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CMS 1500 Provider Manual and Bulletins


CMS 1500 Provider Manual

CMS-1500 Provider Manual Updated
To search for specific information within the PDF document, select Ctrl F on your keyboard and type your keyword in the find box.


Important Policy Changes/Additions

2015 Manual Updates

3/13/15  Updated CLIA Tables in Chapter 10, updated HPV Section

2/19/15  Updated Retention of Records Section 3.8.2, updated Chapter 9 Wyoming HIPAA 5010 Electronic Specifications, updated Benefit Plan Guide

1/28/15 V4  Upated Benefit Plan Guide Appendix

1/26/15 V3  Updated Community Mental Health Center and Susstance Abuse Treatment Center Tables, updated Speech Therapy Billing Code Table to include Code 92610, updated Invoice Charges Section  6.7.1

1/17/15  V2 Added Cod 64570 to Vagus Nerve Stimulation code range

1//1/15  V1  Last Manual from 2014

2014 Manual Updates

12/10/14 Updated Code Range in Section 10.15.9 Synvisc Injections

11/14/14  Updated Telehealth Section in Chapter 6, updated Community Mental Health and Substance Abuse Treament Center taxonomy coding table in Chapter 6.

10/14/14 Added Psychiatry and Physician to the types of groups that PLAT, MSW, PCSW, and PMFT can be enrolled under.

10/01/14 Added information to required documentation for Physical Therapists Section; changed taxonomy and modifiers for Code T2011 Section 10.9.4 and 10.10.7; created new PASSR Level II Billing Code Table Section

9/15/14 Added Contact Lense fitting code for Keratoconus Section

9/01/14 Removed Incentive Payment Section 10.15.9

8/15/14 Updated Cap Limit Waiver Form., Prior Authorization Request Form, and updated Genetic Testing section to include OB/GYN.

7/15/14 Updated Ambulance Basic Life Support Section

7/02/14 Updated procedure code range for Genetic Testing Section 10.14.2

07/01/14 Updated ASC Section 10.6, updated Mental Health Section 10.15.18

06/01/14 Updated covered codes under Section 10.16.5 Pregnant by Choice Covered Codes

05/14/14 Replaced old CMS 1500 claim form and examples with new form throughout the manual

Effective Dates of Service: January 1, 2013 to December 31, 2014
Physician Attestation is a requirement of the ACA to receive supplemental payments; as such Wyoming Medicaid is providing a self-attestation form for the Wyoming Medicaid primary care physicians to print and complete by September 30, 2013 to be retroactive to January 1, 2013.

PCP Attestation Information/Form

This Physician Attestation will be replacing the current Incentive Payment Program for the years 2013 and 2014.



CMS 1500 Provider Bulletins

2015 Provider Bulletins

PERM Provider Education 5.18.15
Provider Workshops - Summer 2015
Electronic Billing Mandate 4.2.15
Re-Enrollment Deadline Approaching 4.1.15
Phototherapy Services 2.20.15

2014 Provider Bulletins

Change to Emergency Indicator 12.18.14
PCP Attestation Ending 12.1.14
Re-Enrollment Reminder Email 10.10.14
New ICD-10 Webiste RA Banner 10.8.14
Reprocessing Claims for PA Units 9.16.14
Independent Enrollment of Licensed Mental Health Professionals 6.27.14
New CMS-1500 Claim Form Reminder 6.23.14
Ambulatory Surgical Center's Reimbursement Methodology
2014 Provider Attestation Rate Change
CMS Claim Form Bulletin 5.14.14
Changes to TC and 26 Modifier Reimbursement
On-line/Web Re-enrollment 5.1.14
Updated CLIA Information
Newborn Baby Information
Wyoming Medicaid ICD-10 Information
New CMS-1500-Claim Form Bulletin 3.12.14
Sample CMS-1500 (2-12) Form
PCP Attestation Rate Table 2014
PCP Attestation Rate Table 2013
UpdatedGenetic Testing Codes Require PA Effective 1.1.14
2nd  Qtr 2014 Health Check Newsletter


2013 Provider Bulletins

V2020 Reimbursement Change 12.6.13
DMEPOS Codes E1399 and K0108 12.2.13
Medicaid and Kid Care Application Changes 9.10.13
PDAP Oxygen Termination 7.1.13
Obstertric Rate Change Email
90863 Mental Health code Requiring Adjustments 6.21.13
Obstetric Rate Changes RA Banner 6.21.13
Changes to Obstertric Rates 6.19.13
New Obstetric Rates for 22 Obstetric Procedure Codes 6.19.13
Change in 90460 Reimbursement Rate
Depo Code Change
Immunization State Letter
Medicaid Co-pay Prior Authorization and Vision Policy Changes Plus 2012 Summary of Changes
PB 2011-01 Medicare and TPL 1-5-11 (v2)
Recovery Audit Contractor Information and Training Opportunities 5.10.13
Reimbursement Change on Contact Lenses
Wyoming Medicaid Fraud/Program Integrity Information


Additional Links

Medicaid and State Healthcare Benefit Plans: Provides client benefit plan names, descriptions, eligibility limitations, coverage types and coverage limitations. This information is useful when determining if a client is eligible for services.

NDC Crosswalk : Provides a listing of the drug related procedure codes requiring an NDC. The listing provides the NDC, HCPCS (J codes), HCPCS and NDC descriptions, effective dates, end dates, and if applicable for Medicare crossovers only.

Carrier Code List: List of Insurance Carrier Codes and Names