Medicare Claims Processing Manual Chapter 32 Guide

Name: Medicare Claims Processing Manual (Pub. 100-04)
Creator: Centers for Medicare & Medicaid Services
License: https://www.usa.gov/government-works

TL;DR

Chapter 32 of the Medicare Claims Processing Manual is the claims companion to many national coverage determinations. For each covered service, from hyperbaric oxygen and cochlear implants to transcatheter valve procedures, CAR T-cell therapy and anti-amyloid antibodies, it lists the codes, bill types, modifiers, diagnosis requirements and edits contractors use. It also covers clinical trial and investigational device billing and payment for emergency, foreign and nonparticipating hospital services.

Chapter 32 at a glance

Current revision: Rev. 13808; Issued May 29, 2026
Effective: June 9, 2025; Implemented October 22, 2025
Sections: 370; 56 top-level sections
Official PDF: 338 pages; clm104c32.pdf
Transmittals in history: 161; Listed at the end of the chapter
Monthly searches: 40; Google Ads, US, October 2026

What chapter 32 governs for billing

When CMS issues or changes a national coverage determination, the coverage text goes into the NCD manual (Pub. 100-03) and the billing instructions usually come here. Each section of chapter 32 is built the same way: the HCPCS and ICD-10 codes that identify the covered service, the institutional bill types and professional places of service where it can be billed, any required modifiers or condition codes, the coverage with evidence development or registry requirements, and the remittance and Medicare Summary Notice messages contractors use when a claim fails. New sections are added as NCDs are issued; sections 414 to 418, for example, cover transcatheter tricuspid valve replacement, tricuspid edge-to-edge repair, renal denervation and cardiac contractility modulation.

Several sections apply across services. Section 66 covers NCD services that count as a significant cost for Medicare Advantage, which the A/B MAC pays under original Medicare rules even though the patient is enrolled in an MA plan, section 67 explains no-cost claims, section 68 covers billing for items and services in investigational device exemption studies, and section 69 covers routine costs in qualifying clinical trials, including the clinical trial modifiers and identifiers. Sections 350 and 360 cover emergency and foreign hospital services and payment for services from nonparticipating providers.

The service-specific sections include diagnostic blood pressure monitoring (10), wound treatments including platelet-rich plasma (11), tobacco cessation counseling (12), hyperbaric oxygen (30), sacral nerve and deep brain stimulation (40 and 50), home INR monitoring (60), stem cell transplantation (90), cochlear implantation (100), bariatric surgery (150), carotid and intracranial stenting (160 and 161), TAVR (290), transcatheter mitral repair (340), CAR T-cell therapy (400), acupuncture for chronic low back pain (410), anti-amyloid monoclonal antibodies for Alzheimer's disease (412) and home noninvasive ventilation (413 and 416).

Sections billing teams use most

Section numbers and headings are CMS's; the notes are ours. Each section number opens the official chapter 32 PDF at the page where that section starts.

Key sections of Medicare Claims Processing Manual Chapter 32: Billing Requirements for Special Services
Section	CMS heading	Why it matters
66	National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage.	NCD services that count as a significant cost for Medicare Advantage and are paid by the A/B MAC.
68	Investigational Device Exemption (IDE) Studies	Billing for investigational device exemption studies.
69	Qualifying Clinical Trails	Routine costs in qualifying clinical trials and the trial identifiers on claims.
290	Transcatheter Aortic Valve Replacement (TAVR) Furnished on or After May 1, 2012	TAVR billing under coverage with evidence development.
400	Chimeric Antigen Receptor (CAR) T-cell Therapy	CAR T-cell therapy billing on inpatient and outpatient claims.
412	Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease (AD)	Anti-amyloid monoclonal antibodies for Alzheimer's disease and the registry requirement.
414	Transcatheter Tricuspid Valve Replacement (TTVR)	Transcatheter tricuspid valve replacement, one of the chapter's newest sections.

How chapter 32 shows up on claims and denials

Chapter 32 edits are precise, so most denials are mechanical. A claim for an NCD-governed service without a covered diagnosis, the required modifier or condition code, or the right bill type is denied with reason code 50 and remark N386, which states the decision was based on a national coverage determination. Clinical trial and registry services fail when the trial identifier or the clinical trial modifier is missing.

Before appealing, open the chapter 32 section for the service and compare the claim line by line with its code list, bill types and modifiers, then read the NCD itself for the coverage criteria. A coding or format error is fixed by a corrected claim; a coverage failure needs documentation that the patient met the NCD's conditions.

Codes you are likely to see on the remittance when a claim runs into this chapter's rules. The code pages explain each code's meaning, root causes and the usual fix.

Remittance codes associated with Medicare Claims Processing Manual Chapter 32: Billing Requirements for Special Services
Code	Type	When it appears
50	Claim adjustment reason code	Service not covered for the diagnosis or circumstances billed.
N386	Remark code	Decision based on a National Coverage Determination.
4	Claim adjustment reason code	Required modifier missing or inconsistent with the procedure.
16	Claim adjustment reason code	Missing trial identifier, registry information or other required data.

