On the CMS-1500 form, the provider type refers to the role or specialty of the healthcare professional or organization rendering the service. While the form itself doesn’t explicitly list provider types, they are conveyed through:
- National Provider Identifier (NPI):
- The provider’s unique identifier is entered in Box 24J (Rendering Provider) and Box 33a (Billing Provider).
- NPIs link to the provider’s specialty information in payer databases.
- Taxonomy Codes:
- Used to specify the provider’s specialty when required by the payer. This code is entered in Box 33b alongside the qualifier
ZZ.
- Used to specify the provider’s specialty when required by the payer. This code is entered in Box 33b alongside the qualifier
- Payer-Specific Requirements:
- Some payers may require additional details in conjunction with the NPI or taxonomy code.
Examples of Common Provider Types:
Here are examples of typical provider types and their taxonomy codes:
| Provider Type | Taxonomy Code | Description |
|---|---|---|
| Physician – Family Medicine | 207Q00000X | Primary care physician specializing in family medicine. |
| Internal Medicine | 207R00000X | Specialist in adult healthcare. |
| Physical Therapist | 225100000X | Provides physical rehabilitation. |
| Chiropractor | 111N00000X | Focuses on spinal adjustments. |
| Psychologist | 103T00000X | Specializes in mental health. |
| Ambulance Service | 341600000X | Emergency or non-emergency transport. |
| Federally Qualified Health Center (FQHC) | 261QF0400X | Federally designated health center. |
Key Form Fields Related to Providers:
- Box 24J: NPI of the rendering provider.
- Box 31: Name and credentials of the provider rendering the service.
- Box 32: Service facility location, if different from the billing provider.
- Box 33: Billing provider’s name, address, and NPI (with taxonomy in 33b if required).