RO Assignment of CMS Certification Numbers

2779 - RO Assignment of CMS Certification Numbers (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) 2779A - Numbering System for CMS Certification Numbers (CCN) (Rev. 152, Issued: 03-25-16, Effective: 04-04-16, Implementation: 04-04-16) Effective in 2007, the CCN replaced the term Medicare Provider Number, Medicare Identification Number or OSCAR Number. The CCN is used to verify Medicare/Medicaid certification for survey and certification, assessment-related activities and communications. Additionally, CMS data systems use the CCN to identify each individual provider or supplier that has or currently does participate in Medicare and/or Medicaid. The RO, not the SA or MAC, assigns the CCN and maintains adequate controls. 2779A1 – CCN for Medicare Providers (Rev. 226; Issued: 12-06-24; Effective: 12-06-24; Implementation: 12-06-24) The CCN for providers and suppliers paid under Medicare Part A have 6 digits. The first 2 digits identify the State in which the provider is located. The last 4 digits identify the type of facility. Following is a list of all State Codes: Alabama 01, B7 New Hampshire 30 Alaska 02 New Jersey 31, 83 Arizona 03, 00, D9 New Mexico 32, 96 Arkansas 04, 89 New York 33, 57, D1 California 05, 55, 75, 92, A0, A1, B2, B3, B4, B5, D6, D7, D8 North Carolina 34, 86, B6 Colorado 06, 91 North Dakota 35 Connecticut 07, 81 Ohio 36, 72, A6, D2 Delaware 08, B9 Oklahoma 37, 90 District of Columbia 09, C0 Oregon 38, 93 Florida 10, 68, 69, A2, C1 Pennsylvania 39, 73, A7, D3 Georgia 11, 85, C2 Puerto Rico 40, 84 Hawaii 12 Rhode Island 41 Idaho 13, 54 South Carolina 42, 87, D4 Illinois 14, 78, C4 South Dakota 43 Indiana 15, C5 Tennessee 44, 88, A8 Iowa 16, 76 Texas 45, 67, 74, 97, A9, E2, E3 Kansas 17, 70 Utah 46 Kentucky 18, B0 Vermont 47 Louisiana 19, 71, 95, A3 Virgin Islands 48 Maine 20, C6 Virginia 49, D5 Maryland 21, 80 Washington 50, 94 Massachusetts 22, 82 West Virginia 51, 58, B1 Michigan 23, A4, C7 Wisconsin 52 Minnesota 24, 77 Wyoming 53 Mississippi 25, A5, C8 Canada 56 Missouri 26, 79, C9 Mexico 59 Montana 27 American Samoa 64 Nebraska 28, D0 Guam 65, C3 Nevada 29, E1 Commonwealth of the Northern Marianas Islands 66, B8 Foreign Countries (exceptions: Canada and Mexico) 99, New State codes must only be used when all of the existing assigned numbers have been assigned within each of the CCN ranges available for a facility type. Assign the last 4 digits, which identify the facility type, sequentially from within the appropriate CCN range. In a State that has more than one State code and/or a facility type that has more than one CCN range available, ensure that all the numbers available in one CCN range have been assigned before implementing the use of a new State code or numbers in a new CCN range. For example: You are assigning a CCN to a new Community Mental Health Center (CMHC) in Florida. Florida has three State Codes: 10, 68 and 69 and three number ranges for CMHCs: 1400-1499, 4600-4799, and 4900-4999. You have been using State Code 68 and the CCN range 4900-4999 for CMHC in Florida, and you last assigned 4999 in that State to a CMHC. Given this information, consider the following scenarios: • Scenario 1. Review the CCN records for Florida to determine if all the numbers in CCN range 4600-4799 were assigned. It is determined that all those numbers were previously assigned in Florida. Therefore, look to CMHC CCN range 1400-1499 as those numbers have not been assigned in Florida; assign 681400 as the CCN for the new CMHC that is being processed. • Scenario 2. Review the CCN records for Florida to determine if all the numbers in CCN range 4600-4799 were previously assigned in Florida. It is determined that some, but not all, of the numbers in that CCN range were assigned. The last number in that range that was assigned was 4701. Assign 684702 as the CCN for the new CMHC that is being processed. • Scenario 3. Review the CCN records for Florida to determine if all the numbers in CCN range 4600-4799 were previously assigned in Florida. It is determined that all the numbers in that range were previously assigned in Florida. It is then determined after