TABLE_NAME,VERSION,COMMENTS
DATA_APC,APC,APC value
DATA_APC,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_APC,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_APC,DESCRIPTION,APC description
DATA_APC,STATUS_INDICATOR,Status indicator assigned to the APC
DATA_APC,PAYMENT_INDICATOR,Payment indicator assigned to the APC
DATA_APC,APC_PAYMENT,Payment amount of the APC
DATA_APC,MENTAL_HEALTH,"APC subject to Mental Health/Partial Hospitalization Program (MH/PHP) logic.
Values:
0 = not applicable
1 = applicable"
DATA_APC,ER_VISIT,"Emergency room visit and critical care APC subject to observation logic.
Values:
0 = not applicable
1 = applicable"
DATA_APC,DEVICE_OFFSET,APC's device offset amount prior to v54. Refer to OFFSET_CODEPAIRS table for device offset amounts after v53.
DATA_APC,COMP1_ID,"APC subject to composite APC processing.
Values:
0 = not applicable
1 = electrophysiology/ablation composite APC (v15.3)
2 = LDR prostate brachytherapy composite APC (v18.3)"
DATA_APC,COMP2_ID,"APC subject to observation composite APC processing prior to v62 (Note: EA&M composite levels I & II combined in v18.0).
Values:
0 = not applicable
1 = possible level II observation composite APC
2 = possible level I observation composite APC"
DATA_APC,COMP3_ID,"APC subject to multiple imaging composite APC processing.
Values:
0 = not applicable
1 = Ultrasound Composite
2 = CT and CTA without Contrast Composite
3 = CT and CTA with Contrast Composite
4 = MRI and MRA without Contrast Composite
5 = MRI and MRA with Contrast Composite"
DATA_APC,NUC_RAD_FB,"APC subject to nuclear medicine/radiopharm processing prior to v54.
Values:
0 = not applicable
1 = applicable"
DATA_APC,CAPC_SRS,"APC subject to comprehensive APC processing for Stereotactic Radiosurgery (SRS).
Values:
0 = not applicable
1 = applicable"
DATA_CAPC,HCPCS,CPT/HCPCS code value.
DATA_CAPC,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_CAPC,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_CAPC,RANK,Ranking of comprehensive APC procedures used to determine primary comprehensive APC procedure when multiple comprehensive APC procedures are present on a claim.
DATA_CAPC,COMPLEXITY_ADJUSTMENT,"Comprehensive APC procedure subject to complexity-adjusted logic when conditions present on claim.
Values:
0 = no complexity adjustment
1 = complexity adjustment applies"
DATA_DISCOUNT_FORMULA,DISCOUNT_KEY,"Discount key used to determine which discount formula to apply when discounting conditions present on claim.
Values: (Key descriptions) H = High, N = No, Y = Yes
HNN
HNY
HYN
HYY
NNN
NNY
NYN
NYY"
DATA_DISCOUNT_FORMULA,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_DISCOUNT_FORMULA,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_DISCOUNT_FORMULA,DISCOUNT_FORMULA,"Discount formula string.
Values:
221113
428813
333333
551113
958813"
DATA_DISCOUNT_FORMULA,DESCRIPTION,"Discount formula description.
Values:
HNN = Highest paying discount-applicable line; no modifier 52, 73, nor 50 is present; line is not an independent or conditional bilateral.
HNY = Highest paying discount-applicable line; no modifier 52 nor 73 is present; modifier 50 is present or the line is an independent or conditional bilateral.
HYN = Highest paying discount-applicable line; either modifier 52 or 73 is present; neither modifier 50 is present and line is not an independent or conditional bilateral.
HYY = Highest paying discount-applicable line; either modifier 52 or 73 is present; and modifier 50 is present or the line is an independent or conditional bilateral.
NNN = Non-highest paying discount-applicable line; no modifier 52, 73, nor 50 is present; line is not an independent or conditional bilateral.
NNY = Non-highest paying discount-applicable line; no modifier 52 nor 73 is present; modifier 50 is present or the line is an independent or conditional bilateral.
