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5.7.1 Provider Types and Selection of Claim Forms
5.7.1.1 Providers and Services Billable on CMS-1500
Claims for the following provider types or services must be billed on a CMS-1500 paper claim form or approved electronic format when requesting payment for medical services and supplies under the CSHCN Services Program:
• Advanced practice registered nurse (APRN), such as pediatric nurse practitioner (PNP), clinical nurse specialist (CNS), and family nurse practitioner (FNP)
•Ambulance
•Augmentative communication devices (ACDs)
•Certified respiratory care practitioner (CRCP)
•Certified registered nurse anesthetists (CRNA)
•Durable medical equipment (DME)
•Freestanding ambulatory surgery center
•Gastrostomy devices
•Genetic services
•Independent laboratory, radiology, and radiation therapy
•Medical foods
•Medical nutritional products and services
•Orthosis and prosthesis
•Outpatient behavioral health services
•Outpatient therapy (physical therapy [PT], occupational therapy [OT], and speech-language pathology [SLP])
•Physician (doctor of medicine [MD] and doctor of osteopathy [DO])
•Podiatry
•Total parenteral nutrition (TPN)
•Vision services
•Any other authorized provider of medical services and supplies not specifically required to use a different claim form when submitting claims to TMHP
Providers are responsible for obtaining these forms from a supplier of their choice.
Refer to: Section 5.7.1.4, "CMS-1500 Paper Claim Form Example".
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