*Indicates fields that are present on the 2002 fee schedule files. Subsequent files are formatted differently and only contain Carrier, Locality, HCPC, and Rate.
| *CARRIER | Carrier Number - This field displays the identification number of the carrier that is associated with HCPC information required. This is a five digit field. | ||||||||||||||||||||||||||||
| *LOCALITY | Locality Code - This field displays the identification number for the area (or county) where the provider is located. This is a two digit field. | ||||||||||||||||||||||||||||
| *HCPC | HCFA Common Procedure Coding System - This field is a code assigned by CMS to identify certain medical procedures or equipment for special pricing. This is a five position alphanumeric field. | ||||||||||||||||||||||||||||
| IND | HCPC Indicator - This field is not used by FISS. | ||||||||||||||||||||||||||||
| NDC | National Drug Code - This field is not used by FISS. | ||||||||||||||||||||||||||||
| ESRD HCPC NARR | End Stage Renal Disease HCFA Common Procedure Coding System Narrative - This is a short description to further define those HCPC codes that are related to ESRD. This is a six position alphanumeric field. | ||||||||||||||||||||||||||||
| HCPC/NDC EFF DATE | HCFA Common Procedure Coding System/National Drug Code Effective Date - This field identifies the date this code became effective. The default for all HCPC codes is 07/01/66. This is a six digit field in MMDDYY format. | ||||||||||||||||||||||||||||
| HCPC/NDC TERM DATE | HCFA Common Procedure Coding System/National Drug Code Termination Date - This field identifies the final date that this code should be used. This is a six digit field in MMDDYY format. | ||||||||||||||||||||||||||||
| *60% RATE |
60% Reimbursement Rate - This field identifies the rate the system uses for calculating reimbursement for the HCPC codes. The system displays 60 percent of the total charge in a dollar figure. This is an eight digit field in 999999.99 format. NOTE: This field is also used to identify the urban fee amount for ambulance fee schedule rates. |
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| *LAB 62% RATE |
62% Lab Reimbursement Rate - This field identifies the rate the system uses for calculating reimbursement for the lab HCPC codes. The system displays 62 percent of the total charge in a dollar figure. This is an eight digit field in the 999999.99 format. NOTE: This field is also used to identify the rural fee amount for ambulance fee schedule rates. |
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| *EFF DATE |
Effective Date - This field identifies the date the change in pricing went into effect. This is a six digit field in MMDDYY format. |
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| *TRM DATE | Termination Date - This field identifies the termination date for each rate listed for this HCPC. This is a six digit field in MMDDYY format. | ||||||||||||||||||||||||||||
| *EFF IND |
Effective Date Indicator - The effective indicator instructs the system to either use the FROM and THRU dates on the claim or to use the system run date to perform edits for this particular HCPC code. This is a one position alphanumeric field. The valid values are:
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| *OVR CD |
Override Code - This field instructs the system in applying the services to the beneficiary's deductible and to coinsurance. This is a one digit field. The valid values are:
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| *FEE IND |
Fee Indicator - This field identifies the fee indicator that is received from CMS in the physician fee schedule abstract test file. This is a one position field, with six occurrences. The valid values are:
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| *OPH IND |
Outpatient Hospital Indicator - This field identifies the outpatient hospital indicator that is received from CMS in the physician fee schedule abstract test file. This is a one digit field, with six occurrences. The valid values are:
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| *REHAB RATE | Rehabilitation Rate - This field identifies the rate the system uses for calculating reimbursement for the HCPCS code when rehabilitation services are billed. | ||||||||||||||||||||||||||||
| *PROF RATE | Professional Service Rate - This field identifies the rate the system uses for calculating reimbursement for the HCPCS when professional services (revenue codes 96X, 97X, or 98X) are billed for dates of service on or after 07/01/01 by critical access providers that have selected provider reimbursement method 'J'. | ||||||||||||||||||||||||||||
| *ALLOWABLE REVENUE CODES | Allowable Revenue Codes - This field identifies the allowable revenue code(s) that this particular HCPC code may use in billing. This is a four position alphanumeric field. The fourth digit of the revenue code may be stored with an 'X' indicating that it is a variable. For example, by storing the revenue code '029X', the system allows this HCPC code with any revenue code that begins with '029'. By leaving this field blank, the system allows a HCPC code on any revenue code. | ||||||||||||||||||||||||||||
| *HCPC DESCRIPTION | HCFA Common Procedure Coding System Description - This field identifies the narrative description of the HCPC code. There are three occurrences of 77 alphanumeric positions per occurrence. | ||||||||||||||||||||||||||||