NYN = Non-highest paying discount-applicable line; either modifier 52 or 73 is present; neither modifier 50 present and line is not an independent or conditional bilateral.
NYY = Non-highest paying discount-applicable line; either modifier 52 or 73 is present; and modifier 50 is present or the line is an independent or conditional bilateral."
DATA_DX09,DIAGNOSIS,Diagnosis code
DATA_DX09,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_DX09,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_DX09,DESCRIPTION,Diagnosis code description
DATA_DX09,LO_AGE,"Lowest valid age for the diagnosis.
Ranges (Low Age/High Age):
0/124 = all valid ages
0/0 = newborn
0/17= pediatric
12/55 = maternity
15/124 = adult"
DATA_DX09,HI_AGE,"Highest valid age for the diagnosis.
Ranges (Low Age/High Age):
0/124 = all valid ages
0/0 = newborn
0/17= pediatric
12/55 = maternity
15/124 = adult"
DATA_DX09,SEX,"Sex restriction value for the diagnosis.
Values:
0 = not applicable
1 = male-only
2 = female-only"
DATA_DX09,EXTERNAL_CAUSE,"Diagnosis identified as an external cause of morbidity diagnosis.
Values:
0 = not applicable
1 = applicable"
DATA_DX09,MENTAL_HEALTH,"Diagnosis identified as a mental health diagnosis.
Values:
0 = not applicable
1 = applicable"
DATA_DX09,MANIFESTATION,"Diagnosis identified as a manifestation diagnosis (Edit 86).
Values:
0 = not applicable
1 = applicable"
DATA_DX09,CODE_FIRST,"Mental health diagnosis may be coded in first position of secondary diagnoses slots (Edit 109).
Values:
0 = not applicable
1 = applicable"
DATA_DX10,DIAGNOSIS,Diagnosis code
DATA_DX10,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_DX10,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_DX10,DESCRIPTION,Diagnosis code description
DATA_DX10,LO_AGE,"Lowest valid age for the diagnosis.
Ranges (Low Age/High Age):
0/124 = all valid ages
0/0 = newborn
0/17= pediatric
12/55, 9/64 (activated v18.3, 2019-10-01) = maternity
15/124 = adult"
DATA_DX10,HI_AGE,"Highest valid age for the diagnosis.
Ranges (Low Age/High Age):
0/124 = all valid ages
0/0 = newborn
0/17= pediatric
12/55, 9/64 (activated v18.3, 2019-10-01) = maternity
15/124 = adult"
DATA_DX10,SEX,"Sex restriction value for the diagnosis.
Values:
0 = not applicable
1 = male-only
2 = female-only"
DATA_DX10,EXTERNAL_CAUSE,"Diagnosis identified as an external cause of morbidity diagnosis.
Values:
0 = not applicable
1 = applicable"
DATA_DX10,MENTAL_HEALTH,"Diagnosis identified as a mental health diagnosis.
Values:
0 = not applicable
1 = applicable"
DATA_DX10,MANIFESTATION,"Diagnosis identified as a manifestation diagnosis (Edit 86).
Values:
0 = not applicable
1 = applicable"
DATA_DX10,CODE_FIRST,"Mental health diagnosis may be coded in first position of secondary diagnoses slots (Edit 109).
Values:
0 = not applicable
1 = applicable"
DATA_EDIT_BYPASS,EDIT,Lists edits allowed by the Contractor Bypass functionality.
DATA_EDIT_BYPASS,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_EDIT_BYPASS,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_EDIT_BYPASS,LINE_BYPASS_REQUIRED,"Indicates whether the bypassed edit is located at the claim level or line level.
Values:
0 = Claim level edit
1 = Line level edit"
DATA_HCPCS,HCPCS,CPT/HCPCS code
DATA_HCPCS,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_HCPCS,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_HCPCS,DESCRIPTION,CPT/HCPCS description
DATA_HCPCS,APC,Default APC assignment for CPT/HCPCS.
