CMS 1500: Supplemental Information in Item 24

Supplemental Information in Item 24

Supplemental information in Item 24 could be confusing. Sometimes, to process a medical claim this supplemental information is required. Without this supplemental information, the CMS 1500 form is considered incomplete and hence can’t be processed. We have shared all the required information along with examples. Kindly note that the following examples demonstrate how the data are to be entered into the fields and are not meant to provide direction on how to code for certain services. Following different types of information are entered into item 24:

• Narrative description of unspecified codes
• National Drug Codes (NDC) for drugs
• Device Identifier of the Unique Device Identifier for supplies
• Contract rate
• Tooth numbers and areas of the oral cavity

Basic Guidelines while Entering Information in Item 24

• If required to report other supplemental information not listed above, follow payer instructions for the use of a qualifier for the information being reported. When reporting a service that does not have a qualifier, enter two blank spaces before entering the information.
• To enter supplemental information, begin at 24A by entering the qualifier and then the information. Do not enter a space between the qualifier and the number/code/information. Do not enter hyphens or spaces within the number/code.
• More than one supplemental item can be reported in the shaded lines of Item Number 24. Enter the first qualifier and number/code/information at 24A. After the first item, enter three blank spaces and then the next qualifier and number/code/information.
• When reporting dollar amounts in the shaded area, always enter the dollar amount, a decimal point, and cents. Use 00 for the cents if the amount is a whole number. Do not use commas. Do not enter dollar signs. Example:
  • 1000.00
  • 123.45
• The following qualifiers are to be used when reporting supplemental services:
  • ZZ: Narrative description of unspecified code
  • N4: National Drug Codes (NDC)
  • DI: Device Identifier of the Unique Device Identifier (UDI)
  • CTR: Contract rate
  • JP: Universal/National Tooth Designation System
  • JO: ANSI/ADA/ISO Specification No. 3950-1984 Dentistry Designation System for Tooth and Areas of the Oral Cavity

Additional Information for Reporting NDC

When entering supplemental information for NDC, add in the following order: qualifier, NDC code, one space, unit/basis of measurement qualifier, quantity. The number of digits for the quantity is limited to eight digits before the decimal and three digits after the decimal. If entering a whole number, do not use a decimal. Do not use commas. Example:

• 1234.56
• 2
• 99999999.999

When a dollar amount is being reported, enter the following after the quantity: one space, dollar amount. Do not enter a dollar sign. The following qualifiers are to be used when reporting NDC unit/basis of measurement:

• F2: International Unit
• ME: Milligram
• UN: Unit
• GR: Gram
• ML: Milliliter

When reporting compound drugs, a statement of ingredients may be required to be attached to the claim. When required to report both the repackaged NDC and original NDC of a drug, use the shaded area of 24. Report the information in the following order: qualifier (N4), NDC code, one space, unit/basis of measurement qualifier, quantity, one space, ORIG, qualifier (N4), NDC code.

UDI Replacement of NDC for Supplies

National Health Related Items Code (NHRIC) and National Drug Code (NDC) numbers assigned to some supplies/devices are being replaced with a Unique Device Identifier (UDI). When required to report a supply and that supply’s NHRIC/NDC has been replaced by a UDI, report the Device Identifier (DI) portion of the UDI.

Medical and Surgical Supplies

The following qualifiers are to be used when regulations mandate the use of the Universal Product Number (UPN) for reporting medical and surgical supplies:

• EN: EAN/UCC – 13
• EO: EAN/UCC – 8
• HI: HIBC (Health Care Industry Bar Code)

Supplier Labeling Standard Primary Data Message

• UK: GTIM 14–digit data structure
• UP: UCC – 12

Information for Reporting Tooth Numbers and Areas of the Oral Cavity

• When reporting tooth numbers, add in the following order: qualifier, tooth number, e.g., JP16. When reporting an area of the oral cavity, enter in the following order: qualifier, area of oral cavity code, e.g., JO10.
• When reporting multiple tooth numbers for one procedure, add in the following order: qualifier, tooth number, blank space, tooth number, blank space, tooth number, etc., e.g., JP1 16 17 32.
• When reporting multiple tooth numbers for one procedure, the number of units reported in 24G is the number of teeth involved in the procedure.
• When reporting multiple areas of the oral cavity for one procedure, add in the following order: qualifier, oral cavity code, blank space, oral cavity code, etc., e.g., JO10 20.
• When reporting multiple areas of the oral cavity for one procedure, the number of units reported in 24G is the number of areas of the oral cavity involved in the procedure.
• The following are the codes for tooth numbers, reported with the JP qualifier:
  • 1 – 32: Permanent dentition
  • 51 – 82: Permanent supernumerary dentition
  • A – T: Primary dentition
  • AS – TS: Primary supernumerary dentition
• The following are the codes for areas of the oral cavity, reported with the JO qualifier:
  • 00: Entire oral cavity
  • 01: Maxillary arch
  • 02: Mandibular arch
  • 10: Upper right quadrant
  • 20: Upper left quadrant
  • 30: Lower left quadrant
  • 40: Lower right quadrant

For further information on these codes, refer to the Current Dental Terminology (CDT) Manual available from the American Dental Association.

We hope that this article has given you a clear idea of how to fill Supplemental information in Item 24. 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:

• Medicare Claims Processing Manual
• CMS-1500 Claim Form Reference Instruction Manual

Additional CMS 1500 Resources

• CMS 1500 Items 1-7: Patient and Insured Information
• CMS 1500 Items 8-13: Patient and Insured Information
• CMS 1500 Items 14-23: Physician or Supplier Information
• CMS 1500 Item 24: Basics
• CMS 1500: Supplemental Information in Item 24
• CMS 1500 Items 25-33: Billing Information