HCPCS2016_recordlayout.txt

  CMS RIF REPORT
  AS OF: 10/28/2015


       NAME                   LENGTH   BEG  END                                         CONTENTS
  -----------------------------------------------------------------------------------------------------------------------
  ***  HCPCS Contractor Record - 2016
                               320      1    320    REC

                                                    2016 Healthcare Common Procedure Coding System (HCPCS)
                                                    Contractor record description.

                                                    STANDARD ALIAS : HCPCS_CNTRCTR_16_REC
                                                    SYSTEM   ALIAS : HCPCS16C

  1.   Healthcare Common Procedure Coding System Code
                                 5      1      5    CHAR

                                                    The Healthcare Common Prodecure Coding System (HCPCS) is a
                                                    collection of codes that represent procedures, supplies,
                                                    products and services which may be provided to Medicare
                                                    beneficiaries and to individuals enrolled in private health
                                                    insurance programs. The codes are divided into two
                                                    levels, or groups, as described Below:

                                                    Level I
                                                    Codes and descriptors copyrighted by the American Medical
                                                    Association's current procedural terminology, fourth
                                                    edition (CPT-4). These are 5 position numeric codes
                                                    representing physician and nonphysician services.

                                                    **** NOTE: ****
                                                    CPT-4 codes including both long and short descriptions
                                                    shall be used in accordance with the CMS/AMA agreement.
                                                    Any other use violates the AMA copyright.

                                                    Level II
                                                    Includes codes and descriptors copyrighted by the
                                                    American Dental Association's current dental terminology,
                                                    seventh edition (CDT-2011/12). These are 5 position
                                                    alpha-numeric codes comprising the d series. All other
                                                    level II codes and descriptors are approved and
                                                    maintained jointly by the alpha-numeric editorial panel
                                                    (consisting of CMS, the Health Insurance Association of
                                                    America, and the Blue Cross and Blue Shield Association).
                                                    These are 5 position alpha- numeric codes representing
                                                    primarily items and nonphysician services that are not
                                                    represented in the level I codes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : HCPCS_CD
                                                    STANDARD ALIAS : HCPCS_CD
                                                    TITLE    ALIAS : HCPCS_CD

                                                    LENGTH         : 5

  2.   HCPCS Code Redefinition Group
                                 5      1      5    GRP


                                                    REDEFINE   : HCPCS_CD

  3.   FILLER                                       CHAR
                                 3      1      3
                                                    DB2      ALIAS : FILLER

                                                    LENGTH         : 3

  4.   HCPCS Modifier Code
                                 2      4      5    CHAR

                                                    A modifier provides the means by which the reporting
                                                    physician or provider can indicate that a service or
                                                    procedure that has been performed has been altered by some
                                                    specific circumstance but not changed in its definition or
                                                    code. The judicious application of modifiers obviates the
                                                    necessity for separate procedure listings that may describe
                                                    the modifying circumstance. Modifiers may be used to
                                                    indicate to the recipient of a report that:
                                                    > A service or procedure has both a professional
                                                    and technical component.
                                                    > A service or procedure was performed by more
                                                    than one physician and/or in more than one
                                                    location.
                                                    > A service or procedure has been increased or
                                                    reduced.
                                                    > Only part of a service was performed.
                                                    > An adjunctive service was performed.
                                                    > A bilateral procedure was performed.
                                                    > A service or procedure was provided more than
                                                    once.
                                                    > Unusual events occurred.

                                                    HCPCS modifier codes are divided into two levels, or
                                                    groups, as described below:

                                                    Level I
                                                    Codes and descriptors copyrighted by the American Medical
                                                    Association's current procedural terminology, fourth
                                                    edition (CPT-4).  These are 2 position numeric codes.

                                                    **** NOTE: ****
                                                    CPT-4 codes including long, short and consumer friendly 
						    descriptions shall be used in accordance with the 
						    CMS/AMA agreement. Any other use violates the AMA copyright.

                                                    Level II
                                                    Codes and descriptors approved and maintained jointly by
                                                    the alpha-numeric editorial panel (consisting of CMS, the
                                                    Health Insurance Association of America, and the Blue
                                                    Cross and Blue Shield Association). These are 2 position
                                                    alpha-numeric codes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MDFR
                                                    STANDARD ALIAS : HCPCS_MDFR_CD

                                                    LENGTH         : 2

                                                    SOURCE         :    CMS

  5.   HCPCS Sequence Number
                                 5      6     10    NUM

                                                    Sequence number by 100s.     Used to group procedure
                                                    or modifier codes together.

