HIPAA
HIPAA mandates that all electronic transactions include only HIPAA-compliant codes; therefore, NIA requires the use of HIPAA-compliant codes on all claims. If a claim is found to contain a non-compliant code, it will be rejected and returned to you for correction before processing.
Professional Services (claims submitted primarily on CMS-1500)
Diagnosis: Use current ICD-9-CM codes for diagnosis on claim submissions (Box 21). Codes are updated annually and become effective on October 1st of each year. Procedure Codes: Use current CPT® (HCPCS Level 1) codes to bill for professional services (Box 24d). CPT® codes are updated annually and become effective on January 1st of each year.
Place of Service: Use current Place of Service Codes (Box 24b).
Facility/Program Services (submitted primarily on UB-04)
Use the current HIPAA-compliant codes (USL) (163K PDF) when billing for facility or program services:
- Use ICD-9-CM codes (for diagnosis)
- Revenue codes
- Type of Bill Codes
- CPT® codes for (professional services)
- HCPCS Level II National Codes and Modifiers (effective January 1, 2005)
Facility providers must submit a license level modifier for the rendering provider.
Where Do I Find the Code Sets?
CPT® codes are copyrighted by the AMA and must be obtained through that organization.
ICD-9-CM manuals may be ordered from the AMA by calling 800-621-8335, or from Channel Publishing at 800-248-2882. A CD-ROM of the complete listing can be ordered from the United States Government Printing Office at: US Government Printing Office, PO Box 371954, Pittsburgh, PA 15250-7594 or call the Ordering Office at 866-512-1800.
Note: All code sets are reviewed and subject to modification annually, so it is important to have the most current version of these codes for billing purposes.
Additional HIPAA-compliant codes may be available as they are assigned by industry code-set owners and will be communicated to providers through this Web site.
NIA will monitor the use of industry standard codes and provide feedback via Explanation of Payments (EOPs).