Medical Billing Forum

Billing => Facility Billing => : loneieagle March 28, 2008, 05:08:58 PM

: Which form should we be using?
: loneieagle March 28, 2008, 05:08:58 PM
We are an outpatient rehabilitation facility located in Michigan. When we bill for a Worker's Comp claim, are we supposed to use a 1500 or UB04 claim form? We get conflicting answers from the insurance companies. What happens is if we bill on a UB04 (facility), the insurance company doesn't want to pay us the statutory rate for "Physical Medicine" because they assume we are a hospital. If we bill on a 1500 (physician) they want the NPI number of the therapist which the therapist doesn't have because the facility does all of the billing. Any light you can shed on this would be appreciated.
: Re: Which form should we be using?
: Michele March 29, 2008, 09:57:37 AM
   Even though the facility does all the billing, the individual therapists need to have individual NPI numbers too, for exactly this reason.  If you are billing for the professional fees for the therapy, then you need to bill on the CMS form (we actually use a C4 form for workers comp) and you do need to indicate the individual therapist's NPI number in box 24J. 

NPI numbers are free, and you can get one fairly quickly by doing their online application at

If you have any problems with the application call us at 1-800-490-4299.  We do offer a service to help with NPI number applications.

For more information on NPI numbers you can visit