                                                    DB2      ALIAS : UNDEFINED
                                                    STANDARD ALIAS : HCPCS_SQNC_NUM

                                                    LENGTH         : 5    SIGNED : N

  6.   HCPCS Record Identification Code
                                 1     11     11    CHAR

                                                    Code to identify record type

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : RIC
                                                    STANDARD ALIAS : HCPCS_REC_IDENT_CD

                                                    LENGTH         : 1

                                                    CODES         :
                                                       3 = First line of procedure record
                                                           also contains detail information
                                                           in positions 92-275
                                                       4 = Second, third, fourth, etc., Description
                                                           of procedure record.  No detail information
                                                           in positions 92-275
                                                       7 = First line of modifier record
                                                           also contains detail information
                                                           in positions 92-275
                                                       8 = Second, third, fourth, etc., Description
                                                           of modifier record.  No detail information
                                                           in positions 92-275

  7.   HCPCS Long Description
                                80     12     91    CHAR

                                                    Contains all text of procedure or modifier long
                                                    descriptions.

                                                    As of 2013, this field contains the consumer friendly
						    descriptions for the AMA CPT codes. The AMA owns the
						    copyright on the CPT codes and descriptions; CPT codes
						    and descriptions are not public property and must always
						    be used in compliance with copyright law.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : DESC_TXT
                                                    STANDARD ALIAS : HCPCS_LONG_DESC_TXT

                                                    LENGTH         : 80

  8.   HCPCS Short Description
                                28     92    119    CHAR

                                                    Short descriptive text of procedure or modifier code
                                                    (28 characters or less).

                                                    The AMA owns the copyright on the CPT codes and
                                                    descriptions; CPT codes and descriptions are not
                                                    public property and must always be used in compliance
                                                    with copyright law.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : SHRTDESC
                                                    STANDARD ALIAS : HCPCS_SHRT_DESC_TXT
                                                    TITLE    ALIAS : HCPCS_SHORT_DESC_TEXT

                                                    LENGTH         : 28

  9.   HCPCS Pricing Indicator Code
                                 2    120    121    CHAR

                                                    Code used to identify the appropriate methodology for
                                                    developing unique pricing amounts under part B. A procedure
                                                    may have one to four pricing codes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : PRCNGCD
                                                    STANDARD ALIAS : HCPCS_PRCNG_IND_CD

                                                    LENGTH         : 2

                                                    CODES         :
                                                       00 = Service not separately priced by part B
                                                            (e.G., services not covered, bundled, used
                                                            by part a only, etc.)
                                                       Physician Fee Schedule And Non-Physician Practitioners
                                                       ------------------------------------------------------
                                                       Linked To The Physician Fee Schedule
                                                       ------------------------------------
                                                       11 = Price established using national rvu's
                                                       12 = Price established using national anesthesia
                                                            base units
                                                       13 = Price established by carriers (e.G., not
                                                            otherwise classified, individual determination,
                                                            carrier discretion)
                                                       Clinical Lab Fee Schedule
                                                       -------------------------
                                                       21 = Price subject to national limitation amount
                                                       22 = Price established by carriers (e.G.,
                                                            gap-fills, carrier established panels)
                                                       Durable Medical Equipment, Prosthetics, Orthotics,
                                                       --------------------------------------------------
                                                       Supplies And Surgical Dressings
                                                       -------------------------------
                                                       31 = Frequently serviced DME (price
                                                            subject to floors and ceilings)
                                                       32 = Inexpensive & routinely purchased
                                                            DME (price subject to floors and
                                                            ceilings)
                                                       33 = Oxygen and oxygen equipment (price
                                                            subject to floors and ceilings)
                                                       34 = DME supplies (price subject to floors
                                                            and ceilings)
                                                       35 = Surgical dressings (price subject to
                                                            floors and ceilings)
                                                       36 = Capped rental DME (price subject to
                                                            floors and ceilings)
                                                       37 = Ostomy, tracheostomy and urological
                                                            supplies (price subject to floors and
                                                            ceilings)
                                                       38 = Orthotics, prosthetics, prosthetic
                                                            devices & vision services (price subject
                                                            to floors and ceilings)
                                                       39 = Parenteral and Enteral Nutrition
                                                       45 = Customized DME items
                                                       46 = Carrier priced (e.g., not otherwise classified,
                                                            individual determination, carrier discretion,
                                                            gap-filled  amounts)
                                                       Other
                                                       -----
                                                       51 = Drugs
                                                       52 = Reasonable charge
                                                       53 = Statute
                                                       54 = Vaccinations
                                                       55 = Splints and Casts (effec 10/1/2014)
                                                       56 = IOL's inserted in a physician's office (eff 10/1/2014)
                                                       57 = Other carrier priced
                                                       99 = Value not established

