Reminder: Diagnosis Pointers on CMS-1500 Claims

When multiple services are performed in a single encounter, certain services may be related to certain diagnoses, while other services are associated with different diagnoses.

On the CMS-1500 claim form, box 24E (Diagnosis Pointer) is used to indicate which diagnosis is related to each specific service billed. If multiple services are performed, providers should enter the diagnosis reference number in box 24E to relate each service to the appropriate diagnosis in box 21.

• Reference numbers entered in box 24E must be 1, 2, 3 or 4, and a valid diagnosis code is required in the corresponding field in box 21.
• Do not enter ICD-9 codes in box 24E. Those codes should be entered in box 21.
• Up to four reference numbers can be entered for each service.

For instructions on completing each section of the CMS-1500 claim form, refer to the Claim Requirements chapter of the Commercial Provider Manual.

May 1, 2011