1
  CMS RIF REPORT FOR RECORD: FI_OP_CLM_REC,  STATUS: PROD, VERSION: 20014
  PRINTED: 01/24/2020,  USER: F43D,  DATA SOURCE: CA REPOSITORY ON DB2T


       NAME                   LENGTH   BEG  END                                         CONTENTS
  -------------------------------------------------------------------------------------------------------------------------------
  ***  FI Outpatient Claim Record (NCH)
                               VAR      1  31388    REC

                                                    STANDARD ALIAS : FI_OP_CLM_REC
                                                    SYSTEM   ALIAS : UTLOUTPK

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       CHOICES_DEMO_LIM
                                                       CLM_OPPS_LIM
                                                       CLM_TRANS_CD_LIM
                                                       HHA_HCPCS_LIM
                                                       MCO_PD_SW_LIM
                                                       MLTPL_REV_CNTR_0001_CD_LIM
                                                       PMT_AMT_EXCEDG_CHRG_AMT_LIM
                                                       REV_CNTR_IDE_NDC_UPC_LIM
                                                       REV_CNTR_TOT_CHRG_AMT_LIM
                                                       REV_RNDRNG_PHYSN_NPI_NUM_LIM
                                                       TOT_CHRG_AMT_LIM

  1.   FI Outpatient Claim Fixed Group
                              1864      1   1864    GRP


  2.   Claim Record Identification Group
                                 8      1      8    GRP


                                                    Effective with Version 'I' the record
                                                    length, version code, record identification,
                                                    code and NCH derived claim type code were moved
                                                    to this group for internal NCH processing.

                                                    STANDARD ALIAS : CLM_REC_IDENT_GRP

  3.   Record Length Count
                                 3      1      3    PACK

                                                    Effective with Version H, the count (in bytes)
                                                    of the length of the claim record.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated with data throughout history
                                                    (back to service year 1991).

                                                    DB2      ALIAS : REC_LNGTH_CNT
                                                    SAS      ALIAS : REC_LEN
                                                    STANDARD ALIAS : REC_LNGTH_CNT

                                                    LENGTH         : 5    SIGNED : Y

                                                    SOURCE         : NCH

  4.   NCH Near-Line Record Version Code
                                 1      4      4    CHAR

                                                    The code indicating the record version of the Nearline file
                                                    where the institutional, carrier or DMERC claims data are
                                                    stored.

                                                    DB2      ALIAS : NCH_REC_VRSN_CD
                                                    SAS      ALIAS : REC_LVL
                                                    STANDARD ALIAS : NCH_NEAR_LINE_REC_VRSN_CD
                                                    TITLE    ALIAS : NCH_VERSION

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_NEAR_LINE_REC_VRSN_CD.

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_NEAR_LINE_REC_VRSN_TB

  5.   NCH Near Line Record Identification Code
                                 1      5      5    CHAR

                                                    A code defining the type of claim record being processed.

                                                    COMMON   ALIAS : RIC
                                                    DB2      ALIAS : NEAR_LINE_RIC_CD
                                                    SAS      ALIAS : RIC_CD
                                                    STANDARD ALIAS : NCH_NEAR_LINE_RIC_CD
                                                    TITLE    ALIAS : RIC

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    RIC_CD.

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_NEAR_LINE_RIC_TB

  6.   NCH MQA RIC Code
                                 1      6      6    CHAR

                                                    Effective with Version H, the code used (for internal
                                                    editing purposes) to identify the record being processed
                                                    through CMS' CWFMQA system.

                                                    NOTE:  Beginning with NCH weekly process date 10/3/97 this
                                                    field was populated with data. Claims processed prior
                                                    to 10/3/97 will contain spaces in this field.

                                                    DB2      ALIAS : NCH_MQA_RIC_CD
                                                    SAS      ALIAS : MQA_RIC
                                                    STANDARD ALIAS : NCH_MQA_RIC_CD
                                                    TITLE    ALIAS : MQA_RIC

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA PROCESS

                                                    CODE TABLE     : NCH_MQA_RIC_TB

  7.   NCH Claim Type Code
                                 2      7      8    CHAR

                                                    The code used to identify the type of claim record being
                                                    processed in NCH.

                                                    NOTE1:  During the Version H conversion this field was
                                                    populated with data throughout history (back to
                                                    service year 1991).

                                                    NOTE2:  During the Version I conversion this field was
                                                    expanded to include inpatient 'full' encounter
                                                    claims (for service dates after 6/30/97).

                                                    NOTE3:  Effective with Version 'J', 3 new code values have
                                                    been added to include a type code for the Medicare
                                                    Advantage claims (IME/GME, no-pay and paid as FFS).
                                                    During the Version 'J' conversion, these type codes were
                                                    populated throughout history. With Version 'J', these claims
                                                    are also being stored in NMUD.  Prior to Version 'J' they
                                                    were only in the NCH.  No history was converted in NMUD.

                                                    DB2      ALIAS : NCH_CLM_TYPE_CD
                                                    SAS      ALIAS : CLM_TYPE
                                                    STANDARD ALIAS : NCH_CLM_TYPE_CD
                                                    TITLE    ALIAS : CLAIM_TYPE

                                                    LENGTH         : 2

                                                    DERIVATIONS :
                                                    FFS CLAIM TYPE CODES DERIVED FROM:
                                                    NCH CLM_NEAR_LINE_RIC_CD
                                                    NCH PMT_EDIT_RIC_CD
                                                    NCH CLM_TRANS_CD
                                                    NCH PRVDR_NUM

                                                    INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                    (Pre-HDC processing -- AVAILABLE IN NCH)
                                                    CLM_MCO_PD_SW
                                                    CLM_RLT_COND_CD
                                                    MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD
                                                    MCO_PRD_EFCTV_DT
                                                    MCO_PRD_TRMNTN_DT

                                                    DERIVATION RULES:

                                                    SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                    FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                    2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                    3.   CLM_TRANS_CD EQUAL '5'

                                                    SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                    2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                    3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                    4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                    OR 'Z'

                                                    SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                    2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                    3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                    4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                    OR 'Z'

                                                    SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                    2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                    3.   CLM_TRANS_CD EQUAL '6'

                                                    SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                    2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                    3.   CLM_TRANS_CD EQUAL 'H'

                                                    SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                    2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                    3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                    SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                    CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                    12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_MCO_PD_SW = '1'
                                                    2.   CLM_RLT_COND_CD = '04'
                                                    3.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = 'C'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS

                                                    SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                    CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                    FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                    2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                    3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                    4.   FI_NUM = 80881

                                                    SET CLM_TYPE_CD TO 62 (Medicare Advantage IME/GME
                                                    CLAIMS - 10/1/05 - FORWARD)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_MCO_PD_SW = '0'
                                                    2.   CLM_RLT_COND_CD = '04' & '69'
                                                    3.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = 'C'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS

                                                    SET CLM_TYPE_CD TO 63 (HMO NO-PAY CLAIMS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED ON OR AFTER 10/6/08
                                                    1.   CLM_THRU_DT ON OR AFTER 10/1/06
                                                    2.   CLM_MCO_PD_SW = '1'
                                                    3.   CLM_RLT_COND_CD = '04'
                                                    4.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = 'A', 'B' OR 'C'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS
                                                    5.   ZERO REIMBURSEMENT (CLM_PMT_AMT)

                                                    SET CLM_TYPE_CD TO 63 (HMO NO-PAY CLAIMS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED PRIOR to 10/6/08
                                                    1.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = 'A', 'B' OR 'C'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS
                                                    2.   ZERO REIMBURSEMENT (CLM_PMT_AMT)

                                                    SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED PRIOR to 10/6/08
                                                    1.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = '1', '2' OR '4'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS


                                                    SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED on or after 10/6/08
                                                    1.   CLM_RLT_COND_CD = '04'
                                                    2.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = '1', '2' OR '4'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS

                                                    SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                    2.   HCPCS_CD not on DMEPOS table

                                                    SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                    2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                    more line item(s) match the HCPCS on the
                                                    DMEPOS table).

                                                    SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                    CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                    2.   HCPCS_CD not on DMEPOS table

                                                    SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                    2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                    more line item(s) match the HCPCS on the
                                                    DMEPOS table).

                                                    SOURCE         : NCH

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       NCH_CLM_TYPE_CD_LIM

                                                    CODE TABLE     : NCH_CLM_TYPE_TB

  8.   Fiscal Intermediary Claim Link Group
                               125      9    133    GRP


                                                    Effective with Version 'I', this group
                                                    contains those fields necessary to keep
                                                    segments together (a claim may have up 10
                                                    segments due to the increase in number of
                                                    revenue center trailers (up to 450).  It is
                                                    also used to house fields necessary for sorting
                                                    and the final action process.

                                                    STANDARD ALIAS : FI_CLM_LINK_GRP

  9.   Claim Locator Number Group
                                11      9     19    GRP


                                                    This number uniquely identifies the beneficiary in
                                                    the NCH Nearline.

                                                    COMMON   ALIAS : HIC
                                                    STANDARD ALIAS : CLM_LCTR_NUM_GRP
                                                    TITLE    ALIAS : HICAN

  10.  Beneficiary Claim Account Number
                                 9      9     17    CHAR

                                                    The number identifying the primary beneficiary
                                                    under the SSA or RRB programs submitted.

                                                    COMMON   ALIAS : CAN
                                                    DB2      ALIAS : BENE_CLM_ACNT_NUM
                                                    SAS      ALIAS : CAN
                                                    STANDARD ALIAS : BENE_CLM_ACNT_NUM
                                                    TITLE    ALIAS : CAN

                                                    LENGTH         : 9

                                                    SOURCE         : SSA,RRB

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       CLM_ACNT_NUM_LIM

  11.  NCH Category Equatable Beneficiary Identification Code
                                 2     18     19    CHAR

                                                    The code categorizing groups of BICs
                                                    representing similar relationships between
                                                    the beneficiary and the primary wage earner.

                                                    The equatable BIC module electronically matches
                                                    two records that contain different BICs where
                                                    it is apparent that both are records for the
                                                    same beneficiary.  It validates the BIC and
                                                    returns a base BIC under which to house the
                                                    record in the National Claims History (NCH)
                                                    databases.  (All records for a beneficiary
                                                    are stored under a single BIC.)

                                                    COMMON   ALIAS : NCH_BASE_CATEGORY_BIC
                                                    DB2      ALIAS : CTGRY_EQTBL_BIC
                                                    SAS      ALIAS : EQ_BIC
                                                    STANDARD ALIAS : NCH_CTGRY_EQTBL_BIC_CD
                                                    TITLE    ALIAS : EQUATED_BIC

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CTGRY_EQTBL_BENE_IDENT_CD.

                                                    SOURCE         : BIC EQUATE MODULE

                                                    CODE TABLE     : CTGRY_EQTBL_BENE_IDENT_TB

  12.  Beneficiary Identification Code
                                 2     20     21    CHAR

                                                    The code identifying the type of relationship between an
                                                    individual and a primary Social Security Administration
                                                    (SSA) beneficiary or a primary Railroad Board (RRB)
                                                    beneficiary.

                                                    COMMON   ALIAS : BIC
                                                    DB2      ALIAS : BENE_IDENT_CD
                                                    SAS      ALIAS : BIC
                                                    STANDARD ALIAS : BENE_IDENT_CD
                                                    TITLE    ALIAS : BIC

                                                    LENGTH         : 2

                                                    SOURCE         : SSA/RRB

                                                    EDIT RULES :
                                                          EDB REQUIRED FIELD

                                                    CODE TABLE     : BENE_IDENT_TB

  13.  NCH State Segment Code
                                 1     22     22    CHAR

                                                    The code identifying the segment of the NCH Nearline file
                                                    containing the beneficiary's record for a specific service
                                                    year.  Effective 12/96, segmentation is by CLM_LCTR_NUM,
                                                    then final action sequence within residence state.  (Prior
                                                    to 12/96, segmentation was by ranges of county codes within
                                                    the residence state.)

                                                    DB2      ALIAS : NCH_STATE_SGMT_CD
                                                    SAS      ALIAS : ST_SGMT
                                                    STANDARD ALIAS : NCH_STATE_SGMT_CD
                                                    TITLE    ALIAS : NEAR_LINE_SEGMENT

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_STATE_SGMT_NEAR_LINE_CD.

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_STATE_SGMT_TB

  14.  Beneficiary Residence SSA Standard State Code
                                 2     23     24    CHAR

                                                    The SSA standard state code of a beneficiary's residence.

                                                    DB2      ALIAS : BENE_SSA_STATE_CD
                                                    SAS      ALIAS : STATE_CD
                                                    STANDARD ALIAS : BENE_RSDNC_SSA_STD_STATE_CD
                                                    TITLE    ALIAS : BENE_STATE_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    1. Used in conjunction with a county code, as
                                                    selection criteria for the determination of
                                                    payment rates for HMO reimbursement.
                                                    2. Concerning individuals directly billable for
                                                    Part B and/or Part A premiums, this element
                                                    is used to determine if the beneficiary
                                                    will receive a bill in English or Spanish.
                                                    3. Also used for special studies.

                                                    SOURCE         : SSA/EDB

                                                    EDIT RULES :
                                                          OPTIONAL: MAY BE BLANK

                                                    CODE TABLE     : GEO_SSA_STATE_TB

  15.  Claim From Date
                                 8     25     32    NUM

                                                    The first day on the billing statement
                                                    covering services rendered to the bene-
                                                    ficiary (a.k.a. 'Statement Covers From Date').

                                                    NOTE:  For Home Health PPS claims, the 'from'
                                                    date and the 'thru' date on the RAP (initial
                                                    claim) must always match.

                                                    DB2      ALIAS : CLM_FROM_DT
                                                    SAS      ALIAS : FROM_DT
                                                    STANDARD ALIAS : CLM_FROM_DT
                                                    TITLE    ALIAS : FROM_DATE

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  16.  Claim Through Date
                                 8     33     40    NUM

                                                    The last day on the billing statement covering
                                                    services rendered to the beneficiary (a.k.a
                                                    'Statement Covers Thru Date').

                                                    NOTE:  For Home Health PPS claims, the 'from'
                                                    date and the 'thru' date on the RAP (initial
                                                    claim) must always match.

                                                    DB2      ALIAS : CLM_THRU_DT
                                                    SAS      ALIAS : THRU_DT
                                                    STANDARD ALIAS : CLM_THRU_DT
                                                    TITLE    ALIAS : THRU_DATE

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  17.  NCH Weekly Claim Processing Date
                                 8     41     48    NUM

                                                    The date the weekly NCH database load
                                                    process cycle begins, during which the claim
                                                    records are loaded into the Nearline file.
                                                    This date will always be a Friday, although
                                                    the claims will actually be appended to the
                                                    database subsequent to the date.

                                                    DB2      ALIAS : NCH_WKLY_PROC_DT
                                                    SAS      ALIAS : WKLY_DT
                                                    STANDARD ALIAS : NCH_WKLY_PROC_DT
                                                    TITLE    ALIAS : NCH_PROCESS_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCFA_CLM_PROC_DT.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          YYYYMMDD

  18.  CWF Claim Accretion Date
                                 8     49     56    NUM

                                                    The date the claim record is accreted (posted/
                                                    processed) to the beneficiary master record
                                                    at the CWF host site and authorization for
                                                    payment is returned to the fiscal interme-
                                                    diary or carrier.

                                                    DB2      ALIAS : CWF_CLM_ACRTN_DT
                                                    SAS      ALIAS : ACRTN_DT
                                                    STANDARD ALIAS : CWF_CLM_ACRTN_DT
                                                    TITLE    ALIAS : ACCRETION_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  19.  CWF Claim Accretion Number
                                 2     57     58    PACK

                                                    The sequence number assigned to the claim
                                                    record when accreted (posted/processed) to
                                                    the beneficiary master record at the CWF host
                                                    site on a given date.  This element indicates
                                                    the position of the claim within that day's
                                                    processing at the CWF host. **(Exception: If
                                                    the claim record is missing the accretion date
                                                    CMS' CWFMQA system places a zero in the
                                                    accretion number.

                                                    DB2      ALIAS : CWF_CLM_ACRTN_NUM
                                                    SAS      ALIAS : ACRTN_NM
                                                    STANDARD ALIAS : CWF_CLM_ACRTN_NUM
                                                    TITLE    ALIAS : ACCRETION_NUMBER

                                                    LENGTH         : 3    SIGNED : Y

                                                    SOURCE         : CWF

  20.  FI Document Claim Control Number
                                23     59     81    CHAR

                                                    Unique control number assigned by an
                                                    intermediary to an institutional claim.

                                                    COMMON   ALIAS : ICN
                                                    DB2      ALIAS : DOC_CLM_CNTL_NUM
                                                    SAS      ALIAS : CLM_CNTL
                                                    STANDARD ALIAS : FI_DOC_CLM_CNTL_NUM
                                                    TITLE    ALIAS : ICN

                                                    LENGTH         : 23

                                                    SOURCE         : CWF

  21.  FI Original Claim Control Number
                                23     82    104    CHAR

                                                    Effective with Version G, the original intermediary
                                                    control number (ICN) which is present on adjustment
                                                    claims, representing the ICN of the original
                                                    transaction now being adjusted.

                                                    COMMON   ALIAS : ORIGINAL_ICN
                                                    DB2      ALIAS : ORIG_CLM_CNTL_NUM
                                                    SAS      ALIAS : ORIGCNTL
                                                    STANDARD ALIAS : FI_ORIG_CLM_CNTL_NUM
                                                    TITLE    ALIAS : ORIGINAL_ICN

                                                    LENGTH         : 23

                                                    SOURCE         : CWF

  22.  Claim Query Code
                                 1    105    105    CHAR

                                                    Code indicating the type of claim record being processed
                                                    with respect to payment (debit/credit indicator;
                                                    interim/final indicator).

                                                    DB2      ALIAS : CLM_QUERY_CD
                                                    SAS      ALIAS : QUERY_CD
                                                    STANDARD ALIAS : CLM_QUERY_CD
                                                    TITLE    ALIAS : QUERY_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_QUERY_TB

  23.  Provider Number
                                 6    106    111    CHAR

                                                    The identification number of the institutional provider
                                                    certified by Medicare to provide services to the
                                                    beneficiary.

                                                    NOTE:  Effective October 1, 2007 the OSCAR Provider
                                                    Number has been renamed the CMS Certification
                                                    Number (CCN).  The name was changed to avoid
                                                    confusion with the National Provider Identifier
                                                    (NPI). The CCN (OSCAR Provider Number) will
                                                    continue to play a critical role in verifying
                                                    that a provider has been Medicare certified and
                                                    for what type of services.

                                                    DB2      ALIAS : PRVDR_NUM
                                                    SAS      ALIAS : PROVIDER
                                                    STANDARD ALIAS : PRVDR_NUM
                                                    TITLE    ALIAS : PROVIDER_NUMBER

                                                    LENGTH         : 6

                                                    CODE TABLE     : PRVDR_NUM_TB

  24.  NCH Daily Process Date
                                 8    112    119    NUM

                                                    Effective with Version H, the date the claim record was
                                                    processed by CMS' CWFMQA system (used for internal editing
                                                    purposes).

                                                    Effective with Version I, this date is used in conjunction
                                                    with the NCH Segment Link Number to keep claims with
                                                    multiple records/ segments together.

                                                    NOTE1:  With Version 'H' this field was populated with
                                                    data beginning with NCH weekly process date 10/3/97.
                                                    Under Version 'I' claims prior to 10/3/97, that were
                                                    blank under Version 'H', were populated with a date.

                                                    DB2      ALIAS : NCH_DAILY_PROC_DT
                                                    SAS      ALIAS : DAILY_DT
                                                    STANDARD ALIAS : NCH_DAILY_PROC_DT
                                                    TITLE    ALIAS : DAILY_PROCESS_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : NCH

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       NCH_DAILY_PROC_DT_LIM

                                                    EDIT RULES :
                                                          YYYYMMDD

  25.  NCH Segment Link Number
                                 5    120    124    PACK

                                                    Effective with Version 'I', the system gen-
                                                    erated number used in conjunction with the
                                                    NCH daily process date to keep records/segments
                                                    belonging to a specific claim together.
                                                    This field was added to ensure that records/
                                                    segments that come in on the same batch with
                                                    the same identifying information in the link
                                                    group are not mixed with each other.

                                                    NOTE:  During the Version I conversion this
                                                    field was populated with data throughout
                                                    history (back to service year 1991).

                                                    DB2      ALIAS : NCH_SGMT_LINK_NUM
                                                    SAS      ALIAS : LINK_NUM
                                                    STANDARD ALIAS : NCH_SGMT_LINK_NUM
                                                    TITLE    ALIAS : LINK_NUM

                                                    LENGTH         : 9    SIGNED : Y

                                                    SOURCE         : NCH

  26.  Claim Total Segment Count
                                 2    125    126    NUM

                                                    Effective with Version I, the count used
                                                    to identify the total number of segments
                                                    associated with a given claim. Each claim
                                                    could have up to 10 segments.

                                                    NOTE:  During the Version I conversion, this
                                                    field was populated with data throughout
                                                    history (back to service year 1991).
                                                    For institutional claims, the count
                                                    for claims prior to 7/00 will be 1 or 2
                                                    (1 if 45 or less revenue center lines on a
                                                    claim and 2 if more than 45 revenue center
                                                    lines on a claim).  For noninstitutional
                                                    claims, the count will always be 1.

                                                    DB2      ALIAS : TOT_SGMT_CNT
                                                    SAS      ALIAS : SGMT_CNT
                                                    STANDARD ALIAS : CLM_TOT_SGMT_CNT
                                                    TITLE    ALIAS : SEGMENT_COUNT

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : CWF

  27.  Claim Segment Number
                                 2    127    128    NUM

                                                    Effective with Version I, the number used
                                                    to identify an actual record/segment (1 - 10)
                                                    associated with a given claim.

                                                    NOTE:  During the Version I conversion this
                                                    field was populated with data throughout
                                                    history (back to service year 1991).
                                                    For institutional claims prior to 7/00,
                                                    this number will be either 1 or 2.  For
                                                    noninstitutional claims, the number will
                                                    always be 1.

                                                    DB2      ALIAS : CLM_SGMT_NUM
                                                    SAS      ALIAS : SGMT_NUM
                                                    STANDARD ALIAS : CLM_SGMT_NUM
                                                    TITLE    ALIAS : SEGMENT_NUMBER

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : CWF

  28.  Claim Total Line Count
                                 3    129    131    NUM

                                                    Effective with Version I, the count used to
                                                    identify the total number of revenue center
                                                    lines associated with the claim.

                                                    NOTE:  During the Version I conversion this
                                                    field was populated with data throughout
                                                    history (back to service year 1991).
                                                    Prior to Version 'I', the maximum line count
                                                    will be no more than 58.  Effective with Version
                                                    'I', the maximum line count could be 450.

                                                    DB2      ALIAS : TOT_LINE_CNT
                                                    SAS      ALIAS : LINECNT
                                                    STANDARD ALIAS : CLM_TOT_LINE_CNT
                                                    TITLE    ALIAS : TOTAL_LINE_COUNT

                                                    LENGTH         : 3    SIGNED : N

                                                    SOURCE         : CWF

  29.  Claim Segment Line Count
                                 2    132    133    NUM

                                                    Effective with Version I, the count used
                                                    to identify the number of lines on a record/
                                                    segment.

                                                    NOTE:  During the Version I conversion this
                                                    field was populated with data throughout
                                                    history (back to service year 1991).
                                                    The maximum line count per record/segment
                                                    on the revenue center trailer is 45.  The
                                                    maximum number of lines on carrier and DMERC
                                                    claims are 13.

                                                    DB2      ALIAS : SGMT_LINE_CNT
                                                    SAS      ALIAS : SGMTLINE
                                                    STANDARD ALIAS : CLM_SGMT_LINE_CNT
                                                    TITLE    ALIAS : SEGMENT_LINE_COUNT

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : CWF

  30.  FI CLAIM COMMON GROUP
                              1091    134   1224    GRP
                                                    ALPHANUM

  31.  NCH Payment and Edit Record Identification Code
                                 1    134    134    CHAR

                                                    The code used for payment and editing purposes that
                                                    indicates the type of institutional claim record.
                                                    Prior to Version H this field was named:
                                                    PMT_EDIT_RIC_CD.

                                                    DB2      ALIAS : PMT_EDIT_RIC_CD
                                                    SAS      ALIAS : PE_RIC
                                                    STANDARD ALIAS : NCH_PMT_EDIT_RIC_CD
                                                    TITLE    ALIAS : NCH_PAYMENT_EDIT_RIC

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : PMT_EDIT_RIC_TB

  32.  Claim Transaction Code
                                 1    135    135    CHAR

                                                    The code derived by CWF to indicate the type of claim
                                                    submitted by an institutional provider.

                                                    DB2      ALIAS : CLM_TRANS_CD
                                                    SAS      ALIAS : TRANS_CD
                                                    STANDARD ALIAS : CLM_TRANS_CD
                                                    TITLE    ALIAS : TRANSACTION_CODE

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       CLM_TRANS_CD_LIM

                                                    CODE TABLE     : CLM_TRANS_TB

  33.  Claim Bill Type Group
                                 2    136    137    GRP


                                                    Effective with Version H, the claim facility type code plus
                                                    the claim service classification type code.  (The first two
                                                    positions of the ('type of bill').  During the Version H
                                                    conversion, this grouping was created throughout history.

                                                    NOTE:  Effective 4/1/2002, TOB code 'XX0' was
                                                    implemented to identify those claims that are
                                                    totally non-covered.

                                                    STANDARD ALIAS : CLM_BILL_TYPE_CD_GRP

                                                    CODE TABLE     : CLM_BILL_TYPE_TB

  34.  Claim Facility Type Code
                                 1    136    136    CHAR

                                                    The first digit of the type of bill (TOB1) submitted on an
                                                    institutional claim used to identify the type of facility
                                                    that provided care to the beneficiary.

                                                    COMMON   ALIAS : TOB1
                                                    DB2      ALIAS : CLM_FAC_TYPE_CD
                                                    SAS      ALIAS : FAC_TYPE
                                                    STANDARD ALIAS : CLM_FAC_TYPE_CD
                                                    TITLE    ALIAS : TOB1

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_FAC_TYPE_TB

  35.  Claim Service Classification Type Code
                                 1    137    137    CHAR

                                                    The second digit of the type of bill (TOB2) submitted on an
                                                    institutional claim record to indicate the classification of
                                                    the type of service provided to the beneficiary.

                                                    COMMON   ALIAS : TOB2
                                                    DB2      ALIAS : SRVC_CLSFCTN_CD
                                                    SAS      ALIAS : TYPESRVC
                                                    STANDARD ALIAS : CLM_SRVC_CLSFCTN_TYPE_CD
                                                    TITLE    ALIAS : TOB2

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_SRVC_CLSFCTN_TYPE_TB

  36.  Claim Frequency Code
                                 1    138    138    CHAR

                                                    The third digit of the type of bill (TOB3) submitted on an
                                                    institutional claim record to indicate the sequence of a
                                                    claim in the beneficiary's current episode of care.

                                                    COMMON   ALIAS : TOB3
                                                    DB2      ALIAS : CLM_FREQ_CD
                                                    SAS      ALIAS : FREQ_CD
                                                    STANDARD ALIAS : CLM_FREQ_CD
                                                    TITLE    ALIAS : FREQUENCY_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_FREQ_TB

  37.  FILLER
                                 1    139    139    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 1

  38.  NCH MQA Query Patch Code
                                 1    140    140    CHAR

                                                    Effective with Version H, a code used (for internal editing
                                                    purposes) to indicate that the CWFMQA process changed the
                                                    query code submitted on the claim record.

                                                    NOTE:  Beginning with NCH weekly process date 10/3/97 this
                                                    field was populated with data.  Claims processed
                                                    prior to 10/3/97 will contain spaces in this field.

                                                    DB2      ALIAS : MQA_QUERY_PATCH_CD
                                                    SAS      ALIAS : MQAQUERY
                                                    STANDARD ALIAS : NCH_MQA_QUERY_PATCH_CD
                                                    TITLE    ALIAS : MQA_QUERY_PATCH_IND

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : NCH_MQA_QUERY_PATCH_TB

  39.  Claim Disposition Code
                                 2    141    142    CHAR

                                                    Code indicating the disposition or outcome of the processing
                                                    of the claim record.

                                                    DB2      ALIAS : CLM_DISP_CD
                                                    SAS      ALIAS : DISP_CD
                                                    STANDARD ALIAS : CLM_DISP_CD
                                                    TITLE    ALIAS : DISPOSITION_CD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_DISP_TB

  40.  NCH Edit Disposition Code
                                 2    143    144    CHAR

                                                    Effective with Version H, a code used (for internal editing
                                                    purposes) to indicate the disposition of the claim after
                                                    editing in the CWFMQA process.

                                                    NOTE:  Beginning with NCH weekly process date 10/3/97 this
                                                    field was populated with data. Claims processed prior
                                                    to 10/3/97 will contain spaces in this field.

                                                    DB2      ALIAS : NCH_EDIT_DISP_CD
                                                    SAS      ALIAS : EDITDISP
                                                    STANDARD ALIAS : NCH_EDIT_DISP_CD
                                                    TITLE    ALIAS : NCH_EDIT_DISP

                                                    LENGTH         : 2

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : NCH_EDIT_DISP_TB

  41.  NCH Claim BIC Modify H Code
                                 1    145    145    CHAR

                                                    Effective with Version H, the code used (for internal
                                                    editing purposes) to identify a claim record that was
                                                    submitted with an incorrect HA, HB, or HC BIC.

                                                    NOTE:  Beginning with NCH weekly process date 10/3/97 this
                                                    field was populated with data.   Claims processed
                                                    prior to 10/3/97 will contain spaces in this field.

                                                    DB2      ALIAS : NCH_BIC_MDFY_CD
                                                    SAS      ALIAS : BIC_MDFY
                                                    STANDARD ALIAS : NCH_CLM_BIC_MDFY_CD
                                                    TITLE    ALIAS : BIC_MODIFY_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : NCH_CLM_BIC_MDFY_TB

  42.  Beneficiary Residence SSA Standard County Code
                                 3    146    148    CHAR

                                                    The SSA standard county code of a beneficiary's residence.

                                                    DB2      ALIAS : BENE_SSA_CNTY_CD
                                                    SAS      ALIAS : CNTY_CD
                                                    STANDARD ALIAS : BENE_RSDNC_SSA_STD_CNTY_CD
                                                    TITLE    ALIAS : BENE_COUNTY_CD

                                                    LENGTH         : 3

                                                    SOURCE         : SSA/EDB

                                                    EDIT RULES :
                                                          OPTIONAL: MAY BE BLANK

  43.  FI Claim Receipt Date
                                 8    149    156    NUM

                                                    The date the fiscal intermediary received the
                                                    institutional claim from the provider.

                                                    DB2      ALIAS : FI_CLM_RCPT_DT
                                                    SAS      ALIAS : RCPT_DT
                                                    STANDARD ALIAS : FI_CLM_RCPT_DT
                                                    TITLE    ALIAS : RECEIPT_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    FICARR_CLM_RCPT_DT.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  44.  FI Claim Scheduled Payment Date
                                 8    157    164    NUM

                                                    The scheduled date of payment to the institu-
                                                    tional provider, as reflected on the claim
                                                    record transmitted to the CWF host.  Note:
                                                    This date is considered to be the date paid
                                                    since no additional information as to the
                                                    actual payment date is available.

                                                    DB2      ALIAS : FI_SCHLD_PMT_DT
                                                    SAS      ALIAS : SCHLD_DT
                                                    STANDARD ALIAS : FI_CLM_SCHLD_PMT_DT
                                                    TITLE    ALIAS : SCHEDULED_PMT_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    FICARR_CLM_PMT_DT.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  45.  CWF Forwarded Date
                                 8    165    172    NUM

                                                    Effective with Version H, the date CWF forwarded the claim
                                                    record to CMS (used for internal editing purposes).

                                                    NOTE:  Beginning with NCH weekly process date 10/3/97 this
                                                    field was populated with data.  Claims processed
                                                    prior to 10/3/97 will contain zeroes in this field.

                                                    DB2      ALIAS : CWF_FRWRD_DT
                                                    SAS      ALIAS : FRWRD_DT
                                                    STANDARD ALIAS : CWF_FRWRD_DT
                                                    TITLE    ALIAS : FORWARD_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  46.  FI Number
                                 5    173    177    CHAR

                                                    The identification number assigned by CMS to a fiscal
                                                    intermediary authorized to process institutional claim
                                                    records.

                                                    Effective October 2006, the Medicare Administrative
                                                    Contractors (MACs) began replacing the existing
                                                    fiscal intermediaries and started processing institu-
                                                    tional claim records for states assigned to its
                                                    jurisdiction.

                                                    NOTE: The 5-position MAC number will be housed in
                                                    the existing FI_NUM field.  During the transition
                                                    from an FI to a MAC the FI_NUM field could contain
                                                    either a FI number or a MAC number.  See the
                                                    FI_NUM table of codes to identify the new MAC
                                                    numbers and their effective dates.

                                                    DB2      ALIAS : FI_NUM
                                                    SAS      ALIAS : FI_NUM
                                                    STANDARD ALIAS : FI_NUM
                                                    TITLE    ALIAS : INTERMEDIARY

                                                    LENGTH         : 5

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    FICARR_IDENT_NUM.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : FI_NUM_TB

  47.  CWF Claim Assigned Number
                                 8    178    185    CHAR

                                                    Effective with Version H, the number assigned
                                                    to an institutional claim record by CWF (used
                                                    for internal editing purposes).

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with
                                                    data.  Claims processed prior to 10/3/97
                                                    will contain spaces in this field.

                                                    DB2      ALIAS : CWF_CLM_ASGN_NUM
                                                    SAS      ALIAS : ASGN_NUM
                                                    STANDARD ALIAS : CWF_CLM_ASGN_NUM
                                                    TITLE    ALIAS : ASSIGNED_NUM

                                                    LENGTH         : 8

                                                    SOURCE         : CWF

  48.  CWF Transmission Batch Number
                                 4    186    189    CHAR

                                                    Effective with Version H, the number assigned
                                                    to each batch of claims transactions sent from
                                                    CWF(used for internal editing purposes).

                                                    NOTE:  Beginning 11/98, this field will be
                                                    populated with data.  Claims processed
                                                    prior to 11/98 will contain spaces in
                                                    this field.

                                                    DB2      ALIAS : TRNSMSN_BATCH_NUM
                                                    SAS      ALIAS : FIBATCH
                                                    STANDARD ALIAS : CWF_TRNSMSN_BATCH_NUM
                                                    TITLE    ALIAS : BATCH_NUM

                                                    LENGTH         : 4

                                                    SOURCE         : CWF

  49.  Beneficiary Mailing Contact ZIP Code
                                 9    190    198    CHAR

                                                    The ZIP code of the mailing address where the
                                                    beneficiary may be contacted.

                                                    DB2      ALIAS : BENE_MLG_ZIP_CD
                                                    SAS      ALIAS : BENE_ZIP
                                                    STANDARD ALIAS : BENE_MLG_CNTCT_ZIP_CD
                                                    TITLE    ALIAS : BENE_ZIP

                                                    LENGTH         : 9

                                                    SOURCE         : EDB

  50.  Beneficiary Sex Identification Code
                                 1    199    199    CHAR

                                                    The sex of a beneficiary.

                                                    COMMON   ALIAS : SEX_CD
                                                    DB2      ALIAS : BENE_SEX_IDENT_CD
                                                    SAS      ALIAS : SEX
                                                    STANDARD ALIAS : BENE_SEX_IDENT_CD
                                                    TITLE    ALIAS : SEX_CD

                                                    LENGTH         : 1

                                                    SOURCE         : SSA,RRB,EDB

                                                    EDIT RULES :
                                                          REQUIRED FIELD

                                                    CODE TABLE     : BENE_SEX_IDENT_TB

  51.  Beneficiary Race Code
                                 1    200    200    CHAR

                                                    The race of a beneficiary.

                                                    DB2      ALIAS : BENE_RACE_CD
                                                    SAS      ALIAS : RACE
                                                    STANDARD ALIAS : BENE_RACE_CD
                                                    TITLE    ALIAS : RACE_CD

                                                    LENGTH         : 1

                                                    SOURCE         : SSA

                                                    CODE TABLE     : BENE_RACE_TB

  52.  Beneficiary Birth Date
                                 8    201    208    NUM

                                                    The beneficiary's date of birth.

                                                    COMMON   ALIAS : DOB
                                                    DB2      ALIAS : BENE_BIRTH_DT
                                                    SAS      ALIAS : BENE_DOB
                                                    STANDARD ALIAS : BENE_BIRTH_DT
                                                    TITLE    ALIAS : BENE_BIRTH_DATE

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  53.  CWF Beneficiary Medicare Status Code
                                 2    209    210    CHAR

                                                    The CWF-derived reason for a beneficiary's
                                                    entitlement to Medicare benefits, as of the
                                                    reference date (CLM_THRU_DT).

                                                    COMMON   ALIAS : MSC
                                                    DB2      ALIAS : BENE_MDCR_STUS_CD
                                                    SAS      ALIAS : MS_CD
                                                    STANDARD ALIAS : CWF_BENE_MDCR_STUS_CD
                                                    TITLE    ALIAS : MSC

                                                    LENGTH         : 2

                                                    DERIVATIONS :
                                                    CWF derives MSC from the following:
                                                    1.  Date of Birth
                                                    2.  Claim Through Date
                                                    3.  Original/Current Reasons for entitlement
                                                    4.  ESRD Indicator
                                                    5.  Beneficiary Claim Number
                                                    Items 1,3,4,5 come from the CWF Beneficiary
                                                    Master Record; item 2 comes from the FI/Carrier
                                                    claim record.  MSC is assigned as follows:

                                                    MSC   OASI   DIB    ESRD    AGE          BIC
                                                    ______ _____  _____  _____   _____        ______
                                                    10      YES   N/A    NO     65 and over   N/A
                                                    11      YES   N/A    YES    65 and over   N/A
                                                    20      NO    YES    NO     under 65      N/A
                                                    21      NO    YES    YES    under 65      N/A
                                                    31      NO    NO     YES    any age       T.

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_MDCR_STUS_CD.  The name has been changed
                                                    to distinguish this CWF-derived field from the
                                                    EDB-derived MSC (BENE_MDCR_STUS_CD).

                                                    SOURCE         : CWF

                                                    CODE TABLE     : BENE_MDCR_STUS_TB

  54.  Claim Patient 6 Position Surname
                                 6    211    216    CHAR

                                                    The first 6 positions of the Medicare patient's
                                                    surname (last name) as reported by the provider
                                                    on the claim.

                                                    NOTE1: Prior to Version H, this field was only
                                                    present on the IP/SNF claim record.
                                                    Effective with Version H, this field is
                                                    present on all claim types.

                                                    NOTE2: For OP, HHA, Hospice and all Carrier
                                                    claims, data was populated beginning
                                                    with NCH weekly process 10/3/97.  Claims
                                                    processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    COMMON   ALIAS : PATIENT_SURNAME
                                                    DB2      ALIAS : PTNT_6_PSTN_SRNM
                                                    SAS      ALIAS : SURNAME
                                                    STANDARD ALIAS : CLM_PTNT_6_PSTN_SRNM_NAME
                                                    TITLE    ALIAS : PATIENT_SURNAME

                                                    LENGTH         : 6

                                                    SOURCE         : CWF

  55.  Claim Patient 1st Initial Given Name
                                 1    217    217    CHAR

                                                    The first initial of the Medicare patient's
                                                    given name (first name) as reported by the
                                                    provider on the claim.

                                                    NOTE1: Prior to Version H, this field was only
                                                    present on the IP/SNF claim record.
                                                    Effective with Version H, this field
                                                    is present on all claim types.

                                                    NOTE2: For OP, HHA, Hospice and all Carrier claims,
                                                    data was populated beginning with NCH
                                                    weekly process date 10/3/97.  Claims
                                                    processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    COMMON   ALIAS : PATIENT_GIVEN_NAME
                                                    DB2      ALIAS : 1ST_INITL_GVN_NAME
                                                    SAS      ALIAS : FRSTINIT
                                                    STANDARD ALIAS : CLM_PTNT_1ST_INITL_GVN_NAME
                                                    TITLE    ALIAS : PATIENT_FIRST_INITIAL

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  56.  Claim Patient First Initial Middle Name
                                 1    218    218    CHAR

                                                    The first initial of the Medicare patient's
                                                    middle name as reported by the provider on
                                                    the claim.

                                                    NOTE1:  Prior to Version H, this field was only
                                                    present on the IP/SNF claim record.
                                                    Effective with Version H, this field is
                                                    present on all claim types.

                                                    NOTE2:  For OP, HHA, Hospice and all Carrier claims,
                                                    data was populated beginning with NCH
                                                    weekly process date 10/3/97.   Claims pro-
                                                    cessed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    COMMON   ALIAS : PATIENT_MIDDLE_NAME
                                                    DB2      ALIAS : 1ST_INITL_MDL_NAME
                                                    SAS      ALIAS : MDL_INIT
                                                    STANDARD ALIAS : CLM_PTNT_1ST_INITL_MDL_NAME
                                                    TITLE    ALIAS : PATIENT_MIDDLE_INITIAL

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  57.  Beneficiary CWF Location Code
                                 1    219    219    CHAR

                                                    The code that identifies the Common Working File
                                                    (CWF) location (the host site) where a beneficiary's
                                                    Medicare utilization records are maintained.

                                                    COMMON   ALIAS : CWF_HOST
                                                    DB2      ALIAS : BENE_CWF_LOC_CD
                                                    SAS      ALIAS : CWFLOCCD
                                                    STANDARD ALIAS : BENE_CWF_LOC_CD
                                                    TITLE    ALIAS : CWF_HOST

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : BENE_CWF_LOC_TB

  58.  Claim Principal Diagnosis Group
                                 8    220    227    GRP


                                                    Effective with Version 'J', the group used to identify
                                                    the principal diagnosis code.
                                                    This group contains the principal diagnosis code
                                                    and the principal diagnosis version code.

                                                    STANDARD ALIAS : CLM_PRNCPAL_DGNS_GRP

  59.  Claim Principal Diagnosis Version Code
                                 1    220    220    CHAR

                                                    Effective with Version 'J', the code used to indicate
                                                    if the diagnosis is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes
                                                    have been expanded to accommodate ICD-10, even though
                                                    ICD-10 is not scheduled for implementation until 10/2013.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : PDVRSNCD
                                                    STANDARD ALIAS : CLM_PRNCPAL_DGNS_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_DGNS_VRSN_TB

  60.  Claim Principal Diagnosis Code
                                 7    221    227    CHAR

                                                    The diagnosis code identifying the diagnosis,
                                                    condition, problem or other reason for the
                                                    admission/encounter/visit shown in the medical
                                                    record to be chiefly responsible for the services
                                                    provided.

                                                    NOTE:  Effective with Version H, this data is also
                                                    redundantly stored as the first occurrence of the
                                                    diagnosis trailer.

                                                    NOTE1: Effective with Version 'J', this field has been
                                                    expanded from 5 bytes to 7 bytes to accommodate
                                                    the future implementation of ICD-10.

                                                    DB2      ALIAS : PRNCPAL_DGNS_CD
                                                    SAS      ALIAS : PDGNS_CD
                                                    STANDARD ALIAS : CLM_PRNCPAL_DGNS_CD

                                                    LENGTH         : 7

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          ICD-9-CM

  61.  FILLER
                                 1    228    228    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 1

  62.  Claim Medicare Non Payment Reason Code
                                 2    229    230    CHAR

                                                    The reason that no Medicare payment is made for
                                                    services on an institutional claim.

                                                    NOTE1:  This field was put on all institutional
                                                    claim types but data did not start coming in on
                                                    OP/HHA/Hospice until 4/1/02.  Prior to 4/1/02,
                                                    data only came in Inpatient/SNF claims.

                                                    NOTE2:  Effective 4/1/02, this field was also
                                                    expanded to two bytes to accommodate new values.
                                                    The NCH Nearline file did not expand the current
                                                    1-byte field but instituted a crosswalk of the
                                                    2-byte field to the 1-byte character value.
                                                    See table of code for the crosswalk.

                                                    NOTE3:  Effective with Version 'J', the field has been
                                                    expanded on the NCH claim to 2 bytes.   With this
                                                    expansion the NCH will no longer use the character
                                                    values to represent the official two byte values being
                                                    sent in by CWF since 4/2002.

                                                    During the Version 'J' conversion, all character values
                                                    were converted to the two byte values.

                                                    DB2      ALIAS : MDCR_NPMT_RSN_CD
                                                    SAS      ALIAS : NOPAY_CD
                                                    STANDARD ALIAS : CLM_MDCR_NPMT_RSN_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_MDCR_NPMT_RSN_TB

  63.  Claim Excepted/Nonexcepted Medical Treatment Code
                                 1    231    231    CHAR

                                                    Effective with Version I, the code used to identify
                                                    whether or not the medical care or treatment received
                                                    by a beneficiary, who has elected care from a
                                                    Religious Nonmedical Health Care Institution (RNHCI),
                                                    is excepted or nonexcepted.  Excepted is medical care
                                                    or treatment that is received involuntarily or is re-
                                                    quired under Federal, State or local law. Nonexcepted is
                                                    defined as medical care or treatment other than excepted.

                                                    DB2      ALIAS : EXCPTD_NEXCPTD_CD
                                                    SAS      ALIAS : TRTMT_CD
                                                    STANDARD ALIAS : CLM_EXCPTD_NEXCPTD_TRTMT_CD
                                                    TITLE    ALIAS : EXCPTD_NEXCPTD_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_EXCPTD_NEXCPTD_TRTMT_TB

  64.  Claim Payment Amount
                                 6    232    237    PACK

                                                    Amount of payment made from the Medicare trust fund for the
                                                    services covered by the claim record.  Generally, the amount
                                                    is calculated by the FI or carrier; and represents what was
                                                    paid to the institutional provider, physician, or supplier,
                                                    with the exceptions noted below.  ***NOTE:  In some
                                                    situations, a negative claim payment amount may be pre-
                                                    sent; e.g., (1) when a beneficiary is charged the full
                                                    deductible during a short stay and the deductible exceeded
                                                    the amount Medicare pays; or (2) when a beneficiary is
                                                    charged a coinsurance amount during a long stay and the
                                                    coinsurance amount exceeds the amount Medicare pays (most
                                                    prevalent situation involves psych hospitals who are paid a
                                                    daily per diem rate no matter what the charges are.)

                                                    Under IP PPS, inpatient hospital services are paid based on
                                                    a predetermined rate per discharge, using the DRG patient
                                                    classification system and the PRICER program.   On the IP
                                                    PPS claim, the payment amount includes the DRG outlier
                                                    approved payment amount, disproportionate share (since
                                                    5/1/86), indirect medical education (since 10/1/88), total
                                                    PPS capital (since 10/1/91).  After 4/1/03, the payment
                                                    amount could also include a "new technology" add-on amount.
                                                    After 7/5/2011, the payment amount could also include
                                                    a payment adjustment given to hospitals to account for
                                                    the higher costs per discharge for "low-income hospitals".
                                                    After 10/1/2012, the payment amount could also include
                                                    adjustments for value based purchasing, readmissions,
                                                    and Model 1, Bundled Payments for Care Improvement. After
                                                    10/1/2014, the payment amount could also include the
                                                    uncompensated care payment (UCP).

                                                    It does NOT include the pass-thru amounts (i.e., capital-
                                                    related costs, direct medical education costs, kidney
                                                    acquisition costs, bad debts); or any beneficiary-paid
                                                    amounts (i.e., deductibles and coinsurance); or any
                                                    any other payer reimbursement.

                                                    Under IRFPPS, inpatient rehabilitation services are paid
                                                    based on a predetermined rate per discharge, using the
                                                    Case Mix Group (CMG) classification system and the PRICER
                                                    program.  From the CMG on the IRF PPS claim, payment is
                                                    based on a standard payment amount for operating and
                                                    capital cost for that facility (including routine and
                                                    ancillary services).   The payment is adjusted for wage,
                                                    the % of low-income patients (LIP), locality, transfers,
                                                    interrupted stays, short stay cases, deaths, and high
                                                    cost outliers.   Some or all of these adjustments could
                                                    apply.  The CMG payment does NOT include certain pass-
                                                    through costs (i.e. bad debts, approved education
                                                    activities); beneficiary-paid amounts, other payer reim-
                                                    bursement,and other services outside of the scope of PPS.

                                                    Under LTCH PPS, long term care hospital services are paid
                                                    based on a predetermined rate per discharge based on the
                                                    DRG and the PRICER program.   Payments are based on a
                                                    single standard Federal rate for both inpatient operating
                                                    and capital-related costs (including routine and ancillary
                                                    services), but do NOT include certain pass-through costs
                                                    (i.e. bad debts, direct medical education, new technologies
                                                    and blood clotting factors).  Adjustments to the payment
                                                    may occur due to short-stay outliers, interrupted stays,
                                                    high cost outliers, wage index, and cost of living adjust-
                                                    ments.

                                                    Under SNF PPS, SNFs will classify beneficiaries using the
                                                    patient classification system known as RUGS III.  For the
                                                    SNF PPS claim, the SNF PRICER will calculate/return the rate
                                                    for each revenue center line item with revenue center code =
                                                    '0022'; multiply the rate times the units count; and then
                                                    sum the amount payable for all lines with revenue center
                                                    code '0022' to determine the total claim payment amount.

                                                    Under Outpatient PPS, the national ambulatory payment
                                                    classification (APC) rate that is calculated for each APC
                                                    group is the basis for determining the total claim payment.
                                                    The payment amount also includes the outlier payment and
                                                    interest.

                                                    Under Home Health PPS, beneficiaries will be classified into
                                                    an appropriate case mix category known as the Home Health
                                                    Resource Group.  A HIPPS code is then generated
                                                    corresponding to the case mix category (HHRG).

                                                    For the RAP, the PRICER will determine the payment amount
                                                    appropriate to the HIPPS code by computing 60% (for first
                                                    episode) or 50% (for subsequent episodes) of the case mix
                                                    episode payment.  The payment is then wage index adjusted.

                                                    For the final claim, PRICER calculates 100% of the amount
                                                    due, because the final claim is processed as an adjustment
                                                    to the RAP, reversing the RAP payment in full.  Although
                                                    final claim will show 100% payment amount, the provider will
                                                    actually receive the 40% or 50% payment. The payment may
                                                    also include outlier payments.

                                                    Exceptions:  For claims involving demos and BBA encounter
                                                    data, the amount reported in this field may not just
                                                    represent the actual provider payment.

                                                    For demo Ids '01','02','03','04' -- claims contain
                                                    amount paid to the provider, except that special
                                                    'differentials' paid outside the normal payment system
                                                    are not included.

                                                    For demo Ids '05','15' -- encounter data 'claims'
                                                    contain amount Medicare would have paid under FFS,
                                                    instead of the actual payment to the MCO.

                                                    For demo Ids '06','07','08' -- claims contain actual
                                                    provider payment but represent a special negotiated
                                                    bundled payment for both Part A and Part B services.
                                                    To identify what the conventional provider Part A
                                                    payment would have been, check value code = 'Y4'.   The
                                                    related noninstitutmonal (physician/supplier) claims
                                                    contain what would have been paid had there been no
                                                    demo.

                                                    For BBA encounter data (non-demo) -- 'claims' contain
                                                    amount Medicare would have paid under FFS, instead of
                                                    the actual payment to the BBA plan.


                                                    COMMON   ALIAS : REIMBURSEMENT
                                                    DB2      ALIAS : CLM_PMT_AMT
                                                    SAS      ALIAS : PMT_AMT
                                                    STANDARD ALIAS : CLM_PMT_AMT
                                                    TITLE    ALIAS : REIMBURSEMENT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H,  the size of this field was
                                                    S9(7)V99.  Also, the noninstitutional claim records
                                                    carried this field as a line item.  Effective with
                                                    Version H, this element is a claim level field
                                                    across all claim types (and the line item field has
                                                    been renamed.)

                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       PMT_AMT_EXCEDG_CHRG_AMT_LIM

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  65.  NCH Primary Payer Claim Paid Amount
                                 6    238    243    PACK

                                                    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 on an
                                                    institutional, carrier, or DMERC claim.

                                                    DB2      ALIAS : PRMRY_PYR_PD_AMT
                                                    STANDARD ALIAS : NCH_PRMRY_PYR_CLM_PD_AMT
                                                    TITLE    ALIAS : PRIMARY_PAYER_AMOUNT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_PRMRY_PYR_CLM_PMT_AMT and the field size
                                                    was S9(7)V99.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  66.  NCH Primary Payer Code
                                 1    244    244    CHAR

                                                    The code, on an institutional claim, specifying a federal
                                                    non-Medicare program or other source that has primary
                                                    responsibility for the payment of the Medicare beneficiary's
                                                    health insurance bills.

                                                    DB2      ALIAS : NCH_PRMRY_PYR_CD
                                                    SAS      ALIAS : PRPAY_CD
                                                    STANDARD ALIAS : NCH_PRMRY_PYR_CD
                                                    TITLE    ALIAS : PRIMARY_PAYER_CD

                                                    LENGTH         : 1

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES

                                                    SET NCH_PRMRY_PYR_CD TO 'A' WHERE THE
                                                    CLM_VAL_CD = '12'

                                                    SET NCH_PRMRY_PYR_CD TO 'B' WHERE THE
                                                    CLM_VAL_CD = '13'

                                                    SET NCH_PRMRY_PYR_CD TO 'C' WHERE THE
                                                    CLM_VAL_CD = '16' and CLM_VAL_AMT is zeroes

                                                    SET NCH_PRMRY_PYR_CD TO 'D' WHERE THE
                                                    CLM_VAL_CD = '14'

                                                    SET NCH_PRMRY_PYR_CD TO 'E' WHERE THE
                                                    CLM_VAL_CD = '15'

                                                    SET NCH_PRMRY_PYR_CD TO 'F' WHERE THE
                                                    CLM_VAL_CD = '16' (CLM_VAL_AMT not
                                                    equal to zeroes)

                                                    SET NCH_PRMRY_PYR_CD TO 'G' WHERE THE
                                                    CLM_VAL_CD = '43'

                                                    SET NCH_PRMRY_PYR_CD TO 'H' WHERE THE
                                                    CLM_VAL_CD = '41'

                                                    SET NCH_PRMRY_PYR_CD TO 'I' WHERE THE
                                                    CLM_VAL_CD = '42'

                                                    SET NCH_PRMRY_PYR_CD TO 'L' (or prior to 4/97
                                                    set code to 'J') WHERE THE CLM_VAL_CD = '47'

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_PRMRY_PYR_CD.

                                                    SOURCE         : NCH

                                                    CODE TABLE     : BENE_PRMRY_PYR_TB

  67.  FI Requested Claim Cancel Reason Code
                                 1    245    245    CHAR

                                                    The reason that an intermediary requested cancelling
                                                    a previously submitted institutional claim.

                                                    DB2      ALIAS : RQST_CNCL_RSN_CD
                                                    SAS      ALIAS : CANCELCD
                                                    STANDARD ALIAS : FI_RQST_CLM_CNCL_RSN_CD
                                                    TITLE    ALIAS : CANCEL_CD

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    INTRMDRY_RQST_CLM_CNCL_RSN_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : FI_RQST_CLM_CNCL_RSN_TB

  68.  FI Claim Action Code
                                 1    246    246    CHAR

                                                    The type of action requested by the intermediary
                                                    to be taken on an institutional claim.

                                                    DB2      ALIAS : FI_CLM_ACTN_CD
                                                    SAS      ALIAS : ACTIONCD
                                                    STANDARD ALIAS : FI_CLM_ACTN_CD
                                                    TITLE    ALIAS : ACTION_CD

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    INTRMDRY_CLM_ACTN_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : FI_CLM_ACTN_TB

  69.  FI Claim Process Date
                                 8    247    254    NUM

                                                    The date the fiscal intermediary completes
                                                    processing and releases the institutional
                                                    claim to the CWF host.

                                                    DB2      ALIAS : FI_CLM_PROC_DT
                                                    SAS      ALIAS : APRVL_DT
                                                    STANDARD ALIAS : FI_CLM_PROC_DT
                                                    TITLE    ALIAS : FI_PROCESS_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  70.  NCH Provider State Code
                                 2    255    256    CHAR

                                                    Effective with Version H, the two position SSA state code
                                                    where provider facility is located.

                                                    NOTE:  During the Version H conversion this field was
                                                    populated with data throughout history (back to service year
                                                    1991).

                                                    DB2      ALIAS : NCH_PRVDR_STATE_CD
                                                    SAS      ALIAS : PRSTATE
                                                    STANDARD ALIAS : NCH_PRVDR_STATE_CD
                                                    TITLE    ALIAS : PROVIDER_STATE_CD

                                                    LENGTH         : 2

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    NCH PRVDR_NUM

                                                    DERIVATION RULES:

                                                    SET NCH_PRVDR_STATE_CD TO
                                                    PRVDR_NUM POS1-2.
                                                    FOR PRVDR_NUM POS1-2 EQUAL '55' OR '75'
                                                    OR '92'
                                                    SET NCH_PRVDR_STATE_CD TO '05'.
                                                    FOR PRVDR_NUM POS1-2 EQUAL '67' OR '74'
                                                    OR '97'
                                                    SET NCH_PRVDR_STATE_CD TO '45'.
                                                    FOR PRVDR_NUM POS1-2 EQUAL '68' OR '69'
                                                    SET NCH_PRVDR_STATE_CD TO '10'.
                                                    FOR PRVDR_NUM POS1-2 EQUAL '78'
                                                    SET NCH_PRVDR_STATE_CD TO '14'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '76'
                                                    SET NCH_PRVDR_STATE_CD TO '16'
                                                    FOR PRVDR_NUM POS1-2 EQUAL '70'
                                                    SET NCH_PRVDR_STATE_CD TO '17'
                                                    FOR PRVDR_NUM POS1-2 EQUAL '71' OR '95'
                                                    SET NCH_PRVDR_STATE_CD TO '19'
                                                    FOR PRVDR_NUMBER POS1-2 EQUAL '77'
                                                    SET NCH_PRVDR_STATE_CD TO '24'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '72'
                                                    SET NCH_PRVDR_STATE_CD TO '36'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '73'
                                                    SET NCH_PRVDR_STATE_CD TO '39'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '81'
                                                    SET NCH_PRVDR_STATE_CD TO '07'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '22'
                                                    SET NCH_PRVDR_STATE_CD TO '22'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '83'
                                                    SET NCH_PRVDR_STATE_CD TO '31'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '84'
                                                    SET NCH_PRVDR_STATE_CD TO '40'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '85'
                                                    SET NCH_PRVDR_STATE_CD TO '11'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '86'
                                                    SET NCH_PRVDR_STATE_CD TO '34'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '87'
                                                    SET NCH_PRVDR_STATE_CD TO '42'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '88'
                                                    SET NCH_PRVDR_STATE_CD TO '44'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '89'
                                                    SET NCH_PRVDR_STATE_CD TO '04'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '90'
                                                    SET NCH_PRVDR_STATE_CD TO '37'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '91'
                                                    SET NCH_PRVDR_STATE_CD TO '06'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '93'
                                                    SET NCH_PRVDR_STATE_CD TO '38'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '94'
                                                    SET NCH_PRVDR_STATE_CD TO '50'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '96'
                                                    SET NCH_PRVDR_STATE_CD TO '32'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '00'
                                                    SET NCH_PRVDR_STATE_CD TO '03'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '54'
                                                    SET NCH_PRVDR_STATE_CD TO '13'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '57'
                                                    SET NCH_PRVDR_STATE_CD TO '33'
                                                    FOR PRVDR_NUM POS1-2 EQUAL TO '58'
                                                    SET NCH_PRVDR_STATE_CD TO '51'

                                                    SOURCE         : NCH

                                                    CODE TABLE     : GEO_SSA_STATE_TB

  71.  Organization NPI Number
                                10    257    266    CHAR

                                                    On an institutional claim, the National
                                                    Provider Identifier (NPI) number assigned
                                                    to uniquely identify the institutional provider
                                                    certified by Medicare to provide services to the
                                                    beneficiary.

                                                    NOTE:  Effective May 2007, the NPI will be-
                                                    come the national standard identifier for
                                                    covered health care providers.  NPIs will
                                                    replace current OSCAR provider number, UPINs,
                                                    NSC numbers, and local contractor provider
                                                    identification numbers (PINs) on standard
                                                    HIPPA claim transactions. (During the NPI
                                                    transition phase (4/3/06 - 5/23/07) the
                                                    capability was there for the NCH to receive NPIs
                                                    along with an existing legacy number (UPIN,
                                                    PIN, OSCAR provider number, etc.)).

                                                    NOTE1:  CMS has determined that dual provider
                                                    identifiers (old legacy numbers and new NPI)
                                                    must be available in the NCH. After the 5/07
                                                    NPI implelmentation, the standard system main-
                                                    tainers will add the legacy number to the claim
                                                    when it is adjudicated.  We will continue to
                                                    receive the OSCAR provider number and any currently
                                                    issued UPINs.  Effective May 2007, no NEW UPINs
                                                    (legacy number) will be generated for NEW
                                                    physicians (Part B and outpatient claims),
                                                    so there will only be NPIs sent in to the NCH
                                                    for those physicians.

                                                    DB2      ALIAS : ORG_NPI_NUM
                                                    SAS      ALIAS : ORGNPINM
                                                    STANDARD ALIAS : ORG_NPI_NUM
                                                    TITLE    ALIAS : ORG_NPI

                                                    LENGTH         : 10

                                                    SOURCE         : CWF

  72.  Attending Physician ID Group
                                24    267    290    GRP


                                                    Name and identification numbers associated
                                                    with the primary care physician.

                                                    STANDARD ALIAS : ATNDG_PHYSN_ID_GRP

  73.  Claim Attending Physician UPIN Number
                                 6    267    272    CHAR

                                                    On an institutional claim, the unique physician
                                                    identification number (UPIN) of the physician
                                                    who would normally be expected to certify and
                                                    recertify the medical necessity of the services
                                                    rendered and/or who has primary responsibility for
                                                    the beneficiary's medical care and treatment
                                                    (attending physician).

                                                    COMMON   ALIAS : ATTENDING_PHYSICIAN_UPIN
                                                    DB2      ALIAS : ATNDG_UPIN_NUM
                                                    SAS      ALIAS : AT_UPIN
                                                    STANDARD ALIAS : CLM_ATNDG_PHYSN_UPIN_NUM
                                                    TITLE    ALIAS : ATTENDING_PHYSICIAN

                                                    LENGTH         : 6

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_PRMRY_CARE_PHYSN_IDENT_NUM and contained
                                                    10 positions (6-position UPIN and 4-position
                                                    physician surname).

                                                    SOURCE         : CWF

  74.  Claim Attending Physician NPI Number
                                10    273    282    CHAR

                                                    On an institutional claim, the national
                                                    provider identifier (NPI) number assigned
                                                    to uniquely identify the physician who has
                                                    overall responsibility for the beneficiary's
                                                    care and treatment.

                                                    NOTE:  Effective May 2007, the NPI will be-
                                                    come the national standard identifier for
                                                    covered health care providers.  NPIs will
                                                    replace current OSCAR provider number, UPINs,
                                                    NSC numbers, and local contractor provider
                                                    identification numbers (PINs) on standard
                                                    HIPPA claim transactions. (During the NPI
                                                    transition phase (4/3/06 - 5/23/07) the
                                                    capability was there for the NCH to receive NPIs
                                                    along with an existing legacy number (UPIN,
                                                    PIN, OSCAR provider number, etc.)).

                                                    NOTE1:  CMS has determined that dual provider
                                                    identifiers (old legacy numbers and new NPI)
                                                    must be available in the NCH. After the 5/07
                                                    NPI implementation, the standard system main-
                                                    tainers will add the legacy number to the claim
                                                    when it is adjudicated.  We will continue to
                                                    receive the OSCAR provider number and any currently
                                                    issued UPINs.  Effective May 2007, no NEW UPINs
                                                    (legacy number) will be generated for NEW
                                                    physicians (Part B and Outpatient claims),
                                                    so there will only be NPIs sent in to the NCH
                                                    for those physicians.

                                                    COMMON   ALIAS : ATTENDING_PHYSICIAN_NPI
                                                    DB2      ALIAS : ATNDG_NPI_NUM
                                                    SAS      ALIAS : AT_NPI
                                                    STANDARD ALIAS : CLM_ATNDG_PHYSN_NPI_NUM
                                                    TITLE    ALIAS : ATNDG_NPI

                                                    LENGTH         : 10

                                                    SOURCE         : CWF

  75.  Claim Attending Physician Surname
                                 6    283    288    CHAR

                                                    Effective with Version H, the last name of the
                                                    attending physician (used for internal editing
                                                    purpose in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : ATNDG_SRNM
                                                    SAS      ALIAS : AT_SRNM
                                                    STANDARD ALIAS : CLM_ATNDG_PHYSN_SRNM_NAME
                                                    TITLE    ALIAS : ANDG_PHYSN_SURNAME

                                                    LENGTH         : 6

                                                    SOURCE         : CWF

  76.  Claim Attending Physician Given Name
                                 1    289    289    CHAR

                                                    Effective with Version H, the first name of the
                                                    attending physician (used for internal editing
                                                    purposes in CMS' CWFMQA system).

