Skip to Main Content
 
 
 
Web Content Viewer

Web Content Viewer

Part A ICD-10 Claims Submission Alternatives

For FROM dates of service (on professional and supplier claims)  or dates of discharge/through dates (on institutional claims) on or after 10/1/2015, entities covered under the HIPAA are required to use the International Classification of Diseases, 10th Edition (ICD-10) code sets adopted under HIPAA.

If you will not be able to complete the necessary systems changes to submit claims with ICD-10 codes by 10/1/2015, or find that you are unable to submit claims on or after 10/1/2015, due to issues with your billing software, vendor or clearinghouse, the following claims submission alternatives are available.

Please note that these claims submission alternatives REQUIRE THE USE OF ICD-10 code sets for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after 10/1/2015. 

Free Billing Software

You may download the free billing software that CMS offers via our website in the Electronic Data Interchange Software section. The software has been updated to support ICD-10 codes and requires a Network Service Vendor in order to transmit claims. The software download is free, but there may be fees associated with submitting claims through the Network Service Vendor. Information about Network Service Vendors is available in the Network Service Vendors section on our website. 

This billing software only works for submitting Fee-for-Service claims to Medicare. It is intended to provide submitters with an ICD-10 compliant claims submission format; it does not provide coding assistance.

Please note that submitting electronic claims to Medicare using the free billing software does not change the requirement for ICD-10 compliant claims to be submitted for FROM dates of service (on professional claims)  or dates of discharge/through dates (on institutional claims) on or after 10/1/2015. Any claims containing ICD-9 codes for FROM dates of service (on professional claims) or dates of discharge/through dates (on institutional claims) on or after 10/1/2015, will be rejected by Medicare.

Direct Data Entry

Providers that bill institutional claims are also permitted to submit claims electronically via DDE screens. For more information about DDE, go to the Enroll in FISS/DDE section on our website.  

Please submit a request to submit claims via DDE by 9/1/2015 to ensure access by 10/1/2015.

Please note that claims submitted via DDE must contain ICD-10 codes for dates of discharge/through dates on or after 10/1/2015.  Those submitted containing ICD-9 codes for dates of discharge/through dates on or after 10/1/2015, will be RTP.

Paper Claims

In limited situations, you may submit paper claims with ICD-10 codes to Medicare. To find more information on when you may submit paper claims, visit http://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/ASCAWaiver.html on the CMS website. Please note that to submit paper claims, a provider must meet the requirements to qualify for a waiver of the ASCA provisions.

Practitioners (physicians and non-physicians) and suppliers use Form CMS-1500 to bill MACs and DME MACs. You can order Form CMS-1500 from printing companies, office supply stores, and the U.S. GPO, U.S. Government Bookstore. U.S. Government Bookstore orders can be placed by calling 866-512-1800 or visiting http://bookstore.gpo.gov/agency/346 on the GPO website.

Institutional providers use Form CMS-1450, also known as the UB-04, to bill MACs. You can order UB-04 claim forms from the NUBC at http://www.nubc.org on the NUBC website.

Also see the ASCA Requirements for Paper Claim Submissions section on our website for more information about submitting paper claims.

Please note that submitting paper claims to Medicare, even if approved for an ASCA waiver, does not change the requirement for ICD-10 compliant claims to be submitted for FROM dates of service (on professional and supplier claims)  or dates of discharge/through dates (on institutional claims) on or after 10/1/2015. Any paper claims containing ICD-9 codes for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after 10/1/2015 will be returned as unprocessable by Medicare.

Please submit a request for an ASCA waiver by 8/17/2015 to ensure a response by 10/1/2015.

If you have questions, please contact the Provider Contact Center. The correct phone number for your state can be found in the Contact Us: Provider Contact Center section on our website.

Part A ICD-10 Claims Submission Alternatives
Web Content Viewer
Complementary Content