What this manual covers
Its instructions are written for contractors as much as for providers. A section usually states the coverage or payment rule, then the coding and claim requirements, and then the edits and remittance messages contractors apply, which is why the manual is the place to look when a denial reason does not explain itself.
Start from the chapter for the provider type, then follow its cross-references: coverage questions go to the Benefit Policy Manual, NCD-governed services to chapter 32 and the NCD manual, and review or enrollment questions to the Program Integrity Manual.
Chapter guides
Each guide explains what the chapter governs for billing in plain English, points to the sections billing teams use most, shows how the chapter's rules surface as claim denials and remittance codes, and lists the chapter's current revision and newest transmittals.
All 39 chapters and their current revisions
The revision is the newest one found in the chapter's table of contents and transmittal history. Chapters with a guide link to it; every chapter links to the official PDF on cms.gov, with its page count.
| Ch. | Chapter | Current revision | Official PDF |
|---|---|---|---|
| 1 | General Billing Requirements | Rev. 13826, June 11, 2026 | 325 pages |
| 2 | Admission and Registration RequirementsAdmission and registration: Medicare beneficiary identifiers, the Medicare Secondary Payer questionnaire and registration requirements. | Rev. 12423, December 20, 2023 | 29 pages |
| 3 | Inpatient Hospital Billing | Rev. 13757, April 30, 2026 | 409 pages |
| 4 | Part B Hospital (Including Inpatient Hospital Part B and OPPS) | Rev. 13799, May 28, 2026 | 316 pages |
| 5 | Part B Outpatient Rehabilitation and CORF/OPT ServicesPart B outpatient rehabilitation and CORF services: therapy billing, functional reporting history and therapy caps and thresholds. | Rev. 11129, November 22, 2021 | 128 pages |
| 6 | SNF Inpatient Part A Billing and SNF Consolidated Billing | Rev. 13089, February 21, 2025 | 97 pages |
| 7 | SNF Part B Billing (Including Inpatient Part B and Outpatient Fee Schedule)SNF Part B billing for inpatients without Part A coverage and for outpatients, including the outpatient fee schedules. | Rev. 10880, August 6, 2021 | 22 pages |
| 8 | Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier ClaimsOutpatient ESRD billing for hospital-based and independent dialysis facilities and physicians, including the ESRD PPS. | Rev. 13740, April 17, 2026 | 90 pages |
| 9 | Rural Health Clinics/ Federally Qualified Health CentersRural health clinic and FQHC claims: visit billing, the all-inclusive rate and FQHC PPS codes. | Rev. 13547, December 18, 2025 | 47 pages |
| 10 | Home Health Agency BillingHome health agency billing: notices of admission, 30-day period claims, HIPPS codes and consolidated billing. | Rev. 13089, February 21, 2025 | 95 pages |
| 11 | Processing Hospice Claims | Rev. 13190, April 24, 2025 | 81 pages |
| 12 | Physicians/Nonphysician Practitioners | Rev. 13316, July 24, 2025 | 217 pages |
| 13 | Radiology Services and Other Diagnostic Procedures | Rev. 13150, April 11, 2025 | 71 pages |
| 14 | Ambulatory Surgical CentersAmbulatory surgical center billing: covered procedures, payment indicators, multiple procedures and device credits. | Rev. 13836, June 24, 2026 | 34 pages |
| 15 | Ambulance | Rev. 13464, November 14, 2025 | 56 pages |
| 16 | Laboratory ServicesLaboratory services: the clinical laboratory fee schedule, specimen collection and travel, CLIA edits and the lab NCDs.Laboratory NCDs and ICD-10 edit lists | Rev. 13746, April 17, 2026 | 82 pages |
| 17 | Drugs and BiologicalsDrugs and biologicals: ASP-based payment, units and the JW and JZ modifiers for discarded amounts.HCPCS drug codes with ASP limits | Rev. 13379, August 21, 2025 | 100 pages |
| 18 | Preventive and Screening ServicesPreventive and screening services: covered tests and visits, frequency limits and cost-sharing waivers.Preventive service NCDs | Rev. 13709, April 2, 2026 | 243 pages |
| 19 | Indian Health ServicesIndian Health Service facility billing under Medicare. | Rev. 11427, May 20, 2022 | 57 pages |
| 20 | Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) | Rev. 12557, March 28, 2024 | 120 pages |
| 21 | Medicare Summary NoticesMedicare Summary Notices: content, messages and the notices beneficiaries receive. | Rev. 13380, August 21, 2025 | 199 pages |
| 22 | Remittance AdviceRemittance advice: the 835, claim adjustment reason and remark codes, and the standard paper remittance.Remittance advice remark codes | Rev. 11427, May 20, 2022 | 20 pages |
| 23 | Fee Schedule Administration and Coding Requirements | Rev. 13701, June 16, 2026 | 126 pages |
| 24 | General EDI and EDI Support Requirements, Electronic Claims, and Mandatory Electronic Filing of Medicare ClaimsEDI and electronic claims: enrollment for EDI, ASCA mandatory electronic filing and its exceptions. | Rev. 13105, April 10, 2025 | 134 pages |
| 25 | Completing and Processing the Form CMS-1450 Data Set | Rev. 12423, December 20, 2023 | 30 pages |
| 26 | Completing and Processing Form CMS-1500 Data Set | Rev. 12779, August 9, 2024 | 78 pages |
