What is a Demonstration Code?

Medicare, Medicaid, Blue Cross Blue Shield, and various other payers often will conduct/sponsor various demonstration projects to test/measure the effect of a potential change in their program. Demonstrations can impact new methods of service delivery, new types of services, payment approaches, providers, health plans, states, etc.. Each individual demonstration will be assigned a code that can be added to claims that meet the criteria of the demonstration. The provider will have to be participating in the demonstration with the payer to be eligible for any benefits.

For paper claims, Demonstration Codes can be added to Box 19 on the CMS Claim Form from the Incident Menu. These cannot be pulled from the Demonstration Code field in the Fee Schedule.

For electronic claims, enter the demonstration code within the Fee Schedule Reference, in the field for 'Demonstration Code'.

Open