ICD Indicator for Claims Submitted on CMS 1500 Form



Effective Oct. 1, 2015, Field 21 of the CMS 1500 form will require an indicator of “9” or “0.” This indicator is for the purposes of the ICD-10 implementation. Entering a “9” will indicate the provider intends to submit ICD-09 codes. Entering a “0” will indicate the provider intends to submit ICD-10 codes. Below is a guide for provider claim staff.

Date of Discharge or Date of Service Claim Submission Date ICD Code Set Required ICD Indicator in Field 21
10/1/2012-9/30/2015 10/1/2012-9/30/2015 ICD-09 None*
10/1/2012-9/30/2015 10/1/2015-beyond ICD-09 9
10/1/2015-beyond 10/1/2015-beyond ICD-10 0

*Leaving this field blank, or entering a "space" will default the claim to ICD-09. 

As a reminder, claims submitted with both ICD-9 and ICD-10 codes will be rejected. In the event that a claim requires both ICD-9 and ICD-10 codes, you must send two separate claims with the appropriate ICD-9 or ICD-10 codes based on the Date of Service or Date of Discharge.

SCDHHS continues to encourage providers and electronic data interchange (EDI) clearinghouses to plan for testing ICD-10 claims submissions through the Medicaid Management Information System (MMIS) through Aug. 28, 2015.

For more information concerning ICD-10 testing, please visit the SCDHHS ICD-10 webpage, https://msp.scdhhs.gov/aca/Links . For additional information concerning the implementation of ICD-10 from the Centers for Medicare and Medicaid Services (CMS), please visit RoadtoICD10 .

If you have any questions concerning this announcement, please contact the Provider Service Center at (888) 289-0709 and reference issue code PS286.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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