                                                    OCCURS MIN: 4 OCCURS MAX: 0

  10.  HCPCS Multiple Pricing Indicator Code
                                 1    128    128    CHAR

                                                    Code used to identify instances where a procedure
                                                    could be priced under multiple methodologies.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MULTCD
                                                    STANDARD ALIAS : HCPCS_MLTPL_PRCNG_IND_CD

                                                    LENGTH         : 1

                                                    CODES         :
                                                       9 = Not applicable as HCPCS not priced separately
                                                           by part B (pricing indicator is 00) or value
                                                           is not established (pricing indicator is '99')
                                                       A = Not applicable as HCPCS priced under one
                                                           methodology
                                                       B = Professional component of HCPCS priced using
                                                           RVU's, while technical component and global
                                                           service priced by Medicare part B carriers
                                                       C = Physician interpretation of clinical lab service
                                                           is priced under physician fee schedule using
                                                           RVU's, while pricing of lab service is paid
                                                           under clinical lab fee schedule
                                                       D = Service performed by physician is priced under
                                                           physician fee schedule using RVU's, while service
                                                           performed by clinical psychologist is priced
                                                           under clinical psychologist fee schedule
                                                           (not applicable as of January 1, 1998)
                                                       E = Service performed by physician is priced under
                                                           physician fee schedule using RVU's, service
                                                           performed by clinical psychologist is priced
                                                           under clinical psychologist's fee schedule and
                                                           service performed by clinical social worker
                                                           is priced under clinical social worker fee
                                                           schedule (not applicable as of January 1, 1998)
                                                       F = Service performed by physician is priced under
                                                           physician fee schedule by carriers, service
                                                           performed by clinical psychologist is priced
                                                           under clinical psychologist's fee schedule and
                                                           service performed by clinical social worker
                                                           is priced under clinical social worker fee
                                                           schedule (not applicable as of January 1, 1998)
                                                       G = Clinical lab service priced under reasonable
                                                           charge when service is submitted on claim with
                                                           blood products, while service is priced under
                                                           clinical lab fee schedule when there are no
                                                           blood products on claim.

  11.  HCPCS Coverage Issues Manual Reference Section Number
                                 6    129    134    CHAR

                                                    Number identifying the reference section of the
                                                    coverage issues manual.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : CIM
                                                    STANDARD ALIAS : HCPCS_CIM_RFRNC_SECT_NUM

                                                    LENGTH         : 6

                                                    OCCURS MIN: 3 OCCURS MAX: 0

  12.  HCPCS Medicare Carriers Manual Reference Section Number
                                 8    147    154    CHAR

                                                    Number identifying a section of the Medicare carriers
                                                    manual.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MCM
                                                    STANDARD ALIAS : HCPCS_MCM_RFRNC_SECT_NUM

                                                    LENGTH         : 8

                                                    OCCURS MIN: 3 OCCURS MAX: 0

  13.  HCPCS Statute Number
                                10    171    180    CHAR

                                                    Number identifying statute reference for coverage or
                                                    noncoverage of procedure or service.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : STATUTE
                                                    STANDARD ALIAS : HCPCS_STATUTE_NUM

                                                    LENGTH         : 10

  14.  HCPCS Lab Certification Code
                                 3    181    183    CHAR

                                                    Code used to classify laboratory procedures according
                                                    to the specialty certification categories listed by
                                                    CMS.     Any generally certified laboratory (e.g., 100)
                                                    may perform any of the tests in its subgroups (e.g.,
                                                    110, 120, etc.).

