Enter the date the service was provided in MMDDYYYY format.
For a Single Date of Service:
In the “From” column, enter the date the service was
provided in MMDDYYYY format. Leave the “To” column
For Consecutive Dates of Service:
In the “From” column, enter the first date of service. In the
“To” column, enter the last date of service. Billing for
consecutive dates of service on a single claim line is
allowed for only certain services. For example, a physician
may bill for hospital visits on successive days by entering
the dates of service in the “From” and “To” boxes, but a
physician may not bill for office visits on successive days
on a single claim line.
Early Intervention Providers:
Enter the date the assessment was completed in the "From” column. In Field 24G, enter
the total number of units spent on the assessment, regardless of the date.
For All Other Early Intervention Services:
Follow the instructions given in the general description.
DME and Oxygen and Respiratory Therapy Equipment Providers:
For Monthly Rentals:
Enter the last date of the monthly rental period in “From.” Leave “To” blank. Use a
separate claim line for each monthly rental period.
For Substitute Rentals:
Enter the date of service in “From”; leave “To” blank. Use a separate claim line for
each rental day.
For Purchases and Repairs:
Enter the date when the service was furnished in “From.” Leave “To” blank.