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Outpatient Claim Submission Reminders for Facility Providers

May 8, 2010

If you are an institutional provider who submits outpatient claims on paper and/or electronically, please be advised of the following information.

An outpatient HCPCS code is required at the service line level, if applicable, in the following locations:

  • Paper Claims — Form Locator 44 on the UB-04 paper claim form
  • Electronic Claims — Service Line Loop 2400 SV2021 Segment on the ANSI 837I (V4010A1) transaction

You should not use HCPCS codes to report hospital outpatient services at the claim level — UB-04 Form Locator 74 (74a-74e) and ANSI V4010A1 Claim Level Loop 2300 HI Segment. Populating these fields is required only when you submit inpatient claims.

Reminder: The ICD-9-CM procedure codes are specified as the Health Insurance Portability Accountability Act (HIPAA) standard code set for inpatient hospital procedures. ICD-9-CM procedure codes should not be reported on outpatient hospital claims.

Questions regarding this notification?

  • Paper Submitters — Refer to our printable UB-04 User Guide , or contact your assigned provider representative.
  • Electronic Submitters — Contact our Electronic Commerce Center at (800) 746-4616 for assistance.

View 2010 Provider News and Updates