CMS 1500 - BOX 32: SERVICE FACILITILY LOCATION INFORMATION

If services were in a location other than the Provider’s office or the member’s home, enter the name and address of that facility.

32 a. Enter the Facility NPI number. Not required at this time.

32 b. Enter the 2-digit MaineCare Identifier (1D) and one space followed by the Facility Provider number. Do not  enter the Servicing Provider ID number here. Not required at this time.


Item 32 Form CMS-1500 (12-90) - Enter the name and address, and ZIP Code of the facility if the services were furnished in a hospital, clinic, laboratory, or facility other than the patient's home or physician's office. Effective for claims received on or after April 1, 2004, enter the name, address, and ZIP Code of the service location for all services other than those furnished in place of service home – 12. Effective for claims received on or after April 1, 2004, on the Form CMS-1500, only one name, address and ZIP Code may be entered in the block.

 If additional entries are needed, separate claim forms shall be submitted. Providers of service (namely physicians) shall identify the supplier's name, address, ZIP Code and PIN when billing for purchased diagnostic tests. When more than one supplier is used, a separate Form CMS-1500 shall be used to bill for each supplier. For foreign claims, only the enrollee can file for Part B benefits rendered outside of the United States.

These claims will not include a valid ZIP Code. When a claim is received for these services on a beneficiary submitted Form CMS-1490S, before the claim is entered in the system, it should be determined if it is a foreign claim. If it is a foreign claim, follow instructions in chapter 1 for disposition of the claim. The carrier processing the foreign claim will have to make necessary accommodations to verify that the claim is not returned as unprocessable due to the lack of a ZIP Code. For durable medical, orthotic, and prosthetic claims, the name, address, or PIN of the location where the order was accepted must be entered (DMERC only). This field is required. When more than one supplier is used, a separate Form CMS-1500 shall be used to bill for each supplier. This item is completed whether the supplier's personnel performs the work at the physician's office or at another location.

If a modifier is billed, indicating the service was rendered in a Health Professional Shortage Area (HPSA) or Physician Scarcity Area (PSA), the physical location where the service was rendered shall be entered if other than home. If the supplier is a certified mammography screening center, enter the 6-digit FDA approved certification number. Complete this item for all laboratory work performed outside a physician's office. If an independent laboratory is billing, enter the place where the test was performed, and the PIN.