According to the Technical Report Version 3 (TR-3) for 5010A1 837 claims, a
discharge date is required for inpatient claims when the patient was discharged
from the facility and the discharge date is known. A discharge date is not to
be sent unless required. For Part B physicians/practitioners and suppliers,
the key to this requirement is being able to determine if the services were
'inpatient' by making reference to the Place of Service (POS) code, available
at http://www.CMS.gov/place-of-service-codes/20_Place_of_Service_Code_Set.asp.
Only POS codes 21, 31, 51, and 61 contain either 'inpatient' or 'inpatient
services' in their description.
Currently, Medicare does not maintain an edit for inbound 837 professional
claims to check that 2300 DTP03 (Discharge Date) is only billed when POS 21,
31, 51, and 61 are billed. However, the Coordination of Benefits Contractor
(COBC), which administers the Medicare claims crossover process on behalf of
CMS, does have HIPAA 5010 editing that will activate when physician or
practitioner billing offices include POS codes such as 11 (office), 22
(outpatient), 23 (emergency room), or 81 (independent lab) on Medicare Part B
claims, as these POS codes are clearly not 'inpatient' by definition.
Consequently, many physician/practitioner offices and DME suppliers are
receiving provider notification letters from their servicing A/B MAC, DME MAC,
or carrier that include an H40142 error code and the following description:
"Discharge Date (DTP-01=096) was not expected because this claim is not for
Inpatient Services."
For physician and practitioner offices, including those that bill Medicare via
hardcopy claims, the key to avoiding receipt of the above HIPAA compliance
error, which prevents crossing over of the affected claims, is to only include
a discharge date, when known, if you are billing a Part B claim for services
with POS codes 21, 31, 51, or 61.
DME suppliers are instructed to include a discharge date on incoming claims
when billing HCPCS E0935 (continuous passive motion [CPM] device). For such
claims, the POS is most often 12 (home). To ensure that your DME claims for a
CPM device will properly cross over, DME suppliers should include discharge
date reporting within the 2400 NTE ("notes segment"), not in 2300 DTP03 on
incoming version 5010A1 837 professional claims, when billing their DME MAC
electronically.
CMS continues to pursue opportunities to ensure that front-end and back-end
Medicare HIPAA 5010 compliance editing becomes more closely aligned.
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It's Not too Late to Give and Get the Flu Vaccine. Take advantage of each
office visit and protect your patients against the seasonal flu. Medicare will
continue to pay for the seasonal flu vaccine and its administration for all
Medicare beneficiaries through the entire flu season. The Centers for Disease
Control and Prevention (CDC) also recommends that patients, healthcare workers
and caregivers be vaccinated against the seasonal flu. Protect your patients.
Protect your family. Protect yourself. Get the Flu Vaccine-Not the Flu.
Remember - The flu vaccine plus its administration are covered Part B benefits.
CMS has posted the 2011-2012 seasonal flu vaccine payment limits at
http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp. Note that
the flu vaccine is NOT a Part D-covered drug.
For more information on coverage and billing of the flu vaccine and its
administration, as well as related educational provider resources, visit
http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and
http://www.cms.gov/immunizations.
________________________________
Note: If you have problems accessing any hyperlink in this message, please
copy and paste the URL into your Internet browser.
If you know someone who would like to subscribe to a Medicare Fee-For-Service
(FFS) provider listserv, go to
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If you would like to unsubscribe from a specific provider listserv, please go
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Please DO NOT respond to this email. This email is a service of CMS and routed
through an electronic mail server to communicate Medicare policy and
operational changes and/or updates. Responses to this email are not routed to
CMS personnel. Inquiries may be sent by going to
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