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : ATNDG_GVN_NAME
                                                    SAS      ALIAS : AT_GVNNM
                                                    STANDARD ALIAS : CLM_ATNDG_PHYSN_GVN_NAME
                                                    TITLE    ALIAS : ATNDG_PHYSN_FIRSTNAME

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  77.  Claim Attending Physician Middle Initial Name
                                 1    290    290    CHAR

                                                    Effective with Version H, the middle initial
                                                    of the attending physician (used for internal
                                                    editing purposes in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : ATNDG_MI_NAME
                                                    SAS      ALIAS : AT_MDL
                                                    STANDARD ALIAS : CLM_ATNDG_PHYSN_MDL_INITL_NAME
                                                    TITLE    ALIAS : ATNDG_PHYSN_MI

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  78.  Operating Physician ID Group
                                24    291    314    GRP


                                                    Name and identification numbers associated
                                                    with the physician who performed the principal
                                                    procedure.

                                                    STANDARD ALIAS : OPRTG_PHYSN_ID_GRP

  79.  Claim Operating Physician UPIN Number
                                 6    291    296    CHAR

                                                    On an institutional claim, the unique physician
                                                    identification number (UPIN) of the physician
                                                    who performed the principal procedure.  This
                                                    element is used by the provider to identify the
                                                    operating physician who performed the surgi-
                                                    cal procedure.

                                                    DB2      ALIAS : OPRTG_UPIN
                                                    SAS      ALIAS : OP_UPIN
                                                    STANDARD ALIAS : CLM_OPRTG_PHYSN_UPIN_NUM
                                                    TITLE    ALIAS : OPRTG_UPIN

                                                    LENGTH         : 6

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_PRNCPAL_PRCDR_PHYSN_NUM and contained
                                                    10 positions (6-position UPIN and 4-position
                                                    physician surname.

                                                    NOTE:  For HHA and Hospice formats beginning
                                                    with NCH weekly process date 10/3/97 this field
                                                    was populated with data.  HHA and Hospice claims
                                                    processed prior to 10/3/97 will contain spaces.

                                                    SOURCE         : CWF

  80.  Claim Operating Physician NPI Number
                                10    297    306    CHAR

                                                    On an institutional claim, the National Provider
                                                    Identifier (NPI) number assigned to uniquely
                                                    identify the physician with the primary
                                                    responsibility for performing the surgical
                                                    procedure(s).

                                                    NOTE:  Effective May 2007, the NPI will become
                                                    the national standard identifier for covered
                                                    health care providers.  NPIs will replace
                                                    the current OSCAR provider number, UPINs, NSC
                                                    numbers, and local contractor provider identi-
                                                    fication numbers (PINs) on standard HIPPA claim
                                                    transactions. (During the NPI transition phase
                                                    (4/3/06 - 5/23/07) the capability was there
                                                    for the NCH to receive NPIs along with an
                                                    existing legacy number (UPIN, PIN, OSCAR provider
                                                    number, etc.)).

                                                    NOTE1:  CMS has determined that dual provider
                                                    identifiers (old legacy number and new NPI)
                                                    must be available in the NCH.  After the 5/07
                                                    NPI implementation, the standard system maint-
                                                    tainers will add the legacy number to the claim
                                                    when its adjudicated. We will continue to re-
                                                    ceive the OSCAR provider number and any currently
                                                    issued UPINs.  Effective May 2007, no NEW UPINs
                                                    (legacy numbers) will be generated for NEW
                                                    physicians (Part B and outpatient claims), so
                                                    there will only be NPIs sent in to the NCH
                                                    for those physicians.

                                                    DB2      ALIAS : OPRTG_NPI
                                                    SAS      ALIAS : OP_NPI
                                                    STANDARD ALIAS : CLM_OPRTG_PHYSN_NPI_NUM
                                                    TITLE    ALIAS : OPRTG_NPI

                                                    LENGTH         : 10

                                                    SOURCE         : CWF

  81.  Claim Operating Physician Surname
                                 6    307    312    CHAR

                                                    Effective with Version H, the last name of the
                                                    operating physician (used for internal editing
                                                    purposes in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with the NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : OPRTG_SRNM
                                                    SAS      ALIAS : OP_SRNM
                                                    STANDARD ALIAS : CLM_OPRTG_PHYSN_SRNM_NAME
                                                    TITLE    ALIAS : OPRTG_PHYSN_SURNAME

                                                    LENGTH         : 6

                                                    SOURCE         : CWF

  82.  Claim Operating Physician Given Name
                                 1    313    313    CHAR

                                                    Effective with Version H, the first name
                                                    of the operating physician (used for internal
                                                    editing purposes in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : OPRTG_GVN_NAME
                                                    SAS      ALIAS : OP_GVN
                                                    STANDARD ALIAS : CLM_OPRTG_PHYSN_GVN_NAME
                                                    TITLE    ALIAS : OPRTG_PHYSN_FIRSTNAME

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  83.  Claim Operating Physician Middle Initial Name
                                 1    314    314    CHAR

                                                    Effective with Version H, the middle initial
                                                    of the operating physician (used for internal
                                                    editing purposes in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : OPRTG_MI_NAME
                                                    SAS      ALIAS : OP_MDL
                                                    STANDARD ALIAS : CLM_OPRTG_PHYSN_MDL_INITL_NAME
                                                    TITLE    ALIAS : OPRTG_PHYSN_MI

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  84.  Other Operating Physician ID Group
                                24    315    338    GRP


                                                    Name and identification numbers associated with
                                                    the other physician.

                                                    STANDARD ALIAS : OTHR_OPRTG_PHYSN_ID_GRP

                                                    COMMENTS :
                                                    This field was renamed from OTHR_PHYSN_ID_GRP to
                                                    OTHR_OPRTG_PHYSN_ID_GRP as part of the CR#7 updates.

  85.  Claim Other Physician UPIN Number
                                 6    315    320    CHAR

                                                    On an institutional claim, the unique physician
                                                    identification number (UPIN) of the other
                                                    physician associated with the institutional
                                                    claim.

                                                    DB2      ALIAS : OTHR_UPIN
                                                    SAS      ALIAS : OT_UPIN
                                                    STANDARD ALIAS : CLM_OTHR_PHYSN_UPIN_NUM
                                                    TITLE    ALIAS : OTH_PHYSN_UPIN

                                                    LENGTH         : 6

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_OTHR_PHYSN_IDENT_NUM and contained
                                                    10 positions (6-position UPIN and 4-position
                                                    other physician surname).

                                                    NOTE:  For HHA and Hospice formats beginning
                                                    with NCH weekly process date 10/3/97 this field
                                                    was populated with data.  HHA and Hospice claims
                                                    processed prior to 10/3/97 will contain spaces.

                                                    SOURCE         : CWF

  86.  Claim Other Physician NPI Number
                                10    321    330    CHAR

                                                    On an institutional claim, the National
                                                    Provider Identifier (NPI) number assigned
                                                    to uniquely identify the other physician
                                                    associated with the institutiohal claim.

                                                    NOTE:  Effective May 2007, the NPI will be-
                                                    come the national standard identifier for
                                                    covered health care providers.  NPIs will
                                                    replace current OSCAR provider number, UPINs,
                                                    NSC numbers, and local contractor provider
                                                    identification numbers (PINs) on standard
                                                    HIPPA claim transactions. (During the NPI
                                                    transition phase (4/3/06 - 5/23/07) the
                                                    capability was there for the NCH to receive NPIs
                                                    along with an existing legacy number (UPIN,
                                                    PIN, OSCAR provider number, etc.)).

                                                    NOTE1:  CMS has determined that dual provider
                                                    identifiers (old legacy numbers and new NPI)
                                                    must be available in the NCH. After the 5/07
                                                    NPI implementation, the standard system main-
                                                    tainers will add the legacy number to the claim
                                                    when it is adjudicated.  We will continue to
                                                    receive the OSCAR provider number and any currently
                                                    issued UPINs.  Effective May 2007, no NEW UPINs
                                                    (legacy number) will be generated for NEW
                                                    physicians (Part B AND outpatient claims),
                                                    so there will only be NPIs sent in to the NCH
                                                    for those physicians.

                                                    DB2      ALIAS : OTHR_NPI
                                                    SAS      ALIAS : OT_NPI
                                                    STANDARD ALIAS : CLM_OTHR_PHYSN_NPI_NUM

                                                    LENGTH         : 10

                                                    SOURCE         : CWF

  87.  Claim Other Physician Surname
                                 6    331    336    CHAR

                                                    Effective with Version H, the last name of the
                                                    other physician (used for internal editing
                                                    purposes in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with the NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : OTHR_SRNM
                                                    SAS      ALIAS : OT_SRNM
                                                    STANDARD ALIAS : CLM_OTHR_PHYSN_SRNM_NAME
                                                    TITLE    ALIAS : OTH_PHYSN_SURNAME

                                                    LENGTH         : 6

                                                    SOURCE         : CWF

  88.  Claim Other Physician Given Name
                                 1    337    337    CHAR

                                                    Effective with Version H, the first name of the
                                                    other physician (used for internal editing
                                                    purposes in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : OTHR_GVN_NAME
                                                    SAS      ALIAS : OT_GVN
                                                    STANDARD ALIAS : CLM_OTHR_PHYSN_GVN_NAME
                                                    TITLE    ALIAS : OTH_PHYSN_FIRSTNAME

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  89.  Claim Other Physician Middle Initial Name
                                 1    338    338    CHAR

                                                    Effective with Version H, the middle initial of
                                                    the other physician (used for internal editing
                                                    purposes in CMS' CWFMQA system.)

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : OTHR_MI_NAME
                                                    SAS      ALIAS : OT_MDL
                                                    STANDARD ALIAS : CLM_OTHR_PHYSN_MDL_INITL_NAME
                                                    TITLE    ALIAS : OTH_PHYSN_MI

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

  90.  Medicaid Provider Identification Number
                                13    339    351    CHAR

                                                    A unique identification number assigned to each provider by
                                                    the state Medicaid agency.  This unique provider number is
                                                    used to ensure proper payment of providers and to maintain
                                                    claims history on individual providers for surveillance and
                                                    utilization review.

                                                    DB2      ALIAS : MDCD_PRVDR_NUM
                                                    SAS      ALIAS : MDCD_PRV
                                                    STANDARD ALIAS : MDCD_PRVDR_IDENT_NUM
                                                    TITLE    ALIAS : MEDICAID_PROVIDER

                                                    LENGTH         : 13

                                                    COMMENTS :
                                                    Prior to Version H the field size was X(12).

                                                    SOURCE         : CWF

  91.  Claim Medicaid Information Code
                                 4    352    355    CHAR

                                                    Effective with Version G, code identifying Medicaid
                                                    information supplied by the contractor to Medicaid.

                                                    DB2      ALIAS : CLM_MDCD_INFO_CD
                                                    SAS      ALIAS : MDCDINFO
                                                    STANDARD ALIAS : CLM_MDCD_INFO_CD
                                                    TITLE    ALIAS : MEDICAID_INFO

                                                    LENGTH         : 4

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_MDCD_INFO_TB

  92.  Claim MCO Paid Switch
                                 1    356    356    CHAR

                                                    A switch indicating whether or not a Managed Care
                                                    Organization (MCO) has paid the provider for an
                                                    institutional claim.

                                                    DB2      ALIAS : CLM_MCO_PD_SW
                                                    SAS      ALIAS : MCOPDSW
                                                    STANDARD ALIAS : CLM_MCO_PD_SW
                                                    TITLE    ALIAS : MCO_PAID_SW

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_GHO_PD_SW.

                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       MCO_PD_SW_LIM

                                                    CODE TABLE     : CLM_MCO_PD_TB

  93.  Claim Treatment Authorization Number
                                18    357    374    CHAR

                                                    The number assigned by the medical reviewer and
                                                    reported by the provider to identify the
                                                    medical review (treatment authorization)
                                                    action taken after review of the beneficiary's
                                                    case.  It designates that treatment covered
                                                    by the bill has been authorized by the payer.
                                                    This number is used by the intermediary and
                                                    the Peer Review Organization.

                                                    NOTE:  Under HH PPS this field will be used to
                                                    link claims to the OASIS assessment used as the
                                                    basis of payment.  This eighteen character string
                                                    consists of the start of care date, the OASIS
                                                    assessment date and the two digit reason for
                                                    assessment code.

                                                    COMMON   ALIAS : TAN
                                                    DB2      ALIAS : TRTMT_AUTHRZTN_NUM
                                                    SAS      ALIAS : AUTHRZTN
                                                    STANDARD ALIAS : CLM_TRTMT_AUTHRZTN_NUM
                                                    TITLE    ALIAS : TREATMENT_AUTHORIZATION

                                                    LENGTH         : 18

                                                    SOURCE         : CWF

  94.  Patient Control Number
                                20    375    394    CHAR

                                                    The unique alphanumeric identifier assigned by the
                                                    provider to the institutional claim to facilitate
                                                    retrieval of individual case records and posting
                                                    of payments.

                                                    DB2      ALIAS : PTNT_CNTL_NUM
                                                    SAS      ALIAS : PTNTCNTL
                                                    STANDARD ALIAS : PTNT_CNTL_NUM
                                                    TITLE    ALIAS : PATIENT_CONTROL_NUM

                                                    LENGTH         : 20

                                                    SOURCE         : CWF

  95.  Claim Medical Record Number
                                17    395    411    CHAR

                                                    The number assigned by the provider to the
                                                    beneficiary's medical record to assist in record
                                                    retrieval.

                                                    DB2      ALIAS : CLM_MDCL_REC_NUM
                                                    SAS      ALIAS : MDCL_REC
                                                    STANDARD ALIAS : CLM_MDCL_REC_NUM
                                                    TITLE    ALIAS : MEDICAL_RECORD_NUM

                                                    LENGTH         : 17

                                                    SOURCE         : CWF

  96.  Claim PRO Control Number
                                12    412    423    CHAR

                                                    Effective with Version G, the unique identifier
                                                    assigned by the Peer Review Organization (PRO)
                                                    for control purposes.

                                                    DB2      ALIAS : CLM_PRO_CNTL_NUM
                                                    SAS      ALIAS : PRO_CNTL
                                                    STANDARD ALIAS : CLM_PRO_CNTL_NUM
                                                    TITLE    ALIAS : PRO_CONTROL_NUM

                                                    LENGTH         : 12

                                                    SOURCE         : CWF

  97.  Claim PRO Process Date
                                 8    424    431    NUM

                                                    Effective with Version H, the date the claim was
                                                    used in the PRO review process.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    DB2      ALIAS : CLM_PRO_PROC_DT
                                                    SAS      ALIAS : PRO_DT
                                                    STANDARD ALIAS : CLM_PRO_PROC_DT
                                                    TITLE    ALIAS : PRO_PROC_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  98.  Patient Discharge Status Code
                                 2    432    433    CHAR

                                                    The code used to identify the status of the
                                                    patient as of the CLM_THRU_DT.

                                                    DB2      ALIAS : PTNT_DSCHRG_STUS
                                                    SAS      ALIAS : STUS_CD
                                                    STANDARD ALIAS : PTNT_DSCHRG_STUS_CD
                                                    TITLE    ALIAS : PTNT_DSCHRG_STUS_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_STUS_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : PTNT_DSCHRG_STUS_TB

  99.  Claim 1st Diagnosis E Code Group
                                 8    434    441    GRP


                                                    Effective with Version 'J', the group used to identify the
                                                    1st diagnosis E code in the diagnosis E trailer.  This group
                                                    contains the 1st diagnosis E code and the 1st diagnosis E
                                                    version code.

                                                    STANDARD ALIAS : CLM_1ST_DGNS_E_CD_GRP

  100. Claim 1st Diagnosis E Version Code
                                 1    434    434    CHAR

                                                    Effective with Version 'J', the code used to indicate if
                                                    the diagnosis code is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes have
                                                    been expanded to accomodate ICD-10, even though ICD-10 is
                                                    not scheduled for implementation until 10/2013.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : E1VRSNCD
                                                    STANDARD ALIAS : CLM_1ST_DGNS_E_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_DGNS_VRSN_TB

  101. Claim 1st Diagnosis E Code
                                 7    435    441    CHAR

                                                    The code used to identify the 1st external cause of
                                                    injury, poisoning, or other adverse effect.  This
                                                    diagnosis E code is also stored as the 1st occurrence
                                                    of the diagnosis E code trailer.

                                                    NOTE:  Effective with Version 'J', this field has been
                                                    expanded from 5 bytes to 7 bytes to accommodate the
                                                    future implementation of ICD-10.

                                                    DB2      ALIAS : CLM_1ST_DGNS_E_CD
                                                    SAS      ALIAS : DGNS_E
                                                    STANDARD ALIAS : CLM_1ST_DGNS_E_CD

                                                    LENGTH         : 7

                                                    COMMENTS :
                                                    Prior to version 'J',  this field was named:
                                                    CLM_DGNS_E_CD.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          ICD-9-CM

  102. Claim PPS Indicator Code
                                 1    442    442    CHAR

                                                    Effective with Version H, the code indicating
                                                    whether or not the (1) claim is PPS and/or (2)
                                                    the beneficiary is a deemed insured Medicare
                                                    Qualified Government Employee (MQGE).

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 through 5/29/98, this field was pop-
                                                    ulated with only the PPS indicator.  Beginning with
                                                    NCH weekly process date 6/5/98, this field was
                                                    additionally populated with the deemed MQGE
                                                    indicator. Claims processed prior to 10/3/97
                                                    will contain spaces.

                                                    DB2      ALIAS : CLM_PPS_IND_CD
                                                    SAS      ALIAS : PPS_IND
                                                    STANDARD ALIAS : CLM_PPS_IND_CD
                                                    TITLE    ALIAS : PPS_IND

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_PPS_IND_TB

  103. Claim Total Charge Amount
                                 6    443    448    PACK

                                                    Effective with Version G, the total charges for
                                                    all services included on the institutional claim.
                                                    This field is redundant with revenue center
                                                    code 0001/total charges.

                                                    DB2      ALIAS : CLM_TOT_CHRG_AMT
                                                    SAS      ALIAS : TOT_CHRG
                                                    STANDARD ALIAS : CLM_TOT_CHRG_AMT
                                                    TITLE    ALIAS : CLAIM_TOTAL_CHARGES

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H the size of this field was
                                                    S9(7)V99.

                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       TOT_CHRG_AMT_LIM

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  104. Claim Pricer Return Code
                                 2    449    450    CHAR

                                                    Effective 1/1/2004 with the implementation of NCH/NMUD
                                                    CR#1, the code used to identify various PPS payment
                                                    adjustment types.  This code identifies the
                                                    payment return code or the error return code for
                                                    every claim type calculated by a PRICER (Inpatient,
                                                    Outpatient, SNF, Inpatient Rehab Facility (IRF),
                                                    Home Health and Hospice).

                                                    The payment return code identifies the type of
                                                    payment calculated by the PRICER software.

                                                    The error return code identifies a condition in
                                                    a claim that prevents the PRICER software from
                                                    calculating a correct payment.

                                                    NOTE:  Prior to 10/2005 (implementation of NCH/NMUD
                                                    CR#2), this data was stored in positions 443-444
                                                    (FILLER) on all institutional claim types.

                                                    DB2      ALIAS : CLM_PRCR_RTRN_CD
                                                    SAS      ALIAS : PRCRRTRN
                                                    STANDARD ALIAS : CLM_PRCR_RTRN_CD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_PRCR_RTRN_TB

  105. Claim Business Segment Identifier Code
                                 4    451    454    CHAR

                                                    Effective 10/1/2005 with the implementation of NCH/NMUD
                                                    CR#2, the identifier that captures the 2-byte juris-
                                                    diction code (represents the USPS state/territory
                                                    abbreviation (i.e. NY = New York) and the 2-byte
                                                    modifier that identifies the type of Medicare FFS
                                                    contract (intermediary, RHHI, carrier or DMERC).
                                                    This 4-byte identifier along with the 5-byte
                                                    FI/Carrier number comprises the Contractor
                                                    Workload Identifier number.  The business segment
                                                    identifier (BSI) is intended to help sort work-
                                                    loads that may be redistributed with the implemen-
                                                    tation of contracting reform as required by MMA.

                                                    DB2      ALIAS : BUSNS_SGMT_ID_CD
                                                    SAS      ALIAS : SGMT_ID
                                                    STANDARD ALIAS : CLM_BUSNS_SGMT_ID_CD

                                                    LENGTH         : 4

                                                    SOURCE         : CWF

  106. Recovery Audit Contractor (RAC) Adjustment Indicator Code
                                 1    455    455    CHAR

                                                    Effective January 5, 2009 with the implementation of
                                                    CR#4, the code used to identify a Recovery Audit
                                                    Contractor (RAC) requested adjustment.  This occurs
                                                    as a result of post-payment review activities done by
                                                    the RAC.

                                                    DB2      ALIAS : RAC_ADJSTMT_CD
                                                    SAS      ALIAS : RACINDCD
                                                    STANDARD ALIAS : CLM_RAC_ADJSTMT_IND_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_RAC_ADJSTMT_TB

  107. Worker's Compensation Indicator Code
                                 1    456    456    CHAR

                                                    This indicator is used to determine whether the
                                                    diagnosis codes on the claims are related to the
                                                    diagnosis codes on the MSP auxiliary file in CWF.

                                                    DB2      ALIAS : CLM_WC_IND_CD
                                                    SAS      ALIAS : WCINDCD
                                                    STANDARD ALIAS : CLM_WC_IND_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_WC_IND_TB

  108. Claim Service Facility Zip Code
                                 9    457    465    CHAR

                                                    Effective with Version 'J', the zip code used to identify
                                                    the location of the facility where the service
                                                    was performed.

                                                    DB2      ALIAS : SRVC_FAC_ZIP_CD
                                                    SAS      ALIAS : SRVCFAC
                                                    STANDARD ALIAS : CLM_SRVC_FAC_ZIP_CD

                                                    LENGTH         : 9

  109. Claim Paperwork (PWK) Code
                                 2    466    467    CHAR

                                                    Effective with CR#6, the code used to indicate a provider
                                                    has submitted an electronic claim that requires
                                                    additional documentation.

                                                    DB2      ALIAS : CLM_PWK_CD
                                                    STANDARD ALIAS : CLM_PWK_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_PWK_TB

  110. Claim Care Improvement Model 1 Code
                                 2    468    469    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 1 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 1 is '61'.

                                                    DB2      ALIAS : CARE_MODEL_1_CD
                                                    SAS      ALIAS : CMODEL1
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_1_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  111. Claim Care Improvement Model 2 Code
                                 2    470    471    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 2 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 2 is '62'.

                                                    DB2      ALIAS : CARE_MODEL_2_CD
                                                    SAS      ALIAS : CMODEL2
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_2_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  112. Claim Care Improvement Model 3 Code
                                 2    472    473    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 3 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 3 is '63'.

                                                    DB2      ALIAS : CARE_MODEL_3_CD
                                                    SAS      ALIAS : CMODEL3
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_3_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  113. Claim Care Improvement Model 4 Code
                                 2    474    475    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 4 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 4 is '64'.

                                                    DB2      ALIAS : CARE_MODEL_4_CD
                                                    SAS      ALIAS : CMODEL4
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_4_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  114. Rendering Physician ID Group
                                26    476    501    GRP


                                                    CR 7115 titled, Primary Care Incentive payment
                                                    Program (PCIP), Section 5501(a) of the Patient
                                                    Protection and Affordable Care Act (ACA),
                                                    Payment to a Critical Access Hospital (CAH) paid
                                                    under the Optional Method, instructed CAH
                                                    providers to submit their NPI using the "Other
                                                    Provider" field.  With the implementation of 5010,
                                                    the "Other Physician Group" was redefined to
                                                    "Other Operating Physician" and thus, not
                                                    appropriate for usage for PCIP reporting.  With the
                                                    implementation of CR7686, CAH providers must
                                                    use the rendering provider fields to populate the
                                                    eligible primary care practitioner NPI in order for
                                                    the primary care services to qualify for the incentive
                                                    bonus.

                                                    STANDARD ALIAS : RNDRNG_PHYSN_ID_GRP

  115. Claim Rendering Physician UPIN Number
                                 6    476    481    CHAR

                                                    Effective with CR#7, the unique physician
                                                    identification number (UPIN) of the rendering
                                                    physician whose services qualify for an incentive
                                                    bonus under the Primary Care Incentive Payment
                                                    Program (PCIP).

                                                    NOTE: CR7115 titled, Primary Care Incentive Payment
                                                    Program (PCIP), Section 5501(a) of the Patient
                                                    Protection and Affordable Care Act (ACA), payment
                                                    to Critical Access Hospitals (CAH) paid under the
                                                    Optional Method, instructed CAH providers to submit
                                                    their NPI using the "Other Provider" field.   With the
                                                    implementation of 5010, the "Other Physician Group" as
                                                    redefined to "Other Operating Physician" and thus, not
                                                    appropriate for usage for PCIP reporting. With the
                                                    implementation of CR7686, CAH providers must use the
                                                    rendering provider fields to populate the eligible
                                                    primary care practitioner NPI in order for primary
                                                    care services to qualify for the incentive bonus.

                                                    DB2      ALIAS : RNDRNG-UPIN
                                                    SAS      ALIAS : R-UPIN
                                                    STANDARD ALIAS : CLM_RNDRNG_PHYSN_UPIN_NUM

                                                    LENGTH         : 6

  116. Claim Rendering Physician NPI Number
                                10    482    491    CHAR

                                                    Effective with CR#7, the national provider
                                                    identifier (NPI) number assigned to uniquely
                                                    identify the rendering physician whose services
                                                    qualify for an incentive bonus under the Primary Care
                                                    Incentive Payment Program (PCIP).

                                                    NOTE: CR7115 titled, Primary Care Incentive Payment
                                                    Program (PCIP), Section 5501(a) of the Patient
                                                    Protection and Affordable Care Act (ACA), payment
                                                    to Critical Access Hospitals (CAH) paid under the
                                                    Optional Method, instructed CAH providers to submit
                                                    their NPI using the "Other Provider" field.   With the
                                                    implementation of 5010, the "Other Physician Group" as
                                                    redefined to "Other Operating Physician" and thus, not
                                                    appropriate for usage for PCIP reporting. With the
                                                    implementation of CR7686, CAH providers must use the
                                                    rendering provider fields to populate the eligible
                                                    primary care practitioner NPI in order for primary
                                                    care services to qualify for the incentive bonus.

                                                    DB2      ALIAS : RNDRNG-NPI
                                                    SAS      ALIAS : R-NPI
                                                    STANDARD ALIAS : CLM_RNDRNG_PHYSN_NPI_NUM

                                                    LENGTH         : 10

  117. Claim Rendering Physician Surname Name
                                 6    492    497    CHAR

                                                    Effective with CR#7, the last name of the rendering
                                                    physician whose services qualify for an incentive
                                                    bonus under the Primary Care Incentive Payment
                                                    Program.

                                                    NOTE: CR7115 titled, Primary Care Incentive Payment
                                                    Program (PCIP), Section 5501(a) of the Patient
                                                    Protection and Affordable Care Act (ACA), payment
                                                    to Critical Access Hospitals (CAH) paid under the
                                                    Optional Method, instructed CAH providers to submit
                                                    their NPI using the "Other Provider" field.   With the
                                                    implementation of 5010, the "Other Physician Group" as
                                                    redefined to "Other Operating Physician" and thus, not
                                                    appropriate for usage for PCIP reporting. With the
                                                    implementation of CR7686, CAH providers must use the
                                                    rendering provider fields to populate the eligibile
                                                    primary care practitioner NPI in order for primary
                                                    care services to qualify for the incentive bonus.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : R-SRNM
                                                    STANDARD ALIAS : CLM_RNDRNG_PHYSN_SRNM_NAME

                                                    LENGTH         : 6

  118. Claim Rendering Physician Given Name
                                 1    498    498    CHAR

                                                    Effective with CR#7, the first name of the rendering
                                                    physician whose services qualify for an incentive
                                                    bonus under the Primary Care Incentive Payment
                                                    Program.

                                                    NOTE: CR7115 titled, Primary Care Incentive Payment
                                                    Program (PCIP), Section 5501(a) of the Patient
                                                    Protection and Affordable Care Act (ACA), payment
                                                    to Critical Access Hospitals (CAH) paid under the
                                                    Optional Method, instructed CAH providers to submit
                                                    their NPI using the "Other Provider" field.   With the
                                                    implementation of 5010, the "Other Physician Group" as
                                                    redefined to "Other Operating Physician" and thus, not
                                                    appropriate for usage for PCIP reporting. With the
                                                    implementation of CR7686, CAH providers must use the
                                                    rendering provider fields to populate the eligibile
                                                    primary care practitioner NPI in order for primary
                                                    care services to qualify for the incentive bonus.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : R-GVN
                                                    STANDARD ALIAS : CLM_RNDRNG_PHYSN_GVN_NAME

                                                    LENGTH         : 1

  119. Claim Rendering Physician Middle Name
                                 1    499    499    CHAR

                                                    Effective with CR#7, the middle initial name of the
                                                    rendering physician whose services qualify for an
                                                    incentive bonus under the Primary Care Incentive
                                                    Payment Program.

                                                    NOTE: CR7115 titled, Primary Care Incentive Payment
                                                    Program (PCIP), Section 5501(a) of the Patient
                                                    Protection and Affordable Care Act (ACA), payment
                                                    to Critical Access Hospitals (CAH) paid under the
                                                    Optional Method, instructed CAH providers to submit
                                                    their NPI using the "Other Provider" field.   With the
                                                    implementation of 5010, the "Other Physician Group" as
                                                    redefined to "Other Operating Physician" and thus, not
                                                    appropriate for usage for PCIP reporting. With the
                                                    implementation of CR7686, CAH providers must use the
                                                    rendering provider fields to populate the eligibile
                                                    primary care practitioner NPI in order for primary
                                                    care services to qualify for the incentive bonus.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : R-MDL
                                                    STANDARD ALIAS : CLM_RNDRNG_PHYSN_MDL_NAME

                                                    LENGTH         : 1

  120. Claim Rendering Physician Specialty Code
                                 2    500    501    CHAR

                                                    Effective with CR#7, the code used to identify the CMS
                                                    specialty code of the rendering physician/practitioner.

                                                    NOTE: A 10 percent initiative payment will be provided to
                                                    primary care practitioners, identified as: (1) in the
                                                    case of physicians, enrolled in Medicare with a primary
                                                    specialty code designation of 08-family practice, 11-
                                                    internal medicine, 37-pediatrics, or 38-geriatrics; or
                                                    (2) in the case of non-physician practitioners, enrolled
                                                    in Medicare with a primary care speciality code designation
                                                    of 50-nurse practitioner, 89-certified clinical nurse
                                                    specialist, or 97-physician assistant; and (3) for whom
                                                    the primary care services displayed in the above table
                                                    accounted for at least 60 perent of the allowed charged
                                                    under the PFS (excluding hospital inpatient care and
                                                    emergency department visits)for such practitioners.

                                                    DB2      ALIAS : RNDRNG_SPCLTY_CD
                                                    SAS      ALIAS : RPSPCLTY
                                                    STANDARD ALIAS : CLM_RNDRNG_PHYSN_SPCLTY_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CMS_PRVDR_SPCLTY_TB

  121. Claim Patient Relationship Code
                                 2    502    503    CHAR

                                                    Effective with CR#7, the code used to identify the
                                                    patient relationship to the beneficiary.

                                                    DB2      ALIAS : CLM_PTNT_RLTNSHP_C
                                                    SAS      ALIAS : PRLTNSHP
                                                    STANDARD ALIAS : CLM_PTNT_RLTNSHP_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    CMS CR7523

                                                    CODE TABLE     : CLM_PTNT_RLTNSHP_TB

  122. Claim Fraud Prevention System (FPS) Model Number
                                 2    504    505    CHAR

                                                    Effective with Version 'K', this field identifies an
                                                    FPS analytic model that identifies claims that may
                                                    be high risk for fraud based on specific information.

                                                    DB2      ALIAS : CLM_FPS_MODEL_NUM
                                                    SAS      ALIAS : FPSMODEL
                                                    STANDARD ALIAS : CLM-FPS-MODEL-NUM

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Valid Values:   0 - 9, A -Z

  123. Claim FPS Reason Code
                                 3    506    508    CHAR

                                                    Effective with Version 'K', this field identifies the
                                                    reason codes used to explain why a claim was not
                                                    paid or how the claim was paid.  These codes also
                                                    show the reason for any claim financial adjustment
                                                    such as denial, reductions or increases in payment.

                                                    DB2      ALIAS : CLM_FPS_RSN_CD
                                                    SAS      ALIAS : FPSRSN
                                                    STANDARD ALIAS : CLM_FPS_RSN_CD

                                                    LENGTH         : 3

                                                    CODE TABLE     : CLM_ADJ_RSN_TB

  124. Claim FPS Remarks Code
                                 5    509    513    CHAR

                                                    Effective with Version 'K', the codes used to
                                                    convey information about remittance processing or
                                                    to provide a supplemental explanation for an
                                                    adjustment already described by a
                                                    Claim Adjustment Reason Code.

                                                    DB2      ALIAS : CLM_FPS_RMRK_CD
                                                    SAS      ALIAS : FPSRMRK
                                                    STANDARD ALIAS : CLM_FPS_RMRK_CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_RMTNC_ADVC_TB

  125. Claim FPS MSN 1 Code
                                 5    514    518    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : CLM_FPS_MSN_1_CD
                                                    SAS      ALIAS : FPSMSN1
                                                    STANDARD ALIAS : CLM-FPS-MSN-1-CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  126. Claim FPS MSN 2 Code
                                 5    519    523    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : CLM_FPS_MSN_2_CD
                                                    SAS      ALIAS : FPSMSN2
                                                    STANDARD ALIAS : CLM-FPS-MSN-2-CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  127. Claim Mass Adjustment Indicator Code
                                 1    524    524    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify if the adjustment claim is part of a mass
                                                    adjustment project.

                                                    DB2      ALIAS : MASS_ADJSTMT_CD
                                                    SAS      ALIAS : MADJSTMT
                                                    STANDARD ALIAS : CLM_MASS_ADJSTMT_IND_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_MASS_ADJSTMT_IND_CD_TB

  128. Claim Next Generation (NG) Affordable Care Organization (ACO) Indicator 1 Code
                                 1    525    525    CHAR

                                                    Effective with CR#11, this field represents the benefit enhancement
                                                    indicator that identifies claims that qualify for a specific
                                                    claims processing edit.

                                                    NOTE:  There are 5 occurrences of this field on a claim, but each
                                                    value can only be represented once.

                                                    NOTE2:  The 5 occurrences of this field are found at the claim level
                                                    on all institutional claim types and at the line level on Carrier
                                                    claims.

                                                    DB2      ALIAS : CLM_NG_ACO_1_CD
                                                    SAS      ALIAS : CNGACO1
                                                    STANDARD ALIAS : CLM_NG_ACO_IND_1_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : NG_ACO_IND_TB

  129. Claim Next Generation (NG) Affordable Care Organization (ACO) Indicator 2 Code
                                 1    526    526    CHAR

                                                    Effective with CR#11, this field represents the benefit enhancement
                                                    indicator that identifies claims that qualify for a specific
                                                    claims processing edit.

                                                    NOTE:  There are 5 occurrences of this field on a claim, but each
                                                    value can only be represented once.

                                                    NOTE2:  The 5 occurrences of this field are found at the claim level
                                                    on all institutional claim types and at the line level on Carrier
                                                    claims.

                                                    DB2      ALIAS : CLM_NG_ACO_2_CD
                                                    SAS      ALIAS : CNGACO2
                                                    STANDARD ALIAS : CLM_NG_ACO_IND_2_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : NG_ACO_IND_TB

  130. Claim Next Generation (NG) Affordable Care Organization (ACO) Indicator 3 Code
                                 1    527    527    CHAR

                                                    Effective with CR#11, this field represents the benefit enhancement
                                                    indicator that identifies claims that qualify for a specific
                                                    claims processing edit.

                                                    NOTE:  There are 5 occurrences of this field on a claim, but each
                                                    value can only be represented once.

                                                    NOTE2:  The 5 occurrences of this field are found at the claim level
                                                    on all institutional claim types and at the line level on Carrier
                                                    claims.

                                                    DB2      ALIAS : CLM_NG_ACO_3_CD
                                                    SAS      ALIAS : CNGACO3
                                                    STANDARD ALIAS : CLM_NG_ACO_IND_3_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : NG_ACO_IND_TB

  131. Claim Next Generation (NG) Affordable Care Organization (ACO) Indicator 4 Code
                                 1    528    528    CHAR

                                                    Effective with CR#11, this field represents the benefit enhancement
                                                    indicator that identifies claims that qualify for a specific
                                                    claims processing edit.

                                                    NOTE:  There are 5 occurrences of this field on a claim, but each
                                                    value can only be represented once.

                                                    NOTE2:  The 5 occurrences of this field are found at the claim level
                                                    on all institutional claim types and at the line level on Carrier
                                                    claims.

                                                    DB2      ALIAS : CLM_NG_ACO_4_CD
                                                    SAS      ALIAS : CNGACO4
                                                    STANDARD ALIAS : CLM_NG_ACO_IND_4_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : NG_ACO_IND_TB

  132. Claim Next Generation (NG) Affordable Care Organization (ACO) Indicator 5 Code
                                 1    529    529    CHAR

                                                    Effective with CR#11, this field represents the benefit enhancement
                                                    indicator that identifies claims that qualify for a specific
                                                    claims processing edit.

                                                    NOTE:  There are 5 occurrences of this field on a claim, but each
                                                    value can only be represented once.

                                                    NOTE2:  The 5 occurrences of this field are found at the claim level
                                                    on all institutional claim types and at the line level on Carrier
                                                    claims.

                                                    DB2      ALIAS : CLM_NG_ACO_5_CD
                                                    SAS      ALIAS : CNGACO5
                                                    STANDARD ALIAS : CLM_NG_ACO_IND_5_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : NG_ACO_IND_TB

  133. Claim Residual Payment Indicator Code
                                 1    530    530    CHAR

                                                    Effective with CR#11, this field is used by CWF claims processing
                                                    for the purpose of bypassing its normal MSP editing that would
                                                    otherwise apply for ongoing responsibility for medicals (ORM) or
                                                    worker's compensation Medicare Set-Aside Arrangements (WCMSA).
                                                    Normally, CWF does not allow a secondary payment on MSP involving
                                                    ORM or WCMSA, so the residual payment indicator will be used to
                                                    allow CWF to make an exception to its normal routine.

                                                    DB2      ALIAS : CLM_RSDL_PMT_CD
                                                    SAS      ALIAS : RSDLPMT
                                                    STANDARD ALIAS : CLM_RSDL_PMT_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : RSDL_PMT_IND_TB

  134. Claim Accountable Care Organization (ACO) Identification Number
                                10    531    540    CHAR

                                                    Effective with CR#12, this field identifies the unique identifi-
                                                    cation number assigned to the Accountable Care Organization (ACO).

                                                    DB2      ALIAS : CLM_ACO_ID_NUM
                                                    SAS      ALIAS : ACOIDNUM
                                                    STANDARD ALIAS : CLM_ACO_ID_NUM

                                                    LENGTH         : 10

                                                    COMMENTS :
                                                    (CMS CR9468) - CWF July 2016 Release

  135. Medicare Beneficiary Identification (MBI) Number
                                11    541    551    CHAR

                                                    Effective with CR#12, this field represents the Medicare beneficiary
                                                    identification number. This field is being added due to the removal
                                                    of the Social Security Number from the Medicare card (SSNRI project).
                                                    The MBI will replace the HICN on the Medicare card.  CMS will
                                                    continue to use the HICN within internal systems.

                                                    NOTE:  We will not see MBI's on the claims until October 2017
                                                    (start of the transition period).

                                                    DB2      ALIAS : MBI_ID
                                                    SAS      ALIAS : MBIID
                                                    STANDARD ALIAS : MBI_ID

                                                    LENGTH         : 11

                                                    COMMENTS :
                                                    SSNRI Project
                                                    CWF October 2017 Release

  136. Claim Beneficiary Identifier Type Code
                                 1    552    552    CHAR

                                                    Effective with CR#12, this field identifies whether the claim was
                                                    submitted by the provider, during the transition period, with a
                                                    HICN or MBI.

                                                    NOTE:  This field will not be populated with data until the start
                                                    of the transition period (October 2017).

                                                    DB2      ALIAS : BENE_ID_TYPE_CD
                                                    SAS      ALIAS : BENEIDCD
                                                    STANDARD ALIAS : CLM_BENE_ID_TYPE_CD

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    (SSNRI Project)
                                                    CWF October 2017 Release

                                                    CODE TABLE     : CLM_BENE_ID_TYPE_TB

  137. Claim Provider Validation Code
                                 2    553    554    CHAR

                                                    Effective with CR#14 (April 2019 release), this field is used to
                                                    inform the Common Working File (CWF) to perform an edit check
                                                    to ensure that the provider that was submitted on the Prior
                                                    Authorization (PA) request is the same provider on the claim.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : CVLDTNCD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_PRVDR_VLDTN_TB

  138. Claim Railroad Board (RRB) Exclusion Indicator Switch
                                 1    555    555    CHAR

                                                    Effective with CR#14 (April 2019 release), this field informs the
                                                    Shared System Maintainer (SSM) and Common Working File (CWF) if
                                                    the Railroad Board (RRB) beneficiary claim should either be in-
                                                    cluded or excluded from Prior Authorization (PA) processing.

                                                    For example, if the field is valued "Y", and it is an RRB bene-
                                                    ficiary claim, it will be excluded from PA processing.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : CEXCLSN

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_RRB_EXCLSN_IND_TB

  139. Claim Model Reimbursement Amount
                                 6    556    561    PACK

                                                    Effective with CR#16, this Claim Level Field will be used to
                                                    identify the "Net Reimbursement Amount" of what Medicare
                                                    would have paid for Global Budget Services from a hospital
                                                    participating in the particular model.  If the claim only
                                                    includes global services, the reimbursement amount (CLM_
                                                    PMT_AMT) will reflect $0 (zero). If the claim includes
                                                    global services and non-global services, the reimbursement
                                                    amount will reflect the amount Medicare actually paid for
                                                    the non-global services.

                                                    Note: This field will be used with future models and not
                                                    just the Pennsylvania Rural Health Model (PARHM) (CR11355).
                                                    A demo code (CLM_DEMO_ID_NUM) will be assigned for future
                                                    models. CLM_RLT_COND_CD = M6 and CLM_VAL_CD = Q4 have been
                                                    created to identify the PARH model.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : CMODELAM
                                                    STANDARD ALIAS : CLM_MODEL_REIMBRSMT_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  140.
                               663    562   1224    CHAR

                                                    DB2      ALIAS : H_FILLER_3

                                                    LENGTH         : 663

  141. Outpatient NCH Edit Code Count
                                 2   1225   1226    NUM

                                                    The count of how many claim edit trailers
                                                    present on an outpatient claim during the
                                                    quality assurance process.  The purpose of
                                                    this count is to indicate how many claim
                                                    edit trailers are present.

                                                    DB2      ALIAS : OP_NCH_EDIT_CD_CNT
                                                    SAS      ALIAS : OPEDCNT
                                                    STANDARD ALIAS : OP_NCH_EDIT_CD_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : NCH

  142. Outpatient NCH Patch Code Count
                                 2   1227   1228    NUM

                                                    Effective with Version H, the count of the
                                                    number of HCFA patch codes annotated to the
                                                    outpatient claim during the Nearline
                                                    maintenance process.   The purpose of this
                                                    count is to indicate how many NCH patch
                                                    trailers are present.

                                                    NOTE1:  During the Version H conversion this
                                                    field was populated with data throughout
                                                    history (back to service year 1991).

                                                    NOTE2:  Effective with Version 'I' the number
                                                    of possible occurrences was reduced to 30.
                                                    Prior to Version 'I' the number of possible
                                                    occurrences was 99.

                                                    DB2      ALIAS : OP_PATCH_CD_CNT
                                                    SAS      ALIAS : OPPATCNT
                                                    STANDARD ALIAS : OP_NCH_PATCH_CD_I_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : NCH

  143. Outpatient MCO Period Count
                                 1   1229   1229    NUM

                                                    Effective with Version H, the count of the
                                                    number of Managed Care Organization (MCO)
                                                    periods reported on an outpatient claim.
                                                    The purpose of this count is to indicate
                                                    how many MCO period trailers are present.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    DB2      ALIAS : OP_MCO_PRD_CNT
                                                    SAS      ALIAS : OPMCOCNT
                                                    STANDARD ALIAS : OP_MCO_PRD_CNT

                                                    LENGTH         : 1    SIGNED : N

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 2

  144. Outpatient Claim Demonstration Id Count
                                 1   1230   1230    NUM

                                                    Effective with Version H, the count of the number
                                                    of claim demonstration IDs reported on an
                                                    outpatient claim.  The purpose of this count
                                                    is to indicate how many claim demonstration
                                                    trailers are present.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated with data where a demo was
                                                    identifiable.

                                                    DB2      ALIAS : OP_CLM_DEMO_ID_CNT
                                                    SAS      ALIAS : OPDEMCNT
                                                    STANDARD ALIAS : OP_CLM_DEMO_ID_CNT

                                                    LENGTH         : 1    SIGNED : N

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 5

  145. FILLER
                                 2   1231   1232    NUM

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 2    SIGNED : N

  146. FILLER
                                 2   1233   1234    NUM

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 2    SIGNED : N

  147. Outpatient Claim Diagnosis Code Count
                                 2   1235   1236    NUM

                                                    The count of the number of diagnosis codes (both
                                                    principal and secondary) reported on an Outpatient claim.
                                                    The purpose of this count is to indicate how many claim
                                                    diagnosis code trailers are present.  Prior to Version
                                                    'J', this field was named:OP_CLM_DGNS_CD_CNT.

                                                    NOTE:  Effective with Version 'J', the count of the
                                                    number of diagnosis code trailers was expanded from 10 to
                                                    25.

                                                    NOTE1: During the Version 'J' conversion, the diagnosis E
                                                    codes were removed from the diagnosis trailer and put in
                                                    the newly created diagnosis E code trailer.  Effective
                                                    with Version 'J', 'E' codes can be found in the diagnosis
                                                    trailer as secondary diagnosis codes.

                                                    DB2      ALIAS : OP_CLM_DGNS_CD_CNT
                                                    SAS      ALIAS : OPDGJCNT
                                                    STANDARD ALIAS : OP_CLM_DGNS_CD_J_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_OTHR_DGNS_CD_CNT and the principal was
                                                    not included in the count.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                       Range: 0 to 25

  148. Outpatient Claim Diagnosis E Code Count
                                 2   1237   1238    NUM

                                                    Effective with Version 'J', the count of the number of
                                                    diagnosis E codes reported on the outpatient claim.
                                                    The purpose of this count is to indicate how many
                                                    diagnosis E trailers are present.

                                                    DB2      ALIAS : DGNS_E_TRLR_CNT
                                                    SAS      ALIAS : OPDECNT
                                                    STANDARD ALIAS : OP_CLM_DGNS_E_CD_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                      Range: 0 to 12

  149. Outpatient Claim Procedure Code Count
                                 2   1239   1240    NUM

                                                    The count of the number of procedure codes (both
                                                    principal and other) reported on an outpatient claim.
                                                    The purpose of this count is to indicate how many claim
                                                    procedure trailers are present.  Prior to Version 'J',
                                                    this field was named:  OP_CLM_PRCDR_CD_CNT.

                                                    NOTE:  Effective with Version 'J', the count of the
                                                    number of procedure code trailers was expanded from 6 to
                                                    25.

                                                    DB2      ALIAS : OP_PRCDR_CD_CNT
                                                    SAS      ALIAS : OPPRJCNT
                                                    STANDARD ALIAS : OP_CLM_PRCDR_CD_J_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          RANGE: 0 TO 25

  150. Outpatient Claim Related Condition Code Count
                                 2   1241   1242    NUM

                                                    The count of the number of condition codes
                                                    reported on an outpatient claim.  The
                                                    purpose of this count is to indicate how
                                                    many condition code trailers are present.

                                                    DB2      ALIAS : OP_CLM_RLT_COND_CD
                                                    SAS      ALIAS : OPCONCNT
                                                    STANDARD ALIAS : OP_CLM_RLT_COND_CD_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_RLT_COND_CD_CNT.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 30

  151. Outpatient Claim Related Occurrence Code Count
                                 2   1243   1244    NUM

                                                    The count of the number of occurrence codes
                                                    reported on an outpatient claim.  The
                                                    purpose of this count is to indicate how
                                                    many occurrence code trailers are present.

                                                    DB2      ALIAS : OP_OCRNC_CD_CNT
                                                    SAS      ALIAS : OPOCRCNT
                                                    STANDARD ALIAS : OP_CLM_RLT_OCRNC_CD_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_RLT_OCRNC_CD_CNT.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 30

  152. Outpatient Claim Occurrence Span Code Count
                                 2   1245   1246    NUM

                                                    The count of the number of occurrence span codes
                                                    reported on an outpatient claim.  The purpose
                                                    of the count is to indicate how many span code
                                                    trailers are present.

                                                    DB2      ALIAS : OP_OCRNC_SPAN_CNT
                                                    SAS      ALIAS : OPSPNCNT
                                                    STANDARD ALIAS : OP_CLM_OCRNC_SPAN_CD_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_OCRNC_SPAN_CD_CNT.

                                                    SOURCE         : NCH

  153. Outpatient Claim Value Code Count
                                 2   1247   1248    NUM

                                                    The count of the number of value codes reported on
                                                    an outpatient claim.  The purpose of the count
                                                    is to indicate how many value code trailers are
                                                    present.

                                                    DB2      ALIAS : OP_CLM_VAL_CD_CNT
                                                    SAS      ALIAS : OPVALCNT
                                                    STANDARD ALIAS : OP_CLM_VAL_CD_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_VAL_CD_CNT.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 36

  154. Outpatient Revenue Center Code Count
                                 2   1249   1250    NUM

                                                    The count of the number of revenue codes
                                                    reported on an inpatient/SNF claim.  The
                                                    purpose of the count is to indicate how
                                                    many revenue center trailers are present.

                                                    DB2      ALIAS : OP_REV_CNTR_CD_CNT
                                                    SAS      ALIAS : OPREVCNT
                                                    STANDARD ALIAS : OP_REV_CNTR_CD_I_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_REV_CNTR_CD_CNT.

                                                    NOTE:  During the Version 'I' conversion the
                                                    number of occurrences changed to 45 (per seg-
                                                    ment - 450 total for claim).   For claims prior
                                                    to Version 'I' the number of occurrences was 58.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 45

  155. FILLER
                                 4   1251   1254    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 4

  156. FI Outpatient Claim Specific Group
                               610   1255   1864    GRP


                                                    STANDARD ALIAS : FI_OP_CLM_SPECF_GRP

  157. Claim Outpatient Service Type Code
                                 1   1255   1255    CHAR

                                                    Code indicating type and priority of outpatient
                                                    service.

                                                    DB2      ALIAS : OP_SRVC_TYPE_CD
                                                    SAS      ALIAS : OPSRVTYP
                                                    STANDARD ALIAS : CLM_OP_SRVC_TYPE_CD
                                                    TITLE    ALIAS : OP_SERVICE_TYPE_CODE

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_OP_SRVC_TYPE_TB

  158. Claim Outpatient Referral Code
                                 1   1256   1256    CHAR

                                                    The code indicating the means by which the
                                                    beneficiary was referred for outpatient
                                                    services.

                                                    DB2      ALIAS : CLM_OP_RFRL_CD
                                                    SAS      ALIAS : OP_RFRL
                                                    STANDARD ALIAS : CLM_OP_RFRL_CD
                                                    TITLE    ALIAS : OP_REFERRAL_CODE

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_OP_RFRL_TB

  159. NCH Beneficiary Blood Deductible Liability Amount
                                 6   1257   1262    PACK

                                                    The amount of money for which the intermediary
                                                    determined the beneficiary is liable for the blood
                                                    deductible.

                                                    DB2      ALIAS : BLOOD_DDCTBL_AMT
                                                    SAS      ALIAS : BLDDEDAM
                                                    STANDARD ALIAS : NCH_BENE_BLOOD_DDCTBL_AMT
                                                    TITLE    ALIAS : BLOOD_DEDUCTIBLE

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES:
                                                    Based on the presence of value code equal to
                                                    '06' move the corresponding value amount to
                                                    NCH_BENE_BLOOD_DDCTBL_AMT.

                                                    COMMENTS :
                                                    Prior to Version H, this field was named:
                                                    BENE_BLOOD_DDCTBL_LBLTY_AMT and the field
                                                    size was S9(5)V99.  Also, for OP claims, this
                                                    field was stored in a blood trailer.  Version
                                                    H eliminated the OP blood trailer.

                                                    SOURCE         : NCH QA PROCESS

  160. NCH Beneficiary Part B Deductible Amount
                                 6   1263   1268    PACK

                                                    The amount of money for which the
                                                    intermediary or carrier has determined that
                                                    the beneficiary is liable for the Part B
                                                    cash deductible on the claim.

                                                    DB2      ALIAS : NCH_PTB_DDCTBL_AMT
                                                    SAS      ALIAS : PTB_DED
                                                    STANDARD ALIAS : NCH_BENE_PTB_DDCTBL_AMT
                                                    TITLE    ALIAS : PTB_DDCTBL

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES (Effective 10/93):
                                                    Based on the presence of value codes A1, B1 or C1
                                                    move the related value amount to the
                                                    NCH_BENE_PTB_DDCTBL_AMT.  *NOTE: Prior to
                                                    10/93, this field was present on the claim
                                                    transmitted by CWF.

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_PTB_DDCTBL_LBLTY_AMT and field size
                                                    was S9(5)V99.

                                                    SOURCE         : NCH QA PROCESS

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  161. NCH Beneficiary Part B Coinsurance Amount
                                 6   1269   1274    PACK

                                                    The amount of money for which the intermediary has
                                                    determined that the beneficiary is liable for Part B
                                                    coinsurance on the institutional claim.

                                                    DB2      ALIAS : PTB_COINSRNC_AMT
                                                    SAS      ALIAS : PTB_COIN
                                                    STANDARD ALIAS : NCH_BENE_PTB_COINSRNC_AMT
                                                    TITLE    ALIAS : BENE_PTB_COINSURANCE_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES (Effective 10/93):
                                                    Based on the presence of value codes A2, B2 or C2
                                                    move the related value amount to the
                                                    NCH_BENE_PTB_COINSRNC_AMT.  *NOTE: Prior to
                                                    10/93, this field was present on the claim
                                                    transmitted by CWF.

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_PTB_COINSRNC_LBLTY_AMT and the field
                                                    size was S9(5)V99.

                                                    SOURCE         : NCH QA PROCESS

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  162. NCH Professional Component Charge Amount
                                 6   1275   1280    PACK

                                                    Effective with Version H, for inpatient and out-
                                                    patient claims, the amount of physician and other
                                                    professional charges covered under Medicare Part B
                                                    (used for internal CWFMQA editing purposes and other
                                                    internal processes (e.g. if computing interim payment
                                                    these charges are deducted)).

                                                    NOTE:  During the Version H conversion this field
                                                    was populated with data throughout history (back to
                                                    service year 1991).

                                                    DB2      ALIAS : PROFNL_CMPNT_AMT
                                                    SAS      ALIAS : PCCHGAMT
                                                    STANDARD ALIAS : NCH_PROFNL_CMPNT_CHRG_AMT
                                                    TITLE    ALIAS : PROFNL_CMPNT_CHARGES

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    DERIVATIONS :

                                                    1. IF INPATIENT - DERIVED FROM:
                                                    CLM_VAL_CD
                                                    Clm_VAL_AMT

                                                    DERIVATION RULES:
                                                    Based on the presence of value code 04 or 05
                                                    move the related value amount to the
                                                    NCH_PROFNL_CMPNT_CHRG_AMT.

                                                    2. IF OUTPATIENT - DERIVED FROM:
                                                    REV_CNTR_CD
                                                    REV_CNTR_TOT_CHRG_AMT

                                                    DERIVATION RULES (Effective 10/98):
                                                    Based on the presence of revenue center codes
                                                    096X, 097X & 098X move the related total charge
                                                    amount to NCH_PROFNL_CMPNT_CHRG_AMT.

                                                    NOTE1:  During the Version H conversion, this
                                                    field was populated with data throughout history
                                                    BUT the derivation rule applied to the outpatient
                                                    claim was incomplete (i.e., revenue codes 0972,
                                                    0973, 0974 and 0979 were omitted from the calcu-
                                                    lation).

                                                    SOURCE         : NCH QA Process

  163. Claim Outpatient Beneficiary Interim Deductible Amount
                                 6   1281   1286    PACK

                                                    Effective with Version H, the amount paid by the
                                                    beneficiary that is being applied to the
                                                    deductible, as reported on the outpatient claim .

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    DB2      ALIAS : INTRM_DDCTBL_AMT
                                                    SAS      ALIAS : INTRMDED
                                                    STANDARD ALIAS : CLM_OP_BENE_INTRM_DDCTBL_AMT
                                                    TITLE    ALIAS : INTRM_DDCTBL

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  164. Claim Outpatient Provider Payment Amount
                                 6   1287   1292    PACK

                                                    Effective with Version H, the amount paid, from the
                                                    Medicare trust fund, to the provider for the
                                                    services reported on the outpatient claim.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    DB2      ALIAS : OP_PRVDR_PMT_AMT
                                                    SAS      ALIAS : PRVDRPMT
                                                    STANDARD ALIAS : CLM_OP_PRVDR_PMT_AMT
                                                    TITLE    ALIAS : OP_PRVDR_PMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : NCH

  165. Claim Outpatient Beneficiary Payment Amount
                                 6   1293   1298    PACK

                                                    Effective with Version H, the amount paid, from the
                                                    Medicare trust fund, to the beneficiary for the
                                                    services reported on the outpatient claim.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    DB2      ALIAS : OP_BENE_PMT_AMT
                                                    SAS      ALIAS : BENEPMT
                                                    STANDARD ALIAS : CLM_OP_BENE_PMT_AMT
                                                    TITLE    ALIAS : OP_BENE_PMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  166. NCH Blood Pints Furnished Quantity
                                 2   1299   1300    PACK

                                                    Number of whole pints of blood furnished to the
                                                    beneficiary.

                                                    DB2      ALIAS : NCH_BLOOD_PT_FRNSH
                                                    STANDARD ALIAS : NCH_BLOOD_PT_FRNSH_QTY
                                                    TITLE    ALIAS : BLOOD_PINTS_FURNISHED

                                                    LENGTH         : 3    SIGNED : Y

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES:
                                                    Based on the presence of value code equal to
                                                    37 move the related value amount to the
                                                    NCH_BLOOD_PT_FRNSH_QTY.

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_BLOOD_PT_FRNSH_QTY.  Also for outpatient
                                                    claims this field was stored in a blood
                                                    trailer.  Version H eliminated the outpatient
                                                    blood trailer.

                                                    SOURCE         : NCH QA Process

                                                    EDIT RULES :
                                                          NUMERIC

  167. NCH Blood Pints Replaced Quantity
                                 2   1301   1302    PACK

                                                    Number of whole pints of blood replaced.

                                                    DB2      ALIAS : BLOOD_PT_RPLC_QTY
                                                    SAS      ALIAS : BLD_RPLC
                                                    STANDARD ALIAS : NCH_BLOOD_PT_RPLC_QTY
                                                    TITLE    ALIAS : BLOOD_PINTS_REPLACED

                                                    LENGTH         : 3    SIGNED : Y

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES:
                                                    Based on the presence of value code equal to
                                                    39 move the related value amount to the
                                                    NCH_BLOOD_PT_RPLC_QTY.

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_BLOOD_PT_RPLC_QTY.  Also for outpatient
                                                    claims this field was stored in a blood
                                                    trailer.  Version H eliminated the outpatient
                                                    blood trailer.


                                                    SOURCE         : NCH QA Process

                                                    EDIT RULES :
                                                          NUMERIC

  168. NCH Blood Pints Not Replaced Quantity
                                 2   1303   1304    PACK

                                                    Number of whole pints of blood not replaced.

                                                    DB2      ALIAS : BLOOD_PT_NRPLC_QTY
                                                    SAS      ALIAS : BLDNRPLC
                                                    STANDARD ALIAS : NCH_BLOOD_PT_NRPLC_QTY
                                                    TITLE    ALIAS : BLOOD_PINTS_NOT_REPLACED

                                                    LENGTH         : 3    SIGNED : Y

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES:
                                                    Subtract value code 39 amount from value code
                                                    37 amount and move the result to
                                                    NCH_BLOOD_PT_NRPLC_QTY.

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_BLOOD_PT_NRPLC_QTY.  Also for outpatient
                                                    claims this field was stored in a blood
                                                    trailer.  Version H eliminated the outpatient
                                                    blood trailer.


                                                    SOURCE         : NCH QA Process

                                                    EDIT RULES :
                                                          NUMERIC

  169. NCH Blood Deductible Pints Quantity
                                 2   1305   1306    PACK

                                                    The quantity of blood pints applied (blood
                                                    deductible).

                                                    DB2      ALIAS : BLOOD_DDCTBL_QTY
                                                    SAS      ALIAS : BLDDEDPT
                                                    STANDARD ALIAS : NCH_BLOOD_DDCTBL_PT_QTY
                                                    TITLE    ALIAS : BLOOD_PINTS_DEDUCTIBLE

                                                    LENGTH         : 3    SIGNED : Y

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    CLM_VAL_CD
                                                    CLM_VAL_AMT

                                                    DERIVATION RULES:
                                                    Based on the presence of value code equal to
                                                    38 move the related value amount to the
                                                    NCH_BLOOD_DDCTBL_PT_QTY.

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_BLOOD_DDCTBL_PT_QTY.  Also for outpatient
                                                    claims this field was stored in a blood
                                                    trailer.  Version H eliminated the outpatient
                                                    blood trailer.


                                                    SOURCE         : NCH QA Process

                                                    EDIT RULES :
                                                          NUMERIC

  170. Claim Outpatient Transaction Type Code
                                 1   1307   1307    CHAR

                                                    Effective with Version H, the code derived
                                                    at CWF based on type of bill and provider number
                                                    to identify the outpatient transaction type.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : OP_TRANS_TYPE_CD
                                                    SAS      ALIAS : TRANTYPE
                                                    STANDARD ALIAS : CLM_OP_TRANS_TYPE_CD
                                                    TITLE    ALIAS : OP_TRANS_TYPE

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_OP_TRANS_TYPE_TB

  171. Claim Outpatient ESRD Method of Reimbursement Code
                                 1   1308   1308    CHAR

                                                    Effective with Version H, the code denoting the
                                                    method of reimbursement selected by the ESRD bene
                                                    for home dialysis (i.e. whether home supplies are
                                                    purchased through a facility or from a supplier.)

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : ESRD_REIMBRSMT_CD
                                                    SAS      ALIAS : ESRDMTHD
                                                    STANDARD ALIAS : CLM_OP_ESRD_MTHD_REIMBRSMT_CD
                                                    TITLE    ALIAS : ESRD_REIMBRSMT_MTHD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_OP_ESRD_MTHD_REIMBRSMT_TB

  172. Claim Patient for Visit Code Group
                                24   1309   1332    GRP


                                                    Effective with Version 'J', the group used to identify
                                                    the patient's reason for visit diagnosis code on the
                                                    outpatient claim.  This group contains the reason for
                                                    visit diagnosis code and the reason for visit diagnosis
                                                    version code.

                                                    STANDARD ALIAS : CLM_PTNT_RSN_VISIT_CD_GRP

                                                    OCCURS MIN: 3 OCCURS MAX: 0

  173. Claim Patient Reason for Visit Version Code
                                 1   1309   1309    CHAR

                                                    Effective with Version 'J', the code used to indicate if the
                                                    diagnosis code/patient reason for visit code is ICD-9
                                                    or ICD-10.

                                                    NOTE:   With 5010, the diagnosis and procedure codes have
                                                    been expanded to accommodate ICD-10, even though ICD-10
                                                    is not scheduled for iomplementation until 10/2014.

                                                    DB2      ALIAS : PTNT_RSN_VRSN_CD
                                                    SAS      ALIAS : PRSNVRSN
                                                    STANDARD ALIAS : CLM_PTNT_RSN_VISIT_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_PTNT_RSN_VISIT_VRSN_TB

  174. Claim Patient Reason for Visit Code
                                 7   1310   1316    CHAR

                                                    The diagnosis code used to identify the patient's
                                                    reason for visit.

                                                    DB2      ALIAS : PTNT_RSN_VISIT_CD
                                                    SAS      ALIAS : PVISITCD
                                                    STANDARD ALIAS : CLM_PTNT_RSN_VISIT_CD

                                                    LENGTH         : 7

                                                    COMMENTS :
                                                    Prior to Version 'J', this field was :CLM_ADMTG_DGNS_CD.
                                                    With Version 'J', the name has changed and there can be
                                                    up to 3 occurrences of this group.

                                                    SOURCE         : CWF

  175. Claim Attending Physician Specialty Code
                                 2   1333   1334    CHAR

                                                    Effective with CR#7, the code used to identify the CMS
                                                    specialty code corresponding to the attending physician.
                                                    The Affordable Care Act (ACA) provides for incentive
                                                    payments for attending physicians and non-physician
                                                    practitioners with specific primary specialty designations.
                                                    In order to determine if the physician or non-physician is
                                                    eligible for the incentive payment, the specialty code,
                                                    NPI and name must be carried on the claims.

                                                    NOTE:  These fields were added on Outpatient, Home Health
                                                    and Hospice claims with CR#6 but was added to the Inpatient/
                                                    SNF claims with CR#7.

