Nine-Digit ZIP Codes Required To Process Claims

Family physicians with Medicare patients in select states and counties will need to add a few more digits to Medicare claim forms in the fall to ensure timely payment.

Beginning Oct. 1, nine-digit ZIP codes will be required in 32 states on the portion of the physician claim form that indicates the geographic location where the health care service was rendered.

Medicare claims lacking the full nine-digit ZIP code will not be processed.

A full explanation of the change and a chart of ZIP codes from the 32 states currently affected appear in the March 9 Medlearn Matters, (PDF file: 8 pages / 220 KB. More about PDFs.) an online CMS provider publication.

The ZIP code list will be updated quarterly on CMS' Web site, so physicians should check there periodically.

Some background: Medicare reimbursement is based on the geographic location where the service was provided, and that location is derived from U.S. Postal Service ZIP codes.

According to Medlearn Matters, some ZIP codes cover more than one payment locality; therefore, although the service actually may have been provided in one county, because of the ZIP code, it may be assigned to a different county.

Use of the nine-digit ZIP code in those instances will help ensure that physicians receive timely and accurate payment for their services.