TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > UB-04 CMS-1450 Claim Filing Instructions


6.6 UB-04 CMS-1450 Claim Filing Instructions

The following provider types may bill electronically or use the UB-04 CMS-1450 claim form when requesting payment:

Provider Types

ASCs (hospital-based)

Comprehensive outpatient rehabilitation facilities (CORFs) (CCP only)


Note: Must use CMS-1500 when billing THSteps.

Home health agencies


Inpatient (acute care, rehabilitation, military, and psychiatric hospitals)


Renal dialysis center

RHCs (freestanding and hospital-based)

Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.