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CMS: Type of Bill Structure Cheat Sheet (DRAFT) by [deleted]

CMS: Type of Bill Structure

This is a draft cheat sheet. It is a work in progress and is not finished yet.

CMS: Claim Submission Bill Types

CMS Coding for Types of Bills
Source: CMS

Structure and Meaning

First Digit: CMS will ignore the leading zero
Second Digit: Type of Facility (CMS will process as the 1st digit)
1 Hospital
2 Skilled Nursing Facility (SNF)
3 Home Health Agency (HHA includes HH PPS)
4 Religious Non-Me­dical (hosp)
6 Interm­ediate Care Facility (ICF)
7 Clinic or Hospital Based Renal Dialysis
8 Special Facility or Hospital ASC Surgery

Third Digit—Bill Classi­fic­ation (Except Clinic, Special Facili­ties) (CMS will process as the 2nd digit)
1 Inpatient (IP), Part A
2 Inpatient, Part B (Inc HHA, Part B Plan, RAP)
3 Outpatient (OP) (Inc HHA, Part A Plan of treatment)
4 Other, Part B ref diag serv; HH no treatment plan
5 Interm­ediate Care—Level I
6 Interm­ediate Care—Level II
8 Swing Beds
(Clinics Only)
1 Rural Health Clinic
2 Hosp based or Free-s­tanding Renal Dialysis Center
3 Free-s­tanding Clinic (FQHC)
4 Outpatient Rehab Facility (ORF)
5 Comp Outpatient Rehab Facility (CORF)
6 Community Mental Health Center (CMHC)
9 Other

(Special Facilities Only)
1 Hospice (nonho­spi­tal­-based)
2 Hospice (hospi­tal­-based)
3 Ambulatory Surgery Center
4 Free-s­tanding Birthing Center
5 Critical Access Hospital
9 Other

Fourth Digit—­Fre­quency

Fourth Digit—­Fre­quency (CMS will process as the 3rd digit)
A Admiss­ion­/El­ection Notice
B Hospic­e/M­edicare Coordi­nated Care Demons­tra­tio­n/R­eli­gious Nonmedical Health Care Instit­ution
C Hospice Change of Provider Notice
D Hospic­e/M­edicare Coordi­nated Care Demons­tra­tio­n/R­eli­gious Nonmedical Health Care Instit­ution Void/C­ancel
E Hospice Change of Ownership
F Benefi­ciary Initiated Adjustment (FI A/B MAC)
G CWF Initiated Adjustment (FI A/B MAC)
H CMS Initiated Adjustment (FI A/B MAC)
I FI Adjustment (other than QIO or Provider) (FI A/B MAC)
J Initiated Adjustment Other (FI A/B MAC)
K OIG Initiated Adjustment (FI A/B MAC)
M MSP Initiated Adjustment (FI A/B MAC)