Use of 9-Digit ZIP codes for Determining the Correct Payment

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Gavin Walker
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Use of 9-Digit ZIP codes for Determining the Correct Payment

Post by Gavin Walker » Mon Aug 27, 2007 9:37 pm

According to the CMS website:

Effective October 1, 2007 providers will have to include the full nine-digit ZIP code for services paid under the Medicare Physician Fee for Service program and anesthesia services when those services are provided in a ZIP code area that crosses payment localities.

We believe this will be significant for many of our customers.

We encourage you to use nine-digit zip codes when necessary.
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

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Gavin Walker
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Post by Gavin Walker » Thu Sep 27, 2007 10:11 am

What You Need to Do
Make sure that if you provide services paid by carriers under the Medicare Physicain Fee Schedule (MPFS) or anesthesia services in a payment locality whose ZIP code matches the defined CMS codes with effective dates of service on or after October 1, 2007, you must include the nine-digit ZIP code on the claim.

If this affects you, make sure that your Provider File Master Address has a valid nine-digit address. If a valid nine-digit ZIP code is not on the file, submit a CMS-855A, the Medicare Enrollment Application, with a valid nine-digit ZIP code.

Additional Information
You can find more information about the use of nine-digit ZIP codes for determining the correct payment locality for anesthesia services and services paid under the (MPFS) by going to CR5208.
You might also want to look at updated Medicare Claims Processing Manual, Publication 100-04, Chapter 1 (General Billing Requirements), Section 10.1.1 (Payment Jurisdiction among Local Carriers for Services Paid Under the Physician Fee Schedule and Anesthesia Services) which you will find as an attachment to this CR.
If you have any questions, please contact your carrier at their toll-free number, which may be found at the CMS web site.
Last edited by Gavin Walker on Fri Mar 28, 2008 4:25 pm, edited 1 time in total.

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Gavin Walker
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Post by Gavin Walker » Fri Mar 28, 2008 4:24 pm

CMS will begin posting additions and deletions to the list of ZIP codes that require a plus four ZIP code extension on their website. A complete list of all ZIP codes requiring a plus four ZIP code extension will also be posted. Make certain you are aware of these resources for checking plus four ZIP code extension requirements.

You can get more information from CMS here.

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