                                                    DB2      ALIAS : CLM_ATNDG_SPCLTY_C
                                                    SAS      ALIAS : ASPCLTY
                                                    STANDARD ALIAS : CLM_ATNDG_PHYSN_SPCLTY_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CMS_PRVDR_SPCLTY_TB

  176. Claim Operating Physician Specialty Code
                                 2   1335   1336    CHAR

                                                    Effective with CR#7, the code used to identify the CMS
                                                    specialty code corresponding to the operating physician.
                                                    The Affordable Care Act (ACA) provides for incentive
                                                    payments for physicians and non-physician practitioners
                                                    with specific primary specialty designations.  In order
                                                    to determine if the physician or non-physicians is
                                                    eligible for the incentive payment, the specialty code,
                                                    NPI and name must be carried on the claims.

                                                    NOTE:  These fields were added on Outpatient, Home Health
                                                    and Hospice claims with CR#6 but was added to the Inpatient/
                                                    SNF claims with CR#7.

                                                    DB2      ALIAS : CLM_OPRTG_SPCLTY_C
                                                    SAS      ALIAS : OPSPCLTY
                                                    STANDARD ALIAS : CLM_OPRTG_PHYSN_SPCLTY_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CMS_PRVDR_SPCLTY_TB

  177. Claim Other Physician Specialty Code
                                 2   1337   1338    CHAR

                                                    Effective with CR#7, the code used to identify the CMS
                                                    specialty code corresponding to the other physician.
                                                    The Affordable Care Act (ACA) provides for incentive
                                                    payments for physicians and non-physician practitioners
                                                    with specific primary specialty designations.  In order
                                                    to determine if the physician or non-physicians is
                                                    eligible for the incentive payment, the specialty code,
                                                    NPI and name must be carried on the claims.

                                                    NOTE:  These fields were added on Outpatient, Home Health
                                                    and Hospice claims with CR#6 but was added to the Inpatient/
                                                    SNF claims with CR#7.

                                                    DB2      ALIAS : CLM_OTHR_SPCLTY_CD
                                                    SAS      ALIAS : OTSPCLTY
                                                    STANDARD ALIAS : CLM_OTHR_PHYSN_SPCLTY_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CMS_PRVDR_SPCLTY_TB

  178. Referring Physician ID Group
                                26   1339   1364    GRP


                                                    Hospice agencies are required to report the
                                                    physician that certified the hospice patient's
                                                    terminal illness on the claim when the certifying
                                                    physician differs from the attending physician.  The
                                                    certifying physician is reported on the UB_04 claim
                                                    in the "Other Physician" field.  With the
                                                    implementation of the electronic claim 837I version
                                                    of the 5010A2 format the field for "other physician"
                                                    is mapped to three possible physician fields.
                                                    Hospices will report the physician certifying the
                                                    terminal illness on the claim when different than the
                                                    attending physician in the referring physician 2310F
                                                    loop of the 837I version 5010A2.   Note:   Even
                                                    though the CR is Hospice specific, CMM wants us
                                                    to add this group to all institutional claim types for
                                                    future use (at this time we are unable to add this
                                                    group to the inpatient/SNF claim type because we
                                                    don't have enough FILLER to accommodate.  We
                                                    will add in the near future when we expand the
                                                    record to include additional FILLER).

                                                    STANDARD ALIAS : RFRG_PHYSN_ID_GRP

                                                    COMMENTS :
                                                    ADD NEW GROUP AND FIELDS TO OUTPATIENT, HOME
                                                    HEALTH AND HOSPICE CLAIM TYPES AT THE CLAIM LEVEL.
                                                    (CMS CR7755)

  179. Claim Referring Physician UPIN Number
                                 6   1339   1344    CHAR

                                                    Effective with CR#7, the unique physician
                                                    identification number (UPIN) of the referring
                                                    physician who certified the hospice patient's
                                                    terminal illness when the certifying physician
                                                    differs from the attending physician.

                                                    NOTE: The business requirement for CR7755 is specific
                                                    to hospice claims but is being added to all claim
                                                    types because the business owner of the CR does not
                                                    know when a business need for the other claim types
                                                    will be implemented so they want the space their for
                                                    future uses.

                                                    DB2      ALIAS : RFRG_UPIN
                                                    SAS      ALIAS : RF-UPIN
                                                    STANDARD ALIAS : CLM_RFRG_PHYSN_UPIN_NUM

                                                    LENGTH         : 6

  180. Claim Referring Physician NPI Number
                                10   1345   1354    CHAR

                                                    Effective with CR#7, the national provider
                                                    identifier (NPI) number assigned to uniquely
                                                    identify the referring physician that certified
                                                    the hospice patient's terminal illness when the
                                                    certifying physician differs from the attending
                                                    physician.

                                                    NOTE: The business requirement for CR7755 is specific
                                                    to hospice claims but is being added to all claim
                                                    types because the business owner of the CR does not
                                                    know when a business need for the other claim types
                                                    will be implemented so they want the space their for
                                                    future uses.

                                                    DB2      ALIAS : RFRG_NPI
                                                    SAS      ALIAS : RF-NPI
                                                    STANDARD ALIAS : CLM_RFRG_PHYSN_NPI_NUM

                                                    LENGTH         : 10

  181. Claim Referring Physician Surname Name
                                 6   1355   1360    CHAR

                                                    Effective with CR#7, the last name of the referring
                                                    physician that certified the hospice patient's
                                                    terminal illness when the certifying physician
                                                    differs from the attending physician.

                                                    NOTE: The business requirement for CR7755 is specific
                                                    to hospice claims but is being added to all claim
                                                    types because the business owner of the CR does not
                                                    know when a business need for the other claim types
                                                    will be implemented so they want the space their for
                                                    future uses.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : RF-SRNM
                                                    STANDARD ALIAS : CLM_RFRG_PHYSN_SRNM_NAME

                                                    LENGTH         : 6

  182. Claim Referring Physician Given Name
                                 1   1361   1361    CHAR

                                                    Effective with CR#7, the first name of the referring
                                                    physician that certified the hospice patient's
                                                    terminal illness when the certifying physician
                                                    differs from the attending physician.

                                                    NOTE: The business requirement for CR7755 is specific
                                                    to hospice claims but is being added to all claim
                                                    types because the business owner of the CR does not
                                                    know when a business need for the other claim types
                                                    will be implemented so they want the space their for
                                                    future uses.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : RF-GVN
                                                    STANDARD ALIAS : CLM_RFRG_PHYSN_GVN_NAME

                                                    LENGTH         : 1

  183. Claim Referring Physician Middle Name
                                 1   1362   1362    CHAR

                                                    Effective with CR#7, the middle initial of the referring
                                                    physician that certified the hospice patient's
                                                    terminal illness when the certifying physician
                                                    differs from the attending physician.

                                                    NOTE: The business requirement for CR7755 is specific
                                                    to hospice claims but is being added to all claim
                                                    types because the business owner of the CR does not
                                                    know when a business need for the other claim types
                                                    will be implemented so they want the space their for
                                                    future uses.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : RF-MDL
                                                    STANDARD ALIAS : CLM_RFRG_PHYSN_MDL_NAME

                                                    LENGTH         : 1

  184. Claim Referring Physician Specialty Code
                                 2   1363   1364    CHAR

                                                    Effective with CR#7, the code used to identify the CMS
                                                    specialty code of the referring physician/practitioner.

                                                    NOTE: The business requirement for CR7755 is specific
                                                    to hospice claims but is being added to all claim
                                                    types because the business owner of the CR does not
                                                    know when a business need for the other claim types
                                                    will be implemented so they want the space there for
                                                    future use.

                                                    DB2      ALIAS : RFRG_SPCLTY_CD
                                                    SAS      ALIAS : RFSPCLTY
                                                    STANDARD ALIAS : CLM_RFRG_PHYSN_SPCLTY_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CMS_PRVDR_SPCLTY_TB

  185. Claim Service Location NPI Number
                                10   1365   1374    CHAR

                                                    Effective with CR#8, the field used to identify the
                                                    National Provider Identifier (NPI) of the location
                                                    where the services were provided.

                                                    NOTE: This data element will not be implemented in
                                                    CWF until the January 2014 release, which means you
                                                    will not begin to see data in this field in the NCH
                                                    until the January implementation.  We are adding the
                                                    field with the NCH CR#8 October release because we
                                                    will not be doing a January 2014 release.

                                                    DB2      ALIAS : SRVC_LOC_NPI_NUM
                                                    SAS      ALIAS : SRVCNPI
                                                    STANDARD ALIAS : SRVC_LOC_NPI_NUM

                                                    LENGTH         : 10

  186. Claim Geographical Adjustment Factor (GAF) Percent
                                 3   1375   1377    PACK

                                                    Effective with CR#9 (October 2014 release), this field represents
                                                    the adjustment made to the encounter-based payment rate for
                                                    geographic differences.

                                                    This field only applies to Outpatient claims.

                                                    DB2      ALIAS : CLM_GAF_PCT
                                                    SAS      ALIAS : GAFPCT

                                                    LENGTH         : 1.4    SIGNED : Y

  187. FILLER
                               487   1378   1864    CHAR

                                                    DB2      ALIAS : H_FILLER_7
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 487

  188. FI Outpatient Claim Trailer Group
                               VAR   1865  31388    GRP


  189. NCH Edit Group
                                65   1865   1929    GRP


                                                    The number of claim edit trailers is determined
                                                    by the claim edit code count.

                                                    STANDARD ALIAS : NCH_EDIT_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 13

                                                       DEPENDING ON : OP_NCH_EDIT_CD_CNT

  190. NCH Edit Trailer Indicator Code
                                 1   1865   1865    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of an NCH edit trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : EDIT_TRLR_IND_CD
                                                    SAS      ALIAS : EDITIND
                                                    STANDARD ALIAS : NCH_EDIT_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : NCH_EDIT_TRLR_IND_TB

  191. NCH Edit Code
                                 4   1866   1869    CHAR

                                                    The code annotated to the claim indicating
                                                    the CWFMQA editing results so users will
                                                    be aware of data deficiencies.

                                                    NOTE:  Prior to Version H only the highest
                                                    priority code was stored.  Beginning 11/98
                                                    up to 13 edit codes may be present.

                                                    COMMON   ALIAS : QA_ERROR_CODE
                                                    DB2      ALIAS : NCH_EDIT_CD
                                                    SAS      ALIAS : EDIT_CD
                                                    STANDARD ALIAS : NCH_EDIT_CD
                                                    TITLE    ALIAS : QA_ERROR_CD

                                                    LENGTH         : 4

                                                    SOURCE         : NCH QA EDIT PROCESS

                                                    CODE TABLE     : NCH_EDIT_TB

  192. NCH Patch Group
                               330   1930   2259    GRP


                                                    STANDARD ALIAS : NCH_PATCH_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 30

                                                       DEPENDING ON : OP_NCH_PATCH_CD_I_CNT

  193. NCH Patch Trailer Indicator Code
                                 1   1930   1930    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of an NCH patch trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : PATCH_TRLR_IND_CD
                                                    SAS      ALIAS : PATCHIND
                                                    STANDARD ALIAS : NCH_PATCH_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_PATCH_TRLR_IND_TB

  194. NCH Patch Code
                                 2   1931   1932    CHAR

                                                    Effective with Version H, the code annotated
                                                    to the claim indicating a patch was applied
                                                    to the record during an NCH Nearline record
                                                    conversion and/or during current processing.

                                                    NOTE:  Prior to Version H this field was located
                                                    in the third and fourth occurrence of the
                                                    CLM_EDIT_CD.

                                                    DB2      ALIAS : NCH_PATCH_CD
                                                    SAS      ALIAS : PATCHCD
                                                    STANDARD ALIAS : NCH_PATCH_CD
                                                    TITLE    ALIAS : NCH_PATCH

                                                    LENGTH         : 2

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_PATCH_TB

  195. NCH Patch Applied Date
                                 8   1933   1940    NUM

                                                    Effective with Version H, the date the NCH patch
                                                    was applied to the claim.


                                                    DB2      ALIAS : NCH_PATCH_APPLY_DT
                                                    SAS      ALIAS : PATCHDT
                                                    STANDARD ALIAS : NCH_PATCH_APPLY_DT
                                                    TITLE    ALIAS : NCH_PATCH_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          YYYYMMDD

  196. MCO Period Group
                                74   2260   2333    GRP


                                                    The number of managed care organization (MCO)
                                                    period data trailers present is determined by
                                                    the claim MCO period trailer count.  This field
                                                    reflects the two most current MCO periods in the
                                                    CWF beneficiary history record.  It may have no
                                                    connection to the services on the claim.

                                                    STANDARD ALIAS : MCO_PRD_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 2

                                                       DEPENDING ON : OP_MCO_PRD_CNT

  197. NCH MCO Trailer Indicator Code
                                 1   2260   2260    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a Managed Care Organization (MCO)
                                                    trailer.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : MCO_TRLR_IND_CD
                                                    SAS      ALIAS : MCOIND
                                                    STANDARD ALIAS : NCH_MCO_TRLR_IND_CD
                                                    TITLE    ALIAS : MCO_INDICATOR

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : NCH_MCO_TRLR_IND_TB

  198. MCO Contract Number
                                 5   2261   2265    CHAR

                                                    Effective with Version H, this field represents
                                                    the plan contract number of the Managed Care
                                                    Organization (MCO).

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : MCO_CNTRCT_NUM
                                                    SAS      ALIAS : MCONUM
                                                    STANDARD ALIAS : MCO_CNTRCT_NUM
                                                    TITLE    ALIAS : MCO_NUM

                                                    LENGTH         : 5

                                                    SOURCE         : CWF

  199. MCO Option Code
                                 1   2266   2266    CHAR

                                                    Effective with Version H, the code indicating
                                                    Managed Care Organization (MCO) lock-in
                                                    enrollment status of the beneficiary.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : MCO_OPTN_CD
                                                    SAS      ALIAS : MCOOPTN
                                                    STANDARD ALIAS : MCO_OPTN_CD
                                                    TITLE    ALIAS : MCO_OPTION_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : MCO_OPTN_TB

  200. MCO Period Effective Date
                                 8   2267   2274    NUM

                                                    Effective with Version H, the date the bene-
                                                    ficiary's enrollment in the Managed Care
                                                    Organization (MCO) became effective.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    DB2      ALIAS : MCO_PRD_EFCTV_DT
                                                    SAS      ALIAS : MCOEFFDT
                                                    STANDARD ALIAS : MCO_PRD_EFCTV_DT
                                                    TITLE    ALIAS : MCO_PERIOD_EFF_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  201. MCO Period Termination Date
                                 8   2275   2282    NUM

                                                    Effective with Version H, the date the bene-
                                                    ficiary's enrollment in the Managed Care
                                                    Organization (MCO) was terminated.

                                                    NOTE:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    DB2      ALIAS : MCO_PRD_TRMNTN_DT
                                                    SAS      ALIAS : MCOTRMDT
                                                    STANDARD ALIAS : MCO_PRD_TRMNTN_DT
                                                    TITLE    ALIAS : MCO_PERIOD_TERM_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  202. MCO Health PLANID Number
                                14   2283   2296    CHAR

                                                    A placeholder field (effective with Version H)
                                                    for storing the Health PlanID associated with
                                                    the Managed Care Organization (MCO).  Prior to
                                                    Version 'I' this field was named:
                                                    MCO_PAYERID_NUM.

                                                    DB2      ALIAS : MCO_PLANID_NUM
                                                    SAS      ALIAS : MCOPLNID
                                                    STANDARD ALIAS : MCO_HLTH_PLANID_NUM
                                                    TITLE    ALIAS : MCO_PLANID

                                                    LENGTH         : 14

                                                    COMMENTS :
                                                    Prior to Version I this field was named:
                                                    MCO_PAYERID_NUM.

                                                    SOURCE         : CWF

  203. Claim Demonstration Identification Group
                                90   2334   2423    GRP


                                                    The number of demonstration identification
                                                    trailers present is determined by the claim
                                                    demonstration identification trailer count.

                                                    STANDARD ALIAS : CLM_DEMO_ID_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 5

                                                       DEPENDING ON : OP_CLM_DEMO_ID_CNT

  204. NCH Demonstration Trailer Indicator Code
                                 1   2334   2334    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a demo trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : NCH_DEMO_TRLR_IND_
                                                    SAS      ALIAS : DEMOIND
                                                    STANDARD ALIAS : NCH_DEMO_TRLR_IND_CD
                                                    TITLE    ALIAS : DEMO_INDICATOR

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_DEMO_TRLR_IND_TB

  205. Claim Demonstration Identification Number
                                 2   2335   2336    CHAR


                                                    Effective with Version H, the number assigned
                                                    to identify a demo.  This field is also used to
                                                    denote special processing (a.k.a. Special Processing
                                                    Number, SPN).

                                                    NOTE: Prior to Version H, Demo ID was stored in the
                                                    redefined Claim Edit Group, 4th occurrence, positions
                                                    3 and 4.   During the H conversion, this field was
                                                    populated with data throughout history (as appro-
                                                    private either by moving ID on Version G or by
                                                    deriving from specific demo criteria).

                                                    01 = Nursing Home Case-Mix and Quality: NHCMQ
                                                    (RUGS) Demo -- testing PPS for SNFs in 6
                                                    states, using a case-mix classification
                                                    system based on resident characteristics and
                                                    actual resources used. The claims carry a
                                                    RUGS indicator and one or more revenue center
                                                    codes in the 9,000 series.

                                                    NOTE1: Effective for SNF claims with NCH weekly
                                                    process date after 2/8/96 (and service date after
                                                    12/31/95) -- beginning 4/97, Demo ID '01' was
                                                    derived in NCH based on presence of RUGS phase #
                                                    '2','3' or '4' on incoming claim; since 7/97, CWF
                                                    has been adding ID to claim.

                                                    NOTE2:  During the Version H conversion, Demo ID
                                                    '01' was populated back to NCH weekly process date
                                                    2/9/96 based on the RUGS phase indicator (stored
                                                    in Claim Edit Group, 3rd occurrence, 4th position,
                                                    in Version G).

                                                    02 = National HHA Prospective Payment Demo --
                                                    testing PPS for HHAs in 5 states, using two
                                                    alternate methods of paying HHAs: per visit
                                                    by type of HHA visit and per episode of HH
                                                    care.

                                                    NOTE1:  Effective for HHA claims with NCH weekly
                                                    process date after 5/31/95 -- beginning 4/97,
                                                    Demo ID '02' was derived in NCH based on HCFA/
                                                    CHPP-supplied listing of provider # and start/
                                                    stop dates of participants.

                                                    NOTE2:  During the Version H conversion, Demo ID
                                                    '02' was populated back to NCH weekly process
                                                    date 6/95 based on the CHPP criteria.

                                                    03 = Telemedicine Demo -- testing covering tradi-
                                                    tionally noncovered physician services for
                                                    medical consultation furnished via two-way, inter-
                                                    active video systems (i.e. teleconsultation)
                                                    in 4 states.  The claims contain line items
                                                    with 'QQ' HCPCS code.

                                                    NOTE1:  Effective for physician/supplier (nonDMERC)
                                                    claims with NCH weekly process date after 12/31/96
                                                    (and service date after 9/30/96) -- since 7/97,
                                                    CWF has been adding Demo ID '03' to claim.

                                                    NOTE2:  During Version H conversion, Demo ID '03'
                                                    was populated back to NCH weekly process date 1/97
                                                    based on the presence of 'QQ' HCPCS on one or more
                                                    line items.

                                                    04 = United Mine Workers of America (UMWA) Managed
                                                    Care Demo -- testing risk sharing for Part A
                                                    services, paying special capitation rates for
                                                    all UMWA beneficiaries residing in 13 desig-
                                                    nated counties in 3 states.   Under the demo,
                                                    UMWA will waive the 3-day qualifying hospital
                                                    stay for a SNF admission.   The claims contain
                                                    TOB '18X','21X','28X' and '51X'; condition
                                                    code = W0; claim MCO paid switch = not '0';
                                                    and MCO contract # = '90091'.

                                                    NOTE:  Initially scheduled to be implemented for
                                                    all SNF claims for admission or services on
                                                    1/1/97 or later, CWF did not transmit any Demo
                                                    ID '04' annotated claims until on or about 2/98.

                                                    05 = Medicare Choices (MCO encounter data) demo --
                                                    testing expanding the type of Managed Care
                                                    plans available and different payment methods
                                                    at 16 MCOs in 9 states.  The claims contain
                                                    one of the specific MCO Plan Contract #
                                                    assigned to the Choices Demo site.

                                                    NOTE1:  Effective for all claim types with NCH
                                                    weekly process date after 7/31/97 -- CWF adds
                                                    Demo ID '05' to claim based on the presence of
                                                    the MCO Plan Contract #.  ***Demonstration was
                                                    terminated 12/31/2000.***

                                                    NOTE2:  During the Version H conversion, Demo ID
                                                    '05' was populated back to NCH weekly process
                                                    date 8/97 based on the presence of the Choices
                                                    indicator (stored as an alpha character cross-
                                                    walked from MCO plan contract # in the Claim
                                                    Edit Group, 4th occurrence, 2nd position, in
                                                    Version 'G').

                                                    06 = Coronary Artery Bypass Graft (CABG) Demo --
                                                    testing bundled payment (all-inclusive global
                                                    pricing) for hospital + physician services
                                                    related to CABG surgery in 7 hospitals in 7
                                                    states.  The inpatient claims contain a DRG
                                                    '106' or '107'.

                                                    NOTE1:  Effective for Inpatient claims and
                                                    physician/supplier claims with Claim Edit Date
                                                    no earlier than 6/1/91 (not all CABG sites
                                                    started at the same time) -- on 5/1/97, CWF
                                                    started transmitting Demo ID '06' on the claim.
                                                    The FI adds the ID to the claim based on the
                                                    presence of DRG '106' or '107' from specific
                                                    providers for specified time periods; the
                                                    carrier adds the ID to the claim based on
                                                    receiving 'Daily Census List' from parti-
                                                    cipating hospitals. ***Demo terminated in
                                                    1998.***

                                                    NOTE2:  During the Version H conversion, any
                                                    claims where Medicare is the primary payer
                                                    that were not already  identified as Demo ID
                                                    '06' (stored in the redefined Claim Edit
                                                    Group, 4th occurrence, positions 3 and 4,
                                                    Version G) were annotated based on the follow-
                                                    ing criteria: Inpatient - presence of DRG '106'
                                                    or '107' and a provider number=220897, 150897,
                                                    380897,450897,110082,230156 or 360085 for
                                                    specified service dates; noninstitutional -
                                                    presence of HCPCS modifier (initial and/or
                                                    second) = 'Q2' and a carrier number =00700/31143
                                                    00630,01380,00900,01040/00511,00710,00623, or
                                                    13630 for specified service dates.

                                                    07 = Virginia Cardiac Surgery Initiative (VCSI)
                                                    (formerly referred to as Medicare Quality Partner-
                                                    ships Demo) -- this is a voluntary consortium of
                                                    the cardiac surgery physician groups and the non-
                                                    Veterans Administration hospitals providing open
                                                    heart surgical services in the Commonwealth of
                                                    Virginia.  The goal of the demo is to share data on
                                                    quality and process innovations in an attempt to
                                                    improve the care for all cardiac patients.  The
                                                    demonstration only affects those FIs that process
                                                    claims from hospitals in Virginia and the carriers
                                                    that process claims from physicians providing
                                                    inpatient services at those hospitals.  The
                                                    hospitals will be reimbursed on a global payment
                                                    basis for selected cardiac surgical diagnosis
                                                    related groups (DRGs).  The inpatient claims will
                                                    contain a DRG '104', '105', '106', '107', '109';
                                                    the related physician/supplier claims will contain
                                                    the claim payment denial reason code = 'D'.

                                                    NOTE:  The implementation date for this demo is 4/1/03.
                                                    The FI will annotate the claim with the demo id
                                                    add Demo ID '07' to claim.  For carrier claims, the
                                                    Standard Systems will annotate the claim with the
                                                    '07' demo number.

                                                    08 = Provider Partnership Demo -- testing per-case
                                                    payment approaches for acute inpatient
                                                    hospitalizations, making a lump-sum payment
                                                    (combining the normal Part A PPS payment with
                                                    the Part B allowed charges into a single fee
                                                    schedule) to a Physician/Hospital Organization
                                                    for all Part A and Part B services associated
                                                    with a hospital admission.  From 3 to 6 hospitals
                                                    in the Northeast and Mid-Atlantic regions may
                                                    participate in the demo.

                                                    NOTE:  The demo is on HOLD.  The FI and carrier will
                                                    add Demo ID '08' to claim.

                                                    15 = ESRD Managed Care (MCO encounter data) --
                                                    testing open enrollment of ESRD beneficiaries
                                                    and capitation rates adjusted for patient
                                                    treatment needs at 3 MCOs in 3 States.  The
                                                    claims contain one of the specific MCO Plan
                                                    Contract # assigned to the ESRD demo site.

                                                    NOTE:  Effective 10/1/97 (but not actually imple-
                                                    mented at a site until 1/1/98) for all claim
                                                    types -- the FI and carrier add Demo ID '15' to
                                                    claim based on the presence of the MCO plan
                                                    contract #.

                                                    30 = Lung Volume Reduction Surgery (LVRS) or
                                                    National Emphysema Treatment Trial (NETT)
                                                    Clinical Study -- evaluating the effective-
                                                    ness of LVRS and maximum medical therapy (in-
                                                    cluding pulmonary rehab) for Medicare bene-
                                                    ficiaries in last stages of emphysema at 18
                                                    hospitals nationally, in collaboration with
                                                    NIH.

                                                    NOTE:  Effective for all claim types (except DMERC)
                                                    with NCH weekly process date after 2/27/98 (and
                                                    service date after 10/31/97) -- the FI adds Demo ID
                                                    '30' based on the presence of a condition code = EY;
                                                    the participating physician (not the carrier) adds
                                                    ID to the noninstitutional claim.  DUE TO THE SEN-
                                                    SITIVE NATURE OF THIS CLINICAL TRIAL AND UNDER THE
                                                    TERMS OF THE INTERAGENCY AGREEMENT WITH NIH, THESE
                                                    CLAIMS ARE PROCESSED BY CWF AND TRANSMITTED TO
                                                    HCFA BUT NOT STORED IN THE NEARLINE FILE (access
                                                    is restricted to study evaluators only).

                                                    31 = VA Pricing Special Processing (SPN) -- not really
                                                    a demo but special request from VA due to
                                                    court settlement; not Medicare services but
                                                    VA inpatient and physician services submitted
                                                    to FI 00400 and Carrier 00900 to obtain
                                                    Medicare pricing -- CWF WILL PROCESS VA
                                                    CLAIMS ANNOTATED WITH DEMO ID '31', BUT WILL
                                                    NOT TRANSMIT TO HCFA (not in Nearline File).

                                                    37 = Medicare Coordinated Care Demonstration -- to test
                                                    whether coordinated care services furnished to
                                                    certain beneficiaries improves outcome of care
                                                    and reduces Medicare expenditures under Part A and
                                                    Part B.  There will be at least 14 Coordinated
                                                    Care Entities (CCEs).  The selected entities will
                                                    be assigned a provider number specifically for the
                                                    demonstration services.

                                                    NOTE:  All claims will be processed by carriers;
                                                    no FI processing (except for Georgetown site)

                                                    37 = Medicare Disease Management (DMD) -- the purpose
                                                    of this demonstration is to study the impact on costs
                                                    and health outcomes of applying disease management
                                                    services supplemented with coverage for prescription
                                                    drugs for certain Medicare beneficiaries with diag-
                                                    nosed, advanced-stage congestive heart failure,
                                                    diabetes, or coronary heart disease.  Three demon-
                                                    stration sites will be used for this demonstration
                                                    and it will last for 3 years. (Effective 4/1/2003).

                                                    NOTE:  All claims will be processed by NHIC-California
                                                    (Carrier).  FIs will only serve as a conduit for trans-
                                                    mitting information to and from CWF about the NOEs.

                                                    38 = Physician Encounter Claims - the purpose of this
                                                    demo id is to identify the physician encounter
                                                    claims being processed at the HCFA Data Center (HDC).
                                                    This number will help EDS in making the claim go
                                                    through the appropriate processing logic, which
                                                    differs from that for fee-for-service.  **NOT
                                                    IN NCH.**

                                                    NOTE: Effective October, 2000. Demo ids will not be
                                                    assigned to Inpatient and Outpatient encounter claims.

                                                    39 = Centralized Billing of Flu and PPV Claims -- The
                                                    purpose of this demo is to facilitate the processing
                                                    carrier, Trailblazers, paying flu and PPV claims
                                                    based on payment localities.  Providers will be
                                                    giving the shots throughout the country and trans-
                                                    mitting the claims to Trailblazers for processing.

                                                    NOTE: Effective October, 2000 for carrier claims.

                                                    40 = Payment of Physician and Nonphysician Services
                                                    in certain Indian Providers -- the purpose of
                                                    this demo is to extend payment for services of
                                                    physician and nonphysician practitioners
                                                    furnished in hospitals and ambulatory care clinics.
                                                    Prior to the legislation change in BIPA, reim-
                                                    bursement for Medicare services provided in IHS
                                                    facilities was limited to services provided in
                                                    hospitals and skilled nursing facilities.  This
                                                    change will allow payment for IHS, Tribe and
                                                    Tribal Organization providers under the Medicare
                                                    physician fee schedule.

                                                    NOTE: Effective July 1, 2001 for institutional and
                                                    carrier claims.

                                                    45 = Chiropractic

                                                    48 = Medical Adult Day-Care Services -- the purpose
                                                    of this demonstration is to provide, as part of the
                                                    episode of care for home health services, medical
                                                    adult day care services to Medicare beneficiaries as
                                                    a substitute for a portion of home health services
                                                    that would otherwise be provided in the beneficiaries
                                                    home.  This demo would last approx. 3 years in not
                                                    more than 5 sites.  Payment for each home health ser-
                                                    vice episode of care will be set at 95% of the amount
                                                    that would otherwise be paid for home health services
                                                    provided entirely in the home.

                                                    NOTE:  Effective July 5, 2005 for HHA claims.

                                                    49 = Hemodialysis

                                                    53 = Extended Stay

                                                    54 = ACE Demo

                                                    56 = ACA 3113 Lab Demo

                                                    58 = used to identify the Multi-payer Advanced Primary
                                                    Care Practice (MAPCP) demonstration.
                                                    (eff. 7/2/12 - CR7693/7283)

                                                    59 = ACO Pioneer Demonstration
                                                    (CMS CR8140) - eff. 1/2014

                                                    60 = Power Motorized Device (PMD)

                                                    61 = CLM-CARE-IMPRVMT-MODEL-1

                                                    62 = CLM-CARE-IMPRVMT-MODEL-2

                                                    63 = CLM-CARE-IMPRVMT-MODEL-3

                                                    64 = CLM-CARE-IMPRVMT-MODEL-4

                                                    65 = rebilled claims due to auditor denials -- code being
                                                    implemented for a demonstration to determine the efficiency
                                                    of allowing providers to rebill for all outpatient services,
                                                    minus a penalty, when an inpatient claim is denied in full
                                                    because of medical review because the beneficiary did not
                                                    require inpatient services. (eff. 7/2/12 -- CR7738)

                                                    66 = rebilled claims due to provider self-audit after
                                                    claim submission/payment -- code being implemented for
                                                    a demonstration to determine the efficiency of allowing
                                                    providers to rebill for all outpatient services, minus a
                                                    penalty, when an inpatient claim is denied in full be-
                                                    cause of medical review because the beneficiary did not
                                                    require inpatient services.  (eff. 7/2/12 -- CR7738)

                                                    67 = rebilled claims due to provider self-audit after
                                                    the patient has been discharged,but prior to payment --
                                                    code being implemented for a demonstration to determine
                                                    the efficiency of allowing providers to rebill for all
                                                    outpatient services, minus a penalty, when an inpatient
                                                    claim is denied in full because of medical review because
                                                    the beneficiary did not require inpatient services.
                                                    (eff. 7/2/12 -- CR7738)

                                                    68 = CWF will not apply the 3-day hospital stay requirement
                                                    when processing a SNF claim.
                                                    (CMS CR8215) - eff. 1/2014

                                                    70 = used for Electrical Workers Insurance Fund claims.
                                                    (eff. 7/2/12)
                                                    71 = Intravenous Immune Globin (IVIG)
                                                    75 = Comprehensive Care for Joint Replacement (CCJR)
                                                    (eff. 4/2016)
                                                    77 = Shared Savings Program (eff. 10/2016)
                                                    78 = Comprehensive Primary Care Plus (CPC+) (eff. 4/2017)
                                                    79 = Acute Myocardial Infarction (AMI) Episode Payment
                                                    Model (EPM) ( (eff. 1/2018)
                                                    80 = Coronary Artery Bypass Graft (CABG) Episode Payment
                                                    Model (EPM)  (eff. 1/2018)
                                                    81 = Surgical Hip and Femur Fracture Treatment (SHFFT)
                                                    Episode Payment Model (EMP) (eff. 1/2018)
                                                    82 = Medicare Diabetes Prevention Program (MDPPs)
                                                    (eff. 4/2018)
                                                    83 = Maryland Primary Care Program (MDPCP)
                                                    (eff. 1/2018)
                                                    87 = Prospective Bundled Payments for Radiation Oncology (RO)
                                                    Model (eff. 1/2020)
                                                    91 = Emergency Triage, Treat, and Transport (ET3) Model - is a
                                                    voluntary, 5-year payment model that will provide
                                                    greater flexibility to ambulance care teams to address
                                                    emergency health care needs of Medicare FFS beneficiaries
                                                    following a 911 call. (eff. 1/2020)
                                                    94 = ESRD Treatment Choices (ETC) - eff. 1/2020 - Outpatient
                                                    and Carrier Only (eff. 1/2020)
                                                    95 = Oncology Care Model Plus (OCM+) - eff. 1/2020

                                                    DB2      ALIAS : CLM_DEMO_ID_NUM
                                                    SAS      ALIAS : DEMONUM
                                                    STANDARD ALIAS : CLM_DEMO_ID_NUM
                                                    TITLE    ALIAS : DEMO_ID

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

  206. Claim Demonstration Information Text
                                15   2337   2351    CHAR

                                                    Effective with Version H, the text field that
                                                    contains related demo information.  For example,
                                                    a claim involving a CHOICES demo id '05' would
                                                    contain the MCO plan contract number in the first
                                                    five positions of this text field.

                                                    NOTE: During the Version H conversion this
                                                    field was populated with data throughout
                                                    history.

                                                    DB2      ALIAS : CLM_DEMO_INFO_TXT
                                                    SAS      ALIAS : DEMOTXT
                                                    STANDARD ALIAS : CLM_DEMO_INFO_TXT
                                                    TITLE    ALIAS : DEMO_INFO

                                                    LENGTH         : 15

                                                    DERIVATIONS :
                                                    DERIVATION RULES:
                                                    Demo ID = 01 (RUGS) -- the text field will contain
                                                    a 2, 3 or 4 to denote the RUGS phase.  If RUGS phase
                                                    is blank or not one of the above the text field
                                                    will reflect 'INVALID'.  NOTE:  In Version 'G', RUGS
                                                    phase was stored in redefined Claim Edit Group,
                                                    3rd occurrence, 4th position.

                                                    Demo ID = 02 (Home Health demo) -- the text field
                                                    will contain PROV#.  When demo number not equal to
                                                    02 then text will reflect 'INVALID'.

                                                    Demo ID = 03 (Telemedicine demo) -- text field will
                                                    contain the HCPCS code.  If the required HCPCS is
                                                    not shown then the text field will reflect
                                                    'INVALID'.

                                                    Demo ID = 04 (UMWA) -- text field will contain
                                                    W0 denoting that condition code W0 was present.
                                                    If condition code W0 not present then the text
                                                    field will reflect 'INVALID'.

                                                    Demo ID = 05 (CHOICES) -- the text field will con-
                                                    tain the CHOICES plan number, if both of the follow-
                                                    ing conditions are met: (1) CHOICES plan number
                                                    present and PPS or Inpatient claim shows that 1st
                                                    3 positions of provider number as '210' and the
                                                    admission date is within HMO effective/termination
                                                    date; or non-PPS claim and the from date is within
                                                    HMO effective/termination date and (2) CHOICES
                                                    plan number matches the HMO plan number.  If
                                                    either condition is not met the text field will
                                                    reflect 'INVALID CHOICES PLAN NUMBER'.  When
                                                    CHOICES plan number not present, text will re-
                                                    flect 'INVALID'.

                                                    NOTE:  In Version 'G', a valid CHOICES plan ID is
                                                    stored as alpha character in redefined Claim
                                                    Edit Group, 4th occurrence, 2nd position.  If
                                                    invalid, CHOICES indicator 'ZZ' displayed.

                                                    Demo ID = 15 (ESRD Managed Care) -- text field
                                                    will contain the ESRD/MCO plan number.  If ESRD/
                                                    MCO plan number not present the field will
                                                    reflect 'INVALID'.

                                                    Demo ID = 38 (Physician Encounter Claims) --
                                                    text field will contain the MCO plan number.
                                                    When MCO plan number not present the field will
                                                    reflect 'INVALID'.


                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       CHOICES_DEMO_LIM

  207. Claim Diagnosis Group
                               225   2424   2648    GRP


                                                    The number of claim diagnosis trailers is
                                                    determined by the claim diagnosis code
                                                    count.  The principal diagnosis is the first occurrence.
                                                    The principal diagnosis is also
                                                    stored (redundantly) in the fixed portion
                                                    of the record.

                                                    NOTE:
                                                    Prior to Version H this group was named:
                                                    CLM_OTHR_DGNS_GRP and did not contain the
                                                    CLM_PRNCPAL_DGNS_CD.

                                                    STANDARD ALIAS : CLM_DGNS_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 25

                                                       DEPENDING ON : OP_CLM_DGNS_CD_J_CNT

  208. NCH Diagnosis Trailer Indicator Code
                                 1   2424   2424    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a diagnosis trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : DGNS_TRLR_IND_CD
                                                    SAS      ALIAS : DGNSIND
                                                    STANDARD ALIAS : NCH_DGNS_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_DGNS_TRLR_IND_TB

  209. Claim Diagnosis Version Code
                                 1   2425   2425    CHAR

                                                    Effective with Version 'J', the code used to indicate if the
                                                    diagnosis code is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes have been
                                                    expanded to accommodate ICD-10, even though ICD-10 is not
                                                    scheduled for implementation until 10/2014.

                                                    DB2      ALIAS : CLM_DGNS_VRSN_CD
                                                    SAS      ALIAS : DVRSNCD
                                                    STANDARD ALIAS : CLM_DGNS_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_DGNS_VRSN_TB

  210. Claim Diagnosis Code
                                 7   2426   2432    CHAR

                                                    The diagnosis code identifying the
                                                    beneficiary's principal or other diagnosis
                                                    (including E code).

                                                    NOTE:
                                                    Prior to Version H, the principal diagnosis
                                                    code was not stored with the 'OTHER' diagnosis
                                                    codes.  During the Version H conversion the
                                                    CLM_PRNCPAL_DGNS_CD was added as the first
                                                    occurrence.

                                                    NOTE1: Effective with Version 'J', this field has been
                                                    expanded from 5 bytes to 7 bytes to accommodate the
                                                    future implementation of ICD-10.

                                                    NOTE2:  Effective with Version 'J', the diagnosis E
                                                    codes are stored in a separate trailer (CLM_DGNS_E_GRP).

                                                    DB2      ALIAS : CLM_DGNS_CD
                                                    SAS      ALIAS : DGNS_CD
                                                    STANDARD ALIAS : CLM_DGNS_CD

                                                    LENGTH         : 7

                                                    EDIT RULES :
                                                          ICD-9-CM

  211. Claim Diagnosis E Group
                               108   2649   2756    GRP


                                                    The number of claim diagnosis E trailers is determined
                                                    by the claim diagnosis E code count.
                                                    This group contains the diagnosis E codes and
                                                    the diagnosis E version code.

                                                    STANDARD ALIAS : CLM_DGNS_E_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 12

                                                       DEPENDING ON : OP_CLM_DGNS_E_CD_CNT

  212. NCH Diagnosis E Trailer Indicator Code
                                 1   2649   2649    CHAR

                                                    Effective with Version 'J', the code indicating the
                                                    presence of a diagnosis E trailer.

                                                    NOTE:  During the Version 'J' conversion, this field
                                                    was populated throughout history.

                                                    DB2      ALIAS : DGNS_E_TRLR_IND_CD
                                                    SAS      ALIAS : ETRLRIND
                                                    STANDARD ALIAS : NCH_DGNS_E_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_DGNS_E_TRLR_IND_TB

  213. Claim Diagnosis Version Code
                                 1   2650   2650    CHAR

                                                    Effective with Version 'J', the code used to indicate if
                                                    the diagnosis code is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes have
                                                    been expanded to accomodate ICD-10, even though ICD-10 is
                                                    not scheduled for implementation until 10/2014.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : EVRSNCD
                                                    STANDARD ALIAS : CLM_DGNS_E_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_DGNS_VRSN_TB

  214. Claim Diagnosis E Code
                                 7   2651   2657    CHAR

                                                    Effective with Version J, the code used to identify the
                                                    external cause of injury, poisoning, or other adverse
                                                    affect.

                                                    NOTE:  Effective with Version 'J', this field has been
                                                    expanded from 5 bytes to 7 bytes to accomodate the future
                                                    implementation of ICD-10.

                                                    During the Version 'J' conversion,  all 'E' codes in the
                                                    diagnosis trailer were moved to the diagnosis 'E'
                                                    trailer.

                                                    With the implementation of Version 'J', diagnosis 'E'
                                                    codes can also be found in the regular diagnosis trailer,
                                                    reflected as secondary diagnosis codes.

                                                    DB2      ALIAS : CLM_DGNS_E_CD
                                                    SAS      ALIAS : EDGNSCD
                                                    STANDARD ALIAS : CLM_DGNS_E_CD

                                                    LENGTH         : 7

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          ICD-9-CM

  215. Claim Procedure Group
                               425   2757   3181    GRP


                                                    The number of claim procedure trailers is determined
                                                    by the claim procedure code count.
                                                    Effective with Version 'J', up to 25 occurrences
                                                    may be reported on a claim.
                                                    Beginning 10/93, up to six
                                                    occurrences (one principal; five others) may be
                                                    reported.

                                                    STANDARD ALIAS : CLM_PRCDR_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 25

                                                       DEPENDING ON : OP_CLM_PRCDR_CD_J_CNT

  216. NCH Procedure Trailer Indicator Code
                                 1   2757   2757    CHAR

                                                    Effective with Version H, the code indicating the presence
                                                    of a procedure trailer.

                                                    NOTE:  During the Version H conversion this field was
                                                    populated throughout history (back to service year 1991).

                                                    DB2      ALIAS : NCH_PRCDR_TRLR_IND
                                                    SAS      ALIAS : PRCDRIND
                                                    STANDARD ALIAS : NCH_PRCDR_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_PRCDR_TRLR_IND_TB

  217. Claim Procedure Version Code
                                 1   2758   2758    CHAR

                                                    Effective with Version 'J', the code used to indicate if
                                                    the surgical procedure code is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes have
                                                    been expanded to accommodate ICD-10, even though ICD-10
                                                    is not scheduled for iomplementation until 10/2014.

                                                    DB2      ALIAS : CLM_PRCDR_VRSN_CD
                                                    SAS      ALIAS : PVRSNCD
                                                    STANDARD ALIAS : CLM_PRCDR_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_PRCDR_VRSN_TB

  218. Claim Procedure Code
                                 7   2759   2765    CHAR

                                                    The code that indicates the principal or other
                                                    procedure performed during the period covered by the
                                                    institutional claim.

                                                    NOTE:
                                                    Effective July 2004, ICD-9-CM procedure codes are no
                                                    longer being accepted on Outpatient claims.  The
                                                    ICD-9-CM codes were named as the HIPPA standard code
                                                    set for inpatient hospital procedures.  HCPCS/CPT codes
                                                    were named as the standard code set for physician services
                                                    and other health care services.

                                                    NOTE1: Effective with Version 'J', the number of procedure
                                                    code occurrences has expanded from 6 to 25.

                                                    DB2      ALIAS : CLM_PRCDR_CD
                                                    SAS      ALIAS : PRCDR_CD
                                                    STANDARD ALIAS : CLM_PRCDR_CD

                                                    LENGTH         : 7

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    NCH CLM_PRCDR_CD

                                                    IF FIELD CONTAINS 4 ALPHA-NUMERIC CHARACTERS OR
                                                    OR 3 ALPHA-NUMERIC CHARACTERS FOLLOWED BY A
                                                    SPACE, ASSUME CODE IS VALID
                                                    OTHERWISE
                                                    MOVE SPACES TO CLM_PRCDR_CD.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          ICD-9-CM

  219. Claim Procedure Performed Date
                                 8   2766   2773    NUM

                                                    On an institutional claim, the date on which
                                                    the principal or other procedure was performed.

                                                    DB2      ALIAS : CLM_PRCDR_PRFRM_DT
                                                    SAS      ALIAS : PRCDR_DT
                                                    STANDARD ALIAS : CLM_PRCDR_PRFRM_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       CLM_PRCDR_PRFRM_DT_LIM

                                                    EDIT RULES :
                                                          YYYYMMDD

  220. Claim Related Condition Group
                                90   3182   3271    GRP


                                                    The number of claim related condition trailers is
                                                    determined by the claim related condition code count.
                                                    Effective 10/93, up to 30 occurrences can be reported
                                                    on an institutional claim.  Prior to 10/93, up to
                                                    10 occurrences could be reported.

                                                    STANDARD ALIAS : CLM_RLT_COND_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 30

                                                       DEPENDING ON : OP_CLM_RLT_COND_CD_CNT

  221. NCH Condition Trailer Indicator Code
                                 1   3182   3182    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a condition code trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : COND_TRLR_IND_CD
                                                    SAS      ALIAS : CONDIND
                                                    STANDARD ALIAS : NCH_COND_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_COND_TRLR_IND_TB

  222. Claim Related Condition Code
                                 2   3183   3184    CHAR

                                                    The code that indicates a condition relating to
                                                    an institutional claim that may affect payer
                                                    processing.

                                                    DB2      ALIAS : CLM_RLT_COND_CD
                                                    SAS      ALIAS : RLT_COND
                                                    STANDARD ALIAS : CLM_RLT_COND_CD
                                                    TITLE    ALIAS : RELATED_CONDITION_CD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_RLT_COND_TB

  223. Claim Related Occurrence Group
                               330   3272   3601    GRP


                                                    The number of claim related occurrence trailers is
                                                    determined by the claim related occurrence code count.
                                                    Effective 10/93, up to 30 occurrences can be reported
                                                    on an institutional claim.  Prior to 10/93, up to 10
                                                    occurrences could be reported.

                                                    STANDARD ALIAS : CLM_RLT_OCRNC_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 30

                                                       DEPENDING ON : OP_CLM_RLT_OCRNC_CD_CNT

  224. NCH Occurrence Trailer Indicator Code
                                 1   3272   3272    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a occurrence code trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : OCRNC_TRLR_IND_CD
                                                    SAS      ALIAS : OCRNCIND
                                                    STANDARD ALIAS : NCH_OCRNC_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_OCRNC_TRLR_IND_TB

  225. Claim Related Occurrence Code
                                 2   3273   3274    CHAR

                                                    The code that identifies a significant event
                                                    relating to an institutional claim that may
                                                    affect payer processing.  These codes are
                                                    claim-related occurrences that are related
                                                    to a specific date.

                                                    DB2      ALIAS : CLM_RLT_OCRNC_CD
                                                    SAS      ALIAS : OCRNC_CD
                                                    STANDARD ALIAS : CLM_RLT_OCRNC_CD
                                                    TITLE    ALIAS : OCCURRENCE_CD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_RLT_OCRNC_TB

  226. Claim Related Occurrence Date
                                 8   3275   3282    NUM

                                                    The date associated with a significant event
                                                    related to an institutional claim that may
                                                    affect payer processing.

                                                    DB2      ALIAS : CLM_RLT_OCRNC_DT
                                                    SAS      ALIAS : OCRNCDT
                                                    STANDARD ALIAS : CLM_RLT_OCRNC_DT
                                                    TITLE    ALIAS : RLT_OCRNC_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  227. Claim Occurrence Span Group
                               190   3602   3791    GRP


                                                    The number of claim occurrence span trailers is
                                                    determined by the claim occurrence span code count.
                                                    Up to 10 occurrences may be reported on an
                                                    institutional claim.

                                                    STANDARD ALIAS : CLM_OCRNC_SPAN_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 10

                                                       DEPENDING ON : OP_CLM_OCRNC_SPAN_CD_CNT

  228. NCH Span Trailer Indicator Code
                                 1   3602   3602    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a span code trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : SPAN_TRLR_IND_CD
                                                    SAS      ALIAS : SPANIND
                                                    STANDARD ALIAS : NCH_SPAN_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_SPAN_TRLR_IND_TB

  229. Claim Occurrence Span Code
                                 2   3603   3604    CHAR

                                                    The code that identifies a significant event
                                                    relating to an institutional claim that may
                                                    affect payer processing. These codes are
                                                    claim-related occurrences that are related
                                                    to a time period (span of dates).

                                                    DB2      ALIAS : CLM_OCRNC_SPAN_CD
                                                    SAS      ALIAS : SPAN_CD
                                                    STANDARD ALIAS : CLM_OCRNC_SPAN_CD
                                                    TITLE    ALIAS : SPAN_CD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_OCRNC_SPAN_TB

  230. Claim Occurrence Span From Date
                                 8   3605   3612    NUM

                                                    The from date of a period associated with
                                                    an occurrence of a specific event relating to
                                                    an institutional claim that may affect payer
                                                    processing.

                                                    DB2      ALIAS : OCRNC_SPAN_FROM_DT
                                                    SAS      ALIAS : SPANFROM
                                                    STANDARD ALIAS : CLM_OCRNC_SPAN_FROM_DT
                                                    TITLE    ALIAS : SPAN_FROM_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  231. Claim Occurrence Span Through Date
                                 8   3613   3620    NUM

                                                    The thru date of a period associated with an
                                                    occurrence of a specific event relating to an
                                                    institutional claim that may affect payer
                                                    processing.

                                                    DB2      ALIAS : OCRNC_SPAN_THRU_DT
                                                    SAS      ALIAS : SPANTHRU
                                                    STANDARD ALIAS : CLM_OCRNC_SPAN_THRU_DT
                                                    TITLE    ALIAS : SPAN_THRU_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  232. Claim Value Group
                               324   3792   4115    GRP


                                                    The number of claim value data trailers present is
                                                    determined by the claim value code count. Effective
                                                    10/93, up to 36 occurrences can be reported on an
                                                    institutional claim.  Prior to 10/93, up to 10
                                                    occurrences could be reported.

                                                    STANDARD ALIAS : CLM_VAL_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 36

                                                       DEPENDING ON : OP_CLM_VAL_CD_CNT

  233. NCH Value Trailer Indicator Code
                                 1   3792   3792    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a value code trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : VAL_TRLR_IND_CD
                                                    SAS      ALIAS : VALIND
                                                    STANDARD ALIAS : NCH_VAL_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_VAL_TRLR_IND_TB

  234. Claim Value Code
                                 2   3793   3794    CHAR

                                                    The code indicating the value of a monetary
                                                    condition which was used by the intermediary
                                                    to process an institutional claim.

                                                    DB2      ALIAS : CLM_VAL_CD
                                                    SAS      ALIAS : VAL_CD
                                                    STANDARD ALIAS : CLM_VAL_CD
                                                    TITLE    ALIAS : VALUE_CD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_VAL_TB

  235. Claim Value Amount
                                 6   3795   3800    PACK

                                                    The amount related to the condition identified
                                                    in the CLM_VAL_CD which was used by the
                                                    intermediary to process the institutional
                                                    claim.

                                                    DB2      ALIAS : CLM_VAL_AMT
                                                    SAS      ALIAS : VAL_AMT
                                                    STANDARD ALIAS : CLM_VAL_AMT
                                                    TITLE    ALIAS : VALUE_AMOUNT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  236. Claim Revenue Center Group
                             27270   4116  31385    GRP


                                                    OCCURS MIN: 0 OCCURS MAX: 45

                                                       DEPENDING ON : OP_REV_CNTR_CD_I_CNT

  237. NCH Revenue Center Trailer Indicator Code
                                 1   4116   4116    CHAR

                                                    Effective with Version H, the code identifying the
                                                    revenue center trailer.

                                                    During the Version H conversion this field was
                                                    populated with data throughout history (back to
                                                    service year 1991).

                                                    DB2      ALIAS : REV_CNTR_TRLR_CD
                                                    SAS      ALIAS : REVIND
                                                    STANDARD ALIAS : NCH_REV_CNTR_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_REV_TRLR_IND_TB

  238. Revenue Center Code
                                 4   4117   4120    CHAR

                                                    The provider-assigned revenue code for each cost center for
                                                    which a separate charge is billed (type of accommodation or
                                                    ancillary).  A cost center is a division or unit within a
                                                    hospital (e.g., radiology, emergency room, pathology).
                                                    EXCEPTION:  Revenue center code 0001 represents the total of
                                                    all revenue centers included on the claim.

                                                    DB2      ALIAS : REV_CNTR_CD
                                                    SAS      ALIAS : REV_CNTR
                                                    STANDARD ALIAS : REV_CNTR_CD
                                                    TITLE    ALIAS : REVENUE_CENTER_CD

                                                    LENGTH         : 4

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_TB

  239. Revenue Center Date
                                 8   4121   4128    NUM

                                                    Effective with Version H, the date applicable
                                                    to the service represented by the revenue center
                                                    code.   This field may be present on any of the
                                                    institutional claim types.  For home health claims
                                                    the service date should be present on all bills
                                                    with from date greater than 3/31/98.  With the
                                                    implementation of outpatient PPS, hospitals will
                                                    be required to enter line item dates of service
                                                    for all outpatient services which require a HCPCS.

                                                    NOTE1:  Beginning with NCH weekly process date
                                                    10/3/97 this field was populated with data.
                                                    Claims processed prior to 10/3/97 will contain
                                                    zeroes in this field.

                                                    NOTE2:  When revenue center code equals '0022'
                                                    (SNF PPS) and revenue center HCPCS code not equal
                                                    to 'AAA00' (default for no assessment), date re-
                                                    presents the MDS RAI assessment reference date.

                                                    NOTE3:  When revenue center code equals '0023'
                                                    (HHPPS), the  date on the initial claim (RAP) must
                                                    represent the first date of service in the episode.
                                                    The final claim will match the '0023' information
                                                    submitted on the initial claim.  The SCIC
                                                    (significant change in condition) claims may show
                                                    additional '0023' revenue lines in which the
                                                    date represents the date of the first service
                                                    under the revised plan of treatment.

                                                    DB2      ALIAS : REV_CNTR_DT
                                                    STANDARD ALIAS : REV_CNTR_DT
                                                    TITLE    ALIAS : REV_CNTR_DATE

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  240. Revenue Center 1st ANSI Code
                                 5   4129   4133    CHAR

                                                    The first code used to identify the
                                                    detailed reason an adjustment was made
                                                    (e.g. reason for denial or reducing payment).

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  Beginning with NCH weekly process date
                                                    7/7/00, this field will be populated with data.
                                                    Claims processed prior to 7/7/00 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : REV_CNTR_ANSI1_CD
                                                    SAS      ALIAS : REVANSI1
                                                    STANDARD ALIAS : REV_CNTR_ANSI_1_CD
                                                    TITLE    ALIAS : ANSI_CD

                                                    LENGTH         : 5

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_ANSI_TB

  241. Revenue Center 2nd ANSI Code
                                 5   4134   4138    CHAR

                                                    The second code used to identify the
                                                    detailed reason an adjustment was made
                                                    (e.g. reason for denial or reducing payment).

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  Beginning with NCH weekly process date
                                                    7/7/00, this field will be populated with data.
                                                    Claims processed prior to 7/7/00 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : REV_CNTR_ANSI2_CD
                                                    SAS      ALIAS : REVANSI2
                                                    STANDARD ALIAS : REV_CNTR_ANSI_2_CD
                                                    TITLE    ALIAS : ANSI_CD

                                                    LENGTH         : 5

                                                    SOURCE         : CWF

  242. Revenue Center 3rd ANSI Code
                                 5   4139   4143    CHAR

                                                    The third code used to identify the
                                                    detailed reason an adjustment was made
                                                    (e.g. reason for denial or reducing payment).

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  Beginning with NCH weekly process date
                                                    7/7/00, this field will be populated with data.
                                                    Claims processed prior to 7/7/00 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : REV_CNTR_ANSI3_CD
                                                    SAS      ALIAS : REVANSI3
                                                    STANDARD ALIAS : REV_CNTR_ANSI_3_CD
                                                    TITLE    ALIAS : ANSI_CD

                                                    LENGTH         : 5

                                                    SOURCE         : CWF

  243. Revenue Center 4th ANSI Code
                                 5   4144   4148    CHAR

                                                    The fourth code used to identify the
                                                    detailed reason an adjustment was made
                                                    (e.g. reason for denial or reducing payment).

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  Beginning with NCH weekly process date
                                                    7/7/00, this field will be populated with data.
                                                    Claims processed prior to 7/7/00 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : REV_CNTR_ANSI4_CD
                                                    SAS      ALIAS : REVANSI4
                                                    STANDARD ALIAS : REV_CNTR_ANSI_4_CD
                                                    TITLE    ALIAS : ANSI_CD

                                                    LENGTH         : 5

                                                    SOURCE         : CWF

  244. Revenue Center APC/HIPPS Code
                                 5   4149   4153    CHAR

                                                    Effective with Version 'I', this field was created
                                                    to house two pieces of data.  The Ambulatory Payment
                                                    Classification (APC) code and the HIPPS code.  The APC
                                                    is used to identify groupings of outpatient services. APC
                                                    codes are used to calculate payment for services under
                                                    OPPS.  The APC is a four byte field.  The HIPPS codes
                                                    are used to identify patient classifications for SNFPPS,
                                                    HHPPS and IRFPPS that will be used to calculate payment.
                                                    The HIPPS code is a five byte field.

                                                    NOTE1:  The APC field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2: Under SNFPPS, HHPPS & IRFPPS, HIPPS codes
                                                    are stored in the HCPCS field. **EXCEPTION: if a
                                                    HHPPS HIPPS code is downcoded/upcoded the downcoded/
                                                    upcoded HIPPS will be stored in this field.

                                                    NOTE3:  Beginning with NCH weekly process date
                                                    8/18/00, this field will be populated with data.
                                                    Claims processed prior to 8/18/00 will contain
                                                    spaces in this field.

                                                    DB2      ALIAS : REV_APC_HIPPS_CD
                                                    SAS      ALIAS : APCHIPPS
                                                    STANDARD ALIAS : REV_CNTR_APC_HIPPS_CD
                                                    TITLE    ALIAS : APC_HIPPS

                                                    LENGTH         : 5

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_APC_TB

  245. Revenue Center Healthcare Common Procedure Coding System Code
                                 5   4154   4158    CHAR

                                                    Healthcare Common Procedure Coding System (HCPCS)
                                                    is a collection of codes that represent procedures,
                                                    supplies, products and services which may be
                                                    provided to Medicare beneficiaries and to
                                                    individuals enrolled in private health
                                                    insurance programs.  The codes are divided
                                                    into three levels, or groups, as described
                                                    below:

                                                    DB2      ALIAS : REV_CNTR_HCPCS_CD
                                                    STANDARD ALIAS : REV_CNTR_HCPCS_CD
                                                    TITLE    ALIAS : HCPCS_CD

                                                    LENGTH         : 5

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCPCS_CD.  With Version H, a prefix
                                                    was added to denote the location of this field
                                                    on each claim type (institutional: REV_CNTR and
                                                    non-institutional: LINE).

                                                    NOTE:  When revenue center code = '0022' (SNF PPS),
                                                    '0023' (HH PPS), or '0024' (IRF PPS); this field
                                                    contains the Health Insurance PPS (HIPPS) code.

                                                    The HIPPS code for SNF PPS contains the rate code/
                                                    assessment type that identifies (1) RUG-III group
                                                    the beneficiary was classified into as of the RAI
                                                    MDS assessment reference date and (2) the type of
                                                    assessment for payment purposes.

                                                    The HIPPS code for Home Health PPS identifies
                                                    (1) the three case-mix dimensions of the HHRG system,
                                                    clinical, functional and utilization, from which a
                                                    beneficiary is assigned to one of the 80 HHRG
                                                    categories and (2) it identifies whether or not
                                                    the elements of the code were computed or derived.
                                                    The HHRGs, represented by the HIPPS coding, will be
                                                    the basis of payment for each episode.

                                                    The HIPPS code (CMG Code) for IRF PPS identifies
                                                    the clinical characteristics of the beneficiary.
                                                    The HIPPS rate/CMG code (AXXYY - DXXYY) must contain
                                                    five digits.  The first position of the code is an
                                                    A, B, C, or 'D'.  The HIPPS code beginning with an
                                                    'A' in front of the CMG is defined as without comor-
                                                    bidity. The 'B' in front of the CMG is defined as
                                                    with comorbidity for Tier 1.  The 'C' is defined
                                                    as comorbidity for Tier 2 and 'D' is defined as
                                                    comorbidity for Tier 3.  The 'XX' in the HIPPS
                                                    rate code is the Rehabilitation Impairment Code
                                                    (RIC).  The 'YY' is the sequential number system
                                                    within the RIC.

                                                    For SNF PPS, HH PPS & IRF PPS HIPPS values see
                                                    CLM_HIPPS_TB.

                                                    Level I
                                                    Codes and descriptors copyrighted by the American
                                                    Medical Association's Current Procedural
                                                    Terminology, Fourth Edition (CPT-4).  These are
                                                    5 position numeric codes representing physician
                                                    and nonphysician services.

                                                    **** Note: ****
                                                    CPT-4 codes including both long and short
                                                    descriptions shall be used in accordance with the
                                                    HCFA/AMA agreement.  Any other use violates the
                                                    AMA copyright.

                                                    Level II
                                                    Includes codes and descriptors copyrighted by
                                                    the American Dental Association's Current Dental
                                                    Terminology, Second Edition (CDT-2).  These are
                                                    5 position alpha-numeric codes comprising
                                                    the D series.  All other level II codes and
                                                    descriptors are approved and maintained jointly
                                                    by the alpha-numeric editorial panel (consisting
                                                    of HCFA, the Health Insurance Association of
                                                    America, and the Blue Cross and Blue Shield
                                                    Association).  These are 5 position alpha-
                                                    numeric codes representing primarily items and
                                                    nonphysician services that are not
                                                    represented in the level I codes.

                                                    Level III
                                                    Codes and descriptors developed by Medicare
                                                    carriers for use at the local (carrier) level.
                                                    These are 5 position alpha-numeric codes in the
                                                    W, X, Y or Z series representing physician
                                                    and nonphysician services that are not
                                                    represented in the level I or level II codes.

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       HHA_HCPCS_LIM

                                                    CODE TABLE     : CLM_HIPPS_TB

  246. Revenue Center HCPCS Initial Modifier Code
                                 2   4159   4160    CHAR

                                                    A first modifier to the procedure code to enable a more
                                                    specific procedure identification for the claim.

                                                    DB2      ALIAS : REV_HCPCS_MDFR_CD
                                                    STANDARD ALIAS : REV_CNTR_HCPCS_INITL_MDFR_CD
                                                    TITLE    ALIAS : INITIAL_MODIFIER

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCPCS_INITL_MDFR_CD.  With Version H, a prefix
                                                    was added to denote the location of this field
                                                    on each claim type (institutional: REV_CNTR and
                                                    non-institutional: LINE).

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          Carrier Information File

  247. Revenue Center HCPCS Second Modifier Code
                                 2   4161   4162    CHAR

                                                    A second modifier to the procedure code to make it more
                                                    specific than the first modifier code to identify the
                                                    procedures performed on the beneficiary for the claim.

                                                    DB2      ALIAS : REV_HCPCS_2ND_CD
                                                    STANDARD ALIAS : REV_CNTR_HCPCS_2ND_MDFR_CD
                                                    TITLE    ALIAS : SECOND_MODIFIER

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCPCS_2ND_MDFR_CD.  With Version H, a prefix
                                                    was added to denote the location of this field
                                                    on each claim type (institutional: REV_CNTR and
                                                    non-institutional: LINE).

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          CARRIER INFORMATION FILE

  248. Revenue Center HCPCS Third Modifier Code
                                 2   4163   4164    CHAR

                                                    Effective with Version I, a third modifier to the
                                                    procedure code to make  it more specific than the
                                                    second modifier code to identify the procedures
                                                    performed on the beneficiary for the claim.

                                                    DB2      ALIAS : REV_HCPCS_3RD_CD
                                                    STANDARD ALIAS : REV_CNTR_HCPCS_3RD_MDFR_CD
                                                    TITLE    ALIAS : THIRD_MODIFIER

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    NOTE:  Beginning with NCH weekly process date
                                                    8/18/00, this field will be populated with data.
                                                    Claims processed prior to 8/18/00 will contain
                                                    spaces in this field.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          CARRIER INFORMATION FILE

  249. Revenue Center HCPCS Fourth Modifier Code
                                 2   4165   4166    CHAR

                                                    Effective with Version I, a fourth modifier to the
                                                    procedure code to make it more specific than the
                                                    third modifier code to identify the procedures
                                                    performed on the beneficiary for the claim.