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : LABCERT
                                                    STANDARD ALIAS : HCPCS_LAB_CRTFCTN_CD

                                                    LENGTH         : 3

                                                    CODES         :
                                                       010 = Histocompatibility testing
                                                       100 = Microbiology
                                                             110 = Bacteriology
                                                             115 = Mycobacteriology
                                                             120 = Mycology
                                                             130 = Parasitology
                                                             140 = Virology
                                                             150 = Other microbiology
                                                       200 = Diagnostic immunology
                                                             210 = Syphilis serology
                                                             220 = General immunology
                                                       300 = Chemistry
                                                             310 = Routine chemistry
                                                             320 = Urinalysis
                                                             330 = Endocrinology
                                                             340 = Toxicology
                                                             350 = Other chemistry
                                                       400 = Hematology
                                                       500 = Immunohematology
                                                             510 = Abo group & RH type
                                                             520 = Antibody detection (transfusion)
                                                             530 = Antibody detection (nontransfusion)
                                                             540 = Antibody identification
                                                             550 = Compatibility testing
                                                             560 = Other immunohematology
                                                       600 = Pathology
                                                             610 = Histopathology
                                                             620 = Oral pathology
                                                             630 = Cytology
                                                       800 = Radiobioassay
                                                       900 = Clinical cytogenetics

                                                    OCCURS MIN: 8 OCCURS MAX: 0

  15.  HCPCS Cross Reference Code
                                 5    205    209    CHAR

                                                    An explicit reference crosswalking a deleted code
                                                    or a code that is not valid for Medicare to a
                                                    valid current code (or range of codes).

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : XREF
                                                    STANDARD ALIAS : HCPCS_XREF_CD

                                                    LENGTH         : 5

                                                    OCCURS MIN: 5 OCCURS MAX: 0

  16.  HCPCS Coverage Code
                                 1    230    230    CHAR

                                                    A code denoting Medicare coverage status.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : CVRG_CD
                                                    STANDARD ALIAS : HCPCS_CVRG_CD

                                                    LENGTH         : 1

                                                    CODES         :

                                                       C = Carrier judgment
						       D = Special coverage instructions apply
                                                       I = Not payable by Medicare
                                                       M = Non-covered by Medicare
                                                       S = Non-covered by Medicare statute
                                                      

  17.  HCPCS ASC Payment Group Code
                                 2    231    232    CHAR

                                                    The 'YY' indicator represents that this procedure is approved to be
                                                    performed in an ambulatory surgical center.  You must access the ASC
                                                    tables on the mainframe or CMS website to get the dollar amounts.

                                                    
                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : ASCIND
                                                    STANDARD ALIAS : HCPCS_ASC_PMT_GRP_CD

                                                    LENGTH         : 2

                                                    EDIT RULES :
                                                             CODE: YY
                                                             BLANK = Not Approved For ASC

  18.  HCPCS ASC Payment Group Effective Date
                                 8    233    240    NUM

                                                    The date the procedure is assigned to the ASC
                                                    payment group.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : ASCGRP
                                                    STANDARD ALIAS : HCPCS_ASC_PMT_GRP_EFCTV_DT
                                                    TITLE    ALIAS : HCPCS_ASC_PMT_GROUP_EFCTV_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    EDIT RULES :
                                                             YYYYMMDD

  19.  HCPCS MOG Payment Group Code
                                 3    241    243    CHAR

                                                    Medicare outpatient groups (MOG) payment group code

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MOGGRP
                                                    STANDARD ALIAS : HCPCS_MOG_PMT_GRP_CD

                                                    LENGTH         : 3

                                                    COMMENTS :
                                                    1St digit indicates the body system
                                                    2nd digit is sequential numbering within the body system
                                                    3rd digit is the level of intensity where:
                                                    '1', '2', '3' or '4' represents levels
                                                    for a given group type
                                                    '0' and '9' represent single level
                                                    for a given group type

                                                    CODES         :
                                                       No MOG applies

                                                       000 = No MOG applies

                                                       Integumentary

                                                       102 = Level II needle biopsy/aspiration
                                                       112 = Level II incision and drainage
                                                       132 = Level II debridement/destruction
                                                       142 = Level II excision/biopsy
                                                       143 = Level III excision/biopsy
                                                       151 = Level I skin repair
                                                       152 = Level II skin repair
                                                       153 = Level III skin repair
                                                       160 = Incision/excision breast
                                                       169 = Breast reconstruction/mastectomy

