Update to Medicare Claims Processing Manual, Chapters 1, 23 and 35

MM10882 – Implementation Date: March 9, 2020

Global Billing Global billing is acceptable when both the TC and PC are performed by the same entity and both the TC and the PC are furnished within the same MPFS payment locality. The TC and PC may be furnished in different locations as long as they are furnished within the same MPFS, payment locality. If the global diagnostic test code is billed, providers should report the name, address and National Provider Identifier (NPI) of the location where the TC was furnished in Items 32 and 32a (or the 837P electronic claim equivalent). See the “Medicare Claims Processing Manual”, Chapter 1, Sections 80.3.2.1.2 and 80.3.2.1.3 for more information regarding what is required in Items 32 and 32a.

Separate TC/PC Billing When the TC and PC are billed separately (not billed globally), providers should report the name, address and NPI of the location where each component was performed. If the billing provider has an enrolled practice location at the address where the service was performed, the billing provider/supplier may report their own name, address and NPI in Items 32 and 32a (or the 837P electronic claim equivalent). If the PC was performed at an unusual or infrequently used location, the location of the provider’s or supplier’s closest Medicare-enrolled practice location may be used in Item 32. The NPI in Item 32a must correspond to the entity identified in Item 32 (no matter if it is the group, hospital, the Independent Diagnostic Testing Facility, or the individual physician. The only exception for Medicare claims is when a service is performed out of jurisdiction and is subject to the anti-markup or a reference lab service. See “Medicare Claims Processing Manual”, Chapter 1,Section 30.2.9 and Chapter 16, Section 40.1 for instructions specific to antimarkup and reference lab, respectively.

Source: https://www.cms.gov/files/document/mm10882