This field is the amount of physician and other professional charges covered under Medicare Part B.
Comments
This variable is not populated for Home Health or Hospice claims.
This field is used for CMS editing purposes and other internal processes (e.g. if computing interim payments, then these charges are deducted).
The source of information for this field for institutional claims is the CLM_VAL_AMT (when the code = 04 or 05, it indicates a professional component charge amount).
For Outpatient claims, this information is from the revenue center codes (when the code=096*, 097*, or 098*, then the REV_CNTR_TOT_CHRG_AMT indicates a professional component charge amount).
This variable is not populated for Home Health or Hospice claims.
This field is used for CMS editing purposes and other internal processes (e.g. if computing interim payments, then these charges are deducted).
The source of information for this field for institutional claims is the CLM_VAL_AMT (when the code = 04 or 05, it indicates a professional component charge amount).
For Outpatient claims, this information is from the revenue center codes (when the code=096*, 097*, or 098*, then the REV_CNTR_TOT_CHRG_AMT indicates a professional component charge amount).
Source: NCH QA Process