CMS 1500 Items 25-33: Billing Information

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Introduction

From electronic options to paper forms, the CMS-1500 remains a common claims format. CMS 1500 items 25-33 contain billing information such as federal tax ID number, total charge, billing provider information, service facility location information, and others. Whether submitting electronically or on paper, you’ll find precise instructions for accurate completion. Let’s understand how to fill CMS 1500 items 25-33.

Details of CMS 1500 Items 25-33

Item 25: Federal Tax ID Number

Enter the ‘Federal Tax ID Number’ (employer ID number or SSN) of the Billing Provider identified in Item Number 33. Enter an X in the appropriate box to indicate which number is being reported. Only one box can be marked. Do not enter hyphens with numbers. Enter numbers left justified in the field.

Item 26 Patient’s Account No.

Enter the patient’s account number assigned by the provider of services or supplier’s accounting system. While the patient’s account number is a required data element in the 837P claim transaction, it is not required on a paper claim.

Item 27 Accept Assignment

The accept assignment indicates that the provider agrees to accept the assignment under the terms of the payer’s program. Enter an X in the correct box. Only one box can be marked.

Item 28 Total Charge

The ‘Total Charge’ is the total billed amount for all services entered in 24F (lines 1–6). Enter the amount right justified in the dollar area of the field. Do not use commas when reporting dollar amounts. Negative dollar amounts are not allowed. Dollar signs should not be entered. Enter 00 in the cents area if the amount is a whole number.

Item 29 Amount Paid

The ’Amount Paid’ is the total amount the patient and other payers paid for the covered services only. Enter the amount right justified in the left-hand area of the field. Do not use commas when reporting dollar amounts. Negative dollar amounts are not allowed. Dollar signs should not be entered. Enter 00 in the right-hand area if the amount is a whole number.

Item 30: Reserved for NUCC Use

This field is reserved for NUCC use. The NUCC will provide instructions for any use of this field. This field was previously used to report ‘Balance Due.’ ‘Balance Due’ does not exist in 5010A1, so this field has been eliminated.

Item 31 Signature of Physician or Supplier Including Degrees or Credentials

Enter the legal signature of the practitioner or supplier, the signature of the practitioner or supplier representative, ‘Signature on File,’ or ‘SOF.’ Enter either the 6-digit date (MM|DD|YY), 8-digit date (MM|DD|YYYY), or alphanumeric date (e.g., January 1, 2021) when the form was signed.

Item 32: Services Facility Location Information

The name and address of the facility where services were rendered identify the site where service(s) were provided. Providers of service (namely physicians) must identify the supplier’s name, address, ZIP code, and NPI number when billing for purchased diagnostic tests. When more than one supplier is used, a separate 1500 Claim Form should be used to bill for each supplier.

If the ‘Service Facility Location’ is a component or subpart of the Billing Provider and they have their NPI that is reported on the claim, then the subpart is reported as the Billing Provider, and ‘Service Facility Location’ is not used. When reporting an NPI in the ‘Service Facility Location,’ the entity must be an external organization to the Billing Provider. Enter the name and address information in the following format:

1st Line – Name
2nd Line – Address
3rd Line – City, State, and ZIP code

Do not use punctuation (i.e., commas, periods) or other symbols in the address (e.g., 123 N Main Street 101 instead of 123 N. Main Street, #101). Enter a space between town name and state code; do not include a comma. Report a 9-digit ZIP code. Enter the 9-digit ZIP code without the hyphen.

Item 32A: NPI #

Only report a Service Facility Location NPI when the NPI is different from the Billing Provider NPI.

Item 32B: Other ID#

The non-NPI ID number of the service facility is the payer-assigned unique identifier of the facility. Enter the qualifier identifying the non-NPI number followed by the ID number. Do not enter a space, hyphen, or other separator between the qualifier and number. The following qualifiers can be used:

0B: State License Number
G2: Provider Commercial Number
LU: Location Number

Item 33: Billing Provider Info and PH#

Enter the provider’s or supplier’s billing name, address, ZIP code, and phone number. The phone number is to be entered in the area to the right of the field title. Enter the name and address information in the following format:

1st Line – Name
2nd Line – Address
3rd Line – City, State, and ZIP code

Item 33A: NPI#

Enter the NPI number of the billing provider in 33a.

Item 33B: Other ID#

Enter the qualifier identifying the non-NPI number followed by the ID number. Do not enter a space, hyphen, or other separator between the qualifier and number. The following qualifiers can be used:

0B: State License Number
G2: Provider Commercial Number
Provider Taxonomy (The qualifier in the 5010A1 for Provider Taxonomy is PXC, but ZZ will remain the qualifier for the 1500 Claim Form.)

The above list contains both provider identifiers, as well as the provider taxonomy code. The provider identifiers are assigned to the provider by a specific payer or a third party to uniquely identify the provider. The taxonomy code is designated by the provider to identify his/her provider grouping, classification, or area of specialization. Both, provider identifiers and provider taxonomy may be used in this field.

We hope that this article has given you a clear idea of how to fill CMS 1500 items 25-33. CMS 1500 items 25-33 contain crucial information for claims to get paid to the right billing entity. The CMS-1500 form is tough to master and it’s just one piece of a big thousand-piece billing puzzle! Don’t worry, contact PrimeCare and forget about your billing worries. We are a trusted medical billing service provider for solo practitioners and small group practices. With our assistance, you can simply focus on your patients and you don’t have to worry about insurance reimbursements. We will handle it for you, ’cause that’s what we are good at. See you soon.

Reference:

Additional CMS 1500 Resources

CMS 1500 Items 25-33: Billing Information