                                                       Musculoskeletal

                                                       201 = Level I skull and facial bone procedures
                                                       202 = Level II skull and facial bone procedures
                                                       211 = Level I hand musculoskeletal procedures
                                                       212 = Level II hand musculoskeletal procedures
                                                       221 = Level I foot musculoskeletal procedures
                                                       222 = Level II foot musculoskeletal procedures
                                                       231 = Level I musculoskeletal procedures
                                                       232 = Level II musculoskeletal procedures
                                                       233 = Level III musculoskeletal procedures
                                                       241 = Level I arthroscopy
                                                       242 = Level II arthroscopy
                                                       260 = Closed treatment fracture finger/toe/trunk
                                                       269 = Closed treatment fracture/dislocation/except
                                                             finger/toe/trunk
                                                       270 = Open/percutaneous treatment fracture or dislocation
                                                       279 = Bone/joint manipulation under anesthesia
                                                       280 = Bunion procedures
                                                       289 = Arthroplasty
                                                       290 = Arthroplasty with prosthesis

                                                       ENT/Respiratory/Cardiovascular/Lymphatic/Endocrine

                                                       302 = Level II ENT procedures
                                                       303 = Level III ENT procedures
                                                       304 = Level IV ENT procedures
                                                       309 = Implantation of cochlear device (ASC rate does
                                                             not include cost of implant)
                                                       310 = Nasal cauterization/packing
                                                       319 = Tonsil/adenoid procedures
                                                       322 = Level II endoscopy upper airway
                                                       323 = Level III endoscopy upper airway
                                                       329 = Endoscopy lower airway
                                                       330 = Thoracentesis/lavage procedures
                                                       350 = Placement transvenous caths/cutdown
                                                       359 = Removal/revision, pacemaker/vascular device
                                                       360 = Vascular ligation
                                                       369 = Vascular repair/fistula construction
                                                       370 = Lymph node excisions
                                                       379 = Thyroid/lymphadenectomy procedures

                                                       Digestive

                                                       400 = Esophageal dilation without endoscopy
                                                       410 = Esophagoscopy
                                                       421 = Level I upper GI endoscopy/intubation
                                                       422 = Level II upper GI endoscopy/intubation
                                                       429 = Lower GI endoscopy
                                                       430 = Anoscopy and diagnostic sigmoidoscopy
                                                       439 = Therapeutic proctosigmoidoscopy
                                                       440 = Small intestine endoscopy
                                                       449 = Percutaneous biliary endoscopic procedures
                                                       450 = Endoscopic retrograde cholangio-pancreatography
                                                             (ERCP)
                                                       460 = Hernia/hydrocele procedures
                                                       472 = Level II anal/rectal procedures
                                                       473 = Level III anal/rectal procedures
                                                       480 = Peritoneal and abdominal procedures
                                                       490 = Tube procedures

                                                       Urinary/Genital

                                                       501 = Level I laparoscopy
                                                       502 = Level II laparoscopy
                                                       509 = Lithotripsy
                                                       511 = Level I cystourethroscopy and other
                                                             genitourinary procedures
                                                       512 = Level II cystourethroscopy and other
                                                             genitourinary procedures
                                                       513 = Level III cystourethroscopy and other
                                                             genitourinary procedures
                                                       521 = Level I urethral procedures
                                                       522 = Level II urethral procedures
                                                       530 = Circumcision
                                                       539 = Penile procedures
                                                       540 = Insertion of penile prosthesis (ASC rate does
                                                             include cost of implant)
                                                       549 = Testes/epididymis procedures
                                                       550 = Prostrate biopsy
                                                       562 = Level II female reproductive procedures
                                                       563 = Level III female reproductive procedures
                                                       570 = Surgical hysteroscopy
                                                       579 = D & C
                                                       580 = Spontaneous abortion
                                                       589 = Therapeutic abortion

                                                       Nervous/Eye

                                                       602 = Level II nervous system injections
                                                       609 = Revision/removal neurological device
                                                       610 = Implantation of neurostimulator electrodes (ASC
                                                             rate does not include cost of implant)
                                                       619 = Implantation of neurological devices (asc rate
                                                             does not include cost of implant)
                                                       621 = Level I nerve procedures
                                                       622 = Level II nerve procedures
                                                       629 = Spinal tap
                                                       639 = Laser eye procedures except retinal
                                                       640 = Cataract procedures
                                                       649 = Cataract procedures with IOL insert (includes
                                                             $150 insert)
                                                       651 = Level I anterior segment eye procedures
                                                       652 = Level II anterior segment eye procedures
                                                       659 = Corneal transplant (ASC rate includes price
                                                             of transplant)
                                                       660 = Posterior segment eye procedures
                                                       669 = Strabismus/muscle procedures
                                                       673 = Level III eye procedure
                                                       674 = Level IV eye procedure
                                                       680 = Vitrectomy
                                                       689 = Implantation/replacement of intraitreal drug

