Instructions for Form UB-04, CMS-1450 Institutional Billing Form (Ambulatory Surgical Centers) - Florida

This document contains official instructions for Form UB-04 , and Form CMS-1450 . Both forms are released and collected by the Florida Department of Financial Services.

FAQ

Q: What is Form UB-04, CMS-1450?
A: Form UB-04, CMS-1450 is the institutional billing form used by Ambulatory Surgical Centers (ASCs) in Florida.

Q: Who uses Form UB-04, CMS-1450?
A: Ambulatory Surgical Centers (ASCs) in Florida use Form UB-04, CMS-1450 for billing purposes.

Q: What is the purpose of Form UB-04, CMS-1450?
A: The purpose of Form UB-04, CMS-1450 is to submit claims for payment from Medicare, Medicaid, and private insurance companies for services provided by Ambulatory Surgical Centers (ASCs) in Florida.

Q: What information is required on Form UB-04, CMS-1450?
A: Form UB-04, CMS-1450 requires information such as patient demographics, dates of service, diagnosis codes, procedure codes, and billing codes.

Q: Can Form UB-04, CMS-1450 be electronically submitted?
A: Yes, Form UB-04, CMS-1450 can be electronically submitted through the Medicare Administrative Contractors (MACs) or using a third-party billing software.

Q: What should I do if I have questions or need assistance with Form UB-04, CMS-1450?
A: If you have questions or need assistance with Form UB-04, CMS-1450, you can contact your Medicare Administrative Contractor (MAC) or seek guidance from the Centers for Medicare & Medicaid Services (CMS).