CMS Medicare Claims Processing Manual

On February 10, 2009, in Documents, by AQ-IQ LLC

Links to all Chapters and Crosswalks.

The Internet-only Manuals (IOMs) are a replica of the Agency’s official record copy. They are CMS’ program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. The CMS program components, providers, contractors, Medicare Advantage organizations and state survey agencies use the IOMs to administer CMS programs.

Use the links below for direct access to these PDF files:

Chapter 1 – General Billing Requirements [PDF, 1 MB]
Chapter 1 Crosswalk [PDF, 458 KB]

Chapter 2 – Admission and Registration Requirements
Chapter 2 Crosswalk [PDF, 355 KB]

Chapter 3 – Inpatient Hospital Billing [PDF, 4 MB]
Chapter 3 Crosswalk [PDF, 376 KB]

Chapter 4 – Part B Hospital (Including Inpatient Hospital Part B and OPPS) [PDF, 941 KB]
Chapter 4 Crosswalk [PDF, 353 KB]

Chapter 5 – Part B Outpatient Rehabilitation and CORF/OPT Services [PDF, 337 KB]
Chapter 5 Crosswalk [PDF, 120 KB]

Chapter 6 – SNF Inpatient Part A Billing [PDF, 493 KB]
Chapter 6 Crosswalk [PDF, 177 KB]

Chapter 7 – SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule) [PDF, 875 KB]
Chapter 7 Crosswalk [PDF, 98 KB]

Chapter 8 – Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims [PDF, 858 KB]
Chapter 8 Crosswalk [PDF, 333 KB]

Chapter 9 – Rural Health Clinics/Federally Qualified Health Centers [PDF, 260 KB]
Chapter 9 Crosswalk [PDF, 198 KB]

Chapter 10 – Home Health Agency Billing [PDF, 286 KB]
Chapter 10 Crosswalk [PDF, 203 KB]

Chapter 11 – Processing Hospice Claims [PDF, 320 KB]
Chapter 11 Crosswalk [PDF, 104 KB]

Chapter 12 – Physicians/Nonphysician Practitioners [PDF, 391 KB]
Chapter 12 Crosswalk [PDF, 314 KB]

Chapter 13 – Radiology Services and Other Diagnostic Procedures [PDF, 158 KB]
Chapter 13 Crosswalk [PDF, 217 KB]

Chapter 14 – Ambulatory Surgical Centers [PDF, 120 KB]
Chapter 14 Crosswalk [PDF, 134 KB]

Chapter 15 – Ambulance [PDF, 452 KB]
Chapter 15 Crosswalk [PDF, 81 KB]

Chapter 16 – Laboratory Services [PDF, 450 KB]
Chapter 16 Crosswalk [PDF, 144 KB]

Chapter 17 – Drugs and Biologicals [PDF, 641 KB]
Chapter 17 Crosswalk [PDF, 118 KB]

Chapter 18 – Preventive and Screening Services [PDF, 961 KB]
Chapter 18 Crosswalk [PDF, 192 KB]

Chapter 19 – Indian Health Services [PDF, 230 KB]

Chapter 20 – Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) [PDF, 748 KB]
Chapter 20 Crosswalk [PDF, 256 KB]

Chapter 21 – Medicare Summary Notices [PDF, 8 MB]
Chapter 21 – Medicare Summary Notices – English Exhibits [ZIP, 2MB]
Chapter 21 – Medicare Summary Notices – Spanish Exhibits [ZIP, 1MB]
Chapter 21 Crosswalk [PDF, 427 KB]

Chapter 22 – Remittance Advice [PDF, 121 KB]
Chapter 22 Crosswalk [PDF, 89 KB]

Chapter 23 – Fee Schedule Administration and Coding Requirements [PDF, 1 MB]
Chapter 23 Crosswalk [PDF, 219 KB]

Chapter 24 – General EDI and EDI Support Requirements, Electronic Claims and Coordination of Benefits Requirements, Mandatory Electronic Filing of Medicare Claims [PDF, 674 KB]
Chapter 24 Crosswalk [PDF, 160 KB]

Chapter 25 – Completing and Processing the Form CMS-1450 Data Set [PDF, 867 KB]
Chapter 25 Crosswalk [PDF, 165 KB]

Chapter 26 – Completing and Processing Form CMS-1500 Data Set [PDF, 596 KB]
Chapter 26 Crosswalk [PDF, 46 KB]

Chapter 27 – Contractor Instructions for CWF [PDF, 459 KB]
Chapter 27 Crosswalk [PDF, 170 KB]

Chapter 28 – Coordination With Medigap, Medicaid, and Other Complementary Insurers [PDF, 619 KB]
Chapter 28 Crosswalk [PDF, 147 KB]

Chapter 29 – Appeals of Claims Decisions [PDF, 840 KB]
Chapter 29 Crosswalk [PDF, 104 KB]

Chapter 30 – Financial Liability Protections [PDF, 1,006 KB]
Chapter 30 Crosswalk [PDF, 228 KB]

Chapter 31 – ANSI X12N Formats Other Than Claims or Remittance [PDF, 83 KB]
Chapter 31 Crosswalk [PDF, 83 KB]

Chapter 32 – Billing Requirements for Special Services [PDF, 1 MB]

Chapter 33 – Miscellaneous Hold Harmless Provisions [PDF, 78 KB]

Chapter 34 – Reopening and Revision of Claim Determinations and Decisions [PDF, 99 KB]

Chapter 35 – Independent Diagnostic Testing Facility (IDTF) [PDF, 50 KB]

Chapter 36 – Competitive Bidding [PDF, 240 KB]

Chapter 37 – Department of Veterans Affairs (VA) Claims Adjudication Services Project [PDF, 42 KB]

Chapter 38 – Emergency Preparedness Fee-For-Service Guidance [PDF, 53KB]

 

Link to all CMS IOMs

 

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