                                                    DB2      ALIAS : REV_HCPCS_4TH_CD
                                                    STANDARD ALIAS : REV_CNTR_HCPCS_4TH_MDFR_CD
                                                    TITLE    ALIAS : FOURTH_MODIFIER

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    NOTE:  Beginning with NCH weekly process date
                                                    8/18/00, this field will be populated with data.
                                                    Claims processed prior to 8/18/00 will contain
                                                    spaces in this field.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          CARRIER INFORMATION FILE

  250. Revenue Center HCPCS Fifth Modifier Code
                                 2   4167   4168    CHAR

                                                    Effective with Version I, a fifth modifier to the
                                                    procedure code to make it more specific than the
                                                    fourth modifier code to identify the procedures
                                                    performed on the beneficiary for the claim.

                                                    DB2      ALIAS : REV_HCPCS_5TH_CD
                                                    SAS      ALIAS : MDFR_CD5
                                                    STANDARD ALIAS : REV_CNTR_HCPCS_5TH_MDFR_CD
                                                    TITLE    ALIAS : FIFTH_MODIFIER

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    NOTE:  Beginning with NCH weekly process date
                                                    8/18/00, this field will be populated with data.
                                                    Claims processed prior to 8/18/00 will contain
                                                    spaces in this field.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          CARRIER INFORMATION FILE

  251. Revenue Center Payment Method Indicator Code
                                 2   4169   4170    CHAR

                                                    Effective with Version 'I', the code used to
                                                    identify how the service is priced for payment.
                                                    This field is made up of two pieces of data,
                                                    1st position being the service indicator and
                                                    the 2nd position being the payment indicator.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    NOTE3:  Effective 10/2005, this field will no longer
                                                    represent the service indicator and the payment
                                                    indicator. This field will now house the 2-byte
                                                    payment indicator.  The status indicator will be housed
                                                    in a new field named: REV_CNTR_STUS_IND_CD.

                                                    DB2      ALIAS : REV_PMT_MTHD_CD
                                                    SAS      ALIAS : PMTMTHD
                                                    STANDARD ALIAS : REV_CNTR_PMT_MTHD_IND_CD
                                                    TITLE    ALIAS : PMT_MTHD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_PMT_MTHD_IND_TB

  252. Revenue Center Discount Indicator Code
                                 1   4171   4171    CHAR

                                                    Effective with Version 'I', this code represents
                                                    a factor that specifies the amount of any APC
                                                    discount.  The discounting factor is applied
                                                    to a line item with a service indicator (part
                                                    of the REV_CNTR_PMT_MTHD_IND_CD) of 'T'.  The
                                                    flag is applicable when more than one significant
                                                    procedure is performed. **If there is no dis-
                                                    counting the factor will be 1.0.**

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    NOTE3:  VALUES D, U & T REPRESENT THE FOLLOWING:
                                                    D = Discounting fraction (currently 0.5)
                                                    U = Number of units
                                                    T = Terminated procedure discount (currently 0.5)

                                                    DB2      ALIAS : REV_DSCNT_IND_CD
                                                    SAS      ALIAS : DSCNTIND
                                                    STANDARD ALIAS : REV_CNTR_DSCNT_IND_CD
                                                    TITLE    ALIAS : REV_CNTR_DSCNT_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_DSCNT_IND_TB

  253. Revenue Center Packaging Indicator Code
                                 1   4172   4172    CHAR

                                                    Effective with Version 'I', the code used to
                                                    identify those services that are packaged/
                                                    bundled with another service.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_PACKG_IND_CD
                                                    SAS      ALIAS : PACKGIND
                                                    STANDARD ALIAS : REV_CNTR_PACKG_IND_CD
                                                    TITLE    ALIAS : REV_CNTR_PACKG_IND

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_PACKG_IND_TB

  254. Revenue Center Pricing Indicator Code
                                 2   4173   4174    CHAR

                                                    Effective with Version 'I', the code used
                                                    to identify if there was a deviation from
                                                    the standard method of calculating payment
                                                    amount.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_PRICNG_IND_CD
                                                    SAS      ALIAS : PRICNG
                                                    STANDARD ALIAS : REV_CNTR_PRICNG_IND_CD
                                                    TITLE    ALIAS : REV_CNTR_PRICNG_IND

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_PRICNG_IND_TB

  255. Revenue Center Obligation to Accept As Full (OTAF) Payment Code
                                 1   4175   4175    CHAR

                                                    Effective with Version 'j' the code used
                                                    to indicate that the provider was obligated
                                                    to accept as full payment the amount re-
                                                    ceived from the primary (or secondary) payer.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_OTAF_IND_CD
                                                    SAS      ALIAS : OTAF
                                                    STANDARD ALIAS : REV_CNTR_OTAF_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          Y = provider is obligated to accept the payment
                                                              as payment in full for the service.
                                                          N or blank  = provider is not obligated to accept
                                                              the payment, or there is no payment by a prior
                                                              payer.

  256. Revenue Center IDE, NDC, UPC Number
                                24   4176   4199    CHAR

                                                    Effective with Version H, the exemption number
                                                    assigned by the Food and Drug Administration (FDA)
                                                    to an investigational device after a manufacturer
                                                    has been approved by FDA to conduct a clinical
                                                    trial on that device.   HCFA established a new
                                                    policy of covering certain IDE's which was
                                                    implemented in claims processing on 10/1/96
                                                    (which is NCH weekly process 10/4/96) for service
                                                    dates beginning 10/1/95.  IDE's are always
                                                    associated with revenue center code '0624'.

                                                    NOTE1:  Prior to Version H a 'dummy' revenue
                                                    center code '0624' trailer was created to store
                                                    IDE's.   The IDE number was housed in two fields:
                                                    HCPCS code and HCPCS initial modifier; the second
                                                    modifier contained the value 'ID'.  There can be
                                                    up to 7 distinct IDE numbers associated with an
                                                    '0624' dummy trailer.  During the Version H con-
                                                    version IDE's were moved from the dummy '0624'
                                                    trailer to this dedicated field.

                                                    NOTE2:  Effective with Version 'I', this field was
                                                    renamed to eventually accommodate the National Drug Code
                                                    (NDC) and the Universal Product Code (UPC).  This field
                                                    could contain either of these 3 fields (there would never
                                                    be an instance where more than one would come in on
                                                    a claim).  The size of this field was expanded to X(24)
                                                    to accommodate either of the new fields (under Version
                                                    'H' it was X(7).  DATA ANAMOLY/LIMITATION:  During an
                                                    CWFMQA review an edit revealed the IDE was missing.
                                                    The problem occurs in claim with an NCH weekly pro-
                                                    cess dates of 6/9/00 through 9/8/00.  During processing
                                                    of the new format the program receives the IDE but
                                                    then blanked out the data.

                                                    DB2      ALIAS : IDE_NDC_UPC_NUM
                                                    SAS      ALIAS : IDENDC
                                                    STANDARD ALIAS : REV_CNTR_IDE_NDC_UPC_NUM
                                                    TITLE    ALIAS : IDE_NDC_UPC

                                                    LENGTH         : 24

                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       REV_CNTR_IDE_NDC_UPC_LIM

  257. Revenue Center NDC Quantity Qualifier Code
                                 2   4200   4201    CHAR

                                                    Effective with Version 'J', the code used to indicate the
                                                    unit of measurement for the drug that was administered.

                                                    DB2      ALIAS : NDC_QTY_QLFR_CD
                                                    SAS      ALIAS : QTYQLFR
                                                    STANDARD ALIAS : REV_CNTR_NDC_QTY_QLFR_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : REV_CNTR_NDC_QTY_QLFR_TB

  258. Revenue Center NDC Quantity
                                 6   4202   4207    PACK

                                                    Effective with Version 'J', the quantity dispensed
                                                    for the drug reflected on the revenue center line item.

                                                    DB2      ALIAS : NDC_QTY_NUM
                                                    SAS      ALIAS : NDCQTY
                                                    STANDARD ALIAS : REV_CNTR_NDC_QTY

                                                    LENGTH         : 7.3    SIGNED : Y

  259. Revenue Center Unit Count
                                 4   4208   4211    PACK

                                                    A quantitative measure (unit) of the number of times the
                                                    service or procedure being reported was performed according
                                                    to the revenue center/HCPCS code definition as described on
                                                    an institutional claim.

                                                    Depending on type of service, units are measured by number
                                                    of covered days in a particular accommodation, pints of
                                                    blood, emergency room visits, clinic visits, dialysis
                                                    treatments (sessions or days), outpatient therapy visits,
                                                    and outpatient clinical diagnostic laboratory tests.

                                                    NOTE1:  When revenue center code = '0022' (SNF PPS) the unit
                                                    count will reflect the number of covered days for each HIPPS
                                                    code and, if applicable, the number of visits for each rehab
                                                    therapy code.

                                                    DB2      ALIAS : REV_CNTR_UNIT_CNT
                                                    SAS      ALIAS : REV_UNIT
                                                    STANDARD ALIAS : REV_CNTR_UNIT_CNT
                                                    TITLE    ALIAS : UNITS

                                                    LENGTH         : 7    SIGNED : Y

                                                    SOURCE         : CWF

  260. Revenue Center Rate Amount
                                 6   4212   4217    PACK

                                                    Charges relating to unit cost associated with
                                                    the revenue center code.  Exception (encounter
                                                    data only):  If plan (e.g. MCO) does not know
                                                    the actual rate for the accommodations, $1 will
                                                    be reported in the field.

                                                    NOTE1:  For SNF PPS claims (when revenue center
                                                    code equals '0022'), CMS has developed a SNF
                                                    PRICER to compute the rate based on the provider
                                                    supplied coding for the MDS RUGS III group and
                                                    assessment type (HIPPS code, stored in revenue
                                                    center HCPCS code field).

                                                    NOTE2:  For OP PPS claims, CMS has developed a
                                                    PRICER to compute the rate based on the Ambulatory
                                                    Payment Classification (APC), discount factor,
                                                    units of service and the wage index.

                                                    NOTE3:  Under HH PPS (when revenue center
                                                    code equals '0023'), CMS has developed a HHA
                                                    PRICER to compute the rate.  On the RAP, the rate is
                                                    determined using the case mix weight associated with
                                                    the HIPPS code, adjusting it for the wage index
                                                    for the beneficiary's site of service, then
                                                    multiplying the result by 60% or 50%, depending on
                                                    whether or not the RAP is for a first episode.

                                                    On the final claim, the HIPPS code could change the
                                                    payment if the therapy threshold is not met, or
                                                    partial episode payment (PEP) adjustment or a
                                                    significant change in condition (SCIC) adjustment.
                                                    In cases of SCICs, there will be more than one
                                                    '0023' revenue center line, each representing the
                                                    payment made at each case-mix level.

                                                    NOTE4:  For IRF PPS claims (when revenue center
                                                    code equals '0024'), CMS has developed a PRICER
                                                    to compute the rate based on the HIPPS/CMG
                                                    (HIPPS code, stored in revenue center HCPCS code
                                                    field).

                                                    DB2      ALIAS : REV_CNTR_RATE_AMT
                                                    SAS      ALIAS : REV_RATE
                                                    STANDARD ALIAS : REV_CNTR_RATE_AMT
                                                    TITLE    ALIAS : CHARGE_PER_UNIT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H the size of this field was:
                                                    S9(7)V99.

                                                    SOURCE         : CWF

  261. Revenue Center Blood Deductible Amount
                                 6   4218   4223    PACK

                                                    Effective with Version 'I', the amount of money
                                                    for which the intermediary determined the
                                                    beneficiary is liable for the blood deductible
                                                    for the line item service.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_BLOOD_DDCTBL
                                                    SAS      ALIAS : REVBLOOD
                                                    STANDARD ALIAS : REV_CNTR_BLOOD_DDCTBL_AMT
                                                    TITLE    ALIAS : BLOOD_DDCTBL_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  262. Revenue Center Cash Deductible Amount
                                 6   4224   4229    PACK

                                                    Effective with Version 'I' the amount of cash
                                                    deductible the beneficiary paid for the line
                                                    item service.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_CASH_DDCTBL
                                                    SAS      ALIAS : REVDCTBL
                                                    STANDARD ALIAS : REV_CNTR_CASH_DDCTBL_AMT
                                                    TITLE    ALIAS : CASH_DDCTBL

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  263. Revenue Center Coinsurance/Wage Adjusted Coinsurance Amount
                                 6   4230   4235    PACK

                                                    Effective with Version 'I', the amount of
                                                    coinsurance applicable to the line item
                                                    service defined by the revenue center and
                                                    HCPCS codes.  For those services subject to
                                                    Outpatient PPS, the applicable coinsurance
                                                    is wage adjusted.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  The above claim types could have lines that
                                                    are not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    NOTE2:  This field will have either a zero
                                                    (for services for which coinsurance is not
                                                    applicable), a regular coinsurance amount
                                                    (calculated on either charges or a fee
                                                    schedule) or if subject to OP PPS the national
                                                    coinsurance amount will be wage adjusted.
                                                    The wage adjusted coinsurance is based on the
                                                    MSA where the provider is located or assigned
                                                    as a result of a reclassification.

                                                    NOTE3:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : ADJSTD_COINSRNC
                                                    SAS      ALIAS : WAGEADJ
                                                    STANDARD ALIAS : REV_CNTR_WAGE_ADJSTD_COINS_AMT
                                                    TITLE    ALIAS : WAGE_ADJSTD_COINS

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  264. Revenue Center Reduced Coinsurance Amount
                                 6   4236   4241    PACK

                                                    Effective with Version 'I', for all services
                                                    subject to Outpatient PPS, the amount of
                                                    coinsurance applicable to the line for a
                                                    particular service (HCPCS) for which the
                                                    provider has elected to reduce the coinsurance
                                                    amount.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  The reduced coinsurance amount cannot
                                                    be lower than 20% of the payment rate for the
                                                    APC line.

                                                    NOTE3:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : RDCD_COINSRNC
                                                    SAS      ALIAS : RDCDCOIN
                                                    STANDARD ALIAS : REV_CNTR_RDCD_COINS_AMT
                                                    TITLE    ALIAS : REDUCED_COINS

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  265. Revenue Center 1st Medicare Secondary Payer Paid Amount
                                 6   4242   4247    PACK

                                                    Effective with Version 'I', the amount paid by
                                                    the primary payer when the payer is primary to
                                                    Medicare (Medicare is secondary).

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_MSP1_PD_AMT
                                                    SAS      ALIAS : REV_MSP1
                                                    STANDARD ALIAS : REV_CNTR_MSP1_PD_AMT
                                                    TITLE    ALIAS : MSP PAID AMOUNT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  266. Revenue Center 2nd Medicare Secondary Payer Paid Amount
                                 6   4248   4253    PACK

                                                    Effective with Version 'I', the amount paid by
                                                    the secondary payer when two payers are primary
                                                    to Medicare (Medicare is the tertiary payer).

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_MSP2_PD_AMT
                                                    SAS      ALIAS : REV_MSP2
                                                    STANDARD ALIAS : REV_CNTR_MSP2_PD_AMT
                                                    TITLE    ALIAS : MSP PAID AMOUNT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  267. Revenue Center Provider Payment Amount
                                 6   4254   4259    PACK

                                                    Effective with Version 'I', the amount paid
                                                    to the provider for the services reported
                                                    on the line item.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    ANAMOLY: For dates of service August 1, 2000 to
                                                    the present, the OPPS revenue center fields are
                                                    being processed differently by FISS and APASS
                                                    (standard systems). For more information on OPPS
                                                    data problems for this time period see Limitations
                                                    Appendix.  The following is how each system handles
                                                    this field:

                                                    FISS:  populated correctly with provider payment
                                                    amount

                                                    APASS: provider payment amount plus interest on
                                                    1st revenue center line (CMM will instruct
                                                    APASS not to include interest)

                                                    Currently, the following FI numbers are under the APASS
                                                    system and all other FI numbers are under FISS.  See
                                                    FI_NUM table of codes for all FI numbers.

                                                    52280 -- Mutual of Omaha (until 6/1/2003)
                                                    00430 -- Washington/Alaska (until 11/1/2003)
                                                    00310 -- North Carolina BC (until 12/1/2003)
                                                    00370 -- Rhode Island (until 2/1/2004)
                                                    00270 -- New Hampshire/Vermont (until 3/1/2004)
                                                    00181 -- Maine/Massachusetts (until 5/1/2004)

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_PRVDR_PMT_AMT
                                                    SAS      ALIAS : RPRVDPMT
                                                    STANDARD ALIAS : REV_CNTR_PRVDR_PMT_AMT
                                                    TITLE    ALIAS : REV_PRVDR_PMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  268. Revenue Center Beneficiary Payment Amount
                                 6   4260   4265    PACK

                                                    Effective with Version I, the amount paid
                                                    to the beneficiary for the services reported
                                                    on the line item.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_BENE_PMT_AMT
                                                    SAS      ALIAS : RBENEPMT
                                                    STANDARD ALIAS : REV_CNTR_BENE_PMT_AMT
                                                    TITLE    ALIAS : REV_BENE_PMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  269. Revenue Center Patient Responsibility Payment Amount
                                 6   4266   4271    PACK

                                                    Effective with Version I, the amount paid
                                                    by the beneficiary to the provider for the
                                                    line item service.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    ANAMOLY:  For dates of service August 1, 2000 to
                                                    present, the OPPS revenue center fields are being
                                                    processed differently by FISS and APASS (standard
                                                    systems). For more information on OPPS data problems
                                                    for this time period see the Limitations Appendix.  The
                                                    following is how each system is handling this field:

                                                    FISS:   populating correctly (sum of coinsurance and
                                                    deductible)

                                                    APASS:  not populating this field

                                                    Currently, the following FI numbers are under the APASS
                                                    system and all other FI numbers are under FISS.  See
                                                    FI_NUM table of codes for all FI numbers.

                                                    52280 -- Mutual of Omaha (until 6/1/2003)
                                                    00430 -- Washington/Alaska (until 11/1/2003)
                                                    00310 -- North Carolina BC (until 12/1/2003)
                                                    00370 -- Rhode Island (until 2/1/2004)
                                                    00270 -- New Hampshire/Vermont (until 3/1/2004)
                                                    00181 -- Maine/Massachusetts (until 5/1/2004)

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_PTNT_RESP_AMT
                                                    SAS      ALIAS : PTNTRESP
                                                    STANDARD ALIAS : REV_CNTR_PTNT_RESP_PMT_AMT
                                                    TITLE    ALIAS : REV_PTNT_RESP

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  270. Revenue Center Payment Amount
                                 6   4272   4277    PACK

                                                    Effective with Version 'I', the line item
                                                    Medicare payment amount for the specific
                                                    revenue center.

                                                    NOTE1:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services
                                                    with dates of service 1/1/02 and forward.

                                                    ANAMOLY:  For dates of service August 1, 2000 to
                                                    present, the OPPS revenue center fields are being
                                                    processed differently by FISS and APASS (standard
                                                    systems). For more information on OPPS data problems
                                                    for this time period see the Limitations Appendix. The
                                                    following is how each system is handling this field:

                                                    FISS:   this field contains provider reimbursement.

                                                    APASS:  provider payment amount plus coinsurance and
                                                    deductible (should not include coinsurance and
                                                    deductible).  Users should rely on provider
                                                    payment amount field for the trust fund
                                                    payment.

                                                    Currently, the following FI numbers are under the APASS
                                                    system and all other FI numbers are under FISS.  See
                                                    FI_NUM table of codes for all FI numbers.

                                                    52280 -- Mutual of Omaha (until 6/1/2003)
                                                    00430 -- Washington/Alaska (until 11/1/2003)
                                                    00310 -- North Carolina BC (until 12/1/2003)
                                                    00370 -- Rhode Island (until 2/1/2004)
                                                    00270 -- New Hampshire/Vermont (until 3/1/2004)
                                                    00181 -- Maine/Massachusetts (until 5/1/2004)

                                                    NOTE2:  It has been discovered that this field may be
                                                    populated with data on claims with dates of service
                                                    prior to 7/00 (implementation of Claim Line Expansion
                                                    OPPS/HHPPS).  The original understanding of the new
                                                    revenue center fields was that data would be populated
                                                    on claims with dates of service 7/00 and forward.  Data
                                                    has been found in claims with dates of service prior to
                                                    7/00 because the Standard Systems have processed any
                                                    claim coming in 7/00 and after, meeting the above criteria,
                                                    through the Outpatient Code Editor (OCE) regardless of the
                                                    dates of service.

                                                    DB2      ALIAS : REV_CNTR_PMT_AMT
                                                    SAS      ALIAS : REVPMT
                                                    STANDARD ALIAS : REV_CNTR_PMT_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  271. Revenue Center Total Charge Amount
                                 6   4278   4283    PACK

                                                    The total charges (covered and non-covered) for all
                                                    accommodations and services (related to the revenue code)
                                                    for a billing period before reduction for the deductible and
                                                    coinsurance amounts and before an adjustment for the cost of
                                                    services provided.  NOTE: For accommodation revenue center
                                                    total charges must equal the rate times units (days).

                                                    EXCEPTIONS:
                                                    (1)  For SNF RUGS demo claims only (9000 series revenue
                                                    center codes), this field contains SNF customary
                                                    accommodation charge, (ie., charges related to the
                                                    accommodation revenue center code that would have been
                                                    applicable if the provider had not been participating in the
                                                    demo).

                                                    (2)  For SNF PPS (non demo claims), when revenue center code
                                                    = '0022', the total charges will be zero.

                                                    (3)  For Home Health PPS (RAPs), when revenue center code =
                                                    '0023', the total charges will equal the dollar amount for
                                                    the '0023' line.

                                                    (4) For Home Health PPS (final claim), when revenue center
                                                    code = '0023', the total charges will be the sum of the
                                                    revenue center code lines (other than '0023').

                                                    (5) For Inpatient Rehabilitation Facility (IFR) PPS, when
                                                    the revenue center code = '0024', the total charges will
                                                    be zero.  For accommodation revenue codes (010X - 021X),
                                                    total charges must equal the rate times the units.

                                                    (6)  For encounter data, if the plan (e.g. MCO) does not
                                                    know the actual charges for the accommodations the total
                                                    charges will be $1 (rate) times units (days).

                                                    DB2      ALIAS : REV_TOT_CHRG_AMT
                                                    SAS      ALIAS : REV_CHRG
                                                    STANDARD ALIAS : REV_CNTR_TOT_CHRG_AMT
                                                    TITLE    ALIAS : REVENUE_CENTER_CHARGES

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H the size of this field was:
                                                    S9(7)V99.

                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       MLTPL_REV_CNTR_0001_CD_LIM
                                                       REV_CNTR_TOT_CHRG_AMT_LIM

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  272. Revenue Center Non-Covered Charge Amount
                                 6   4284   4289    PACK

                                                    The charge amount related to a revenue center code for
                                                    services that are not covered by Medicare.

                                                    NOTE:  Prior to Version H the field size was S9(7)V99 and
                                                    the element was only present on the Inpatient/SNF format.
                                                    As of NCH weekly process date 10/3/97 this field was added
                                                    to all institutional claim types.

                                                    DB2      ALIAS : REV_NCVR_CHRG_AMT
                                                    SAS      ALIAS : REV_NCVR
                                                    STANDARD ALIAS : REV_CNTR_NCVR_CHRG_AMT
                                                    TITLE    ALIAS : REV_CENTER_NONCOVERED_CHARGES

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  273. Revenue Center Deductible Coinsurance Code
                                 1   4290   4290    CHAR

                                                    Code indicating whether the revenue center charges
                                                    are subject to deductible and/or coinsurance.

                                                    DB2      ALIAS : DDCTBL_COINSRNC_CD
                                                    SAS      ALIAS : REVDEDCD
                                                    STANDARD ALIAS : REV_CNTR_DDCTBL_COINSRNC_CD
                                                    TITLE    ALIAS : REVENUE_CENTER_DEDUCTIBLE_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_DDCTBL_COINSRNC_TB

  274. Revenue Center Consolidated Billing Code
                                 1   4291   4291    CHAR

                                                    Effective 1/1/2004 with the implementation of NCH/NMUD
                                                    CR#1, this code is reflected on outpatient claims only
                                                    to identify those line item services (i.e. therapy
                                                    and nonroutine supply services) that are subject
                                                    to SNF and Home Health consolidated billing. If the
                                                    line item service was paid by an intermediary prior
                                                    to the submission of the SNF or home health claim
                                                    an adjustment for the outpatient claim will be submitted
                                                    identifying those services that are subject to
                                                    consolidated billing.

                                                    NOTE1:  Prior to 10/2005 (implementation of NCH/NMUD
                                                    CR#2), this data was stored in position 175 (FILLER)
                                                    in the revenue center trailer.

                                                    NOTE2:  Effective July 2005, this data will no longer
                                                    be coming into the NCH.  This process is being handled
                                                    in the new CWF override processing.

                                                    DB2      ALIAS : CNSLDTD_BLG_CD
                                                    SAS      ALIAS : RCNSLDTD
                                                    STANDARD ALIAS : REV_CNTR_CNSLDTD_BLG_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_CNSLDTD_BLG_TB

  275. Revenue Center Status Indicator Code
                                 2   4292   4293    CHAR

                                                    Effective 10/3/2005 with the implementation of NCH/NMUD
                                                    CR#2, the code used to identify the status of the
                                                    line item service.  This field along with the
                                                    payment method indicator field is used to identify
                                                    how the service was priced for payment.

                                                    NOTE1:  This 2-byte indicator is being added due to
                                                    an expansion of a field that currently exist on the
                                                    revenue center trailer.  The status indicator is
                                                    currently the 1st position of the Revenue Center
                                                    Payment Method Indicator Code.  The payment method
                                                    indicator code is being split into two 2-byte
                                                    fields (payment indicator and status indicator). The
                                                    expanded payment indicator will continue to be stored
                                                    in the existing payment method indicator field. The
                                                    split of the current payment method indicator field
                                                    is due to the expansion of both pieces of date from
                                                    1-byte to 2-bytes.

                                                    NOTE2:  This field is populated for those claims
                                                    that are required to process through Outpatient
                                                    PPS Pricer.  The type of bills (TOB) required to
                                                    process through are: 12X, 13X, 14X (except Maryland
                                                    providers, Indian Health Providers, hospitals located
                                                    in American Samoa, Guam and Saipan and Critical
                                                    Access Hospitals (CAH)); 76X; 75X and 34X if
                                                    certain HCPCS are on the bill; and any outpatient
                                                    type of bill with a condition code '07' and certain
                                                    HCPCS.  These claim types could have lines that are
                                                    not required to price under OPPS rules so those
                                                    lines would not have data in this field.

                                                    Additional exception:  Virgin Island hospitals and
                                                    hospitals that furnish only inpatient Part B services.

                                                    DB2      ALIAS : REV_STUS_IND_CD
                                                    SAS      ALIAS : RSTUSIND
                                                    STANDARD ALIAS : REV_CNTR_STUS_IND_CD

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : REV_CNTR_STUS_IND_TB

  276. Revenue Center Duplicate Claim Check Indicator Code
                                 1   4294   4294    CHAR

                                                    Effective 1/1/2009 with the implementation of NCH/NMUD
                                                    CR#4, the code used to identify an item or service that
                                                    appeared to be a duuplicate but has been reviewed by an
                                                    FI or MAC and appropriately approved for payment.

                                                    DB2      ALIAS : DUP_CLM_CHK_IND_CD
                                                    SAS      ALIAS : DUP-CHK
                                                    STANDARD ALIAS : REV_CNTR_DUP_CLM_CHK_IND_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : REV_CNTR_DUP_CLM_CHK_IND_TB

  277. Revenue Center APC Buffer Code
                                 2   4295   4296    CHAR

                                                    APC - Ambulatory Payment Classification
                                                    Effective 1/1/2009 with the implementation of CR#4, the
                                                    code used to identify related line items that make up a
                                                    composite APC group.  This field is only applicable to
                                                    outpatient PPS claims.

                                                    DB2      ALIAS : REV_CNTR_BUFR_CD
                                                    SAS      ALIAS : APCBUFR
                                                    STANDARD ALIAS : REV_CNTR_APC_BUFR_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : REV_CNTR_APC_BUFR_TB

  278. Revenue Center Rendering Physician NPI Num
                                10   4297   4306    CHAR

                                                    Effective with Version 'J', the NPI of the rendering
                                                    physician who performed the service.

                                                    DB2      ALIAS : RNDRNG_NPI_NUM
                                                    SAS      ALIAS : REVNPI
                                                    STANDARD ALIAS : REV_CNTR_RNDRNG_PHYSN_NPI_NUM

                                                    LENGTH         : 10

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       REV_RNDRNG_PHYSN_NPI_NUM_LIM

  279. Revenue Center Rendering Physician Surname
                                 6   4307   4312    CHAR

                                                    Effective with Version 'J', the 6 position last name
                                                    of the rendering physician who performed the service.

                                                    DB2      ALIAS : RNDRNG_SRNM_NAME
                                                    SAS      ALIAS : REVSRNM
                                                    STANDARD ALIAS : REV_CNTR_RNDRNG_SRNM_NAME

                                                    LENGTH         : 6

  280. Revenue Center Paperwork (PWK) Code
                                 2   4313   4314    CHAR

                                                    Effective with CR#6, the code used to indicate a provider
                                                    has submitted an electronic claim that requires additional
                                                    documentation.

                                                    DB2      ALIAS : REV_CNTR_PWK_CD
                                                    STANDARD ALIAS : REV_CNTR_PWK_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : REV_CNTR_PWK_TB

  281. Rendering Physician Specialty Code
                                 2   4315   4316    CHAR

                                                    Effective with CR#7, the code used to identify the
                                                    CMS specialty code corresponding to the rendering
                                                    physician at the revenue center line.

                                                    NOTE:  Medicare needs to identify primary physicians/
                                                    practitioners of service not only for use in standard
                                                    claims transactions but also for review, fraud detection,
                                                    and planning purposes.  In order to do this, CMS must
                                                    be able to determine the rendering physician/practitioner
                                                    for each service billed to Medicare and store this infor-
                                                    mation in our databases that serve as the source for data
                                                    analysis.

                                                    DB2      ALIAS : REV_CNTR_SPCLTY_CD
                                                    SAS      ALIAS : RSPCLTY
                                                    STANDARD ALIAS : REV_CNTR_PHYSN_SPCLTY_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    (CMS CR7578)

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       REV_CNTR_RNDRNG_SPCLTY_CD_LIM

                                                    CODE TABLE     : CMS_PRVDR_SPCLTY_TB

  282. Revenue Center Therapy CAP Indicator 1 Code
                                 1   4317   4317    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify whether the claim line is subject to a therapy cap.

                                                    DB2      ALIAS : REV_THRPY_CAP_1_CD
                                                    SAS      ALIAS : RTHRPY1
                                                    STANDARD ALIAS : REV_CNTR_THRPY_CAP_IND_1_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : REV_CNTR_THRPY_CAP_IND_CD_TB

  283. Revenue Center Therapy CAP Indicator 2 Code
                                 1   4318   4318    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify whether the claim line is subject to a therapy cap.

                                                    DB2      ALIAS : REV_THRPY_CAP_2_CD
                                                    SAS      ALIAS : RTHRPY2
                                                    STANDARD ALIAS : REV_CNTR_THRPY_CAP_IND_2_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : REV_CNTR_THRPY_CAP_IND_CD_TB

  284. Revenue Center Therapy CAP Indicator 3 Code
                                 1   4319   4319    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify whether the claim line is subject to a therapy cap.

                                                    DB2      ALIAS : REV_THRPY_CAP_3_CD
                                                    SAS      ALIAS : RTHRPY3
                                                    STANDARD ALIAS : REV_CNTR_THRPY_CAP_IND_3_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : REV_CNTR_THRPY_CAP_IND_CD_TB

  285. Revenue Center Therapy CAP Indicator 4 Code
                                 1   4320   4320    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify whether the claim line is subject to a therapy cap.

                                                    DB2      ALIAS : REV_THRPY_CAP_4_CD
                                                    SAS      ALIAS : RTHRPY4
                                                    STANDARD ALIAS : REV_CNTR_THRPY_CAP_IND_4_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : REV_CNTR_THRPY_CAP_IND_CD_TB

  286. Revenue Center Therapy CAP Indicator 5 Code
                                 1   4321   4321    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify whether the claim line is subject to a therapy cap.

                                                    DB2      ALIAS : REV_THRPY_CAP_5_CD
                                                    SAS      ALIAS : RTHRPY5
                                                    STANDARD ALIAS : REV_CNTR_THRPY_CAP_IND_5_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : REV_CNTR_THRPY_CAP_IND_CD_TB

  287. Revenue Center FPS Model Number
                                 2   4322   4323    CHAR

                                                    Effective with Version 'K', this field identifies an
                                                    FPS analytic model that identifies claims that may
                                                    be high risk for fraud based on specific information.

                                                    DB2      ALIAS : REV_FPS_MODEL_NUM
                                                    SAS      ALIAS : RMODEL
                                                    STANDARD ALIAS : REV_CNTR_FPS_MODEL_NUM

                                                    LENGTH         : 2

  288. Revenue Center FPS Reason Code
                                 3   4324   4326    CHAR

                                                    Effective with Version 'K', this field identifies the
                                                    reason codes used to explain why a claim was not
                                                    paid or how the claim was paid.  These codes also
                                                    show the reason for any claim financial adjustment
                                                    such as denial, reductions or increases in payment.

                                                    DB2      ALIAS : REV-FPS-RSN-CD
                                                    SAS      ALIAS : RFPSRSN
                                                    STANDARD ALIAS : REV_CNTR_FPS_RSN_CD

                                                    LENGTH         : 3

                                                    CODE TABLE     : CLM_ADJ_RSN_TB

  289. Revenue Center FPS Remark Code
                                 5   4327   4331    CHAR

                                                    Effective with Version 'K', the codes used to
                                                    convey information about remittance processing or
                                                    to provide a supplemental explanation for an
                                                    adjustment already described by a Claim
                                                    Adjustment Reason Code.

                                                    DB2      ALIAS : REV_FPS_RMRK_CD
                                                    SAS      ALIAS : RFPSRMRK
                                                    STANDARD ALIAS : REV_CNTR_FPS_RMRK_CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_RMTNC_ADVC_TB

  290. Revenue Center FPS MSN 1 Code
                                 5   4332   4336    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : REV_FPS_MSN_1_CD
                                                    SAS      ALIAS : RFPSMSN1
                                                    STANDARD ALIAS : REV_CNTR_FPS_MSN_1_CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  291. Revenue Center FPS MSN 2 Code
                                 5   4337   4341    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : REV_FPS_MSN_2_CD
                                                    SAS      ALIAS : RFPSMSN2
                                                    STANDARD ALIAS : REV_CNTR_FPS_MSN_2_CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  292. Revenue Center Patient/Initial Visit Add-On Payment Amount
                                 6   4342   4347    PACK

                                                    Effective with CR#9 (October 2014 release), this field represents
                                                    a base rate increase factor of 1.3516 for new patient initial
                                                    preventive physical examination (IPPE) and annual wellness
                                                    visit.

                                                    NOTE:  This field only applies to Outpatient claims.

                                                    DB2      ALIAS : REV_ADD_ON_AMT
                                                    SAS      ALIAS : ADDONAMT
                                                    STANDARD ALIAS : REV_CNTR_PTNT_ADD_ON_PMT_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  293. Revenue Center Prior Authorization Indicator Code
                                 4   4348   4351    CHAR

                                                    Effective with CR#9 (October 2014 release), this indicator is
                                                    assigned by CMS for each prior authorization program to define
                                                    the applicable line of busines (i.e. Part A, Part B, DME, Home
                                                    Health and Hospice).

                                                    NOTE: This field applies to all institutional claim.

                                                    DB2      ALIAS : REV_AUTHRZTN_CD
                                                    SAS      ALIAS : REVPRIOR
                                                    STANDARD ALIAS : REV_CNTR_PRIOR_AUTHRZTN_IND_CD

                                                    LENGTH         : 4

                                                    CODE TABLE     : REV_CNTR_PRIOR_AUTHRZTN_TB

  294. Revenue Center Unique Tracking Number
                                14   4352   4365    CHAR

                                                    Effective with CR#9 (October 2014 release), this field
                                                    represents the number assigned to each prior
                                                    authorization request.

                                                    NOTE: This field applies to all institutional claims.

                                                    DB2      ALIAS : REV_UNIQ_TRKNG_NUM
                                                    SAS      ALIAS : REVTRKNG
                                                    STANDARD ALIAS : REV_CNTR_UNIQ_TRKNG_NUM

                                                    LENGTH         : 14

                                                    DERIVATIONS :
                                                    Position 1 - 2 = MAC Identifier (e.g. RR for Railroad,
                                                    OF = Jurisdiction F, 05 = Jurisdiction
                                                    5, etc.)
                                                    Position 3     = Line of Business (e.g. A = Part A,
                                                    B = Part B, D = DME & H = Home Health
                                                    Hospice)
                                                    Position 4- 14 = a unique sequence number assigned by
                                                    the Shared System

  295. Revenue Center Representative Payee (RP) Indicator Code
                                 1   4366   4366    CHAR

                                                    Effective with CR#11, this field will be used to designate by-
                                                    passing of the prior authorization processing for claims with a
                                                    representative payee when an 'R' is present in the field.

                                                    NOTE:  Data will not start coming in until April 2016.  This field
                                                    was added to the January 2016 release because our workload (FA fix)
                                                    will not allow us to implement another CR in April.

                                                    DB2      ALIAS : REV_CNTR_RP_IND_CD
                                                    SAS      ALIAS : RCRPIND
                                                    STANDARD ALIAS : REV_CNTR_RP_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : RP_IND_TB

  296. Revenue Center Transitional Drug Add-On Payment Amount
                                 6   4367   4372    PACK

                                                    Effective with CR#13 (January 2018 release), the amount for the
                                                    Transitional Drug Add-On Payment Adjustment (TDAPA) for ESRD
                                                    claims (72X) with injectable, intraveneous, and oral
                                                    calcimimetics when reported with an AX modifier.   These
                                                    services qualify for an add-on payment from the ESRD Pricer.

                                                    NOTE:  This field only applies to Outpatient claims.

                                                    DB2      ALIAS : TRNSTNL_DRUG_AMT
                                                    SAS      ALIAS : TDAPAAMT
                                                    STANDARD ALIAS : REV_CNTR_TRNSTNL_DRUG_AMT

                                                    LENGTH         : 7.4    SIGNED : Y

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                           $$$$$$$cccc

  297. Revenue Center Model Reimbursement Amount
                                 6   4373   4378    PACK

                                                    Effective with CR#16, this line-level field will be used
                                                    to identify the "Net Reimbursement Amount" of what
                                                    Medicare would have paid for the Global Budget Service
                                                    reflected at the line level, from a hospital participating
                                                    in the particular model.

                                                    Note: For the participating hospitals in the PA model
                                                    all inpatient and outpatient services (Facility/Technical
                                                    Services) are considered part of the Model/Global
                                                    Budget Services. Basically, all of the services for a
                                                    participating hospital would be global except for CAH
                                                    Method II (85X) claim lines with revenue center codes
                                                    096X, 097X and 098X. The CAH Method II professional
                                                    services (rev codes 096X, 097X and 098X) process as they
                                                    do today, they have nothing to do with the model.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : RCMODELA
                                                    STANDARD ALIAS : REV_CNTR_MODEL_REIMBRSMT_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  298.
                               343   4379   4721    CHAR

                                                    DB2      ALIAS : H_FILLER_8

                                                    LENGTH         : 343

  299. End of Record Code
                                 3  31386  31388    CHAR

                                                    Effective with Version 'I', the code used
                                                    to identify the end of a record/segment or
                                                    the end of the claim.

                                                    DB2      ALIAS : END_REC_CD
                                                    SAS      ALIAS : EOR
                                                    STANDARD ALIAS : END_REC_CD
                                                    TITLE    ALIAS : END_OF_REC

                                                    LENGTH         : 3

                                                    COMMENTS :
                                                    Prior to Version I this field was named:
                                                    END_REC_CNSTNT.

                                                    SOURCE         : NCH

                                                    CODE TABLE     : END_REC_TB



                                                     QUERY: RIFQQ11, RIFQQ21 ON DB2T
                                                    ***********END OF MAIN REPORT FOR RECORD: FI_OP_CLM_REC***********


1
  TABLE OF CODES APPENDIX FOR RECORD: FI_OP_CLM_REC,  STATUS: PROD, VERSION: 20014
  PRINTED: 01/24/2020,  USER: F43D,  DATA SOURCE: CA REPOSITORY ON DB2T


 BENE_CWF_LOC_TB                         Beneficiary Common Working File Location Table

       B = Mid-Atlantic
       C = Southwest
       D = Northeast
       E = Great Lakes
       F = Great Western
       G = Keystone
       H = Southeast
       I = South
       J = Pacific



 BENE_IDENT_TB                           Beneficiary Identification Code (BIC) Table

       Social Security Administration:

       A  = Primary claimant
       B  = Aged wife, age 62 or over (1st
            claimant)
       B1 = Aged husband, age 62 or over (1st
            claimant)
       B2 = Young wife, with a child in her care
            (1st claimant)
       B3 = Aged wife (2nd claimant)
       B4 = Aged husband (2nd claimant)
       B5 = Young wife (2nd claimant)
       B6 = Divorced wife, age 62 or over (1st
            claimant)
       B7 = Young wife (3rd claimant)
       B8 = Aged wife (3rd claimant)
       B9 = Divorced wife (2nd claimant)
       BA = Aged wife (4th claimant)
       BD = Aged wife (5th claimant)
       BG = Aged husband (3rd claimant)
       BH = Aged husband (4th claimant)
       BJ = Aged husband (5th claimant)
       BK = Young wife (4th claimant)
       BL = Young wife (5th claimant)
       BN = Divorced wife (3rd claimant)
       BP = Divorced wife (4th claimant)
       BQ = Divorced wife (5th claimant)
       BR = Divorced husband (1st claimant)
       BT = Divorced husband (2nd claimant)
       BW = Young husband (2nd claimant)
       BY = Young husband (1st claimant)
       C1-C9,CA-CZ = Child (includes minor, student
                     or disabled child)
       D  = Aged widow, 60 or over (1st claimant)
       D1 = Aged widower, age 60 or over (1st
            claimant)
       D2 = Aged widow (2nd claimant)
       D3 = Aged widower (2nd claimant)
       D4 = Widow (remarried after attainment of
            age 60) (1st claimant)
       D5 = Widower (remarried after attainment of
            age 60) (1st claimant)
       D6 = Surviving divorced wife, age 60 or over
            (1st claimant)
       D7 = Surviving divorced wife (2nd claimant)
       D8 = Aged widow (3rd claimant)
       D9 = Remarried widow (2nd claimant)
       DA = Remarried widow (3rd claimant)
       DD = Aged widow (4th claimant)
       DG = Aged widow (5th claimant)
       DH = Aged widower (3rd claimant)
       DJ = Aged widower (4th claimant)
       DK = Aged widower (5th claimant)
       DL = Remarried widow (4th claimant)
       DM = Surviving divorced husband (2nd
            claimant)
       DN = Remarried widow (5th claimant)
       DP = Remarried widower (2nd claimant)
       DQ = Remarried widower (3rd claimant)
       DR = Remarried widower (4th claimant)
       DS = Surviving divorced husband (3rd
            claimant)
       DT = Remarried widower (5th claimant)
       DV = Surviving divorced wife (3rd claimant)
       DW = Surviving divorced wife (4th claimant)
       DX = Surviving divorced husband (4th
            claimant)
       DY = Surviving divorced wife (5th claimant)
       DZ = Surviving divorced husband (5th
            claimant)
       E  = Mother (widow) (1st claimant)
       E1 = Surviving divorced mother (1st
            claimant)
       E2 = Mother (widow) (2nd claimant)
       E3 = Surviving divorced mother (2nd
            claimant)
       E4 = Father (widower) (1st claimant)
       E5 = Surviving divorced father (widower)
            (1st claimant)
       E6 = Father (widower) (2nd claimant)
       E7 = Mother (widow) (3rd claimant)
       E8 = Mother (widow) (4th claimant)
       E9 = Surviving divorced father (widower)
            (2nd claimant)
       EA = Mother (widow) (5th claimant)
       EB = Surviving divorced mother (3rd
            claimant)
       EC = Surviving divorced mother (4th
            claimant)
       ED = Surviving divorced mother (5th
            claimant
       EF = Father (widower) (3rd claimant)
       EG = Father (widower) (4th claimant)
       EH = Father (widower) (5th claimant)
       EJ = Surviving divorced father (3rd
            claimant)
       EK = Surviving divorced father (4th
            claimant)
       EM = Surviving divorced father (5th
            claimant)
       F1 = Father
       F2 = Mother
       F3 = Stepfather
       F4 = Stepmother
       F5 = Adopting father
       F6 = Adopting mother
       F7 = Second alleged father
       F8 = Second alleged mother
       J1 = Primary prouty entitled to HIB
            (less than 3 Q.C.) (general fund)
       J2 = Primary prouty entitled to HIB
            (over 2 Q.C.) (RSI trust fund)
       J3 = Primary prouty not entitled to HIB
            (less than 3 Q.C.) (general fund)
       J4 = Primary prouty not entitled to HIB
            (over 2 Q.C.) (RSI trust fund)
       K1 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (1st claimant)
       K2 = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (1st claimant)
       K3 = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (1st
            claimant)
       K4 = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (1st
            claimant)
       K5 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (2nd claimant)
       K6 = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (2nd claimant)
       K7 = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (2nd
            claimant)
       K8 = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (2nd
            claimant)
       K9 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (3rd claimant)
       KA = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (3rd claimant)
       KB = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (3rd
            claimant)
       KC = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (3rd
            claimant)
       KD = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (4th claimant)
       KE = Prouty wife entitled to HIB (over 2 Q.C
            (4th claimant)
       KF = Prouty wife not entitled to HIB (less
            than 3 Q.C.)(4th claimant)
       KG = Prouty wife not entitled to HIB (over
            2 Q.C.)(4th claimant)
       KH = Prouty wife entitled to HIB (less than
            3 Q.C.)(5th claimant)
       KJ = Prouty wife entitled to HIB (over 2
            Q.C.) (5th claimant)
       KL = Prouty wife not entitled to HIB (less
            than 3 Q.C.)(5th claimant)
       KM = Prouty wife not entitled to HIB (over
            2 Q.C.) (5th claimant)
       M  = Uninsured-not qualified for deemed HIB
       M1 = Uninsured-qualified but refused HIB
       T  = Uninsured-entitled to HIB under deemed
            or renal provisions
       TA = MQGE (primary claimant)
       TB = MQGE aged spouse (first claimant)
       TC = MQGE disabled adult child (first claimant)
       TD = MQGE aged widow(er) (first claimant)
       TE = MQGE young widow(er) (first claimant)
       TF = MQGE parent (male)
       TG = MQGE aged spouse (second claimant)
       TH = MQGE aged spouse (third claimant)
       TJ = MQGE aged spouse (fourth claimant)
       TK = MQGE aged spouse (fifth claimant)
       TL = MQGE aged widow(er) (second claimant)
       TM = MQGE aged widow(er) (third claimant)
       TN = MQGE aged widow(er) (fourth claimant)
       TP = MQGE aged widow(er) (fifth claimant)
       TQ = MQGE parent (female)
       TR = MQGE young widow(er) (second claimant)
       TS = MQGE young widow(er) (third claimant)
       TT = MQGE young widow(er) (fourth claimant)
       TU = MQGE young widow(er) (fifth claimant)
       TV = MQGE disabled widow(er) fifth claimant
       TW = MQGE disabled widow(er) first claimant
       TX = MQGE disabled widow(er) second claimant
       TY = MQGE disabled widow(er) third claimant
       TZ = MQGE disabled widow(er) fourth claimant
       T2-T9 = Disabled child (second to ninth
               claimant)
       W  = Disabled widow, age 50 or over (1st
            claimant)
       W1 = Disabled widower, age 50 or over (1st
            claimant)
       W2 = Disabled widow (2nd claimant)
       W3 = Disabled widower (2nd claimant)
       W4 = Disabled widow (3rd claimant)
       W5 = Disabled widower (3rd claimant)
       W6 = Disabled surviving divorced wife (1st
            claimant)
       W7 = Disabled surviving divorced wife (2nd
            claimant)
       W8 = Disabled surviving divorced wife (3rd
            claimant)
       W9 = Disabled widow (4th claimant)
       WB = Disabled widower (4th claimant)
       WC = Disabled surviving divorced wife (4th
            claimant)
       WF = Disabled widow (5th claimant)
       WG = Disabled widower (5th claimant)
       WJ = Disabled surviving divorced wife (5th
            claimant)
       WR = Disabled surviving divorced husband
            (1st claimant)
       WT = Disabled surviving divorced husband
            (2nd claimant)

       Railroad Retirement Board:

          NOTE:
          Employee:  a Medicare beneficiary who is
                     still working or a worker who
                     died before retirement
          Annuitant: a person who retired under the
                     railroad retirement act on or
                     after 03/01/37
          Pensioner: a person who retired prior to
                     03/01/37 and was included in the
                     railroad retirement act

       10 = Retirement - employee or annuitant
       80 = RR pensioner (age or disability)
       14 = Spouse of RR employee or annuitant
            (husband or wife)
       84 = Spouse of RR pensioner
       43 = Child of RR employee
       13 = Child of RR annuitant
       17 = Disabled adult child of RR annuitant
       46 = Widow/widower of RR employee
       16 = Widow/widower of RR annuitant
       86 = Widow/widower of RR pensioner
       43 = Widow of employee with a child in her care
       13 = Widow of annuitant with a child in her care
       83 = Widow of pensioner with a child in her care
       45 = Parent of employee
       15 = Parent of annuitant
       85 = Parent of pensioner
       11 = Survivor joint annuitant
            (reduced benefits taken to insure benefits
            for surviving spouse)



 BENE_MDCR_STUS_TB                       CWF Beneficiary Medicare Status Table

       10 = Aged without ESRD
       11 = Aged with ESRD
       20 = Disabled without ESRD
       21 = Disabled with ESRD
       31 = ESRD only



 BENE_PRMRY_PYR_TB                       Beneficiary Primary Payer Table

       A = Working aged bene/spouse with employer
           group health plan (EGHP)
       B = End stage renal disease (ESRD) beneficiary
           in the 18 month coordination period with
           an employer group health plan
       C = Conditional payment by Medicare; future
           reimbursement expected
       D = Automobile no-fault (eff. 4/97; Prior
           to 3/94, also included any liability
           insurance)
       E = Workers' compensation
       F = Public Health Service or other federal
           agency (other than Dept. of Veterans
           Affairs)
       G = Working disabled bene (under age 65
           with LGHP)
       H = Black Lung
       I = Dept. of Veterans Affairs
       J = Any liability insurance
           (eff. 3/94 - 3/97)
       L = Any liability insurance (eff. 4/97)
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       M = Override code:  EGHP services involved
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       N = Override code:  non-EGHP services involved
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       BLANK = Medicare is primary payer (not sure
               of effective date: in use 1/91, if
               not earlier)

                    ***Prior to 12/90***

       Y = Other secondary payer investigation
           shows Medicare as primary payer
       Z = Medicare is primary payer

       NOTE:  Values C, M, N, Y, Z and BLANK
              indicate Medicare is primary payer.
              (values Z and Y were used prior to
              12/90.  BLANK was suppose to be
              effective after 12/90, but may have
              been used prior to that date.)



 BENE_RACE_TB                            Beneficiary Race Table

       0 = Unknown
       1 = White
       2 = Black
       3 = Other
       4 = Asian
       5 = Hispanic
       6 = North American Native