DATA_HCPCS,LO_AGE,"Lowest valid age for the CPT/HCPCS.
Ranges (Low Age/High Age):
0/124 = all valid ages
0/0 = newborn
0/17= pediatric
12/55, 9/64 (activated v18.3, 2019-10-01) = maternity
15/124 = adult"
DATA_HCPCS,HI_AGE,"Highest valid age for the CPT/HCPCS.
Ranges (Low Age/High Age):
0/124 = all valid ages
0/0 = newborn
0/17= pediatric
12/55, 9/64 (activated v18.3, 2019-10-01) = maternity
15/124 = adult"
DATA_HCPCS,SEX,"Sex restriction value for the CPT/HCPCS.
Values:
0 = not applicable
1 = male-only
2 = female-only"
DATA_HCPCS,STATUS_INDICATOR,Default status indicator assigned to CPT/HCPCS.
DATA_HCPCS,PAYMENT_INDICATOR,Default payment indicator assigned to CPT/HCPCS.
DATA_HCPCS,QUESTIONABLE,"Questionable service (Edit 12).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NOT_RECOGNIZED_MCARE,Code not recognized by Medicare for outpatient claims; alternate code for same service may be available (Edit 28)
DATA_HCPCS,NOT_RECOGNIZED_OPPS,"Not recognized by OPPS (Edit 62).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NON_COVERED,"Non-covered service (Edit 9).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NON_REPORTABLE_SITE,"C-HCPCS codes only reportable for OPPS claims (Edit 55).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BILATERAL_CONDITIONAL,"Conditional bilateral code from Medicare physician fee schedule.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BILATERAL_INDEPENDENT,"Independent bilateral code from Medicare physician fee schedule.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BILATERAL_INHERENT,"Inherent bilateral code from Medicare physician fee schedule.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NCCI_CODE1,"Code 1 of code pair subject to NCCI PTP editing.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NCCI_CODE2,"Code 2 of code pair subject to NCCI PTP editing.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,VACCINE,"Vaccine services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ANTIGEN,"Antigens for allergen immunotherapy services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SPLINT,"Splint application services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,CAST,"Cast application services that may be paid for Home Health Agency (HHA) or Hospice claims under OPPS.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NEGATIVE_PRESSURE_WOUND_THERAPY,"NPWT services separately payable on Home Health Agency (HHA) claims with bill type 34x.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SOMETIMES_THERAPY,"Wound care services that may be considered sometimes therapy and payable under fee schedule if performed by a therapist.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ACTIVITY_THERAPY,"Activity therapy service not payable outside of a partial hospitalization program (PHP).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,OCCUPATIONAL_THERAPY,"Occupational therapy service only billable on partial hospitalization claims (PHP).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,DEDUCTIBLE_NA,"Deductible is not applicable for CPT/HCPCS.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,DEDUCTIBLE_COINS_NA,"Deductible and Coinsurance are not applicable for CPT/HCPCS.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,COINS_NA,"Coinsurance not applicable for CPT/HCPCS.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BLOOD_SERVICE,"Blood transfusion or exchange (Edit 43).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BLOOD_PRODUCT,"Blood product (Edit 43).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PACKED_RED_CELLS,"Packed red blood cells reported with revenue code 381 (Edit 79).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,WHOLE_BLOOD,"Whole blood reported with revenue code 382 (Edit 79).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,EDUCATIONAL,"Education and Training HCPCS (Edit 35).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,OBSERVATION,"Observation CPT/HCPCS code requires revenue code 762 (Edit 44).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,OBSERVATION_HOURLY,"Observation code requires the number of observation hours reported in the units of service field.