ZIP Code Required for MPFSDB Claims
Jurisdiction, and therefore reimbursement, for any service paid
under the Medicare Physician Fee Schedule Database (MPFSDB) is based
on the location where the service was performed. This is a provision
of Section 1848(B)(1) of the Social Security Act, which established
Physician Payment Reform (PPR), and is described in section 14-3-3101
of the Medicare Carriers Manual. In order for Medicare carriers
to monitor compliance with this provision, claims will be processed
according to the ZIP code representing the location where the service
was performed.
Claims for services paid under the MPFSDB must include the correct
two-digit state code and five-digit ZIP code for the physical location
of the service. Claims already contain this information for service
rendered either in the patient's home (place of service 12) or in
the office (place of service 11), if the address for the office
is the same as for the provider number reported in item 33 of the
claim form (CMS-1500). If the service was not rendered in the patient's
home or at the office address for the provider number in item 33,
the facility name, address, city, state, and ZIP code for the location
of service must be reported in item 32 of the CMS-1500. See page
47 of the May 2002 Communiqué for a table of
the relevant electronic claim specifications.
Since the billing requirements do not allow for ZIP codes to be
line item specific, and only one zip code is allowed per claim,
providers must prepare a separate claim for each ZIP code in which
services were furnished.
The format for a ZIP code is five-digit numeric (the four-digit
extension is not allowed).
Electronic billers may need to contact their software support. For
additional information regarding electronic error report, pre-pass
editing, or other Electronic Data Interchange issues, please call
us at 877-567-7261. For Minnesota EDI issues, please call one of
the following numbers: 952-885-2882, 952-885-2881, or 952-885-2811.
Page Last Updated: Tuesday, 04-Dec-2007 13:19:17 CST
