The lactation support services benefit program is administered by the Colorado Department of Health Care Policy & Financing (the Department). This billing manual provides information regarding coverage, policy and billing requirements. The information in this manual is subject to change as the Department periodically modifies the lactation support services program’s benefits and services. The manual will be updated as new policies are implemented.
Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for general information about Health First Colorado (Colorado’s Medicaid program). The General Provider Information Manual provides information about billing Health First Colorado, reimbursement policies, provider participation, eligibility requirements and other useful information.
- Program Overview
- Provider Qualifications and Enrollment
- Supervision Requirement
- Billing Information
- Covered Lactation Support Services
- Coding Table for Lactation Support Services
- Reporting Units of Service
- Recommendation for Lactation Support Services
- Documentation Requirements
- Physical Health Managed Care
- Inpatient Hospital and Freestanding Birth Center Services
- Place of Service Codes
- Contact Information
- CMS 1500 Paper Claim Reference Table
- Timely Filing
- Lactation Support Services Revision Log
Return to Billing Manuals Web Page
Program Overview
On December 1, 2024, the Colorado Department of Health Care Policy and Financing (the Department) implemented a lactation support services benefit for Health First Colorado members. This program is based on legislation HB22-1289.
Rules and Regulations
The lactation support services benefit program is administered by the Department. Rules governing the program are outlined in the Code of Colorado Regulations 10 C.C.R. 2505-10 8.732.7. Providers are required to comply with all rules and guidance provided by the Department and are encouraged to contact the Department’s policy specialists with any questions at HCPF_MaternalChildHealth@state.co.us. Updates to policy and guidance will be published in this manual. Providers will be given notice of updates through the Department’s monthly Provider Bulletin.
This program gives people access to lactation support services, including training and counseling the breastfeeding (or lactating) member about breastfeeding and human lactation. It provides comprehensive, skilled care and evidence-based information for breastfeeding and human lactation.
To be eligible for the program, a member must meet the following criteria:
- Be eligible for Health First Colorado
- Be a pregnant, postpartum or pediatric member who is breastfeeding
Provider Qualifications and Enrollment
Providers must be enrolled as Health First Colorado providers to:
- Treat a Health First Colorado member
- Submit claims for payment to Health First Colorado
Visit the Provider Enrollment web page if interested in becoming a Health First Colorado provider.
Eligible Rendering Providers
Lactation support services may only be provided by enrolled individual providers with training in advanced lactation support. Providers may not bill for services provided by un-enrolled providers, such as supervised interns or persons undergoing training to become a CLE, CLC, or IBCLC.
The following enrolled provider types (PT) may provide lactation support services if it is within their scope of practice according to state licensing requirements and laws and the provider has training in advanced lactation support:
- International Board-Certified Lactation Consultant (IBCLC) – PT 70
- Certified Lactation Counselor (CLC) - PT 71
- Certified Lactation Educator (CLE) - PT 71
- Certified Professional Midwife (CPM)/Direct Entry Midwife (DEM) - PT 69
- Certified Midwife (CM) - PT 80
- Certified Nurse Midwife (CNM) - PT 22
- Licensed Physician (MD) – PT 05
- Licensed Osteopath (DO) - PT 26
- Licensed Physician Assistant (PA) – PT 39
- Licensed Advanced Practice Nurse (APN) – PT 41
- Licensed Registered Nurse (RN) – PT 24 (enrolled as a Non-Physician Practitioner-Individual)
Eligible Billing Providers
Group Provider Types
The only group provider types that may bill for lactation support services are:
- Federally Qualified Health Center (PT32)
- Rural Health Clinic (PT45)
- Indian Health Services (PT61)
- Clinic (PT 16)
- Non-physician Practitioner Group (PT 25)
- Lactation/Doula Professional Group (PT 72)
Federally Qualified Health Centers and Rural Health Clinics (PT 32 and 45)
Refer to the Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) billing manual for details regarding billing lactation support services in an FQHC/RHC setting. Lactation support services provided by an employee at an FQHC/RHC site are billed as part of the encounter rate for the FQHC/RHC and may result in a payment when delivered by a provider included in the FQHC/RHC visit definition (10 CCR 8.700 & 8.740). Lactation support services are not billed separately on professional claim forms (CMS 1500). Lactation support services provided by an employee at an FQHC/RHC site that are not included in the FQHC/RHC visit definition should be included in the FQHC/RHC cost report.
