Accept assignment – Field 27 of cms 1500

Check the appropriate block to indicate whether the provider of service or supplier accepts assignment of Medicare benefits. If Medigap is indicated in item 9 and Medigap payment
authorization is given in item 13, the provider of service or supplier shall also be a Medicare
participating provider of service or supplier and must accept assignment of Medicare
benefits for all covered charges for all patients.

The following providers of service/suppliers and claims can only be paid on
assignment basis:

• Clinical diagnostic laboratory services;
• Physician services to individuals dually entitled to Medicare and Medicaid;
• Participating physician/supplier services;
• Services of physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives,
certified registered nurse anesthetists, clinical psychologists, and clinical social workers;
• Ambulatory surgical center services for covered ASC procedures;
• Home dialysis supplies and equipment paid under Method II;
• Ambulance services;
• Drugs and biologicals and
• Simplified billing roster for influenza virus vaccine and pneumococcal vaccine