Monday, October 25, 2010

how to report inaccurage zip code in CMS 1500

New Zip Codes

New zip codes are considered urban until CMS determines that the zip code is located in a rural area. However, despite the default designation of new zip codes as urban, the carriers have discretion to determine that a new zip code is rural until designated otherwise. If the carrier designates a new zip code as rural, and CMS later changes the designation to urban, then the carrier as well as any supplier paid for mileage or for air services with a rural adjustment will be held harmless for this adjustment.

Reporting Inaccurate Zip Code Information

Suppliers who knowingly and willfully report a surrogate zip code because they do not know the proper zip code may be engaging in abusive and/or potentially fraudulent billing. Furthermore, a supplier that specifies a surrogate rural zip code on a claim when not appropriate to do so, for the purpose of receiving a higher payment than would have been paid otherwise, may be committing abuse and/or potential fraud.

For suppliers submitting claims using the CMS 1500 claim form, the five-digit zip code would be entered in item 23. When reporting claims using the CMS 1491, report the five-digit zip code in item 12. Zip code information may be found at the United States Postal Service website at

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