Current revision and recent transmittals

The chapter PDF posted on cms.gov is current through Rev. 13808, issued May 29, 2026, effective June 9, 2025, implemented October 22, 2025 (change request 14177). That revision changed sections 416 (Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)), 416.1 (Coverage), 416.2 (Claims Processing Instructions). Its subject line reads: “Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)”.

The newest rows of the transmittal history printed at the end of the chapter (161 revisions in all). Rows whose subject could not be read reliably from the PDF table are left out; the PDF has the complete list.

Newest transmittals for Medicare Claims Processing Manual Chapter 32: Billing Requirements for Special Services
Revision	Issued	Subject	CR
R13808CP	May 29, 2026	Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)	14177
R13806CP	May 28, 2026	Cardiac Contractility Modulation (CCM) for Heart Failure (HF)	14311
R13802CP	May 28, 2026	NCD 20.40-Renal Denervation (RDN) for Uncontrolled Hypertension	14302
R13801CP	May 28, 2026	NCD 20.38 - Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)	14200
R13800CP	May 28, 2026	NCD 20.37 - Transcatheter Tricuspid Valve Replacement (TTVR)	14149
R13611CP	January 30, 2026	Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)	14177

Sections ordered by the date in the revision note printed under each heading.

Most recently revised sections of Medicare Claims Processing Manual Chapter 32: Billing Requirements for Special Services
Section	Heading	Revision
416	Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)	Rev. 13808, May 29, 2026; effective June 9, 2025
416.1	Coverage	Rev. 13808, May 29, 2026; effective June 9, 2025
416.2	Claims Processing Instructions	Rev. 13808, May 29, 2026; effective June 9, 2025
418	Cardiac Contractility Modulation (CCM) for Heart Failure (HF)	Rev. 13806, May 28, 2026; effective October 28, 2025
418.1	Coding Requirements for Cardiac Contractility Modulation (CCM) for Heart Failure (HF)	Rev. 13806, May 28, 2026; effective October 28, 2025
418.2	Claims Processing Instructions for Cardiac Contractility Modulation (CCM) for Heart Failure (HF) Professional Claims	Rev. 13806, May 28, 2026; effective October 28, 2025
418.3	Claims Processing Instructions for Cardiac Contractility Modulation (CCM) for Heart Failure (HF) Institutional Claims	Rev. 13806, May 28, 2026; effective October 28, 2025
418.4	Messages	Rev. 13806, May 28, 2026; effective October 28, 2025

Section index

Every section in the chapter's table of contents, grouped under its top-level heading, with the PDF page where it starts. Open a heading to see its subsections.

10 Diagnostic Blood Pressure Monitoring · p. 11 · 1 subsections

Open section 10 in the PDF
10.1 Ambulatory Blood Pressure Monitoring (ABPM) Billing Requirements · p. 11

11 Wound Treatments · p. 13 · 8 subsections

Open section 11 in the PDF
11.1 Electrical Stimulation · p. 13
11.2 Electromagnetic Therapy · p. 15
11.3 Autologous Platelet-Rich Plasma (PRP) for Chronic Non-Healing Wounds · p. 16
11.3.1 Policy · p. 17
11.3.2 Healthcare Common Procedure Coding System (HCPCS) Codes and Diagnosis Coding · p. 17
11.3.3 Types of Bill (TOB) · p. 20
11.3.5 Place of Service (POS) for Professional Claims · p. 20
11.3.6 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claim Adjustment Reason Codes (CARCs) and Group Codes · p. 20

12 Counseling to Prevent Tobacco Use · p. 22 · 8 subsections

Open section 12 in the PDF
12.1 Counseling to Prevent Tobacco Use HCPCS and Diagnosis Coding · p. 22
12.2 Counseling to Prevent Tobacco Use A/B MAC (B) Billing Requirements · p. 24
12.3 A/B MAC (A) Billing Requirements · p. 25
12.4 Remittance Advice (RA) Notices · p. 27
12.5 Medicare Summary Notices (MSNs) · p. 27
12.6 Post-Payment Review for Counseling To Prevent Tobacco Use Services · p. 27
12.7 Common Working File (CWF) Inquiry · p. 27
12.8 Provider Access to Counseling To Prevent Tobacco Use Services Eligibility Data · p. 28

20 Billing Requirements for Coverage of Kidney Disease Patient Education Services · p. 28 · 4 subsections

Open section 20 in the PDF
20.1 Additional Billing Requirements Applicable to Claims Submitted to Fiscal Intermediaries (FIs) · p. 28
20.2 Healthcare Common Procedure Coding System (HCPCS) Procedure Codes and Applicable Diagnosis Codes · p. 29
20.3 Medicare Summary Notices (MSNs) and Claim Adjustment Reason Codes (CARCs) · p. 29
20.4 Advance Beneficiary Notice (ABN) Information · p. 30

30 Hyperbaric Oxygen (HBO) Therapy · p. 30 · 2 subsections

Open section 30 in the PDF
30.1 Billing Requirements for HBO Therapy for the Treatment of Diabetic Wounds of the Lower Extremities · p. 30
30.2 Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Application of Oxygen) · p. 32

