Codes and standards

Find procedural guidelines and standards for general and specialty coding, preventive services, National Provider Identifier (NPI) instructions, and available government programs below.

More resources

CMS-1500 (08/05) required fields (PDF)

UB-04 (CMS-1450) required fields (PDF)

Present on Admission (POA) indicators for inpatient claims: Provider Q&A (PDF)

Coding guidelines for preventive care services commercial (non-Medicare) plans (PDF)

Provider Manual topics

Administrative simplification
Applying for an NPI
Adverse events
CMS-1450 (UB-04) claims — coding for services provided
CMS-1500 claims — coding for services provided
CMS-1500 claims data reporting requirements
Code edit or coding policy services reconsideration process
Code editing and review process for professional claims
General Medicare data requirements
Kaiser Permanente NPI billing requirements
Mental health coding, including substance use treatment
NPI and taxonomy requirements
Physician reimbursement for medical (non-psychiatric) surgical and anesthesia services
Variations to code edits of coding policy for claims

Provider manual