Claim submission guidelines
Outpatient Prospective Payment System (OPPS) addendums updates A, B, D1, and E
Review to find quarterly updates related to OPPS and I/OCE and review accessing the addendums* listed below.
Automated process for multiple PTAN matches to single NPI will reduce claim processing delays: Part B
For Part B providers with multiple billing PTANs linked to a single NPI, learn about our automated process to match the most appropriate PTAN to your NPI.
Process for supplying invoice amount on certain HCPCS codes - avoid rejected claims
The drug codes list and radiopharmaceutical codes lists have been updated.
Process for pathology, laboratory, and other codes
Avoid negative impacts to your claims by providing the medical records for the laboratory, pathology and other codes claims submissions indicated in this article. First Coast requests specific…
Hospital off-campus outpatient department reporting requirements
Effective July 6, 2026, outpatient claims with type of bills (TOB) 13X or 14X will be returned to provider (RTP) for reason code 34554 if modifier ER, PO, or PN is billed on all service lines, and…
Correct date of service for specific services
Physicians and non-physician practitioners need to identify the correct date of service for the services they provide to a Medicare patient. This article will discuss some of the situations where…
Appropriate use of not otherwise classified codes when billing drugs and biologicals
Correct coding requires the most specific code available describing a service to be reported. Not otherwise classified (NOC) codes must only be used when a more specific HCPCS or CPT code is not…
Appropriate use of not otherwise classified codes
Correct coding requires the most specific code available describing a service to be reported. Not otherwise classified (NOC) codes must only be used when a more specific HCPCS or CPT code is not…
Drugs and biologicals Part B: Using the JW and JZ modifiers
The JW and JZ modifier policy applies to all drugs separately payable under Medicare Part B described as supplied in a “single-dose” containers. Read this article to understand how these modifiers…