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,OBSERVATION_DIRECT_ADMIT,"Observation code for direct admission or referral to hospital observation.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,OBSERVATION_HOSPITAL_ONLY,"Observation code can only be reported with bill type 13x or 85x (Edit 53).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,TRAUMA_REVENUE_CODE,"Revenue code 068x is required for trauma response critical care services (Edit 76).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,TRAUMA_CRITICAL_CARE,"Critical care services required to be reported with trauma response service (Edit 76).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,CRITICAL_CARE_ANCILLARY,"Critical care ancillary service.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,STV_PACKAGED,"Code packaged when status indicator S, T, or V procedure present.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,T_PACKAGED,"Code packaged when status indicator T procedure present.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,HAS_DEV_REQ_PROC,"Device CPT/HCPCS that require a surgical implantation procedure code to be reported (Edit 77), v58.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SEPARATE_PROCEDURE,"Separate inpatient procedure (Edit 45).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,STATUTORY_EXCLUSION,"Statutory exclusion (Edit 50).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,DMERC_BILLABLE_ONLY,"Billable to Durable Medical Equipment Regional Carrier (DMERC) only (Edit 61).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,UNCLASSIFIED_DRUG,"Unclassified Drug (Edit 66).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,RADIO_PHARM,"Radiolabeled product(s) required for nuclear medicine procedure, prior to v54.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NUCLEAR_MED,"Nuclear medicine procedure requires diagnostic radiopharmaceutical, prior to v54.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,MID_QUARTER_DATE_EDIT,"The mid-quarter date edit returned when conditions present on claim.
Values:
0 = not applicable
67 = Service provided prior to FDA approval
68 = Service provided prior to date of NCD approval
69 = Service provided outside approval period
83 = Service provided on or after effective date of NCD noncoverage
110 = Service provided prior to initial marketing date"
DATA_HCPCS,DATE_APPROVED,"The effective mid-quarter date of approval for FDA, National Coverage Determination (NCD), or initial marketing date.
Values:
0 = not applicable
YYYYMMDD = approval date for code"
DATA_HCPCS,DATE_TERMINATED,"The mid-quarter date when a code approval period becomes inactive.
Values:
0 = not applicable
YYYYMMDD = termination date for code"
DATA_HCPCS,NON_BILLABLE_MAC,"Not billable to MAC (Edit 72).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,HAS_DEVICE_PAIR1,"Surgical implantation procedure that requires a device CPT/HCPCS to be reported (Edit 71), prior to v58.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,HAS_DEVICE_PAIR2,"Surgical implantation procedure that may require a second device HCPCS to be reported (Edit 71), prior to v58.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PH_PRIMARY,"Primary partial hospitalization program (PHP) service (e.g. psychotherapy) subject to the partial hospitalization program logic.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PH_SERVICE,"Services applicable to the partial hospitalization program.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,DAILY_MENTAL_HEALTH,"Mental health services that count towards the daily mental health service total.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,MH_NOT_PH,"Mental health service that is not payable under the partial hospitalization program (PHP) (Edit 80).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PH_NOT_MH,"Partial hospitalization service that is not payable on a mental health claim (Edit 81).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PH_DURATION,"Numeric value representing the duration of a partial hospitalization program (PHP) service that counts towards the weekly requirements for the partial hospitalization program (PHP) (Edit 95).