 BENE_SEX_IDENT_TB                       Beneficiary Sex Identification Table

       1 = Male
       2 = Female
       0 = Unknown



 CLM_ADJ_RSN_TB                          Claim Adjustment Reason Code

      1   = Deductible Amount
            Start: 01/01/1995
      2   = Coinsurance Amount
            Start: 01/01/1995
      3   = Co-payment Amount
            Start: 01/01/1995
      4   = The procedure code is inconsistent with the
            modifier used or a required modifier is
            missing. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 01/01/1995
      5   = The procedure code/bill type is
            inconsistent with the place of service.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      6   = The procedure/revenue code is inconsistent
            with the patient's age. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      7   = The procedure/revenue code is inconsistent
            with the patient's gender. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      8   = The procedure code is inconsistent with the
            provider type/specialty (taxonomy). Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      9   = The diagnosis is inconsistent with the
            patient's age. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      10  = The diagnosis is inconsistent with the
            patient's gender. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      11  = The diagnosis is inconsistent with the
            procedure. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
            Last Modified: 09/20/2009
      12  = The diagnosis is inconsistent with the
            provider type. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      13  = The date of death precedes the date of
            service.
            Start: 01/01/1995
      14  = The date of birth follows the date of
            service.
            Start: 01/01/1995
      15  = The authorization number is missing,
            invalid, or does not apply to the billed
            services or provider.
            Start: 01/01/1995
      16  = Claim/service lacks information which is
            needed for adjudication. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject
            Reason Code, or Remittance Advice Remark
            Code that is not an ALERT.)
            Start: 01/01/1995
      17  = Requested information was not provided or
            was insufficient/incomplete. At least one
            Remark Code must be provided (may be
            comprised of either the Remittance Advice
            Remark Code or NCPDP Reject Reason Code.)
            Start: 01/01/1995
            Stop: 07/01/2009
      18  = Duplicate claim/service. This change
            effective 1/1/2013: Exact duplicate claim/
            service (Use only with Group Code OA)
            Start: 01/01/1995
      19  = This is a work-related injury/illness and
            thus the liability of the Worker's
            Compensation Carrier.
            Start: 01/01/1995
      20  = This injury/illness is covered by the
            liability carrier.
            Start: 01/01/1995
      21  = This injury/illness is the liability of
            the no-fault carrier.
            Start: 01/01/1995
      22  = This care may be covered by another payer
            per coordination of benefits.
            Start: 01/01/1995
      23  = The impact of prior payer(s) adjudication
            including payments and/or adjustments.
            (Use only with Group Code OA)
            Start: 01/01/1995
      24  = Charges are covered under a capitation
            agreement/managed care plan.
            Start: 01/01/1995
      25  = Payment denied. Your Stop loss deductible
            has not been met.
            Start: 01/01/1995
            Stop: 04/01/2008
      26  = Expenses incurred prior to coverage.
            Start: 01/01/1995
      27  = Expenses incurred after coverage terminated
            Start: 01/01/1995
      28  = Coverage not in effect at the time the
            service was provided.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Redundant to codes 26&27.
      29  = The time limit for filing has expired.
            Start: 01/01/1995
      30  = Payment adjusted because the patient has
            not met the required eligibility, spend
            down, waiting, or residency requirements.
            Start: 01/01/1995
            Stop: 02/01/2006
      31  = Patient cannot be identified as our insured
            Start: 01/01/1995
      32  = Our records indicate that this dependent is
            not an eligible dependent as defined.
            Start: 01/01/1995
      33  = Insured has no dependent coverage.
            Start: 01/01/1995
      34  = Insured has no coverage for newborns.
            Start: 01/01/1995
      35  = Lifetime benefit maximum has been reached.
            Start: 01/01/1995
      36  = Balance does not exceed co-payment amount.
            Start: 01/01/1995
            Stop: 10/16/2003
      37  = Balance does not exceed deductible.
            Start: 01/01/1995
            Stop: 10/16/2003
      38  = Services not provided or authorized by
            designated (network/primary care) providers.
            Start: 01/01/1995
            Stop: 01/01/2013
      39  = Services denied at the time authorization/
            pre-certification was requested.
            Start: 01/01/1995
      40  = Charges do not meet qualifications for
            emergent/urgent care. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      41  = Discount agreed to in Preferred Provider
            contract.
            Start: 01/01/1995
            Stop: 10/16/2003
      42  = Charges exceed our fee schedule or maximum
            allowable amount. (Use CARC 45)
            Start: 01/01/1995
            Stop: 06/01/2007
      43  = Gramm-Rudman reduction.
            Start: 01/01/1995
            Stop: 07/01/2006
      44  = Prompt-pay discount.
            Start: 01/01/1995
      45  = Charge exceeds fee schedule/maximum
            allowable or contracted/legislated fee
            arrangement. (Use Group Codes PR or CO
            depending upon liability). This change
            effective 7/1/2013: Charge exceeds fee
            schedule/maximum allowable or contracted/
            legislated fee arrangement. (Use only with
            Group Codes PR or CO depending upon
            liability)
            Start: 01/01/1995
      46  = This (these) service(s) is (are) not
            covered.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 96.
      47  = This (these) diagnosis(es) is (are) not
            covered, missing, or are invalid.
            Start: 01/01/1995
            Stop: 02/01/2006
      48  = This (these) procedure(s) is (are) not
            covered.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 96.
      49  = These are non-covered services because this
            is a routine exam or screening procedure
            done in conjunction with a routine exam.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      50  = These are non-covered services because this
            is not deemed a 'medical necessity' by the
            payer. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 01/01/1995
      51  = These are non-covered services because this
            is a pre-existing condition. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      52  = The referring/prescribing/rendering
            provider is not eligible to refer/prescribe
            /order/perform the service billed.
            Start: 01/01/1995
            Stop: 02/01/2006
      53  = Services by an immediate relative or a
            member of the same household are not
            covered.
            Start: 01/01/1995
      54  = Multiple physicians/assistants are not
            covered in this case. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      55  = Procedure/treatment is deemed experimental/
            investigational by the payer. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      56  = Procedure/treatment has not been deemed
            'proven to be effective' by the payer.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      57  = Payment denied/reduced because the payer
            deems the information submitted does not
            support this level of service, this many
            services, this length of service, this
            dosage, or this day's supply.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Split into codes 150, 151, 152, 153
            and 154.
      58  = Treatment was deemed by the payer to have
            been rendered in an inappropriate or
            invalid place of service. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      59  = Processed based on multiple or concurrent
            procedure rules. (For example multiple
            surgery or diagnostic imaging, concurrent
            anesthesia.) Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      60  = Charges for outpatient services are not
            covered when performed within a period of
            time prior to or after inpatient services.
            Start: 01/01/1995
      61  = Penalty for failure to obtain second
            surgical opinion. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      62  = Payment denied/reduced for absence of,
            or exceeded, pre-certification/
            authorization.
            Start: 01/01/1995
            Stop: 04/01/2007
      63  = Correction to a prior claim.
            Start: 01/01/1995
            Stop: 10/16/2003
      64  = Denial reversed per Medical Review.
            Start: 01/01/1995
            Stop: 10/16/2003
      65  = Procedure code was incorrect. This payment
            reflects the correct code.
            Start: 01/01/1995
            Stop: 10/16/2003
      66  = Blood Deductible.
            Start: 01/01/1995
      67  = Lifetime reserve days. (Handled in QTY,
            QTY01=LA)
            Start: 01/01/1995
            Stop: 10/16/2003
      68  = DRG weight. (Handled in CLP12)
            Start: 01/01/1995
            Stop: 10/16/2003
      69  = Day outlier amount.
            Start: 01/01/1995
      70  = Cost outlier - Adjustment to compensate for
            additional costs.
            Start: 01/01/1995
      71  = Primary Payer amount.
            Start: 01/01/1995
            Stop: 06/30/2000
            Notes: Use code 23.
      72  = Coinsurance day. (Handled in QTY, QTY01=CD)
            Start: 01/01/1995
            Stop: 10/16/2003
      73  = Administrative days.
            Start: 01/01/1995
            Stop: 10/16/2003
      74  = Indirect Medical Education Adjustment.
            Start: 01/01/1995
      75  = Direct Medical Education Adjustment.
            Start: 01/01/1995
      76  = Disproportionate Share Adjustment.
            Start: 01/01/1995
      77  = Covered days. (Handled in QTY, QTY01=CA)
            Start: 01/01/1995
            Stop: 10/16/2003
      78  = Non-Covered days/Room charge adjustment.
            Start: 01/01/1995
      79  = Cost Report days. (Handled in MIA15)
            Start: 01/01/1995
            Stop: 10/16/2003
      80  = Outlier days. (Handled in QTY, QTY01=OU)
            Start: 01/01/1995
            Stop: 10/16/2003
      81  = Discharges.
            Start: 01/01/1995
            Stop: 10/16/2003
      82  = PIP days.
            Start: 01/01/1995
            Stop: 10/16/2003
      83  = Total visits.
            Start: 01/01/1995
            Stop: 10/16/2003
      84  = Capital Adjustment. (Handled in MIA)
            Start: 01/01/1995
            Stop: 10/16/2003
      85  = Patient Interest Adjustment (Use Only Group
            code PR)
            Start: 01/01/1995
            Notes: Only use when the payment of
            interest is the responsibility of the
            patient.
      86  = Statutory Adjustment.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Duplicative of code 45.
      87  = Transfer amount.
            Start: 01/01/1995
            Stop: 01/01/2012
      88  = Adjustment amount represents collection
            against receivable created in prior
            overpayment.
            Start: 01/01/1995
            Stop: 06/30/2007
      89  = Professional fees removed from charges.
            Start: 01/01/1995
      90  = Ingredient cost adjustment. Note: To be
            used for pharmaceuticals only.
            Start: 01/01/1995
      91  = Dispensing fee adjustment.
            Start: 01/01/1995
      92  = Claim Paid in full.
            Start: 01/01/1995
            Stop: 10/16/2003
      93  = No Claim level Adjustments.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: As of 004010, CAS at the claim level
            is optional.
      94  = Processed in Excess of charges.
            Start: 01/01/1995
      95  = Plan procedures not followed.
            Start: 01/01/1995
      96  = Non-covered charge(s). At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT.) Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      97  = The benefit for this service is included in
            the payment/allowance for another service/
            procedure that has already been adjudicated.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      98  = The hospital must file the Medicare claim
            for this inpatient non-physician service.
            Start: 01/01/1995
            Stop: 10/16/2003
      99  = Medicare Secondary Payer Adjustment Amount.
            Start: 01/01/1995
            Stop: 10/16/2003
      100 = Payment made to patient/insured/responsible
            party/employer.
            Start: 01/01/1995
      101 = Predetermination: anticipated payment upon
            completion of services or claim
            adjudication.
            Start: 01/01/1995
      102 = Major Medical Adjustment.
            Start: 01/01/1995
      103 = Provider promotional discount (e.g., Senior
            citizen discount).
            Start: 01/01/1995
      104 = Managed care withholding.
            Start: 01/01/1995
      105 = Tax withholding.
            Start: 01/01/1995
      106 = Patient payment option/election not in
            effect.
            Start: 01/01/1995
      107 = The related or qualifying claim/service was
            not identified on this claim. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      108 = Rent/purchase guidelines were not met.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      109 = Claim/service not covered by this payer/
            contractor. You must send the claim/service
            to the correct payer/contractor.
            Start: 01/01/1995
      110 = Billing date predates service date.
            Start: 01/01/1995
      111 = Not covered unless the provider accepts
            assignment.
            Start: 01/01/1995
      112 = Service not furnished directly to the
            patient and/or not documented.
            Start: 01/01/1995
      113 = Payment denied because service/procedure
            was provided outside the United States or
            as a result of war.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use Codes 157, 158 or 159.
      114 = Procedure/product not approved by the Food
            and Drug Administration.
            Start: 01/01/1995
      115 = Procedure postponed, canceled, or delayed.
            Start: 01/01/1995
      116 = The advance indemnification notice signed
            by the patient did not comply with
            requirements.
            Start: 01/01/1995
      117 = Transportation is only covered to the
            closest facility that can provide the
            necessary care.
            Start: 01/01/1995
      118 = ESRD network support adjustment.
            Start: 01/01/1995
      119 = Benefit maximum for this time period or
            occurrence has been reached.
            Start: 01/01/1995
      120 = Patient is covered by a managed care plan.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 24.
      121 = Indemnification adjustment - compensation
            for outstanding member responsibility.
            Start: 01/01/1995
      122 = Psychiatric reduction.
            Start: 01/01/1995
      123 = Payer refund due to overpayment.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Refer to implementation guide for
            proper handling of reversals.
      124 = Payer refund amount - not our patient.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Refer to implementation guide for
            proper handling of reversals.
      125 =  Submission/billing error(s). At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 01/01/1995
      126 = Deductible -- Major Medical
            Start: 02/28/1997
            Stop: 04/01/2008
            Notes: Use Group Code PR and code 1.
      127 = Coinsurance -- Major Medical
            Start: 02/28/1997
            Stop: 04/01/2008
            Notes: Use Group Code PR and code 2.
      128 = Newborn's services are covered in the
            mother's Allowance.
            Start: 02/28/1997
      129 = Prior processing information appears
            incorrect. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 02/28/1997
      130 = Claim submission fee.
            Start: 02/28/1997
      131 = Claim specific negotiated discount.
            Start: 02/28/1997
      132 = Prearranged demonstration project
            adjustment.
            Start: 02/28/1997
      133 = The disposition of the claim/service is
            pending further review. This change
            effective 1/1/2013: The disposition of the
            claim/service is pending further review.
            (Use only with Group Code OA)
            Start: 02/28/1997
      134 = Technical fees removed from charges.
            Start: 10/31/1998
      135 = Interim bills cannot be processed.
            Start: 10/31/1998
      136 = Failure to follow prior payer's coverage
            rules. (Use Group Code OA). This change
            effective 7/1/2013: Failure to follow prior
            payer's coverage rules. (Use only with
            Group Code OA)
            Start: 10/31/1998
      137 = Regulatory Surcharges, Assessments,
            Allowances or Health Related Taxes.
            Start: 02/28/1999
      138 = Appeal procedures not followed or time
            limits not met.
            Start: 06/30/1999
      139 = Contracted funding agreement - Subscriber
            is employed by the provider of services.
            Start: 06/30/1999
      140 = Patient/Insured health identification
            number and name do not match.
            Start: 06/30/1999
      141 = Claim spans eligible and ineligible periods
            of coverage.
            Start: 06/30/1999
            Stop: 07/01/2012
      142 = Monthly Medicaid patient liability amount.
            Start: 06/30/2000
      143 = Portion of payment deferred.
            Start: 02/28/2001
      144 = Incentive adjustment, e.g. preferred
            product/service.
            Start: 06/30/2001
      145 = Premium payment withholding
            Start: 06/30/2002
            Stop: 04/01/2008
            Notes: Use Group Code CO and code 45.
      146 = Diagnosis was invalid for the date(s) of
            service reported.
            Start: 06/30/2002
      147 = Provider contracted/negotiated rate expired
            or not on file.
            Start: 06/30/2002
      148 = Information from another provider was not
            provided or was insufficient/incomplete.
            At least one Remark Code must be provided
            (may be comprised of either the NCPDP
            Reject Reason Code, or Remittance Advice
            Remark Code that is not an ALERT.)
            Start: 06/30/2002
      149 = Lifetime benefit maximum has been reached
            for this service/benefit category.
            Start: 10/31/2002
      150 = Payer deems the information submitted does
            not support this level of service.
            Start: 10/31/2002
      151 = Payment adjusted because the payer deems
            the information submitted does not support
            this many/frequency of services.
            Start: 10/31/2002
      152 = Payer deems the information submitted does
            not support this length of service. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 10/31/2002
      153 = Payer deems the information submitted does
            not support this dosage.
            Start: 10/31/2002
      154 = Payer deems the information submitted does
            not support this day's supply.
            Start: 10/31/2002
      155 = Patient refused the service/procedure.
            Start: 06/30/2003
      156 = Flexible spending account payments. Note:
            Use code 187.
            Start: 09/30/2003
            Stop: 10/01/2009
      157 = Service/procedure was provided as a result
            of an act of war.
            Start: 09/30/2003
      158 = Service/procedure was provided outside of
            the United States.
            Start: 09/30/2003
      159 = Service/procedure was provided as a result
            of terrorism.
            Start: 09/30/2003
      160 = Injury/illness was the result of an
            activity that is a benefit exclusion.
            Start: 09/30/2003
      161 = Provider performance bonus
            Start: 02/29/2004
      162 = State-mandated Requirement for Property and
            Casualty, see Claim Payment Remarks Code
            for specific explanation.
            Start: 02/29/2004
      163 = Attachment referenced on the claim was not
            received.
            Start: 06/30/2004
      164 = Attachment referenced on the claim was not
            received in a timely fashion.
            Start: 06/30/2004
      165 = Referral absent or exceeded.
            Start: 10/31/2004
      166 = These services were submitted after this
            payers responsibility for processing claims
            under this plan ended.
            Start: 02/28/2005
      167 = This (these) diagnosis(es) is (are) not
            covered. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Payment Information REF), if present.
            Start: 06/30/2005
      168 = Service(s) have been considered under the
            patient's medical plan. Benefits are not
            available under this dental plan.
            Start: 06/30/2005
      169 = Alternate benefit has been provided.
            Start: 06/30/2005
      170 = Payment is denied when performed/billed by
            this type of provider. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
      171 = Payment is denied when performed/billed by
            this type of provider in this type of
            facility. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 06/30/2005
      172 = Payment is adjusted when performed/billed
            by a provider of this specialty. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 06/30/2005
      173 = Service was not prescribed by a physician.
            This change effective 7/1/2013: Service/
            equipment was not prescribed by a
            physician.
            Start: 06/30/2005
      174 = Service was not prescribed prior to
            delivery.
            Start: 06/30/2005
      175 = Prescription is incomplete.
            Start: 06/30/2005
      176 = Prescription is not current.
            Start: 06/30/2005
      177 = Patient has not met the required
            eligibility requirements.
            Start: 06/30/2005
      178 = Patient has not met the required spend
            down requirements.
            Start: 06/30/2005
      179 = Patient has not met the required waiting
            requirements. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF)
            , if present.
            Start: 06/30/2005
      180 = Patient has not met the required residency
            requirements.
            Start: 06/30/2005
      181 = Procedure code was invalid on the date of
            service.
            Start: 06/30/2005
      182 = Procedure modifier was invalid on the date
            of service.
            Start: 06/30/2005
      183 = The referring provider is not eligible to
            refer the service billed. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
      184 = The prescribing/ordering provider is not
            eligible to prescribe/order the service
            billed. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 06/30/2005
      185 = The rendering provider is not eligible to
            perform the service billed. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
            Last Modified: 09/20/2009
      186 = Level of care change adjustment.
            Start: 06/30/2005
      187 = Consumer Spending Account payments
            (includes but is not limited to Flexible
            Spending Account, Health Savings Account,
            Health Reimbursement Account, etc.)
            Start: 06/30/2005
      188 = This product/procedure is only covered when
            used according to FDA recommendations.
            Start: 06/30/2005
      189 = 'Not otherwise classified' or 'unlisted'
            procedure code (CPT/HCPCS) was billed when
            there is a specific procedure code for this
            procedure/service
            Start: 06/30/2005
      190 = Payment is included in the allowance for a
            Skilled Nursing Facility (SNF) qualified
            stay.
            Start: 10/31/2005
      191 = Not a work related injury/illness and thus
            not the liability of the workers'
            compensation carrier Note: If adjustment is
            at the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF)
            Start: 10/31/2005
      192 = Non standard adjustment code from paper
            remittance. Note: This code is to be used
            by providers/payers providing Coordination
            of Benefits information to another payer in
            the 837 transaction only. This code is only
            used when the non-standard code cannot be
            reasonably mapped to an existing Claims
            Adjustment Reason Code, specifically
            Deductible, Coinsurance and Co-payment.
            Start: 10/31/2005
      193 = Original payment decision is being
            maintained. Upon review, it was determined
            that this claim was processed properly.
            Start: 02/28/2006
      194 = Anesthesia performed by the operating
            physician, the assistant surgeon or the
            attending physician.
            Start: 02/28/2006
      195 = Refund issued to an erroneous priority
            payer for this claim/service.
            Start: 02/28/2006
      196 = Claim/service denied based on prior payer's
            coverage determination.
            Start: 06/30/2006
            Stop: 02/01/2007
            Notes: Use code 136.
      197 = Precertification/authorization/notification
            absent.
            Start: 10/31/2006
      198 = Precertification/authorization exceeded.
            Start: 10/31/2006
      199 = Revenue code and Procedure code do not
            match.
            Start: 10/31/2006
      200 = Expenses incurred during lapse in coverage
            Start: 10/31/2006
      201 = Workers' Compensation case settled. Patient
            is responsible for amount of this claim/
            service through WC 'Medicare set aside
            arrangement' or other agreement. (Use group
            code PR). This change effective 7/1/2013:
            Workers Compensation case settled. Patient
            is responsible for amount of this claim/
            service through WC 'Medicare set aside
            arrangement' or other agreement. (Use only
            with Group Code PR)
            Start: 10/31/2006
      202 = Non-covered personal comfort or convenience
            services.
            Start: 02/28/2007
      203 = Discontinued or reduced service.
            Start: 02/28/2007
      204 = This service/equipment/drug is not covered
            under the patient's current benefit plan
            Start: 02/28/2007
      205 = Pharmacy discount card processing fee
            Start: 07/09/2007
      206 = National Provider Identifier - missing.
            Start: 07/09/2007
      207 = National Provider identifier - Invalid
            format
            Start: 07/09/2007
      208 = National Provider Identifier - Not matched.
            Start: 07/09/2007
      209 = Per regulatory or other agreement. The
            provider cannot collect this amount from
            the patient. However, this amount may be
            billed to subsequent payer. Refund to
            patient if collected. (Use Group code OA)
            This change effective 7/1/2013: Per
            regulatory or other agreement. The provider.
            cannot collect this amount from the patient
            However, this amount may be billed to
            subsequent payer. Refund to patient if
            collected. (Use only with Group code OA)
            Start: 07/09/2007
      210 = Payment adjusted because pre-certification/
            authorization not received in a timely fashion
            Start: 07/09/2007
      211 = National Drug Codes (NDC) not eligible for
            rebate, are not covered.
            Start: 07/09/2007
      212 = Administrative surcharges are not covered
            Start: 11/05/2007
      213 = Non-compliance with the physician self
            referral prohibition legislation or payer
            policy.
            Start: 01/27/2008
      214 = Workers' Compensation claim adjudicated as
            non-compensable. This Payer not liable for
            claim or service/treatment. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            Workers' Compensation only
            Start: 01/27/2008
      215 = Based on subrogation of a third party
            settlement
            Start: 01/27/2008
      216 = Based on the findings of a review
            organization
            Start: 01/27/2008
      217 = Based on payer reasonable and customary
            fees. No maximum allowable defined by
            legislated fee arrangement. (Note: To be
            used for Property and Casualty only)
            Start: 01/27/2008
      218 = Based on entitlement to benefits. Note:
            If adjustment is at the Claim Level, the
            payer must send and the provider should
            refer to the 835 Insurance Policy Number
            Segment (Loop 2100 Other Claim Related
            Information REF qualifier 'IG') for the
            jurisdictional regulation. If adjustment is
            at the Line Level, the payer must send and
            the provider should refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment information REF)
            To be used for Workers' Compensation only
            Start: 01/27/2008
      219 = Based on extent of injury. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF).
            Start: 01/27/2008
      220 = The applicable fee schedule/fee database
            does not contain the billed code. Please
            resubmit a bill with the appropriate fee
            schedule/fee database code(s) that best
            describe the service(s) provided and
            supporting documentation if required.
            (Note: To be used for Property and Casualty
            only)
            Start: 01/27/2008
      221 = Workers' Compensation claim is under
            investigation. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). This change
            effective 7/1/2013: Claim is under
            investigation. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). (Note: To be used
            by Property & Casualty only)
            Start: 01/27/2008
      222 = Exceeds the contracted maximum number of
            hours/days/units by this provider for this
            period. This is not patient specific. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 06/01/2008
      223 = Adjustment code for mandated federal, state
            or local law/regulation that is not already
            covered by another code and is mandated
            before a new code can be created.
            Start: 06/01/2008
      224 = Patient identification compromised by
            identity theft. Identity verification
            required for processing this and future
            claims.
            Start: 06/01/2008
      225 = Penalty or Interest Payment by Payer (Only
            used for plan to plan encounter reporting
            within the 837)
            Start: 06/01/2008
      226 = Information requested from the Billing/
            Rendering Provider was not provided or was
            insufficient/incomplete. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.) This change effective
            7/1/2013: Information requested from the
            Billing/Rendering Provider was not provided
            or not provided timely or was insufficient/
            incomplete. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 09/21/2008
      227 = Information requested from the patient/
            insured/responsible party was not provided
            or was insufficient/incomplete. At least
            one Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 09/21/2008
      228 = Denied for failure of this provider,
            another provider or the subscriber to
            supply requested information to a previous
            payer for their adjudication
            Start: 09/21/2008
      229 = Partial charge amount not considered by
            Medicare due to the initial claim Type of
            Bill being 12X. Note: This code can only
            be used in the 837 transaction to convey
            Coordination of Benefits information when
            the secondary payer's cost avoidance policy
            allows providers to bypass claim submission
            to a prior payer. Use Group Code PR. This
            change effective 7/1/2013: Partial charge
            amount not considered by Medicare due to
            the initial claim Type of Bill being 12X.
            Note: This code can only be used in the
            837 transaction to convey Coordination of
            Benefits information when the secondary
            payer's cost avoidance policy allows
            providers to bypass claim submission to a
            prior payer. (Use only with Group Code PR)
            Start: 01/25/2009
      230 = No available or correlating CPT/HCPCS code
            to describe this service. Note: Used only
            by Property and Casualty.
            Start: 01/25/2009
      231 = Mutually exclusive procedures cannot be
            done in the same day/setting. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 07/01/2009
      232 = Institutional Transfer Amount. Note -
            Applies to institutional claims only and
            explains the DRG amount difference when the
            patient care crosses multiple institutions.
            Start: 11/01/2009
      233 = Services/charges related to the treatment
            of a hospital-acquired condition or
            preventable medical error.
            Start: 01/24/2010
      234 = This procedure is not paid separately. At
            least one Remark Code must be provided
            (may be comprised of either the NCPDP
            Reject Reason Code, or Remittance Advice
            Remark Code that is not an ALERT.)
            Start: 01/24/2010
      235 = Sales Tax
            Start: 06/06/2010
      236 = This procedure or procedure/modifier
            combination is not compatible with another
            procedure or procedure/modifier combination
            provided on the same day according to the
            National Correct Coding Initiative. This
            change effective 7/1/2013: This procedure
            or procedure/modifier combination is not
            compatible with another procedure or
            procedure/modifier combination provided on
            the same day according to the National
            Correct Coding Initiative or workers
            compensation state regulations/ fee
            schedule requirements.
            Start: 01/30/2011
      237 = Legislated/Regulatory Penalty. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 06/05/2011
      238 = Claim spans eligible and ineligible periods
            of coverage, this is the reduction for the
            ineligible period (use Group Code PR). This
            change effective 7/1/2013: Claim spans
            eligible and ineligible periods of coverage
            , this is the reduction for the ineligible
            period. (Use only with Group Code PR)
            Start: 03/01/2012
      239 = Claim spans eligible and ineligible periods
            of coverage. Rebill separate claims.
            Start: 03/01/2012
      240 = The diagnosis is inconsistent with the
            patient's birth weight. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/03/2012
      241 = Low Income Subsidy (LIS) Co-payment Amount
            Start: 06/03/2012
      242 = Services not provided by network/primary
            care providers.
            Start: 06/03/2012
      243 = Services not authorized by network/primary
            care providers.
            Start: 06/03/2012
      244 = Payment reduced to zero due to litigation.
            Additional information will be sent
            following the conclusion of litigation.
            To be used for Property & Casualty only.
            Start: 09/30/2012
      245 = Provider performance program withhold.
            Start: 09/30/2012
      246 = This non-payable code is for required
            reporting only.
            Start: 09/30/2012
      247 = Deductible for Professional service
            rendered in an Institutional setting and
            billed on an Institutional claim.
            Start: 09/30/2012
            Notes: For Medicare Bundled Payment use
            only, under the Patient Protection and
            Affordable Care Act (PPACA).
      248 = Coinsurance for Professional service
            rendered in an Institutional setting and
            billed on an Institutional claim.
            Start: 09/30/2012
            Notes: For Medicare Bundled Payment use
            only, under the Patient Protection and
            Affordable Care Act (PPACA).
      249 = This claim has been identified as a
            readmission. (Use only with Group Code CO)
            Start: 09/30/2012
      250 = The attachment content received is
            inconsistent with the expected content.
            Start: 09/30/2012
      251 = The attachment content received did not
            contain the content required to process
            this claim or service.
            Start: 09/30/2012
      252 = An attachment is required to adjudicate
            this claim/service. At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT).
            Start: 09/30/2012
      A0  = Patient refund amount.
            Start: 01/01/1995
      A1  = Claim/Service denied. At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT.)
            Start: 01/01/1995
      A2  = Contractual adjustment.
            Start: 01/01/1995
            Stop: 01/01/2008
            Notes: Use Code 45 with Group Code 'CO' or
            use another appropriate specific adjustment
            code.
      A3  = Medicare Secondary Payer liability met.
            Start: 01/01/1995
            Stop: 10/16/2003
      A4  = Medicare Claim PPS Capital Day Outlier
            Amount.
            Start: 01/01/1995
            Stop: 04/01/2008
      A5  = Medicare Claim PPS Capital Cost Outlier
            Amount.
            Start: 01/01/1995
      A6  = Prior hospitalization or 30 day transfer
            requirement not met.
            Start: 01/01/1995
      A7  = Presumptive Payment Adjustment
            Start: 01/01/1995
      A8  = Ungroupable DRG.
            Start: 01/01/1995
      B1  = Non-covered visits.
            Start: 01/01/1995
      B2  = Covered visits.
            Start: 01/01/1995
            Stop: 10/16/2003
      B3  = Covered charges.
            Start: 01/01/1995
            Stop: 10/16/2003
      B4  = Late filing penalty.
            Start: 01/01/1995
      B5  = Coverage/program guidelines were not met
            or were exceeded.
            Start: 01/01/1995
      B6  = This payment is adjusted when performed/
            billed by this type of provider, by this
            type of provider in this type of facility,
            or by a provider of this specialty.
            Start: 01/01/1995
            Stop: 02/01/2006
      B7  = This provider was not certified/eligible
            to be paid for this procedure/service on
            this date of service. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      B8  = Alternative services were available, and
            should have been utilized. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      B9  = Patient is enrolled in a Hospice.
            Start: 01/01/1995
      B10 = Allowed amount has been reduced because a
            component of the basic procedure/test was
            paid. The beneficiary is not liable for
            more than the charge limit for the basic
            procedure/test.
            Start: 01/01/1995
      B11 = The claim/service has been transferred to
            the proper payer/processor for processing.
            Claim/service not covered by this payer/
            processor.
            Start: 01/01/1995
      B12 = Services not documented in patients'
            medical records.
            Start: 01/01/1995
      B13 = Previously paid. Payment for this claim/
            service may have been provided in a
            previous payment.
            Start: 01/01/1995
      B14 = Only one visit or consultation per
            physician per day is covered.
            Start: 01/01/1995
      B15 = This service/procedure requires that a
            qualifying service/procedure be received
            and covered. The qualifying other service/
            procedure has not been received/adjudicated
            . Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      B16 = 'New Patient' qualifications were not met.
            Start: 01/01/1995
      B17 = Payment adjusted because this service was
            not prescribed by a physician, not
            prescribed prior to delivery, the
            prescription is incomplete, or the
            prescription is not current.
            Start: 01/01/1995
            Stop: 02/01/2006
      B18 = This procedure code and modifier were
            invalid on the date of service.
            Start: 01/01/1995
            Stop: 03/01/2009
      B19 = Claim/service adjusted because of the
            finding of a Review Organization.
            Start: 01/01/1995
            Stop: 10/16/2003
      B20 = Procedure/service was partially or fully
            furnished by another provider.
            Start: 01/01/1995
      B21 = The charges were reduced because the
            service/care was partially furnished by
            another physician.
            Start: 01/01/1995
            Stop: 10/16/2003
      B22 = This payment is adjusted based on the
            diagnosis.
            Start: 01/01/1995
      B23 = Procedure billed is not authorized per
            your Clinical Laboratory Improvement
            Amendment (CLIA) proficiency test.
            Start: 01/01/1995
      D1  = Claim/service denied. Level of subluxation
            is missing or inadequate.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D2  = Claim lacks the name, strength, or dosage
            of the drug furnished.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D3  = Claim/service denied because information to
            indicate if the patient owns the equipment
            that requires the part or supply was
            missing.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D4  = Claim/service does not indicate the period
            of time for which this will be needed.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D5  = Claim/service denied. Claim lacks
            individual lab codes included in the test.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D6  = Claim/service denied. Claim did not include
            patient's medical record for the service.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D7  = Claim/service denied. Claim lacks date of
            patient's most recent physician visit.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D8  = Claim/service denied. Claim lacks
            indicator that 'x-ray is available for
            review.'
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D9  = Claim/service denied. Claim lacks invoice
            or statement certifying the actual cost
            of the lens, less discounts or the type of
            intraocular lens used.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D10 = Claim/service denied. Completed physician
            financial relationship form not on file.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D11 = Claim lacks completed pacemaker
            registration form.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D12 = Claim/service denied. Claim does not
            identify who performed the purchased
            diagnostic test or the amount you were
            charged for the test.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D13 = Claim/service denied. Performed by a
            facility/supplier in which the ordering/
            referring physician has a financial
            interest.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D14 = Claim lacks indication that plan of
            treatment is on file.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D15 = Claim lacks indication that service was
            supervised or evaluated by a physician.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D16 = Claim lacks prior payer payment information
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code âN4ã.
      D17 = Claim/Service has invalid non-covered days.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D18 = Claim/Service has missing diagnosis
            information.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D19 = Claim/Service lacks Physician/Operative or
            other supporting documentation
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D20 = Claim/Service missing service/product
            information.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D21 = This (these) diagnosis(es) is (are) missing
            or are invalid
            Start: 01/01/1995
            Stop: 06/30/2007
      D22 = Reimbursement was adjusted for the reasons
            to be provided in separate correspondence.
            (Note: To be used for Workers' Compensation
            only) - Temporary code to be added for time
            frame only until 01/01/2009. Another code
            to be established and/or for 06/2008
            meeting for a revised code to replace or
            strategy to use another existing code
            Start: 01/27/2008
            Stop: 01/01/2009
      D23 = This dual eligible patient is covered by
            Medicare Part D per Medicare Retro-
            Eligibility. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 11/01/2009
            Stop: 01/01/2012
      W1  = Workers' compensation jurisdictional fee
            schedule adjustment. Note: If adjustment
            is at the Claim Level, the payer must send
            and the provider should refer to the 835
            Class of Contract Code Identification
            Segment (Loop 2100 Other Claim Related
            Information REF). If adjustment is at the
            Line Level, the payer must send and the
            provider should refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment information REF).
            Start: 02/29/2000
      W2  = Payment reduced or denied based on workers'
            compensation jurisdictional regulations or
            payment policies, use only if no other code
            is applicable. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            Workers' Compensation only.
            Start: 10/17/2010
      W3  = The Benefit for this Service is included
            in the payment/allowance for another
            service/procedure that has been performed
            on the same day. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present. For use by Property and
            Casualty only.
            Start: 09/30/2012
      W4  = Workers' Compensation Medical Treatment
            Guideline Adjustment.
            Start: 09/30/2012
      Y1  = Payment denied based on Medical Payments
            Coverage (MPC) or Personal Injury
            Protection (PIP) Benefits jurisdictional
            regulations or payment policies, use only
            if no other code is applicable. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            P&C Auto only.
            Start: 09/30/2012
      Y2  = Payment adjusted based on Medical Payments
            Coverage (MPC) or Personal Injury
            Protection (PIP) Benefits jurisdictional
            regulations or payment policies, use only
            if no other code is applicable. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            P&C Auto only.
            Start: 09/30/2012
      Y3  = Medical Payments Coverage (MPC) or Personal
            Injury Protection (PIP) Benefits
            jurisdictional fee schedule adjustment.
            Note: If adjustment is at the Claim Level,
            the payer must send and the provider should
            refer to the 835 Class of Contract Code
            Identification Segment (Loop 2100 Other
            Claim Related Information REF). If
            adjustment is at the Line Level, the payer
            must send and the provider should refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            information REF). To be used for P&C Auto
            only.
            Start: 09/30/2012



 CLM_BENE_ID_TYPE_TB                     Claim Beneficiary Identifier Type Table

       M = MBI
       H = HICN



 CLM_BILL_TYPE_TB                        Claim Bill Type Table

       11 = Hospital-inpatient (Part A)
       12 = Hospital-inpatient or home health visits (Part B only)
       13 = Hospital-outpatient (HHA-A also) (under OPPS 13X
            must be used for ASC claims submitted for OPPS
            payment -- eff. 7/00)
       14 = Hospital-Laboratory Services Provided to
            Non-patients
       15 = Hospital-intermediate care - level I (obsolete)
       16 = Hospital-intermediate care - level II (obsolete)
       17 = Hospital-intermediate care - level III (obsolete)
       18 = Hospital-swing beds
       19 = Reserved for national assignment
       21 = SNF-inpatient (including Part A)
       22 = SNF-inpatient or home health visits (Part B only)
       23 = SNF-outpatient (HHA-A also)
       24 = SNF-other (Part B) - (obsolete)
       25 = SNF-intermediate care - level I (obsolete)
       26 = SNF-intermediate care - level II (obsolete)
       27 = SNF-intermediate care - level III (obsolete)
       28 = SNF-swing beds
       29 = SNF-reserved for national assignment
       31 = HHA-inpatient (including Part A) (obsolete)
       32 = HHA-Home Health Services under a Plan of Treatment
            (name revised 10/2013)
       33 = HHA-outpatient (plan of treatment under Part A,
            including DME under Part A) (term. 10/2013)
       34 = HHA-other (for medical and surgical services not
            under a plan of treatment) (obsolete)
       35 = HHA-intermediate care - level I (obsolete)
       36 = HHA-intermediate care - level II (obsolete)
       37 = HHA-intermediate care - level III (obsolete)
       38 = HHA-swing beds (obsolete)
       39 = HHA-reserved for national assignment
       41 = Religious Nonmedical Health Care Institution (RNHCI)
            hospital-inpatient (including Part A) (all references
            to Christian Science (CS) is obsolete eff. 8/00 and
            replaced with RNHCI)
       42 = RNHCI hospital-inpatient or home health visits (Part B only)
       43 = RNHCI hospital-outpatient (HHA-A also)
       44 = RNHCI hospital-other (Part B) - (obsolete)
       45 = RNHCI hospital-intermediate care - level I (obsolete)
       46 = RNHCI hospital-intermediate care - level II (obsolete)
       47 = RNHCI hospital-intermediate care - level III (obsolete)
       48 = RNHCI hospital-swing beds (obsolete)
       49 = RNHCI hospital-reserved for national assignment
       51 = CS extended care-inpatient (including Part A) OBSOLETE
            eff. 7/00 - implementation of Religious Nonmedical
            Health Care Institutions (RNHCI)
       52 = RNHCI extended care-inpatient or home health visits
            (Part B only) (eff. 7/00) - OBSOLETE; prior to 7/00
            Christian Science (CS)
       53 = RNHCI extended care-outpatient (HHA-A also) (eff. 7/00);
            OBSOLETE - prior to 7/00 referenced CS
       54 = RNHCI extended care-other (Part B)(eff. 7/00)- OBSOLETE;
            prior to 7/00 referenced CS
       55 = RNHCI extended care-intermediate care - level I (eff. 7/00)
            OBSOLETE - prior to 7/00 referenced CS
       56 = RNHCI extended care-intermediate care - level II (eff. 7/00)
            OBSOLETE - prior to 7/00 referenced CS
       57 = RNHCI extended care-intermediate care - level III (eff. 7/00)
            OBSOLETE - prior to 7/00 referenced CS
       58 = RNHCI extended care-swing beds (eff. 7/00)- OBSOLETE
            prior to 7/00 referenced CS
       59 = RNHCI extended care-reserved for national assignment
            (eff. 7/00) - OBSOLETE; prior to 7/00 referenced CS
       61 = Intermediate care-inpatient (including Part A)
            OBSOLETE
       62 = Intermediate care-inpatient or home health visits (Part B only)
            OBSOLETE
       63 = Intermediate care-outpatient (HHA-A also) - OBSOLETE
       64 = Intermediate care-other (Part B)- OBSOLETE
       65 = Intermediate care-intermediate care - level I
       66 = Intermediate care-intermediate care - level II
       67 = Intermediate care-intermediate care - level III - OBSOLETE
       68 = Intermediate care-swing beds - OBSOLETE
       69 = Reserved for national assignment
       71 = Clinic-rural health
       72 = Clinic-hospital based or independent renal dialysis facility
       73 = Clinic-Freestanding
       74 = Clinic-ORF only (eff 4/97);
            ORF and CMHC (10/91 - 3/97)
       75 = Clinic-CORF
       76 = Clinic-CMHC (eff 4/97)
       77 = Clinic-Federally Qualified Health Center (FQHC)
            eff. 4/2010
       78 = Clinic-reserved for national assignment
       79 = Clinic-other
       81 = Hospice (non-hospital based)
       82 = Hospice (hospital based)
       83 = Ambulatory Aurgical Center
            (Discontinued for Hospitals Subject to Outpatient PPS;
             hospitals must use 13X for ASC claims submitted for OPPS
             payment -- eff. 7/00)
       84 = Freestanding Birthing Center
       85 = Critical Access Hospital (eff. 10/94)
       86 = Residential Facility (eff. 4/1/2010)
       87 = Reserved for national assignment
       88 = Reserved for national assignment
       89 = Special facility or ASC surgery-other
       91 = Reserved for national assignment
       92 = Reserved for national assignment
       93 = Reserved for national assignment
       94 = Reserved for national assignment
       95 = Reserved for national assignment
       96 = Reserved for national assignment
       97 = Reserved for national assignment
       98 = Reserved for national assignment
       99 = Reserved for national assignment



 CLM_CARE_IMPRVMT_MODEL_TB               Claim Care Improvement Model Table


      61 = CLAIM CARE IMPROVEMENT MODEL 1
      62 = CLAIM CARE IMPROVEMENT MODEL 2
      63 = CLAIM CARE IMPROVEMENT MODEL 3
      64 = CLAIM CARE IMPROVEMENT MODEL 4



 CLM_DGNS_VRSN_TB                        Claim Diagnosis Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_DISP_TB                             Claim Disposition Table

       01 = Debit accepted
       02 = Debit accepted (automatic adjustment)
            applicable through 4/4/93
       03 = Cancel accepted
       61 = *Conversion code: debit accepted
       62 = *Conversion code: debit accepted
             (automatic adjustment)
       63 = *Conversion code: cancel accepted

          *Used only during conversion period:
                1/1/91 - 2/21/91



 CLM_EXCPTD_NEXCPTD_TRTMT_TB             Claim Excepted/Nonexcepted Treatment Table

      0 = No Entry
      1 = Excepted
      2 = Nonexcepted



 CLM_FAC_TYPE_TB                         Claim Facility Type Table

       1 = Hospital
       2 = Skilled nursing facility (SNF)
       3 = Home health agency (HHA)
       4 = Religious Nonmedical (Hospital)
           (eff. 8/1/00); prior to 8/00 referenced Christian
           Science (CS)
       5 = Religious Nonmedical (Extended Care)
           (eff. 8/1/00); prior to 8/00 referenced CS
           (discontinued effective 10/1/05)
       6 = Intermediate care
       7 = Clinic or hospital-based renal dialysis facility
       8 = Special facility or ASC surgery
       9 = Reserved



 CLM_FPS_MSN_CD_TB                       Claim FPS MSN Code Table

      Section 1 Ambulance
      1.1   = Payment for transportation is allowed
              only to the closest facility that can
              provide the necessary care.
      1.10  = Air ambulance is not covered since you
              were not taken to the airport by
              ambulance.
      1.11  = The information provided does not support
              the need for an air ambulance.
              The approved amount is based on ground
              ambulance.
      1.2   = Payment is denied because the ambulance
              company is not approved by Medicare.
      1.3   = Ambulance service to a funeral home is
              not covered.
      1.4   = Transportation in a vehicle other than
              an ambulance is not covered.
      1.5   = Transportation to a facility to be closer
              to home or family is not covered.
      1.6   = This service is included in the allowance
              for the ambulance transportation.
      1.7   = Ambulance services to or from a doctor's
              office are not covered.
      1.8   = This service is denied because you
              refused to be transported.
      1.9   = Payment for ambulance services does not
              include mileage when you were not in the
              ambulance.

      Section 10 Foot Care	
      10.1  = Shoes are only covered as part of a leg
              brace.

      Section 11 Transfer of Claims or Parts of Claims
      11.1  = Your claim has been forwarded to the
              correct Medicare contractor for
              processing. You will receive a notice
              from them.
      11.10 = We have identified you as a Railroad
              Retirement Board (RRB) Medicare
              beneficiary. You must send your claim
              for these services for processing to the
              RRB carrier Palmetto GBA, at PO Box
              10066, Augusta, GA 30999.
      11.11 = This claim/service is not payable under
              our claims jurisdiction. We have notified
              your provider to send your claim for
              these services to the United Mine
              Workers of America for processing.
      11.2  = This information is being sent to
              Medicaid. They will review it to see if
              additional benefits can be paid.
      11.3  = Our records show that you are enrolled in
              a Medicare health plan. Your provider
              must bill this service to the plan.
      11.4  = Our records show that you are enrolled in
              a Medicare health plan. Your claim was
              sent to the plan for processing.
      11.5  = This claim will need to be submitted to
              (another carrier, a Durable Medical
              Equipment Medicare Administrative
              Contractor (DME MAC), or Medicaid agency)
      11.6  = We have asked your provider to submit
              this claim to the proper Medicare
              Administrative Contractor (MAC). That
              MAC is (name and address).
              NOTE: Due to different systems'
              capabilities, DMACs may omit the final
              sentence in this message, "That MAC is
              (name and address)," whenever this
              message is used. Part A and Part B MACs
              are expected to use the complete message.
              This instruction also applies to the
              Spanish translation of the message.
      11.7  = This claim/service is not payable under
              our claims jurisdiction area. We have
              notified your provider that they must
              forward the claim/service to the correct
              carrier for processing.
      11.8  = This claim will need to be submitted to
              the Region B Durable Medical Equipment
              Regional Carrier.
      11.9  = This claim/service is not payable under
              our claims jurisdiction. We have
              notified your provider to send your
              claim for these services to the Railroad
              Retirement Board Medicare carrier.

      Section 12 Hearing Aids	
      12.1  = Hearing aids are not covered.

      Section 13 Skilled Nursing Facility
      13.1  = No qualifying hospital stay dates were
              shown for this skilled nursing facility
              stay.
      13.10 = Medicare Part B doesn't pay for items or
              services provided by this type of
              healthcare provider since our records
              show that you were receiving Medicare
              Part A benefits in a skilled nursing
              facility on this date.
      13.11 = You have ___ days(s) remaining of your
              total 100 days of skilled nursing
              facility benefits for this benefit period
      13.12 = Medicare Part B doesn't pay separately
              for this item/service. Payment for this
              item/service should be included in
              another Medicare benefit. The hospital/
              nursing facility must bill for this
              Medicare service.
      13.2  = Skilled nursing facility benefits are
              only available after a hospital stay of
              at least 3 days.
      13.3  = Information provided does not support the
              need for skilled nursing facility care.
      13.4  = Information provided does not support the
              need for continued care in a skilled
              nursing facility.
      13.5  = You were not admitted to the skilled
              nursing facility within 30 days of your
              hospital discharge.
      13.6  = Rural primary care skilled nursing
              facility benefits are only available
              after a hospital stay of at least 2 days.
      13.7  = Normally, care is not covered when
              provided in a bed that is not certified
              by Medicare. However, since you received
              covered care, we have decided that you
              will not have to pay the facility for
              anything more than Medicare coinsurance
              and noncovered items.
      13.8  = The skilled nursing facility should file
              a claim for Medicare benefits because
              you were an inpatient.
      13.9  = Medicare Part B does not pay for this
              item or service since our records show
              that you were in a skilled nursing
              facility on this date.

      Section 14 Laboratory
      14.1  = The laboratory is not approved for this
              type of test.
      14.10 = Medicare does not allow a separate
              payment for EKG readings.
      14.11 = A travel allowance is paid only when a
              covered specimen collection fee is billed
      14.12 = Payment for transportation can only be
              made if an X-ray or EKG is performed.
      14.13 = The laboratory was not approved for this
              test on the date it was performed.
      14.2  = Medicare approved less for this
              individual test because it can be done
              as part of a complete group of tests.
      14.3  = Services or items not approved by the
              Food and Drug Administration are not
              covered.
      14.4  = Payment denied because the claim did not
              show who performed the test and/or the
              amount charged.
      14.5  = Payment denied because the claim did not
              show if the test was purchased by the
              physician or if the physician performed
              the test.
      14.6  = This test must be billed by the
              laboratory that did the work.
      14.7  = This service is paid at 100% of the
              Medicare approved amount.
      14.8  = Payment cannot be made because the
              physician has a financial relationship
              with the laboratory.
      14.9  = Medicare cannot pay for this service for
              the diagnosis shown on the claim.

      Section  Medical Necessity
      15.1  = The information provided does not support
              the need for this many services or items.
      15.10 = Medicare does not pay for more than one
              assistant surgeon for this procedure.
      15.11 = Medicare does not pay for an assistant
              surgeon for this procedure/surgery.
      15.12 = Medicare does not pay for two surgeons
              for this procedure.
      15.13 = Medicare does not pay for team surgeons
              for this procedure.
      15.14 = Medicare does not pay for acupuncture.
      15.15 = Payment has been reduced because
              information provided does not support the
              need for this item as billed.
      15.16 = Your claim was reviewed by our medical
              staff.
      15.17 = We have approved this service at a
              reduced level.
      15.18 = Medicare does not cover this service at
              home.
      15.19 = Local Coverage Determinations (LCDs) help
              Medicare decide what is covered. An LCD
              was used for your claim. You can compare
              your case to the LCD, and send
              information from your doctor if you
              think it could change our decision.
              Call 1-800-MEDICARE (1-800-633-4227) for
              a copy of the LCD.
      15.2  = The information provided does not support
              the need for this equipment.
      15.20 = The following policies were used when we
              made this decision: _____
      15.21 = The information provided does not support
              the need for this many services or items
              in this period of time but you do not
              have to pay this amount.
      15.22 = The information provided does not support
              the need for this many services or items
              in this period of time so Medicare will
              not pay for this item or service.
      15.3  = The information provided does not support
              the need for the special features of this
              equipment.
      15.4  = The information provided does not support
              the need for this service or item.
      15.5  = The information provided does not support
              the need for similar services by more
              than one doctor during the same time
              period.
      15.6  = The information provided does not support
              the need for this many services or items
              within this period of time.
      15.7  = The information provided does not support
              the need for more than one visit a day.
      15.8  = The information provided does not support
              the level of service as shown on the
              claim.
      15.9  = The Quality Improvement Organization did
              not approve this service.
      15.96 = Medicare does not pay for this
              investigational device(s).
      15.97 = Medicare cannot pay for this
              investigational device because the
              approved period for the investigational
              device in the FDA clinical trial has not
              begun.
      15.98 = Medicare cannot pay for this
              investigational device because the
              approved period for the investigational
              device in the FDA clinical trial has
              expired.
      15.99 = Medicare does not pay for this many
              services on the same day. You cannot be
              billed for this service.

      Section 16 Miscellaneous
      16.1  = The service cannot be approved because
              the date on the claim shows it was billed
              before it was provided.
      16.10 = Medicare does not pay for this item or
              service.
      16.11 = Payment was reduced for late filing.  You
              cannot be billed for the reduction.
      16.12 = Outpatient mental health services are
              paid at 50% of the approved charges.
      16.13 = The code(s) your provider used is/are not
              valid for the date of service billed.
      16.14 = The attached check replaces your previous
              check (#____) dated (______).
      16.15 = The attached check replaces your previous
              check.
      16.16 = As requested, this is a duplicate copy of
              your Medicare Summary Notice.
              See "Message Expiration Date" and
              "Message Notes" columns ------->
      16.17 = Medicare only pays for these services if
              you get them with total parenteral
              nutrition.
      16.18 = Medicare won't pay for services provided
              before certified parenteral/enteral
              nutrition therapy started.
      16.19 = The amount Medicare pays for a
              parenteral/enteral nutrition supply is
              based on the level of care you need
              (based on your diagnosis).
      16.2  = This service cannot be paid when provided
              in this location/facility.
      16.20 = The approved payment for calories/grams
              is the most Medicare may allow for the
              diagnosis stated.
      16.21 = The procedure code was changed to reflect
              the actual service rendered.
      16.22 = Medicare does not pay for services when
              no charge is indicated.
      16.23 = This check is for the amount you overpaid
      16.24 = Services provided aboard a ship are
              covered only when the ship is of United
              States registry and is in United States
              waters. In addition, the service must be
              provided by a doctor licensed to practice
              in the United States.
      16.25 = Medicare does not pay for this much
              equipment, or this many services or
              supplies.
      16.26 = Medicare does not pay for services or
              items related to a procedure that has not
              been approved or billed.
      16.27 = This service is not covered since our
              records show you were in the hospital at
              this time.
      16.28 = Medicare does not pay for services or
              equipment that you have not received.
      16.29 = Payment is included in another service
              you have received.
      16.3  = The claim did not show that this service
              or item was prescribed by your doctor.
      16.30 = Services billed separately on this claim
              have been combined under this procedure.
      16.31 = You are responsible to pay the primary
              physician care the agreed monthly charge.
      16.32 = Medicare does not pay separately for this
              service.
      16.33 = Your payment includes interest because
              Medicare exceeded processing time limits.
      16.34 = You should not be billed for this service
              . You are only responsible for any
              deductible and coinsurance amounts listed
              in the "You May Be Billed" column.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes."
      16.35 = You do not have to pay this amount.
      16.36 = If you have already paid it, you are
              entitled to a refund from this provider.
      16.37 = Please see the back of this notice.
              See "Message Expiration Date" and
              "Message Notes" columns
      16.38 = Charges are not incurred for leave of
              absence days.
      16.39 = Only one provider can be paid for this
              service per calendar month. Payment has
              already been made to another provider for
              this service.
      16.4  = This service requires prior approval by
              the Quality Improvement Organization.
      16.40 = Only one inpatient service per day is
              allowed.
      16.41 = Payment is being denied because you
              refused to request reimbursement under
              your Medicare benefits.
      16.42 = The provider's determination of
              noncoverage is correct.
      16.43 = This service cannot be approved without a
              treatment plan and supervision of a
              doctor.
      16.44 = Routine care is not covered.
      16.45 = You cannot be billed separately for this
              item or service. You do not have to pay
              this amount.
      16.46 = Medicare payment limits do not affect a
              Native American's right to free care at
              Indian Health Institutions.
      16.47 = When deductible is applied to outpatient
              psychiatric services, you may be billed
              for up to the approved amount. The "You
              May Be Billed" column will tell you the
              correct amount to pay your provider.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed" when your MAC
              implements the new MSN design.
      16.48 = Medicare does not pay for this item or
              service for this condition.
      16.49 = This claim/service is not covered because
              alternative services were available, and
              should have been utilized.
      16.5  = This service cannot be approved without a
              treatment plan by a physical or
              occupational therapist.
      16.50 = The doctor or supplier may not bill more
              than the Medicare allowed amount.
      16.51 = This service is not covered prior to July
              1, 2001.
      16.52 = This service was denied because coverage
              for this service is provided only after a
              documented failed trial of pelvic muscle
              exercise training.
      16.53 = The amount Medicare paid the provider for
              this claim is ($______).
      16.54 = This service is not covered prior to
              January 1, 2002.
      16.55 = The provider billed this charge as
              non-covered.
      16.56 = Claim denied because information from the
              Social Security Administration indicates
              that you have been deported.
      16.57 = Medicare Part B does not pay for this
              item or service since our records show
              that you were in a Medicare health plan
              on this date. Your provider must bill
              this service to the Medicare health plan.
      16.58 = The provider billed this charge as
              non-covered. You do not have to pay this
              amount.
      16.59 = Medicare doesn't pay for missed
              appointments.
      16.6  = This item or service cannot be paid
              unless the provider accepts assignment.
      16.60 = Want to see your MSN right away? Access
              your Original Medicare claims directly at
              www.MyMedicare.gov, usually within 24
              hours after Medicare processes the claim.
              You can also order duplicate MSNs, track
              your preventive services, and print an
              "On the Go" report to share with your
              provider.
      16.61 = Outpatient mental health services are
              paid at 55% of the approved amount.
      16.62 = Outpatient mental health services are
              paid at 60% of the approved amount
      16.63 = Outpatient mental health services are
              paid at 65% of the approved amount.
      16.64 = IMPORTANT:  Starting in March 2010,
              Medicare will begin to mail Part A and
              Part B MSNs in the same envelope when
              possible.
      16.66 = Medicare doesn't pay for DMEPOS items or
              services when provided by a hospital or
              physician if there is no matching date of
              discharge or date of service.
      16.67 = Medicare doesn't pay for services or
              items when provided by a hospital when
              there is no matching date of discharge.
      16.7  = Your provider must complete and submit
              your claim.
      16.71 = Your provider must complete and submit
              your claim.
      16.72 = This claim was denied because it was
              Submitted with a non-affirmative prior
              authorization request.
      16.73 = This claim has received a payment
              reduction because it did not first go
              through the prior authorization process.
      16.74 = This claim is denied because there is no
              record of a prior authorization request
              to support this record.
      16.76 = This service/item was not covered because
              you have exceeded the lifetime limit for
              getting this service/item.
      16.77 = This service/item was not covered because
              it was not provided as part of a
              qualifying trial/study.
      16.8  = Payment is included in another service
              received on the same day.
      16.9  = This allowance has been reduced by the
              amount previously paid for a related
              procedure.
      16.98 = The amount you paid to the provider for
              this claim was more than the required
              payment. You should be receiving a refund
              of $______ from your provider, which is
              the difference between what you paid and
              what you should have paid.
      16.99 = The amount owed you is $________.
              Medicare no longer routinely issues
              payment under $1 This amount due will be
              included on a future check issued to you.
              If you want this money issued immediately
              , please contact us at the address and
              phone number shown at the bottom of this
              page.

      Section 17 Non Physician Services	
      17.1  = Services performed by a private duty
              nurse are not covered.
      17.10 = The allowance has been reduced because
              the anesthesiologist medically directed
              concurrent procedures.
      17.11 = This item or service cannot be paid as
              billed.
      17.12 = This service is not covered when provided
              by an independent therapist.
      17.13 = Each year, Medicare pays for a limited
              amount of physical therapy and speech-
              language pathology services and a
              separate amount of occupational therapy
              services. Medically necessary therapy
              over these limits is covered when
              approved by Medicare.
      17.14 = Charges for maintenance therapy are not
              covered.
      17.15 = This service cannot be paid unless
              certified by your physician every (___)
              days.
      17.16 = The hospital should file a claim for
              Medicare benefits because these services
              were performed in a hospital setting.
      17.17 = Medicare already paid for an initial
              visit for this service with this
              physician, another physician in his group
              practice, or a provider. Your doctor or
              provider must use a different code to
              bill for subsequent visits.
      17.18 = ($) has been applied during this calendar
              year (CCYY) towards the ($) limit on
              outpatient physical therapy and speech-
              language pathology benefits.
      17.19 = ($) has been applied during this calendar
              year (CCYY) towards the ($) limit on
              outpatient occupational therapy benefits.
      17.2  = This anesthesia service must be billed by
              a doctor.
      17.21 = The items or service was denied because
              Medicare can't pay for services ordered
              by or referred by this provider at this
              time" for this message number.
      17.25 = Medicare does not pay for services of a
              nurse practitioner/clinical nurse
              specialist for this place and/or date of
              service.
      17.3  = This service was denied because you did
              not receive it under the direct
              supervision of a doctor.
      17.33 = Medicare does not pay for services by a
              noncertified nonphysician practitioner.
      17.4  = Services performed by an audiologist are
              not covered except for diagnostic
              procedures.
      17.5  = Your provider's employer must file this
              claim and agree to accept assignment.
      17.6  = Full payment was not made for this
              service(s) because the yearly limit has
              been met.
      17.7  = This service must be performed by a
              licensed clinical social worker.
      17.8  = Payment was denied because the maximum
              benefit allowance has been reached.
      17.9  = Medicare (Part A/Part B) pays for this
              service. The provider must bill the
              correct Medicare contractor.

      Section 18 Preventive Care	
      18.1  = Routine examinations and related services
              aren't covered.
      18.10 = Expired
      18.11 = Expired
      18.12 = Screening mammograms are covered annually
              for women 40 years of age and older.
      18.13 = This service isn't covered for people
              under 50 years old.
      18.14 = Service is being denied because it has
              not been (12/24/48) months since your
              last (test/procedure) of this kind.
      18.15 = Medicare only covers this procedure for
              people considered to be at high risk for
              colorectal cancer.
      18.16 = This service is being denied because
              payment has already been made for a
              similar procedure within a set time frame
      18.17 = Medicare pays for a screening Pap test
              and a screening pelvic examination once
              every 2 years unless high risk factors
              are present.
      18.18 = Medicare does not pay for this service
              separately since payment of it is
              included in our allowance for other
              services you received on the same day.
      18.19 = This service isn't covered until after
              your 50th birthday.
      18.2  = This immunization and/or preventive care
              is not covered.
      18.20 = Expired
      18.21 =	
      18.22 = This service was denied because Medicare
              only allows the Welcome to Medicare
              preventive visit within the first 12
              months you have Part B coverage.
      18.23 = You pay 25% of the Medicare-approved
              amount for this service.
      18.24 = This service was denied. Medicare doesn't
              cover an Annual Wellness Visit within the
              first 12 months of your Medicare Part B
              coverage. Medicare does cover a one-time
              Welcome to Medicare preventive visit with
              in the first 12 months.
      18.25 = Your Annual Wellness Visit has been
              approved. You will qualify for another
              Annual Wellness Visit 12 months after the
              date of this visit.
      18.26 = This service was denied because it
              occurred too soon after your last covered
              Annual Wellness Visit. Medicare only
              covers one Annual Wellness Visit within
              a 12 month period.
      18.27 = This service was denied because it
              occurred too soon after your Initial
              Preventive Physical Exam.
      18.3  = Screening mammography is not covered for
              women under 35 years of age.
      18.4  = This service is being denied because it
              has not been (__) months since your last
              examination of this kind.
      18.5  = Medicare will pay for another screening
              mammogram in 12 months.
      18.6  = A screening mammography is covered only
              once for women age 35 - 39.
      18.7  = Screening pap tests are covered only once
              every 24 months unless high risk factors
              are present.
      18.8  = Deleted during EOMB-MSN transition.
      18.9  = Deleted during EOMB-MSN transition.
      18.94 = Medicare pays for screening Pap smear
              and/or screening pelvic examination
              (including a clinical breast examination)
              only once every 2 years unless high risk
              factors are present.

      Section 19 Hospital Based Physician Services
      19.1  = Services of a hospital-based specialist
              are not covered unless there is an
              agreement between the hospital and the
              specialist.
      19.2  = Payment was reduced because this service
              was performed in a hospital outpatient
              setting rather than a provider's office.
      19.3  = Only one hospital visit or consultation
              per provider is allowed per day.

      Section 2 Blood
      2.1  = The first three pints of blood used in
              each year are not covered.
      2.2  = Charges for replaced blood are not covered

      Section 20 Benefit Limits
      20.1  = You have used all of your benefit days
              for this period.
      20.10 = This service was denied because Medicare
              only pays up to 10 hours of diabetes
              education training during the initial
              12-month period. Our records show you
              have already obtained 10 hours of
              training.
      20.11 = This service was denied because Medicare
              pays for two hours of follow-up diabetes
              education training during a calendar year
              . Our records show you have already
              obtained two hours of training for this
              calendar year.
      20.12 = This service was denied because Medicare
              only covers this service once a lifetime.
      20.13 = This service was denied because Medicare
              only pays up to three hours of medical
              nutrition therapy during a calendar year.
              Our records show you have already
              received three hours of medical nutrition
              therapy.
      20.14 = This service was denied because Medicare
              only pays two hours of follow-up for
              medical nutrition therapy during a
              calendar year. Our records show you have
              already received two hours of follow-up
              services for this calendar year.
      20.2  = You have reached your limit of 190 days
              of psychiatric hospital services.
      20.3  = You have reached your limit of 60
              lifetime reserve days.
      20.4  = (__) of the Benefit Days Used were
              charged to your Lifetime Reserve Day
              benefit.
      20.5  = These services cannot be paid because
              your benefits are exhausted at this time.
      20.6  = Days used has been reduced by the primary
              group insurer's payment.
      20.7  = You have (___) day(s) remaining of your
              190-day psychiatric limit.
      20.8  = Days are being subtracted from your total
              inpatient hospital benefits for this
              benefit period.
      20.9  = Services after (mm/dd/yy) cannot be paid
              because your benefits were exhausted.
      20.91 = This service was denied. Medicare covers
              a one-time initial preventative physical
              exam (Welcome to Medicare physical exam)
              if you get it within the first 12 months
              of the effective date of your Medicare
              Part B coverage.

      Section 21 Restrictions to Coverage
      21.1  = Services performed by an immediate
              relative or a member of the same
              household are not covered.
      21.10 = A surgical assistant is not covered for
              this place and/or date of service.
      21.11 = This service was not covered by Medicare
              at the time you received it.
      21.12 = This hospital service was not covered
              because the attending physician was not
              eligible to receive Medicare benefits at
              the time the service was performed.
      21.13 = This surgery was not covered because the
              attending physician was not eligible to
              receive Medicare benefits at the time the
              service was performed.
      21.14 = Medicare cannot pay for this
              investigational device because the FDA
              clinical trial period has not begun.
      21.15 = Medicare cannot pay for this
              investigational device because the FDA
              clinical trial period has ended.
      21.16 = Medicare does not pay for this
              investigational device.
      21.17 = Your provider submitted noncovered
              charges. You are responsible for paying
              these charges.
      21.18 = This item or service is not covered when
              performed or ordered by this provider.
      21.19 = This provider decided to dropout of
              Medicare. No payment can be made for
              this service. You are responsible for
              this charge. Under Federal law, your
              doctor cannot charge you more than the
              limiting charge amount.
      21.2  = The provider of this service is not
              eligible to receive Medicare payments.
      21.20 = This provider decided to dropout of
              Medicare. No payment can be made for
              this service. You are responsible for
              this charge.
      21.21 = This service was denied because Medicare
              only covers this service under certain
              circumstances.
      21.22 = Medicare does not pay for this service
              because it is considered investigational
              and/or experimental in these
              circumstances.
      21.23 = Your claim is being denied because the
              physician noted on the claim has been
              deceased for more than 15 months.
      21.24 = This service is not covered for patients
              over age 60.
      21.25 = This service was denied because Medicare
              only covers this service in certain
              settings.
      21.26 = Claim denied because services were
              provided by an Opt-Out physician or
              practitioner. No Medicare payment may be
              made.
      21.27 = Services provided by a Medicare
              sanctioned/excluded provider. No
              Medicare payment may be made.
      21.3  = This provider was not covered by
              Medicare when you received this service.
      21.30 = The provider decided to drop out of
              Medicare. No payment can be made for this
              service. You are responsible for this
              charge.
      21.31 = This service was not covered by Medicare
              at the time you recieved it.
      21.32 = This service was denied because Medicare
              only covers this service under certain
              circumstances.
      21.4  = Services provided outside the United
              States are not covered. See your
              Medicare Handbook for services received
              in Canada and Mexico.
      21.5  = Services needed as a result of war are
              not covered.
      21.6  = This item or service is not covered when
              performed, referred or ordered by this
              provider.
      21.7  = This service should be included on your
              inpatient bill.
      21.8  = Services performed using equipment that
              has not been approved by the Food and
              Drug Administration are not covered.
      21.9  = Payment cannot be made for unauthorized
              service outside the managed care plan.

      Section 22 Split Claims
      22.1  = Your claim was separated for processing.
              The remaining services may appear on a
              separate notice.

      Section 23 Surgery
      23.1  = The cost of care before and after the
              surgery or procedure is included in the
              approved amount for that service.
      23.10 = Payment has been reduced because this
              procedure was terminated before
              anesthesia was started.
      23.11 = Payment cannot be made because the
              surgery was canceled or postponed.
      23.12 = Payment has been reduced because the
              surgery was canceled after you were
              prepared for surgery.
      23.13 = Because you were prepared for surgery and
              anesthesia was started, full payment is
              being made even though the surgery was
              canceled.
      23.14 = The assistant surgeon must file a
              separate claim for this service.
      23.15 = The approved amount is less because the
              payment is divided between two doctors.
      23.16 = An additional amount is not allowed for
              this service when it is performed on both
              the left and right sides of the body.
      23.17 = Medicare won't cover these services
              because they are not considered medically
              necessary.
      23.2  = Cosmetic surgery and related services are
              not covered.
      23.3  = Medicare does not pay for surgical
              supports except primary dressings for
              skin grafts.
      23.4  = A separate charge is not allowed because
              this service is part of the major
              surgical procedure.
      23.5  = Payment has been reduced because a
              different doctor took care of you before
              and/or after the surgery.
      23.6  = This surgery was reduced because it was
              performed with another surgery on the
              same day.
      23.7  = Payment cannot be made for an assistant
              surgeon in a teaching hospital unless a
              resident doctor was not available.
      23.8  = This service is not payable because it is
              part of the total maternity care charge.
      23.9  = Payment has been reduced because the
              charges billed did not include post-
              operative care.

      Section 24 'Help Stop Fraud' messages
      24.1  = Protect your Medicare number as you would
              a credit card number.
      24.10 = Always read the front and back of your
              Medicare Summary Notice.
      24.11 = Beware of Medicare scams, such as offers
              of free milk or cheese for your Medicare
              number.
      24.12 = Read your Medicare Summary Notice
              carefully for accuracy of dates, services
              , and amounts billed to Medicare.
      24.13 = Be sure you understand anything you are
              asked to sign.
      24.14 = Be sure any equipment or services you
              received were ordered by your doctor.
      24.15 = Review your Medicare Summary Notice and
              report items and services that you did
              not receive to Medicare's Fraud Hotline
              at 1-866-417-2078.
              FLORIDA - SPECIFIC MESSAGE
      24.16 = Report items and services that you did
              not receive to Medicare's Fraud Hotline
              at 1-866-417-2078.
              FLORIDA - SPECIFIC MESSAGE
      24.19 = You may see some claims that have been
              adjusted. For an explanation see the
              General Information section
              See Expiration Date and Message Notes
              ------->
      24.2  = Beware of telemarketers or advertisements
              offering free or discounted Medicare
              items and services.
      24.22 = You can make a difference!  Last year,
              tax-payers saved $4 billion-the largest
              sum ever recovered in a single year-
              thanks in large part to people who came
              forward and reported suspicious activity.
              See "Message Implementation Date" and
              "Message Notes" columns. ---->
      24.3  = Beware of door-to-door solicitors
              offering free or discounted Medicare
              items or services.
      24.4  = Only your physician can order medical
              equipment for you.
      24.5  = Always review your Medicare Summary
              Notice for correct information about the
              items or services you received.
      24.6  = Do not sell your Medicare number or
              Medicare Summary Notice.
      24.7  = Do not accept free medical equipment you
              don't need.
      24.8  = Beware of advertisements that read,
              "This item is approved by Medicare", or
              "No out-of-pocket expenses."
      24.9  = Be informed - Read your Medicare Summary
              Notice.
              See "Message Expiration Date" and
              "Message Notes" columns ----->

      Section 25 Time Limit for filing
      25.1  = This claim was denied because it was
              filed after the time limit.
      25.2  = You can be billed only 20% of the charges
              that would have been approved.
      25.3  = The time limit for filing your claim has
              expired, therefore appeal rights are not
              applicable for this claim.

      Section 26 Vision	
      26.1  = Eye refractions are not covered.
      26.2  = Eyeglasses or contact lenses are only
              covered after cataract surgery or if the
              natural lens of your eye is missing.
      26.3  = Only one pair of eyeglasses or contact
              lenses is covered after cataract surgery
              with lens implant.
      26.4  = This service is not covered when
              performed by this provider.
      26.5  = This service is covered only in
              conjunction with cataract surgery.
      26.6  = Payment was reduced because the service
              was terminated early.

      Section 27 Hospice
      27.1  = This service is not covered because you
              are enrolled in a hospice.
      27.10 = The documentation indicates that the
              service level of continuous home care
              wasn't reasonable and necessary.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.11 = The provider has billed in error for the
              routine home care items or services
              received.
      27.12 = The documentation indicates that your
              respite level of care exceeded five
              consecutive days. Therefore, payment
              for every day beyond the 5th day will be
              paid at the routine home care rate.
      27.13 = According to Medicare hospice
              requirements, this service is not covered
              because the service was provided by a
              non-attending physician.
      27.2  = Medicare will not pay for inpatient
              respite care when it exceeds five
              consecutive days at a time.
      27.3  = The physician certification requesting
              hospice services was not received timely.
      27.4  = The documentation received indicates that
              the general inpatient care level of
              services were not necessary for care
              related to the terminal illness.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.5  = Payment for the day of discharge from the
              hospital will be made to the hospice
              agency at the routine home care rate.
      27.6  = The documentation indicates the level of
              care was at the respite level not the
              general inpatient level of care.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.7  = According to Medicare hospice
              requirements, the hospice election
              consent was not signed timely.
      27.8  = The documentation submitted does not
              support that your illness is terminal.
      27.9  = The documentation indicates your
              inpatient level of care was not
              reasonable and necessary. Therefore,
              payment will be adjusted to the routine
              home care rate.
      27.99 = Medicare allows your doctor to charge for
              developing a plan of treatment for your
              home health or hospice services.

      Section 28 Mandatory	
      28.1  = Because you have Medicaid, your provider
              must agree to accept assignment.

      Section 29 MSP	
      29.1  = Secondary payment cannot be made because
              the primary insurer information was
              either missing or incomplete.
      29.10 = These services cannot be paid because you
              received them on or before you received
              a liability insurance payment for this
              injury or illness.
      29.11 = Our records show that an automobile
              medical, liability, or no-fault insurance
              plan is primary for these services.
              Submit this claim to the primary payer.
      29.12 = Our records show that these services may
              be covered under the Black Lung Program.
              Contact the U.S. Department of Labor,
              Federal Black Lung Program, P.O. Box 8302
              , London, KY 40742-8302
      29.13 = Medicare does not pay for these services
              because they are payable by another
              government agency. Submit this claim to
              that agency.
      29.14 = Medicare's secondary payment is ($______)
              . This is the difference between the
              primary insurer's approved amount of
              ($______) and the primary insurer's paid
              amount of ($______).
      29.15 = Medicare's secondary payment is ($______)
              . This is the difference between
              Medicare's approved amount of ($______)
              and the primary insurer's paid amount of
              ($______).
      29.16 = Your primary insurer approved and paid (
              $______) on this claim. Therefore, no
              secondary payment will be made by
              Medicare.
      29.17 = Your provider agreed to accept ($______)
              as payment in full on this (claim/service
              ). Your primary insurer has already paid
              ($______) so Medicare's payment is the
              difference between the two amounts.
      29.18 = The amount listed in the "You May Be
              Billed" column assumes that your primary
              insurer paid the provider. If your
              primary insurer paid you, then you are
              responsible to pay the provider the
              amount your primary insurer paid to you
              plus the amount in the "You May Be Billed
              " column.
              This message should be revised to read
              "If your primary insurer paid you for
              this claim, you are responsible to pay
              that amount to your provider plus the
              amount in the "Maximum You May Be Billed"
              column."
              See "Message Implementation Date" and
              "Message Notes" columns.
      29.19 = If your primary insurer paid your
              provider for this claim, you now only
              need to pay your provider the difference
              between the amount charged and the amount
              your primary insurer paid.
      29.2  = No payment was made because your primary
              insurer's payment satisfied the
              provider's bill.
      29.20 = If your primary insurer paid your
              provider for this claim, you only need to
              pay the difference between the amount
              your provider agreed to accept and the
              amount your primary insurer paid.
      29.21 = If your primary insurer made payment on
              this claim, you may be billed the
              difference between the amount charged and
              your primary insurer's payment.
      29.22 = If your primary insurer paid the provider
              , you need to pay the provider the
              difference between the limiting charge
              amount and the amount the primary
              insurer paid your provider.
      29.23 = No payment can be made because payment
              was already made by either worker's
              compensation or the Federal Black Lung
              Program.
      29.24 = No payment can be made because payment
              was already made by another government
              entity.
      29.25 = Medicare paid all covered services not
              paid by other insurer.
      29.26 = The primary payer is _________.
      29.27 = Your primary group's payment satisfied
              Medicare deductible and coinsurance.
      29.28 = Your responsibility on this claim has
              been reduced by the amount paid by your
              primary insurer.
      29.29 = Your provider is allowed to collect a
              total of ($______) on this claim. Your
              primary insurer paid ($_____) and
              Medicare paid ($______). You are
              responsible for the unpaid portion of
              ($______).
      29.3  = Medicare benefits are reduced because
              some of these expenses have been paid by
              your primary insurer.
      29.30 = ($______) of the money approved by your
              primary insurer has been credited to your
              Medicare Part B (A) deductible. You do
              not have to pay this amount.
      29.31 = Resubmit this claim with the missing or
              correct information.
      29.32 = Medicare's secondary payment is ($______)
              . This is the difference between
              Medicare's limiting charge amount of
              ($______) and the primary insurer's paid
              amount of ($______).
      29.33 = Your claim has been denied by Medicare
              because you may have funds set aside from
              your settlement to pay for your future
              medical expenses and prescription drug
              treatment related to your injury(ies).
      29.34 = The claim for this item/service was
              submitted by your complementary insurer
              on your behalf.
      29.35 = Per statute, Medicare only accepts claims
              from your complementary insurer when
              Medicare is the primary payer.
      29.71 = Medicare benefits are being paid on the
              condition that if you receive payment
              from liability insurance, an automobile
              medical insurance policy or plan, or any
              other no-fault insurance, you must repay
              Medicare.
      29.4  = In the future, if you send claims to
              Medicare for secondary payment, please
              send them to (carrier MSP address).
      29.5  = Our records show that Medicare is your
              secondary payer. This claim must be sent
              to your primary insurer first.
      29.6  = Our records show that Medicare is your
              secondary payer. Services provided
              outside your prepaid health plan are not
              covered. We will pay this time only
              since you were not previously notified.
      29.7  = Medicare cannot pay for this service
              because it was furnished by a provider
              who is not a member of your employer
              prepaid health plan. Our records show
              that you were informed of this rule.
      29.8  = This claim is denied because the
              service(s) may be covered by the worker's
              compensation plan. Ask your provider to
              submit a claim to that plan.
      29.9  = Since your primary insurance benefits
              have been exhausted, Medicare will be
              primary on this accident related service.

      Section 3 Chiropractic
      3.1   = This service is covered only when recent
              x-rays support the need for the service.
      3.7   = Medicare does not pay for this unless a
              sympton or sign of a problem is stated
              on the claim.
      3.18  = This represents an adjustment of a
              previously processed claim. If an
              underpayment was made, the attached
              check pays the total claim allowed minus
              the amount originally paid. If an
              overpayment requiring a refund was made
              and a refund has not already been
              submitted, you will be contacted by
              letter from the Medicare claims office.

