BC Advantage - 2007 Issue 7

Nine-Digit ZIP Codes Required for Some MPFS and Anesthesia Service Payments

Medicare carriers and Fiscal Intermediaries (FIs) use the ZIP code on the claim where the service was performed to determine the payment locality for services paid under the Medicare Physician Fee Schedule (MPFS) and anesthesia services.Unfortunately, some 5-digit ZIP codes fall into more than one payment locality, crossing county and sometimes state lines. In order to correct this, effective October 1, 2007, CMS will require the submission of 9-digit ZIP codes to carriers and FIs for MPFS and anesthesia services from providers in those problem 5-digit ZIP codes. Services provided in Place of Service (POS) "Home" and for...

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