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ICD-10 Claims Submission Alternatives

For FROM dates of service (on professional and supplier claims)  or dates of discharge/through dates (on institutional claims) on or after October 1, 2015, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) are required to use the International Classification of Diseases, 10th Edition (ICD-10) code sets adopted under HIPAA.

If you will not be able to complete the necessary systems changes to submit claims with ICD-10 codes by October 1, 2015, or find that you are unable to submit claims on or after October 1, 2015, due to issues with your billing software, vendor or clearinghouse, the following claims submission alternatives are available.

Please note that these claims submission alternatives REQUIRE THE USE OF ICD-10 code sets for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015.

  • Free Billing Software

    You may download the free billing software that CMS offers via our website at:

    The software has been updated to support ICD-10 codes and requires a Network Service Vendor in order to transmit claims. The software download is free, but there may be fees associated with submitting claims througha Network Service Vendor. Information about Network Service Vendors is available at:

    In addition, it is necessary to have a CGS Submitter ID to use the free billing software to submit claims to CGS.

    • If you currently do not have a CGS Submitter ID to submit claims directly to CGS (e.g. you submit claims through a clearinghouse or billing service), you will need to complete the necessary CGS enrollment forms in order to obtain a CGS Submitter ID.
    • If you currently have a CGS Submitter ID, you will use that to submit claims with the free billing software.

    The CGS enrollment forms are available on the EDI Enrollment Web page on the CGS website. Forms should be submitted to CGS as soon as possible, but no later than September 14, 2015, to allow CGS time to process your request and for any testing you might want to do prior to the October 1, 2015, ICD-10 mandate. You will also need to allow for any additional time to sign up and establish connectivity to CGS through the Network Service Vendor you choose.

    This billing software only works for submitting Fee-for-Service claims to Medicare. It is intended to provide submitters with an ICD-10 compliant claims submission format; it does not provide coding assistance.

    Please note that submitting electronic claims to Medicare using the free billing software does not change the requirement for ICD-10 compliant claims to be submitted for FROM dates of service (on professional claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015. Any claims containing ICD-9 codes for FROM dates of service (on professional claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015, will be rejected by Medicare.

  • Provider Internet Portals

    You may register for access to our provider portal, myCGS, by following the instructions on the Web Portal Registration ChecklistPDF. You may use the portal for submission of ICD-10 compliant professional claims. 

    Please submit a request for access to the provider portal, myCGS by September 8, 2015, to ensure access by October 1, 2015.

    Please note that claims submitted via our provider portal must contain ICD-10 codes for FROM dates of service on or after October 1, 2015. Those submitted containing ICD-9 codes for FROM dates of service on or after October 1, 2015, will be rejected by Medicare.

  • Paper Claims

    In limited situations, you may submit paper claims with ICD-10 codes to Medicare. To find more information on when you may submit paper claims, visit http://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/ASCAWaiver.htmlExternal Website on the CMS website. Please note that to submit paper claims, a provider must meet the requirements to qualify for a waiver of the Administrative Simplification Compliance Act (ASCA) provisions.

    Practitioners (physicians and non-physicians) and suppliers use Form CMS-1500 to bill MACs and DME MACs. You can order Form CMS-1500 from printing companies, office supply stores, and the U.S. Government Printing Office (GPO), U.S. Government Bookstore. U.S. Government Bookstore orders can be placed by calling (866) 512-1800 or visiting http://bookstore.gpo.gov/agency/346External Website on the GPO website.

    Institutional providers use Form CMS-1450, also known as the UB-04, to bill MACs. You can order UB-04 claim forms from the National Uniform Billing Committee (NUBC) at http://www.nubc.orgExternal Website on the NUBC website.

    Also see the Submitting Paper Claims CGS Web page for more information about submitting paper claims.

    Please note that submitting paper claims to Medicare, even if approved for an ASCA waiver, does not change the requirement for ICD-10 compliant claims to be submitted for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015.  Any paper claims containing ICD-9 codes for FROM dates of service (on professional and supplier claims) or dates of discharge/through dates (on institutional claims) on or after October 1, 2015 will be returned as unprocessable by Medicare.

    Please submit a request for an ASCA waiver by September 8, 2015, to ensure a response by October 1, 2015.

If you have questions, please contact us at 1.866.276.9558 and select Option 2.

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