MLN Matters Number: MM5970                                            Related Change Request (CR) #: 5970
Related CR Release Date: March 21, 2008                               Effective Date: April 21, 2008
Related CR Transmittal #: R1480CP                                        Implementation Date: April 21, 2008

Web Site for Additions and Deletions of ZIP Codes Requiring a Plus-Four ZIP Code Extension

Provider Types Affected
Physicians, providers, and other health care providers submitting claims to Medicare fiscal intermediaries (FI), carriers, Part A/B Medicare Administrative Contractors (A/B MAC) or regional home health intermediaries (RHHI) for services paid under the Medicare Physician Fee Schedule (MPFS) and for anesthesia services

Provider Action Needed
Impact to You
The ZIP code where services are rendered determines the payment locality for services paid under the MPFS and for anesthesia services. Certain ZIP codes fall into more than one payment locality and require a plus four ZIP code extension to ensure proper payment. (See the MLN Matters article at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5208.pdf on the Centers for Medicare & Medicaid Services (CMS) Web site for further details regarding ZIP code reporting.)

What You Need to Know
The CMS will begin posting additions and deletions to the list of ZIP codes that require a plus-four ZIP code extension on their Web site. A complete list of all ZIP codes requiring a plus four ZIP code extension will also be posted.

What You Need to Do
Make certain your billing staffs are aware of these resources for checking plus four ZIP code extension requirements.

Key Points of CR5970

• To access a file containing the quarterly additions and deletions to the list of ZIP Codes requiring a plus-four extension refer to http://www.cms.hhs.gov/prospmedicarefeesvcpmtgen/01_overview.asp on the CMS Web site. The file is named “ZIP Code Changes” and can be found in the Downloads section of this Web page.
• To access a file containing all ZIP Codes requiring a plus four extension, refer to http://www.cms.hhs.gov/prospmedicarefeesvcpmtgen/01_overview.asp on the CMS Web site. The file is named “ZIP Codes Requiring +4 Ext” and can be found in the Downloads section of this Web page.
• Upon release of a new quarterly update, the previous quarter’s additions and deletions are incorporated into the file name “ZIP Codes Requiring +4 Ext” file and are not included in the “ZIP Code Changes” file.

Additional Information
To see the official instruction (CR5970) issued to your Medicare FI, carrier, A/B MAC or RHHI refer to http://www.cms.hhs.gov/Transmittals/downloads/R1480CP.pdf on the CMS Web site.

If you have questions, please contact your Medicare FI, carrier, A/B MAC or RHHI at their toll-free number which may be found at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web 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. CPT only copyright 2007 American Medical Association.

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Posted: 03/31/2008