      Section 30 Reasonable Charge and Fee Schedule
      30.1  = The approved amount is based on a special
              payment method.
      30.2  = The facility fee allowance is greater
              than the billed amount.
      30.3  = Your doctor did not accept assignment for
              this service. Under Federal law, your
              doctor cannot charge more than ($______)
              . If you have already paid more than
              this amount, you are entitled to a refund
              from the provider.
      30.4  = A change in payment methods has resulted
              in a reduced or zero payment for this
              procedure.
      30.41 = What Medicare pays for a service or item
              may be higher than the billed amount.
              This amount is correct. Medicare pays
              this provider less than the billed amount
              on other claims since payment rates are
              set in advance for certain services and
              averaged out over an entire year.
      30.5  = This amount is the difference in billed
              amount and Medicare approved amount.

      Section 31 Adjustments	
      31.1  = This is a adjustment to a previously
              processed claim and/or deductible record.
      31.10 = This is an adjustment to a previously
              processed charge (s). This notice may
              not reflect the charges as they were
              originally submitted.
      31.11 = The previous notice we sent stated that
              your doctor could not charge more than
              ($______). This additional payment
              allows your doctor to bill you the full
              amount charged.
      31.12 = The previous notice we sent stated the
              amount you could be charged for this
              service. This additional payment changed
              that amount. Your doctor cannot charge
              you more than ($______).
      31.13 = The Medicare paid amount has been reduced
              by ($______) previously paid for this
              claim.
      31.14 = This payment is the result of an
              Administrative Law Judge's decision.
      31.15 = An adjustment was made based on a
              redetermination.
      31.16 = An adjustment was made based on a
              reconsideration.
      31.17 = This is an internal adjustment.  No
              action is required on your part.
      31.18 = This adjustment has resulted in an
              overpayment to your provide/supplier.
              Your provider/supplier has been requested
              to repay $________ to Medicare. You do
              not have to pay this amount.
      31.19 = If you do not agree with the Medicare
              approved amount(s), you may ask for a
              reconsideration. You must request a
              reconsideration within 180 days of the
              date of receipt of this notice. You may
              present any new evidence which could
              affect your decision. Call us at the
              number in the Customer Service block if
              you need more information about the
              reconsideration process.
              This message should be revised to read,
              "If you disagree with the Medicare-
              approved amount, you may ask for a
              redetermination within 120 days of
              receipt of this notice. Call
              1-800-MEDICARE if you need information
              on the redetermination process." when
              your MAC implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes" colums. ----->
      31.2  = A payment adjustment was made based on a
              telephone review.
      31.3  = This notice is being sent to you as the
              result of a reopening request.
      31.4  = This notice is being sent to you as the
              result of a fair hearing request.
      31.5  = If you do not agree with the Medicare
              approved amount(s) and $100 or more is
              in dispute (less deductible and
              coinsurance), you may ask for a hearing.
              You must request a hearing within 6
              months of the date of this notice. To
              meet the limit you may combine amounts
              on other claims that have been reviewed.
              At the hearing, you may present any new
              evidence which could affect the decision.
              Call us at the number in the Customer
              Service block if you need more
              information about the hearing process.
      31.6  = A payment adjustment was made based on a
              Quality Improvement Organization request.
      31.7  = This claim was previously processed under
              an incorrect Medicare claim number or
              name. Our records have been corrected.
      31.8  = This claim was adjusted to reflect the
              correct provider.
      31.9  = This claim was adjusted because there
              was an error in billing.
      31.95 = Per our telephone call, no payment can be
              made on your review request. The approved
              amount is the total allowance we can make
              for this service.
      31.96 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not separately pay for these charges
              because the cost of related care before
              and after the surgery/procedure is part
              of the approved amount for the surgery/
              procedure.
      31.97 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not pay for this many services
              within this period of time.
      31.98 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not pay for routine foot care.
      31.99 = As a result of the Hearing Officer's
              decision, no additional payment can be
              made.

      Section  Overpayments/Offsets	
      32.1  = ($______) of this payment has been
              withheld to recover a previous
              overpayment.
      32.2  = You should not be billed separately by
              your physician(s) for services provided
              during this inpatient stay.
      32.3  = Medicare has paid $_______ for hospital
              and doctor services. You shouldn't be
              billed separately by your doctor(s) for
              services you got during this inpatient
              stay.

      Section 33 Ambulatory Surgical Centers	
      33.1  = The ambulatory surgical center must bill
              for this service.

      Section 34 Patient Paid/Split Payments	
      34.1  = Of the total ($______) paid on this claim
              , we are paying you ($______) because
              you paid your provider more than your
              20% coinsurance on Medicare approved
              services. The remaining ($______) was
              paid to the provider.
      34.2  = The amount in the "You May Be Billed"
              column has been reduced by the amount
              you paid the provider at the time the
              services were rendered.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes" columns. ------>
      34.3  = After applying Medicare guidelines and
              the amount you paid to the provider at
              the time the services were rendered, our
              records indicate you are entitled to a
              refund. Please contact your provider.
      34.4  = We are paying you ($______) because the
              amount you paid the provider was more
              than you may be billed for Medicare
              approved charges.
      34.5  = The amount owed you is ($______).
              Medicare does not routinely issue checks
              for amounts under $1.00. This amount due
              will be included in your next check.
              If you want this money issued immediately
              , please contact us at the address or
              phone number in the Customer Service
              Information box.
              The last sentence of this message should
              be revised to read, "If you want this
              money issued immediately, please call
              1-800-MEDICARE (1-800-633-4227)." when
              your MAC implements the new MSN design.
               See "Message Implementation Date" and
               Message Notes" columns.
      34.6  = Your check includes ($_____) which was
              withheld on a prior claim.
      34.7  = This check includes an amount less than
              $1.00 that was withheld on a prior claim.
      34.8  = The amount you paid the provider for this
              claim was more than the required payment.
              You should be receiving a refund of
              ($_____) from your provider, which is
              the difference between what you paid and
              what you should have paid.
      34.9  = If you already paid the supplier/provider
              , the supplier/provider must refund any
              amount that exceeds the Medicare approved
              amount.

      Section 35 Supplemental Coverage/Medigap
      35.1  = This information is being sent to your
              private insurer(s). Send any questions
              regarding your benefits to them.
      35.2  = We have sent your claim to your Medigap
              insurer. Send any questions regarding
              your benefits to them.
      35.3  = A copy of this notice will not be
              forwarded to your Medigap insurer because
              the Medigap information submitted on the
              claim was incomplete or invalid. Please
              submit a copy of this notice to your
              Medigap insurer.
      35.4  = A copy of this notice will not be
              forwarded to your Medigap insurer because
              your provider does not participate in the
              Medicare program. Please submit a copy
              of this notice to your Medigap insurer.
      35.5  = We did not send this claim to your
              private insurer. They have indicated no
              additional payment can be made. Send any
              questions regarding your benefits to them
      35.6  = Your supplemental policy is not a Medigap
              policy under Federal and State law or
              regulation. It is your responsibility to
              file a claim directly with your insurer.
      35.7  = Please do not submit this notice to them
              (add-on to other messages as appropriate).

      Section 36 Limitation of Liability
      36.1  = Our records show that you were informed
              in writing, before receiving the service
              that Medicare would not pay. You are
              liable for this charge. If you do not
              agree with this statement, you may ask
              for a review.
      36.2  = You didn't know this service isn't
              covered so you don't have to pay. If you
              paid and do not receive a refund from
              your provider, you have 6 months to send
              a copy of this notice, your provider's
              bill, and proof that you paid to the
              address on the last page of this notice.
              Future services of this type won't be
              paid.
      36.3  = Your provider was told that you're owed
              a refund for this service. If you don't
              get a refund within 30 days of getting
              this notice, send a copy of this notice
              to the address on the last page. Refunds
              may be delayed if your provider appeals
              this decision.
      36.4  = You are getting a refund because your
              provider didn't tell you in writing that
              Medicare wouldn't pay for this service.
              In the future, you will have to pay for
              the service.
      36.5  = You are getting a refund because your
              provider didn't tell you in writing that
              Medicare would approve a reduced level/
              amount of services. In the future, you
              will have to pay for the service.
      36.6  = Medicare is paying this claim, this time
              only, because it appears that neither you
              nor the provider knew that the service(s)
              would be denied. You will have to pay for
              future services of this type.
      36.7  = This code is for informational/reporting
              purposes only. You should not be charged
              for this code. If there is a charge, you
              do not have to pay the amount.

      Section 37 Deductible/Coinsurance
      37.1  = This approved amount has been applied
              toward your deductible.
      37.10 = You have now met ($______) of your
              ($______) Part A deductible for this
              benefit period.
      37.11 = You have met the Part B deductible for
              (year).
      37.12 = You have met the Part A deductible for
              this benefit period.
      37.13 = You have met the blood deductible for
              (year).
      37.14 = You have met ($______) pint(s) of your
              blood deductible for (year).
      37.15 = After your deductible and coinsurance
              were applied, the amount Medicare paid
              was reduced due to Federal, State and
              local rules.
      37.16 = You have now met $_______ of your
              $_______ Part B deductible for calendar
              year ____.
      37.17 = The "Maximum You May Be Billed" column
              includes $_______ for your Part B
              deductible, $_______ for your Part B
              coinsurance, $_______ for your Part A
              deductible, and $_______ for your Part A
              coinsurance and/or lifetime reserve
              coinsurance.
              *If your MAC will implement the new MSN
              design AFTER 07/01/13, use the following
              language for this message from 07/01/13
              until your MAC DOES implement the new MSN
              design: The "You May Be Billed" column
              includes $_______ for your Part B
              deductible, $_______ for your Part B
              coinsurance, $_______ for your Part A
              deductible, and $_______ for your Part A
              coinsurance and/or lifetime reserve
              coinsurance.
      37.2  = ($______) of this approved amount has
              been applied toward your deductible.
      37.3  = ($______) was applied to your inpatient
              deductible.
      37.4  = ($______) was applied to your inpatient
              coinsurance.
      37.5  = ($______) was applied to your skilled
              nursing facility coinsurance.
      37.6  = ($______) was applied to your blood
              deductible.
      37.7  = Part B cash deductible does not apply to
              these services.
      37.8  = This coinsurance amount reflects the
              amount that you are required to pay for
              outpatient mental health treatment
              services under the Medicare program.
      37.9  = You have now met ($______) of your
              ($______) Part B deductible for (year).

      Section 38 General Information	
      38.1  = Discontinued 2002
      38.10 = Compare the services you receive with
              those that appear on your Medicare
              Summary Notice. If you have questions,
              call your doctor or provider. If you feel
              further investigation is needed due to
              possible fraud or abuse, call the phone
              number in the Customer Service
              Information Box.
              The last sentence of this message should
              be revised to read, "If you feel further
              investigation is needed due to possible
              fraud or abuse, call 1-800-MEDICARE
              (1-800-633-4227)." when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              Message Notes" columns. ----->
      38.11 = Preventive Messages:

              January - Cervical Health

              January is cervical health month. The
              Pap test is the most effective way to
              screen for cervical cancer. Medicare
              helps pay for screening Pap tests every
              two years. For more information on Pap
              tests, call your Medicare carrier.

              January - National Glaucoma Awareness
              Month (Optional)
              Glaucoma may cause blindness. Medicare
              helps pay for a yearly dilated eye exam
              for people at high risk for Glaucoma.
              African-Americans over 50 and people with
              diabetes or a family history of glaucoma
              are at higher risk. Talk to your doctor
              to learn if this exam is right for you.

              February - General Preventive Services
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              March - National Colorectal Cancer
              Awareness Month
              Colorectal cancer is the second leading
              cancer killer in the United States.
              Medicare helps pay for colorectal cancer
              screening tests. Talk to your doctor
              about screening options that are right
              for you.

              April - General Preventive Services
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              May - National Osteoporosis Month
              Do you know how strong your bones are?
              Medicare helps pay for bone mass
              measurement tests to measure the strength
              of bones for people at risk of
              osteoporosis. Talk to your doctor to
              learn if this test is right for you.

              May - Breast Cancer Awareness (to
              coordinate with Mother's Day) - Optional
              Early detection is the best protection
              from breast cancer. Get a mammogram.
              Not just once, but for a lifetime.
              Medicare helps pay for screening
              mammograms.

              June - General Preventive Services
              Message:
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              July- Glaucoma Awareness
              Glaucoma may cause blindness. Medicare
              helps pay for a yearly dilated eye exam
              for people at high risk for Glaucoma.
              African-American people over 50, and
              people with diabetes or a family history
              of glaucoma are at higher risk. Talk to
              your doctor to learn if this exam is
              right for you.

              August - National Immunization Awareness
              Month (Contractors may elect to print
              this message during a different month of
              their choosing, but the message about
              the pneumococcal shot must be printed one
              month of each year.)
              Get a pneumococcal shot. You may only
              need it once in a lifetime. Contact your
              health care provider about getting this
              shot. You pay nothing if your health
              care provider accepts Medicare assignment
              	
              September - Cold and Flu Campaign
              During this flu season, get your flu shot
              . Contact your health care provider for
              the flu shot. Get the flu shot, not the
              flu. You pay nothing if your health care
              provider accepts Medicare assignment.

              September - Prostate Cancer Awareness
              Month - Optional
              Prostate cancer is the second leading
              cause of cancer deaths in men. Medicare
              covers prostate screening tests once
              every 12 months for men with Medicare who
              are over age 50.

              October - Breast Cancer Awareness Month
              Early detection is your best protection.
              Schedule your mammogram today, and
              remember that Medicare helps pay for
              screening mammograms.

              October - Continuation of Cold/Flu
              Campaign (optional)
              If you have not received your flu shot,
              it is not too late. Please contact your
              health care provider about getting the
              flu shot.

              November - American Diabetes Month
              Medicare covers expanded benefits to help
              control diabetes

      Section 38 General Information
      38.12 = If you appeal this drug claim
              determination, send it to the Medicare
              contractor who processed your doctor's
              claim for giving you the drug.
      38.13 = If you aren't due a payment check from
              Medicare, your Medicare Summary Notices
              (MSN) will now be mailed to you on a
              quarterly basis. You will no longer get
              a monthly statement in the mail for these
              types of MSNs. You will now get a
              statement every 90 days summarizing all
              of your Medicare claims. Your provider
              may send you a bill that you may need to
              pay before you get your MSN. When you
              get your MSN, look to see if you paid
              more than the MSN says is due. If you
              paid more, call your provider about a
              refund. If you have any questions about
              the bill from your provider, you should
              call your provider.
      38.14 = Have limited income?  Social Security
              can help with prescription drug costs.
              For more information on Extra Help with
              prescription drug costs and how to apply,
              visit www.socialsecurity.gov on the web
              or call 1-800-772-1213. TTY users should
              call 1-800-325-0778.
      38.15 = If the coinsurance amount you paid is
              more than the amount shown on your notice
              , you are entitled to a refund. Please
              contact your provider.
      38.18 = ALERT:  Coverage by Medicare will be
              limited for outpatient physical therapy
              (PT), speech-language pathology (SLP),
              and occupational therapy (OT) services
              for services received on January 1, 2006
              through December 31, 2007. The limits are
              $1,740 in 2006 and $1780 in 2007 for PT
              and SLP combined and $1,740 in 2006 and
              $1780 in 2007 for OT. Medicare pays up
              to 80 percent of the limits after the
              deductible has been met. These limits
              don't apply to certain therapy approved
              by Medicare or to therapy you get at
              hospital outpatient departments, unless
              you are a resident of and occupy a
              Medicare-certified bed in a skilled
              nursing facility. If you have questions,
              please call 1-800-MEDICARE.
              You have the right to request an itemized
              statement which details each Medicare
              item or service which you have received
              from your physician, hospital, or any
              other health supplier or health
              professional. Please contact them
              directly, in writing, if you would like
              an itemized statement.
              Beneficiaries needing or receiving home
              health care may qualify for the new Home
              Health Independence Demonstration and
              have the freedom to leave home more often
              while remaining eligible for Medicare
              home health services. To qualify, you
              must meet several criteria, have a
              permanent disabling condition, and live
              in Colorado, Massachusetts, or Missouri.
              For more information, ask your home
              health agency about the "Home Health
              Independence Demonstration"; call 1(800)
              MEDICARE (1-800-633-4227); or visit our
              website at: www.cms.hhs.gov/researchers/
              demos/homehealthindependence.asp
      38.18 = ALERT:  Coverage by Medicare will be
              limited for outpatient physical therapy
              (PT), speech-language pathology (SLP),
              and occupational therapy (OT) services
              for services received on January 1, 2006
              through December 31, 2007. The limits are
              $1,740 in 2006 and $1780 in 2007 for PT
              and SLP combined and $1,740 in 2006 and
              $1780 in 2007 for OT. Medicare pays up
              to 80 percent of the limits after the
              deductible has been met. These limits
              don't apply to certain therapy approved
              by Medicare or to therapy you get at
              hospital outpatient departments, unless
              you are a resident of and occupy a
              Medicare-certified bed in a skilled
              nursing facility. If you have questions,
              please call 1-800-MEDICARE.
      38.19 = Medicare Open Enrollment is from October
              15 to December 7. This is when you can
              compare and change your health and drug
              plan coverage. If you're happy with your
              current plan, you don't have to do
              anything. Call 1-800-MEDICARE (1 800-633-
              4227) for more information.
      38.2  = Discontinued
      38.20 = You have the right to request an itemized
              statement which details each Medicare
              item or service you have received from a
              physician, hospital, or any other
              healthcare provider or supplier. Contact
              your provider to get an itemized
              statement.
      38.22 = Planning to retire? Does your current
              insurance pay before Medicare pays? Call
              Medicare within the 6 months before you
              retire to update your records. Make sure
              your health care bills get paid correctly
      38.23 = Save tax dollars by getting your
              "Medicare & You" handbook electronically.
              Visit www.mymedicare.gov to sign up.
      38.24 = Please have your complete Medicare number
              with you when you call so your record
              can be located. To protect your privacy,
              this MSN doesn't include your entire
              number.
      38.25 = This item or service is being denied.
              Medicare won't pay for a Medical
              Nutrition Therapy service and Diabetes
              Self Management Training item or service
              performed on the same date for the same
              person with Medicare.
      38.26 = Your claims may have been adjusted since
              Medicare changed how it pays for certain
              services in 2010. You can compare claims
              that have been changed to previous
              statements you received in the past.
              Your provider may owe you a refund or
              you may have to pay more coinsurance.
              Call your provider or 1-800-MEDICARE.
      38.27 = Get a pneumococcal shot. You may only
              need it once in a lifetime. Contact your
              health care provider about getting this
              shot. You pay nothing if your health
              care provider accepts Medicare assignment
      38.28 = Early detection is your best protection.
              Schedule your mammogram today, and
              remember that Medicare helps pay for
              screening mammograms.
      38.3  = If you change your address, contact the
              Social Security Administration by calling
              1-800-772-1213.
      38.31 = To report a change of address, call
              Social Security at 1-800-772-1213. TTY
              users should call 1-800-325-0778.
      38.32 = Welcome to your new Medicare Summary
              Notice! It has clear language, larger
              print, and a personal summary of your
              claims and deductibles. This improved
              notice better explains how to get help
              with your questions, report fraud, or
              file an appeal. It also includes
              important information from Medicare!
      38.4  = You're at high risk for complications
              from the flu and it's very important
              that you get vaccinated. Please contact
              your healthcare provider about getting
              the flu vaccine.
      38.5  = If you haven't gotten your flu vaccine,
              it isn't too late. Please contact your
              health care provider about getting the
              vaccine.
      38.6  = January is cervical cancer prevention
              month.
      38.7  = The Pap test is the most effective way
              to screen for cervical cancer.
      38.8  = Medicare helps pay for screening Pap
              tests once every two years.
      38.9  = Colorectal cancer is the second leading
              cancer killer in the United States.
              Medicare helps pay for screening tests
              that can find polyps before they become
              cancerous and find cancer early when
              treatment may work best. Medicare helps
              pay for screening tests. Talk to your
              doctor about the screening options that
              are right for you.

      Section 4 End-Stage Renal Disease (ESRD)
      4.1   = This charge is more than Medicare pays
              for maintenance treatment of renal
              disease.
      4.10  = No more than ($______) can be paid for
              these supplies each month.
      4.11  = The amount listed in the "You May Be
              Billed" column is based on the Medicare
              approved amount. You are not responsible
              for the difference between the amount
              charged and the approved amount.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
      4.12  = This service has been denied/rejected
              since payment was made to your End Stage
              Renal Disease (ESRD) dialysis facility.
      4.18  = Medicare cannot pay more than $_____ each
              month for these supplies. The provider
              cannot bill you for the supplies over
              this limit.
      4.2   = This service is covered up to (insert
              appropriate number) months after
              transplant and release from the
              hospital.
      4.3   = Prescriptions for immunosuppressive drugs
              are limited to a 30-day supply.
      4.4   = Only one supplier per month may be paid
              for these supplies/services.
      4.5   = Medicare pays the professional part of
              this charge to the hospital.
      4.6   = Payment has been reduced by the number
              of days you were not in the usual place
              of treatment.
      4.7   = Payment for all equipment and supplies
              is made through your dialysis center.
              They will bill Medicare for these
              services.
      4.8   = This service cannot be paid because you
              did not choose an option for your
              dialysis equipment and supplies.
      4.9   = Payment was reduced or denied because the
              monthly maximum allowance for this home
              dialysis equipment and supplies has been
              reached.

      Section 41 Home Health Messages
      41.1  = Medicare will only pay for this service
              when it is provided in addition to other
              services.
      41.10 = Patients eligible to receive home health
              benefits from another government agency
              are not eligible to receive Medicare
              benefits for the same service.
      41.11 = The doctor's orders for home health
              services were incomplete.
      41.12 = According to the medical record, the
              provider has billed in error for these
              items/services.
      41.13 = The provider has billed for services/
              items not documented in your record.
      41.14 = This service/item was billed incorrectly.
      41.15 = The information provided indicates that
              you are able to perform personal care
              activities on your own.
      41.16 = To receive Medicare payment, you must
              have a signed doctor's order before you
              receive the services.
      41.2  = This service must be performed by a nurse
              who has the required psychiatric nurse
              credentials.
      41.3  = The medical information did not support
              the need for continued services.
      41.4  = Medicare considers this item to be
              inappropriate for home use.
      41.5  = Medicare does not pay for comfort or
              convenience items.
      41.6  = This item was not furnished under a plan
              of care established by your physician.
      41.7  = This item is not considered by Medicare
              to be a prosthetic and/or orthotic device
      41.8  = The information provided indicates that
              your illness or injury doesn't restrict
              your ability to leave your home, except
              with the assistance of another individual
              or the aid of a supportive device (such
              as crutches, a cane, a wheelchair, or a
              walker).
      41.9  = Services exceeded those ordered by your
              physician.

      Section 42 Religious Nonmedical Health Care
      Institutions
      42.1  = You received medical care at a facility
              other than a religious nonmedical health
              care institution but that care did not
              revoke your election to receive benefits
              for religious nonmedical health care.
      42.2  = Since you received medical care at a
              facility other than a religious
              nonmedical health care institution,
              benefits for religious nonmedical health
              care services have been revoked for these
              services unless you file a new election.
      42.3  = This service is not covered since you did
              not elect to receive religious
              nonmedical health care services instead
              of regular Medicare services.
      42.4  = This service is not covered because you
              received medical health care services
              which revoked your election to religious
              nonmedical health care services.
      42.5  = This service is not covered because you
              requested in writing that your election
              to religious nonmedical health care
              services be revoked.

      Section 5 Number/Name/Enrollment
      5.1   = Our records show that you do not have
              Medicare entitlement under the number
              shown on this notice. If you do not
              agree, please contact your local Social
              Security office.
      5.2   = The name or Medicare number was incorrect
              or missing. Please check your Medicare
              card. If the information on this notice
              is different from your card, contact your
              provider.
      5.3   = Our records show that the date of death
              was before the date of service.
      5.4   = If you cash the enclosed check, you are
              legally obligated to make payment for
              these services. If you do not wish to
              assume this obligation, please return
              this check.
      5.5   = Our records show you did not have Part A
              (B) coverage when you received this
              service. If you disagree, please contact
              us at the customer service number shown
              on this notice.
      5.6   = The name or Medicare number was incorrect
              or missing. Ask your provider to use the
              name or number shown on this notice for
              future claims.
      5.7   = Medicare payment may not be made for the
              item or service because on the date of
              service you were not lawfully present in
              the United States.

      Section 6 Drugs	
      6.1   = This drug is covered only when Medicare
              pays for the transplant.
      6.2   = Drugs not specifically classified as
              effective by the Food and Drug
              Administration are not covered.
      6.3   = Payment cannot be made for oral drugs
              that do not have the same active
              ingredients as they would have if given
              by injection.
      6.4   = Medicare does not pay for an oral
              anti-emetic drug that is not administered
              for use immediately before, at, or within
              48 hours after administration of a
              Medicare covered chemotherapy drug.
      6.5   = Medicare cannot pay for this injection
              because one or more requirements for
              coverage were not met.

      Section 43 Demonstration Project Messages
      60.1  = In partnership with physicians in your
              area, ____________ is participating in a
              Medicare demonstration project that uses
              a simplified payment method to combine
              all hospital and physician care related
              to your hospital service.
      2/18/13= Even though this service is being paid
              in accordance with the rules and
              guidelines under the Competitive Bidding
              Demonstration, future claims may be
              denied when this item is provided to this
              patient by a non-demonstration supplier.
              If you would like more information
              egarding this project, you may contact
              1-888-289-0710.
      60.11 = These services are covered by a
              demonstration project or payment model
              pilot. It will pay for all services
              related to this hospital stay. If you
              have already paid a provider for any of
              these services, you should receive a
              refund.
      60.12 = Your co-payment under this demonstration
              is the lesser of 20% of the Medicare
              allowed amount or 20% of the allowed
              amount under your drug discount card.
      60.13 = This claim is being processed under a
              demonstration project. Services cannot
              be covered because you do not reside in
              one of the demonstration areas.
      60.14 = This claim is being processed under a
              demonstration project. Services cannot
              be covered because your doctor does not
              have a practice in one of the
              demonstration areas.
      60.15 = Beginning April 1, 2005 through March 31,
              2007, Medicare will cover additional
              chiropractic services. For more
              information, talk to your chiropractor,
              call 1-800-MEDICARE, or go to
              http://www.cms.hhs.gov/researchers/demos
              /eccs/default.asp.
      60.16 = This claim is being processed under a
              demonstration or payment model pilot.
              All hospital and doctor services related
              to your hospital stay have been combined
              into a single payment. You may have to
              pay any unmet deductible and coinsurance
              amounts.
      60.2  = The total Medicare approved amount for
              your hospital service is ($______).
              ($______) is the Part A Medicare amount
              for hospital services and ($_______) is
              the Part B Medicare amount for physician
              services (of which Medicare pays 80
              percent). You are responsible for any
              deductible and coinsurance amounts
              represented.
      60.3  = Medicare has paid ($______) for hospital
              and physician services. Your Part A
              deductible is ($______). Your Part A
              coinsurance is ($______) Your Part B
              coinsurance is ($______).
      60.4  = This claim is being processed under a
              demonstration project.
      60.5  = This claim is being processed under a
              demonstration project. If you would like
              more information about this project,
              please contact 1-888-289-0710.
      60.6  = A claim has been submitted on your behalf
              indicating that you are participating in
              the Medicare Coordinated Care
              Demonstration project. However, our
              records indicate that you are not
              currently enrolled or your enrollment
              has not yet been approved for the
              demonstration.
      60.7  = A claim has been submitted on your behalf
              indicating that you are participating in
              the Medicare Coordinated Care
              Demonstration project. However, our
              records indicate that either you have
              terminated your election to participate
              in the demonstration project or the dates
              of service are outside the demonstration
              participation dates.
      60.8  = The approved amount is based on the
              maximum allowance for this item under the
              DMEPOS Competitive Bidding Demonstration.
      60.9  = Our records indicate that this patient
              began using this service(s) prior to the
              current round of the DMEPOS Competitive
              Bidding Demonstration. Therefore, the
              approved amount is based on the allowance
              in effect prior to this round of bidding
              for this item.

      Section 7 Duplicate Bills
      7.1   = This is a duplicate of a charge already
              submitted.
      7.15  = Medicare records show that payment for
              this service has already been made by
              another contractor.
      7.2   = This is a duplicate of a claim processed
              by another contractor. You should
              receive a Medicare Summary Notice from
              them.
      7.3   = This service/item is a duplicate of a
              previously processed service. You may
              only appeal the decision that this
              service/item is a duplicate. The appeals
              information on this notice only applies
              to the duplicate service issue.
      7.4   = The claim for the billing fee was denied
              because it was submitted past the allowed
              time frame.
      7.7   = Your physician has elected to participate
              in the Competitive Acquisition Program
              for these drugs. Claims for these drugs
              must be billed by the appropriate drug
              vendor instead of your physician.
      7.8   = Your physician has elected to participate
              in the Competitive Acquisition Program
              (CAP) for Medicare Part B drugs. Medicare
              cannot pay for the administration of the
              drug(s) being billed because these
              drug(s) are not available from the CAP
              vendor.

      Section 8 Durable Medical Equipment (DME)
      8.1   = Your supplier is responsible for the
              servicing and repair of your rented
              equipment.
      8.2   = To receive Medicare payment, you must
              have a doctor's prescription before you
              rent or purchase this equipment.
      8.10  = Payment is included in the approved
              amount for other equipment.
      8.11  = The purchase allowance has been reached.
              If you continue to rent this piece of
              equipment, the rental charges are your
              responsibility.
      8.12  = The approved charge is based on the
              amount of oxygen prescribed by the doctor
      8.13  = Monthly rental payments can be made for
              up to 15 months from the first paid
              rental month or until the equipment is
              no longer needed, whichever comes first.
      8.14  = Your equipment supplier must furnish and
              service this item for as long as you
              continue to need it. Medicare will pay
              for maintenance and/or servicing for
              every 6 month period after the end of
              the 15th paid rental month.
      8.15  = Maintenance and/or servicing of this item
              is not covered until 6 months after the
              end of the 15th paid rental month.
      8.16  = Monthly allowance includes payment for
              oxygen and supplies.
      8.17  = Payment for this item is included in the
              monthly rental payment amount.
      8.18  = Payment is denied because the supplier
              did not have a written order from your
              doctor prior to delivery of this item.
      8.19  = Sales tax is included in the approved
              amount for this item.
      8.2   = To receive Medicare payment, you must
              have a doctor's prescription before you
              rent or purchase this equipment.
      8.20  = Medicare does not pay for this equipment
              or item.
      8.21  = Medicare won't cover this item without a
              new, revised or renewed certificate of
              medical necessity.
      8.22  = No further payment can be made because
              the cost of repairs has added up to the
              purchase price of this item.
      8.23  = No payment can be made because the item
              has reached the 15-month limit.
              Separate payments can be made for
              maintenance or servicing every 6 months.
      8.24  = The claim doesn't show that you own the
              equipment requiring these parts or
              supplies.
      8.25  = Payment cannot be made until you tell
              your supplier whether you want to rent
              or buy this equipment.
      8.26  = Payment is reduced by 25% beginning the
              4th month of rental.
      8.27  = Payment is limited to 13 monthly rental
              payments because you have decided to
              purchase this equipment.
      8.28  = Maintenance, servicing, replacement, or
              repair of this item is not covered.
      8.29  = Payment is allowed only for the seat lift
              mechanism, not the entire chair.
      8.3   = This equipment is not covered because its
              primary use is not for medical purposes.
      8.30  = This item is not covered because the
              doctor did not complete the certificate
              of medical necessity.
      8.31  = Payment is denied because blood gas tests
              cannot be performed by a durable medical
              equipment supplier.
      8.32  = This item can only be rented for 2 months
              . If the item is still needed, it must
              be purchased.
      8.33  = This is the next to last payment for this
              item.
      8.34  = This is the last payment for this item.
      8.35  = This item is not covered when oxygen is
              not being used.
      8.36  = Payment is denied because the certificate
              of medical necessity on file was not in
              effect for this date of service.
      8.37  = An oxygen recertification form was sent
              to the physician.
      8.38  = This item must be rented for 2 months
              before purchasing it.
      8.39  = This is the 10th month of rental payment.
              Your supplier should offer you the choice
              of changing the rental to a purchase
              agreement.
      8.4   = Payment can't be made for equipment
              that's the same or similar to equipment
              already being used.
      8.40  = We have previously paid for the purchase
              of this item.
      8.41  = Payment for the amount of oxygen supplied
              has been reduced or denied because the
              monthly limit has been reached.
      8.42  = Standby equipment is not covered.
      8.43  = Payment has been denied because this
              equipment cannot deliver the liters per
              minute prescribed by your doctor.
      8.44  = Payment is based on a standard item
              because information did not support the
              need for a deluxe or more expensive item.
      8.45  = Payment for electric wheelchairs is
              allowed only if the purchase decision is
              made in the first or tenth month of
              rental.
      8.46  = Payment is included in the allowance for
              another item or service provided at the
              same time.
      8.47  = Supplies or accessories used with
              noncovered equipment are not covered.
      8.48  = Payment for this drug is denied because
              the need for the equipment has not been
              established.
      8.49  = This allowance has been reduced because
              part of this item was paid on another
              claim.
      8.5   = Rented equipment that is no longer needed
              or used is not covered.
      8.50  = Medicare can't pay for this drug/
              equipment because our records show that
              your supplier isn't licensed to dispense
              prescription drugs, and, therefore, can't
              assure the safety and effectiveness of
              the drug/equipment.
      8.51  = You are not liable for any additional
              charge as a result of receiving an
              upgraded item.
      8.52  = You signed an Advanced Beneficiary Notice
              (ABN). You are responsible for the
              difference between the upgrade amount and
              the Medicare payment.
      8.53  = This item or service was denied because
              the upgrade information was invalid.
      8.54  = If a supplier knew that Medicare wouldn't
              pay and you paid, you might get a refund
              unless you signed a notice in advance.
              Refunds may be delayed if the provider
              appeals. Call your supplier if you don't
              hear anything within 30 days.
      8.55  = Medicare will process your first claim
              but, from now on, you must use a
              Medicare-enrolled supplier and put the
              supplier ID number on your claim. For a
              list of Medicare-enrolled suppliers call
              1-800-MEDICARE or visit www.medicare.gov/
              supplier
      8.56  = Medicare can't process this claim because
              you were already notified that you must
              use a supplier who has a Medicare
              supplier identification number, and this
              supplier doesn't have one.
      8.57  = Your equipment supplier must furnish and
              service this item for as long as you
              continue to need it. Medicare will pay
              for maintenance and/or servicing for
              every 3-month period after the end of
              the 15th paid rental month.
      8.58  = No payment can be made because the item
              has reached the 15-month limit. Separate
              payments can be made for maintenance or
              servicing every 3 months.
      8.59  = Durable Medical Equipment Regional
              Carriers only pay for Epoetin Alfa and
              Darbepoetin Alfa for Method II End Stage
              Renal Disease home dialysis patients.
      8.6   = A partial payment has been made because
              the purchase allowance has been reached.
              No further rental payments can be made.
      8.60  = Payment is denied because there is no
              hospital stay/surgery on file for
              implantation of the Durable Medical
              Equipment (DME) or prosthetic device.
      8.61  = This supplier isn't located in your
              competitive bidding area, but is required
              to accept the same price as a supplier
              in your area. This supplier may not
              charge you more than 20% of the bid price
              , plus any unmet deductibles.
      8.62  = This supplier didn't win a contract for
              furnishing this item in the competitive
              bidding area where you received it. This
              supplier isn't allowed to charge you for
              this item unless you signed a written
              notice agreeing to pay before you got
              the item.
      8.63  = This supplier isn't located in your
              competitive bidding area, but is located
              in a different competitive bidding area.
              This supplier won a contract under
              national competitive bidding in their
              area. They must accept the bid price from
              your area as payment in full, and may not
              charge you more than 20% of the bid
              price for your area, plus any unmet
              deductibles.
      8.64  = Monthly payments can be made for 13
              months, or until the equipment is no
              longer needed, whichever comes first.
              After the 13th month, your supplier must
              transfer title of this equipment to you.
      8.65  = Medicare will pay for medically necessary
              maintenance and/or servicing as needed
              after the end of the 13th paid rental
              month.
      8.66  = Medicare has paid for 36 months of rental
              for your oxygen equipment. Your supplier
              must transfer title of this equipment to
              you. No further rental payments will be
              made. We will continue to pay for
              delivery of oxygen contents, as
              appropriate, and necessary maintenance of
              your equipment.
      8.67  = Medicare has already paid for 36 months
              of rental for your oxygen equipment. The
              supplier should have transferred the
              title for the equipment to you. The
              supplier may not collect any more money
              from you for this equipment, and must
              provide you with a refund of any money
              you have already paid.
      8.68  = Medicare will pay for you to rent oxygen
              for up to 36 months (or until you no
              longer need the equipment). After
              Medicare makes 36 payments, your supplier
              will transfer the title of the equipment
              to you, and you will own the equipment.
      8.69  = Medicare will pay to maintain and service
              your oxygen equipment. This will start
              six months after the supplier transfers
              the title of the equipment to you.
      8.7   = This equipment is covered only if rented.
      8.70  = The Medicare-approved amount is based on
              the bid price for this item under the
              DMEPOS competitive bidding program.
      8.71  = Our records show that you began using
              this item before the current round of
              competitive bidding and you decided to
              keep getting this item from your current
              supplier. The Medicare-approved amount
              is based on the bid price for this item.
      8.72  = This item must be provided by a contract
              supplier under the DMEPOS competitive
              bidding program. You should not be billed
              for this item or service. You do not have
              to pay this amount. There are no Medicare
              appeal rights related to this item.	
      8.73  = The claim for this service was processed
              according to rules of the DMEPOS
              competitive bidding program.
      8.74  = You signed an Advanced Beneficiary Notice
              (ABN) saying that you wanted to get this
              item from a non-winning supplier under
              the DMEPOS Competitive Bidding Program.
              Therefore, Medicare will not pay for this
              item. You must pay the supplier in full.
      8.75  = Our records show that you began using
              this item before competitive bidding
              started for this item in your area.
              Because you decided to keep getting this
              item from your current supplier, this
              item will be paid at the standard payment
              amount and not at the bid price.
      8.76  = This item or service is not covered
              because the claim shows that it was not
              given in a skilled nursing facility or a
              nursing facility. The claim for this item
              or service was processed according to the
              rules of the DMEPOS competitive bidding
              program.
      8.78  = Medicare has paid for 36 months for your
              oxygen equipment. Your supplier is
              required to provide the oxygen equipment
              and related supplies, at no charge, for
              the remainder of the equipment's 5 year
              lifetime.
      8.79  = Medicare has paid 36 months of rental for
              your oxygen equipment. The supplier may
              not collect any more money from you for
              this equipment, and must refund any money
              you have already paid.
      8.8   = This equipment is covered only if
              purchased.
      8.80  = Medicare will pay for rental of this
              equipment for 36 months (or until you no
              longer need the equipment). After 36
              months, Medicare will continue to pay for
              delivery of liquid or gaseous contents,
              as long as it is still medically
              necessary.
      8.81  = If the provider/supplier should have
              known that Medicare would not pay for the
              denied items or services and did not
              tell you in writing before providing them
              that Medicare probably would deny payment
              , you may be entitled to a refund of any
              amounts you paid. However, if the
              provider/supplier requests a review of
              this claim within 30 days, a refund is
              not required until we complete our review
              . If you paid for this service and do not
              hear anything about a refund within the
              next 30 days, contact your provider/
              supplier.
      8.9   = Payment has been reduced by the amount
              already paid for the rental of this
              equipment.
      8.90  = You live in a Competitive Bidding Area.
              This is a Competitive Bidding item.
              The Medicare approved amount is based on
              the bid price for this item under the
              DMEPOS competitive bidding program.
      8.91  = Our records show that you began using
              this item before the DMEPOS Competitive
              Bidding program began and you decided to
              keep renting this item from your current
              supplier. The Medicare-approved amount is
              based on the bid price for this item for
              the area where you live.
      8.92  = You live in a Competitive Bidding Area
              and this item must be provided by a
              Medicare-contract supplier under the
              DMEPOS competitive bidding program.
              Medicare won't pay for this item and you
              shouldn't be billed for this item or
              service. You don't have to pay this
              amount. Medicare appeal rights don't
              apply to this item.
      8.93  = Medicare only pays 36 monthly payments
              for your oxygen. After 36 months, the
              supplier is still responsible for
              providing you with that equipment for 5
              years. You shouldn't pay any more
              copayments.
      8.95  = Our records show that you began using
              this item before the DMEPOS Competitive
              Bidding program started for this item in
              your area. Because you decided to keep
              renting this item from your current
              supplier, this item will be paid at the
              standard payment amount and not at the
              bid price.
      8.96  = This item or service isn't covered
              because the claim shows that it wasn't
              provided in a skilled nursing facility or
              nursing facility. The claim for this item
              or service was processed according to the
              rules of the DMEPOS competitive bidding
              program.
      8.97  = Starting January 1, 2011, you may have to
              use certain Medicare-contracted suppliers
              to get certain medical equipment and
              supplies. Visit www.medicare.gov or call
              1-800-MEDICARE for details

      Section 9 Failure to Furnish Information
      9.1   = The information we requested was not
              received.
      9.2   = This item or service was denied because
              information required to make payment was
              missing.
      9.3   = Please ask your provider to submit a new,
              complete claim to us.
      9.4   = This item or service was denied because
              information required to make payment was
              incorrect.
      9.5   = Our records show your doctor did not
              order this supply or amount of supplies.
      9.6   = Please ask your provider to resubmit this
              claim with a breakdown of the charges or
              services.
      9.7   = We have asked your provider to resubmit
              the claim with the missing or correct
              information.
      9.8   = The hospital has been asked to submit
              additional information, you should not be
              billed at this time.
      9.9   = This service is not covered unless the
              supplier/provider files an electronic
              media claim (EMC).

      Section 96 Jurisdiction-Specific	
      96.10 = Go paperless, go green! If you live in
              CT or NY you can stop getting paper
              Medicare Summary Notices (MSNs) in the
              mail, and get Electronic MSNs (eMSNs)
              online instead. To sign up, go to
              www.mymedicare.gov or call 1-800-
              MEDICARE (1-800-633-4227).
              * See Message Notes ----------->

      Section 97 FISS Part A	
      97.xx = The entire range of 97.xx messages
              have been blocked off for FISS/Part A
              usage.

      Section 99 Florida-Specific	
      99.xx = The entire range of 99.xx messages have
              been blocked off for Florida usage.



 CLM_FREQ_TB                             Claim Frequency Table

       0 = Non-payment/zero claims
       1 = Admit thru discharge claim
       2 = Interim - first claim
       3 = Interim - continuing claim (not valid for
           PPS claims)
       4 = Interim - last claim (not valid for PPS claims)
       5 = Late charge(s) only claim
       6 = Reserved for national assignment; Adjustment of prior claim.
           Obsolete
       7 = Replacement of prior claim;
           eff 10/93, provider debit
       8 = Void/cancel prior claim
           eff 10/93, provider cancel
       9 = Final claim -- used in an HH PPS
           episode to indicate the claim
           should be processed like debit/
           credit adjustment to RAP (initial
           claim) (eff. 10/00)
       A = Admission election notice - used when hospice
           or Religious Nonmedical Health Care Institution
           is submitting the HCFA-1450 as an
           admission notice - hospice NOE only
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
           is reported on them.
       B = Hospice/Medicare Coordinated Care Demonstration/
           RNCHI - Termination/Revocation Notice - hospice
           NOE only  (eff 9/93)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
           is reported on them.
       C = Hospice change of provider notice
           - hospice NOE only (eff 9/93)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
       D = Hospice/Medicare Coordinated Care Demonstration/
           RNHCI - void/cancel
           -  hospice NOE only  (eff 9/93)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
       E = Hospice change of ownership
           - hospice NOE only  (eff 1/97)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
       F = Beneficiary initiated adjustment claim
           (eff 10/93)
       G = CWF initiated adjustment claim (eff 10/93)
       H = CMS initiated adjustment claim (eff 10/93)
       I = Intermediary adjustment claim (other than PRO
           or provider) - used to identify a
           debit adjustment initiated by CMS or
           an intermediary (other than QIO or Provider)
           - eff 10/93, used to identify intermediary
           initiated adjustment only
       J = Other adjustment request (eff 10/93)
       K = OIG initiated adjustment (eff 10/93)
       M = MSP initiated adjustment (eff 10/93)
       N = Reserved for national assignment
       O = Nonpayment/Zero claims
       P = Adjustment required by Quality Improvement
           Organization (QIO) -- formerly Peer Review
           Organization (PRO)
       Q = Claim Submitted for Reconsideration Outside of
           Timely Limits
       X = Replacement of Prior Abbreviated Encounter Submission
           (used by Medicare Advantage contractor or other plan
           required to submit encounter data);
           Special adjustment processing - used for QA editing (eff 8/92)
           Obsolete
       Z = New Abbreviated Encounter Submission (TOB '11Z') used
           for MCO enrollee hospital discharges 7/1/97 - 12/31/98;
           not stored in the NCH.  Exception:  Problem in
           startup months may have resulted in this abbreviated
           UB-92 being erroneously stored in the NCH.



 CLM_HIPPS_TB                            Claim SNF, HHA & IRF Health Insurance PPS Table

      **********************************************************
      Please refer to the CMS website for the latest information
      on the HIPPS Codes.  The URL is
      http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/
      ProspMedicareFeeSvcPmtGen/HIPPSCodes.html
      (paste into browser address bar without any spaces)
      **********************************************************



 CLM_MASS_ADJSTMT_IND_CD_TB              Claim Mass Adjustment Indicator Code Table

      M = Mass Adjustment (MPFS)
      O = Mass Adjustment (Other)



 CLM_MCO_PD_TB                           Claim MCO Paid Switch Code Table

      1 = MCO has paid the provider for a claim
      BLANK or 0 = MCO has not paid the provider
                   for a claim



 CLM_MDCD_INFO_TB                        Claim Medicaid Information Table

      164 = Number of attachments submitted
      166 = Abortion/sterilization code
      167 = Child Health Assurance Program Referral Code
      168 = Civilian Health and Medical Program of the
            Uniformed Services Code



 CLM_MDCR_NPMT_RSN_TB                    Claim Medicare Non-Payment Reason Table

      Valid Values effective 1/2011 (2-byte values are replacing
      the character values)
       A = Covered worker's compensation (Obsolete)
       B = Benefit exhausted
       C = Custodial care - noncovered care
           (includes all 'beneficiary at fault'
           waiver cases) (Obsolete)
       E = HMO out-of-plan services not emergency
           or urgently needed (Obsolete)
       E = MSP cost avoided - IRS/SSA/HCFA Data
           Match (eff. 7/00)
       F = MSP cost avoid HMO Rate Cell (eff. 7/00)
       G = MSP cost avoided Litigation Settlement
           (eff. 7/00)
       H = MSP cost avoided Employer Voluntary
           Reporting (eff. 7/00)
       J = MSP cost avoid Insurer Voluntary
           Reporting (eff. 7/00)
       K = MSP cost avoid Initial Enrollment
           Questionnaire (eff. 7/00)
       N = All other reasons for nonpayment
       P = Payment requested
       Q = MSP cost avoided Voluntary Agreement
           (eff. 7/00)
       R = Benefits refused, or evidence not
           submitted
       T = MSP cost avoided - IEQ contractor
           (eff. 9/76) (obsolete 6/30/00)
       U = MSP cost avoided - HMO rate cell
           adjustment (eff. 9/76) (Obsolete 6/30/00)
       V = MSP cost avoided - litigation
           settlement (eff. 9/76) (Obsolete 6/30/00)
       W = Worker's compensation (Obsolete)
       X = MSP cost avoided - generic
       Y = MSP cost avoided - IRS/SSA data
           match project (obsolete 6/30/00)
       Z = Zero reimbursement RAPs -- zero reimbursement
           made due to medical review intervention or
           where provider specific zero payment has been
           determined. (effective with HHPPS - 10/00)
       00 = MSP cost avoided - COB Contractor
       12 = MSP cost avoided - BCBS Voluntary Agreements
       13 = MSP cost avoided - Office of Personnel Management
       14 = MSP cost avoided - Workman's Compensation (WC) Datamatch
       15 = MSP cost avoided - Workman's Compensation Insurer Voluntary
            Data Sharing Agreements (WC VDSA) (eff. 4/2006)
       16 = MSP cost avoided - Liability Insurer VDSA (eff. 4/2006)
       17 = MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006)
       18 = MSP cost avoided - Pharmacy Benefit Manager Data
            Sharing Agreement (eff. 4/2006)
       19 = MSP cost avoided - Worker's Compensation Medicare Set-Aside
            Arrangement
       21 = MSP cost avoided - MIR Group Heqalth Plan (eff. 1/2009)
       22 = MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009)
       25 = MSP cost avoided - Recovery Audit Contractor - California
            (eff. 10/2005)
       26 = MSP cost avoided - Recovery Audit Contractor - Florida
            (eff. 10/2005)
       39 = MSP cost avoided - GHP Recovery
       41 = MSP cost avoided - NGHP Non-ORM
       42 = MSP cost avoided - NGHP ORM Recovery
       43 = MSP cost avoided - COBC/Medicare Part C/Medicare Advantage

      Prior to 1/2011, the character values below were used to
      represent the 2-byte values

      NOTE: Effective 4/1/02, the Medicare nonpayment reason
      code was expanded to a 2-byte field.  The NCH instituted
      a crosswalk from the 2-byte code to a 1-byte character
      code. Below are the character codes (found in NCH &
      NMUD). At some point, NMUD will carry the 2-byte code
      but NCH will continue to have the 1-byte character
      code.

      ! = MSP cost avoided - COB Contractor ('00' 2-byte code)
      @ = MSP cost avoided - BC/BS Voluntary Agreements
          ('12' 2-byte code)
      # = MSP cost avoided - Office of Personnel Management
          ('13' 2-byte code)
      $ = MSP cost avoided - Workman's Compensation (WC) Datamatch
          ('14' 2-byte code)
      * = MSP cost avoided - Workman's Compensation Insurer
          Voluntary Data Sharing Agreements (WC VDSA)
          ('15' 2-byte code) (eff. 4/2006)
      ( = MSP cost avoided - Liability Insurer VDSA
          ('16' 2-byte code) (eff. 4/2006)
      ) = MSP cost avoided - No-Fault Insurer VDSA
          ('17' 2-byte code) (eff. 4/2006)
      + = MSP cost avoided - Pharmacy Benefit Manager Data
          Sharing Agreement ('18' 2-byte code) (eff. 4/2006)
      < = MSP cost avoided - MIR Group Health Plan
          ('21' 2-byte code) (eff. 1/2009)
      > = MSP cost avoided - MIR non-Group Health Plan
          ('22' 2-byte code) (eff. 1/2009)
      % = MSP cost avoided - Recovery Audit Contractor -
          - California ('25' 2-byte code) (eff. 10/2005)
      & = MSP cost avoided - Recovery Audit Contractor -
          Florida ('26' 2-byte code) (eff. 10/2005)



 CLM_OCRNC_SPAN_TB                       Claim Occurrence Span Table

       70 = Qualifying Stay Dates for SNF Use
            Only - the from/through dates of at
            least a 3-day inpatient hospital stay
            that qualifies the resident for Medicare
            payment of SNF services billed.  Code
            can only be used by SNF for billing.
       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 noncovered
            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 noncovered care
            for which hospital may charge
            bene. The FI or PRO must have
            approved such charges in advance.
            patient must be notified in writing
            3 days prior to noncovered period
       77 = Provider liability (utilization charged) -
            The from/thru dates of period of noncovered
            care for which the provider is liable.
            Eff 3/92, 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 = Provider Liability (non-utilization) (Payer code) -
            Eff 3/92, from/thru dates of
            period of noncovered care where
            bene is not charged with utilization,
            deductible, or coinsurance.
            and provider is liable.
            Eff 9/93, noncovered period of care
            due to lack of medical necessity.
       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  (CR7716) - eff. 7/2/12
       82 - 99 = Reserved for state assignment
       M0 = QIO/UR approved stay dates - Eff 10/93,
            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 noncovered care
            that is denied due to lack of medical
            necessity or custodial care for which the
            provider is liable. (eff. 10/01)
       M2 = Dates of Inpatient Respite Care -- from/thru
            dates of a period of inpatient respite care
            for hospice patients. (eff. 10/00)
       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.



 CLM_OP_ESRD_MTHD_REIMBRSMT_TB           Claim Outpatient ESRD Method of Reimbursement Table

      0 = Not ESRD
      1 = Method 1 - Home supplies purchased
      through a facility
      2 = Method 2 - Home supplies purchased
      from a supplier.



 CLM_OP_RFRL_TB                          Claim Outpatient Referral Table

         * For Outpatient Claims:  Effective 3/91 *

       1 = Non-Health Care Facility Point of Origin
           (Physician Referral) - The patient presents
           to this facility an order from a physician
           for services or seeks scheduled services
           for which an order is not required (e.g.
           mammography).  Includes non-emergent self
           referrals.  NOTE:  Includes patients coming
           from home, a physician's office or work-
           place.
       2 = Clinical referral - The patient was
           referred to this facility for outpatient
           or referenced diagnostic services
           by this facility's clinic or other
           outpatient department physician
       3 = Reserved for national assignment.
           (eff. 10/1/07).
           Prior to 10/1/07, HMO referral - The patient
           referenced diagnostic services by a
           HMO physician.
       4 = Transfer from a hospital (Different
           Facility) - The patient was admitted to
           this facility as a hospital transfer from
           an acute care facility where he or she was
           an outpatient. NOTE: Excludes Transfers from
           Hospital Inpatient in the same facility (see
           code D).
       5 = Transfer from a SNF for Intermediate Care
           Facility (ICF) - The patient was referred
           to this facility for outpatient or referenced
           diagnostic services by a physician of the SNF
           or ICF where he or she was a resident.
       6 = Transfer from another health care
           facility - The patient was referred to
           this facility for services by (a
           physician of) another type of health
           care facility not defined elsewhere in
           this code list where he or she was an
           outpatient.
       7 = Emergency room - The patient received un-
           scheduled services in tis facility's
           emergency department and discharged without
           an inpatient admission.  Includes self
           referrals in emergency situations that
           require immediate medical attention.
           OBSOLETE - 7/1/10
       8 = Court/law enforcement - The patient was
           referred to this facility upon the
           direction of a court of law, or upon
           the request of a law enforcement
           agency representative for outpatient
           or referenced diagnostic services.
       9 = Information not available - For
           Medicare outpatient claims this is
           not a valid code.
       A = Reserved for National Assignment. (eff. 10/1/07)
           Prior to 10/07, defined as: Transfer from a
           Critical Access Hospital (CAH) -- The patient
           was referred to this facility for outpatient
           or referenced diagnostic services by
           (a physician of) the CAH were the patient
           is an inpatient.
       B = Transfer from Another Home Health Agency -
           The patient was admitted to this home health
           agency as a transfer from another home health
           agency. Discontinued 7/1/10 - replaced with
           condition code 47.
       C = Readmission to Same Home Health Agency - The
           patient was readmitted to this home health
           agency as a transfer from another home health
           agency. Discontinued 7/1/10
       D = Transfer from hospital inpatient in the same
           facility resulting in separate claim to the
           payer.
       E = Transfer from Ambulatory Surgery Center - The
           patient received outpatient services in this
           facility for outpatient or referenced diagnostic
           services from an ambulatory surgery center.
           (eff. 10/1/2007)
       F = Transfer from Hospice and is under a Hospice
           plan of care or enrolled in a Hospice program -
           the patient was referred to this facility for
           outpatient or referenced diagnostic services
           from a hospice.
           (eff. 10/1/2007)



 CLM_OP_SRVC_TYPE_TB                     Claim Outpatient Service Type Table

       0 = Blank
       1 = Emergency - The patient required
           immediate medical intervention as a
           result of severe, life threatening, or
           potentially disabling conditions.
           Generally, the patient was admitted
           through the emergency room.
       2 = Urgent - The patient required immediate
           attention for the care and treatment
           of a physical or mental disorder.
           Generally, the patient was admitted to
           the first available and suitable
           accommodation.
       3 = Elective - The patient's condition
           permitted adequate time to schedule the
           availability of suitable accommodations.
       4 = Newborn - Use of this code necessitates the use of special
           Point of Origin codes
       5 = Trauma Center - visits to a trauma center/hospital as
           licensed or designated by the State or local government
           authority authorized to do so, or as verified by the
           American College of Surgeons and involving a trauma
           activation.
       6 THRU 8 =  Reserved.
       9 =  Unknown - Information not available.