Lactation support service providers who provide lactation support services at a FQHC or RHC but are not employed by the FQHC/RHC can bill for services separately on a professional claim form (CMS 1500) and use the applicable Place of Service codes. These claims are reimbursed at the Health First Colorado Fee Schedule rate.
Indian Health Services (PT 61)
Refer to the Indian Health Services (IHS) billing manual for details regarding billing lactation support services in an outpatient setting. Lactation support services provided at an IHS site are billed per encounter as part of the all-inclusive rate. They are not billed separately on professional claim forms (CMS 1500).
Back to Top
Clinics and Non-Physician Practitioner Groups (PT 16 and 25)
When claims are submitted using Clinics and Non-Physician Practitioner Groups as the billing provider, the rendering provider’s National Provider Identifier (NPI) listed on the claim must be the individual provider who rendered the service. The rendering provider must be formally affiliated with the group in order for the claim to be processed.
Lactation/Doula Professional Groups (PT 72)
When claims are submitted using the Lactation/Doula Professional Group as the billing provider, the rendering provider’s National Provider Identifier (NPI) listed on the claim must be the individual provider who rendered the service. The rendering provider must be formally affiliated with the group in order for the claim to be processed.
A Lactation/Doula Professional Group consists of any of the following professionals who are enrolled with the Department as approved providers:
- International Board-Certified Lactation Consultant (IBCLC) – PT 70
- Certified Lactation Counselor – PT 71
- Certified Lactation Educator – PT 71
- Doula – PT 79
This billing provider type must have at least one IBCLC or Doula affiliated with the group.
Individual Billing Providers
Individual providers may choose to be their own billing provider for lactation support services. The following list of providers can have billing status when enrolling with Health First Colorado:
- International Board-Certified Lactation Consultant (IBCLC) – PT 70
- Certified Midwife (CM) – PT 80
- Certified Nurse Midwife (CNM) – PT 22
- Licensed Physician (MD) – PT 05
- Licensed Osteopath (DO) - PT 26
- Licensed Advanced Practice Nurse (APN) – PT 41
Supervision Requirements
International Board-Certified Lactation Consultants (IBCLCs) with current certification by the International Board of Lactation Consultant Examiners (IBLCE) may provide lactation support services without supervision.
Certified Lactation Counselors (CLCs) with current certification by the Academy of Lactation Policy and Practice, Inc. (ALPP) and Certified Lactation Educators (CLEs) with current certification by the Childbirth and Postpartum Professional Association (CAPPA) may only provide lactation support services under the general supervision of enrolled:
- Physicians (MDs) PT 05/65
- Osteopaths (DOs) PT 26
- Physician Assistants (PAs) PT 39
- Advanced Practice Nurses (APNs) - PT 41
- Certified Nurse Midwives (CNMs) – PT 22
- International-Board Certified Lactation Consultants (IBCLCs) – PT 70
A Certified Lactation Counselor (CLC)/Certified Lactation Educator (CLE) may render services but does not bill directly. Claims must be submitted through the enrolled group. Claims must identify the CLC/CLE with their National Provider Identifier (NPI) number as the rendering provider.
Billing Information
Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for general information.
Covered Lactation Support Services
Lactation support services are billed using a single Healthcare Common Procedure Coding System (HCPCS) procedure code (S9443), one of two modifier codes indicating individual (U1) or group settings (U2) and an additional modifier code if services are delivered via telemedicine (FQ, FR, 93, 95), as shown in the tables below.
