Claims


How Do I File Part B Claims to Medicare?

  • File Electronically: Most providers submit electronic ANSI 837P claims
    • Before filing claims electronically to Medicare, you must have an EDI enrollment packet on file with Palmetto GBA. See our Electronic Data Interchange (EDI) resources for more information on enrolling for electronic claim submissions.
    • View the Electronic Filing Instructions
    • Palmetto GBA Interactive CMS-1500 Claim Form Instructions — This resource can also be helpful to providers who submit electronic claims. The help files for each CMS-1500 claim form field include the corresponding ANSI ASC 837P v5010 Loop, Segment, and Element, when applicable.
  • File via Paper: Some providers that meet exceptions to mandatory electronic billing are allowed to submit CMS-1500 paper claim forms.
  • File an eClaim: eServices users also have the ability to submit paperless eClaims through the portal
Claims must be filed to the appropriate MAC no later than 12 months, one calendar year, from the date of service. Timely filing is determined by the date a processable claim is received by the appropriate MAC. Claims that are rejected as unprocessable are not considered submitted claims for the purposes of determining timely filing. Rejected claims must be corrected and resubmitted no later than 12 months from the date of service. Medicare will deny claims received after the deadline date. 

For more information on timely filing including the limited exceptions to the 12-month timely filing period, see IOM Pub. 100-04, Chapter 1 (PDF, 1.62 MB), Section 70 - Time Limitations for Filing Part A and Part B Claims.

For information on submitting a request for a timely filing extension, see Checklist for Timely Filing Extension.

The Advanced Communication Engine (ACE) Is Really SMART!

If you submit claims via the Electronic Data Interchange (EDI) option, our ACE tool will return pre-adjudicated Part B claims information through a claim acknowledgement transaction report, called a Medicare 277CA report. Submitters will receive the Medicare 277CA report with ACE smart edits if a claim is identified as containing a potential claim submission error that requires the submitters attention.

Smart Edits generate rejection alerts that provide submitters with granular messaging or educational awareness related to billing issues identified with their claim submission. The ACE tool affords you the opportunity to correct your billing issues prior to the claim being adjudicated in the claims processing system, allowing for more efficient and accurate claims processing.




