US · guidance
CMS Pub. 100-04, ch. 1, § 70.2.3
In Accordance with CMS Instructions
The CMS instructions for submitting institutional claims to Medicare are contained in
this manual. General instructions that reflect guidance on reporting institutional claim
data are found in Chapter 25. These instructions apply to all institutional claim types,
whether paper or electronic. Additional chapters in this manual supplement these general
instructions. For example, see instructions for inpatient hospital billing in Chapter 3, or
inpatient skilled nursing billing in Chapter 6. General information about billing for
physician and other supplier services and about the CMS 1500 claim form can be found
in Chapter 26, Completing and Processing Form CMS-1500 Data Set, as well as chapters
throughout this manual relative to specific policies and topics. For example see Chapter
12, Physicians/Nonphysician Practitioners, Chapter 13, Radiology Services and Other
Diagnostic Services, or Chapter 16, Laboratory Services for detailed instructions for
specific services.
In order to constitute a Medicare claim, services submitted for payment must be
submitted to the appropriate Medicare contractor (§70.2.1), in a proper claim format
(§70.2.2), and in accordance with these CMS claim completion instructions. Services
submitted for payment in a manner not complete and consistent according to these
instructions will not be accepted into Medicare’s electronic claims processing system and
will not be considered filed for purposes of determining timely filing.
History
(Rev. 3086, Issued: 10-03-14, Effective: ICD-10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD- 10; ASC X12: November 4, 2014)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7cd492d5510c50937aab1c4f206e11a8f5bdb2842c445ae29c7894288292e52c
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