Values:
0 = 1 hour or not applicable
1 = 0.25 hour
2 = 0.5 hour
3 = 0.75 hour"
DATA_HCPCS,PH_ADDON,"Partial hospitalization program (PHP) add-on codes excluded from the PHP daily count and subject to editing (Edit 84).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,TOKEN_CHARGE_ONLY,"Radiolabeled product provided during an inpatient stay under Medicare Part B that may have a line item charge reported as $1.01 or less.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SKIN_SUBSTITUTE_SG,"Skin substitute application procedure (v13.0-v14.3).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SKIN_SUBSTITUTE,"Skin substitute product (v13.0-v14.3).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,CAPC_EXCLUSION,"Code excluded from comprehensive APC packaging.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,CAPC_SRS_PLAN_AND_PREP,"Stereotactic Radiosurgery planning and preparation procedure.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,DEVICE_PROCEDURE,"Device-dependent procedure (Edit 92).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,DEVICE,"Device for a device-dependent procedure (Edit 92).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SKIN_SUBSTITUTE_SG_LO,"Low-cost skin substitute procedure (Edit 87).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SKIN_SUBSTITUTE_LO,"Low-cost skin substitute product (Edit 87).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SKIN_SUBSTITUTE_SG_HI,"High-cost skin substitute procedure (Edit 87).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,SKIN_SUBSTITUTE_HI,"High-cost skin substitute product (Edit 87).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,LAB_SERVICE,"Non-packaged laboratory service for bill type 14x (v62).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,FQHC_PREVENTIVE,"FQHC PPS preventive service for bill type 77x.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,FQHC_FLU_PPV,"FQHC PPS influenza/PPV vaccine service for bill type 77x.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,FQHC_NON_COVERED,"FQHC PPS non-covered service for bill type 77x.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,FQHC_ADDON,"FQHC PPS mental health add-on service requires primary procedure code for bill type 77x.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,FQHC_PRIMARY,"FQHC PPS primary procedure service code not reported with mental health add-on service code for bill type 77x.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,FQHC_CHRONIC_CARE,"FQHC Chronic Care Management code.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,RHC_MODIFIER_CONFLICT,"Not eligible for the all-inclusive rate under Rural Health Clinic (RHC).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BYPASS_E72_FQHC_RHC,"Not subject to edit 72 under FQHC and RHC.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,DEV_PROC_BYPASS,"Device codes that bypass edit 71 and 77 for dates prior to 8/13/2013.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,CORNEA_TRANSPLANT,"Code may be paired with cornea tissue processing code (Edit 93).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,CORNEA_TISSUE_PROCESSING,"Cornea tissue processing code (Edit 93).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ADVANCED_CARE_PLANNING,"Advanced care planning code.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ANNUAL_WELLNESS_VISIT,"Medicare annual wellness visit code.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,TERMINATED_DEVICE_PROCEDURE,"Device intensive procedure may be subject to payment offset/credit for the following conditions: terminated procedure reported with modifier 73 or procedures subject to full or partial device credit due to the presence of condition code 49, 50 or 53.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PASSTHROUGH_DEVICE,"Pass-through device subject to payment offset for device procedure logic.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PASSTHROUGH_RADIOPHARM,"Pass-through radiopharmaceutical subject to payment offset for nuclear medicine procedure logic.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PASSTHROUGH_SKIN_PRODUCT,"Pass-through skin substitute product subject to payment offset for skin substitute implantation procedure logic.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PASSTHROUGH_CONTRAST,"Pass-through contrast agent subject to payment offset for radiological procedure logic.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,PASSTHROUGH_STRESS_AGENT,"Pass-through pharmacologic stress agent subject to payment offset for myocardial perfusion imaging procedure logic.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,NON_STANDARD_CT_SCAN,"Code may be reported with modifier CT for non-standard NEMA equipment.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,FILM_XRAY,"Film x-ray code subject to payment reduction when reported with applicable radiological modifier FX or FY.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ALLOGENEIC_TRANSPLANT,"Allogeneic transplant procedure (Edit 100).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BYPASS_E99,"Blood clotting factor excluded from edit (Edit 99).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,OVERRIDE_SECTION603,"Not subject to payment reduction under Section 603 requirements.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ADDON_TYPE1,"Type I add-on code (Edit 106).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ADDON_TYPE2,"Type II add-on code (Edit 107).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ADDON_TYPE3,"Type III add-on code (Edit 108).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BIOSIMILAR,"Biosimilar code required to be reported with an applicable manufacturer modifier.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BUNDLED_IN_BIOLOGICAL,"Cost of service bundled into cost of drug or biological (Edit 111).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,BYPASS_E92_MODIFIER,"Device procedure may bypass edit 92 if the appropriate modifier is present on the line.
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,ADDON_DRUG_ADMIN,"Drug administration add-on code (Edit 106).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,INFORMATION_ONLY,"Information-only service (Edit 112).
