Mastering CMS 1500 Form Field 32: Service Facility Location & Billing Rules Explained

Navigating the CMS 1500 claim form can be complex, especially when it comes to ensuring accurate billing. One crucial section that often requires careful attention is box 32 CMS 1500, officially known as ‘Service Facility Location Information’. This field is vital for specifying where medical services were rendered, impacting everything from payment processing to compliance. This comprehensive guide will walk you through the precise requirements for completing Field 32 on the CMS 1500 form, covering general guidelines, specific rules for facilities, diagnostic tests, foreign claims, durable medical equipment, and more, helping you achieve accurate and efficient billing.

General Guidelines for Completing CMS 1500 Box 32

Field 32 on the CMS 1500 form is designated for ‘Service Facility Location Information’. It requires the name, address, and ZIP Code of the facility where services were furnished, particularly if these services took place in a setting other than the patient’s home (place of service 12) or the physician’s office. These guidelines became effective for claims received on or after April 1, 2004, and remain current for accurate billing today.

Important Note on the Carrier Block: While this article focuses on Field 32 for ‘Service Facility Location Information’, it’s important not to confuse it with the ‘carrier block’ (also known as the top-right block where payer information is entered). Field 32 specifically details where the service was provided, not who is paying for it.

Key points for Field 32 submission:

• Single Entry Per Claim: Only one name, address, and ZIP Code may be entered in Field 32 per claim form. If services involved multiple distinct service locations that require separate identification in Box 32, separate CMS 1500 claim forms must be submitted.
• Required Information: Always include the facility’s full name, street address, and 5-digit ZIP Code.
• Example: If a service was performed at ‘Community Hospital Lab, 123 Main Street, Anytown, CA 90210’, this full address must be entered in Box 32.

Billing for Purchased Diagnostic Tests in Box 32

When billing for diagnostic tests that were purchased from another entity, providers (such as physicians) must identify the supplier’s information in Field 32.

Specific requirements include:

• Supplier’s Information: Enter the name, address, and ZIP Code of the supplier from whom the diagnostic test was purchased.
• Multiple Suppliers: If diagnostic tests were purchased from more than one supplier, a separate CMS 1500 form must be submitted for each individual supplier.
• Example: If Dr. Smith purchases a specialized lab test from ‘Advanced Diagnostics, 456 Oak Avenue, Metropolis, NY 10001’, then ‘Advanced Diagnostics, 456 Oak Avenue, Metropolis, NY 10001’ should appear in Field 32 on the claim for that test.

Foreign Claims and CMS 1500 Field 32

For services rendered outside the United States, only the enrollee (patient) can file for Medicare Part B benefits. These foreign claims will inherently not include a valid U.S. ZIP Code in Field 32.

Key considerations for foreign claims:

• Beneficiary Submission: Foreign claims are typically submitted by the beneficiary using Form CMS-1490S. Before processing, these claims are identified as foreign.
• ZIP Code Exemption: Carriers processing foreign claims are instructed to make accommodations to prevent the claim from being returned as unprocessable due to the absence of a U.S. ZIP Code. Refer to official CMS guidance for foreign claim disposition for detailed instructions.

Durable Medical Equipment, Orthotic, and Prosthetic Claims (DMEPOS)

For Durable Medical Equipment (DME), orthotic, and prosthetic claims, Field 32 requires specific information regarding the supplier. This applies to claims processed by a Durable Medical Equipment Regional Carrier (DMERC).

Requirements for DMEPOS claims in Box 32:

• Order Acceptance Location: The name and address of the location where the order for the DME, orthotic, or prosthetic item was accepted must be entered.
• Mandatory Field: This field is always required for DMEPOS claims.
• Multiple Suppliers: If more than one supplier is involved, a separate CMS 1500 form must be used for each supplier.
• Service Location Irrelevance: This item must be completed regardless of whether the supplier’s personnel performed work at a physician’s office or another location.
• Example: If ‘Mobility Solutions Inc.’ at ‘789 Business Park Drive, Cityville, TX 77001’ accepted the order for a wheelchair, this information is entered in Field 32.

Billing for Services in HPSA and PSA Locations

If a modifier is used on the claim to indicate that the service was rendered in a Health Professional Shortage Area (HPSA) or a Physician Scarcity Area (PSA), then Field 32 must accurately reflect the physical location where that service was performed, provided it was not the patient’s home.

• Example: If a physician provides a service with a HPSA modifier at ‘Rural Health Clinic, 10 Main Street, Smalltown, GA 30303’, then ‘Rural Health Clinic, 10 Main Street, Smalltown, GA 30303’ must be entered in Field 32.

Mammography Screening Centers and Box 32

For services provided by a certified mammography screening center, Field 32 requires a specific identification number.

• FDA Certification Number: Enter the 6-digit FDA-approved certification number of the mammography screening center.
• Example: If a mammography center’s FDA certification number is ‘123456’, this number is entered in Field 32.

Laboratory Work Performed Outside a Physician’s Office

Field 32 must be completed for all laboratory work performed outside of a physician’s office, indicating the exact location where the test was conducted.

• Independent Laboratory Billing: If an independent laboratory is billing for services, enter the full name, address, and ZIP Code of the facility where the test was performed.
• Example: For a blood test processed by ‘Community Lab Services, 555 Lab Lane, Health City, FL 33101’, that address must be in Field 32.

Frequently Asked Questions About CMS 1500 Box 32

• What to enter in Box 32 of CMS 1500?
  Enter the name, address, and ZIP Code of the facility where the service was rendered if it was a hospital, clinic, laboratory, or any facility other than the patient’s home or physician’s office. For specific scenarios like purchased diagnostic tests or DMEPOS, further details (e.g., supplier’s information, order acceptance location) are required.
• Field 32 CMS 1500 for diagnostic tests?
  For purchased diagnostic tests, enter the name, address, and ZIP Code of the entity that supplied the diagnostic test. If multiple suppliers were used, submit a separate CMS 1500 form for each supplier.
• Is Field 32 always required on the CMS 1500 form?
  Field 32 is required when services are furnished in a hospital, clinic, laboratory, or any facility other than the patient’s home or physician’s office. It is also mandatory for Durable Medical Equipment (DME), orthotic, and prosthetic claims, among other specific scenarios.
• Can I put multiple addresses in Box 32?
  No, only one name, address, and ZIP Code may be entered in Field 32 on a single CMS 1500 form. If services were provided at multiple distinct locations requiring separate identification in Field 32, separate claim forms must be submitted.
• What is the purpose of Field 32?
  Field 32 serves to identify the specific physical location where medical services were rendered. This information is crucial for proper claim adjudication, compliance, and to ensure that services are billed appropriately based on the service facility.