Prior authorization requests are not required. There are no amount, duration or scope limitations for the lactation support services benefit.
Appropriate diagnosis codes must be utilized when billing for lactation support services (e.g., Z39.1: encounter for care and examination of a lactating mother).
Services for the lactating member and child must be billed on one claim under the lactating member's identification number. Providers may not submit two separate claims for both the lactating member and child for services. If the lactating member is not eligible for benefits, lactation support services may be billed under the pediatric member who is breastfeeding under the following conditions:
- The breastfeeding child is eligible for benefits
- The breastfeeding child has their own Health First Colorado identification number
A lactation support provider who renders services to more than one member at a time must bill appropriately using the approved group session modifier U2. The group session must be an instructor-led breastfeeding education group. A claim for payment may be submitted for each enrolled Health First Colorado member that received services in the group session. Such claims must be coded using S9443 with the U2 modifier.
Coding Table for Lactation Support Services
| Procedure Code | Description | Modifier |
|---|---|---|
| S9443 | Lactation Support Services 1 unit of service = 15 minutes of direct member contact services provided. Instructions for rounding increments are found below.
Telemedicine service delivery is allowed. | U1 = individual session
U2 = group session |
Important Notes on S9443
Although the formal definition of HCPCS procedure code S9443 is “Lactation classes, non-physician provider, per session,” the Department instructs providers to use this procedure code under the direction detailed in this billing manual. Key differences are:
- The Department considers this procedure code’s unit of service to be “per 15 minutes” rather than “per session.”
- This procedure code should be reported for lactation support services by any eligible provider, including physicians, rather than just “non-physicians.”
| Modifier Codes for Telemedicine Service Delivery for S9443 | Description |
|---|---|
| FQ | The service was furnished using audio-only communication technology. |
| FR | The supervising practitioner was present through two-way audio/video communication technology. |
| 93 | Synchronous telemedicine service was rendered via telephone or other real-time interactive audio-only telecommunications system. |
| 95 | Synchronous telemedicine service was rendered via real-time interactive audio and video telecommunications system. |
Reporting Units of Service
Providers should not bill for services performed for less than 8 minutes when only one service is provided in a day. Providers should bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes. Providers should bill 2 units if the duration of a single modality or procedure in a day is greater than or equal to 23 minutes through and including 37 minutes. Time intervals for 1 through 8 units are as follows:
| Billed Units Increment | Time Spent in Direct Patient Contact |
|---|---|
| 1 unit of service | 8 minutes through 22 minutes |
| 2 units of service | 23 minutes through 37 minutes |
| 3 units of service | 38 minutes through 52 minutes |
| 4 units of service | 53 minutes through 67 minutes |
| 5 units of service | 68 minutes through 82 minutes |
| 6 units of service | 83 minutes through 97 minutes |
| 7 units of service | 98 minutes through 112 minutes |
| 8 units of service | 113 minutes through 127 minutes |
This pattern remains the same for treatment times in excess of 2 hours.
Example: A member received a total of 120 minutes of lactation support services using HCPCS code S9443, which is defined in 15-minute units, on a given date of service. The provider should report 8 units of code S9443.
Recommendation for Lactation Support Services
Lactation support services are provided as preventative services and require an electronic or written recommendation by a physician or other licensed practitioner of the healing arts acting within their scope of practice in accordance with 42 CFR 440.130(c).
- The lactating individual-child dyad requires a recommendation on file from a physician or other licensed practitioner of the healing arts. This recommendation authorizes lactation support services from pregnancy through the duration of breastfeeding.
