Add-on (Late Charges) Claim
An add-on claim (type of bill 815 or 825) can be submitted to add physician charges (revenue code 0657) only when the original claim did not include physician charges. The “From” and “To” dates submitted on the add-on claim must match the “From” and “To” dates on the original claim. If the original claim contained physician charges, and you need to add additional physician charges, an adjustment to the original claim must be submitted. If the original claim has already been adjusted, an add-on claim can not be submitted. Instead, perform an adjustment to the adjusted claim to add the physician charges.
The Fiscal Intermediary Standard System (FISS) allows only one add-on claim per original claim. Therefore, if an add-on claim has already processed and you need to add additional physician charges, the first add-on claim must be canceled (type of bill 8X8) and a new add-on claim with all the physician charges must be resubmitted.
Add-on claims must meet the same timely filing requirements as an original claim. In addition to the usual claim information, include the following on an add-on claim.
| TOB field on the Fiscal Intermediary Standard System (FISS) Claim Page 01 | Enter the type of bill (TOB) 815 or 825. |
| STMT DATES FROM / TO field on the FISS Claim Page 01 | Enter the same statement covers period (“from” and “to” dates) as the original claim. |
| REV field on the FISS Claim Page 02 | Enter revenue code “0657” to add-on the physician charges. |
| HCPC on the FISS Claim Page 02 | Enter the HCPCS code for the add-on physician charges. |
| TOT UNIT on the FISS Claim Page 02 | Enter the total units for the add-on physician charge. |
| COV UNIT on the FISS Claim Page 02 | Enter the total covered units for the add-on physician charge. |
| TOT CHARGE on the FISS Claim Page 02 | Enter the total charge for the add-on physician charge revenue code. |
| SERV DATE on the FISS Claim Page 02 | Enter the date the physician provided the service. |
Page last updated: September 23, 2008