a review of the CCN records that all of the numbers in CCN range 1400-1499 were previously assigned in Florida. Look to see if all three CMHC CCN ranges for State Code 10 have been assigned. It is determined that all three CCN ranges have been previously assigned. Then look to State Code 69. You find that no CCN for CMHC in Florida has been assigned under State Code 69. The new CCN that will be assigned to the new Florida CMHC will be 691400 because is the first CCN range under State Code 69 listed for CMHCs. However, if it is determined that one of the CMHC CCN ranges under State Code 69 has been previously assigned, begin with the next available number in that CCN range. NOTE: Once the remaining pool of two digit State numeric codes are exhausted, CMS will implement a two digit alpha-numeric code system for State Codes. For example: A0, A1, A2,… B0, B1, B2,…, Z8, and finally Z9). This numbering system will provide a pool of 260 new State Codes for future use. Use the following CCN ranges for the facility types indicated: 0001-0879 Short-term (General and Specialty) Hospitals 0880-0899 Reserved for hospitals participating in ORD demonstration project 0900-0999 Multiple Hospital Component in a Medical Complex (Numbers Retired) 1000-1199 Federally Qualified Health Centers (also CCN range 1800-1989) 1200-1224 Alcohol/Drug Hospitals (Numbers Retired) 1225-1299 Medical Assistance Facilities 1300-1399 Critical Access Hospitals 1400-1499 Continuation of Community Mental Health Centers (also CCN ranges 4600-4799 and 4900-4999) 1500-1799 Hospices 1800-1989 Federally Qualified Health Centers (also CCN range 1000-1199) 1990-1999 Religious Non-medical Health Care Institutions (formerly Christian Science Sanatoria (Hospital Services) 2000-2299 Long-Term Care Hospitals (Excluded from IPPS) 2300-2499 Hospital-based Renal Dialysis Facilities 2500-2899 Independent Renal Dialysis Facilities 2900-2999 Independent Special Purpose Renal Dialysis Facility 1/ 3000-3024 Formerly Tuberculosis Hospitals (Numbers Retired) 3025-3099 Rehabilitation Hospitals (Excluded from IPPS) 3100-3199 Home Health Agencies (also CCN ranges 7000-8499 and 9000-9799) 3200-3299 Continuation of Comprehensive Outpatient Rehabilitation Facilities (also CCN ranges 4500-4599 and 4800-4899) 3300-3399 Children’s Hospitals (Excluded from IPPS) 3400-3499 Continuation of Rural Health Clinics (Provider-based) (also CCN ranges 3975-3999 and 8500-8899) 3500-3699 Hospital-based Satellite Renal Dialysis Facilities 3700-3799 Hospital-based Special Purpose Renal Dialysis Facility 1/ 3800-3974 Rural Health Clinics (Free-standing) (also CCN range 8900-8999) 3975-3999 Rural Health Clinics (Provider-based) (also CCN ranges 3400-3499 and 8500-8899) 4000-4499 Psychiatric Hospitals (Excluded from IPPS) 4500-4599 Comprehensive Outpatient Rehabilitation Facilities (also CCN ranges 3200-3299 and 4800-4899) 4600-4799 Community Mental Health Centers (also CCN ranges 1400-1499 and 4900-4999) 4800-4899 Continuation of Comprehensive Outpatient Rehabilitation Facilities (also CCN ranges 3200-3299 and 4500-4599) 4900-4999 Continuation of Community Mental Health Centers (also CCN ranges 1400-1499 and 4600-4799) 5000-6499 Skilled Nursing Facilities 6500-6989 Outpatient Physical Therapy Services 6990-6999 Numbers Reserved (formerly Christian Science Sanatoria (Skilled Nursing Services) 7000-8499 Continuation of Home Health Agencies (also CCN ranges 3100-3199 and 9000-9799) 8500-8899 Continuation of Rural Health Clinics (Provider-based) (also CCN ranges 3400-3499 and 3975-3999) 8900-8999 Continuation of Rural Health Clinics (Free-standing) (also CCN range 3800-3974) 9000-9799 Continuation of Home Health Agencies (also CCN ranges 3100-3199 and 7000-8499) 9800-9899 Transplant Centers 9900-9999 Reserved for Future Use 1/ Special Purpose Renal Dialysis Facilities (SPRDFs – these facilities will be assigned the same CCN whenever they are recertified) NOTE: Religious Nonmedical Health Care Institutions (RNHCI) are not certified by SAs. The CCN for RNHCIs are assigned by the Boston CMS RO. EXCEPTION - Organ procurement organizations (OPOs) are assigned a 6-digit alphanumeric CCN. The first 2 digits identify the State Code. The third digit is the alpha character “P.” The remaining 3 digits are the unique facility identifier. EXCEPTION- As of the cost reporting period beginning on or after October 1, 2019, an IPPS-excluded hospital is no longer precluded from having an IPPS-excluded psychiatric and/or rehabilitation unit. See section 2779C and 2779C1 for additional CCN numbering detail. Note: An IPPS-excluded hospital may not have an IPPS-excluded unit of the same type (psychiatric or rehabilitation) as the hospital (for example, an Inpatient Rehabilitation Facility (IRF) may not have an IRF unit). 