  20.  HCPCS MOG Payment Policy Indicator
                                 1    244    244    CHAR

                                                    Indicator identifying whether a HCPCS code is subject
                                                    to payment of an ASC facility fee, to a separate
                                                    fee under another provision of Medicare, or to no
                                                    fee at all.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MOGIND
                                                    STANDARD ALIAS : HCPCS_MOG_PMT_PLCY_IND_CD

                                                    LENGTH         : 1

                                                    CODES         :
                                                       1 = ASC covered procedure
                                                       2 = Bundled service/no separate payment
                                                       3 = Excluded from ASC list
                                                       4 = Invalid code/90 day grace period
                                                       6 = Separate payment when furnished in an ASC
                                                       7 = ASC restricted coverage procedure
                                                       9 = ASC payment not applicable

  21.  HCPCS MOG Effective Date
                                 8    245    252    NUM

                                                    The date the procedure is assigned to the Medicare
                                                    outpatient group (MOG) payment group.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MOGDTE
                                                    STANDARD ALIAS : HCPCS_MOG_PMT_GRP_EFCTV_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    EDIT RULES :
                                                             YYYYMMDD

  22.  HCPCS Processing Note Number
                                 4    253    256    CHAR

                                                    Number identifying the processing note contained
                                                    in Appendix A of the HCPCS manual.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : PROCNOTE
                                                    STANDARD ALIAS : HCPCS_PRCSG_NOTE_NUM

                                                    LENGTH         : 4

  23.  HCPCS Berenson-Eggers Type Of Service Code
                                 3    257    259    CHAR

                                                    This field is valid beginning with 2003 data.
                                                    The Berenson-Eggers Type of Service (BETOS) for the
                                                    procedure code based on generally agreed upon clinically
                                                    meaningful groupings of procedures and services.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : BETOS
                                                    STANDARD ALIAS : HCPCS_BETOS_CD
                                                    TITLE    ALIAS : BETOS_CD

                                                    LENGTH         : 3

                                                    CODE TABLE     : BETOS_TB

  24.  FILLER                                       CHAR
                                 1    260    260
                                                    DB2      ALIAS : FILLER

                                                    LENGTH         : 1

  25.  HCPCS Type Of Service Code
                                 1    261    261    CHAR

                                                    The carrier assigned CMS type of service which
                                                    describes the particular kind(s) of service
                                                    represented by the procedure code.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : TYPESRVC
                                                    STANDARD ALIAS : HCPCS_TYPE_SRVC_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CMS_TYPE_SRVC_TB

                                                    OCCURS MIN: 5 OCCURS MAX: 0

  26.  HCPCS Anesthesia Base Unit Quantity
                                 3    266    268    NUM

                                                    The base unit represents the level of intensity for
                                                    anesthesia procedure services that reflects all
                                                    activities except time.     These activities include
                                                    usual preoperative and post-operative visits, the
                                                    administration of fluids and/or blood incident to
                                                    anesthesia care, and monitering procedures.
                                                    (Note: the payment amount for anesthesia services
                                                    is based on a calculation using base unit, time
                                                    units, and the conversion factor.)

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : BASEUNIT
                                                    STANDARD ALIAS : HCPCS_ANSTHSA_BASE_UNIT_QTY
                                                    TITLE    ALIAS : HCPCS_ANESTHESIA_BASE_UNIT_QTY

                                                    LENGTH         : 3    SIGNED : N

  27.  HCPCS Code Added Date
                                 8    269    276    NUM

                                                    The year the HCPCS code was added to the Healthcare
                                                    common procedure coding system.