- Providers must maintain the record of a licensed provider’s recommendation for each member before initiating lactation care, storing the record in a manner consistent with HIPAA requirements. All claims for lactation support services must have the National Provider Identifier (NPI) number of the enrolled provider who ordered the items to be indicated on the claim in the appropriate Ordering, Prescribing and Referring (OPR) field on the claim. The enrolled provider types who may recommend these services are:
- Physicians (PT 05/65)
- Osteopaths (PT 26)
- Physician Assistants (PT 39)
- Advanced Practice Nurses (PT 41)
- Nurse Midwives (PT 22)
- The recommending provider indicated on the claim must be actively enrolled with Health First Colorado (42 CFR 455.410(b)). The claim will be denied if the indicated provider is not actively enrolled. Reference the Ordering, Prescribing, and Referring Claim Project Identifier for further details.
- If a licensed provider listed in this manual renders a service under their own ordering authority, then that rendering physician’s NPI number should be placed in the applicable OPR field on the claim. This does not apply to providers enrolled as IBCLC, CLC and CLEs.
OPR Field on Professional Claims
- Paper claims use field 17.b
- Electronic submissions use loop 2420 with qualifier DK (Ordering), DN (Referring) or DQ (Supervising)
- Claims submitted through the Provider Web Portal use the “Referring Provider” field
Documentation Requirements
The provider must maintain documentation in accordance with 10 CCR 2505-10 8.130.2 that complies with state and federal regulations. The provider must retain records that specifically record the dates and precise times at which direct services provided to a member began and ended, among other general requirements for documentation. These timestamps are critical for validating the number of units of service that are billed.
Physical Health Managed Care
Lactation support services are not included in Health First Colorado physical health managed care plans. Lactation support services are still covered benefits for members enrolled in those plans as “wrap-around” benefits of the plan.
All claims for lactation support services should be billed to the Department’s Fiscal Agent, Gainwell Technologies, even if the member is attributed to a Health First Colorado physical health managed care plan.
Inpatient Hospital and Freestanding Birth Center Services
Professional services provided by a lactation support services provider associated with newborn deliveries and immediate postnatal breastfeeding support care for the lactating individual are part of the hospital’s facility All Patient Refined-Diagnosis Related Group (APR-DRG) payment and the Freestanding Birth Center’s delivery payment. Such circumstances are not eligible for billing through the Lactation Support Services benefit. Place of Service codes 21 (Inpatient Hospital) and 25 (Freestanding Birth Center) are not available for billing use. HCPCS codes for lactation support services cannot be billed for dates on or during the date span of the delivery and inpatient stay. Refer to the Obstetrical Care Billing Manual.
Place of Service Coding
Providers may provide lactation support services in a variety of settings, including the member’s home, clinics, provider offices or via telehealth. The visit setting should be indicated on the claim using the Place of Service code. A full list of allowable places of service for lactation support services is indicated below.
Lactation support services can be provided via telemedicine with Place of Service codes 02 or 10. Telehealth services must adhere to the Telemedicine Billing Manual.
Official descriptors of the Place of Service can be found on the Centers for Medicare and Medicaid Services (CMS) website.
The following Place of Service codes are allowed:
| Allowed Place of Service Code | Description (short) |
|---|---|
| 02 | Telehealth Provided Other than in Patient’s Home |
| 04 | Homeless Shelter |
| 10 | Telehealth Provided in Patient’s Home |
| 11 | Office |
| 12 | Home |
| 15 | Mobile Unit |
| 19 | Off Campus-Outpatient Hospital |
| 20 | Urgent Care Facility |
| 22 | On Campus-Outpatient Hospital |
| 49 | Independent Clinic |
| 50 | Federally Qualified Health Center |
| 71 | Public Health Clinic |
| 72 | Rural Health Clinic |
Contact Information
Contact the Provider Services Call Center with billing inquiries.
Contact the Department’s Lactation Support Services policy specialist at HCPF_MaternalChildHealth@state.co.us for all other inquiries.
