10/18/2020 100-04 | CMS

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100-04

Publication # 100-04

Title Medicare Claims Processing Manual

Downloads

Chapter 1 - General Billing Requirements (PDF)

Chapter 1 Crosswalk (PDF)
Chapter 2 - Admission and Registration Requirements (PDF)
Chapter 2 Crosswalk (PDF)
Chapter 3 - Inpatient Hospital Billing (PDF)
Chapter 3 Crosswalk (PDF)
Chapter 4 - Part B Hospital (Including Inpatient Hospital Part B and OPPS) (PDF)
Chapter 4 Crosswalk (PDF)
Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services (PDF)
Chapter 5 Crosswalk (PDF)
Chapter 6 - Inpatient Part A Billing and SNF Consolidated Billing (PDF)
Chapter 6 Crosswalk (PDF)
Chapter 7 - SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule) (PDF)
Chapter 7 Crosswalk (PDF)
Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims
(PDF)
Chapter 8 Crosswalk (PDF)
Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers (PDF)
Chapter 9 Crosswalk (PDF)
Chapter 10 - Home Health Agency Billing (PDF)
Chapter 10 Crosswalk (PDF)
Chapter 11 - Processing Hospice Claims (PDF)
Chapter 11 Crosswalk (PDF)
Chapter 12 - Physicians/Nonphysician Practitioners (PDF)
Chapter 12 Crosswalk (PDF)
Chapter 13 - Radiology Services and Other Diagnostic Procedures (PDF)
Chapter 13 Crosswalk (PDF)
Chapter 14 - Ambulatory Surgical Centers (PDF)
Chapter 14 Crosswalk (PDF)
Chapter 15 - Ambulance (PDF)
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912 1/3
10/18/2020 100-04 | CMS

Chapter 15 Crosswalk (PDF)

Chapter 16 - Laboratory Services (PDF)
Chapter 16 Crosswalk (PDF)
Chapter 17 - Drugs and Biologicals (PDF)
Chapter 17 Crosswalk (PDF)
Chapter 18 - Preventive and Screening Services (PDF)
Chapter 18 Crosswalk (PDF)
Chapter 19 - Indian Health Services (PDF)
Chapter 20 - Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
(PDF)
Chapter 20 Crosswalk (PDF)
Chapter 21 - Medicare Summary Notices (PDF)
Chapter 21 - Medicare Summary Notices - English Exhibits (ZIP)
Chapter 21 - Medicare Summary Notices - Spanish Exhibits (ZIP)
Chapter 21 Crosswalk (PDF)
Chapter 22 - Remittance Advice (PDF)
Chapter 22 Crosswalk (PDF)
Chapter 23 - Fee Schedule Administration and Coding Requirements (PDF)
Chapter 23 Crosswalk (PDF)
Chapter 24 - General EDI and EDI Support Requirements, Electronic Claims and Coordination
of Benefits Requirements, Mandatory Electronic Filing of Medicare Claims (PDF)
Chapter 24 Crosswalk (PDF)
Chapter 25 - Completing and Processing the Form CMS-1450 Data Set (PDF)
Chapter 25 Crosswalk (PDF)
Chapter 26 - Completing and Processing Form CMS-1500 Data Set (PDF)
Chapter 26 Crosswalk (PDF)
Chapter 27 - Contractor Instructions for CWF (PDF)
Chapter 28 - Coordination With Medigap, Medicaid, and Other Complementary Insurers (PDF)
Chapter 28 Crosswalk (PDF)
Chapter 29 - Appeals of Claims Decisions (PDF)
Chapter 29 Crosswalk (PDF)
Chapter 30 - Financial Liability Protections (PDF)
Chapter 30 Crosswalk (PDF)
Chapter 31 - ANSI X12N Formats Other Than Claims or Remittance (PDF)
Chapter 31 Crosswalk (PDF)
Chapter 32 - Billing Requirements for Special Services (PDF)
Chapter 33 - Miscellaneous Hold Harmless Provisions (PDF)
Chapter 34 - Reopening and Revision of Claim Determinations and Decisions (PDF)
Chapter 35 - Independent Diagnostic Testing Facility (IDTF) (PDF)
Chapter 36 - Competitive Bidding (PDF)
Chapter 37 - Department of Veterans Affairs (VA) Claims Adjudication Services Project (PDF)
Chapter 38 - Emergency Preparedness Fee-For-Service Guidance (PDF)
Chapter 39 – Opioid Treatment Programs (OTPs) (PDF)
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912 2/3
10/18/2020 100-04 | CMS

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