Claims

Published 09/28/2023

You are responsible for determining the correct diagnostic and procedural coding for the services you furnish to Medicare patients. Medicare contractors cannot make determinations about the proper use of codes for you or your staff. If you have a question about interpretation of procedural and diagnostic coding, please contact the entities that have responsibility for those coding sets:
  • Current Procedural Terminology (CPT) codes are proprietary to the American Medical Association (AMA). As such, CPT coding questions should be referred to the AMA. The AMA offers CPT Information Services (CPT-IS). This internet-based service is a benefit to AMA members and is available as a subscription fee-based service for non-members and nonphysicians. The AMA also offers CPT Assistant. Information about these resources is found on the AMA's website.
  • The American Hospital Association (AHA) has a website with many resources for answers to coding questions. The website also has a direct link to the AHA Coding Clinic whereby coding questions may be submitted and tracked.
  • Level II Healthcare Common Procedure Coding System (HCPCS) codes related to durable medical equipment or prosthetics, orthotics, and supplies are answered by the Pricing, Data Analysis and Coding (PDAC) Contractor. Information about the PDAC Contractor and the services it provides can be found on the PDAC's website.
  • Additional information can be found about these resources on the CMS HCPCS General Information web page.

The information above can be found on the CMS IOM Manuals, Publication 100-09, Chapter 6, and Section 30.1.1 (PDF).

Last Reviewed: 09/28/2023

If you believe the information is incorrect, you must contact your Medicare Contractor for assistance.

Last Reviewed:09/28/2023

The claims submission feature is only available for Part B providers.

While eServices provider administrators will have access to the feature by default, provider users must be granted permission by an active provider administrator on their account.

Additionally, new registrants must wait 48-72 hours (not including weekends and holidays) before the Claim Submission feature is available. If the provider administrator still cannot access the Claim Submission sub-tab after 72 hours has elapsed, they will need to contact their Medicare Contractor for assistance. 

Last Reviewed: 09/28/2023


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