Back to Top
CMS 1500 Paper Claim Reference Table
The following paper claim form reference table shows required, optional and conditional fields and detailed field completion instructions for the CMS 1500 professional claim form.
| CMS Field Number & Label | Field is? | Instructions | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Insurance Type | Required | Place an "X" in the box marked as Medicaid. | ||||||||||||
| 1a. Insured's ID Number | Required | Enter the member's Health First Colorado seven-digit Health First Colorado ID number as it appears on the Medicaid Identification card. Example: A123456. | ||||||||||||
| 2. Patient's Name | Required | Enter the member's last name, first name and middle initial. | ||||||||||||
| 3. Patient's Date of Birth/Sex | Required | Enter the member's birth date using two digits for the month, two digits for the date and two digits for the year. Example: 070114 for July 1, 2014. Place an "X" in the appropriate box to indicate the sex of the member. | ||||||||||||
| 4. Insured's Name | Conditional | Complete if the member is covered by a Medicare health insurance policy. Enter the insured's full last name, first name and middle initial. If the insured used a last name suffix (e.g., Jr, Sr), enter it after the last name and before the first name. | ||||||||||||
| 5. Patient's Address | Not Required | |||||||||||||
| 6. Patient's Relationship to Insured | Conditional | Complete if the member is covered by a commercial health insurance policy. Place an "X" in the box that identifies the member's relationship to the policyholder. | ||||||||||||
| 7. Insured's Address | Not Required | |||||||||||||
| 8. Reserved for NUCC Use | Not Required | |||||||||||||
| 9. Other Insured's Name | Conditional | If field 11d is marked "YES," enter the insured's last name, first name and middle initial. | ||||||||||||
| 9a. Other Insured's Policy or Group Number | Conditional | If field 11d is marked "YES," enter the policy or group number. | ||||||||||||
| 9b. Reserved for NUCC Use | ||||||||||||||
| 9c. Reserved for NUCC Use | ||||||||||||||
| 9d. Insurance Plan or Program Name | Conditional | If field 11D is marked "YES" enter the insurance plan or program name. | ||||||||||||
| 10a-c. Is patient's condition related to? | Conditional | When appropriate, place an "X" in the correct box to indicate whether one or more of the services described in field 24 are for a condition or injury that occurred on the job, as a result of an auto accident or other. | ||||||||||||
| 10d. Reserved for Local Use | ||||||||||||||
| 11. Insured's Policy, Group or FECA Number | Conditional | Complete if the member is covered by a Medicare health insurance policy. Enter the insured's policy number as it appears on the ID card. Only complete if field 4 is completed. | ||||||||||||
| 11a. Insured's Date of Birth, Sex | Conditional | Complete if the member is covered by a Medicare health insurance policy. Enter the insured's birth date using two digits for the month, two digits for the date and two digits for the year. Example: 070114 for July 1, 2014. Place an "X" in the appropriate box to indicate the sex of the insured. | ||||||||||||
| 11b. Other Claim ID | Not Required | |||||||||||||
| 11c. Insurance Plan Name or Program Name | Not Required | |||||||||||||
| 11d. Is there another Health Benefit Plan? | Conditional | When appropriate, place an "X" in the correct box. If marked "YES," complete 9, 9a and 9d. | ||||||||||||
| 12. Patient's or Authorized Person's Signature | Required | Enter "Signature on File," "SOF" or legal signature. If there is no signature on file, leave blank or enter "No Signature on File." Enter the date the claim form was signed. | ||||||||||||
| 13. Insured's or Authorized Person's Signature | Not Required | |||||||||||||
| 14. Date of Current Illness, Injury or Pregnancy | Conditional | Complete if information is known. Enter the date of illness, injury or pregnancy (date of the last menstrual period) using two digits for the month, two digits for the date and two digits for the year. Example: 070114 for July 1, 2014. Enter the applicable qualifier to identify which date is being reported. 431 - Onset of Current Symptoms or Illness 484 - Last Menstrual Period | ||||||||||||
| 15. Other Date Not | Not Required | |||||||||||||
| 16. Date Patient Unable to Work in Current Occupation | Not Required | |||||||||||||
| 17. Name of Referring Physician | Conditional | |||||||||||||