                                                    DB2      ALIAS : HCPCS_CD_ADD_DT
                                                    SAS      ALIAS : ADD_DT
                                                    STANDARD ALIAS : HCPCS_CD_ADD_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    EDIT RULES :
                                                             YYYYMMDD

  28.  HCPCS Action Effective Date
                                 8    277    284    NUM

                                                    Effective date of action to a procedure or
                                                    modifier code

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : EFCTV_DT
                                                    STANDARD ALIAS : HCPCS_ACTN_EFCTV_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    EDIT RULES :
                                                             YYYYMMDD

  29.  HCPCS Termination Date
                                 8    285    292    NUM

                                                    Last date for which a procedure or modifier
                                                    code may be used by Medicare providers.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : TERM_DT
                                                    STANDARD ALIAS : HCPCS_TRMNTN_DT
                                                    TITLE    ALIAS : HCPCS_TERMINATION_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    EDIT RULES :
                                                             YYYYMMDD

  30.  HCPCS Action Code
                                 1    293    293    CHAR

                                                    A code denoting the change made to a procedure
                                                    or modifier code within the HCPCS system.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : ACTN_CD
                                                    STANDARD ALIAS : HCPCS_ACTN_CD

                                                    LENGTH         : 1

                                                    CODES         :
                                                       A = Add procedure or modifier code
                                                       B = Change in both administrative data field
                                                           and long description of procedure or
                                                           modifier code
                                                       C = Change in long description of procedure or
                                                           modifier code
                                                       D = Discontinue procedure or modifier code
                                                       F = Change in administrative data field of
                                                           procedure or modifier code
                                                       N = No maintenance for this code
                                                       P = Payment change (MOG, pricing indicator codes,
                                                           anesthesia base units,Ambulatory Surgical Centers)
                                                       R = Re-activate discontinued/deleted procedure
                                                           or modifier code
                                                       S = Change in short description of procedure code
                                                       T = Miscellaneous change (BETOS, type of service)

  31.  FILLER                                       CHAR
                                27    294    320
                                                    DB2      ALIAS : FILLER

                                                    LENGTH         : 27



                                                          *******************************************************



  TABLE OF CODES APPENDIX                                HCPCS_CTRTR_16_REC
   


 BETOS_TB                                                   BETOS Table



   M1A = Office visits - new
   M1B = Office visits - established
   M2A = Hospital visit - initial
   M2B = Hospital visit - subsequent
   M2C = Hospital visit - critical care
   M3  = Emergency room visit
   M4A = Home visit
   M4B = Nursing home visit
   M5A = Specialist - pathology
   M5B = Specialist - psychiatry
   M5C = Specialist - opthamology
   M5D = Specialist - other
   M6  = Consultations
   P0  = Anesthesia
   P1A = Major procedure - breast
   P1B = Major procedure - colectomy
   P1C = Major procedure - cholecystectomy
   P1D = Major procedure - turp
   P1E = Major procedure - hysterectomy
   P1F = Major procedure - explor/decompr/excisdisc
   P1G = Major procedure - Other
   P2A = Major procedure, cardiovascular-CABG
   P2B = Major procedure, cardiovascular-Aneurysm repair
   P2C = Major Procedure, cardiovascular-Thromboendarterectomy
   P2D = Major procedure, cardiovascualr-Coronary angioplasty (PTCA)
   P2E = Major procedure, cardiovascular-Pacemaker insertion
   P2F = Major procedure, cardiovascular-Other
   P3A = Major procedure, orthopedic - Hip fracture repair
   P3B = Major procedure, orthopedic - Hip replacement
   P3C = Major procedure, orthopedic - Knee replacement
   P3D = Major procedure, orthopedic - other
   P4A = Eye procedure - corneal transplant
   P4B = Eye procedure - cataract removal/lens insertion
   P4C = Eye procedure - retinal detachment
   P4D = Eye procedure - treatment of retinal lesions
   P4E = Eye procedure - other
   P5A = Ambulatory procedures - skin
   P5B = Ambulatory procedures - musculoskeletal
   P5C = Ambulatory procedures - inguinal hernia repair
   P5D = Ambulatory procedures - lithotripsy
   P5E = Ambulatory procedures - other
   P6A = Minor procedures - skin
   P6B = Minor procedures - musculoskeletal
   P6C = Minor procedures - other (Medicare fee schedule)
   P6D = Minor procedures - other (non-Medicare fee schedule)
   P7A = Oncology - radiation therapy
   P7B = Oncology - other
   P8A = Endoscopy - arthroscopy
   P8B = Endoscopy - upper gastrointestinal
   P8C = Endoscopy - sigmoidoscopy
   P8D = Endoscopy - colonoscopy
   P8E = Endoscopy - cystoscopy
   P8F = Endoscopy - bronchoscopy
   P8G = Endoscopy - laparoscopic cholecystectomy
   P8H = Endoscopy - laryngoscopy
   P8I = Endoscopy - other
   P9A = Dialysis services (medicare fee schedule)
   P9B = Dialysis services (non-medicare fee schedule)
   I1A = Standard imaging - chest
   I1B = Standard imaging - musculoskeletal
   I1C = Standard imaging - breast
   I1D = Standard imaging - contrast gastrointestinal
   I1E = Standard imaging - nuclear medicine
   I1F = Standard imaging - other
   I2A = Advanced imaging - CAT/CT/CTA: brain/head/neck
   I2B = Advanced imaging - CAT/CT/CTA: other
   I2C = Advanced imaging - MRI/MRA: brain/head/neck
   I2D = Advanced imaging - MRI/MRA: other
   I3A = Echography/ultrasonography - eye
   I3B = Echography/ultrasonography - abdomen/pelvis
   I3C = Echography/ultrasonography - heart
   I3D = Echography/ultrasonography - carotid arteries
   I3E = Echography/ultrasonography - prostate, transrectal
   I3F = Echography/ultrasonography - other
   I4A = Imaging/procedure - heart including cardiac
                              catheterization
   I4B = Imaging/procedure - other
   T1A = Lab tests - routine venipuncture (non Medicare
                     fee schedule)
   T1B = Lab tests - automated general profiles
   T1C = Lab tests - urinalysis
   T1D = Lab tests - blood counts
   T1E = Lab tests - glucose
   T1F = Lab tests - bacterial cultures
   T1G = Lab tests - other (Medicare fee schedule)
   T1H = Lab tests - other (non-Medicare fee schedule)
   T2A = Other tests - electrocardiograms
   T2B = Other tests - cardiovascular stress tests
   T2C = Other tests - EKG monitoring
   T2D = Other tests - other
   D1A = Medical/surgical supplies
   D1B = Hospital beds
   D1C = Oxygen and supplies
   D1D = Wheelchairs
   D1E = Other DME
   D1F = Prosthetic/Orthotic devices
   D1G = Drugs Administered through DME
   O1A = Ambulance
   O1B = Chiropractic
   O1C = Enteral and parenteral
   O1D = Chemotherapy
   O1E = Other drugs
   O1F = Hearing and speech services
   O1G = Immunizations/Vaccinations
   Y1  = Other - Medicare fee schedule
   Y2  = Other - non-Medicare fee schedule
   Z1  = Local codes
   Z2  = Undefined codes

