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PARTIES(S)TRANSMITTAL
Complete and send this form, together with the applicable fee(s), to: Mail Stop ISSUE FEE
Commissioner for Patents
P.O. Box 1450
Alexandria, Virginia 223141450
or Fax
(571)2732885
INSTRUCTIONS:
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How to fill out partbfeestransmittal complete and send
How to fill out partbfeestransmittal complete and send
01
Start by opening the Part B Fee for Service Transmittal form.
02
Fill out the header section of the form, which includes the date, provider name, provider number, and Medicare ID number.
03
Provide the patient's information, including their name, Medicare ID number, and date of birth.
04
Indicate the type of service being provided and the corresponding procedure codes.
05
Document the total charges for each procedure code and indicate any applicable modifiers.
06
Include any additional information or documentation required for the specific service being provided.
07
Double-check all the information for accuracy and completeness.
08
Once the form is filled out, review the submission instructions to determine the appropriate method of sending the completed form.
09
Follow the instructions to either mail or electronically submit the Part B Fee for Service Transmittal form.
10
Retain a copy of the completed form for your records.
Who needs partbfeestransmittal complete and send?
01
Healthcare providers who offer services covered by the Medicare Part B Fee for Service program need to complete and send the Part B Fee for Service Transmittal form. This includes doctors, specialists, outpatient facilities, and other healthcare professionals who bill Medicare for their services.
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