HCPCS Modifier NCPT Modifier 80HCPCS Modifier QLHCPCS Modifier T4HCPCS Modifier MDHCPCS Modifier UNHCPCS Modifier E3CPT Modifier 24CPT Modifier 81CPT Modifier 82HCPCS Modifier FXHCPCS Modifier GEHCPCS Modifier T3HCPCS Modifier UHCPCS Modifier MEHCPCS Modifier EJHCPCS Modifier DACPT Modifier 50HCPCS Modifier FYHCPCS Modifier MDCPT Modifier 66HCPCS Modifier JWHCPCS Modifier WHCPCS Modifier F7HCPCS Modifier CTHCPCS Modifier ATHCPCS Modifier F9HCPCS Modifier QQHCPCS Modifier LRHCPCS Modifier Q1HCPCS Modifier GPCPT Modifier 91HCPCS Modifier MAHCPCS Modifier XECPT Modifier 26HCPCS Modifier FCHCPCS Modifier USHCPCS Modifier FAHCPCS Modifier SCHCPCS Modifier QXHCPCS Modifier AQHCPCS Modifier CBHCPCS Modifier QDHCPCS Modifier PHCPCS Modifier G7HCPCS Modifier MGHCPCS Modifier T2Modifier Lookup: Your Resource for Correct Claim SubmissionHCPCS Modifier LSHCPCS Modifier GQHCPCS Modifier T6HCPCS Modifier ETCPT Modifier 63CPT Modifier 47HCPCS Modifier T5CPT Modifier 76HCPCS Modifier LTHCPCS Modifier Q8HCPCS Modifier G8CPT Modifier 3PHCPCS Modifier E2HCPCS Modifier Q0HCPCS Modifier JDHCPCS Modifier V6HCPCS Modifier AFHCPCS Modifier EBHCPCS Modifier GVCPT Modifier 8PHCPCS Modifier YOHCPCS Modifier GBHCPCS Modifier CMHCPCS Modifier GOHCPCS Modifier RHCPCS Modifier GJCPT Modifier 57HCPCS Modifier MFHCPCS Modifier QPHCPCS Modifier BOHCPCS Modifier T8HCPCS Modifier LDHCPCS Modifier F4HCPCS Modifier TCHCPCS Modifier CSHCPCS Modifier AKHCPCS Modifier HCPT Modifier 52HCPCS Modifier CHHCPCS Modifier T7HCPCS Modifier V7HCPCS Modifier AAHCPCS Modifier RRHCPCS Modifier CIHCPCS Modifier UEHCPCS Modifier CHCPCS Modifier Q4HCPCS Modifier AYHCPCS Modifier T1HCPCS Modifier RAHCPCS Modifier QJHCPCS Modifier F8HCPCS Modifier BAHCPCS Modifier IHCPCS Modifier FBHCPCS Modifier QTHCPCS Modifier F5HCPCS Modifier ASCPT Modifier 73HCPCS Modifier F3HCPCS Modifier CQHCPCS Modifier QSHCPCS Modifier AEHCPCS Modifier URHCPCS Modifier MCHCPCS Modifier SHCPCS Modifier T9HCPCS Modifier OHCPCS Modifier AGHCPCS Modifier G0HCPCS Modifier RCHCPCS Modifier TSHCPCS Modifier DHCPCS Modifier XCPT Modifier 74HCPCS Modifier E4HCPCS Modifier F2HCPCS Modifier Q9HCPCS Modifier REHCPCS Modifier CNHCPCS Modifier QCHCPCS Modifier F1HCPCS Modifier Q7HCPCS Modifier VPHCPCS Modifier CGHCPCS Modifier QZHCPCS Modifier E1HCPCS Modifier GGHCPCS Modifier UQHCPCS Modifier KZHCPCS Modifier QWHCPCS Modifier LCCPT Modifier 2PHCPCS Modifier RTHCPCS Modifier FHCPCS Modifier XUCPT Modifier 59HCPCS Modifier JACPT Modifier 23HCPCS Modifier JBCPT Modifier 90HCPCS Modifier GWHCPCS Modifier TAHCPCS Modifier BLHCPCS Modifier QYHCPCS Modifier EHCPCS Modifier GNHCPCS Modifier F6HCPCS Modifier JCHCPCS Modifier GHCPCS Modifier Q5HCPCS Modifier RIHCPCS Modifier NUHCPCS Modifier G9CPT Modifier 51HCPCS Modifier GUHCPCS Modifier SGHCPCS Modifier QKHCPCS Modifier UPHCPCS Modifier Q3HCPCS Modifier MHHCPCS Modifier EYHCPCS Modifier MBHCPCS Modifier GMHCPCS Modifier LMCPT Modifier 77HCPCS Modifier APHCPCS Modifier ADHCPCS Modifier SWHCPCS Modifier COHCPCS Modifier GCHCPCS Modifier GSHCPCS Modifier GHCPT Modifier 53HCPCS Modifier JElectronic Claim Required: DenialsLipid Panels: Medical Necessity DenialsDiagnostic Cardiology Services: Medical Necessity DenialsHot or Cold Packs: Bundling DenialsCode/Modifier Combination Invalid and Modifier Invalid/MissingCLIA: Laboratory TestsE/M Service: Duplicate DenialsSkilled Nursing Facility: Not Covered by This Payer (Consolidated Billing Denials)Chiropractic Manipulative Treatment DenialsEKG, EKG Rhythm Strip and Cardiac Echography: NCCI Bundling DenialsNCCI Bundling DenialsSubmitted to Incorrect Program: 'Jurisdiction' DenialsHospice: Non-Attending Physician DenialsEye Refraction: Statutory DenialsChest X-ray or EKG: Duplicate DenialsGlycosylated Hemoglobin A1C: Medical Necessity DenialsVenipuncture: Statutory DenialsNPI: Troubleshooting RejectionsE/M Services: CCI Bundling DenialsCLIA Certification Number RequiredVenipuncture: Not Covered by This Payer (Facility Setting)Provider Certification DenialsE/M Service: Global Surgery DenialsDuplicate Denials: Compliance MattersAnesthesia Services: Bundling DenialsUnlisted Supplies: Bundling DenialsX-Rays: Denied for ChiropractorsClinical Laboratory Procedures: Duplicate DenialsEstablished Patient Office Visits: NCCI Bundling DenialsReason Code CO-96: Non-covered ChargesRESOLVED: Jurisdiction J Part B Provider Payments DelayedNew Medicare Beneficiary Identifier (MBI) Get It, Use ItMedicare Beneficiary Identifier (MBI) Required Starting January 1, 2020Medicare Beneficiary Identifier (MBI) ReminderMedicare Beneficiary Identifier (MBI) Lookup ToolTop Reasons for Claim Denials and RejectionsRoutine Physical Exams: Statutory DenialsCARC 22CARC 18CARC 109CMS MLN Fact Sheet: Medical Record Maintenance and Access RequirementsMSP: Eligibility & DenialsMedicare Payments DelayedCPT Modifier 78CPT Modifier 58CPT Modifier 79CPT Modifier 25Checklist for Timely Filing ExtensionAffinity: HCPCS Code Q4159 Requires InvoiceCARC 181HCPCS Modifier Q6HCPCS Modifier EAHCPCS Modifier ECHCPCS Modifier PAHCPCS Modifier PBHCPCS Modifier PCHCPCS Modifier CRHCPCS Modifier GAHCPCS Modifier GXHCPCS Modifier PIHCPCS Modifier PSCPT Modifier 62HCPCS Modifier PTHCPCS Modifier AZHCPCS Modifier AIHCPCS Modifier GYHCPCS Modifier GZHCPCS Modifier CKHCPCS Modifier CLHCPCS Modifier AHHCPCS Modifier AJHCPCS Modifier XSHCPCS Modifier PDHCPCS Modifier CJHCPCS Modifier XPHCPCS Modifier FSCARC 50New Year: Identify Beneficiary Insurance Changes For 2022CPT Modifier 54CPT Modifier 55CPT Modifier 1PRESOLVED: Continuous Peripheral Nerve Block (CPNB) DenialsPhysical & Occupational Therapy and Speech Language Pathology Caps: Financial Limitation DenialsApril 2022 Release Dark Days for the Common Working File (CWF) HostsSave Time and a Phone call - Check Your Claim Status and DetailsRESOLVED: Quarterly NCCI Procedure-to-Procedure Edit Replacement FilesOPEN: Update to CMS Ambulance Rural ZIP Code FileCPT Modifier 22CPT Modifier 33HCPCS Modifier FTRESOLVED: Incorrect Coinsurance Percentage Applied for Drugs and BiologicalsHCPCS Modifier KXOPEN: Certain Amniotic Fluid and Placental Tissue Claims to Be Reopened and ReviewedOPEN: Medicare Improperly Paid Physicians for Spinal Facet-Joint Denervation SessionsRESOLVED: MCS Data Center Claim Data PurgeRESOLVED: Revised April 2022 Ambulatory Surgical Center (ASC) Drug File

Last Updated: 02/25/2021