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Code indicating the type of service, as defined in the CMS Medicare Carrier Manual, for this line item on the non-institutional claim.
The code indicating the diagnosis supporting this line item procedure/service on the non-institutional claim.
Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9/ICD-10.
The amount representing the lower of fee schedule for purchase of new or used DME, or actual charge. In case of rental DME, this amount represents the purchase cap; rental payments can only be made until the cap is met.
This line item field is applicable to non-institutional claims involving DME, prosthetic, orthotic and supply items, immunosuppressive drugs, parenteral nutrition (PEN), ESRD and oxygen items referred to as DMEPOS.
Beginning date (1st expense) for this line item service on the non-institutional encounter record.
Beginning date (1st expense) for this line item service on the non-institutional claim.
Line Foreign Address Indicator on the durable medical equipment (DME) claim line
The ending date (last expense) for the line item service on the non-institutional encounter record.
It is almost always the same as the line-level first expense date (variable called LINE_1ST_EXPNS_DT); exception is for DME claims - where some services are billed in advance.
The ending date (last expense) for the line item service on the non-institutional claim.
It is almost always the same as the line-level first expense date (variable called LINE_1ST_EXPNS_DT); exception is for DME claims - where some services are billed in advance.
Indicates if the line on the encounter record is the latest action.
The maximum amount displayed at the claim line level as determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment.
This field should be populated with the amount that would have been paid had the services been provided on a fee –for-service (FFS) basis.
The total amount paid by Medicaid or the managed care plan on this claim or adjustment at the claim detail level.
The amount paid by Medicaid/CHIP or the managed care plan on this claim on the claim line level toward the beneficiary’s Medicare coinsurance.
The amount paid by Medicaid/CHIP or the managed care plan on this claim at the claim line level toward the beneficiary’s Medicare deductible.
The amount paid by Medicare on this claim line or adjustment line.
This field is the National Drug Code (NDC) identifying the specific drug.
On the DMERC claim, the National Drug Code identifying the oral anti-cancer drugs.
This line item field was added as a placeholder on the Carrier claim.
Amount of payment made from the trust funds (after deductible and coinsurance amounts have been paid) for the line item service on the non-institutional claim.
The first field used to identify amounts that were used to adjust the amount payable when processing the line item.
Source: NCH
The second field used to identify amounts that were used to adjust the amount payable when processing the line item.
The third field used to identify amounts that were used to adjust the amount payable when processing the line item.
The fourth field used to identify amounts that were used to adjust the amount payable when processing the line item.
The fifth field used to identify amounts that were used to adjust the amount payable when processing the line item.
The sixth field used to identify amounts that were used to adjust the amount payable when processing the line item.
The field used to identify amounts that were used to adjust the amount payable when processing the line item.
The first code used to identify the reason the claim payment amount was adjusted during claims processing.
The second code used to identify the reason the claim payment amount was adjusted during claims processing.
The third code used to identify the reason the claim payment amount was adjusted during claims processing.
The fourth code used to identify the reason the claim payment amount was adjusted during claims processing.
The fifth code used to identify the reason the claim payment amount was adjusted during claims processing.
The sixth code used to identify the reason the claim payment amount was adjusted during claims processing.
The seventh code used to identify the reason the claim payment amount was adjusted during claims processing.
The amount paid by insurance other than Medicare or Medicaid on this claim.
The code indicating that the amount shown in the payment field on the non-institutional line item represents either 80% or 100% of the allowed charges less any deductible, or 100% limitation of liability only.
The payment (reimbursement) made to the beneficiary related to the line item service on the non-institutional claim.
The 9-digit zip code for the primary practice/business location of the physician receiving the payment or other transfer of value.
The code indicating where the service was performed; the place of service.
The code indicating the place of service, as defined in the Medicare Carrier Manual, for this line item on the noninstitutional claim.
The amount of a payment made on behalf of a Medicare beneficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges for to the line item service on the non-institutional claim.
The primary payer allowed charge amount for the line item service on the noninstitutional claim.
If there is a primary payer other than Medicare, there may be an allowed payment for the provider; if so, this field is populated.
The code specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's medical bills relating to the line item service on the non-institutional claim.
The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges.
: AHRQ Clinical Classifications Software (CCS) procedure category code. The Clinical Classifications Software Refined (CCSR) aggregates International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) codes into clinically meaningful categories. The CCSR for ICD-10-PCS procedures aggregates more than 80,000 ICD-10-PCS procedure codes into over 320 clinical categories across 31 clinical domains.
A field to capture the CPT or HCPCS code that describes a service or good rendered by the provider to an enrollee on the specified date of service.
These are fields to capture a modifier code associated with the LINE_PRCDR_CD field on the OT claim line. The first modifier is reported in LINE_PRCDR_MDFR_CD_1. If more than one modifier is reported, the additional codes are in fields LINE_PRCDR_MDFR_CD_2 through LINE_PRCDR_MDFR_CD_4.
These are fields to capture a modifier code associated with the LINE_PRCDR_CD field on the OT claim line. The first modifier is reported in LINE_PRCDR_MDFR_CD_1. If more than one modifier is reported, the additional codes are in fields LINE_PRCDR_MDFR_CD_2 through LINE_PRCDR_MDFR_CD_4.