AMA Clinical Examples in Radiology - 2008 Bulletin 2
Indicate Purchased Diagnostic Services on Your Claims
Indicate Purchased Diagnostic Services on Your Claims The Centers for Medicare & Medicaid Services (CMS) provided instruction to carriers on how to process claims for diagnostic services when there is no indication of whether the diagnostic services were purchased on claims submitted to CMS. The instruction indicates that if there is no indicator on the claim forms, the service will not be considered a purchased service. A "Yes/No" indicator in Block 20 of the Form CMS-1500 or PS1 segment on the electronic claim form must be used to indicate that the service was purchased. Note: This policy applies only...
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Article Overview
This article covers CMS instructions for reporting purchased diagnostic services on claims, with emphasis on the claim form indicator used for those services and the scope of the policy. It is relevant to billing staff, coders, and compliance personnel who work with diagnostic service claims and Medicare claim submission requirements. The article also notes the claim types and administrative context in which the guidance applies.
Why This Topic Matters
Accurate claim reporting helps reduce unprocessable claims and supports compliance with CMS billing requirements for purchased diagnostic services.
What You Will Learn
- How CMS addresses purchased diagnostic services on claims
- Where the purchased-service indicator is reported on claim forms
- Which claim types are affected by the policy
- Why the guidance matters for claim processing and compliance
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle personnel
- Compliance staff
- Radiology practices
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