2779A2 – CCN for Suppliers (Rev. 198, Issued: 01-17-20, Effective: 01-17-20, Implementation: 01-17-20) Suppliers that are paid by Part B carriers have a 10-digit alphanumeric CCN. The first 2 digits identify the State in which the supplier is located. (See list of State Codes under subsection 2779A1.) The third digit is an alpha character that identifies the type of facility. The remaining 7 digits are the unique facility identifier. (Exception: CLIA numbers will continue to be used for fee and certificate issuance.) The RO assigns the following alpha-characters in the third position as indicated: C - Ambulatory Surgical Centers D - Clinical Laboratory Improvement Amendments of 1988 (CLIA) Laboratories X - Portable X-Ray Facilities (Exception: CLIA numbers are system generated by the database that maintains the CLIA application.) The last 7 digits of the CCN for the above suppliers will be within the number series 0000001-9999999. Examples: ASC 10C0001062 CLIA 45D0634589 Portable X-Ray 21X0009807 2779B – CMS Certification Numbers for Medicaid Providers (Rev. 123, Issued: 10-03-14, Effective: 10-03-14, Implementation: 10-03-14) For certification purposes, title XIX-only providers are identified by a 6-digit alphanumeric CCN. The first 2 digits identify the State in which the provider is located. The third position, which is an alpha character, identifies the type of facility by level or type of care being provided. The last 3 digits make up a sequential number series beginning with 001. The RO uses the following groups of alphanumeric numbers for the type of facility as indicated: A001-A999 NF (Formerly assigned to Medicaid SNF) B001-B999 NF (Formerly assigned to Medicaid SNF) Expansion of A001-A999 E001-E999 NF (Formerly assigned to ICF) F001-F999 NF (Formerly assigned to ICF) Expansion of E001-E999 G001-G999 ICF/IID H001-H999 ICF/IID Expansion of G001-G999 K001-K999 Medicaid HHAs L001-L999 Psychiatric Residential Treatment Facilities (PRTF) J001-J099 Medicaid-Only Short-term acute care hospitals J100-J199 Medicaid-Only Children’s Hospitals J200-J299 Medicaid-Only Children’s Psychiatric Hospitals J300-J399 Medicaid-Only Psychiatric Hospitals J400-J499 Medicaid-Only Rehabilitation Hospitals J500-J599 Medicaid-Only Long-term Hospitals J600-J999 Reserved for future use 2779C - Special Numbering System for Units of Hospitals That Are Excluded From the Inpatient Prospective Payment System (IPPS) and Hospitals and CAHs with Swing-Bed Approval (Rev. 198, Issued: 01-17-20, Effective: 01-17-20, Implementation: 01-17-20) An alpha character in the third position of a hospital’s or CAH’s CCN identifies either its swing-bed approval or its status as an IPPS-excluded rehabilitation or psychiatric unit. The first 2 digits identify the State in which the provider is located. The third position (which is alpha) identifies the type of unit or swing-bed designation. The last 3 digits must be exactly the same as the last 3 digits of the CCN of the hospital or CAH operating the unit(s), unless as noted below in Section 2779C1. NOTE: As of the cost reporting period beginning on or after October 1, 2019, an IPPS- excluded hospital is no longer precluded from having an IPPS-excluded psychiatric and/or rehabilitation unit (see Section 2779C1 for CCN numbering). The RO assigns the following alpha-characters in the third position as indicated: M - Psychiatric Unit of a CAH R - Rehabilitation Unit of a CAH S - Psychiatric Unit of a Short-Term, Cancer, Children’s, LTCH, or Rehabilitation Hospital T - Rehabilitation Unit of a