Billing office visit copay in cms 1500
Billing for Office Visit Co-Pays
To submit a claim for an office visit co-pay the following fields need to be completed:
• Field 24D – Enter the procedure code for the office visit
• Field 24F – Enter the amount of the co-pay
• Field 28 – Enter the amount of the co-pay
• Field 29 – Leave blank
A copy of the TPL voucher must be included. On the voucher, indicate the column that shows the co-pay or patient responsibility amount.
Providers who bill electronically would follow the same procedures by completing the Procedure Code and Billed Amount fields. In the Other Insurance Reason Code field, fill in the appropriate code for co-pay billing.