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Minnesota Legislature

Office of the Revisor of Statutes

Chapter 62J

Section 62J.52

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62J.52 ESTABLISHMENT OF UNIFORM BILLING FORMS.
    Subdivision 1. Uniform billing form CMS 1450. (a) On and after January 1, 1996, all
institutional inpatient hospital services, ancillary services, institutionally owned or operated
outpatient services rendered by providers in Minnesota, and institutional or noninstitutional home
health services that are not being billed using an equivalent electronic billing format, must be
billed using the uniform billing form CMS 1450, except as provided in subdivision 5.
    (b) The instructions and definitions for the use of the uniform billing form CMS 1450
shall be in accordance with the uniform billing form manual specified by the commissioner. In
promulgating these instructions, the commissioner may utilize the manual developed by the
National Uniform Billing Committee, as adopted and finalized by the Minnesota Uniform
Billing Committee.
    (c) Services to be billed using the uniform billing form CMS 1450 include: institutional
inpatient hospital services and distinct units in the hospital such as psychiatric unit services,
physical therapy unit services, swing bed (SNF) services, inpatient state psychiatric hospital
services, inpatient skilled nursing facility services, home health services (Medicare part A), and
hospice services; ancillary services, where benefits are exhausted or patient has no Medicare part
A, from hospitals, state psychiatric hospitals, skilled nursing facilities, and home health (Medicare
part B); institutional owned or operated outpatient services such as waivered services, hospital
outpatient services, including ambulatory surgical center services, hospital referred laboratory
services, hospital-based ambulance services, and other hospital outpatient services, skilled
nursing facilities, home health, freestanding renal dialysis centers, comprehensive outpatient
rehabilitation facilities (CORF), outpatient rehabilitation facilities (ORF), rural health clinics, and
community mental health centers; home health services such as home health intravenous therapy
providers, waivered services, personal care attendants, and hospice; and any other health care
provider certified by the Medicare program to use this form.
    (d) On and after January 1, 1996, a mother and newborn child must be billed separately,
and must not be combined on one claim form.
    (e) Services provided by Medicare Critical Access Hospitals electing Method II billing
will be allowed an exception to this provision to allow the inclusion of the professional fees on
the CMS 1450.
    Subd. 2. Uniform billing form CMS 1500. (a) On and after January 1, 1996, all
noninstitutional health care services rendered by providers in Minnesota except dental or
pharmacy providers, that are not currently being billed using an equivalent electronic billing
format, must be billed using the health insurance claim form CMS 1500, except as provided in
subdivision 5.
    (b) The instructions and definitions for the use of the uniform billing form CMS 1500 shall
be in accordance with the manual developed by the Administrative Uniformity Committee
entitled standards for the use of the CMS 1500 form, dated February 1994, as further defined
by the commissioner.
    (c) Services to be billed using the uniform billing form CMS 1500 include physician services
and supplies, durable medical equipment, noninstitutional ambulance services, independent
ancillary services including occupational therapy, physical therapy, speech therapy and audiology,
home infusion therapy, podiatry services, optometry services, mental health licensed professional
services, substance abuse licensed professional services, nursing practitioner professional
services, certified registered nurse anesthetists, chiropractors, physician assistants, laboratories,
medical suppliers, and other health care providers such as day activity centers and freestanding
ambulatory surgical centers.
    (d) Services provided by Medicare Critical Access Hospitals electing Method II billing
will be allowed an exception to this provision to allow the inclusion of the professional fees on
the CMS 1450.
    Subd. 3. Uniform dental billing form. (a) On and after January 1, 1996, all dental services
provided by dental care providers in Minnesota, that are not currently being billed using an
equivalent electronic billing format, shall be billed using the American Dental Association
uniform dental billing form.
(b) The instructions and definitions for the use of the uniform dental billing form shall be
in accordance with the manual developed by the Administrative Uniformity Committee dated
February 1994, and as amended or further defined by the commissioner.
    Subd. 4. Uniform pharmacy billing form. (a) On and after January 1, 1996, all pharmacy
services provided by pharmacists in Minnesota that are not currently being billed using an
equivalent electronic billing format shall be billed using the NCPDP/universal claim form, except
as provided in subdivision 5.
(b) The instructions and definitions for the use of the uniform claim form shall be in
accordance with instructions specified by the commissioner of health, except as provided in
subdivision 5.
    Subd. 5. State and federal health care programs. (a) Skilled nursing facilities and ICF/MR
services billed to state and federal health care programs administered by the Department of
Human Services shall use the form designated by the Department of Human Services.
(b) On and after July 1, 1996, state and federal health care programs administered by the
Department of Human Services shall accept the CMS 1450 for community mental health center
services and shall accept the CMS 1500 for freestanding ambulatory surgical center services.
(c) State and federal health care programs administered by the Department of Human
Services shall be authorized to use the forms designated by the Department of Human Services
for pharmacy services.
(d) State and federal health care programs administered by the Department of Human
Services shall accept the form designated by the Department of Human Services, and the CMS
1500 for supplies, medical supplies, or durable medical equipment. Health care providers may
choose which form to submit.
(e) Personal care attendant and waivered services billed on a fee-for-service basis directly to
state and federal health care programs administered by the Department of Human Services shall
use either the CMS 1450 or the CMS 1500 form, as designated by the Department of Human
Services.
History: 1994 c 625 art 9 s 3; 2000 c 460 s 4-6; 1Sp2003 c 14 art 7 s 14,15; 2005 c 106 s
3-5; 2007 c 147 art 9 s 6,7