Chapter 2: Two Sections of the CMS-1500 Flashcards
What are the two sections of the CMS-1500 claim form?
Patient and Insured Information and Physician or Supplier Information.
What is the first section of Patient and Insured Information?
Patient’s name, date of birth (DOB), gender and address.
What is the second section of Patient and Insured Information?
Insured’s name and relationship to the patient.
What is the third section of Patient and Insured Information?
Primary insurance information.
What is the fourth section of Patient and Insured Information?
Secondary insurance information (if applicable)
What is the first section of Physician or Supplier Information?
ICD-10-CM code(s).
What is the second section of Physician or Supplier Information?
CPT codes, modifiers (if applicable) and units of service.
What is the third section of Physician or Supplier Information?
Date of service (DOS)
What is the fourth section of Physician or Supplier Information?
Place of Service (POS)
What does all professional claims require to identify the location where the patient received the service?
A two-digit place of service (POS) code.
What is the first component that commonly reported POS codes for physician claims include?
Telehealth - 02.
What is the second component that commonly reported POS codes for physician claims include?
Provider’s Office - 11.
What is the third component that commonly reported POS codes for physician claims include?
Inpatient Hospital - 21.
What is the fourth component that commonly reported POS codes for physician claims include?
Outpatient Hospital/Observation Area - 22.
What is the fifth component that commonly reported POS codes for physician claims include?
Emergency Room - 23
