| Filename: Filetype: Interacts with HEALTHpac via: | dc07hcpc.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 | HCPCS Code |
| FILLER | 3 | 1-3 | Filler |
| MDFR_CD |
2 | 4-5 | HCPCS Modifier |
| 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 | HCPCS Long Description |
| SHORT_DESC_TEXT | 28 | 92-119 | HCPCS 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.) 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 = Priced by carriers under clinical psychologist fee schedule (not applicable as of january 1, 1998) 56 = Priced by carriers under clinical social worker fee schedule (not applicable as of january 1, 1998) 57 = Other carrier priced 99 = Value not established |
| MLTPL_PRCNG_IND_CD | 1 | 128 | Multiple Pricing Indicator Code 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. |
| 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 |
| LAB_CRTFCTN_CD |
3 | 181-183 | HCPCS Lab Certification Code 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 |
| 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 |
| ASC_PMT_GRP_CD |
2 | 231-232 | ASC Payment Group Code |
| ASC_PMT_GRP_EFCTV_DT | 8 | 233-240 | ASC Payment Group Effective Date |
| MOG_PMT_GRP_CD | 3 | 241-243 | Medicare outpatient groups (MOG) payment group code |
| MOG_PMT_PLCY_IND_CD | 1 | 244 | MOG Payment Policy Indicator |
| MOG_PMT_GRP_EFCTV_DT | 8 | 245-252 | MOG Effective Date (YYYYMMDD) |
| 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) 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 |
| Filler2 | 1 | 260 | Filler |
| TYPE_SRVC_CD |
1 | 261 | Type Of Service Code 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) |
| ANESTHESIA_BASE_UNIT_QTY | 3 | 266-268 | Anesthesia Base Unit Qty |
| 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 |