Short-Term, Cancer, Children’s, LTCH, or Psychiatric Hospital U - Swing-Bed Approval for Short-Term Hospitals W- Swing-Bed Approval for Long-Term Care Hospitals Z - Swing-Bed Approval for CAHs EXAMPLE: 21-0101 - ABC Hospital (Short-Term Hospital) • 21-T101 - ABC Hospital’s IPPS-excluded Rehabilitation Unit • 21-S101 – ABC Hospital’s IPPS-excluded Psychiatric Unit • 21-U101- ABC Hospital’s Swing-bed Approval • NOTE: If it meets the applicable requirements, an acute care hospital or a CAH could have swing-bed approval, an IPPS-excluded rehabilitation unit, and/ or an IPPS-excluded psychiatric unit. 2779C1- Special Numbering System for IPPS-Excluded Hospitals with IPPS-Excluded Units (Rev. 198, Issued: 01-17-20, Effective: 01-17-20, Implementation: 01-17-20) If an IPPS-excluded hospital also has an IPPS-excluded unit, the fourth position within the CCN requires an additional alpha-character to identify the IPPS-excluded unit type. Note: No special fourth position alpha character is needed for cancer hospitals. The RO assigns the following alpha-characters in the fourth position as indicated in the table below. Note: This table does not apply to CAHs. Parent IPPS-Excluded Hospital Psychiatric Unit Range Rehab Unit Range LTCH XX-2000 through XX-2299 XX-2000 through XX- 2099 XX-SA00 through XX- SA99 XX-TA00 through XX- TA99 XX-2100 through XX- 2199 XX-SB00 through XX- SB99 XX-TB00 through XX- TB99 XX-2200 through XX- 2299 XX-SC00 through XX- SC99 XX-TC00 through XX- TC99 Rehabilitation Hospital XX-3025 through XX-3099 XX-SD00 through XX- SD99 Not Applicable Children’s Hospital XX-3300 through XX-3399 XX-SE00 through XX- SC99 XX-TE00 through XX- TE99 Psychiatric Hospital XX-4000 through XX-4499 Not Applicable XX-4000 through XX- 4099 XX-TF00 through XX- TF99 XX-4100 through XX- 4199 XX-TG00 through XX- TG99 XX-4200 through XX- 4299 XX-TH00 through XX- TH99 XX-4300 through XX- 4399 XX-TJ00 through XX- TJ99 XX-4400 through XX- 4499 XX-TK00 through XX- TK99 NOTE: An IPPS-excluded hospital may not have an IPPS-excluded unit of the same type (psychiatric or rehabilitation) as the hospital (for example, an Inpatient Rehabilitation Facility (IRF) may not have an IRF unit). EXAMPLE: 21-2026 - XYZ Hospital (IPPS-excluded Long Term Care Hospital) • 21-SA26 - XYZ Long Term Care Hospital’s IPPS-excluded Psychiatric Unit • 21-TA26 – XYZ Long Term Care Hospital’s IPPS-excluded Rehabilitation Unit 2779D - Assigning LTC CMS Certification Numbers (Rev. 91, Issued: 09-27-13, Effective: 09-27-13, Implementation: 09-27-13) The RO assigns only one CCN per facility. (For purposes of this section, “facility” means an institution providing SNF and/or NF or ICF/IID care at the same address.) Use XX- 5000 series for facilities providing Medicare or Medicare/Medicaid services, and the alphanumeric series (XX-A000 or XX-E000 or XX-G000) for Medicaid-only facilities, as shown in the following charts: FREE STANDING LTC FACILITIES FACILITY 18 or 18/19 19 NF ICF/IID TYPE SNF CCN XX-5000 XX-A000 or XX-G000 XX-E000 SNF/NF DUALLY-PARTICIPATING AND/OR DISTINCT PART FACILITIES FACILITY 18/19 18 SNF or 18/19 18 or 18/19 TYPE SNF/NF Dually participating Dually participating Dually with SNF or NF DP with SNF or NF DP participating CCN XX-5000 XX-5000 XX-5000 FACILITY TYPE 19 NF 19 NF With ICF/IID DP CCN XX-A000 XX-A000 or XX-E000 or XX-G000* *EXCEPTION: As the chart indicates, the RO always assigns a separate ICF/IID (XX- G000) number to an ICF/IID or ICF/IID DP. NOTE: When a LTC facility is a unit of a hospital, the RO issues a number separate from the hospital number according to the above guidelines. A hospital is permitted to have only one hospital-based SNF DP and one hospital-based NF DP. 2779E - Assigning Emergency Hospital CMS Certification Numbers (Non-Participating Hospitals) (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) The CCN for emergency hospitals is a 6-position alphanumeric code. The first 2 digits are the State code. The third, fourth, and fifth digits represent a sequence number. The first emergency number in a State would contain the sequence number 001. In the sixth position use the letter “E” for non-Federal emergency hospitals, or “F” for Federal emergency hospitals. For example, the 34th emergency hospital issued a CCN in Maryland would have the number “21-034E.” The RO assigns the CCN in strict numerical sequence without regard to the Federal or non-Federal status. If a terminated facility again qualifies as an emergency hospital, the RO issues a new CCN. For a non- participating hospital that is now fully participating, see subsection I. 2779F - Merger of Facilities or CHOW (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) The RO does not change the CCN merely because the institution has been sold, or has changed ownership or its form of business organization. If 2 or more pre-existing provider enterprises have merged, but continue to operate as separate facilities, each will have a separate provider agreement and will keep its original number. This is true even though the merged-but-separate facilities may adopt a common name. However, if the merged facilities operate as a single institution, it must submit a single cost report, which necessitates a single provider agreement/CCN. When the RO assigns a single CCN, the notices of utilization mailed to beneficiaries will not identify which component rendered the service but will show the name of the organization to which the CCN is assigned (which may be entirely different from the name of the component). To avoid misunderstanding on the part of beneficiaries, CMS must approve, in advance, some method devised by the provider for informing its Medicare patients as to the designation on the notices of utilization. The RO uses the CCN previously assigned to the larger of the merging facilities or, in the case of the merger of 2 provider corporations, uses the CCN of the surviving corporation and retires the other number or numbers. These principles also apply if providers merge with previous non-providers. In a merger of corporations where the non-provider corporation is the surviving corporation and the facilities will use a common number, retain the original number. This rule does not, however, preclude retention of a separate number for a distinct part SNF, or for a distinct part of a psychiatric hospital. 2779G - Notification of Change in CMS Certification Numbers (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) To notify the intermediary of a correction of a CCN, or the assignment of any number different from that initially sent to a hospital, the RO prepares a CMS-2007. Follow the procedure in §2783 noting in Item V of CMS-2007 the reason for the number change. 2779H - Retirement of CMS Certification Numbers (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) The CCN will be classified as retired in these situations: • The provider agreement is terminated; EXCEPTION: Where a terminated facility is subsequently reinstated as a provider of services fully retroactive to the day of its termination, the RO reassigns the original CCN as there has been no break in the period of participation. When this occurs, show “reinstated with no break in participation,” in item 24 of Form CMS-1539: • An erroneous assignment that is used by the facility is subsequently replaced by the RO with a correct number; or • A non-participating hospital or SNF now meets the requirements and wishes to participate. The RO assigns a new number and retires the old number. 2779I - Control of CMS Certification Numbers (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) The RO may give responsibility for assigning the CCN to one person, with sufficient alternates so that a trained person will always be available. This control may be maintained electronically or manually. The following is a suggested manual control: Prepare a loose-leaf ledger for the numbers with a tab divider for each State. Maintain separate pages for each type of provider, including non-participating emergency hospitals, and make entries in strict numerical sequence. 