Claim Forms: Billing Items & Modifier Codes - Box 24
The Billing Items section includes the following information that populates into Box 24 on the CMS 1500 claim form:
- Date of Service (Last Session, Custom Date, Today, Date Range)
- Procedure (CPT) Codes
- Units
- Fee (per unit)
- Modifier Codes
- Diagnostic Pointer selection
The CMS 1500 form can only accommodate 6 billing items. If more than 6 billing items are added to the form, only the first 6 will transmit to the form or to the Clearinghouse.
NEW as of 3/29/24: Date Range for Date(s) of Service in a CMS 1500
In a standard, print CMS 1500 you can have a Date(s) of Service range for a Procedure Code. In order to better accommodate Organizations who have bundled weekly case rates, and need the ability to have a Date Range applied to each Procedure Code, we have added the ability to add a Date Range for Date(s) of Service in CMS 1500s.
In order to select a Date Range for your Date(s) of Service, select "Date Range" within the "Date of Service" dropdown menu. You will then see the following view.
CPT Codes (Box 24D)
CPT codes are the shortened form of Current Procedural Technology. CPT codes show what treatment you provided for your client. They include every type of service or procedure (tests, evaluations, etc.). The CPT codes that you include on your Superbill or CMS 1500 claim are the services your client could be reimbursed for.
If there is a billable CPT Code for your profession that is not listed in our directory, email hello@gethealthie.com to request that we add your code.
Note: Providers can add a CPT code with a modifier, but it will not be able to be billed. To have the code billed on the CMS1500, you'll have to use the standard CPT code and add the modifier on the CMS 1500 itself.
If you are unsure of what CPT codes to use in practice, please review our helpful resources for general guidance.
Units (Box 24G)
When billing insurance, units translate to the duration of time for a service. Typically, 1 unit represents 15 minutes (although some CPT codes are based on a different unit of time).
Example: 60 minute session = 4 units (15 minutes each).
If you've been reimbursed a very small amount for a claim, one of the first things you'll want to do is check how many units you included on the claim. You can learn how to correct a claim here.
If you are unsure of how many units to use in practice, please review our helpful resources for general guidance.
Fee (Box 24F)
The fee is your cost per unit.
If you charge $130 for a 60 minute consultation, this will translate to 4 units, at $32.50 per unit (4 x $32.50 = $130). Healthie will automatically calculate the total cost for the service and populate it into Box 24F - Charges. You may want to review the claim before submitting to ensure that you've entered the number of units and fee correctly.
While this is the amount you may be charging for the session, this may not be the amount that you are reimbursed. If you are contracted with insurance, you will only be reimbursed at your contracted rate.
If you are unsure of what fee to use in practice, please review our helpful resources for general guidance.
Modifier Codes (Box 24 D)
A modifier is a 2-digit code that enables a provider to indicate that a service or procedure has been performed has been altered by some specific circumstance but has not changed in its definition or code (ie. commonly telehealth services).
Common modifier codes:
- GQ – Asynchronous Telecommunications systems, such as a pre-recorded video
- GT – Interactive Audio and Video Telecommunications systems, including a live video conferencing session
- G0 – Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
- 95 – Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications system
Different insurance payers may require a specific combination of place of service codes and modifier codes, to properly reimburse for services. Please contact the insurer you're in-network with directly to learn if/when to use a modifier code.
If you are unsure of what modifier code(s) to use in practice, please review our helpful resources for general guidance.
Diagnostic Pointers
You can learn more about diagnosis codes and diagnostic pointers here.
Need more help?
If you're new to insurance billing or Superbills, you'll find a wealth of helpful information here.