Values:
0 = not applicable
1 = applicable"
DATA_HCPCS,UNUSED,For future use
DATA_MODIFIER,MODIFIER,Modifier value
DATA_MODIFIER,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_MODIFIER,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_MODIFIER,DESCRIPTION,Modifier description
DATA_MODIFIER,DATE_ACTIVATED,Mid-Quarter effective date of Modifier usage (YYYYMMDD).
DATA_MODIFIER,NCCI,"Codepair excluded from NCCI editing (Edit 20 and 40) if modifier present and bypass allowed (e.g. NCCI modifier indicator = 1).
Values:
0 = not applicable
1 = applicable"
DATA_MODIFIER,THERAPY,"Therapy modifier (e.g. Speech therapist, physical therapist) used in reporting therapy services.
Values:
0 = not applicable
1 = applicable"
DATA_MODIFIER,NON_DISCOUNT,"Modifier excludes lines from discounting.
Values:
0 = not applicable
1 = applicable"
DATA_MODIFIER,DIED_TRANSFERRED,"Modifier used to identify when a patient has died or was transferred (Edit 60).
Values:
0 = not applicable
1 = applicable"
DATA_MODIFIER,DEVICE_REQ_EXCLUSION,"Modifier identifies early termination of procedure for discounting or subject to terminated device procedure credit.
Values:
0 = not applicable
1 = applicable"
DATA_PAYMENT_INDICATOR,PAYMENT_INDICATOR,Payment indicator value
DATA_PAYMENT_INDICATOR,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_PAYMENT_INDICATOR,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_PAYMENT_INDICATOR,DESCRIPTION,Payment indicator description
DATA_REVENUE,REVENUE_CODE,Revenue center code
DATA_REVENUE,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_REVENUE,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_REVENUE,DESCRIPTION,Revenue code description
DATA_REVENUE,STATUS_INDICATOR,Assigned status indicator when no CPT/HCPCS is reported.
DATA_REVENUE,NOT_RECOGNIZED,"Revenue code not recognized by Medicare without an accompanying CPT/HCPCS (Edit 65).
Values:
0 = not applicable
1 = applicable"
DATA_REVENUE,THERAPY,"Revenue code used in reporting therapy services.
Values:
0 = not applicable
1 = applicable"
DATA_REVENUE,BYPASS_E48,"Revenue code bypasses edit 48 (revenue code requires CPT/HCPCS).
Values:
0 = not applicable
1 = applicable"
DATA_REVENUE,STATUTORY_EXCLUSION,"Revenue code subject to statutory exclusion without an accompanying CPT/HCPCS (Edit 50).
Values:
0 = not applicable
1 = applicable"
DATA_REVENUE,BUNDLED_IN_BIOLOGICAL,"Revenue code subject to ""bundled in biological"" logic without an accompanying CPT/HCPCS (Edit 111).
Values:
0 = not applicable
1 = applicable"
DATA_STATUS_INDICATOR,STATUS_INDICATOR,Status indicator value
DATA_STATUS_INDICATOR,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_STATUS_INDICATOR,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
DATA_STATUS_INDICATOR,DESCRIPTION,Status indicator description
MAP_ADDON_DRUG_ADMIN,ADDON,Drug administration add-on procedure code
MAP_ADDON_DRUG_ADMIN,ADDON_PRIMARY,Drug administration primary procedure code
MAP_ADDON_DRUG_ADMIN,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_ADDON_DRUG_ADMIN,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_ADDON_TYPE1,ADDON,Type I add-on procedure code
MAP_ADDON_TYPE1,ADDON_PRIMARY,Type I primary procedure code
MAP_ADDON_TYPE1,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_ADDON_TYPE1,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_ADDON_TYPE2,ADDON,Type II add-on procedure code
MAP_ADDON_TYPE2,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_ADDON_TYPE2,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_ADDON_TYPE3,ADDON,Type III add-on procedure code
MAP_ADDON_TYPE3,ADDON_PRIMARY,Type III primary procedure code
MAP_ADDON_TYPE3,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_ADDON_TYPE3,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_BIOSIMILAR,HCPCS,CPT/HCPCS code
MAP_BIOSIMILAR,MODIFIER,Modifier required for CPT/HCPCS reporting.
