 35 – 40 = Unassigned 41 = Ambulance, Land 42 = Ambulance, Air or Water 43 – 48 = Unassigned 49 = Independent Clinic 50 = Federally Qualified Health Center 51 = Inpatient Psychiatric Facility 52 = Psychiatric 53 = Community Mental Health Center 54 = Intermediate Care Facility 55 = Residential Substance Abuse Treatment Facility 56 = Psychiatric Residential Treatment Center 57 = Non-Residential Substance Abuse Treatment Facility 58 & 59 = Unassigned 60 = Mass Immunization Center 61 = Comprehensive 62 = Comprehensive Outpatient Rehabilitation Facility 63 & 64 = Unassigned 65 = End-Stage Renal Disease Treatment Facility 66 – 70 = Unassigned 71 = State Public Health Clinic 72 = Rural Health Clinic 73 – 80 = Unassigned 81 = Independent Laboratory 99 = Other Unlisted Facility


24c Defaults to 1 for CMS services

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