40 Sacral Nerve Stimulation · p. 33 · 9 subsections

Open section 40 in the PDF
40.1 Coverage Requirements · p. 33
40.2 Billing Requirements · p. 33
40.2.1 Healthcare Common Procedural Coding System (HCPCS) · p. 34
40.2.2 Payment Requirements for Test Procedures (HCPCS Codes 64585, 64590 and 64595) · p. 34
40.2.3 Payment Requirements for Device Codes A4290, E0752 and E0756 · p. 35
40.2.4 Payment Requirements for Codes C1767, C1778, C1820, C1883 and C1897 · p. 35
40.3 Bill Types · p. 35
40.4 Revenue Codes · p. 35
40.5 Claims Editing · p. 35

50 Deep Brain Stimulation for Essential Tremor and Parkinson's Disease · p. 36 · 16 subsections

Open section 50 in the PDF
50.1 Coverage Requirements · p. 36
50.2 Billing Requirements · p. 38
50.2.1 Part A Intermediary Billing Procedures · p. 38
50.3 Payment Requirements · p. 38
50.3.1 Part A Payment Methods · p. 38
50.3.2 Bill Types · p. 38
50.3.3 Revenue Codes · p. 38
50.4 Allowable Codes · p. 38
50.4.1 Allowable Covered Diagnosis Codes · p. 38
50.4.2 Allowable Covered Procedure Codes · p. 39
50.4.3 Healthcare Common Procedure Coding System (HCPCS) · p. 40
50.5 Ambulatory Surgical Centers · p. 41
50.6 Claims Editing for Intermediaries · p. 41
50.7 Remittance Advice Notice for A/B MACs (A) · p. 41
50.8 Medicare Summary Notices (MSN) Messages for Intermediaries · p. 41
50.9 Provider Notification · p. 42

60 Coverage and Billing for Home Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management · p. 42 · 18 subsections

Open section 60 in the PDF
60.1 Coverage Requirements · p. 42
60.2 Intermediary Payment Requirements · p. 43
60.2.1 Part A Payment Methods · p. 43
60.3 Intermediary Billing Procedures · p. 43
60.3.1 Bill Types · p. 43
60.3.2 Revenue Codes · p. 43
60.4 Intermediary Allowable Codes · p. 43
60.4.1 Allowable Covered Diagnosis Codes · p. 43
60.4.2 Healthcare Common Procedure Coding System (HCPCS) for Intermediaries · p. 46
60.5 Carrier Billing Instructions · p. 47
60.5.1 HCPCS for Carriers · p. 47
60.5.2 Applicable Diagnosis Codes for A/B MACs (B) · p. 48
60.6 Carrier Claims Requirements · p. 51
60.7 Carrier Payment Requirements · p. 51
60.8 Carrier and Intermediary General Claims Processing Instructions · p. 51
60.8.1 Remittance Advice Notices · p. 52
60.8.2 Medicare Summary Notice (MSN) Messages · p. 52
60.12 Coverage for PET Scans for Dementia and Neurodegenerative Diseases · p. 52

66 National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage. · p. 55 · 2 subsections

Open section 66 in the PDF
66.1 Institutional Billing for National Coverage Determination (NCDs) services that are considered a significant cost for Medicare Advantage · p. 55
66.2 Services Identified as having Significant Cost for Medicare Advantage · p. 56

67 No Cost Claims · p. 56 · 3 subsections

Open section 67 in the PDF
67.1 Practitioner Billing for No Cost Items · p. 56
67.2 Institutional Billing for No Cost Items · p. 56
67.2.1 Billing No Cost Items Due to Recall, Replacement, or Free Sample · p. 57

68 Investigational Device Exemption (IDE) Studies · p. 58 · 3 subsections

Open section 68 in the PDF
68.1 Billing Requirements for Providers Billing for Routine Care Items and Services in Category A IDE Studie · p. 58
68.2 Billing Requirements for Providers Billing for Category B IDE Devices and Routine Care Items and Services in Category B IDE Studies · p. 60
68.4 Billing Requirements for Providers Billing Routine Costs of Clinical Trials Involving a Category B IDE

69 Qualifying Clinical Trails · p. 65 · 11 subsections

Open section 69 in the PDF
69.1 General · p. 65
69.2 Payment for Qualifying Clinical Trial Services · p. 66
69.3 Medical Records Documentation Requirements · p. 66
69.4 Local Medical Review Policy · p. 66
69.5 Billing Requirements - General · p. 66
69.6 Requirements for Billing Routine Costs of Clinical Trials · p. 67
69.7 Reserved for Future Use · p. 70
69.8 Handling Erroneous Denials of Qualifying Clinical Trial Services · p. 70
69.9 Billing and Processing Fee for Service Claims for Covered Clinical Trial Services Furnished to Managed Care Enrollees · p. 70
69.10 CWF Editing Of Clinical Trial Claims For Managed Care Enrollees · p. 71
69.11 Resolution of CWF UR 5232 Rejects · p. 71

70 Billing Requirements for Islet Cell Transplantation for Beneficiaries in a National Institutes of Health (NIH) Clinical Trial · p. 71 · 5 subsections

