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 |
Filler3 | 27 | 294-320 | Filler |