2779J - ESRD CMS Certification Numbers (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) It is important for both reimbursement and survey purposes to assign the ESRD facility the correct CCN in accordance with the guidelines contained in §2779.A.1. ESRD facilities and their CCN are as follows: 0001-0879 Short Term (General and Specialty) Hospitals 2000-2299 Long Term Hospitals 2300-2499 Chronic Renal Disease Facilities (Hospital-Based) 2500-2899 Non-Hospital Renal Disease Treatment Centers 2900-2999 Independent Special Purpose Renal Disease Facilities 3300-3399 Children’s Hospitals 3500-3699 Renal Disease Treatment Centers (Hospital Satellites) 3700-3799 Hospital-Based Special Purpose Renal Dialysis Facilities 1 - Hospital-Based Renal Dialysis Facilities, 2300-2499 The CMS is required to make determinations concerning hospital-based and independent ESRD facilities to determine their proper reimbursement in accordance with §1881(b)(7), 42 CFR 413.174, and §2287. Please note that in accordance with 42 CFR 413.174(d)(3). The physical location of an ESRD facility on the premises of a hospital is not considered when determining if the ESRD facility is hospital-based. In accordance with 42 CFR 413.174, hospital corporate control is a critical factor in determining whether an ESRD facility is hospital-based. Hospitals may have a lease arrangement for the management of a hospital-based ESRD facility by a non-hospital manager. ESRD CCN 2300-2499, for Hospital-Based Renal Dialysis Facilities are used for ESRD facilities that have been determined by the CMS to be hospital-owned, hospital- administered ESRD facilities physically located on the hospital’s premises as opposed to independent ESRD facilities and Hospital-Based Renal Disease Satellite Facilities. The satellites are hospital-based, but are physically located off the hospital’s premises. 2 - Hospital-Based Renal Dialysis Satellite Facilities, 3500-3699 ESRD CCN 3500-3699 for Hospital-Based Renal Dialysis Satellite Facilities are used for those ESRD facilities that are hospital-owned and hospital administered, but that are not located on the hospital’s premises. This is why they are referred to as hospital-based satellites. In determining whether such a satellite facility is hospital-based, use the same criteria as you would in making a hospital-based determination under the 2300-2499 series, except that you would assign a 3500-3699 number to such a facility because it is off the premises of the hospital to which it is based. The word premises per se is not defined in the statute, regulations, or in the SOM, but there is a definition of “furnishes on the premises” at 42 CFR 405.2102 that states “the ESRD facility furnishes services on its main premises; or its other premises that are: (a) contiguous with or in immediate proximity to the main premises, and under the direction of the same professional staff and governing body as the main premises, or (b) approved on a time-limited basis as a special purpose renal dialysis facility.” Thus, in addition to the regulations, which should assist you in determining whether the facility is an integral part of the hospital, you may use the “furnishes on the premises” definition to distinguish between a hospital-based entity under the 2300-2499 series as opposed to an entity under the 3500-3699 number series. Also, we do not believe that these satellites will be furnishing inpatient dialysis services. The CMS will make or approve the determination that a particular ESRD facility meets the requirements to be hospital-based, and if it is off the hospital’s premises, a hospital-based satellite. It is conceivable that a hospital-based ESRD facility could have a 2300-2499 number assigned to the location on the hospital’s premises, and one or more 3500-3699 numbers for those locations (satellites) off the premises (each satellite is given a separate 3500- 3699 number). If an ESRD facility that is assigned a 2300-2499 number moves off the hospital’s premises and is determined to be a satellite, it should receive a number in the 3500-3699 series. However, if a satellite changes its address but is still considered off the hospital’s premises, it should retain the 3500-3699 number it was originally issued rather than being issued a new 3500-3699 number. Any questions concerning billing should be referred to the RO financial component or the fiscal intermediary as you determine