| 17b. NPI of Referring Physician | Required | Required in accordance with Program Rule 8.125.8.A | ||||||||||||
| 18. Hospitalization Dates Related to Current Service | Not Required | |||||||||||||
| 19. Additional Claim Information | Conditional | |||||||||||||
| 20. Outside Lab? $ Charges | Conditional | Complete if all laboratory work was referred to and performed by an outside laboratory. If this box is checked, no payment will be made to the physician for lab services. Do not complete this field if any laboratory work was performed in the office. Practitioners may not request payment for services performed by an independent or hospital laboratory. | ||||||||||||
| 21. Diagnosis or Nature of Illness or Injury | Required | Enter at least one but no more than twelve diagnosis codes based on the member's diagnosis/condition. Enter applicable ICD-10 code: Z33.1 or Z39.2 depending on the procedure code billed. | ||||||||||||
| 22. Medicaid Resubmission Code | Conditional | List the original reference number for resubmitted claims. When resubmitting a claim, enter the appropriate bill frequency code in the left-hand side of the field. 7 - Replacement of prior claim 8 - Void/Cancel of prior claim This field is not intended for use with original claim submissions. | ||||||||||||
| 23. Prior Authorization | Not Required | Prior Authorization Enter the six-character prior authorization number from the approved Prior Authorization Request (PAR). Do not combine services from more than one approved PAR on a single claim form. Do not attach a copy of the approved PAR unless advised to do so by the authorizing agent or the fiscal agent. | ||||||||||||
| 24. Claim Line Detail | Information | The paper claim form allows entry of up to six detailed billing lines. Fields 24A through 24J apply to each billed line. Do not enter more than six lines of information on the paper claim. If more than six lines of information are entered, the additional lines will not be entered for processing. Each claim form must be fully completed (totaled). Do not file continuation claims (e.g., Page 1 of 2). | ||||||||||||
| 24A. Dates of Service | Required | The field accommodates the entry of two dates: a "From" date of services and a "To" date of service. Enter the date of service using two digits for the month, two digits for the date and two digits for the year. Example: 010119 for January 1, 2019.
| ||||||||||||
| 24B. Place of Service | Required | Reference the billing policy found in this manual for allowed Place of Service codes. | ||||||||||||
| 24C. EMG | Conditional | Enter a "Y" for YES or leave blank for NO in the bottom unshaded area of the field to indicate the service was rendered for a life-threatening condition or one that requires immediate medical intervention. | ||||||||||||
24D.Procedures, Services, or Supplies
| Required | Enter the HCPCS procedure code that specifically describes the service for which payment is requested: S9443 All procedures must be identified with codes in the current edition of Physicians Current Procedural Terminology (CPT). CPT is updated annually. HCPCS Level II Codes The current Medicare coding publication (for Medicare crossover claims only). Only approved codes from the current CPT or HCPCS publications will be accepted. | ||||||||||||
| 24D. Modifier | Conditional | Enter the appropriate procedure-related modifier that applies to the billed service. Up to four modifiers may be entered when using the paper claim form. Please reference the billing policy detailed in this manual for specific modifier code use. | ||||||||||||
| 24E. Diagnosis Pointer | Required | Enter the diagnosis code reference letter (A-L) that relates the date of service and the procedures performed to the primary diagnosis. At least one diagnosis code reference letter must be entered. When multiple services are performed, the primary reference letter for each service should be listed first and other applicable services should follow. This field allows for the entry of 4 characters in the unshaded area. | ||||||||||||
| 24F. $ Charges | Required | Enter the usual and customary charge for the service represented by the procedure code on the detail line. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number. Some CPT procedure codes are grouped with other related CPT procedure codes. When more than one procedure from the same group is billed, special multiple pricing rules apply. The base procedure is the procedure with the highest allowable amount. The base code is used to determine the allowable amounts for additional CPT surgical procedures when more than one procedure from the same grouping is performed. Submitted charges cannot be more than charges made to non-Health First Colorado-covered individuals for the same service. Do not deduct Health First Colorado co-pay or commercial insurance payments from the usual and customary charges. | ||||||||||||
