When billing a Centers for Medicare and Medicaid Services (CMS) program, what will happen to a claim if the most specific code available is not used?
A) Claim will be paid at a lower rate.
B) Claim will not be processed.
C) Claim will be rejected.
D) Claim will be paid with a 10 percent penalty.

Question

Quizplus · Accepted Answer

Claims submitted to the Centers for Medicare and Medicaid Services (CMS) must use the most specific code available to accurately describe the service or item provided. If a less specific code is used, the claim may be rejected because it does not provide sufficient detail to justify the billing, leading to issues in processing and payment.

When Billing a Centers for Medicare and Medicaid Services (CMS)