appropriate. NOTE: In determining whether an entity is hospital-based for reimbursement purposes, the requirements at §2287 must be met. 3 - Hospital-Based Special Purpose Renal Dialysis Facilities, 3700-3799 In order to be classified as a Hospital-Based Special Purpose Renal Dialysis Facility and issued a number under the 3700-3799 series, an ESRD facility must be determined to be hospital-based, and meet the definition at 42 CFR 405.2102, and the requirements at 42 CFR 405.2164 for such a facility. A facility under this category should bill Medicare under the CCN of the hospital to which it is based. There should be very few of these facilities. 4 - Independent Renal Dialysis Facilities, 2500-2899 Independent Renal Dialysis Facilities, issued a number under the 2500-2899 series, are independent ESRD facilities. These facilities do not meet the definition of hospital-based irrespective of whether they are located on or off the hospital’s premises. A determination of independent, as opposed to hospital-based, will be based on the statutory and regulatory provisions and manual instructions. Independent facilities bill under their own numbers. ESRD facilities located at skilled nursing facilities will be determined to be independent. 5 - Independent Special Purpose Renal Dialysis Facilities, 2900-2999 The same requirements that apply to a Hospital-Based Special Purpose Renal Dialysis Facility apply to a facility of the same type which is independent except that the independent facility by virtue of its independent status, bills under its own number which is in the 2900-2999 series. 6 - Other When an ESRD facility proposes to change from hospital-based to independent or vice- versa, an onsite survey is not necessary unless there is a physical relocation of the facility. However, a determination as to the proper facility definition and if necessary, the changing of the number designation, must be made in accordance with the guidance described here and in §2287. If an ESRD facility proposes to add a location that has not been previously surveyed, an onsite inspection would be required. In the absence of an onsite survey and certification, the proposed facility has no authority to bill Medicare for ESRD services provided at the proposed site. (See §3222.) There are some instances when an ESRD facility’s CCN requires a change as a result of an action taken by the ESRD facility. If a hospital-based facility converts to an independent ESRD facility or if an independent ESRD facility converts to a hospital-based ESRD facility, there must be a CCN change. Satellite ESRD facilities must be hospital owned and are considered hospital-based. A hospital may have more than one ESRD satellite facility. The CCN of the ESRD facility may remain the same in the following situations: • A hospital-based ESRD facility retains ownership of the facility but contracts with another entity for management of the facility; • The hospital closes the dialysis facility but retains its transplant program. The CMS terminates the outpatient dialysis services but retains the ESRD CCN for the still active transplant program; • The hospital closes the transplant program but retains the ESRD facility. In such case, CMS terminates the transplant program but keeps the ESRD CCN active for the dialysis program; • The ESRD facility is purchased by another ESRD facility of the same type. For example, independent by independent or hospital-based by hospital-based; and • The geographic location of the ESRD facility is changed within the same state. A recertification survey is always required when a dialysis facility relocates within a state. If a geographic location is changed to another state, the ESRD facility at the old location must be terminated and the relocated ESRD facility must qualify as a new applicant with a new identification number in the state to which it moved. Information contained in Medicare approval letters of ESRD facilities that are issued numbers under the above categories is essential in central office for data collection and program information purposes. Therefore, please send a copy of all Medicare approval letters issued in your region