 CMS_TYPE_SRVC_TB                                    CMS Type of Service Table



  1 = Medical care
  2 = Surgery
  3 = Consultation
  4 = Diagnostic radiology
  5 = Diagnostic laboratory
  6 = Therapeutic radiology
  7 = Anesthesia
  8 = Assistant at surgery
  9 = Other medical items or services
  0 = Whole blood only eff 01/96,
      whole blood or packed red cells before 01/96
  A = Used durable medical equipment (DME)
  B = High risk screening mammography
      (obsolete 1/1/98)
  C = Low risk screening mammography
      (obsolete 1/1/98)
  D = Ambulance (eff 04/95)
  E = Enteral/parenteral nutrients/supplies
      (eff 04/95)
  F = Ambulatory surgical center (facility
      usage for surgical services)
  G = Immunosuppressive drugs
  H = Hospice services (discontinued 01/95)
  I = Purchase of DME (installment basis)
      (discontinued 04/95)
  J = Diabetic shoes (eff 04/95)
  K = Hearing items and services (eff 04/95)
  L = ESRD supplies (eff 04/95)
      (renal supplier in the home before 04/95)
  M = Monthly capitation payment for dialysis
  N = Kidney donor
  P = Lump sum purchase of DME, prosthetics,
      orthotics
  Q = Vision items or services
  R = Rental of DME
  S = Surgical dressings or other medical supplies
      (eff 04/95)
  T = Psychological therapy (term. 12/31/97)
      outpatient mental health limitation (eff. 1/1/98)
  U = Occupational therapy
  V = Pneumococcal/flu vaccine (eff 01/96),
      Pneumococcal/flu/hepatitis B vaccine (eff 04/95-12/95),
      Pneumococcal only before 04/95
  W = Physical therapy
  Y = Second opinion on elective surgery
      (obsoleted 1/97)
  Z = Third opinion on elective surgery
      (obsoleted 1/97)