| 24G. Days or Units | Required | Enter the number of services provided for each procedure code. Enter whole numbers only. Do not enter fractions or decimals. | ||||||||||||
| 24H. EPSDT/Family Plan | Conditional | EPSDT (shaded area) For Early & Periodic Screening, Diagnosis and Treatment related services, enter the response in the shaded portion of the field as follows: AV - Available- Not Used S2 - Under Treatment ST - New Service Requested NU - Not Used Family Planning (unshaded area) If the service is Family Planning (e.g., contraception, sterilization), enter "Y" for YES or "N" for NO in the bottom unshaded area of the field. | ||||||||||||
| 24I. ID Qualifier | Not Required | |||||||||||||
| 24J. Rendering Provider ID # | Required | In the shaded portion of the field, enter the National Provider Identifier (NPI) or the Health First Colorado provider number assigned to the individual who actually performed or rendered the billed service. This number cannot be assigned to a group or clinic. | ||||||||||||
| 25. Federal Tax ID Number | Not Required | |||||||||||||
| 26. Patient's Account Number | Optional | Enter information that identifies the member or claim in the provider's billing system. Submitted information appears on the Remittance Advice (RA). | ||||||||||||
| 27. Accept Assignment? | Required | The accept assignment indicates that the provider agrees to accept assignment under the terms of the payer's program. | ||||||||||||
| 28. Total Charge | Required | Enter the sum of all charges listed in field 24F. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number. | ||||||||||||
| 29. Amount Paid | Conditional | Enter the total amount paid by Medicare or any other commercial health insurance that has made payment on the billed services. Do not use commas when reporting dollar amounts. Enter 00 in the cents area if the amount is a whole number. | ||||||||||||
| 30. Rsvd for NUCC Use | ||||||||||||||
| 31. Signature of Physician or Supplier Including Degrees or Credentials | Required | Each claim must bear the signature of the enrolled provider or the signature of a registered authorized agent. Each claim must have the date the enrolled provider or registered authorized agent signed the claim form. Enter the date the claim was signed using two digits for the month, two digits for the date and two digits for the year. Example: 070116 for July 1, 2016. Unacceptable signature alternatives: Claim preparation personnel may not sign the enrolled provider's name. Initials are not acceptable as a signature. Typed or computer printed names are not acceptable as a signature. "Signature on file" notation is not acceptable in place of an authorized signature. | ||||||||||||
| 32. Service Facility Location Information 32a- NPI Number 32b- Other ID # | Required | Enter the name, address and ZIP code of the individual or business where the member was seen or service was performed in the following format: 1st Line: Name 2nd Line: Address 3rd Line: City, State and ZIP Code If the Provider Type is not able to obtain a National Provider Identifier (NPI), enter the eight-digit Health First Colorado provider number of the individual or organization. | ||||||||||||
| 33. Billing Provider Info & Ph # | Required | Enter the name of the individual or organization that will receive payment for the billed services in the following format: 1st Line: Name 2nd Line: Address 3rd Line: City, State and ZIP Code | ||||||||||||
| 33a- NPI Number | Required | |||||||||||||
| 33b- Other ID # | If the Provider Type is not able to obtain a National Provider Identifier (NPI), enter the eight-digit Health First Colorado provider number of the individual or organization. | |||||||||||||
CMS 1500 Lactation Support Service Example
Timely Filing
Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down for more information on timely filing policy, including the resubmission rules for denied claims.
Lactation Support Specialist Billing Manual Revision Log
Revision Date | Addition/Changes | Made by |
|---|---|---|
| 11/12/2024 | Creation of Manual | HCPF |