If you are an institutional provider who submits outpatient claims on paper and/or electronically, please be advised of the following information:
An outpatient HCPCS procedure code is required at the service line level, if applicable, in the following locations:
- Paper claims — On the UB-04 paper claim form, enter the HCPCS code in Form Locator 44.
- Electronic claims — On the ANSI 837I (V4010A1) transaction, include the Qualifier "HC" in Service Line Loop 2400, Segment SV202-1; and include the HCPCS procedure code in Segment SV202-2.
To help avoid claim processing delays, you should not use HCPCS codes to report hospital outpatient services at the claim level — UB-04 Form Locator 74 (74a-74e) and ANSI 837I V4010A1 Claim Level Loop 2300 HI Segment. Populating these fields is required only when you submit inpatient claims.
Reminder: The ICD-9-CM procedure codes are specified as the Health Insurance Portability Accountability Act (HIPAA) standard code set for inpatient hospital procedures. ICD-9-CM procedure codes should not be reported on outpatient hospital claims.
Questions regarding this notification?
- Paper submitters — Refer to our Claim Form - Educational Resource or contact your Facility Provider Network office.
- Electronic submitters — Email our Electronic Commerce Center for assistance.