| 27 | Contractor Instructions for CWFCommon Working File: contractor instructions for the CWF edits that coordinate claims across contractors. | Rev. 13314, July 24, 2025 | 74 pages |
| 28 | Coordination With Medigap, Medicaid, and Other Complementary InsurersCoordination with Medigap, Medicaid and other complementary insurers, including claim crossover. | Rev. 13314, July 24, 2025 | 109 pages |
| 29 | Appeals of Claims DecisionsAppeals of claims decisions: redetermination, reconsideration, ALJ hearing, Council review and judicial review.Medicare redetermination · Claim adjustment reason codes | Rev. 12423, December 20, 2023 | 103 pages |
| 30 | Financial Liability Protections | Rev. 12934, October 31, 2024 | 195 pages |
| 31 | ANSI X12 Formats Other than Claims or RemittanceANSI X12 transactions other than claims and remittances, such as eligibility and claim status. | Rev. 10236, July 31, 2020 | 11 pages |
| 32 | Billing Requirements for Special Services | Rev. 13808, May 29, 2026 | 338 pages |
| 33 | Miscellaneous Hold Harmless ProvisionsMiscellaneous hold harmless provisions. | Rev. 739, November 1, 2005 | 17 pages |
| 34 | Reopening and Revision of Claim Determinations and DecisionsReopening and revision of claim determinations, including clerical error reopenings. | Rev. 4219, January 25, 2019 | 19 pages |
| 35 | Independent Diagnostic Testing Facility (IDTF)Independent diagnostic testing facility billing. | Rev. 4473, December 6, 2019 | 7 pages |
| 36 | Competitive BiddingDMEPOS competitive bidding program claims processing. | Rev. 11427, May 20, 2022 | 47 pages |
| 37 | Department of Veterans Affairs (VA) Claims Adjudication Services ProjectDepartment of Veterans Affairs claims adjudication project. | Rev. 11427, May 20, 2022 | 7 pages |
| 38 | Emergency Preparedness Fee-For-Service GuidanceEmergency preparedness guidance for fee-for-service claims. | Rev. 10135, May 15, 2020 | 5 pages |
| 39 | Opioid Treatment Programs (OTPs)Opioid treatment program billing for the weekly bundled payments. | Rev. 13572, March 3, 2026 | 15 pages |
How to read a manual chapter
Every chapter opens with a table of contents and a revision line showing the newest transmittal that changed it. Sections are numbered in tens with decimal subsections (the Program Integrity Manual prefixes each number with the chapter, as in 3.2.3), and CMS adds new numbers rather than renumbering, which is what makes a citation durable. Directly under each section heading a revision note gives the transmittal number with its issue, effective and implementation dates, so you can tell at a glance whether a rule changed recently and whether the change reached back to earlier dates of service. Instructions are addressed to the Medicare Administrative Contractors, so a sentence such as “MACs shall deny” tells you both the rule and the edit that enforces it.
The transmittal history at the end of the chapter is the change log. Each row gives the revision, the issue date, a subject line, the implementation date and the change request number; the change request itself, published separately on cms.gov, explains the business requirements contractors had to build. When a chapter refers to another publication, such as a coverage condition in the Benefit Policy Manual or a review rule in the Program Integrity Manual, follow the reference: the manuals are written to be read together, and the guides on this site link the matching chapters. Coverage limits for specific services also sit in national and local coverage determinations; the LCD lookup guide shows how to find the contractor policy that applies.
Where QuickIntell fits with claims processing rules
The Claims Processing Manual is the checklist a clean claim has to pass. QuickRCM covers eligibility, claim readiness, denials, posting and A/R with configurable automation and human review, and QuickCode supports qualified coder review of the coding and modifier questions these chapters answer.
Frequently asked questions
How many chapters does the Medicare Claims Processing Manual have?
The Medicare Claims Processing Manual (Pub. 100-04) has 39 chapters in the copy CMS posted on cms.gov as of September 27, 2026. Each chapter is a separate PDF with its own table of contents and revision history.
Which Claims Processing Manual chapter changed most recently?
Chapter 14, Ambulatory Surgical Centers, carries the newest revision in this build: Rev. 13836, issued June 24, 2026. The table on this page lists the current revision of every chapter.
Which Claims Processing Manual chapters have guides on this site?
14 chapters: 1, 3, 4, 6, 11, 12, 13, 15, 20, 23, 25, 26, 30, 32. A chapter gets a plain-English guide when people search for it by name at least 40 times a month; every other chapter is listed with its official PDF.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- Medicare Claims Processing Manual (Pub. 100-04)Version 39 chapter PDFs; newest revision Rev. 13836 (chapter 14), issued 2026-06-24 · effective 2026-09-27 · file 100-04-claims-processing-manual/*.pdf (39 chapters; SHA-256 of their sha256sum listing)SHA-256 f87bc3bcd9d1570d…
Disclaimer
Operational reference to the CMS Medicare Claims Processing Manual. Chapters change by transmittal; confirm the current chapter PDF on cms.gov before relying on it. Not legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.