to: Centers for Medicare & Medicaid Services Office of Clinical Standards and Quality Information Systems Group 7500 Security Boulevard Mail Stop S3-02-01 Baltimore, Maryland 21244-1850. You should also send to the Office of Clinical Standards and Quality (OCSQ) notices of any numbers that are terminated or changed (e.g., hospital-based to independent or vice- versa) for whatever reasons. In addition, it would be helpful if all ESRD facility notices, including those sent to the fiscal intermediary, contain the CCN of the ESRD facility to which the notice applies (numbers of both the ESRD facility and the hospital to which it is based, when applicable). You should apprise the appropriate ESRD network of the information mentioned above at the same time that you notify OCSQ. A Form CMS- 855A must be completed by the ESRD facility when there is a change, addition, or deletion affecting an ESRD facility. You should follow the instructions for issuing a “Provider Tie-In Notice,” Form CMS-2000, when an ESRD facility is being added, deleted, or changed. This is particularly important because fiscal intermediaries often cross regional boundaries. NOTE: The RO refers all Forms CMS-1539 that report changes in provider status to its data entry section for input into the ASPEN data system. When ROs send correspondence concerning certification to ESRD facilities, the following information should always appear: • The assigned CCN with caption; • CMS cross reference CCN with caption (if applicable); • Medicare approval date; • Number of stations; • Services offered; • Name of facility; • Facility’s physical location address; • Facility’s mailing address; • Facility’s type or status (hospital-based/independent/satellite); • Facility contact for ESRD network; • Facility ownership (corporation/partnership/sole proprietorship/etc.; and • RO contact (name and phone number). EXAMPLE Maryland Short-Term Hospitals CCN Name and Address of Provider Date # Assigned 21-0001 Calvert Hospital 101 Chase Street Baltimore, Maryland 4/10/66 21-0002 Red River Hospital 401 River Road Baltimore, Maryland 4/11/66 2779K – HHA Branch CMS Certification Numbers (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) HHA Branches are identified by the assignment of a 10-digit alpha-numeric number. Each branch is numbered with the same CCN as the parent or subunit with 2 modifications: (1) The letter “Q” will be in the third position between the state code and the 4-digit provider designation; and (2) three additional digits are added to the end of the number. The last 3 digits are a one-up number for each consecutive branch. These digits allow the capability of assigning up to 999 branches to one parent or subunit HHA. The branch CCN will be used only once. In the event that an HHA branch closes, its unique branch CCN is terminated and will not be reused to identify another branch of that HHA or subunit. Example: ABC Home Health Agency has three branches. Its CCN is 017001. ABC’s three branches would be assigned the numbers 01Q7001001, 01Q7001002, and 01Q7001003. 2779L – Outpatient Physical Therapy (OPT) Extension CMS Certification Numbers (Rev. 29, Issued: 04-20-07; Effective/Implementation Dates: 10-01-2007) OPT extensions are identified by the assignment of a 10-digit alpha-numeric number. Each extension is numbered with the same CCN as the parent with two modifications: (1) The letter “P” will be in the third position between the state code and the 4-digit provider designation; and (2) three additional digits are added to the end of the number. The last 3 digits are a one-up sequence number for each extension number starting with 001. These digits allow the capability of assigning up to 999 extensions to one OPT. The extension CCN will be used only once. In the event that an OPT extension closes, its unique extension identification number is terminated and will not be reused to identify another extension of that OPT. OPT extension CCN are not used for reimbursement purposes. Example: Vibrant Physical Therapy has three extensions. Its CCN is 556599. Vibrant’s three extensions would be assigned the numbers 55P6599001, 55P6599002, and 55P6599003.