Federal tax id number and accept assignment field on CMS 1500
Billing instruction for Ambulance Billing – Box 24h to 27
| BlockNo. | Block Name | Block Code | Notes |
| 24h | EPSDT/Family Planning | A | Enter the 2-digit visit code, if applicable. Visit codes are especially important if providing services that do not require copay (i.e., for a pregnant recipient or long term care resident.) For a complete listing and description of Attachment Type Codes, please refer to the CMS- 1500 Claim Form Desk Reference, located in Appendix A of the handbook. Note: When billing for mileage, it is not necessary to enter a visit code, as the Department does not assess a copayment on mileage charges. |
| 24i | ID Qualifier | A | Enter the two-digit ID Qualifier: 1D = 13-digit Provider ID Number (legacy #) |
| 24j (a) | Rendering Provider ID # | A | Complete with the Rendering Provider’s Provider ID number (nine-digit provider number and the applicable four-digit service location – 13-digits total). Note: Only one rendering provider per claim form. |
| 24j (b) | NPI | A | Enter the 10-digit NPI number of the rendering provider. |
| 25 | Federal Tax I.D. Number | M | Enter the provider’s Federal Tax Employer Identification Number (EIN) or SSN and place an X in the appropriate block. |
| 26 | Patient’s Account Number | O | Use of this block is strongly recommended. It can contain up to 10 alpha, numeric, or alphanumeric characters and can be used to enter the patient’s account number or name. Information in this block will appear in the first column of the Detail Page in the RA Statement and will help identify claims if an incorrect recipient number is listed. |
| 27 | Accept Assignment? | LB | Do not complete this block. |