70 = Payer use only, the non-utilization from/thru dates for PPS-inlier stay where bene had exhausted all full/coinsurance days but covered on cost report. SNF qualifying hospital stay from/thru dates
71 = Hospital prior stay dates — the from/thru dates of any hospital stay that ended within 60 days of this hospital or SNF admission
72 = First/Last visit — the dates of the first and last visits occurring in this billing period if the dates are different from those in the statement covers period
73 = Benefit eligibility period — the inclusive dates during which CHAMPUS medical benefits are available to a sponsor's bene as shown on the bene's ID card
74 = Non-covered level of care — the from/thru dates of a period at a non-covered level of care in an otherwise covered stay, excluding any period reported with occurrence span code 76, 77, or 79
75 = The from/thru dates of SNF level of care during IP hospital stay. Shows PRO approval of patient remaining in hospital because SNF bed not available. Not applicable to swing bed cases. PPS hospitals use in day outlier cases only
76 = Patient liability — from/thru dates of period of non-covered care for which hospital may charge bene. The FI or PRO must have approved such charges in advance. Patient must be notified in writing three days prior to non-covered period
77 = Provider liability (utilization charged) — the from/thru dates of period of non-covered care for which the provider is liable. Applies to provider liability where bene is charged with utilization and is liable for deductible/coinsurance
78 = SNF prior stay dates — the from/thru dates of any SNF stay that ended within 60 days of this hospital or SNF admission
79 = Payer code — verified non-covered stay dates for which the provider is liable
80 = Prior Same-SNF Stay Dates for Payment Ban Purposes — the from/thru dates of a prior same-SNF stay indicating a patient resided in the SNF prior to, and if applicable, during a payment ban period up until their discharge to a hospital
81 = Antepartum Days (eff. 7/2/12)
82 = Hospital at Home Care Dates — the from/through dates of a period of hospital at home care provided during an inpatient hospital stay. (eff. 7/2022)
83–99 = Reserved for national assignment
M0 = PRO/UR approved stay dates — the first and last days that were approved where not all of the stay was approved
M1 = Provider liability no utilization — from/thru dates of a period of non-covered care that is denied due to lack of medical necessity or custodial care for which the provider is liable. (eff. 10/2001)
M2 = Dates of inpatient respite care — from/thru dates of a period of inpatient respite care for hospice patients. (eff. 10/2000)
M3 = ICF Level of Care — the from/through dates of a period of intermediate level of care during an inpatient hospital stay
M4 = Residential Level of Care — the from/through dates of a period of residential level of care during an inpatient hospital stay
MR = Reserved for disaster related occurrence span code
Z0-Z9 = Payer code — not currently used by Medicare
ZA-ZZ – Payer code — not currently used by Medicare