A = Gramm-Rudman reduction required for services (03/2003/1986–09/30/1986)
B = Interest addition
C = Positive rounding adjustment (due to line-item distribution from total claim reimbursement amount)
D = Negative rounding adjustment (due to line-item distribution from total claim reimbursement amount)
E = Primary Payer allowed charge
F = Payment Reduction (Good cause or Late Billing)
G = Payment Reduction (PMDP Demonstration Reduction)
H = Payment Reduction (Sequestration Reduction)
I = Payment Reduction (ePrescribing Negative Adjustment)
J = ACO Payment Adjustment Amount (Pioneer reduction) — the amount that would have been paid if
not for the Pioneer reduction — eff. 1/2014
K = Payment Reduction (ASC Quality Reporting Payment Reduction) — eff. 1/2014
L = ACO Payment Adjustment Amount (Pioneer reduction) — the actual amount of the Pioneer reduction — eff. 1/2014
M = Payment Reduction (Physician Quality Reporting System [PQRS] Negative Payment Adjustment) — eff. 1/2015
N = None (no amount to apply)
O = Negative or Positive Adjustment (Value Based Modifier [VBM] for reduction) — eff. 1/2015
P = Value Based Payment Modifier (VBM) Positive Payment Adjustment — eff. 1/2015
Q = Electronic Health Record (EHR) Negative Payment Adjustment — eff. 1/2015
R = Part B Drug Payment Model
S = Prior Authorization Reduction — eff. 10/2016
T = Comprehensive Primary Care Plus (CPC+) Payment Adjustment — eff. 4/2017
U = Maryland Primary Care Program (MDPCP) Adjustment — eff. 1/2019
V = Positive Amount for Quality Payment Program (QPP) payment adjustment — eff. 1/2019
W = Negative Amount for Quality Payment Program (QPP) payment adjustment — eff. 1/2019
X = Emergency Triage, Treat, and Transport (ET3) Model Payment — to indicate the amount by which
each line was adjusted for the 15% bonus payment. — eff. 1/2020
Y = Oncology Care Model Plus (OCM+) Population Based Payment Claims Reductions — eff. 1/2020
A2 = Flat Visit Reduction Amount (PCF Model)
A3 = Flat Visit Fee Increased Amount (PCF Model)
A4 = KCF Model Reduction Amount
A5 = CKCC Model Reduction Amount
A6 = Performance Payment Adjustment (PPA) Addition (eff. 1/2022)
A7 = Performance Payment Adjustment (PPA) Reduction (eff. 1/2022)
A8 = Performance Based Adjustment (PBA) Addition (eff. 4/2022)
A9 = Performance Based Adjustment (PBA) Reduction (eff. 4/2022)
B1 = PTA/OTA 15% reduction for Therapy (eff.1/2022)
B2 = Co-Insurance Reduction Amount (eff. 1/2023)