JotPsych Notes: payers and codes

How to send Medicare claims from offices in two states

The ZIP code where you saw the patient decides the Medicare contractor for your claim. Each office's claims go to that office's contractor.

Nate Peereboom
Co-founder, JotPsych

Your practice has offices in two states, and Medicare claims from the second office come back unpaid. Find each office's Medicare contractor first.

How Medicare routes claims from one practice with offices in two states

an illustration of the Medicare Claims Processing Manual, chapter 1, section 10.1.1

Visit at the office in state one

Visit

Office one's address

State one's contractor

Visit at the office in state two

Visit

Office two's address

State two's contractor

From section 10.1.1 of Medicare's claims manual. When the two states have different contractors, one practice sends each contractor its own claims.

Look up each office's Medicare contractor. Each Medicare Administrative Contractor (MAC) processes claims for a set area, called a jurisdiction, and Medicare's list of MACs shows which contractor serves each state. Some contractors serve several states, so your two offices may share one contractor.
Put each office's address on its own claims. The ZIP code where you saw the patient decides your claim's contractor, per Medicare's claims manual. Medicare reads that ZIP code from the address in Box 32, the claim form's service facility field. Medicare prices the claim by the same ZIP code. Each of your offices gets its own area's rates.
Send each office's claims to its own contractor. Your staff at one office can send the claims for both offices, but each claim must name the office where the visit happened. Claims that don't name that office come back unprocessable.
Keep billing by office after you reassign payments. Your clinicians may reassign their Medicare payments to your group. Reassignment doesn't change a claim's contractor. Each claim still goes to the contractor for the area where your clinician saw the patient.
Read each contractor's remittance. Your claims sent to the wrong contractor come back unprocessable, with claim adjustment reason code 109 and remark code N104. Send each unprocessable claim again, to the right contractor.

What decides which contractor gets a Medicare claim from a practice with two offices

per the Medicare Claims Processing Manual, chapter 1, revision issued June 11, 2026

Fact on the claim	Decides the contractor?	Manual section
ZIP code of the office where you saw the patient	Yes	10.1.1
The office your staff send claims from	No	10.1.1.A
The group your clinicians reassign payments to	No	10.1.1.3

From chapter 1 of Medicare's claims manual, revision issued June 11, 2026. Check the ZIP code in Box 32, the claim form's service facility field, before you send each claim.

Name the office on every claim, even with both your offices in one state, since some states have more than one Medicare pricing area. The ZIP code rule covers visits outside your office too: your claim for a hospital visit in another state goes to that state's contractor.

In JotPsych, add each office as a service facility, with the ZIP code Medicare reads from Box 32.

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Sources:

Centers for Medicare & Medicaid Services, Medicare Claims Processing Manual, chapter 1, revision 13826, issued June 11, 2026: sections 10.1.1, 10.1.1.A (multiple offices), 10.1.1.3 (reassigned services), and 10.1.9.1 (claims sent to the wrong contractor). Read October 5, 2026.
Centers for Medicare & Medicaid Services, Who are the MACs: A/B MACs process Medicare Part A and Part B claims for a defined area, or jurisdiction. Read October 5, 2026.