Open section 70 in the PDF
70.1 Healthcare Common Procedure Coding System (HCPCS) Codes for Carriers · p. 72
70.2 Applicable Modifier for Islet Cell Transplant Claims for Carriers · p. 72
70.3 Special Billing and Payment Requirements for Carriers · p. 72
70.4 Special Billing and Payment Requirements for A/B MACs (A) · p. 72
70.5 Special Billing and Payment Requirements Medicare Advantage (MA) Beneficiaries · p. 76

80 Billing of the Diagnosis and Treatment of Peripheral Neuropathy with Loss of Protective Sensation in People with Diabetes · p. 77 · 8 subsections

Open section 80 in the PDF
80.1 General Billing Requirements · p. 77
80.2 Applicable HCPCS Codes · p. 77
80.3 Diagnosis Codes · p. 79
80.4 Payment · p. 79
80.5 Applicable Revenue Codes · p. 80
80.6 Editing Instructions for A/B MACs (A) · p. 80
80.7 CWF General Information · p. 81
80.8 CWF Utilization Edits · p. 82

90 Stem Cell Transplantation · p. 83 · 7 subsections

Open section 90 in the PDF
90.1 General · p. 108
90.2 HCPCS and Diagnosis Coding - ICD-9-CM Applicable · p. 109
90.2.1 HCPCS and Diagnosis Coding for Stem Cell Transplantation - ICD-10-CM Applicable · p. 110
90.3 Non-Covered Conditions · p. 114
90.4 Edits · p. 114
90.5 Suggested MSN and RA Messages · p. 115
90.6 Clinical Trials for Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome (MDS) · p. 115

100 Billing Requirements for Expanded Coverage of Cochlear Implantation · p. 117 · 7 subsections

Open section 100 in the PDF
100.1 A/B MACs (Part A) Billing Procedures · p. 118
100.1.1 Applicable Bill Types · p. 118
100.1.2 Special Billing Requirements for A/B MACs (A) for Inpatient Billing · p. 118
100.2 A/B MACs (Part A) Payment Requirements · p. 118
100.3 A/B MACs (Part B) Billing Procedures · p. 118
100.4 Healthcare Common Procedural Coding System (HCPCS) · p. 119
100.5 Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), Group Codes, and Medicare Summary Notice (MSN) Messages · p. 120

110 Coverage and Billing for Ultrasound Stimulation for Nonunion Fracture Healing · p. 122 · 5 subsections

Open section 110 in the PDF
110.1 Coverage Requirements · p. 122
110.2 Intermediary Billing Requirements · p. 122
110.3 Bill Types · p. 123
110.4 Carrier and Intermediary Billing Instructions · p. 123
110.5 DMERC Billing Instructions · p. 123

120 Presbyopia-Correcting (P-C IOLS) and Astigmatism-Correcting Intraocular Lenses (A-C IOLs) (General Policy Information) · p. 123 · 4 subsections

Open section 120 in the PDF
120.1 Payment for Services and Supplies · p. 124
120.2 Coding and General Billing Requirements · p. 125
120.3 Provider Notification Requirements · p. 126
120.4 Beneficiary Liability · p. 127

130 External Counterpulsation (ECP) Therapy · p. 127 · 2 subsections

Open section 130 in the PDF
130.1 Billing and Payment Requirements · p. 127
130.2 Special Intermediary Billing and Payment Requirements · p. 129

140 Cardiac Rehabilitation (CR) Programs, Intensive Cardiac Rehabilitation (ICR) Programs, and Pulmonary Rehabilitation (PR) Programs On or After January 1, 2024 · p. 129 · 21 subsections

Open section 140 in the PDF
140.1 CR Program Services Furnished On or Before Dec. 31, 2009 · p. 129
140.1.1 Coding Requirements for CR Services Furnished On or Before Dec. 31, 2009 · p. 130
140.2 CR Program Services Effective for Dates of Service On or After January 1, 2024 · p. 130
140.2.1 Coding Requirements for CR Services Furnished On or After January 1, 2010 · p. 131
140.2.2 Claims Processing Requirements for Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Services Furnished On or After January 1, 2010 · p. 132
140.2.2.1 Correct Place of Service (POS) Codes for CR and ICR Services on Professional Claims · p. 133
140.2.2.2 Requirements for CR and ICR Services on Institutional Claims · p. 133
140.2.2.3 Frequency Edits for CR and ICR Claims · p. 134
140.2.2.4 Edits for CR Services Exceeding 36 Sessions · p. 134
140.2.2.5 Edits for ICR Services Exceeding 126 Days and 72 Sessions · p. 135
140.2.2.6 Supplier Specialty Code 31 Requirements for ICR Claims · p. 135
140.3 ICR Program Services Effective for Dates of Service On or After January 1, 2024 · p. 136
140.3.1 Coding Requirements for ICR Services Furnished On or After January 1, 2010 · p. 137
140.4 PR Program Services Effective for Dates of Service On or After January 1, 2024 · p. 138
140.4.1 Coding Requirements for PR Services Furnished On or After January 1, 2010 · p. 138
140.4.2 Claims Processing Requirements for Pulmonary Rehabilitation (PR) Services Furnished On or After January 1, 2010 · p. 139
140.4.2.1 Correct Place of Service (POS) Codes for PR Services on Professional Claims · p. 139
140.4.2.2 Requirements for PR Services on Institutional Claims · p. 140
140.4.2.3 Daily Frequency Edits for PR Claims · p. 140
140.4.2.4 Edits for PR Services Exceeding 36 Sessions · p. 141
140.4.2.5 Edits for PR Services Exceeding 72 Sessions · p. 141