 CLM_OP_TRANS_TYPE_TB                    Claim Outpatient Transaction Type Table

      A = Outpatient Psychiatric Hospital
      B = Outpatient TB Hospital
      C = Outpatient General Care Hospital
      D = Outpatient SNF
      E = Home Health Agency
      F = Comprehensive Health Care
      G = Clinical Rehab Agency
      H = Rural Health Clinic
      I = Satellite Dialysis Facility
      J = Limited Care Facility
      0 = Christian Science SNF
      1 = Psychiatric Hospital Facility
      2 = TB Hospital Facility
      3 = General Care Hospital
      4 = Regulary SNF
      Spaces = Home Health/Hospice



 CLM_PPS_IND_TB                          Claim PPS Indicator Table

      ***Effective NCH weekly process date 10/3/97 - 5/29/98***

      0 = not PPS bill (claim contains no PPS indicator)
      2 = PPS bill ( claim contains PPS indicator)

      ***Effective NCH weekly process date 6/5/98***

      0 = not applicable (claim contains neither PPS
      nor deemed insured MQGE status indicators)
      1 = Deemed insured MQGE (claim contains deemed
      insured MQGE indicator but not PPS indicator)
      2 = PPS bill ( claim contains PPS indicator but no
      deemed insured MQGE status indicator)
      3 = Both PPS and deemed insured MQGE (contains both
      PPS and deemed insured MQGE indicators)



 CLM_PRCDR_VRSN_TB                       Claim Procedure Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_PRCR_RTRN_TB                        Claim Pricer Return Code Table

      *******Home Health Pricer Return Codes************
      *****TOB 32X or 33X, DOS 10/1/2000 and after******

      Home Health Payment Return Codes:
      00 = Final payment where no outlier applies
      01 = Final payment where outlier applies
      03 = Initial percentage payment, 0%
      04 = Initial percentage payment, 50%
      05 = Initial percentage payment, 60%
      06 = LUPA payment only
      07 = Final payment, SCIC
      08 = Final payment, SCIC with outlier
      09 = Final payment, PEP
      11 = Final payment, PEP with outlier
      12 = Final payment, SCIC within PEP
      13 = FInal payment, SCIS within PEP with outlier

      Home Health Error Return Codes:
      10 = Invalid TOB
      15 = Invalid PEP Days
      16 = Invalid HRG Days, >60
      20 = PEP indicator invalid
      25 = Med review indicator invalid
      30 = Invalid MSA code
      35 = Invalid Initial Payment Indicator
      40 = Dates < October 1, 2000 or invalid
      70 = Invalid HRG Code
      75 = No HRG present in 1st occurrence
      80 = Invalid Revenue code
      85 = No revenue code present on HH final claim/
           adjustment

      *********Hospice Pricer Return Codes************
      **************TOB 81X or 82X********************

      Hospice Payment Return Codes:
      00 = Home rate returned

      Hospice Error Return Codes:
      10 = Bad units
      20 = Bad units2 < 8
      30 = Bad MSA code
      40 = Bad hospice wage index from MSA file
      50 = Bad bene wage index from MSA file
      51 = Bad provider number

      *************SNF Pricer Return Codes*********
      *******************TOB 21X*******************

      SNF Payment return codes:
      00 = RUG III group rate returned

      SNF Error return codes:
      20 = Bad RUG code
      30 = Bad MSA code
      40 = Thru date < July 1, 1998 or invalid
      50 = Invalid Federal blend for that year
      60 = Invalid Federal blend
      61 = Federal blend = 0 and SNF thru date < January
           1, 2000

      ****Inpatient Hospital Pricer Return Codes******
      ******************TOB 11X***********************

      Inpatient Hospital Payment return codes:
      00 = Paid normal DRG payment
      01 = Paid as a day outlier (Note: day outlier no longer
           being paid as of 10/1/97)
      02 = Paid as a cost outlier
      03 = Transfer paid on a per diem basis up to and
           including the ful DRG
      05 = Transfer paid on a per diem basis up to and
           including the full DRG which also qualified
           for a cost outlier payment
      06 = Provider refused cost outlier
      10 = DRG is 209, 210, or 211 and post-acute transfer
      12 = Post-acute transfer with specific DRGs.  The
           following DRG's: 14, 113, 236, 263, 264, 429,
           483
      14 = Paid normal DRG payment with per diem days =
           or > GM ALOS
      16 = Paid as a cost outlier with per diem days = or
           > GM ALOS

      Inpatient Hospital Error return codes:
      51 = No provider specific information found
      52 = Invalid MSA# in provider file
      53 = Waiver state - not calculated by PPS
      54 = DRG < 001 or > 511, or = 214, 215, 221, 222, 438,
           456, 457, 458
      55 = Discharge date < provider effective start date or
           discharge date < MSA effective start date for PPS
      56 = Invalid length of stay
      57 = Review code invalid (Not 00, 03, 06, 07, 09)
      58 = Total charges not numeric
      61 = Lifetime reserve days not numeric or BILL-LTR-DAYS
           > 60
      62 = Invalid number of covere days
      65 = PAY-CODE not = A, B or C on provider specific file
           for capital
      67 = Cost outlier with LOS > covered days

      ************Outpatient PPS Pricer Return Codes******

      Outpatient PPS Payment return codes:
      01 = Line processed to payment
      20 = Line processed but payment = 0 bene deductible
           = > adjusted payment

      Outpatient PPS Error return codes:
      30 = Missing, deleted or invalid APC
      38 = Missing or invalid discount factor
      40 = Invalid service indicator passed by the OCE
      41 = Service indicator invalid for OPPS PRICER
      42 = APC = '00000' or (packaging flag = 1 or 2)
      43 = Payment indicator not = to 1 or 5 thru 9
      44 = Service indicator = 'H' but payment indicator
           not = to 6
      45 = Packaging flag not = to 0
      46 = Line item denial/reject flag not = to 0
           or line item denial/reject flag = to 1 and (APC
           not = 0033 or 0034 or 0322 or 0323 or 0324 or 0325
           or 0373 or 0374)) or line item action flag not = to
           1
      47 = Line item action flag = 2 or 3
      48 = Payment adjustment flag not valid
      49 = Site of service flag not = to 0 or (APC 0033 is not
           on the claim and service indicator = 'P' or APC =
           0322, 0325, 0373, 0374)
      50 = Wage index not located
      51 = Wage index equals zero
      52 = Provider specific file wage index reclassification
           code invalid or missing
      53 = Service from date not numeric or < 20000801
      54 = Service from date < provider effective date
           or service from date > provider termination date

      ***Inpatient Rehab Facility (IRF) Pricer Return Codes***

      IRF Payment return codes:
      00 = Paid normal CMG payment without outlier
      01 = Paid normal CMG payment with outlier
      02 = Transfer paid on a per diem basis without outlier
      03 = Transfer paid on a per diem basis with outlier
      04 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- without outlier
      05 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- with outlier
      06 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           without outlier
      07 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           with outlier
      10 = Paid normal CMG payment with penalty without
           outlier
      11 = Paid normal CMG payment with penalty with
           outlier
      12 = Transfer paid on a per diem basis with penalty
           without outlier
      13 = Transfer paid on a per diem basis with penalty
           with outlier
      14 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- with penalty
           without outlier
      15 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- with penalty
           with outlier
      16 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           with penalty without outlier
      17 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           with penalty with outlier

      IRF Error return codes:
      50 = Provider specific rate not numeric
      51 = Provider record terminated
      52 = Invalid wage index
      53 = Waiver state - not calculated by PPS
      54 = CMG on claim not found in table
      55 = Discharge date < provider effective start
           date or discharge date < MSA effective start
           date for PPS
      56 = Invalid length of stay
      57 = Provider specific rate zero when blended payment
           requested
      58 = Total covered charges not numeric
      59 = Provider specific record not found
      60 = MSA wage index record not found
      61 = Lifetime reserve days not numeric or
           BILL-LTR-DAYS > 60
      62 = Invalid number of covered days
      65 = Operating cost-to-charge ratio not numeric
      67 = Cost outlier with LOS > covered days or cost
           outlier threshold calculation
      72 = Invalid blend indicator (not 3 or 4)
      73 = Discharged before provider FY begin date
      74 = Provider FY begin date not in 2002

      *Long Term Care Hospital (LTCH) Pricer Return Codes*

      LTCH Payment return codes:
      00 = Normal DRG payment without outlier
      01 = Normal DRG payment with outlier
      02 = Short stay payment without outlier
      03 = Short stay payment with outlier
      04 = Blend year 1 - 80% facility rate plus 20%
           normal DRG payment without outlier
      05 = Blend year 1 - 80% facility rate plus 20%
           normal DRG payment with outlier
      06 = Blend year 1 - 80% facility rate plus 20%
           short stay payment without outlier
      07 = Blend year 1 - 80% facility rate plus 20%
           short stay payment with outlier
      08 = Blend year 2 - 60% facility rate plus 40%
           normal DRG payment without outlier
      09 = Blend year 2 - 60% facility rate plus 40%
           normal DRG payment with outlier
      10 = Blend year 2 - 60% facility rate plus 40%
           short stay payment without outlier
      11 = Blend year 2 - 60% facility rate plus 40%
           short stay payment with outlier
      12 = Blend year 3 - 40% facility rate plus 60%
           normal DRG payment without outlier
      13 = Blend year 3 - 40% facility rate plus 60%
           normal DRG payment with outlier
      14 = Blend year 3 - 40% facility rate plus 60%
           short stay payment without outlier
      15 = Blend year 3 - 40% facility rate plus 60%
           short stay payment with outlier
      16 = Blend year 4 - 20% facility rate plus 80%
           normal DRG payment without outlier
      17 = Blend year 4 - 20% facility rate plus 80%
           normal DRG payment with outlier
      18 = Blend year 4 - 20% facility rate plus 80%
           short stay payment without outlier
      19 = Blend year 4 - 20% facility rate plus 80%
           short stay payment with outilier

      LTCH Error return codes:
      50 = Provider specific rate not numeric
      51 = Provider record terminated
      52 = Invalid wage index
      53 = Waiver state - not calculated by PPS
      54 = DRG on claim not found in table
      55 = Discharge date < provider effective start date
           or discharge date < MSA effective start date
           for PPS
      56 = Invalid length of stay
      57 = Provider specific rate zero when blended payment
           requested
      58 = Total covered charges not numeric
      59 = Provider specific record not found
      60 = MSA wage index record not found
      61 = Lifetime reserve days not numeric or BILL-LTR-DAYS
           > 60
      62 = Invalid number of covered days
      65 = Operating cost-to-charge ratio not numeric
      67 = Cost outlier with LOS > covered days or cost
           outlier threshold calculation
      72 = Invalid blend indicator (not 1 thru 5)
      73 = Discharged before provider FY begin date
      74 = Provider FY begin date not in 2002

      ***End Stage Renal Disease (ESRD) Pricer Return Codes***

      ESRD Payment return codes:
      00 = ESRD PPS payment calculated
      01 = ESRD facility rate > zero

      ESRD Error return codes:
      50 = ESRD facility rate not numeric
      52 = Provider type not = '40' or '41'
      53 = Special payment indicator not = '1'
           or blank
      54 = Date of birth not numeric or = zero
      55 = Patient weight not numeric or = zero
      56 = Patient height not numeric or = zero
      57 = Revenue center code not in range
      58 = Condition code not = '73' or '74' or blank
      60 = MSA wage adjusted rate record not found
      98 = Claim through date before 4/1/2005 or not numeric



 CLM_PRVDR_VLDTN_TB                      Claim Provider Validation Code Table

      RP = Rendering Provider
      OP = Operating Physician
      CP = Ordering/Referring Physician
      AP = Attending Physician
      FA = Facility



 CLM_PTNT_RLTNSHP_TB                     Claim Patient Relationship Table

       01 = Spouse
       04 = Grandparent
       05 = Grandchild
       07 = Niece/Nephew
       10 = Foster child
       15 = Ward of the court
       17 = Step child
       18 = Patient is insured
       19 = Natural child/insured financial responsibility
       20 = Employee
       21 = Unknown
       22 = Handicapped dependent
       23 = Sponsored dependent
       24 = Minor dependent of a minor dependent
       32 = Mother
       33 = Father
       39 = Organ donor
       40 = Cadaver donor
       41 = Injured plaintiff
       43 = Natural child/insured does not have financial responsibility



 CLM_PTNT_RSN_VISIT_VRSN_TB              Claim Patient Reason for Visit Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_PWK_TB                              Claim Paperwork Code Table


      P1 = one iteration is present
      P2 = two iterations are present
      P3 = three iterations are present
      P4 = four iterations are present
      P5 = five iterations are present
      P6 = six iterations are present
      P7 = seven iterations are present
      P8 = eight iterations are present
      P9 = nine iterations are present
      P0 = ten iterations are present



 CLM_QUERY_TB                            Claim Query Table

       0 = Credit adjustment
       1 = Interim bill
       2 = Home Health Agency (HHA) benefits
           exhausted (obsolete 7/98)
       3 = Final bill
       4 = Discharge notice (obsolete 7/98)
       5 = Debit adjustment



 CLM_RAC_ADJSTMT_TB                      Recovery Audit Contractor (RAC) Adjustment Indicator Table

      R = RAC adjusted claim
      Spaces



 CLM_RLT_COND_TB                         Claim Related Condition Table

       01 = Military service related - Medical
            condition incurred during military
            service.
       02 = Employment related - Patient alleged
            that the medical condition causing this
            episode of care was due to environment/
            events resulting from employment.
       03 = Patient covered by insurance not
            reflected here - Indicates that patient
            or patient representative has stated
            that coverage may exist beyond that
            reflected on this bill.
       04 = Information Only Bill - Health Maintenance
            Organization (HMO) enrollee - Medicare bene-
            ficiary is enrolled in an HMO.  Eff 9/93, hospital
            must also expect to receive payment from HMO.
       05 = Lien has been filed - Provider has
            filed legal claim for recovery of funds
            potentially due a patient as a result
            of legal action initiated by or on
            behalf of the patient.
       06 = ESRD patient in 1st 30 months of entitlement
            covered by employer group health insurance -
            indicates Medicare may be secondary
            insurer.  Eff 3/1/96, ESRD patient in 1st
            30 months of entitlement covered by employer
            group health insurance.
       07 = Treatment of nonterminal condition for
            hospice patient - The patient is a
            hospice enrollee, but the provider is
            not treating a terminal condition and
            is requesting Medicare reimbursement.
       08 = Beneficiary would not provide information
            concerning other insurance coverage.
       09 = Neither patient nor spouse is employed
            - Code indicates that in response to
            development questions, the patient and
            spouse have denied employment.
       10 = Patient and/or spouse is employed but
            no EGHP coverage exists or (eff 9/93)
            other employer sponsored/provided
            health insurance covering patient.
       11 = The disabled beneficiary and/or family
            member has no group coverage from a LGHP
            or (eff 9/93) other employer
            sponsored/provided health insurance
            covering patient.
       12 = Payer code - Reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.
       13 = Payer code - Reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.
       14 = Payer code - Reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.
       15 = Payer code - reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.  Prior to 3/07, clean
            claim (eff 10/92) OBSOLETE
       16 = Payer code - reserved for internal
            use only by third party payers.   CMS
            will assign as needed.   Providers will
            not report them.  Prior to 3/07. SNF
            transition exemption - An exemption from
            the post-hospital requirement applies
            for this SNF stay for the qualifying
            stay dates are more than 30 days prior
            to the admission date. OBSOLETE
       17 = Patient is homeless (eff. 3/07). Prior to
            3/07, code indicated Patient is over 100 years
            old - patient was over 100 years old at the
            date of admission.
       18 = Maiden name retained - A dependent
            spouse entitled to benefits who does
            not use her husband's last name.
       19 = Child retains mother's name - A
            patient who is a dependent child
            entitled to CHAMPVA benefits that does
            not have father's last name.
       20 = Bene requested billing - Provider
            realizes the services on this bill are at a
            noncovered level of care or otherwise excluded
            from coverage, but the bene has requested
            formal determination
       21 = Billing for denial notice - The SNF or HHA
            realizes services are at a noncovered level of
            care or excluded, but requests a Medicare denial
            in order to bill medicaid or other insurer
       22 = Patient on multiple drug regimen - A
            patient who is receiving multiple
            intravenous drugs while on home IV
            therapy
       23 = Homecaregiver available - The patient
            has a caregiver available to assist him
            or her during self-administration of an
            intravenous drug
       24 = Home IV patient also receiving HHA
            services - the patient is under care
            of HHA while receiving home IV drug
            therapy services
       25 = Patient is Non-U.S. resident
       26 = VA eligible patient chooses to
            receive services in Medicare certified
            facility rather than a VA facility
            (eff 3/92)
       27 = Patient referred to a sole community
            hospital for a diagnostic laboratory
            test - (sole community hospital only).
            (eff 9/93)
       28 = Patient and/or spouse's EGHP is
            secondary to Medicare -
            Qualifying EGHP for employers who have
            fewer than 20 employees. (eff 9/93)
       29 = Disabled beneficiary and/or family
            member's LGHP is secondary to
            Medicare - Qualifying LGHP for
            employer having fewer than 100 full and
            part-time employees
       30 = Qualifying Clinical Trials - Non-research
            services provided to all patients, in-
            cluding managed care enrollees, enrolled
            in a Qualified Clinical Trial.
       31 = Patient is student (full time - day) -
            Patient declares that he or she is
            enrolled as a full time day student.
       32 = Patient is student (cooperative/work
            study program)
       33 = Patient is student (full time - night)
            - Patient declares that he or she is
            enrolled as a full time night student.
       34 = Patient is student (part time) -
            Patient declares that he or she is
            enrolled as a part time student.
       36 = General care patient in a special
            unit - Patient is temporarily placed in
            special care unit bed because no
            general care beds were available.
       37 = Ward accommodation is patient's
            request - Patient is assigned to ward
            accommodations at patient's request.
       38 = Semi-private room not available -
            Indicates that either private or ward
            accommodations were assigned because
            semi-private accomodations were not
            available.
       39 = Private room medically necessary -
            Patient needed a private room for
            medical reasons.
       40 = Same day transfer - Patient
            transferred to another facility
            before midnight of the day of admission.
       41 = Partial hospitalization - Eff 3/92,
            indicates claim is for partial
            hospitalization services.  For OP
            services, this includes a variety
            of psych programs.
       42 = Continuing Care Not Related to Inpatient
            Admission - continuing care not related
            to the condition or diagnosis for which
            the beneficiary received inpatient
            hospital services. (eff. 10/01)
       43 = Continuing Care Not Provided Within
            Prescribed Postdischarge Window -
            continuing care was related to the
            inpatient admission but the prescribed
            care was not provided within the post-
            discharge window.(eff. 10/01)
       44 = Inpatient Admission Changed to Outpatient -
            For use on outpatient claims only, when the
            physician ordered inpatient services, but
            upon internal review performed before the
            claim was initially submitted, the hospital
            determined the services did not meet its
            inpatient criteria. (eff. 4/1/04)
       45 = Ambiguous Gender Category - claim indicates
            patient has ambiguous gender characteristics
            (e.g. transgendered or hermaphordite).
       46 = Nonavailability statement on file for
            CHAMPUS claim for nonemergency IP care
            for CHAMPUS bene residing within the
            catchment area (usually a 40 mile
            radius) of a uniform services hospital.
       47 = Transfer from another Home Health Agency.
            (eff. 7/1/10)
       48 = Psychiatric Residential Treatment Centers for
            Children and Adolescents (RTCs)
       49 = Product Replacement within Product Lifecycle-
            replacement of a product earlier than the
            anticipated lifecycle due to an indication
            that the product is not functioning properly
            (eff. 4/2006)
       50 = Product Replacement for Known Recall of
            a Product - Manufacturer or FDA has iden-
            tified the product for recall and therefore
            replacement. (eff. 4/2006)
       51 = Reserved for national assignment.
       52 = Used to indicate a discharge due to the patient's
            unavailability/inability to receive hospice services
            from the hospice which has been responsible for
            the patient. (effective 7/2/12 - CR7677)
       53 = Reserved for national assignment.
       54 = No skilled HH visits in billing period (eff. 7/2016)
       55 = SNF bed not available - The patient's
            SNF admission was delayed more than 30
            days after hospital discharge because
            a SNF bed was not available.
       56 = Medical appropriateness - Patient's
            SNF admission was delayed more than 30
            days after hospital discharge because
            physical condition made it inappropriate
            to begin active care within that period
       57 = SNF readmission - Patient previously
            received Medicare covered SNF care
            within 30 days of the current SNF
            admission.
       58 = Payment of SNF claims for beneficiaries
            disenrolling from terminating M+C plans
            plans who have not met the 3-day hospital
            stay requirement (eff. 10/1/00)
       59 = Non-primary ESRD facility - code indicates
            that ESRD beneficiary received non-scheduled
            or emergency dialysis services at a facility
            other than his/her primary ESRD dialysis
            facility.
       60 = Operating cost day outlier - A hospital
            being paid under a prospective payment
            system (PPS) is reporting this stay as a
            day outlier.
       61 = Operating cost cost outlier - A hospital
            is being paid under a prospective payment
            system (PPS) is requesting additional payment
            for this stay as a cost outlier.
       62 = Payer Code - providers do not report this code.
            PIP bill - This bill is a periodic interim
            payment bill. Obsolete
       63 = Payer Code - providers do not report this code.
            PRO denial received before batch
            clearance report - The HCSSACL receipt date
            is used on PRO adjustment if the PRO's
            notification is before orig bill's acceptance
            report. (Payer only code eff 9/93)
       64 = Payer Code - providers do not report this code.
            Other than cleam claim - the claim is not a
            'clean claim'. Obsolete
       65 = Payer Code - Providers do not report this code.
            Non-PPS code - The bill is not a prospective
            payment system bill.  Obsolete
       66 = Outlier not claimed - Bill may meet
            the criteria for cost outlier, but the
            hospital did not claim the cost outlier
            (PPS)
       67 = Beneficiary elects not to use LTR days
       68 = Beneficiary elects to use LTR days
       69 = IME/DGME/N&AH Payment Only - providers
            request for supplemental IME/DGME/N&AH payment for
            each discharge of MCO enrollee, beginning 1/1/98,
            from teaching hospitals (facilities with approved
            medical residency training program); not
            stored in NCH.  Exception:  problem in
            startup year may have resulted in this
            special IME payment request being erroneously
            stored in NCH.  If present, disregard claim
            as condition code '69' is not valid NCH
            claim.
       70 = Self-administered EPO - Billing is
            for a home dialysis patient who self
            administers EPO.
       71 = Full care in unit - Billing is for a
            patient who received staff assisted
            dialysis services in a hospital or
            renal dialysis facility.
       72 = Self care in unit - Billing is for a
            patient who managed his own dialysis
            services without staff assistance in a
            hospital or renal dialysis facility.
       73 = Self care training - Billing is for
            special dialysis services where the
            patient and helper (if necessary) were
            learning to perform dialysis.
       74 = Home - Billing is for a patient who
            received dialysis services at home.
       75 = Home 100% reimbursement -
            (not to be used for services after 4/15/90)
            The billing is for home dialsis patient using
            a dialysis machine that was purchased
            under the 100% program.
       76 = Back-up facility - Billing is for a
            patient who received dialysis services
            in a back-up facility.
       77 = Provider accepts or is obligated/
            required due to contractual agreement
            or law to accept payment by a primary
            payer as payment in full - Medicare
            pays nothing.
       78 = New coverage not implemented by HMO -
            eff 3/92, indicates newly covered
            service under Medicare for which HMO
            does not pay.
       79 = CORF services provided off site -
            Code indicates that physical therapy,
            occupational therapy, or speech path-
            ology services were provided off site.
       80 = Home Dialysis - Nursing Facility - Home
            dialysis furnished in a SNF or nursing
            facility.  (eff. 4/4/05)
       81 - 99 = Reserved for state assignment.
       85 = Delayed Recertification of Hospice Terminal
            Illness (eff. 1/2017)
       A0 = TRICARE External Partnership Program -
            This code identifies TRICARE claims submitted
            under the External Partnership Program.
       A0 = Special Zip Code Reporting - five digit
            zip code of the location from which the
            beneficiary is initially placed on board
            the ambulance. (eff. 9/01) Obsolete
       A0 = CHAMPUS external partnership program
            special program indicator code. (eff 10/93)
            (obsolete)
       A1 = EPSDT/CHAP - Early and periodic
            screening diagnosis and treatment
            special program indicator code. (eff 10/93)
       A2 = Physically handicapped children's
            program - Services provided receive
            special funding through Title 8 of
            the Social Security Act or the CHAMPUS
            program for the handicapped. (eff 10/93)
       A3 = Special federal funding - Designed for
            uniform use by state uniform billing
            committees.
            Special program indicator code (eff 10/93)
       A4 = Family planning - Designed for
            uniform use by state uniform billing
            committees.
            Special program indicator code (eff 10/93)
       A5 = Disability - Designed for uniform
            use by state uniform billing
            committees.
            Special program indicator code (eff 10/93)
       A6 = PPV/Medicare 100% Payment - Identifies that
            pneumococcal pneumonia 100% payment
            vaccine (PPV) services should be
            reimbursed under a special Medicare
            program provision.
            Special program indicator code (eff 10/93)
       A7 = Induced abortion to avoid danger to
            woman's life. (terminated)
            Special program indicator code (eff 10/93)
       A7 = Hospital services provided in a mobile facility
            or with portable units (eff. 4/2020)
       A8 = Induced abortion - Victim of rape/
            incest.
            Special program indicator code (eff 10/93)
       A9 = Second opinion surgery - Services
            requested to support second opinion
            on surgery.  Part B deductible and
            coinsurance do not apply.
            Special program indicator code (eff 10/93)
       AA = Abortion Performed due to Rape (eff. 10/1/02)
       AB = Abortion Performed due to Incest (eff. 10/1/02)
       AC = Abortion Performed due to Serious Fetal
            Genetic Defect, Deformity or Abnormality
            (eff. 10/1/02)
       AD = Abortion Performed due to a Life Endangering
            Physical Condition Caused by, arising from
            or exacerbated by the Pregnancy itself
            (eff. 10/1/02)
       AE = Abortion Performed due to physical health of
            mother that is not life endangering (eff.
            10/1/02)
       AF = Abortion Performed due to emotional/
            psychological health of mother (eff. 10/1/02)
       AG = Abortion performed due to social economic
            reasons (eff. 10/1/02)
       AH = Elective Abortion (eff. 10/1/02)
       AI = Sterilization (eff. 10/1/02)
       AJ = Payer Responsible for copayment (4/1/03)
       AK = Air Ambulance Required - For ambulance
            claims.  Time needed to transport poses a
            threat. (eff. 10/16/03)
       AL = Specialized Treatment/bed Unavailable -
            For ambulance claims. Specialized treatment
            bed unavailable. Transported to alternate
            facility. (eff. 10/16/03)
       AM = Non-emergency Medically Necessary Stretcher
            Transport Required - For ambulance claims.
            Non-emergency medically necessary stretcher
            transport required. (eff. 10/16/03)
       AN = Preadmission Screening Not Required - person
            meets the criteria for an exemption from
            preadmission screening. (eff. 1/1/04)
       B0 = Medicare Coordinated Care Demonstration
            Program - patient is a participant in
            a Medicare Coordinated Care Demonstration
            (eff. 10/01)
       B1 = Beneficiary ineligible for demonstration
            program (eff. 10/01).
       B2 = Critical Access Hospital Ambulance Attestation -
            Attestation by CAH that it meets the criteria
            for exemption from the Ambulance Fee Schedule
       B3 = Pregnancy Indicator - Indicates the patient is
            pregnant. Required when mandated by law.
            (eff. 10/16/03)
       B4 = Admission Unrelated to Discharge - Admission
            unrelated to discharge on same day.  This
            code is for discharges starting on January
            1, 2004.
       B5 = Special program indicator
            Reserved for national assignment.
       B6 = Special program indicator
            Reserved for national assignment.
       B7 = Special program indicator
            Reserved for national assignment.
       B8 = Special program indicator
            Reserved for national assignment.
       B9 = Special program indicator
            Reserved for national assignment.
       BP = Gulf Oil Spill of 2010 - The code identifies
            claims where the provision of all services
            on the claim are related, in whole or in
            part, to an illness, injury, or condition
            that was caused by or exacerbated by the
            effects, direct or indirect, of the 2010 oil
            spill in the Gulf of Mexico and/or circum-
            stances related to such spill, including but
            not limited to subsequent clean-up activites.
       C0 = Reserved for national assignment.
       C1 = Approved as billed - The services
            provided for this billing period have
            been reviewed by the QIO/UR or
            intermediary and are fully approved
            including any day or cost outlier. (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to type of bills other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C2 = Automatic approval as billed based on
            focused review.  (No longer used for
            Medicare)
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to type of bills other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C3 = Partial approval - The services
            provided for this billing period have
            been reviewed by the QIO/UR or
            intermediary and some portion has been
            denied (days or services). (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to type of bills other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C4 = Admission/services denied - Indicates
            that all of the services were denied
            by the QIO/UR.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C5 = Postpayment review applicable - QIO/UR
            review to take place after payment.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C6 = Admission preauthorization - The
            QIO/UR authorized this admission/
            service but has not reviewed the
            services provided.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C7 = Extended authorization - the QIO has
            authorized these services for an
            extended length of time but has not
            reviewed the services provided.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C8 = Reserved for national assignment.
            QIO approval indicator services (eff 10/93)
       C9 = Reserved for national assignment.
            QIO approval indicator services (eff 10/93)
       D0 = Changes to service dates.
            Change condition (eff 10/93)
       D1 = Changes in charges.
            Change condition (eff 10/93)
       D2 = Changes in revenue codes/HCPCS/HIPPS
            Rate Code
            Change condition (eff 10/93)
       D3 = Second or subsequent interim
            PPS bill.
            Change condition (eff 10/93)
       D4 = Change in ICD-9-CM diagnosis and/or
            procedure code
            Change condition (eff 10/93)
       D5 = Cancel only to correct a beneficiary
            claim account number or provider
            identification number.
            change condition (eff 10/93)
       D6 = Cancel only to repay a duplicate
            payment or OIG overpayment (includes
            cancellation of an OP bill containing
            services required to be included on the
            IP bill). Change condition eff 10/93.
       D7 = Change to make Medicare the secondary
            payer.
            Change condition (eff 10/93)
       D8 = Change to make Medicare the primary
            payer.
            Change condition (eff 10/93)
       D9 = Any other change.
            Change condition (eff 10/93)
       DR = Disaster Relief (eff. 10/2005) - Code used
            to facilitate claims processing and track
            services and items provided to victims of
            Hurricane Katrina and any future disasters.
       E0 = Change in patient status.
            Change condition (eff 10/93)
       EY = National Emphysema Treatment Trial (NETT)
            or Lung Volume Reduction Surgery (LVRS)
            clinical study (eff. 11/97) Obsolete
       G0 = Multiple medical visits occur on the same
            day in the same revenue center but visits
            are distinct and constitute independent
            visits (allows for payment under outpatient
            PPS -- eff. 7/3/00).
       H0 = Delayed Filing, Statement of Intent
            Submitted -- statement of intent was sub-
            mitted within the qualifying period to
            specifically identify  the existence of
            another third party liability situation.
            (eff. 9/01)
       H2 = Discharge by a Hospice Provider for Cause
            (eff. 1/1/09).
       M0 = Reserved for national assignment.
       M0 = All inclusive rate for outpatient services.
            (payer only code). Obsolete
       M1 = Reserved for national assignment.
       M1 = Roster billed influenza virus vaccine.
            (payer only code)
            Eff 10/96, also includes pneumoccocal
            pneumonia vaccine (PPV)  Obsolete
       M2 = Reserved for national assignment.
       M2 = HH override code - home health total
            reimbursement exceeds the $150,000 cap
            or the number of total visits exceeds the
            150 limitation. (eff 4/3/95) Obsolete
            (payer only code)
       M6 = Pennsylvania (PA) Rural Health Model (PARHM)
            (payer only code)
       P1 = Do Not Resuscitate Order (DNR) - for
            public health reporting only - code
            indicates that a DNR order was written at
            the time of or within the first 24 hours
            of the patient's admission to the hospital
            and is clearly documented in the patient's
            medical record.
       P7 = Direct Inpatient Admission from Emergency
            Room - for public health reporting only
            when required by state or federal law or
            regulations.  Code indicates that patient
            was admitted directly from this facility's
            emergency room department.  (eff. 7/1/10)
       W0 = United Mine Workers of America (UMWA)
            SNF demonstration indicator (eff 1/97);
            but no claims transmitted until 2/98)
       W2 = Duplicate of Original Bill - code indicates
            bill is exact duplicate of the original bill
            submitted. (eff. 10/1/08)
       W3 = Level I Appeal - code indicates bill is
            submitted for reconsideration; the Level
            of appeal/reconsideration (I) is specified/
            defined by the payer. (eff. 10/1/08)
       W4 = Level II Appeal - Code indicates bill is
            submitted for reconsideration; the Level of
            appeal/reconsideration (II) is specified/
            defined by the payer. (eff. 10/1/08)
       W5 = Level III Appeal - Code indicates bill is
            submitted for reconsideration; the Level of
            appeal/reconsideration (III) is specified/
            defined by the payer.  (eff. 10/1/08)
       XX = Transgender/Hermaphrodite Beneficiaries
            (eff. 1/2/07) Obsolete



 CLM_RLT_OCRNC_TB                        Claim Related Occurrence Table


       01 = Auto accident - The date of an auto
            accident.
       02 = No-fault insurance involved, including
            auto accident/other - The date of an
            accident where the state has applicable
            no-fault liability laws, (i.e., legal
            basis for settlement without admission
            or proof of guilt).
       03 = Accident/tort liability - The date of
            an accident resulting from a third
            party's action that may involve a civil
            court process in an attempt to require
            payment by the third party, other than
            no-fault liability.
       04 = Accident/employment related - The
            date of an accident relating to the
            patient's employment.
       05 = Accident/No medical liability coverage -
            code indicating accident related injury
            for which there is no medical payment or
            third payrt liability coverage. Provide
            the date of accident/injury.
       05 = Other accident - The date of an accident
            not described by the codes 01 thru 04.
            (obsolete)
       06 = Crime victim - Code indicating the
            date on which a medical condition
            resulted from alleged criminal action
            committed by one or more parties.
       07 = Reserved for national assignment.
       08 = Reserved for national assignment.
       09 = Start of Infertility Treatment Cycle -
            code indicating the start date of
            infertility treatment cycle.
       10 = Last Menstrual Period - code indicating
            the date of the last mentrual period;
            ONLY applies when patient is being
            treated for maternity related condi-
            tions.
       11 = Onset of symptoms/illness - The date
            the patient first became aware of
            symptoms/illness.
       12 = Date of onset for a chronically
            dependent individual - Code indicates
            the date the patient/bene became
            a chronically dependent individual.
       13 = Reserved for national assignment.
       14 = Reserved for national assignment.
       15 = Reserved for national assignment.
       16 = Date of Last Therapy - code denotes
            last day of therapy services (e.g.,
            physical therapy, occupational therapy,
            speech therapy).
       17 = Date outpatient occupational therapy
            plan established or last reviewed -
            Code indicating the date an occupational
            therapy plan was established or
            last reviewed (eff 3/93)
       18 = Date of retirement (patient/bene)
            - Code indicates the date of retirement
            for the patient/bene.
       19 = Date of retirement spouse -
            Code indicates the date of retirement
            for the patient's spouse.
       20 = Guarantee of payment began - The date
            on which the provider began claiming
            Medicare payment under the guarantee
            of payment provision.
       21 = UR notice received - Code indicating
            the date of receipt by the hospital & SNF
            of the UR committee's finding that the
            admission or future stay was not
            medically necessary.
       22 = Active care ended - The date on which
            a covered level of care ended in a SNF
            or general hospital, or date active care
            ended in a psychiatric or tuberculosis
            hospital or date on which patient was
            released on a trial basis from a resi-
            dential facility.  Code is not required
            if code "21" is used.
       23 = Cancellation of Hospice benefits - The
            date the RHHI cancelled the hospice benefit.
            (eff. 10/00).  NOTE: this will be different
            than the revocation of the hospice benefit
            by beneficiaries.
            Benefits exhausted - The last date
            for which benefits can be paid.
            (term 9/30/93; replaced by code A3)
       24 = Date insurance denied - The date the
            insurer's denial of coverage was
            received by a higher priority payer.
       25 = Date benefits terminated by primary
            payer - The date on which coverage
            (including worker's compensation benefits
            or no-fault coverage) is no longer
            available to the patient.
       26 = Date skilled nursing facility (SNF)
            bed available - The date on which a SNF
            bed became available to a hospital
            inpatient who required only SNF level of
            care.
       27 = Date of Hospice Certification or Re-Certifi-
            cation -- code indicates the date of certifi-
            cation or recertification of the hospice
            benefit period, beginning with the first two
            initial benefit periods of 90 days each and
            the subsequent 60-day benefit periods.
            (eff. 9/01)
       27 = Date home health plan established or
            last reviewed - Code indicating the
            date a home health plan of treatment
            was established or last reviewed. (Obsolete)
            not used by hospital unless owner of facility
       28 = Date comprehensive outpatient rehabi-
            litation plan established or last re-
            viewed - Code indicating the date a
            comprehensive outpatient rehabilitation
            plan was established or last reviewed.
            not used by hospital unless owner of facility
       29 = Date OPT plan established or last
            reviewed - the date a plan of treatment
            was established for outpatient physical
            therapy.
            Not used by hospital unless owner of facility
       30 = Date speech pathology plan treatment
            established or last reviewed - The date
            a speech pathology plan of treatment
            was established or last reviewed.
            Not used by hospital unless owner of facility
       31 = Date bene notified of intent
            to bill (accommodations) - The date of
            the notice provided to the patient by
            the hospital stating that he no longer
            required a covered level of IP care.
       32 = Date bene notified of intent
            to bill (procedures or treatment) - The
            date of the notice provided to the patient
            by the hospital stating requested care
            (diagnostic procedures or treatments) is
            not considered reasonable or necessary.
       33 = First day of the Medicare coordination
            period for ESRD bene - During
            which Medicare benefits are secondary
            to benefits payable under an EGHP.
            Required only for ESRD beneficiaries.
       34 = Date of election of extended care
            facilities - The date the guest elected
            to receive extended care services (used
            by Religious Nonmedical Health Care
            Institutions only).
       35 = Date treatment started for physical
            therapy - Code indicates the date
            services were initiated by the billing
            provider for physical therapy.
       36 = Date of discharge for the IP
            hospital stay when patient
            received a transplant procedure
            - Hospital is billing for
            immunosuppressive drugs.
       37 = The date of discharge
            for the IP hospital stay when
            patient received a noncovered
            transplant procedure - Hospital
            is billing for immunosuppresive drugs.
       38 = Date treatment started for home IV
            therapy - Date the patient was first
            treated in his home for IV therapy.
       39 = Date discharged on a continuous
            course of IV therapy - Date the patient
            was discharged from the hospital on a
            continuous course of IV therapy.
       40 = Scheduled date of admission - The
            date on which a patient will be admitted
            as an inpatient to the hospital.
            (This code may only be used on an
            outpatient claim.)
       41 = Date of First Test for Pre-admission
            Testing - The date on which the first
            outpatient diagnostic test was
            performed as part of a pre-admission
            testing (PAT) program.  This code may
            only be used if a date of admission
            was scheduled prior to the administration
            of the test(s). (eff. 10/01)
       42 = Date of discharge/termination of hospice
            care - for the final bill for hospice
            care.  Eff 5/93, definition revised to
            apply only to date patient revoked
            hospice election.
       43 = Scheduled Date of Canceled Surgery -
            date which ambulatory surgery was
            scheduled. (eff. 9/01)
       44 = Date treatment started for occupational
            therapy - Code indicates the date
            services were initiated by the billing
            provider for occupational therapy.
       45 = Date treatment started for speech
            therapy - Code indicates the date
            services were initiated by the billing
            provider for speech therapy.
       46 = Date treatment started for cardiac
            rehabilitation - Code indicates the
            date services were initiated by the
            billing provider for cardiac
            rehabilitation.
       47 = Date Cost Outlier Status Begins - code
            indicates that this is the first day
            the cost outlier threshold is reached.
            For Medicare purposes, a bene must have
            regular coinsurance and/or lifetime
            reserve days available beginning on this
            date to allow coverage of additional daily
            charges for the purpose of making cost
            outlier payments. (eff. 9/01)
       48 = Payer code - Code reserved for
            internal use only by third party
            payers.  HCFA assigns as needed for
            your use.  Providers will not report it.
       49 = Payer code - Code reserved for
            internal use only by third party
            payers.  HCFA assigns as needed for
            your use.  Providers will not report it.
       50 = Assessment Date - code indicating an
            assessment date as defined by the
            assessment instrument applicable to this
            provider type (e.g. Minimum Data Set (MDS)
            for skilled nursing).  eff. 1/1/11
       51 = Date of Last Kt/V Reading - for in-center
            hemodialysis patients, this is the date
            of the last reading taken during the
            billing period.   For peritoneal dialysis
            patients (and home hemodialysis patients),
            this date may be before the current billing
            period but should be within 4 months of the
            date of service.  eff. 7/1/10
       52 = Medical Certification/recertification
            date - the date of the most recent non-
            hospice medical certification or recerti-
            fication of the patient.  Use occurrence
            code 27 for Date of Hospice Certification
            or Recertification.  eff. 1/1/11
       54 = Physician Follow-up Date - Last date of a
            physician follow-up with the patient.
            eff. 1/1/11
       55 = Used to report date of death.
            NOTE: The date of death will be present when
            the patient discharge status code is
            20, 40, 41 or 42.
       A1 = Birthdate, Insured A - The birthdate of
            the individual in whose name the insurance
            is carried. (Eff 10/93)
       A2 = Effective date, Insured A policy - A
            code indicating the first date insurance
            is in force. (eff 10/93)
       A3 = Benefits exhausted - Code indicating
            the last date for which benefits are
            available and after which no payment
            can be made to payer A.  (eff 10/93)
       A4 = Split Bill Date - date patient became
            eligible due to medically needy spend
            down (sometimes referred to as "Split
            Bill Date").
       B1 = Birthdate, Insured B - The birthdate of
            the individual in whose name the insurance
            is carried. (eff 10/93)
       B2 = Effective date, Insured B policy - A
            code indicating the first date insurance
            is in force. (eff 10/93)
       B3 = Benefits exhausted - code indicating
            the last date for which benefits are
            available and after which no payment
            can be made to payer B.  (eff 10/93)
       C1 = Birthdate, Insured C - The birthdate of
            the individual in whose name the insurance
            is carried. (eff 10/93)
       C2 = Effective date, Insured C policy - A
            code indicating the first date insurance
            is in force. (eff 10/93) Obsolete
       C3 = Benefits exhausted - Code indicating
            the last date for which benefits are
            available and after which no payment
            can be made to payer C.  (eff 10/93)
            Obsolete



