US · guidance
CMS Pub. 100-04, ch. 20, § 110.1
Billing/Claim Formats
The DME MAC and the A/B MAC (B) are billed on the ASC X12 837 professional claim
format or if permissible Form CMS-1500.
The A/B MAC (A) (including the A/B MAC (HHH)) is billed on the ASC X12 837
institutional claim format or if permissible Form CMS-1450.
Note that the ASC X12 formats support reporting of the CMNs in the FRM segment
The National Council for Prescription Drug Programs (NCPDP) Telecommunications
Standard Version D0 and Batch Standard 1.2 is the HIPAA standard for electronic retail
pharmacy drug claims and related coordination of benefits (COB).
This standard will be used by all DME MACs that process retail pharmacy drug
transactions. All other claims submitted to the DME MAC by pharmacies, other than
retail pharmacy drug claims, must be sent in the ASC X12 837 professional claim format.
History
(Rev. 2993, Effective: ASC X12 - 01-01-12, ICD-10 - Upon Implementation of ICD- 10; Implementation: ASC X12 - 08-25-14, ICD-10 - Upon Implementation of ICD- 10)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
632377ec02147ea6310cf660218b38ee63ef5da5bac4ba5bcbbbba23904f9646
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