Radiation Oncology Claims Filing Instructions

Completing the CMS 1500 Claim Form

When completing the CMS 1500 claim form for radiation oncology, please note the following:

• For purposes of billing clinical treatment management, be sure to indicate the date the current course of treatment began in Block 14.
• If another disease site has been found and a new course of treatment is begun, a new course of treatment date should be listed in Block 14.
• Be sure to indicate the name of the referring or ordering physician in Block 17. If known, place the referring physician's HMSA provider number in Block 17a.
• Use Block 19 to indicate the number of fractions being billed per week (see example).
• Bill each week's treatment on a separate line.

For an example of a correctly completed CMS 1500 claim form, click here [PDF].

Completing an EMC claim

When completing an EMC claim please note the following:

• Be sure to indicate the date the current course of treatment began in the Diagnosis (IX) record. For purposes of billing clinical treatment management, use the date that the course of treatment began. If another disease site has been found, a new course of treatment date should be listed.
• Be sure to indicate the name of the referring or ordering physician in the Clinic/Date Processing Reference (H3) record. If known, also include the referring physician's HMSA provider number.
• Use the Complaint/Cause of Injury (IN) record and information narrative field to indicate the range of dates and the number of fractions being billed per week (see example below).

Example

5 fractions, 2/23 - 2/27/98; 5 fractions, 3/2 - 3/6/98; 3 fractions, 3/9 - 3/11/98

Revision History