044-51 Wyo. Code R. § 51-4

Current through April 27, 2019

Section 51-4 - Requirements for Use of HCFA Form 1500

(a) Health care practitioners shall use the HCFA Form 1500 and instructions provided by HCFA for use of the HCFA Form 1500 when filing claims with issuers for professional services. Health care practitioners that bill patients directly shall provide a properly completed HCFA Form 1500 in addition to any other explanatory information used to bill the patient when requested by the patient.

(b) Issuers may only require health care practitioners to use the following coding system and/or descriptors for the initial filing of claims for health care services:

(i) HCPCS Codes;

(ii) ICD-CM Codes;

(iii) In the case of Workers' Compensation, specific body part and other information used for the coding of charges; and

(iv) NDC codes for pharmaceuticals supplied by physicians and home health agency.

(c) Issuers may only require health care practitioners to use other explanations with a code or to furnish additional information with the initial submission of a HCFA Form 1500 under the following circumstances:

(i) When the procedure code used describes a treatment or service that is not otherwise classified; or

(ii) When the procedure code is followed by a CPT modifier. Health care practitioners may use item 19 of the HCFA Form 1500 to explain multiple modifiers, unless item 19 is used for other purposes in accordance with the instructions for this form.

(d) Health care practitioners may use item 19 of the HCFA Form 1500 to indicate the form is an amended version of a form previously submitted to the issuer by inserting the word "amended" in the space provided.

(e) Health care practitioners billing for services based on the amount of time involved shall define on line 19 the time interval in Item 24 G of the HCFA Form 1500, if the time interval is not already defined by the HCPCS code. If not defined by either HCPCS or in line 19, units will be assumed to be days of treatment.

(f) Health care practitioners shall provide the unique physician identification number, as assigned by HCFA, in box 17a and the federal tax identification number or social security number to complete Item 25 of the HCFA Form 1500, as required by the HCFA instructions.

044-51 Wyo. Code R. § 51-4

Amended, Eff. 7/13/2017.