MAP_BIOSIMILAR,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_BIOSIMILAR,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_CAPC,CODE1,1st CPT/HCPCS code of a complexity-adjusted code pair under comprehensive APCs
MAP_CAPC,CODE2,2nd CPT/HCPCS code of a complexity-adjusted code pair under comprehensive APCs
MAP_CAPC,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_CAPC,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_CAPC,APC,Comprehensive APC assignment for complexity-adjusted code pair
MAP_CODEPAIR,CODE1,1st CPT/HCPCS code of pair.
MAP_CODEPAIR,CODE2,2nd CPT/HCPCS code of pair.
MAP_CODEPAIR,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_CODEPAIR,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_CODEPAIR,DEVICE_PAIR1,"Procedure Code1 has a 1st required device Code2 (Edit 71 if an associated code2 is not present), v58.
Values:
0 = not applicable
1 = applicable"
MAP_CODEPAIR,DEVICE_PAIR2,"Procedure Code1 has a 2nd required device Code2 (Edit 71 if an associated code 2 is not present), v58.
Values:
0 = not applicable
1 = applicable"
MAP_CODEPAIR,DEV_REQ_PROC,"Device Code1 has a required procedure Code2 (Edit 77 if an associated code2 is not present), v58.
Values:
0 = not applicable
1 = applicable"
MAP_CODEPAIR,DEV_OFFSET_PAIR,"Code pair eligible for offset if reported with either modifer FC or FB, v54.
Values:
0 = not applicable
1 = applicable"
MAP_CODEPAIR,DEV_PROC_BYPASS,"Code pair bypasses code pair requirements for edits 71 and 77, v58.
Values:
0 = not applicable
1 = applicable"
MAP_COMPOSITE,HCPCS,CPT/HCPCS code
MAP_COMPOSITE,COMPOSITE_APC,Composite APC
MAP_COMPOSITE,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_COMPOSITE,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_COMPOSITE,LIST_TYPE,"Type of Composite list.
Values:
A = Imaging composite
B = EA&M composite for observation
C = Electrophysiology/Ablation composite"
MAP_CONFLICT_RHC,HCPCS,CPT/HCPCS code
MAP_CONFLICT_RHC,MODIFIER,Conflicting modifier if reported with CPT/HCPCS (column1)
MAP_CONFLICT_RHC,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_CONFLICT_RHC,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_FQHC_VISIT,CODE1,Code 1 of a FQHC qualifying visit code pair
MAP_FQHC_VISIT,CODE2,Code 2 of a FQHC qualifying visit code pair
MAP_FQHC_VISIT,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_FQHC_VISIT,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_MODIFIER_CONFLICT,MODIFIER1,Modifier1 required for CPT/HCPCS reporting (code 1 of modifier conflict)
MAP_MODIFIER_CONFLICT,MODIFIER2,Modifier2 required for CPT/HCPCS reporting (code 2 of modifier conflict)
MAP_MODIFIER_CONFLICT,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_MODIFIER_CONFLICT,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_NCCI,CODE1,Code 1 of a NCCI code pair
MAP_NCCI,CODE2,Code 2 of a NCCI code pair
MAP_NCCI,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_NCCI,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_NCCI,MOD_INDICATOR,"Indicates whether an appropriate modifier can be applied to suppress editing.
Values:
0 = modifier not allowed; services represented by code combination not paid separately
1 = modifier allowed; billed services may be justifiable for the code combination
9 = no longer an active NCCI edit; code combinations are billable; no modifier needed"
MAP_PH_ADDON,ADDON,Partial Hospitalization Program (PHP) Add-on Code (Edit 84).
MAP_PH_ADDON,ADDON_PRIMARY,Partial Hospitalization Program (PHP) Primary Procedure.
