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PAP208

From and To Dates of Service on a CMS 1500


Provider Administrative Policy

Section
Claims Submission
Policy Date
November 2007
Status/Date
Revised/February 2013
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

From and To Dates of Service on a CMS 1500

Hospitalization Dates (Box 18)
When billing consecutive "from" and "to" dates for professional service for hospitalization on a CMS 1500 form, please use the following guidelines:

  • If you supply the "from" date (mm/dd/yyyy) in box 18 without the "to" date (mm/dd/yyyy), Blue Cross of Idaho will return/deny the claim for a corrected bill.
  • If you supply the "to" date (mm/dd/yyyy) without the "from" date (mm/dd/yyyy), Blue Cross of Idaho will return/deny the claim for a corrected bill.

Service Dates (Box 24A) 
When billing dates of service in Box 24A, please complete both the "from" date box (mm/dd/yyyy) and the "to" date box (mm/dd/yyyy) for each date of service.  Please use only one date of service per line.

  • If you only populate the "from" date in box 24A and leave the "to" date blank, Blue Cross of Idaho will return/deny the claim for a corrected bill.

Use box 24G to report units for the same procedure performed multiple times for the same patient on a single date of service.

If you are shipping to the patient, the date of service is the ship date.

Exceptions: Procedure Codes 59425, 59426 and 77427

  1. If you bill procedure codes 59425 or 59426 (antepartum care only, four to six visits or seven or more visits), please put the dates of the first and last visits in box 24A. It is not necessary to bill individual dates of service for these codes since the descriptions include multiple dates. You must include a date of onset (LMP) in box 14 when billing these codes. Submit procedure code 77427 (radiation treatment management, five treatments) with "from" and "to" dates of service and specify one unit in box 24G.
  2. You may combine consecutive dates of service for a single procedure code on one line. The units must match or equal the number of days.

Monthly Services
When billing for ancillary services on a monthly billing cycle, such as oxygen therapy, it is important that you bill the "from" and "to" dates in box 24A as the same date even though you are representing an entire month.  Please use the earliest service date to populate those fields.  For example, bill claims for the month of January with both "from" and "to" dates of 01/01/09-01/01/09 and a unit of one. Please note:  If you submit a claim to Blue Cross of Idaho as a secondary policy, and the "from/through" dates are not billed per Blue Cross of Idaho guidelines, we will change the "from and through" dates to process the claim.

Weekly Services
When billing home IV, services must be billed " from and through" dates for the total episode of care or a maximum of a 7 day span on a single line. This applies to nursing services, therapy drugs, per diems, ancillary charges and any additional services that a home IV provider would bill. For further instruction on home IV billing, please see PAP243.

Daily Services
When billing daily or per diem services such as enteral, home IV, home health or daily DME rentals such as bililights or CPMs, it is important you bill the "from" and "to" dates in box 24 with the date span of services. For example, a claim for a CPM rental of 14 days with both "from" and "to" dates 01/01/09-01/14/09 with 14 units.


Policy History

Date Action Reason
February 2014 Revised Added home IV to last paragraph.
February 2013 Revised Grammatical changes
September 2012 Revised Updated language on weekly services requirements
January 2012 Revised Added language regarding weekly services
June 2011 Revised Added clarification
April 2011 Revised Added corrected bill submission statement
October 2009 Revised Per diem therapies added
July 2009 Revised One date of service line added

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