150 Billing Requirements for Bariatric Surgery for Morbid Obesity · p. 142 · 10 subsections

Open section 150 in the PDF
150.1 General · p. 142
150.2 HCPCS Procedure Codes for Bariatric Surgery · p. 143
150.3 ICD Procedure Codes for Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity (A/MACs only) · p. 144
150.4 ICD Diagnosis Codes for Bariatric Surgery · p. 151
150.5 ICD Diagnosis Codes for BMI ≥35 · p. 151
150.5.1 ICD Codes for Type II Diabetes Mellitus Complication · p. 152
150.6 Claims Guidance for Payment · p. 157
150.7 Medicare Summary Notices (MSNs) and Claim Adjustment Reason Codes · p. 158
150.8 B/MAC Billing Requirements
150.9 Advance Beneficiary Notice and HINN Information · p. 159

160 PTA for Implanting the Carotid Stent · p. 159 · 5 subsections

Open section 160 in the PDF
160.1 Category B Investigational Device Exemption (IDE) Study Coverage · p. 159
160.2 Post-Approval Study Coverage · p. 160
160.2.1 Carotid Artery Stenting (CAS) Post-Approval Extension Studies · p. 160
160.3 Carotid Artery Stenting (CAS) With Embolic Protection Coverage · p. 165
160.4 510k Post-Approval Extension Studies using 510k-Cleared Embolic Protection Devices during Carotid Artery Stenting (CAS) Procedures

161 Intracranial PTA With Stenting · p. 166

Open section 161 in the PDF

170 Billing Requirements for Lumbar Artificial Disc Replacement · p. 171 · 5 subsections

Open section 170 in the PDF
170.1 General · p. 172
170.2 Carrier Billing Requirements · p. 172
170.3 A/B MAC (A) Billing Requirements · p. 173
170.4 Reasons for Denial and Medicare Summary Notice (MSN), Claim Adjustment Reason Code Messages and Remittance Advice Remark Code · p. 173
170.5 Advance Beneficiary Notice (ABN and Hospital Issued Notice of Noncoverage (HINN) Information · p. 174

180 Cryosurgery of the Prostate Gland · p. 174 · 5 subsections

Open section 180 in the PDF
180.1 Coverage Requirements · p. 174
180.2 Billing Requirements · p. 175
180.3 Payment Requirements · p. 175
180.4 Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Group Codes, and Medicare Summary Notice Messages · p. 176
180.5 Additional CWF and Contractor Requirements · p. 179

190 Billing Requirements for Extracorporeal Photopheresis · p. 180 · 4 subsections

Open section 190 in the PDF
190.1 Applicable Intermediary Bill Types · p. 180
190.2 Healthcare Common Procedural Coding System (HCPCS), Applicable Diagnosis Codes and Procedure Code · p. 180
190.3 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RAs) and Claim Adjustment Reason Coded · p. 182
190.4 Advance Beneficiary Notice and Hospital Issued Notice of Noncoverage Information · p. 183

200 Billing Requirements for Vagus Nerve Stimulation (VNS) · p. 184 · 6 subsections

Open section 200 in the PDF
200.1 General · p. 184
200.2 ICD-9 Diagnosis Codes for Vagus Nerve Stimulation (Covered since DOS on and after July 1, 1999) · p. 184
200.3 Carrier/MAC Billing Requirements · p. 186
200.4 Fiscal Intermediary Billing Requirements · p. 186
200.5 Medicare Summary Notice (MSN), Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) Messages · p. 186
200.6 Advance Beneficiary Notice and HINN Information · p. 187

210 Billing Requirements for Continuous Positive Airway Pressure (CPAP) for Obstructive Sleep Apnea (OSA) · p. 187

Open section 210 in the PDF

220 Billing Requirements for Thermal Intradiscal Procedures (TIPs) Claims · p. 187 · 4 subsections

Open section 220 in the PDF
220.1 General · p. 187
220.2 Contractors, A/B Medicare Administrative Contractors (MACs) · p. 187
220.3 Medicare Summary Notice (MSN), Claim Adjustment Reason Code (CARC), and Remittance Advise Remark Code (RARC) · p. 188
220.4 Advanced Beneficiary Notice (ABN) · p. 188

230 Billing Wrong Surgical or Other Invasive Procedures Performed on a Patient, Surgical or Other Invasive Procedures Performed on the Wrong Body Part, and Surgical or Other Invasive Procedures Performed on the Wrong Patient · p. 188

Open section 230 in the PDF

240 Special Instructions for Certain Claims with a Gender/Procedure Conflict · p. 190 · 2 subsections

Open section 240 in the PDF
240.1 Billing Instructions for Institutional Providers · p. 190
240.2 Billing Instructions for Physicians and Non-Physician Practitioners · p. 191

