For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is P or 1,
- Use TOS P if the drug is administered through durable medical equipment (DME); or
- Use TOS 1 if the drug is administered in the office.
Claim Form CMS :
In the 1960s there were a number of different claim forms and coding
systems required by third-party payers to communicate information
regarding procedures and services to agencies concerned with insurance
claims. However, there was no standardized form for physicians and other
health care providers to report health care services. Therefore, the
American Medical Association (AMA) embraced an assignment in the 1980s
to work with the Centers for Medicare & Medicaid Services (CMS;
formerly known as HCFA), and many other payer organizations through a
group called the Uniform Claim Form Task Force to standardize and
promote the use of a universal health claim form.
Although many providers now submit electronic claims, many of their
software/hardware systems depend on the existing 1500 Claim Form in its
current image. Minor changes have been made to the form in order to
accommodate the National Provider Identifier (NPI) as well as other
identifiers.
The 1500 Health Insurance Claim Form answers the needs of many health
payers. It is the basic paper claim form prescribed by many health plans
for claims submitted by physicians and suppliers, and in some cases,
for ambulance services.
