Medicare defines a claim as a request for payment of benefits or services a patient gets. Medicare requires health care professionals or suppliers who furnish covered services to submit claims. You can’t charge patients for completing or filing a Medicare claim.
Table 1: How to Submit Fee-for-Service & Medicare Advantage Claims| Submitting Fee-for-Service Claims | Submitting Medicare Advantage Claims |
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| For patients enrolled in Original FFS Medicare, submit claims for services to the appropriate MAC for covered Medicare Part A and Part B services. Contact your MAC if you have questions about the Medicare Program. | For patients enrolled in a Medicare Advantage (MA) plan, submit claims to the patient’s MA plan. To learn more, visit the MA Claims Processing Contacts
webpage. |
To learn more about Part B, click the button below.
Medicare Part B covers the following types of services:
- Physicians' services
- Services and supplies
- Hospital services incident to physicians' services rendered to outpatients and partial
hospitalization services incident to such services
- Diagnostic services
- Outpatient physical therapy services, occupational therapy services, and speech-language
pathology services
- Rural health clinic (RHC) services and Federally Qualified Health Center (FQHC) services
- Home dialysis supplies and equipment, self-care home dialysis support services, and
institutional dialysis services and supplies
- Services furnished by a physician assistant or by a nurse practitioner
- Certified nurse-midwife services
- Qualified psychologist services
- Opioid Use Disorder (OUD) treatment services
- Clinical social worker services
- Preventive services
- Telehealth services
- Lab Tests
- DME
- Ambulance service where using other methods of transportation is contraindicated by the person’s condition
- Prosthetic and orthotic devices, other than dental, that replace all or part of an internal body organ, including colostomy bags and supplies related to colostomy care
- Services of a certified registered nurse anesthetist
- Services covered under Part B when the service doesn't exist under Part A or has been exhausted under Part A
- Services covered under Part B when A/B rebilling is allowed