250 Pharmacogenomic Testing for Warfarin Response · p. 191 · 3 subsections

Open section 250 in the PDF
250.1 Coverage Requirements · p. 191
250.2 Billing Requirements · p. 191
250.3 Payment Requirements · p. 192

260 Dermal Injections for Treatment of Facial Lipodystophy Syndrome (FLS) · p. 193 · 5 subsections

Open section 260 in the PDF
260.1 Policy · p. 193
260.2 Billing Instructions · p. 194
260.2.1 Hospital Billing Instructions · p. 194
260.2.2 Practitioner Billing Instructions · p. 195
260.3 Claims Processing System Editing · p. 196

270 Claims Processing for Implantable Automatic Defibrillators · p. 197 · 2 subsections

Open section 270 in the PDF
270.1 Coding Requirements for Implantable Automatic Defibrillators · p. 197
270.2 Billing Requirements for Patients Enrolled in a Data Collection System · p. 199

280 Autologous Cellular Immunotherapy Treatment of Metastatic Prostate Cancer · p. 201 · 5 subsections

Open section 280 in the PDF
280.1 Policy · p. 201
280.2 Healthcare Common Procedure Coding System (HCPCS) Codes and Diagnosis Coding · p. 201
280.3 Types of Bill (TOB) and Revenue Codes · p. 204
280.4 Payment Method · p. 204
280.5 Medicare Summary Notices (MSNs), Remittance Advice Remark Codes (RARCs), Claims Adjustment Reason Codes (CARCs), and Group Codes · p. 205

290 Transcatheter Aortic Valve Replacement (TAVR) Furnished on or After May 1, 2012 · p. 206 · 5 subsections

Open section 290 in the PDF
290.1 Coding Requirements for TAVR Furnished on or After May 1, 2012, through December 31, 2012 · p. 206
290.1.1 Coding Requirements for TAVR Services Furnished On or After January 1, 2013 · p. 206
290.2 Claims Processing Requirements for TAVR Services on Professional Claims · p. 207
290.3 Claims Processing Requirements for TAVR Services on Inpatient Hospital Claims · p. 209
290.4 Claims Processing Requirements for TAVR Services for Medicare Advantage (MA) Plan Participants · p. 210

300 Billing Requirements for Ocular Photodynamic Therapy (OPT) with Verteporfin · p. 210 · 4 subsections

Open section 300 in the PDF
300.1 Coding Requirements for OPT with Verteporfin · p. 210
300.2 Claims Processing Requirements for OPT with Verteporfin Services on Professional Claims and Outpatient Facility Claims · p. 211
300.3 Claims Processing Requirements for OPT with Verteporfin Services on Inpatient Facility Claims · p. 213
300.4 Medicare Summary Notice (MSN) and Remittance Advice (RA) Messages · p. 213

310 Transesophageal Doppler Used for Cardiac Monitoring · p. 213 · 3 subsections

Open section 310 in the PDF
310.1 Coding Requirements for Transesophageal Doppler Cardiac Monitoring Furnished Before October 1, 2012 · p. 214
310.2 Coding Requirements for Transesophageal Doppler Monitoring Furnished On or After October 1, 2012 · p. 214
310.3 Correct Place of Service (POS) Code for Transesophageal Doppler Cardiac Monitor Services on Professional Claims · p. 215

320 Artificial Hearts and Related Devices · p. 215 · 7 subsections

Open section 320 in the PDF
320.1 Coding Requirements for Artificial Hearts Furnished Before May 1, 2008 · p. 215
320.2 Coding Requirements for Artificial Hearts Furnished After May 1, 2008 · p. 215
320.3 Ventricular Assist Devices (VADs) · p. 223
320.3.1 Postcardiotomy · p. 224
320.3.2 Bridge-to-Transplantation (BTT) · p. 224
320.3.3 Other · p. 224
320.3.4 Replacement Accessories and Supplies for External VADs or Any VAD · p. 230

330 Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS) · p. 233 · 2 subsections

Open section 330 in the PDF
330.1 Claims Processing Requirements for Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS) on Professional Claims · p. 233
330.2 Claims Processing Requirements for PILD for Outpatient Facilities · p. 236

340 Transcatheter Mitral Valve Repair (TMVR) · p. 236 · 4 subsections

Open section 340 in the PDF
340.1 Coding Requirements for TMVR for Mitral Valve TEER Claims Furnished on or After August 7, 2014 · p. 237
340.2 Claims Processing Requirements for Mitral Valve TEER Services on Professional Claims · p. 238
340.3 Claims Processing Requirements for Mitral Valve TEER Services on Inpatient Hospital Claims · p. 239
340.4 Claims Processing Requirements for Mitral Valve TEER Services for Medicare Advantage (MA) Plan Participants · p. 240