MAP_PH_ADDON,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_PH_ADDON,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_S603_OVERRIDE,HCPCS,Radiation treatment CPT/HCPCS subject to section 603 logic when reported with modifier PN.
MAP_S603_OVERRIDE,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_S603_OVERRIDE,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_S603_OVERRIDE,APC,APC assignment for radiation treatment CPT/HCPCS when subject to section 603 logic.
MAP_STATUS_PAYMENT,STATUS_INDICATOR,Status indicator (for internal use)
MAP_STATUS_PAYMENT,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_STATUS_PAYMENT,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
MAP_STATUS_PAYMENT,PAYMENT_INDICATOR,Default payment indicator assigned to status indicator (for internal use).
OFFSET_APC,GROUP_ID,"Group of pass-through items or services.
Values:
1 = Radiopharmaceutical
2 = Drug/Biological (Skin Product, Radiological Contrast, or Stress Agent)"
OFFSET_APC,LIST_ID,"Type of pass-through item or service.
Values:
1 = Radiopharmaceutical
2 = Skin Product
3 = Radiological Contrast
4 = Stress Agent"
OFFSET_APC,APC,Associated procedure APC for pairing with the pass-through item or service.
OFFSET_APC,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
OFFSET_APC,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
OFFSET_APC,AMOUNT,Amount of payment offset applied to pass-through item or service
OFFSET_CODEPAIR,LIST_ID,"Type of pass-through device.
Values:
1 = Device"
OFFSET_CODEPAIR,CODE1,1st CPT/HCPCS in pair
OFFSET_CODEPAIR,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
OFFSET_CODEPAIR,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
OFFSET_CODEPAIR,CODE2,2nd CPT/HCPCS in pair
OFFSET_CODEPAIR,AMOUNT,Offset amount applied to passthrough device when applicable.
OFFSET_CODEPAIR,DATE_ACTIVATED,Mid-quarter effective date (YYYYMMDD) of offset amount to be returned.
OFFSET_HCPCS,LIST_ID,"Type of pass-through device offset.
Values:
5 = Terminated Device Procedure (activated V18.0, 2017-01-01)"
OFFSET_HCPCS,HCPCS,Procedure code subject to possible device offset/credit.
OFFSET_HCPCS,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
OFFSET_HCPCS,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
OFFSET_HCPCS,AMOUNT,Amount of payment offset/credit applied to terminated device procedure.
PBT_CONTROL,PBT_INDEX,Identifies execution path by concept (for internal use)
PBT_CONTROL,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
PBT_CONTROL,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
PBT_CONTROL,DX_PROC_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,LINE_ITEM_DATE,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,APC_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,AGE_SEX_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,UNIT_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,MODIFIER_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,NCCI_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,PH_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,MH_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,APC_RETURN_BUF,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,REV_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,OPPS_EDITS,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,BILL_TYPE,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,HCPC,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,NON_MCARE,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,PROC_MOD,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,HCPC_REQ,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,OBSERVATION,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,OPPS_PROC,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,DME,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,DX_PROC_EDITS2,Identifies logic associated with excution path (for internal use)
PBT_CONTROL,REV_EDITS2,Identifies logic associated with excution path (for internal use)
PBT_MAP,ROW_ID,Identifies execution path by bill type (for internal use)
PBT_MAP,LO_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
PBT_MAP,HI_VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
PBT_MAP,RULE,Identifies additional execution path criteria (for internal use)
PBT_MAP,PBT_INDEX,Identifies execution path by bill type (for internal use)
PBT_MAP,LO_BILL,Identifies the lowest bill type involved in the concept (for internal use)
PBT_MAP,HI_BILL,Identifies the highest bill type involved in the concept (for internal use)
VERSION_RANGE,VERSION,Version signature (for internal use). Refer to VERSION_RANGE table to determine date.
VERSION_RANGE,DATE_STARTED,The first date of the given version (for internal use).
VERSION_RANGE,DATE_ENDED,The last date of the given version (for internal use).
VERSION_RANGE,VERSION_ID,String representation of the version (exposed externally).
