Filename:
Filetype:

Interacts with
HEALTHpac via:
dc07cdt4.txt
ascii text

use m7hcpcup.dbc to update HP3.5
use m9hcpcup.dbc to update HP4


Record Layout:
Note that only the CD field and the first 40 characters of the LONG_DESC_TXT are currently used in the HEALTHpac system.

Field Size Position  Description
CD 5 1-5 CDT4 Code
SQNC_NUM 5 6-10 Description Sequence Number
REC_IDENT_CD
1 11 Record ID
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
LONG_DESC_TXT 80 12-91 CDT-4 Long Description
SHORT_DESC_TEXT 28 92-119 CDT-4 Short Description 
PRCNG_IND_CD
2(4) 120-127 Pricing Indicator -
Code used to identify the appropriate methodology for developing unique pricing amounts under Medicare Part B. A procedure may have one to four pricing codes.
CODES:
00 = Service not separately priced by part B
(e.G., services not covered, bundled, used
by part a only, etc.)

13 = Price established by carriers (e.G., not
otherwise classified, individual determination,
carrier discretion)
MLTPL_PRCNG_IND_CD 1 128 Multiple Pricing Indicator Code
CODES:
9 = Not applicable as code not priced separately
by part B (pricing indicator is 00) or value
is not established (pricing indicator is '99')
A = Not applicable as code priced under one
methodology
B = Professional component of code 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.
CIM_RFRNC_SECT_NUM 6(3) 129-146 HCPCS Coverage Issues Manual Reference Section Number
MCM_RFRNC_SECT_NUM 8(3) 147-170 HCPCS Medicare Carriers Manual Reference Section Number
HCPCS_STATUTE_NUM
10 171-180 HCPCS Statute Number
Filler1
3 181-183 Filler
XREF_CD
5(5) 205-229 Cross Reference Code 
CVRG_CD
1 230 Coverage Code
CODES:
D = Special coverage instructions apply
I = Not payable by Medicare (no grace period)
G = Not payable by Medicare (90 day grace period)
M = Non-covered by Medicare
S = Non-covered by Medicare statute
C = Carrier judgment
FILLER4
22 231-252 Filler
PRCSG_NOTE_NUM
4 253-256 Number identifying the processing note contained
in Appendix A of the HCPCS manual. 
BETOS_CD
3 257-259 Berenson-Eggers Type of Service (BETOS)
Filler2 1 260 Filler 
TYPE_SRVC_CD
1 261 Type Of Service Code
FILLER5 3 266-268 Filler
CD_ADD_DT 8 269-276 Code Added Date
ACTN_EFCTV_DT 8 277-284 Action Effective Date 
TERMINATION_DT
8 285-292 Termination Date
ACTN_CD 1 293

Action Code
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)
R = Re-activate discontinued/deleted procedure
or modifier code
S = Change in short description of procedure code
T = Miscellaneous change (BETOS, type of service)
 

Filler3 27 294-320 Filler