350 Emergency and Foreign Hospital Services · p. 240 · 19 subsections

Open section 350 in the PDF
350.1 Services Rendered By Nonparticipating Providers · p. 240
350.2 Establishing an Emergency · p. 242
350.3 Qualifications of an Emergency Services Hospital · p. 243
350.4 Coverage Requirements for Emergency Hospital Services Furnished Outside of the United States · p. 243
350.5 Services Furnished in a Foreign Hospital Nearest to Beneficiary's U.S. Residence · p. 244
350.6 Coverage of Physician and Ambulance Services Furnished Outside U.S. · p. 245
350.7 Claims for Services Furnished in Canada to Qualified Railroad Retirement Beneficiaries · p. 246
350.8 Claims from Hospital-Leased Laboratories Not Meeting Conditions of Participation · p. 246
350.9 Nonemergency Part B Medical and Other Health Services · p. 247
350.10 Elections to Bill for Services Rendered By Nonparticipating Hospitals · p. 248
350.11 Processing Claims · p. 249
350.11.1 Contractors Designated to Process Foreign Claims · p. 250
350.11.2 Contractor Processing Guidelines · p. 251
350.11.3 Medicare Approved Charges for Services Rendered in Canada or Mexico · p. 251
350.11.4 Accessibility Criteria · p. 251
350.11.5 Medical Necessity · p. 253
350.11.6 Time Limitation on Emergency and Foreign Claims · p. 255
350.11.7 Payment Denial for Medicare Services Furnished to Alien Beneficiaries Who Are Not Lawfully Present in the United States · p. 256
350.12 Appeals on Claims for Emergency and Foreign Services · p. 257

360 Payment for Services Received By Nonparticipating Providers · p. 257 · 12 subsections

Open section 360 in the PDF
360.1 Payment for Services from Foreign Hospitals · p. 260
360.1.1 Attending Physician's Statement and Documentation of Medicare Emergency · p. 260
360.2 Designated Contractors · p. 261
360.3 Model Letters, Nonparticipating Hospital and Emergency Claims · p. 261
360.3.1 Model Letter to Nonparticipating Hospital That Elected to Bill For Current Year · p. 261
360.3.2 Model Letter to Nonparticipating Hospital That Did Not Elect to Bill for Current Year · p. 261
360.3.3 Model Letter to Nonparticipating Hospital That Requests to Bill the Program · p. 262
360.3.4 Full Denial - Hospital-Filed or Beneficiary-Filed Emergency Claim · p. 263
360.3.5 Partial Denial - Hospital-Filed or Beneficiary-Filed Emergency Claim · p. 264
360.3.6 Denial - Military Personnel/Eligible Dependents · p. 265
360.3.7 Full Denial - Shipboard Claim - Beneficiary filed · p. 266
360.3.8 Full Denial - Foreign Claim - Beneficiary Filed · p. 267

370 Microvolt T-wave Alternans (MTWA) · p. 268 · 2 subsections

Open section 370 in the PDF
370.1 Coding and Claims Processing for MTWA · p. 268
370.2 Messaging for MTWA · p. 270

380 Leadless Pacemakers · p. 270 · 5 subsections

Open section 380 in the PDF
380.1 Leadless Pacemaker Coding and Billing Requirements for Professional Claims · p. 270
380.1.1 Leadless Pacemaker Place of Service Restrictions · p. 271
380.1.2 Leadless Pacemaker Modifier · p. 271
380.1.3 Leadless Pacemaker Additional Claim Billing Information · p. 271
380.2 Leadless Pacemaker Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Medicare Summary Notice (MSN) Messages · p. 271

390 Supervised exercise therapy (SET) of Symptomatic Peripheral Artery Disease · p. 272 · 5 subsections

Open section 390 in the PDF
390.1 General Billing Requirements · p. 273
390.2 Coding Requirements for SET · p. 273
390.3 Special Billing Requirements for Institutional Claims · p. 274
390.4 Common Working File (CWF) Requirements · p. 274
390.5 Applicable Medicare Summary Notice (MSN), Remittance Advice Remark Codes (RARC) and Claim Adjustment Reason Code (CARC) Messaging · p. 275

400 Chimeric Antigen Receptor (CAR) T-cell Therapy · p. 277 · 11 subsections

Open section 400 in the PDF
400.1 Coverage Requirements · p. 278
400.2 Billing Requirements · p. 278
400.2.1 A/B Medicare Administrative Contractor (MAC) (A) Bill Types · p. 278
400.2.2 A/B MAC (A) Revenue Codes · p. 279
400.2.3 A/B MAC Billing Healthcare Common Procedural Coding System (HCPCS) Codes · p. 279
400.2.3.1 A/B MAC (B) Places of Service (POS) · p. 280
400.2.4 A/B MAC Diagnosis Requirements · p. 280
400.2.5 Billing Information for Professional Claims · p. 282
400.3 Payment Requirements · p. 283
400.4 Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs),Group Codes, and Medicare Summary Notice (MSN) Messages · p. 286
400.5 Claims Editing · p. 288

410 Acupuncture for Chronic Low Back Pain (cLBP) · p. 288 · 5 subsections

Open section 410 in the PDF
410.1 Coverage Requirements
410.2 Claims Processing General Information · p. 289
410.3 Institutional Claims Bill Type and Revenue Coding Information · p. 289
410.4 Messaging · p. 290
410.5 Common Working File (CWF) Editing · p. 291

