How to Fill Out a HCFA Form: Units, Charges, and NPI Placement
Short answer: The units column and the charge column ask for two different things. One hour of a fifteen minute timed code is four units, and the charge box needs the total for all four units, not the rate for one. Put your NPI on each service line and again at the bottom of the form with your name, your credentials, and your contact phone number. Leave the service facility location blank when that information is the same as what is in box 33.
Where a hand filled HCFA goes wrong
Two things cause most of the trouble. The charge column gets the per unit rate instead of the total for the units billed, so the claim is underbilled and nobody catches it. And the NPI makes it onto the service lines but not the bottom of the form, or the other way around, so the claim rejects over a field that was almost right.
There is also a smaller point worth knowing before you start. You may not have to be filling one of these out by hand at all.
The steps
Enter the number of units for the service. For a fifteen minute timed code, one hour is four units.
Enter the charge for all of the units billed, not the rate for a single unit.
Worked example from the video: four units at forty dollars each is a line charge of one hundred sixty dollars. One hundred sixty is what goes in the charge box for that line.
Let the form total the service lines from there.
Use your own fee schedule. The figures above are examples only.
At the bottom of the form, add your name.
Add your credentials.
Add your NPI number.
Add your contact phone number.
Put your NPI number on each service line.
Put your NPI number at the bottom of the form as well. Both locations are needed.
Leave the service facility location alone. There is no longer a need to complete it as long as that information is the same as what is in box 33.
Consider not handwriting these at all. Office Ally Service Center includes a free service where you type the person's information in rather than handwriting the form.
Sign up for your own account to use it. Once you do, the information is filled out and stored for you, so chart notes and billing information do not have to be written out by hand.
Why the units column deserves a second look
Anyone billing in fifteen minute units should treat that column as a calculation, not a lookup. The form accepts a per unit rate next to a units count of four without complaint. Nothing flags it, because nothing is technically wrong with the numbers on their own.
The mistake this prevents
An underbilled claim is expensive precisely because it works. A rejected claim comes back and demands attention. An underbilled claim quietly pays less than it should, month after month, and the pattern only surfaces when somebody runs a practice analysis by CPT code and wonders why a timed code earns so much less than expected. The facility line runs in the opposite direction. When the service facility location duplicates the information in box 33, completing it is what triggers the rejection, so the correct action is to leave it blank. Filling in every field on a form is a reasonable instinct and it is wrong here. Check both ends of the form before it leaves your desk.
More Office Ally training
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Medical Receptionist and Biller Course: mariematteson.com/medcourse
Marie Matteson, MS, is a healthcare consultant, educator, and Office Ally specialist with more than 30 years in healthcare, emergency medicine, and practice management. Helping you understand what's really going on.
All patient and practice information referenced here has been redacted and the dollar figures shown are examples only. Claim form versions and completion requirements change over time and vary by payer. This content is educational and is not billing, legal, or coding advice. Always follow your payer contracts, your practice policies, and current coding guidelines. Not affiliated with or endorsed by Office Ally.
© Marie Matteson. All rights reserved.
