National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

Institutional Value Code Changes

Note: This article was revised on July 24, 2007, to add clarifying language regarding the use of value codes on adjustments. (See paragraph 3 of the Background section.) All other information remains the same.  

Provider Types Affected
Providers who bill fiscal intermediaries (FI), Part A/B Medicare Administrative Contractors (A/B MAC), or regional home health intermediaries (RHHI) for Medicare services  

What You Need to Know
Value codes A1, A2, A7, B1, B2, B7, C1, C2, and C7 are now restricted to use only in paper claims, and are no longer available for use on X12N 837 institutional claim transactions.  

Background
The National Uniform Billing Committee (NUBC) has restricted the use of value codes A1, A2, A7, B1, B2, B7, C1, C2, and C7 to paper claims only. These value codes are no longer available for use on X12N 837 institutional claim transactions

Your Medicare FI, RHHI, or A/B MAC will create edits to restrict the use of these value codes to paper claims, and to not allow their use on direct data entry claims. Further, Medicare will ensure that any paper claim data from value codes A1, A2, A7, B1, B2, B7, C1, C2, or C7 are migrated to the appropriate X12N 837 2320 Claim Level Adjustment (CAS) segment (claim adjustment reason code “PR”) for coordination of benefits files.

Note that CR5411 does not say that adjustments that might previously be reported on an electronic claim using the value codes A1, A2, A7, B1, B2, B7, C1, C2, or C7 must now all be reported in the claim level CAS. Requirements already in the 837-I Implementation Guide that apply to reporting of adjustments in either the claim or the service level CASs apply when submitting initial electronic claims that involve such adjustments.  

Additional Information
You can find the official instruction, CR 5411, issued to your FI, A/B MAC, or RHHI by visiting http://www.cms.hhs.gov/Transmittals/downloads/R261OTN.pdf on the CMS Web site

If you have any questions, please contact your FI, RHHI, or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM5411 Revised
Related Change Request (CR) #: 5411
Related CR Release Date: January 19, 2007
Effective Date: July 1, 2007
Related CR Transmittal #: R261OTN
Implementation Date: July 2, 2007