411 Home Infusion Therapy Services · p. 292 · 6 subsections

Open section 411 in the PDF
411.1 Policy · p. 292
411.2 Coverage Requirements · p. 292
411.3 Home Infusion Drugs: Healthcare Common Procedural Coding System (HCPCS) Drug Codes · p. 292
411.4 Billing and Payment Requirements · p. 296
411.5 Return as Un-Processable, Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Group Codes, and Medicare Summary Notice Messages · p. 299
411.6 CWF and MCS Editing Requirements · p. 300

412 Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease (AD) · p. 301 · 3 subsections

Open section 412 in the PDF
412.1 Coding Information · p. 301
412.2 Claim Processing Instructions · p. 301
412.3 Messaging · p. 302

413 Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD) · p. 303 · 2 subsections

Open section 413 in the PDF
413.1 Coverage · p. 303
413.2 Claims Processing Instructions · p. 304

414 Transcatheter Tricuspid Valve Replacement (TTVR) · p. 304 · 4 subsections

Open section 414 in the PDF
414.1 Coding Requirements for TTVR · p. 304
414.2 Claims Processing Instructions for TTVR Professional Claims · p. 305
414.3 Claims Processing Instructions for TTVR Institutional Claims · p. 305
414.4 Messages · p. 306

415 Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER) · p. 307 · 4 subsections

Open section 415 in the PDF
415.1 Coding Requirements for T-TEER · p. 307
415.2 Claims Processing Instructions for T-TEER Professional Claims · p. 307
415.3 Claims Processing Instructions for T-TEER Institutional Claims · p. 308
415.4 Messages · p. 308

416 Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD) · p. 309 · 4 subsections

Open section 416 in the PDF
416.1 Coverage · p. 309
416.2 Claims Processing Instructions · p. 309
416.3 Claims Processing Instructions for Cardiac Contractility Modulation (CCM) for Heart Failure (HF) Institutional Claims
416.4 Messages

417 Renal Denervation (RDN) for Uncontrolled Hypertension 417. 1 Coding Requirements · p. 310 · 3 subsections

Open section 417 in the PDF
417.2 Special Intermediary Claims Processing Requirements · p. 312
417.3 Special Professional Billing Requirements · p. 312
417.4 Messaging · p. 312

418 Cardiac Contractility Modulation (CCM) for Heart Failure (HF) · p. 314 · 4 subsections

Open section 418 in the PDF
418.1 Coding Requirements for Cardiac Contractility Modulation (CCM) for Heart Failure (HF) · p. 314
418.2 Claims Processing Instructions for Cardiac Contractility Modulation (CCM) for Heart Failure (HF) Professional Claims · p. 316
418.3 Claims Processing Instructions for Cardiac Contractility Modulation (CCM) for Heart Failure (HF) Institutional Claims · p. 316
418.4 Messages · p. 317

Using this chapter in a denial or appeal

Start with the remittance. The claim adjustment reason code says what happened to the line, the remark code narrows it, and the group code says who is liable. Match that to the section of the chapter that sets the rule, then read the section in the official PDF rather than a summary: the wording that matters, such as a time limit, a modifier requirement or a documentation element, is usually a single sentence. Check the revision note under the section heading, because a rule that changed after the date of service may not apply to the claim, and an effective date earlier than the issue date can make a new rule reach back.

When the chapter supports the claim, cite it precisely in the redetermination request: the publication number, chapter, section and revision. When it does not, the fix is usually a corrected claim or better documentation rather than an appeal, and a coding or format rejection is corrected and resubmitted because it carries no appeal rights. Manual instructions bind the Medicare Administrative Contractor, so they settle most first-level disputes; at the hearing level, administrative law judges give them substantial deference without being bound by them. If the issue turns on whether a service is covered at all, read the matching Benefit Policy Manual chapter and any national coverage determination or local coverage determination as well, because coverage and billing rules are written in different places.

How QuickIntell works with Claims Processing Manual chapter 32

QuickRCM covers eligibility, claim readiness, denials, posting and A/R with configurable automation and human review, which is where the billing rules in this chapter are checked before a claim goes out. QuickCode supports qualified coder review of the coding and modifier questions the chapter answers.

See QuickRCM for claim readiness See QuickCode for coder review Book a meeting

Frequently asked questions: chapter 32

Why do NCD billing instructions sit in chapter 32?

CMS publishes the coverage decision in the NCD manual (Pub. 100-03) and the claims processing instructions, such as codes, bill types, modifiers and edits, in chapter 32 of the Claims Processing Manual, usually through the same change request.

Where are the clinical trial billing rules?

Chapter 32 section 69 covers routine costs in qualifying clinical trials, and section 68 covers investigational device exemption studies, including the identifiers and modifiers the claim must carry.

Does chapter 32 cover CAR T-cell therapy?

Yes. Section 400 gives the billing instructions for CAR T-cell therapy, which is covered under NCD 110.24.

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, Chapter 32: Billing Requirements for Special Services
Version Rev. 13808, issued 2026-05-29 · effective 2025-06-09 · file clm104c32.pdfSHA-256 4b97c91824f4f86e…
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

This guide summarizes a CMS manual chapter in our own words for billing teams; section headings and transmittal subjects are quoted from the chapter PDF. The chapter itself is the authority, and it changes by transmittal. 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.

Medicare Claims Processing Manual Chapter 32: Billing Requirements for Special Services