 CLM_RMTNC_ADVC_TB                       Claim Remittance Advice Code Table

       M1 =   X-ray not taken within the past 12 months
              or near enough to the start of treatment.
              Start: 01/01/1997
       M2 =   Not paid separately when the patient is
              an inpatient.
              Start: 01/01/1997
       M3 =   Equipment is the same or similar to
              equipment already being used.
              Start: 01/01/1997
       M4 =   Alert: This is the last monthly
              installment payment for this durable
              medical equipment.
              Start: 01/01/1997
       M5 =   Monthly rental payments can continue
              until the earlier of the 15th month from
              the first rental month, or the month when
              the equipment is no longer needed.
              Start: 01/01/1997
       M6 =   Alert: You must furnish and service this
              item for any period of medical need for
              the remainder of the reasonable useful
              lifetime of the equipment.
              Start: 01/01/1997
       M7 =   No rental payments after the item is
              purchased, or after the total of issued
              rental payments equals the purchase
              price.
              Start: 01/01/1997
       M8 =   We do not accept blood gas tests results
              when the test was conducted by a medical
              supplier or taken while the patient is on
              oxygen.
              Start: 01/01/1997
       M9 =   Alert: This is the tenth rental month.
              You must offer the patient the choice of
              changing the rental to a purchase
              agreement.
              Start: 01/01/1997 |
      M10 =   Equipment purchases are limited to the
              first or the tenth month of medical
              necessity.
              Start: 01/01/1997
      M11 =   DME, orthotics and prosthetics must be
              billed to the DME carrier who services
              the patient's zip code.
              Start: 01/01/1997
      M12 =   Diagnostic tests performed by a
              physician
              must indicate whether purchased services
              are included on the claim.
              Start: 01/01/1997
      M13 =   Only one initial visit is covered per
              specialty per medical group.
              Start: 01/01/1997 |
      M14 =   No separate payment for an injection
              administered during an office visit, and
              no payment for a full office visit if the
              patient only received an injection.
              Start: 01/01/1997
      M15 =   Separately billed services/tests have
              been bundled as they are considered
              components of the same procedure.
              Separate payment is not allowed.
              Start: 01/01/1997
      M16 =   Alert: Please see our web site,
              mailings,
              or bulletins for more details concerning
              this policy/procedure/decision.
              Start: 01/01/1997 |
              Notes: (Reactivated 4/1/04, Modified
              11/18/05, 4/1/07)
      M17 =   Alert: Payment approved as you did not
              know, and could not reasonably have been
              expected to know, that this would not
              normally have been covered for this
              patient. In the future, you will be
              liable for charges for the same
              service(s) under the same or similar
              conditions.
              Start: 01/01/1997
      M18 =   Certain services may be approved for
              home
              use. Neither a hospital nor a Skilled
              Nursing Facility (SNF) is considered to
              be a patient's home.
              Start: 01/01/1997
      M19 =   Missing oxygen certification/
              recertification.
              Start: 01/01/1997
      M20 =   Missing/incomplete/invalid HCPCS.
              Start: 01/01/1997
      M21 =   Missing/incomplete/invalid place of
              residence for this service/item provided
              in a home.
              Start: 01/01/1997
      M22 =   Missing/incomplete/invalid number of
              miles traveled.
              Start: 01/01/1997
      M23 =   Missing invoice.
              Start: 01/01/1997
      M24 =   Missing/incomplete/invalid number of
              doses per vial.
              Start: 01/01/1997 |
      M25 =   The information furnished does not
              substantiate the need for this level
              of service. If you believe the service
              should have been fully covered as billed,
              or if you did not know and could not
              reasonably have been expected to know
              that we would not pay for this level of
              service, or if you notified the patient
              in writing in advance that we would not
              pay for this level of service and he/she
              agreed in writing to pay, ask us to
              review your claim within 120 days of the
              date of this notice. If you do not
              request an appeal, we will, upon
              application from the patient, reimburse
              him/her for the amount you have collected
              from him/her in excess of any deductible
              and coinsurance amounts. We will recover
              the reimbursement from you as an
              overpayment.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 6/30/03,
              8/1/05, 11/5/07, 11/1/10)
      M26 =   The information furnished does not
              substantiate the need for this level of
              service. If you have collected any amount
              from the patient for this level of
              service /any amount that exceeds the
              limiting charge for the less extensive
              service, the law requires you to refund
              that amount to the patient within 30 days
              of receiving this notice.= The
              requirements for refund are in 1824(I) of
              the Social Security Act and 42CFR411.408.
              The section specifies that physicians who
              knowingly and willfully fail to make
              appropriate refunds may be subject to
              civil monetary penalties and/or exclusion
              from the program. If you have any
              questions about this notice, please
              contact this office.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 6/30/03,
              8/1/05, 11/5/07. Also refer to N356)
      M27 =   Alert: The patient has been relieved of
              liability of payment of these items and
              services under the limitation of
              liability provision of the law. The
              provider is ultimately liable for the
              patient's waived charges, including any
              charges for coinsurance, since the items
              or services were not reasonable and
              necessary or constituted custodial care,
              and you knew or could reasonably have
              been expected to know, that they were
              not covered. You may appeal this
              determination. You may ask for an appeal
              regarding both the coverage
              determination and the issue of whether
              you exercised due care. The appeal
              request must be filed within 120 days of
              the date you receive this notice. You
              must make the request through this
              office.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 8/1/05,
              4/1/07, 8/1/07)
      M28 =   This does not qualify for payment under
              Part B when Part A coverage is exhausted
              or not otherwise available.
              Start: 01/01/1997
      M29 =   Missing operative note/report.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03, 7/1/2008)
              Related to N233
      M30 =   Missing pathology report.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 2/28/03)
              Related to N236
      M31 =   Missing radiology report.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 2/28/03) Related
              to N240
      M32 =   Alert: This is a conditional payment
              made pending a decision on this service
              by the patient's primary payer. This
              payment may be subject to refund upon
              your receipt of any additional payment
              for this service from another payer. You
              must contact this office immediately
              upon receipt of an additional payment
              for this service.
              Start: 01/01/1997 |
              Notes: (Modified 4/1/07)
      M33 =   Missing/incomplete/invalid UPIN for the
              ordering/referring/performing provider.
              Start: 01/01/1997 | Stop: 08/01/2004
              Notes: Consider using M68
      M34 =   Claim lacks the CLIA certification
              number.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA120
      M35 =   Missing/incomplete/invalid pre-
              operative
              photos or visual field results.
              Start: 01/01/1997 | Stop: 02/05/2005
              Notes: Consider using N178
      M36 =   This is the 11th rental month. We
              cannot
              pay for this until you indicate that the
              patient has been given the option of
              changing the rental to a purchase.
              Start: 01/01/1997
      M37 =   Not covered when the patient is under
              age 35.
              Start: 01/01/1997 |
              Notes: (Modified 3/8/11)
      M38 =   The patient is liable for the charges
              for this service as you informed the
              patient in writing before the service
              was furnished that we would not pay for
              it, and the patient agreed to pay.
              Start: 01/01/1997
      M39 =   The patient is not liable for payment
              for this service as the advance notice
              of non-coverage you provided the patient
              did not comply with program
              requirements.
              Start: 01/01/1997 |
              Notes: (Modified 2/1/04, 4/1/07,
              11/1/09, 11/1/12) Related to N563
      M40 =   Claim must be assigned and must be
              filed
              by the practitioner's employer.
              Start: 01/01/1997
      M41 =   We do not pay for this as the patient
              has no legal obligation to pay for this.
              Start: 01/01/1997
      M42 =   The medical necessity form must be
              personally signed by the attending
              physician.
              Start: 01/01/1997
      M43 =   Payment for this service previously
              issued to you or another provider by
              another carrier/intermediary.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using Reason Code 23
      M44 =   Missing/incomplete/invalid condition
              code.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M45 =   Missing/incomplete/invalid occurrence
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to
              N299
      M46 =   Missing/incomplete/invalid occurrence
              span code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to
              N300
      M47 =   Missing/incomplete/invalid internal or
              document control number.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M48 =   Payment for services furnished to
              hospital inpatients (other than
              professional services of physicians) can
              only be made to the hospital. You must
              request payment from the hospital rather
              than the patient for this service.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using M97
      M49 =   Missing/incomplete/invalid value
              code(s)
              or amount(s).
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M50 =   Missing/incomplete/invalid revenue
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M51 =   Missing/incomplete/invalid procedure
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to N301
      M52 =   Missing/incomplete/invalid "from"
              date(s) of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M53 =   Missing/incomplete/invalid days or
              units
              of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M54 =   Missing/incomplete/invalid total
              charges.
              Start: 01/01/1997 |
      M55 =   We do not pay for self-administered
              anti-emetic drugs that are not
              administered with a covered oral
              anti-cancer drug.
              Start: 01/01/1997
      M56 =   Missing/incomplete/invalid payer
              identifier.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M57 =   Missing/incomplete/invalid provider
              identifier.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      M58 =   Missing/incomplete/invalid claim
              information. Resubmit claim after
              corrections.
              Start: 01/01/1997 | Stop: 02/05/2005
      M59 =   Missing/incomplete/invalid "to" date(s)
              of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M60 =   Missing Certificate of Medical
              Necessity.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 6/30/03)
              Related to N227
      M61 =   We cannot pay for this as the approval
              period for the FDA clinical trial has
              expired.
              Start: 01/01/1997
      M62 =   Missing/incomplete/invalid treatment
              authorization code.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M63 =   We do not pay for more than one of
              these
              on the same day.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using M86
      M64 =   Missing/incomplete/invalid other
              diagnosis.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M65 =   One interpreting physician charge can
              be submitted per claim when a purchased
              diagnostic test is indicated.
              Please submit a separate claim for each
              interpreting physician.
              Start: 01/01/1997
      M66 =   Our records indicate that you billed
              diagnostic tests subject to price
              limitations and the procedure code
              submitted includes a professional
              component. Only the technical component
              is subject to price limitations.
              Please submit the technical and
              professional components of this service
              as separate line items.
              Start: 01/01/1997
      M67 =   Missing/incomplete/invalid other
              procedure code(s).
              Start: 01/01/1997
              Notes: (Modified 12/2/04) Related to
              N302
      M68 =   Missing/incomplete/invalid attending,
              ordering, rendering, supervising or
              referring physician identification.
              Start: 01/01/1997
              Stop: 06/02/2005
      M69 =   Paid at the regular rate as you did not
              submit documentation to justify the
              modified procedure code.
              Start: 01/01/1997 |
              Notes: (Modified 2/1/04)
      M70 =   Alert: The NDC code submitted for this
              service was translated to a HCPCS code
              for processing, but please continue to
              submit the NDC on future claims for this
              item.
              Start: 01/01/1997 |
              Notes: (Modified 4/1/2007, 8/1/07)
      M71 =   Total payment reduced due to overlap of
              tests billed.
              Start: 01/01/1997
      M72 =   Did not enter full 8-digit date
              (MM/DD/CCYY).
              Start: 01/01/1997 |
              Stop: 10/16/2003
              Notes: Consider using MA52
      M73 =   The HPSA/Physician Scarcity bonus can
              only be paid on the professional
              component of this service. Rebill as
              separate professional and technical
              components.
              Start: 01/01/1997
              Notes: (Modified 8/1/04)
      M74 =   This service does not qualify for a
              HPSA/Physician Scarcity bonus payment.
              Start: 01/01/1997
              Notes: (Modified 12/2/04)
      M75 =   Multiple automated multichannel tests
              performed on the same day combined for
              payment.
              Start: 01/01/1997
              Notes: (Modified 11/5/07)
      M76 =   Missing/incomplete/invalid diagnosis or
              condition.
              Start: 01/01/1997
              Notes: (Modified 2/28/03)
      M77 =   Missing/incomplete/invalid place of
              service.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: (Modified 2/28/03)
      M78 =   Missing/incomplete/invalid HCPCS
              modifier.
              Start: 01/01/1997
              Stop: 05/18/2006
              Notes: (Modified 2/28/03,) Consider
              using Reason Code 4
      M79 =   Missing/incomplete/invalid charge.
              Start: 01/01/1997
              Notes: (Modified 2/28/03)
      M80 =   Not covered when performed during the
              same session/date as a previously
              processed service for the patient.
              Start: 01/01/1997
              Notes: (Modified 10/31/02)
      M81 =   You are required to code to the highest
              level of specificity.
              Start: 01/01/1997
              Notes: (Modified 2/1/04)
      M82 =   Service is not covered when patient is
              under age 50.
              Start: 01/01/1997
      M83 =   Service is not covered unless the
              patient is classified as at high risk.
              Start: 01/01/1997
      M84 =   Medical code sets used must be the
              codes
              in effect at the time of service
              Start: 01/01/1997
              Notes: (Modified 2/1/04)
      M85 =   Subjected to review of physician
              evaluation and management services.
              Start: 01/01/1997
      M86 =   Service denied because payment already
              made for same/similar procedure within
              set time frame.
              Start: 01/01/1997
      M87 =   Claim/service(s) subjected to CFO-CAP
              prepayment review.
              Start: 01/01/1997
      M88 =   We cannot pay for laboratory tests
              unless billed by the laboratory that did
              the work.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using Reason Code B20
      M89 =   Not covered more than once under age
              40.
              Start: 01/01/1997
      M90 =   Not covered more than once in a 12
              month
              period.
              Start: 01/01/1997
      M91 =   Lab procedures with different CLIA
              certification numbers must be billed on
              separate claims.
              Start: 01/01/1997
      M92 =   Services subjected to review under the
              Home Health Medical Review Initiative.
              Start: 01/01/1997 | Stop: 08/01/2004
      M93 =   Information supplied supports a break
              in
              therapy. A new capped rental period
              began with delivery of this equipment.
              Start: 01/01/1997
      M94 =   Information supplied does not support a
              break in therapy. A new capped rental
              period will not begin.
              Start: 01/01/1997
      M95 =   Services subjected to Home Health
              Initiative medical review/cost report
              audit.
              Start: 01/01/1997
      M96 =   The technical component of a service
              furnished to an inpatient may only be
              billed by that inpatient facility. You
              must contact the inpatient facility for
              technical component reimbursement. If
              not already billed, you should bill us
              for the professional component only.
              Start: 01/01/1997
      M97 =   Not paid to practitioner when provided
              to patient in this place of service.
              Payment included in the reimbursement
              issued the facility.
              Start: 01/01/1997
      M98 =   Begin to report the Universal Product
              Number on claims for items of this type.
              We will soon begin to deny payment for
              items of this type if billed without the
              correct UPN.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M99
      M99 =   Missing/incomplete/invalid Universal
              Product Number/Serial Number.
              Start: 01/01/1997
      M100 =  We do not pay for an oral anti-emetic
              drug that is not administered for use
              immediately before, at, or within 48
              hours of administration of a covered
              chemotherapy drug.
              Start: 01/01/1997
      M101 =  Begin to report a G1-G5 modifier with
              this HCPCS. We will soon begin to deny
              payment for this service if billed
              without a G1-G5 modifier.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M78
      M102 =  Service not performed on equipment
              approved by the FDA for this purpose.
              Start: 01/01/1997
      M103 =  Information supplied supports a break
              in therapy.  However, the medical info-
              mation we have for this patient does not
              support the need for this item
              as billed. We have approved payment for
              this item at a reduced level, and a new
              capped rental period will begin with the
              delivery of this equipment.
              Start: 01/01/1997
      M104 =  Information supplied supports a break
              in therapy. a new capped rental period
              will begom wieth delivery of the
              equipment.  This is the maximum approved
              under the fee schedule for this item or
              service.
              Start: 01/01/1997
      M105 =  Information supplied does not support a
              break in therapy. The medical
              information we have for this patient
              does not support the need for this item
              as billed. We have approved payment for
              this item at a reduced level, and a new
              capped rental period will not begin.
              Start: 01/01/1997
      M106 =  Information supplied does not support a
              break in therapy. A new capped rental
              period will not begin. This is the
              maximum approved under the fee schedule
              for this item or service.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using MA 31
      M107 =  Payment reduced as 90-day rolling
              average hematocrit for ESRD patient
              exceeded 36.5%.
              Start: 01/01/1997
      M108 =  Missing/incomplete/invalid provider
              identifier for the provider who
              interpreted the diagnostic test.
              Start: 01/01/1997 | Stop: 06/02/2005
      M109 =  We have provided you with a bundled
              payment for a teleconsultation. You must
              send 25 percent of the teleconsultation
              payment to the referring practitioner.
              Start: 01/01/1997
      M110 =  Missing/incomplete/invalid provider
              identifier for the provider from whom
              you purchased interpretation services.
              Start: 01/01/1997 | Stop: 06/02/2005
      M111 =  We do not pay for chiropractic
              manipulative treatment when the patient
              refuses to have an x-ray taken.
              Start: 01/01/1997
      M112 =  Reimbursement for this item is based on
              the single payment amount required under
              the DMEPOS Competitive Bidding Program
              for the area where the patient resides.
              Start: 01/01/1997
      M113 =  Our records indicate that this patient
              began using this item/service prior to
              the current contract period for the
              DMEPOS Competitive Bidding Program.
              Start: 01/01/1997
      M114 =  This service was processed in
              accordance with rules and guidelines
              under the DMEPOS Competitive Bidding
              Program or a Demonstration Project.
              For more information regarding these
              these projects, contact your local
              contractor.
              Start: 01/01/1997
      M115 =  This item is denied when provided to
              this patient by a non-contract or non-
              demonstration supplier.
              Start: 01/01/1997
      M116 =  Processed under a demonstration project
              or program. Project or program is
              ending and additional services may not
              be paid under this project or program.
              Start: 01/01/1997
      M117 =  Not covered unless submitted via
              electronic claim.
              Start: 01/01/1997
      M118 =  Letter to follow containing further
              information.
              Start: 01/01/1997
              Stop: 01/01/2011
      M119 =  Missing/incomplete/invalid/
              deactivated/withdrawn National Drug
              Code (NDC).
              Start: 01/01/1997
      M120 =  Missing/incomplete/invalid provider
              identifier for the substituting
              physician who furnished the service(s)
              under a reciprocal billing or locum
              tenens arrangement.
              Start: 01/01/1997
              Stop: 06/02/2005
      M121 =  We pay for this service only when
              performed with a covered cryosurgical
              ablation.
              Start: 01/01/1997
      M122 =  Missing/incomplete/invalid level of
              subluxation.
              Start: 01/01/1997
      M123 =  Missing/incomplete/invalid name,
              strength, or dosage of the drug
              furnished.
              Start: 01/01/1997
      M124 =  Missing indication of whether the
              patient owns the equipment that
              requires the part or supply.
              Start: 01/01/1997
              Notes: Related to N230
      M125 =  Missing/incomplete/invalid information
              on the period of time for which the
              service/supply/equipment will be
              needed.
              Start: 01/01/1997 |
      M126 =  Missing/incomplete/invalid individual
              lab codes included in the test.
              Start: 01/01/1997 |
      M127 =  Missing patient medical record for this
              service.
              Start: 01/01/1997 |
              Notes: Related to N237
      M128 =  Missing/incomplete/invalid date of the
              patient's last physician visit.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      M129 =  Missing/incomplete/invalid indicator of
              x-ray availability for review.
              Start: 01/01/1997
      M130 =  Missing invoice or statement certifying
              the actual cost of the lens, less
              discounts, and/or the type of
              intraocular lens used.
              Start: 01/01/1997
              Notes: Related to N231
      M131 =  Missing physician financial
              relationship form.
              Start: 01/01/1997
              Notes: Related to N239
      M132 =  Missing pacemaker registration form.
              Start: 01/01/1997
              Notes: Related to N235
      M133 =  Claim did not identify who performed
              the purchased diagnostic test or the
              amount you were charged for the test.
              Start: 01/01/1997
      M134 =  Performed by a facility/supplier in
              which the provider has a financial
              interest.
              Start: 01/01/1997
      M135 =  Missing/incomplete/invalid plan of
              treatment.
              Start: 01/01/1997
      M136 =  Missing/incomplete/invalid indication
              that the service was supervised or
              evaluated by a physician.
              Start: 01/01/1997
      M137 =  Part B coinsurance under a
              demonstration project or pilot program.
              Start: 01/01/1997
      M138 =  Patient identified as a demonstration
              participant but the patient was not
              enrolled in the demonstration at the
              time services were rendered. Coverage
              is limited to demonstration
              participants.
              Start: 01/01/1997
      M139 =  Denied services exceed the coverage
              limit for the demonstration.
              Start: 01/01/1997
      M140 =  Service not covered until after the
              patient's 50th birthday, i.e., no
              coverage prior to the day after the
              50th birthday
              Start: 01/01/1997
              Stop:  1/30/2004
              Notes: Consider using M82
      M141 =  Missing physician certified plan of
              care.
              Start: 01/01/1997
              Notes: Related to N238
      M142 =  Missing American Diabetes Association
              Certificate of Recognition.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: Related to N226
      M143 =  The provider must update license
              information with the payer.
              Start: 01/01/1997 |
      M144 =  Pre-/post-operative care payment is
              included in the allowance for the
              surgery/procedure.
              Start: 01/01/1997
      MA01 =  Alert: If you do not agree with what we
              approved for these services, you may
              appeal our decision. To make sure that
              we are fair to you, we require another
              individual that did not process your
              initial claim to conduct the appeal.
              However, in order to be eligible for an
              appeal, you must write to us within 120
              days of the date you received this
              notice, unless you have a good reason
              for being late.
              Start: 01/01/1997
              8/1/05, 4/1/07)
      MA02 =  Alert: If you do not agree with this
              determination, you have the right to
              appeal. You must file a written request
              for an appeal within 180 days of the
              date you receive this notice.
              Start: 01/01/1997
      MA03 =  If you do not agree with the approved
              amounts and $100 or more is in dispute
              (less deductible and coinsurance), you
              may ask for a hearing within six months
              of the date of this notice. To meet the
              $100, you may combine amounts on other
              claims that have been denied, including
              reopened appeals if you received a
              revised decision. You must appeal each
              claim on time.
              Start: 01/01/1997
              Stop: 10/01/2006
              Last Modified: 11/18/2005
              Notes: Consider using MA02 (Modified
              10/31/02, 6/30/03, 8/1/05, 11/18/05)
      MA04 =  Secondary payment cannot be considered
              without the identity of or payment
              information from the primary payer. The
              information was either not reported or
              was illegible.
              Start: 01/01/1997
      MA05 =  Incorrect admission date patient status
              or type of bill entry on claim.
              Start: 01/01/1997
              Stop: 10/16/2003
              Notes: Consider using MA30, MA40 or
              MA43
      MA06 =  Missing/incomplete/invalid beginning
              and/or ending date(s).
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using MA31
      MA07 =  Alert: The claim information has also
              been forwarded to Medicaid for review.
              Start: 01/01/1997
      MA08 =  Alert: Claim information was not
              forwarded because the supplemental
              coverage is not with a Medigap plan,
              or you do not participate in Medicare.
              Start: 01/01/1997
      MA09 =  Claim submitted as unassigned but
              processed as assigned. You agreed to
              accept assignment for all claims.
              Start: 01/01/1997
      MA10 =  Alert: The patient's payment was in
              excess of the amount owed. You must
              refund the overpayment to the patient.
              Start: 01/01/1997
      MA11 =  Payment is being issued on a
              conditional basis. If no-fault
              insurance, liability insurance,
              Workers' Compensation, Department of
              Veterans Affairs, or a group health
              plan for employees and dependents also
              covers this claim, a refund may be due
              us. Please contact us if the patient is
              covered by any of these sources.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M32
      MA12 =  You have not established that you have
              the right under the law to bill for
              services furnished by the person(s)
              that furnished this (these) service(s).
              Start: 01/01/1997
      MA13 =  Alert: You may be subject to penalties
              if you bill the patient for amounts not
              reported with the PR (patient
              responsibility) group code.
              Start: 01/01/1997
      MA14 =  Alert: The patient is a member of an
              employer-sponsored prepaid health plan.
              Services from outside that health plan
              are not covered. However, as you were
              not previously notified of this, we are
              paying this time. In the future, we
              will not pay you for non-plan services.
              Start: 01/01/1997
      MA15 =  Alert: Your claim has been separated to
              expedite handling. You will receive a
              separate notice for the other services
              reported.
              Start: 01/01/1997 |
      MA16 =  The patient is covered by the Black
              Lung Program. Send this claim to the
              Department of Labor, Federal Black Lung
              Program, P.O. Box 828, Lanham-Seabrook
              MD 20703.
              Start: 01/01/1997
      MA17 =  We are the primary payer and have paid
              at the primary rate. You must contact
              the patient's other insurer to refund
              any excess it may have paid due to its
              erroneous primary payment.
              Start: 01/01/1997
      MA18 =  Alert: The claim information is also
              being forwarded to the patient's
              supplemental insurer. Send any
              questions regarding supplemental
              benefits to them.
              Start: 01/01/1997
      MA19 =  Alert: Information was not sent to the
              Medigap insurer due to
              incorrect/invalid information you
              submitted concerning that insurer.
              Please verify your information and
              submit your secondary claim directly to
              that insurer.
              Start: 01/01/1997
      MA20 =  Skilled Nursing Facility (SNF) stay not
              covered when care is primarily related
              to the use of an urethral catheter for
              convenience or the control of
              incontinence.
              Start: 01/01/1997
      MA21 =  SSA records indicate mismatch with name
              and sex.
              Start: 01/01/1997
      MA22 =  Payment of less than $1.00 suppressed.
              Start: 01/01/1997
      MA23 =  Demand bill approved as result of
              medical review.
              Start: 01/01/1997
      MA24 =  Christian Science Sanitarium/ Skilled
              Nursing Facility (SNF) bill in the same
              benefit period.
              Start: 01/01/1997 |
      MA25 =  A patient may not elect to change a
              hospice provider more than once in a
              benefit period.
              Start: 01/01/1997
      MA26 =  Alert: Our records indicate that you
              were previously informed of this rule.
              Start: 01/01/1997 |
      MA27 =  Missing/incomplete/invalid entitlement
              number or name shown on the claim.
              Start: 01/01/1997 |
      MA28 =  Alert: Receipt of this notice by a
              physician or supplier who did not
              accept assignment is for information
              only and does not make the physician or
              supplier a party to the determination.
              No additional rights to appeal this
              decision, above those rights already
              provided for by regulation/instruction,
              are conferred by receipt of this
              notice.
              Start: 01/01/1997 |
      MA29 =  Missing/incomplete/invalid provider
              name, city, state, or zip code.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA30 =  Missing/incomplete/invalid type of
              bill.
              Start: 01/01/1997 |
      MA31 =  Missing/incomplete/invalid beginning
              and ending dates of the period billed.
              Start: 01/01/1997 |
      MA32 =  Missing/incomplete/invalid number of
              covered days during the billing period.
              Start: 01/01/1997 |
      MA33 =  Missing/incomplete/invalid noncovered
              days during the billing period.
              Start: 01/01/1997 |
      MA34 =  Missing/incomplete/invalid number of
              coinsurance days during the billing
              period.
              Start: 01/01/1997
      MA35 =  Missing/incomplete/invalid number of
              lifetime reserve days.
              Start: 01/01/1997 |
      MA36 =  Missing/incomplete/invalid patient
              name.
              Start: 01/01/1997 |
      MA37 =  Missing/incomplete/invalid patient's
              address.
              Start: 01/01/1997 |
      MA38 =  Missing/incomplete/invalid birth date.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA39 =  Missing/incomplete/invalid gender.
              Start: 01/01/1997 |
      MA40 =  Missing/incomplete/invalid admission
              date.
              Start: 01/01/1997 |
      MA41 =  Missing/incomplete/invalid admission
              type.
              Start: 01/01/1997 |
      MA42 =  Missing/incomplete/invalid admission
              source.
              Start: 01/01/1997 |
      MA43 =  Missing/incomplete/invalid patient
              status.
              Start: 01/01/1997 |
      MA44 =  Alert: No appeal rights. Adjudicative
              decision based on law.
              Start: 01/01/1997
      MA45 =  Alert: As previously advised, a portion
              or all of your payment is being held in
              a special account.
              Start: 01/01/1997
      MA46 =  The new information was considered but
              additional payment will not be issued.
              Start: 01/01/1997 |
      MA47 =  Our records show you have opted out of
              Medicare, agreeing with the patient not
              to bill Medicare for
              services/tests/supplies furnished. As
              result, we cannot pay this claim. The
              patient is responsible for payment.
              Start: 01/01/1997
      MA48 =  Missing/incomplete/invalid name or
              address of responsible party or primary
              payer.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: (Modified 2/28/03)
      MA49 =  Missing/incomplete/invalid six-digit
              provider identifier for home health
              agency or hospice for physician(s)
              performing care plan oversight
              services.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using MA76
      MA50 =  Missing/incomplete/invalid
              Investigational Device Exemption number
              for FDA-approved clinical trial
              services.
              Start: 01/01/1997 |
      MA51 =  Missing/incomplete/invalid CLIA
              certification number for laboratory
              services billed by physician office
              laboratory.
              Start: 01/01/1997 |
              Stop: 02/05/2005
              Notes: Consider using MA120
      MA52 =  Missing/incomplete/invalid date.
              Start: 01/01/1997 | Stop: 06/02/2005
      MA53 =  Missing/incomplete/invalid Competitive
              Bidding Demonstration Project
              identification.
              Start: 01/01/1997 |
      MA54 =  Physician certification or election
              consent for hospice care not received
              timely.
              Start: 01/01/1997
      MA55 =  Not covered as patient received medical
              health care services, automatically
              revoking his/her election to receive
              religious non-medical health care
              services.
              Start: 01/01/1997
      MA56 =  Our records show you have opted out of
              Medicare, agreeing with the patient not
              to bill Medicare for
              services/tests/supplies furnished. As
              result, we cannot pay this claim. The
              patient is responsible for payment, but
              under  Federal law, you cannot charge
              the patient more than the limiting
              charge amount.
              Start: 01/01/1997
      MA57 =  Patient submitted written request to
              revoke his/her election for religious
              non-medical health care services.
              Start: 01/01/1997
      MA58 =  Missing/incomplete/invalid release of
              information indicator.
              Start: 01/01/1997 |
      MA59 =  Alert: The patient overpaid you for
              these services. You must issue the
              patient a refund within 30 days for the
              difference between his/her payment and
              the total amount shown as patient
              responsibility on this notice.
              Start: 01/01/1997 |
      MA60 =  Missing/incomplete/invalid patient
              relationship to insured.
              Start: 01/01/1997 |
      MA61 =  Missing/incomplete/invalid social
              security number or health insurance
              claim number.
              Start: 01/01/1997 |
      MA62 =  Alert: This is a telephone review
              decision.
              Start: 01/01/1997 |
      MA63 =  Missing/incomplete/invalid principal
              diagnosis.
              Start: 01/01/1997 |
      MA64 =  Our records indicate that we should be
              the third payer for this claim. We
              cannot process this claim until we have
              received payment information from the
              primary and secondary payers.
              Start: 01/01/1997
      MA65 =  Missing/incomplete/invalid admitting
              diagnosis.
              Start: 01/01/1997 |
      MA66 =  Missing/incomplete/invalid principal
              procedure code.
              Start: 01/01/1997 |
              Notes: Related to N303
      MA67 =  Correction to a prior claim.
              Start: 01/01/1997
      MA68 =  Alert: We did not crossover this claim
              because the secondary insurance
              information on the claim was incomplete.
              Please supply complete information or
              use the PLANID of the insurer to assure
              correct and timely routing of the claim.
              Start: 01/01/1997 |
      MA69 =  Missing/incomplete/invalid remarks.
              Start: 01/01/1997
      MA70 =  Missing/incomplete/invalid provider
              representative signature.
              Start: 01/01/1997 |
      MA71 =  Missing/incomplete/invalid provider
              representative signature date.
              Start: 01/01/1997 |
      MA72 =  Alert: The patient overpaid you for
              these assigned services. You must issue
              the patient a refund within 30 days for
              the difference between his/her payment
              to you and the total of the amount
              shown as patient responsibility and as
              paid to the patient on this notice.
              Start: 01/01/1997 |
      MA73 =  Informational remittance associated
              with a Medicare demonstration. No
              payment issued under fee-for-service
              Medicare as patient has elected managed
              care.
              Start: 01/01/1997
      MA74 =  This payment replaces an earlier
              payment for this claim that was either
              lost, damaged or returned.
              Start: 01/01/1997
      MA75 =  Missing/incomplete/invalid patient or
              authorized representative signature.
              Start: 01/01/1997
      MA76 =  Missing/incomplete/invalid provider
              identifier for home health agency or
              hospice when physician is performing
              care plan oversight services.
              Start: 01/01/1997
      MA77 =  Alert: The patient overpaid you. You
              must issue the patient a refund within
              30 days for the difference between the
              patient's payment less the total of our
              and other payer payments and the amount
              shown as patient responsibility on this
              notice.
              Start: 01/01/1997
      MA78 =  The patient overpaid you. You must
              issue the patient a refund within 30
              days for the difference between our
              allowed amount total and the amount
              paid by the patient.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using MA59
      MA79 =  Billed in excess of interim rate.
              tart: 01/01/1997
      MA80 =  Informational notice. No payment issued
              for this claim with this notice.
              Payment issued to the hospital by its
              intermediary for all services for this
              encounter under a demonstration
              project.
              Start: 01/01/1997
      MA81 =  Missing/incomplete/invalid
              provider/supplier signature.
              Start: 01/01/1997 |
      MA82 =  Missing/incomplete/invalid
              provider/supplier billing
              number/identifier or billing name,
              address, city, state, zip code, or
              phone number.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA83 =  Did not indicate whether we are the
              primary or secondary payer.
              Start: 01/01/1997 |
      MA84 =  Patient identified as participating in
              the National Emphysema Treatment Trial
              but our records indicate that this
              patient is either not a participant,
              or has not yet been approved for this
              phase of the study. Contact Johns
              Hopkins University, the study coordinator,
              to resolve if there was a discrepancy.
              Start: 01/01/1997
      MA85 =  Our records indicate that a primary
              payer exists (other than ourselves);
              however, you did not complete or enter
              accurately the insurance
              plan/group/program name or
              identification number. Enter the PlanID
              when effective.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA86 =  Missing/incomplete/invalid group or
              policy number of the insured for the
              primary coverage.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA87 =  Missing/incomplete/invalid insured's
              name for the primary payer.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA88 =  Missing/incomplete/invalid insured's
              address and/or telephone number for the
              primary payer.
              Start: 01/01/1997 |
      MA89 =  Missing/incomplete/invalid patient's
              relationship to the insured for the
              primary payer.
              Start: 01/01/1997 |
      MA90 =  Missing/incomplete/invalid employment
              status code for the primary insured.
              Start: 01/01/1997
      MA91 =  This determination is the result of the
              appeal you filed.
              Start: 01/01/1997
      MA92 =  Missing plan information for other
              insurance.
              Start: 01/01/1997
              Notes: Related to N245
              N245
      MA93 =  Non-PIP (Periodic Interim Payment)
              claim.
              Start: 01/01/1997
      MA94 =  Did not enter the statement "Attending
              physician not hospice employee" on the
              claim form to certify that the
              rendering physician is not an employee
              of the hospice.
              Start: 01/01/1997
              Notes: (Reactivated 4/1/04, Modified
              8/1/05)
      MA95 =  A not otherwise classified or unlisted
              procedure code(s) was billed but a
              narrative description of the procedure
              was not entered on the claim. Refer to
              item 19 on the HCFA-1500.
              Start: 01/01/1997
              Stop:  01/01/2004
              Notes: (Deactivated 2/28/2003)
              (Erroneous description corrected
              9/2/2008) Consider using M51
      MA96 =  Claim rejected. Coded as a Medicare
              Managed Care Demonstration but patient
              is not enrolled in a Medicare managed
              care plan.
              Start: 01/01/1997
      MA97 =  Missing/incomplete/invalid Medicare
              Managed Care Demonstration contract
              number or clinical trial registry
              number.
              Start: 01/01/1997 |
      MA98 =  Claim Rejected. Does not contain the
              correct Medicare Managed Care
              Demonstration contract number for this
              beneficiary.
              Start: 01/01/1997 |
              Stop: 10/16/2003
              Notes: Consider using MA97
      MA99 =  Missing/incomplete/invalid Medigap
              information.
              Start: 01/01/1997 |
      MA100 = Missing/incomplete/invalid date of
              current illness or symptoms
              Start: 01/01/1997 |
      MA101 = A Skilled Nursing Facility (SNF) is
              responsible for payment of outside
              providers who furnish these
              services/supplies to residents.
              Start: 01/01/1997
              Stop: 01/01/2011
              Notes: Consider using N538
      MA102 = Missing/incomplete/invalid name or
              provider identifier for the
              rendering/referring/ ordering/
              supervising provider.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using M68
      MA103 = Hemophilia Add On.
              Start: 01/01/1997
      MA104 = Missing/incomplete/invalid date the
              patient was last seen or the provider
              identifier of the attending physician.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M128 or M57
      MA105 = Missing/incomplete/invalid provider
              number for this place of service.
              Start: 01/01/1997
              Stop: 06/02/2005
      MA106 = PIP (Periodic Interim Payment) claim.
              Start: 01/01/1997
      MA107 = Paper claim contains more than three
              separate data items in field 19.
              Start: 01/01/1997
      MA108 = Paper claim contains more than one data
              item in field 23.
              Start: 01/01/1997
      MA109 = Claim processed in accordance with
              ambulatory surgical guidelines.
              Start: 01/01/1997
      MA110 = Missing/incomplete/invalid information
              on whether the diagnostic test(s) were
              performed by an outside entity or if no
              purchased tests are included on the
              claim.
              Start: 01/01/1997
      MA111 = Missing/incomplete/invalid purchase
              price of the test(s) and/or the
              performing laboratory's name and
              address.
              Start: 01/01/1997
      MA112 = Missing/incomplete/invalid group
              practice information.
              Start: 01/01/1997
      MA113 = Incomplete/invalid taxpayer
              identification number (TIN) submitted
              by you per the Internal Revenue
              Service. Your claims cannot be
              processed without your correct TIN, and
              you may not bill the patient pending
              correction of your TIN. There are no
              appeal rights for unprocessable claims,
              but you may resubmit this claim after
              you have notified this office of your
              correct TIN.
              Start: 01/01/1997
      MA114 = Missing/incomplete/invalid information
              on where the services were furnished.
              Start: 01/01/1997
      MA115 = Missing/incomplete/invalid physical
              location (name and address, or PIN)
              where the service(s) were rendered in a
              Health Professional Shortage Area
              (HPSA).
              Start: 01/01/1997
      MA116 = Did not complete the statement
              'Homebound' on the claim to validate
              whether laboratory services were
              performed at home or in an institution.
              Start: 01/01/1997
              Notes: (Reactivated 4/1/04)
      MA117 = This claim has been assessed a $1.00
              user fee.
              Start: 01/01/1997
      MA118 = Coinsurance and/or deductible amounts
              apply to a claim for services or
              supplies furnished to a Medicare-
              eligible veteran through a facility of
              the Department of Veterans Affairs. No
              Medicare payment issued.
              Start: 01/01/1997
      MA119 = Provider level adjustment for late
              claim filing applies to this claim.
              Start: 01/01/1997
              Stop: 05/01/2008
              Notes: Consider using Reason Code B4
      MA120 = Missing/incomplete/invalid CLIA
              certification number.
              Start: 01/01/1997
      MA121 = Missing/incomplete/invalid x-ray date.
              Start: 01/01/1997
      MA122 = Missing/incomplete/invalid initial
              treatment date.
              Start: 01/01/1997
      MA123 = Your center was not selected to
              participate in this study, therefore,
              we cannot pay for these services.
              Start: 01/01/1997
      MA124 = Processed for IME only.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using Reason Code 74
      MA125 = Per legislation governing this program,
              payment constitutes payment in full.
              Start: 01/01/1997
      MA126 = Pancreas transplant not covered unless
              kidney transplant performed.
              Start: 10/12/2001
      MA127 = Reserved for future use.
              Start: 10/12/2001
              Stop:  06/02/2005
      MA128 = Missing/incomplete/invalid FDA approval
              number.
              Start: 10/12/2001
      MA129 = This provider was not certified for
              this procedure on this date of service.
              Start: 10/12/2001
              Stop:  01/31/2004
              Notes: Consider using MA120 and Reason
              Code B7
      MA130 = Your claim contains incomplete and/or
              invalid information, and no appeal
              rights are afforded because the claim
              is unprocessable. Please submit a new
              claim with the complete/correct
              information.
              Start: 10/12/2001
      MA131 = Physician already paid for services in
              conjunction with this demonstration
              claim. You must have the physician
              withdraw that claim and refund the
              payment before we can process your
              claim.
              Start: 10/12/2001
      MA132 = Adjustment to the pre-demonstration
              rate.
              Start: 10/12/2001
      MA133 = Claim overlaps inpatient stay. Rebill
              only those services rendered outside
              the inpatient stay.
              Start: 10/12/2001
      MA134 = Missing/incomplete/invalid provider
              number of the facility where the patient resides.
              Start: 10/12/2001
      N1 = Alert: You may appeal this decision in
           writing within the required time limits
           following receipt of this notice by
           following the instructions included in
           your contract or plan benefit
           documents.
           Start: 01/01/2000
      N2 = This allowance has been made in
           accordance with the most appropriate
           course of treatment provision of the
           plan.
           Start: 01/01/2000
      N3 = Missing consent form.
           Start: 01/01/2000
           Notes: Related to N228
      N4 = Missing/Incomplete/Invalid prior Insurance
           Carrier(s) EOB.
           Start: 01/01/2000
      N5 = EOB received from previous payer. Claim
           not on file.
           Start: 01/01/2000
      N6 = Under FEHB law (U.S.C. 8904(b)), we
           cannot pay more for covered care than
           the amount Medicare would have allowed
           if the patient were enrolled in
           Medicare Part A and/or Medicare Part B.
           Start: 01/01/2000
      N7 = Processing of this claim/service has
           included consideration under Major
           Medical provisions.
           Start: 01/01/2000
      N8 = Crossover claim denied by previous
           payer and complete claim data not
           forwarded. Resubmit this claim to this
           payer to provide adequate data for
           adjudication.
           Start: 01/01/2000
      N9 = Adjustment represents the estimated
           amount a previous payer may pay.
           Start: 01/01/2000
      N10 = Payment based on the findings of a
            review organization/professional
            consult/manual adjudication/medical or
            dental advisor.
            Start: 01/01/2000
      N11 = Denial reversed because of medical
            review.
            Start: 01/01/2000
      N12 = Policy provides coverage supplemental
            to Medicare. As the member does not
            appear to be enrolled in the applicable
            part of Medicare, the member is
            responsible for payment of the portion
            of the charge that would have been
            covered by Medicare.
            Start: 01/01/2000 |
      N13 = Payment based on professional/technical
            component modifier(s).
            Start: 01/01/2000
      N14 = Payment based on a contractual amount
            or agreement, fee schedule, or maximum
            allowable amount.
            Start: 01/01/2000 |
            Stop: 10/01/2007
            Notes: Consider using Reason Code 45
      N15 = Services for a newborn must be billed
            separately.
            Start: 01/01/2000
      N16 = Family/member Out-of-Pocket maximum has
            been met. Payment based on a higher
            percentage.
            Start: 01/01/2000
      N17 = Per admission deductible.
            Start: 01/01/2000
            Stop: 08/01/2004
            Notes: Consider using Reason Code 1
      N18 = Payment based on the Medicare allowed
            amount.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using N14
      N19 = Procedure code incidental to primary
            procedure.
            Start: 01/01/2000
      N20 = Service not payable with other service
            rendered on the same date.
            Start: 01/01/2000
      N21 = Alert: Your line item has been
            separated into multiple lines to
            expedite handling.
            Start: 01/01/2000
      N22 = This procedure code was added/changed
             because it more accurately describes
             the services rendered.
             Start: 01/01/2000
      N23 = Alert: Patient liability may be
            affected due to coordination of
            benefits with other carriers and/or
            maximum benefit provisions.
            Start: 01/01/2000
      N24 = Missing/incomplete/invalid Electronic
            Funds Transfer (EFT) banking
            information.
            Start: 01/01/2000
      N25 = This company has been contracted by
             your benefit plan to provide
             administrative claims payment services
             only. This company does not assume
             financial risk or obligation with
             respect to claims processed on behalf
             of your benefit plan.
             Start: 01/01/2000
      N26 = Missing itemized bill/statement.
             Start: 01/01/2000
             Related to N232
      N27 = Missing/incomplete/invalid treatment
            number.
            Start: 01/01/2000
            Last Modified: 02/28/2003
            Notes: (Modified 2/28/03)
      N28 = Consent form requirements not
            fulfilled.
            Start: 01/01/2000
      N29 = Missing documentation/orders/
            notes/summary/report/chart.
            Start: 01/01/2000
            Notes: Related to N225
      N30 = Patient ineligible for this service.
            Start: 01/01/2000 | Last Modified: 06/30/2003
      N31 = Missing/incomplete/invalid prescribing
            provider identifier.
            Start: 01/01/2000
      N32 = Claim must be submitted by the provider
            who rendered the service.
            Start: 01/01/2000
      N33 = No record of health check prior to
            initiation of treatment.
            Start: 01/01/2000
      N34 = Incorrect claim form/format for this
            service.
            Start: 01/01/2000
      N35 = Program integrity/utilization review
            decision.
            Start: 01/01/2000
      N36 = Claim must meet primary payer's
            processing requirements before we can
            consider payment.
            Start: 01/01/2000
      N37 = Missing/incomplete/invalid tooth
            number/letter.
            Start: 01/01/2000
      N38 = Missing/incomplete/invalid place of
            service.
            Start: 01/01/2000
            Stop: 02/05/2005
            Notes: Consider using M77
      N39 = Procedure code is not compatible with
            tooth number/letter.
            Start: 01/01/2000
      N40 = Missing radiology film(s)/image(s).
            Start: 01/01/2000
            Notes: Related to N242
      N41 = Authorization request denied.
            Start: 01/01/2000 |
            Stop: 10/16/2003
            Notes: Consider using Reason Code 39
      N42 = No record of mental health assessment.
            Start: 01/01/2000
      N43 = Bed hold or leave days exceeded.
            Start: 01/01/2000
      N44 = Payer's share of regulatory surcharges,
            assessments, allowances or health
            care-related taxes paid directly to the
            regulatory authority.
            Start: 01/01/2000 |
            Stop: 10/16/2003
            Notes: Consider using Reason Code 137
      N45 = Payment based on authorized amount.
            Start: 01/01/2000
      N46 = Missing/incomplete/invalid admission
            hour.
            Start: 01/01/2000
      N47 = Claim conflicts with another inpatient
            stay.
            Start: 01/01/2000
      N48 = Claim information does not agree with
            information received from other
            insurance carrier.
            Start: 01/01/2000
      N49 = Court ordered coverage information
            needs validation.
            Start: 01/01/2000
      N50 = Missing/incomplete/invalid discharge
            information.
            Start: 01/01/2000
      N51 = Electronic interchange agreement not on
            file for provider/submitter.
            Start: 01/01/2000
      N52 = Patient not enrolled in the billing
            provider's managed care plan on the
            date of service.
            Start: 01/01/2000
      N53 = Missing/incomplete/invalid point of
            pick-up address.
            Start: 01/01/2000
            Notes: (Modified 2/28/03)
      N54 = Claim information is inconsistent with
            pre-certified/authorized services.
            Start: 01/01/2000
      N55 = Procedures for billing with
            group/referring/performing providers
            were not followed.
            Start: 01/01/2000
      N56 = Procedure code billed is not
            correct/valid for the services billed
            or the date of service billed.
            Start: 01/01/2000
      N57 = Missing/incomplete/invalid prescribing
            date.
            Start: 01/01/2000
            Notes: Related to N304
      N58 = Missing/incomplete/invalid patient
            liability amount.
            Start: 01/01/2000
      N59 = Please refer to your provider manual
            for additional program and provider
            information.
            Start: 01/01/2000
      N60 = A valid NDC is required for payment of
            drug claims effective October 02.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using M119
      N61 = Rebill services on separate claims.
            Start: 01/01/2000
      N62 = Dates of service span multiple rate
            periods. Resubmit separate claims.
            Start: 01/01/2000
      N63 = Rebill services on separate claim
            lines.
            Start: 01/01/2000
      N64 = The "from" and "to" dates must be
            different.
            Start: 01/01/2000
      N65 = Procedure code or procedure rate count
            cannot be determined, or was not on
            file, for the date of service/provider.
            Start: 01/01/2000
      N66 = Missing/incomplete/invalid
            documentation.
            Start: 01/01/2000
            Stop: 02/05/2005
            Notes: Consider using N29 or N225.
      N67 = Professional provider services not paid
            separately. Included in facility
            payment under a demonstration project.
            Apply to that facility for payment, or
            resubmit your claim if: the facility
            notifies you the patient was excluded
            from this demonstration; or if you
            furnished these services in another
            location on the date of the patient's
            admission or discharge from a
            demonstration hospital. If services
            were furnished in a facility not
            involved in the demonstration on the
            same date the patient was discharged
            from or admitted to a demonstration facility,
            you must report the provider
            ID number for the non-demonstration
            facility on the new claim.
            Start: 01/01/2000
      N68 = Prior payment being cancelled as we
            were subsequently notified this patient
            was covered by a demonstration project
            in this site of service. Professional
            services were included in the payment
            made to the facility. You must contact
            the facility for your payment. Prior
            payment made to you by the patient or
            another insurer for this claim must be
            refunded to the payer within 30 days.
            Start: 01/01/2000
      N69 = PPS (Prospective Payment System) code
            changed by claims processing system.
            Start: 01/01/2000
      N70 = Consolidated billing and payment
            applies.
            Start: 01/01/2000
      N71 = Your unassigned claim for a drug or
            biological, clinical diagnostic
            laboratory services or ambulance
            service was processed as an assigned
            claim. You are required by law to
            accept assignment for these types of
            claims.
            Start: 01/01/2000
      N72 = PPS (Prospective Payment System) code
            changed by medical reviewers. Not
            supported by clinical records.
            Start: 01/01/2000
      N73 = A Skilled Nursing Facility is
            responsible for payment of outside
            providers who furnish these services/
            supplies under arrangement to
            its residents.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using MA101 or N200
      N74 = Resubmit with multiple claims, each
            claim covering services provided in
            only one calendar month.
            Start: 01/01/2000
      N75 = Missing/incomplete/invalid tooth
            surface information.
            Start: 01/01/2000
      N76 = Missing/incomplete/invalid number of
            riders.
            Start: 01/01/2000
      N77 = Missing/incomplete/invalid designated
            provider number.
            Start: 01/01/2000
      N78 = The necessary components of the child
            and teen checkup (EPSDT) were not
            completed.
            Start: 01/01/2000
      N79 = Service billed is not compatible with
            patient location information.
            Start: 01/01/2000
      N80 = Missing/incomplete/invalid prenatal
            screening information.
            Start: 01/01/2000 |
      N81 = Procedure billed is not compatible with
            tooth surface code.
            Start: 01/01/2000
      N82 = Provider must accept insurance payment
            as payment in full when a third party
            payer contract specifies full
            reimbursement.
            Start: 01/01/2000
      N83 = No appeal rights. Adjudicative decision
            based on the provisions of a
            demonstration project.
            Start: 01/01/2000
      N84 = Alert: Further installment payments are
            forthcoming.
            Start: 01/01/2000 |
      N85 = Alert: This is the final installment
            payment.
            Start: 01/01/2000 | Last Modified: 04/01/2007
            Notes: (Modified 4/1/07, 8/1/07)
      N86 = A failed trial of pelvic muscle
            exercise training is required in order
            for biofeedback training for the
            treatment of urinary incontinence to be
            covered.
            Start: 01/01/2000
      N87 = Home use of biofeedback therapy is not
            covered.
            Start: 01/01/2000
      N88 = Alert: This payment is being made
            conditionally. An HHA episode of care
            notice has been filed for this patient.
            When a patient is treated under a HHA
            episode of care, consolidated billing
            requires that certain therapy services
            and supplies, such as this, be included
            in the HHA's payment. This payment will
            need to be recouped from you if we
            establish that the patient is
            concurrently receiving treatment under
            a HHA episode of care.
            Start: 01/01/2000
      N89 = Alert: Payment information for this
            claim has been forwarded to more than
            one other payer, but format limitations
            permit only one of the secondary payers
            to be identified in this remittance
            advice.
            Start: 01/01/2000
      N90 = Covered only when performed by the
            attending physician.
            Start: 01/01/2000
      N91 = Services not included in the appeal
            review.
            Start: 01/01/2000
      N92 = This facility is not certified for
            digital mammography.
            Start: 01/01/2000
      N93 = A separate claim must be submitted for
            each place of service. Services
            furnished at multiple sites may not be
            billed in the same claim.
            Start: 01/01/2000
      N94 = Claim/Service denied because a more
            specific taxonomy code is required for
            adjudication.
            Start: 01/01/2000
      N95 = This provider type/provider specialty
            may not bill this service.
            Start: 07/31/2001
      N96 = Patient must be refractory to
            conventional therapy (documented
            behavioral, pharmacologic and/or
            surgical corrective therapy) and be an
            appropriate surgical candidate such
            that implantation with anesthesia can
            occur.
            Start: 08/24/2001
      N97 = Patients with stress incontinence,
            urinary obstruction, and specific
            neurologic diseases (e.g., diabetes
            with peripheral nerve involvement)
            which are associated with secondary
            manifestations of the above three
            indications are excluded.
            Start: 08/24/2001
      N98 = Patient must have had a successful test
            stimulation in order to support
            subsequent implantation. Before a
            patient is eligible for permanent
            implantation, he/she must demonstrate a
            50 percent or greater improvement
            through test stimulation. Improvement
            is measured through voiding diaries.
            Start: 08/24/2001
      N99 = Patient must be able to demonstrate
            adequate ability to record voiding
            diary data such that clinical results
            of the implant procedure can be
            properly evaluated.
            Start: 08/24/2001
      N100 = PPS (Prospect Payment System) code
             corrected during adjudication.
             Start: 09/14/2001
      N101 = Additional information is needed in
             order to process this claim. Please
             resubmit the claim with the
             identification number of the provider
             where this service took place. The
             Medicare number of the site of service
             provider should be preceded with the
             letters 'HSP' and entered into item #32
             on the claim form. You may bill only one
             site of service provider number per
             claim.
             Start: 10/31/2001
             Stop: 01/31/2004
             Notes: Consider uisng MA105
      N102 = This claim has been denied without
             reviewing the medical record because
             the requested records were not received
             or were not received timely.
             Start: 10/31/2001
      N103 = Social Security records indicate that
             this patient was a prisoner when the
             service was rendered. This payer does
             not cover items and services furnished
             to an individual while he or she is in
             a Federal facility, or while he or she
             is in State or local custody under a
             penal authority, unless under State or
             local law, the individual is personally
             liable for the cost of his or her
             health care while incarcerated and the
             State or local government pursues such
             debt in the same way and with the same
             vigor as any other debt.
             Start: 10/31/2001
      N104 = This claim/service is not payable under
             our claims jurisdiction area. You can
             identify the correct Medicare
             contractor to process this
             claim/service through the CMS website
             at www.cms.gov.
             Start: 01/29/2002
      N105 = This is a misdirected claim/service for
             an RRB beneficiary. Submit paper claims
             to the RRB carrier: Palmetto GBA, P.O.
             Box 10066, Augusta, GA 30999. Call
             866-749-4301 for RRB EDI information
             for electronic claims processing.
             Start: 01/29/2002
      N106 = Payment for services furnished to
             Skilled Nursing Facility (SNF)
             inpatients (except for excluded
             services) can only be made to the SNF.
             You must request payment from the SNF
             rather than the patient for this
             service.
             Start: 01/31/2002
      N107 = Services furnished to Skilled Nursing
             Facility (SNF) inpatients must be
             billed on the inpatient claim. They
             cannot be billed separately as
             outpatient services.
             Start: 01/31/2002
      N108 = Missing/incomplete/invalid upgrade
             information.
             Start: 01/31/2002 |
             Last Modified: 02/28/2003
             Notes: (Modified 2/28/03)
      N109 = This claim/service was chosen for
             complex review and was denied after
             reviewing the medical records.
             Start: 02/28/2002
             Last Modified: 03/01/2009
             Notes: (Modified 3/1/2009)
      N110 = This facility is not certified for film
             mammography.
             Start: 02/28/2002
      N111 = No appeal right except duplicate
             claim/service issue. This service was
             included in a claim that has been
             previously billed and adjudicated.
             Start: 02/28/2002
      N112 = This claim is excluded from your
             electronic remittance advice.
             Start: 02/28/2002
      N113 = Only one initial visit is covered per
             physician, group practice or provider.
             Start: 04/16/2002
      N114 = During the transition to the Ambulance
             Fee Schedule, payment is based on the
             lesser of a blended amount calculated
             using a percentage of the reasonable
             charge/cost and fee schedule amounts,
             or the submitted charge for the
             service. You will be notified yearly
             what the percentages for the blended
             payment calculation will be.
             Start: 05/30/2002
      N115 = This decision was based on a Local
             Coverage Determination (LCD). An LCD
             provides a guide to assist in
             determining whether a particular item
             or service is covered. A copy of this
             policy is available at www.cms.gov/mcd,
             or if you do not have web access, you
             may contact the contractor to request a
             copy of the LCD.
             Start: 05/30/2002
      N116 = This payment is being made
             conditionally because the service was
             provided in the home, and it is
             possible that the patient is under a
             home health episode of care. When a
             patient is treated under a home health
             episode of care, consolidated billing
             requires that certain therapy services
             and supplies, such as this, be included
             in the home health agency's (HHA's)
             payment. This payment will need to be
             recouped from you if we establish that
             the patient is concurrently receiving
             treatment under an HHA episode of care.
             Start: 06/30/2002
      N117 = This service is paid only once in a
             patient's lifetime.
             Start: 07/30/2002
      N118 = This service is not paid if billed more
             than once every 28 days.
             Start: 07/30/2002
      N119 = This service is not paid if billed once
             every 28 days, and the patient has
             spent 5 or more consecutive days in any
             inpatient or Skilled /nursing Facility
             (SNF) within those 28 days.
             Start: 07/30/2002
      N120 = Payment is subject to home health
             prospective payment system partial
             episode payment adjustment. Patient was
             transferred/discharged/readmitted
             during payment episode.
             Start: 08/09/2002
      N121 = Medicare Part B does not pay for items
             or services provided by this type of
             practitioner for beneficiaries in a
             Medicare Part A covered Skilled Nursing
             Facility (SNF) stay.
             Start: 09/09/2002
      N122 = Add-on code cannot be billed by itself.
             Start: 09/12/2002
      N123 = This is a split service and represents
             a portion of the units from the
             originally submitted service.
             Start: 09/24/2002
      N124 = Payment has been denied for the/made
             only for a less extensive service/item
             because the information furnished does
             not substantiate the need for the (more
             extensive) service/item. The patient is
             liable for the charges for this
             service/item as you informed the
             patient in writing before the
             service/item was furnished that we
             would not pay for it, and the patient
             agreed to pay.
             Start: 09/26/2002
             "Payment has been (denied for the/made
             only for a less extensive) service/item
             because the information furnished does
             not substantiate the need for the (more
             extensive) service/item. If you have
             collected any amount from the patient,
             you must refund that amount to the
             patient within 30 days of receiving
             this notice.
             The requirements for a refund are in
             Ì1834(a)(18) of the Social Security Act
             (and in ÌÌ1834(j)(4) and 1879(h) by
             cross-reference to Ì1834(a)(18)).
             Section 1834(a)(18)(B) specifies that
             suppliers which knowingly and willfully
             fail to make appropriate refunds may be
             subject to civil money penalties and/or
             exclusion from the Medicare program. If
             you have any questions about this
             notice, please contact this office."
             Start: 09/26/2002
      N126 = Social Security Records indicate that
             this individual has been deported. This
             payer does not cover items and services
             furnished to individuals who have been
             deported.
             Start: 10/17/2002
      N127 = This is a misdirected claim/service for
             a United Mine Workers of America (UMWA)
             beneficiary. Please submit claims to
             them.
             Start: 10/31/2007
      N128 = This amount represents the prior to
             coverage portion of the allowance.
             Start: 10/31/2002
      N129 = Not eligible due to the patient's age.
             Start: 10/31/2002
      N130 = Consult plan benefit
             documents/guidelines for information
             about restrictions for this service.
             Start: 10/31/2002
      N131 = Total payments under multiple contracts
             cannot exceed the allowance for this
             service.
             Start: 10/31/2002
      N132 = Alert: Payments will cease for services
             rendered by this US Government debarred
             or excluded provider after the 30 day
             grace period as previously notified.
             Start: 10/31/2002
      N133 = Alert: Services for predetermination
             and services requesting payment are
             being processed separately.
             Start: 10/31/2002
      N134 = Alert: This represents your scheduled
             payment for this service. If treatment
             has been discontinued, please contact
             Customer Service.
             Start: 10/31/2002
      N135 = Record fees are the patient's
             responsibility and limited to the
             specified co-payment.
             Start: 10/31/2002
      N136 = Alert: To obtain information on the
             process to file an appeal in Arizona,
             call the Department's Consumer
             Assistance Office at (602) 912-8444
             or (800) 325-2548.
             Start: 10/31/2002
      N137 = Alert: The provider acting on the
             Member's behalf, may file an appeal with
             the Payer. The provider, acting on the
             Member's behalf, may file a complaint
             with the State Insurance Regulatory
             Authority without first filing an appeal,
             if the coverage decision involves an
             urgent condition for which care has not
             been rendered. The address may be
             obtained from the State Insurance
             Regulatory Authority.
             Start: 10/31/2002
      N138 = Alert: In the event you disagree with
             the Dental Advisor's opinion and have
             additional information relative to the
             case, you may submit radiographs to the
             Dental Advisor Unit at the subscriber's
             dental insurance carrier for a second
             Independent Dental Advisor Review.
             Start: 10/31/2002
      N139 = Alert: Under the Code of Federal
             Regulations, Chapter 32, Section 199.13
             a non-participating provider is not an
             appropriate appealing party. Therefore,
             if you disagree with the Dental
             Advisor's opinion, you may appeal the
             determination if appointed in writing,
             by the beneficiary, to act as his/her
             representative. Should you be appointed
             as a representative, submit a copy of
             this letter, a signed statement
             explaining the matter in which you
             disagree, and any radiographs and
             relevant information to the subscriber's
             Dental insurance carrier within 90 days
             from the date of this letter.
             Start: 10/31/2002
      N140 = Alert: You have not been designated as
             an authorized OCONUS provider therefore
             are not considered an appropriate
             appealing party. If the beneficiary has
             appointed you, in writing, to act as
             his/her representative and you disagree
             with the Dental Advisor's opinion, you
             may appeal by submitting a copy of this
             letter, a signed statement explaining
             the matter in which you disagree, and
             any relevant information to the
             subscriber's Dental insurance carrier
             within 90 days from the date of this
             letter.
             Start: 10/31/2002
      N141 = The patient was not residing in a
             long-term care facility during all or
             part of the service dates billed.
             Start: 10/31/2002
      N142 = The original claim was denied. Resubmit
             a new claim, not a replacement claim.
             Start: 10/31/2002
      N143 = The patient was not in a hospice
             program
             during all or part of the service dates
             billed.
             Start: 10/31/2002
      N144 = The rate changed during the dates of
             service billed.
             Start: 10/31/2002
      N145 = Missing/incomplete/invalid provider
             identifier for this place of service.
             Start: 10/31/2002
             Stop: 06/02/2005
      N146 = Missing screening document.
             Start: 10/31/2002
             Notes: Related to N243
      N147 = Long term care case mix or per diem
             rate cannot be determined because the
             patient ID number is missing, incomplete
             or invalid on the assignment request.
             Start: 10/31/2002
      N148 = Missing/incomplete/invalid date of last
             menstrual period.
             Start: 10/31/2002
      N149 = Rebill all applicable services on a
             single claim.
             Start: 10/31/2002
      N150 = Missing/incomplete/invalid model
             number.
             Start: 10/31/2002
      N151 = Telephone contact services will not be
             paid until the face-to-face contact
             requirement has been met.
             Start: 10/31/2002
      N152 = Missing/incomplete/invalid replacement
             claim information.
             Start: 10/31/2002
      N153 = Missing/incomplete/invalid room and
             board rate.
             Start: 10/31/2002
      N154 = Alert: This payment was delayed for
             correction of provider's mailing
             address.
             Start: 10/31/2002
      N155 = Alert: Our records do not indicate that
             other insurance is on file. Please
             submit other insurance information for
             our records.
             Start: 10/31/2002
      N156 = Alert: The patient is responsible for
             the difference between the approved
             treatment and the elective treatment.
             Start: 10/31/2002
      N157 = Transportation to/from this destination
             is not covered.
             Start: 02/28/2003
      N158 = Transportation in a vehicle other than
             an ambulance is not covered.
             Start: 02/28/2003
      N159 = Payment denied/reduced because mileage
             is not covered when the patient is not
             in the ambulance.
             Start: 02/28/2003
      N160 = The patient must choose an option
             before a payment can be made for this
              procedure/ equipment/ supply/ service.
              Start: 02/28/2003
      N161 = This drug/service/supply is covered
             only when the associated service is
             covered.
             Start: 02/28/2003
      N162 = Alert: Although your claim was paid,
             you have billed for a test/specialty
             not included in your laboratory
             Certification. Your failure to correct
             the laboratory certification information
             will result in a denial of payment in
             the near future.
             Start: 02/28/2003|
      N163 = Medical record does not support code
             billed per the code definition.
             Start: 02/28/2003
      N164 = Transportation to/from this destination
             is not covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N157
      N165 = Transportation in a vehicle other than
             an ambulance is not covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N158)
      N166 = Payment denied/reduced because mileage
             is not covered when the patient is not
             in the ambulance.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N159
      N167 = Charges exceed the post-transplant
             coverage limit.
             Start: 02/28/2003
      N168 = The patient must choose an option
              before
              a payment can be made for this
              procedure/ equipment/ supply/ service.
              Start: 02/28/2003
              Stop: 01/31/2004
              Notes: Consider using N160
      N169 = This drug/service/supply is covered
             only when the associated service is
             covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N161
      N170 = A new/revised/renewed certificate of
             medical necessity is needed.
             Start: 02/28/2003
      N171 = Payment for repair or replacement is
             not covered or has exceeded the purchase
             price.
             Start: 02/28/2003
      N172 = The patient is not liable for the
             denied/adjusted charge(s) for receiving
             any updated service/item.
             Start: 02/28/2003
      N173 = No qualifying hospital stay dates were
             provided for this episode of care.
             Start: 02/28/2003
      N174 = This is not a covered
             service/procedure/
             equipment/bed, however patient liability
             is limited to amounts shown in the
             adjustments under group 'PR'.
             Start: 02/28/2003
      N175 = Missing review organization approval.
             Start: 02/28/2003
             Notes: Related to N241
      N176 = Services provided aboard a ship are
             covered only when the ship is of United
             States registry and is in United States
             waters. In addition, a doctor licensed
             to practice in the United States must
             provide the service.
             Start: 02/28/2003
      N177 = Alert: We did not send this claim to
             patient's other insurer. They have
             indicated no additional payment can be
             made.
             Start: 02/28/2003
      N178 = Missing pre-operative photos or visual
             field results.
             Start: 02/28/2003
             Notes: Related to N244
      N179 = Additional information has been
             requested from the member. The charges
             will be reconsidered upon receipt of that
             information.
             Start: 02/28/2003
      N180 = This item or service does not meet the
             criteria for the category under which it
             was billed.
             Start: 02/28/2003
      N181 = Additional information is required from
             another provider involved in this service.
             Start: 02/28/2003
             Last Modified: 12/01/2006
             Notes: (Modified 12/1/06)
      N182 = This claim/service must be billed
             according to the schedule for this plan.
             Start: 02/28/2003
      N183 = Alert: This is a predetermination
             advisory message, when this service is
             submitted for payment additional
             documentation as specified in plan
             documents will be required to process
             benefits.
             Start: 02/28/2003
      N184 = Rebill technical and professional
             components separately.
             Start: 02/28/2003
      N185 = Alert: Do not resubmit this
             claim/service.
             Start: 02/28/2003
      N186 = Non-Availability Statement (NAS)
             required for this service. Contact the
             nearest Military Treatment Facility
             (MTF) for assistance.
              Start: 02/28/2003
      N187 = Alert: You may request a review in
             writing within the required time limits
             following receipt of this notice by
             following the instructions included in
             your contract or plan benefit documents.
             Start: 02/28/2003
      N188 = The approved level of care does not
             match the procedure code submitted.
             Start: 02/28/2003
      N189 = Alert: This service has been paid as a
             one-time exception to the plan's benefit
             restrictions.
             Start: 02/28/2003
      N190 = Missing contract indicator.
             Start: 02/28/2003
             Notes: Related to N229
      N191 = The provider must update insurance
             information directly with payer.
             Start: 02/28/2003
      N192 = Patient is a Medicaid/Qualified
             Medicare Beneficiary
             Start: 02/28/2003
      N193 = Specific federal/state/local program may
             cover this service through another payer.
             Start: 02/28/2003
      N194 = Technical component not paid if
             provider does not own the equipment
             used.
             Start: 02/25/2003
      N195 = The technical component must be billed
             separately.
             Start: 02/25/2003
      N196 = Alert: Patient eligible to apply for
             other coverage which may be primary.
             Start: 02/25/2003
      N197 = The subscriber must update insurance
             information directly with payer.
             Start: 02/25/2003
      N198 = Rendering provider must be affiliated
             with the pay-to provider.
             Start: 02/25/2003
      N199 = Additional payment/recoupment approved
             based on payer-initiated review/audit.
             Start: 02/25/2003
      N200 = The professional component must be
             billed separately.
             Start: 02/25/2003
      N201 = A mental health facility is responsible
             for payment of outside providers who
             furnish these services/supplies to residents.
             Start: 02/25/2003
             Stop: 01/01/2011
             Notes: Consider using N538
      N202 = Additional information/explanation will
             be sent separately
             Start: 06/30/2003
      N203 = Missing/incomplete/invalid anesthesia
             time/units
             Start: 06/30/2003
      N204 = Services under review for possible
             pre-existing condition. Send medical
             records for prior 12 months
             Start: 06/30/2003
      N205 = Information provided was illegible
             Start: 06/30/2003
      N206 = The supporting documentation does not
             match the information sent on the claim.
             Start: 06/30/2003
             Notes: (Modified 3/6/12)
      N207 = Missing/incomplete/invalid weight.
             Start: 06/30/2003
      N208 = Missing/incomplete/invalid DRG code
             Start: 06/30/2003
      N209 = Missing/incomplete/invalid taxpayer
             identification number (TIN).
             Start: 06/30/2003
      N210 = Alert: You may appeal this decision
             Start: 06/30/2003
      N211 = Alert: You may not appeal this decision
             Start: 06/30/2003
      N212 = Charges processed under a Point of
             Service benefit
             Start: 02/01/2004
      N213 = Missing/incomplete/invalid
             facility/discrete unit DRG/DRG exempt
             status information
             Start: 04/01/2004
      N214 = Missing/incomplete/invalid history of
             the related initial surgical
             procedure(s)
             Start: 04/01/2004
      N215 = Alert: A payer providing supplemental
             or secondary coverage shall not require
             a claims determination for this service
             from a primary payer as a condition of
             making its own claims determination.
             Start: 04/01/2004
      N216 = We do not offer coverage for this type
             of service or the patient is not
             enrolled in this portion of our benefit
             package
             Start: 04/01/2004
      N217 = We pay only one site of service per
             provider per claim
             Start: 08/01/2004
      N218 = You must furnish and service this item
             for as long as the patient continues to
             need it. We can pay for maintenance
             and/or servicing for the time period
             specified in the contract or coverage manual.
             Start: 08/01/2004
      N219 = Payment based on previous payer's
             allowed amount.
             Start: 08/01/2004
      N220 = Alert: See the payer's web site or
             contact the payer's Customer Service
             department to obtain forms and
             instructions for filing a provider
             dispute.
             Start: 08/01/2004
      N221 = Missing Admitting History and Physical
             report.
             Start: 08/01/2004
      N222 = Incomplete/invalid Admitting History
             and Physical report.
             Start: 08/01/2004
      N223 = Missing documentation of benefit to the
             patient during initial treatment period.
      N224 = Incomplete/invalid documentation of
             benefit to the patient during initial
             treatment period.
             Start: 08/01/2004
      N225 = Incomplete/invalid
             documentation/orders/notes/summary/
             report/chart.
             Start: 08/01/2004
      N226 = Incomplete/invalid American Diabetes
             Association Certificate of Recognition.
             Start: 08/01/2004
      N227 = Incomplete/invalid Certificate of
             Medical Necessity.
             Start: 08/01/2004
      N228 = Incomplete/invalid consent form.
             Start: 08/01/2004
      N229 = Incomplete/invalid contract indicator.
             Start: 08/01/2004
      N230 = Incomplete/invalid indication of
             whether the patient owns the equipment
             equipment that requires the part or
             or supply.
             Start: 08/01/2004
      N231 = Incomplete/invalid invoice or statement
             certifying the actual cost of the lens,
             less discounts, and/or the type of
             intraocular lens used.
             Start: 08/01/2004
      N232 = Incomplete/invalid itemized
             bill/statement.
             Start: 08/01/2004
      N233 = Incomplete/invalid operative
             note/report.
             Start: 08/01/2004
      N234 = Incomplete/invalid oxygen
             certification/re-certification.
             Start: 08/01/2004
      N235 = Incomplete/invalid pacemaker
             registration form.
             Start: 08/01/2004
      N236 = Incomplete/invalid pathology report.
             Start: 08/01/2004
      N237 = Incomplete/invalid patient medical
             record for this service.
             Start: 08/01/2004
      N238 = Incomplete/invalid physician certified
             plan of care
             Start: 08/01/2004
      N239 = Incomplete/invalid physician financial
             relationship form.
             Start: 08/01/2004
      N240 = Incomplete/invalid radiology report.
             Start: 08/01/2004
      N241 = Incomplete/invalid review organization
             approval.
             Start: 08/01/2004
      N242 = Incomplete/invalid radiology film(s)
             /image(s).
             Start: 08/01/2004
      N243 = Incomplete/invalid/not approved
             screening document.
             Start: 08/01/2004
      N244 = Incomplete/invalid pre-operative
             photos/visual field results.
             Start: 08/01/2004
      N245 = Incomplete/invalid plan information for
             other insurance
             Start: 08/01/2004
      N246 = State regulated patient payment
             limitations apply to this service.
             Start: 12/02/2004
      N247 = Missing/incomplete/invalid assistant
             surgeon taxonomy.
             Start: 12/02/2004
      N248 = Missing/incomplete/invalid assistant
             surgeon name.
             Start: 12/02/2004
      N249 = Missing/incomplete/invalid assistant
             surgeon primary identifier.
             Start: 12/02/2004
      N250 = Missing/incomplete/invalid assistant
             surgeon secondary identifier.
             Start: 12/02/2004
      N251 = Missing/incomplete/invalid attending
             provider taxonomy.
             Start: 12/02/2004
      N252 = Missing/incomplete/invalid attending
             provider name.
             Start: 12/02/2004
      N253 = Missing/incomplete/invalid attending
             provider primary identifier.
             Start: 12/02/2004
      N254 = Missing/incomplete/invalid attending
             provider secondary identifier.
             Start: 12/02/2004
      N255 = Missing/incomplete/invalid billing
             provider taxonomy.
             Start: 12/02/2004
      N256 = Missing/incomplete/invalid billing
             provider/supplier name.
             Start: 12/02/2004
      N257 = Missing/incomplete/invalid billing
             provider/supplier primary identifier.
             Start: 12/02/2004
      N258 = Missing/incomplete/invalid billing
             provider/supplier address.
             Start: 12/02/2004
      N259 = Missing/incomplete/invalid billing
             provider/supplier secondary identifier.
             Start: 12/02/2004
      N260 = Missing/incomplete/invalid billing
             provider/supplier contact information.
             Start: 12/02/2004
      N261 = Missing/incomplete/invalid operating
             provider name.
             Start: 12/02/2004
      N262 = Missing/incomplete/invalid operating
             provider primary identifier.
             Start: 12/02/2004
      N263 = Missing/incomplete/invalid operating
             provider secondary identifier.
             Start: 12/02/2004
      N264 = Missing/incomplete/invalid ordering
             provider name.
             Start: 12/02/2004
      N265 = Missing/incomplete/invalid ordering
             provider primary identifier.
             Start: 12/02/2004
      N266 = Missing/incomplete/invalid ordering
             provider address.
             Start: 12/02/2004
      N267 = Missing/incomplete/invalid ordering
             provider secondary identifier.
             Start: 12/02/2004
      N268 = Missing/incomplete/invalid ordering
             provider contact information.
             Start: 12/02/2004
      N269 = Missing/incomplete/invalid other
             provider name.
             Start: 12/02/2004
      N270 = Missing/incomplete/invalid other
             provider primary identifier.
             Start: 12/02/2004
      N271 = Missing/incomplete/invalid other
             provider secondary identifier.
             Start: 12/02/2004
      N272 = Missing/incomplete/invalid other payer
             attending provider identifier.
             Start: 12/02/2004
      N273 = Missing/incomplete/invalid other payer
             operating provider identifier.
             Start: 12/02/2004
      N274 = Missing/incomplete/invalid other payer
             other provider identifier.
             Start: 12/02/2004
      N275 = Missing/incomplete/invalid other payer
             purchased service provider identifier.
             Start: 12/02/2004
      N276 = Missing/incomplete/invalid other payer
             referring provider identifier.
             Start: 12/02/2004
      N277 = Missing/incomplete/invalid other payer
             rendering provider identifier.
             Start: 12/02/2004
      N278 = Missing/incomplete/invalid other payer
             service facility provider identifier.
             Start: 12/02/2004
      N279 = Missing/incomplete/invalid pay-to
             provider name.
             Start: 12/02/2004
      N280 = Missing/incomplete/invalid pay-to
             provider primary identifier.
             Start: 12/02/2004
      N281 = Missing/incomplete/invalid pay-to
             provider address.
             Start: 12/02/2004
      N282 = Missing/incomplete/invalid pay-to
             provider secondary identifier.
             Start: 12/02/2004
      N283 = Missing/incomplete/invalid purchased
             service provider identifier.
             Start: 12/02/2004
      N284 = Missing/incomplete/invalid referring
             provider taxonomy.
             Start: 12/02/2004
      N285 = Missing/incomplete/invalid referring
             provider name.
             Start: 12/02/2004
      N286 = Missing/incomplete/invalid referring
             provider primary identifier.
             Start: 12/02/2004
      N287 = Missing/incomplete/invalid referring
             provider secondary identifier.
             Start: 12/02/2004
      N288 = Missing/incomplete/invalid rendering
             provider taxonomy.
             Start: 12/02/2004
      N289 = Missing/incomplete/invalid rendering
             provider name.
             Start: 12/02/2004
      N290 = Missing/incomplete/invalid rendering
             provider primary identifier.
             Start: 12/02/2004
      N291 = Missing/incomplete/invalid rendering
             provider secondary identifier.
             Start: 12/02/2004
      N292 = Missing/incomplete/invalid service
             facility name.
             Start: 12/02/2004
      N293 = Missing/incomplete/invalid service
             facility primary identifier.
             Start: 12/02/2004
      N294 = Missing/incomplete/invalid service
             facility primary address.
             Start: 12/02/2004
      N295 = Missing/incomplete/invalid service
             facility secondary identifier.
             Start: 12/02/2004
      N296 = Missing/incomplete/invalid supervising
             provider name.
             Start: 12/02/2004
      N297 = Missing/incomplete/invalid supervising
             provider primary identifier.
             Start: 12/02/2004
      N298 = Missing/incomplete/invalid supervising
             provider secondary identifier.
             Start: 12/02/2004
      N299 = Missing/incomplete/invalid occurrence
             date(s).
             Start: 12/02/2004
      N300 = Missing/incomplete/invalid occurrence
             span date(s).
             Start: 12/02/2004
      N301 = Missing/incomplete/invalid procedure
             date(s).
             Start: 12/02/2004
      N302 = Missing/incomplete/invalid other
             procedure date(s).
             Start: 12/02/2004
      N303 = Missing/incomplete/invalid principal
             procedure date.
             Start: 12/02/2004
      N304 = Missing/incomplete/invalid dispensed
             date.
             Start: 12/02/2004
      N305 = Missing/incomplete/invalid accident
             date.
             Start: 12/02/2004
      N306 = Missing/incomplete/invalid acute
             manifestation date.
             Start: 12/02/2004
      N307 = Missing/incomplete/invalid adjudication
             or payment date.
             Start: 12/02/2004
      N308 = Missing/incomplete/invalid appliance
             placement date.
             Start: 12/02/2004
      N309 = Missing/incomplete/invalid assessment
             date.
             Start: 12/02/2004
      N310 = Missing/incomplete/invalid assumed or
             relinquished care date.
             Start: 12/02/2004
      N311 = Missing/incomplete/invalid authorized
             to return to work date.
             Start: 12/02/2004
      N312 = Missing/incomplete/invalid begin
             therapy date.
             Start: 12/02/2004
      N313 = Missing/incomplete/invalid
             certification revision date.
             Start: 12/02/2004
      N314 = Missing/incomplete/invalid diagnosis
             date.
             Start: 12/02/2004
      N315 = Missing/incomplete/invalid disability
             from date.
             Start: 12/02/2004
      N316 = Missing/incomplete/invalid disability
             to date.
             Start: 12/02/2004
      N317 = Missing/incomplete/invalid discharge
             hour.
             Start: 12/02/2004
      N318 = Missing/incomplete/invalid discharge or
             end of care date.
             Start: 12/02/2004
      N319 = Missing/incomplete/invalid hearing or
             vision prescription date.
             Start: 12/02/2004
      N320 = Missing/incomplete/invalid Home Health
             Certification Period.
             Start: 12/02/2004
      N321 = Missing/incomplete/invalid last
             admission period.
             Start: 12/02/2004
      N322 = Missing/incomplete/invalid last
             certification date.
             Start: 12/02/2004
      N323 = Missing/incomplete/invalid last contact
             date.
             Start: 12/02/2004
      N324 = Missing/incomplete/invalid last
             seen/visit date.
             Start: 12/02/2004
      N325 = Missing/incomplete/invalid last worked
             date.
             Start: 12/02/2004
      N326 = Missing/incomplete/invalid last x-ray
             date.
             Start: 12/02/2004
      N327 = Missing/incomplete/invalid other insured
             birth date.
             Start: 12/02/2004
      N328 = Missing/incomplete/invalid Oxygen
             Saturation Test date.
             Start: 12/02/2004
      N329 = Missing/incomplete/invalid patient
             birth date
             Start: 12/02/2004
      N330 = Missing/incomplete/invalid patient
             death date.
             Start: 12/02/2004
      N331 = Missing/incomplete/invalid physician
             order date.
             Start: 12/02/2004
      N332 = Missing/incomplete/invalid prior
             hospital discharge date.
             Start: 12/02/2004
      N333 = Missing/incomplete/invalid prior
             placement date.
             Start: 12/02/2004
      N334 = Missing/incomplete/invalid re-  evaluation
             date
             Start: 12/02/2004
      N335 = Missing/incomplete/invalid referral
             date.
             Start: 12/02/2004
      N336 = Missing/incomplete/invalid replacement
             date.
             Start: 12/02/2004
      N337 = Missing/incomplete/invalid secondary
             diagnosis date.
             Start: 12/02/2004
      N338 = Missing/incomplete/invalid shipped  date.
             Start: 12/02/2004
      N339 = Missing/incomplete/invalid similar
             illness or symptom date.
             Start: 12/02/2004
      N340 = Missing/incomplete/invalid subscriber
             birth date.
             Start: 12/02/2004
      N341 = Missing/incomplete/invalid surgery date.
             Start: 12/02/2004
      N342 = Missing/incomplete/invalid test
             performed date.
             Start: 12/02/2004
      N343 = Missing/incomplete/invalid
             Transcutaneous Electrical Nerve
             Stimulator (TENS) trial start date.
             Start: 12/02/2004
      N344 = Missing/incomplete/invalid
             Transcutaneous Electrical Nerve
             Stimulator (TENS) trial end date.
             Start: 12/02/2004
      N345 = Date range not valid with units
             submitted.
             Start: 03/30/2005
      N346 = Missing/incomplete/invalid oral cavity
             designation code.
             Start: 03/30/2005
      N347 = Your claim for a referred or purchased
             service cannot be paid because payment
             has already been made for this same
             service to another provider by a payment
             contractor representing the payer.
             Start: 03/30/2005
      N348 = You chose that this service/supply/drug
             would be rendered/supplied and billed by
             a different practitioner/supplier.
             Start: 08/01/2005
      N349 = The administration method and drug must
             be reported to adjudicate this service.
             Start: 08/01/2005
      N350 = Missing/incomplete/invalid description
             of service for a Not Otherwise Classified
             (NOC) code or for an Unlisted/By Report
             procedure.
             Start: 08/01/2005
      N351 = Service date outside of the approved
             treatment plan service dates.
             Start: 08/01/2005
      N352 = Alert: There are no scheduled payments
             for this service. Submit a claim for
             each patient visit.
             Start: 08/01/2005
      N353 = Alert: Benefits have been estimated,
             when the actual services have been
             rendered, additional payment will be
             considered based on the submitted claim.
             Start: 08/01/2005
      N354 = Incomplete/invalid invoice
             Start: 08/01/2005
            "Alert: The law permits exceptions to
             the refund requirement in two cases: -
             If you did not know, and could not have
             reasonably been expected to know, that
             we would not pay for this service; or -
             If you notified the patient in writing
             before providing the service that you
             believed that we were likely to deny the
             service, and the patient signed a
             statement agreeing to pay for the
             service.
             If you come within either exception, or
             if you believe the carrier was wrong in
             its determination that we do not pay for
             this service, you should request appeal
             of this determination within 30 days of
             the date of this notice. Your request
             for review should include any additional
             information necessary to support your
             position.
             If you request an appeal within 30 days
             of receiving this notice, you may delay
             refunding the amount to the patient
             until you receive the results of the
             review. If the review decision is
             favorable to you, you do not need to
             make any refund. If, however, the review
             is unfavorable, the law specifies that
             you must make the refund within 15 days
             of receiving the unfavorable review
             decision.
             The law also permits you to request an
             appeal at any time within 120 days of
             the date you receive this notice.
             However, an appeal request that is
             received more than 30 days after the
             date of this notice, does not permit you
             to delay making the refund. Regardless
             of when a review is requested, the
             patient will be notified that you have
             requested one, and will receive a copy
             of the determination.
             The patient has received a separate
             notice of this denial decision. The
             notice advises that he/she may be
             entitled to a refund of any amounts
             paid, if you should have known that we
             would not pay and did not tell him/her.
             It also instructs the patient to contact
             our office if he/she does not hear
             anything about a refund within 30 days"
             Start: 08/01/2005
      N356 = Not covered when performed with, or
             subsequent to, a non-covered service.
             Start: 08/01/2005
      N357 = Time frame requirements between this
             service/procedure/supply and a related
             service/procedure/supply have not been
             met.
             Start: 11/18/2005
      N358 = Alert: This decision may be reviewed if
             additional documentation as described in
             the contract or plan benefit documents
             is submitted.
             Start: 11/18/2005
      N359 = Missing/incomplete/invalid height.
             Start: 11/18/2005
      N360 = Alert: Coordination of benefits has not
             been calculated when estimating benefits
             for this pre-determination. Submit
             payment information from the primary
             payer with the secondary claim.
             Start: 11/18/2005
      N361 = Payment adjusted based on multiple
             diagnostic imaging procedure rules
             Start: 11/18/2005
             Stop: 10/01/2007
             Notes: (Modified 12/1/06)
             Consider using Reason Code 59
      N362 = The number of Days or Units of Service
             exceeds our acceptable maximum.
             Start: 11/18/2005
      N363 = Alert: in the near future we are
             implementing new policies/procedures
             that would affect this determination.
             Start: 11/18/2005
      N364 = Alert: According to our agreement, you
             must waive the deductible and/or
             coinsurance amounts.
             Start: 11/18/2005
      N365 = This procedure code is not payable.
             It is for reporting/information purposes
             only.
             Start: 04/01/2006
      N366 = Requested information not provided. The
             claim will be reopened if the
             information previously requested is
             submitted within one year after the date
             of this denial notice.
             Start: 04/01/2006
      N367 = Alert: The claim information has been
             forwarded to a Consumer Spending Account
             processor for review; for example,
             flexible spending account or health
             savings account.
             Start: 04/01/2006
             Last Modified: 07/01/2008
      N368 = You must appeal the determination of
             the previously adjudicated claim.
             Start: 04/01/2006
      N369 = Alert: Although this claim has been
             processed, it is deficient according to
             state legislation/regulation.
             Start: 04/01/2006
      N370 = Billing exceeds the rental months
             covered/approved by the payer.
             Start: 08/01/2006
      N371 = Alert: title of this equipment must be
             transferred to the patient.
             Start: 08/01/2006
      N372 = Only reasonable and necessary
             maintenance/service charges are covered.
             Start: 08/01/2006
      N373 = It has been determined that another
             payer paid the services as primary when
             they were not the primary payer.
             Therefore, we are refunding to the payer
             that paid as primary on your behalf.
             Start: 12/01/2006
      N374 = Primary Medicare Part A insurance has
             been exhausted and a Part B Remittance
             Advice is required.
             Start: 12/01/2006
      N375 = Missing/incomplete/invalid
             questionnaire/information required to
             determine dependent eligibility.
             Start: 12/01/2006
      N376 = Subscriber/patient is assigned to
             active military duty, therefore
             primary coverage may be TRICARE.
             Start: 12/01/2006
      N377 = Payment based on a processed
             replacement claim.
             Start: 12/01/2006
      N378 = Missing/incomplete/invalid prescription
             quantity.
             Start: 12/01/2006
      N379 = Claim level information does not match
             line level information.
             Start: 12/01/2006
      N380 = The original claim has been processed,
             submit a corrected claim.
             Start: 04/01/2007
      N381 = Consult our contractual agreement for
             restrictions/billing/payment information
             related to these charges.
             Start: 04/01/2007
      N382 = Missing/incomplete/invalid patient
             identifier.
             Start: 04/01/2007
      N383 = Not covered when deemed cosmetic.
             Start: 04/01/2007
             Last Modified: 03/08/2011
             Notes: (Modified 3/8/11)
      N384 = Records indicate that the referenced
             body part/tooth has been removed in a
             previous procedure.
             Start: 04/01/2007
      N385 = Notification of admission was not
             timely
             according to published plan procedures.
             Start: 04/01/2007
      N386 = This decision was based on a National
             Coverage Determination (NCD). An NCD
             provides a coverage determination as to
             whether a particular item or service is
             covered. A copy of this policy is
             available at www.cms.gov/mcd/search.asp.
             If you do not have web access, you may
             contact the contractor to request a copy
             of the NCD.
             Start: 04/01/2007
      N387 = Alert: Submit this claim to the
             patient's other insurer for potential
             payment of supplemental benefits. We did
             not forward the claim information.
             Start: 04/01/2007
      N388 = Missing/incomplete/invalid prescription
             number.
             Start: 08/01/2007
      N389 = Duplicate prescription number
             submitted.
             Start: 08/01/2007
      N390 = This service/report cannot be billed
             separately.
             Start: 08/01/2007
      N391 = Missing emergency department records.
             Start: 08/01/2007
      N392 = Incomplete/invalid emergency department
             records.
             Start: 08/01/2007
      N393 = Missing progress notes/report.
             Start: 08/01/2007
      N394 = Incomplete/invalid progress
             notes/report.
             Start: 08/01/2007
      N395 = Missing laboratory report.
             Start: 08/01/2007
      N396 = Incomplete/invalid laboratory report.
             Start: 08/01/2007
      N397 = Benefits are not available for
             incomplete service(s)/undelivered
             item(s).
             Start: 08/01/2007
      N398 = Missing elective consent form.
             Start: 08/01/2007
      N399 = Incomplete/invalid elective consent
             form.
             Start: 08/01/2007
      N400 = Alert: Electronically enabled providers
             should submit claims electronically.
             Start: 08/01/2007
      N401 = Missing periodontal charting.
             Start: 08/01/2007
      N402 = Incomplete/invalid periodontal
             charting.
             Start: 08/01/2007
      N403 = Missing facility certification.
             Start: 08/01/2007
      N404 = Incomplete/invalid facility
             certification.
             Start: 08/01/2007
      N405 = This service is only covered when the
             donor's insurer(s) do not provide
             coverage for the service.
             Start: 08/01/2007
      N406 = This service is only covered when the
             recipient's insurer(s) do not provide
             coverage for the service.
             Start: 08/01/2007
      N407 = You are not an approved submitter for
             this transmission format.
             Start: 08/01/2007
      N408 = This payer does not cover deductibles
             assessed by a previous payer.
             Start: 08/01/2007
      N409 = This service is related to an
             accidental injury and is not covered
             unless provided within a specific time
             frame from the date of the accident.
             Start: 08/01/2007
      N410 = Not covered unless the prescription
             changes.
             Start: 08/01/2007
      N411 = This service is allowed one time in a
             6-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N412 = This service is allowed 2 times in a
             12-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N413 = This service is allowed 2 times in a
             benefit year. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N414 = This service is allowed 4 times in a
             12-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N415 = This service is allowed 1 time in an
             18-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N416 = This service is allowed 1 time in a
             3-year period. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N417 = This service is allowed 1 time in a
             5-year period. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N418 = Misrouted claim. See the payer's claim
             submission instructions.
             Start: 08/01/2007
      N419 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             retroactive rate change.
             Start: 08/01/2007
      N420 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             Coordination of Benefits or Third Party
             Liability Recovery.
             Start: 08/01/2007
      N421 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             review organization decision.
             Start: 08/01/2007
      N422 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             payer's contract incentive program.
             Start: 08/01/2007
      N423 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             non standard program.
             Start: 08/01/2007
      N424 = Patient does not reside in the
             geographic area required for this type
             of payment.
             Start: 08/01/2007
      N425 = Statutorily excluded service(s).
             Start: 08/01/2007
      N426 = No coverage when self-administered.
             Start: 08/01/2007
      N427 = Payment for eyeglasses or contact
             lenses can be made only after cataract
             surgery.
             Start: 08/01/2007
      N428 = Not covered when performed in this
             place of surgery.
             Start: 08/01/2007
      N429 = Not covered when considered routine.
             Start: 08/01/2007
      N430 = Procedure code is inconsistent with the
             units billed.
             Start: 11/05/2007
      N431 = Not covered with this procedure.
             Start: 11/05/2007
      N432 = Adjustment based on a Recovery Audit.
             Start: 11/05/2007
      N433 = Resubmit this claim using only your
             National Provider Identifier (NPI)
             Start: 02/29/2008
      N434 = Missing/Incomplete/Invalid Present on
             Admission indicator.
             Start: 07/01/2008
      N435 = Exceeds number/frequency approved
             /allowed within time period without
             support documentation.
             Start: 07/01/2008
      N436 = The injury claim has not been accepted
             and a mandatory medical reimbursement
             has been made.
             Start: 07/01/2008
      N437 = Alert: If the injury claim is accepted,
             these charges will be reconsidered.
             Start: 07/01/2008
      N438 = This jurisdiction only accepts paper
             claims
             Start: 07/01/2008
      N439 = Missing anesthesia physical status
             report/indicators.
             Start: 07/01/2008
      N440 = Incomplete/invalid anesthesia physical
             status report/indicators.
             Start: 07/01/2008
      N441 = This missed appointment is not covered.
             Start: 07/01/2008
      N442 = Payment based on an alternate fee
             schedule.
             Start: 07/01/2008
      N443 = Missing/incomplete/invalid total time
             or begin/end time.
             Start: 07/01/2008
      N444 = Alert: This facility has not filed the
             Election for High Cost Outlier form with
             the Division of Workers' Compensation.
             Start: 07/01/2008
      N445 = Missing document for actual cost or
             paid amount.
             Start: 07/01/2008
      N446 = Incomplete/invalid document for actual
             cost or paid amount.
             Start: 07/01/2008
      N447 = Payment is based on a generic
             equivalent
             as required documentation was not
             provided.
             Start: 07/01/2008
      N448 = This drug/service/supply is not
             included
             in the fee schedule or
             contracted/legislated fee arrangement
             Start: 07/01/2008
      N449 = Payment based on a comparable
             drug/service/supply.
             Start: 07/01/2008
      N450 = Covered only when performed by the
             primary treating physician or the
             designee.
             Start: 07/01/2008
      N451 = Missing Admission Summary Report.
             Start: 07/01/2008
      N452 = Incomplete/invalid Admission Summary
             Report.
             Start: 07/01/2008
      N453 = Missing Consultation Report.
             Start: 07/01/2008
      N454 = Incomplete/invalid Consultation Report.
             Start: 07/01/2008
      N455 = Missing Physician Order.
             Start: 07/01/2008
      N456 = Incomplete/invalid Physician Order.
             Start: 07/01/2008
      N457 = Missing Diagnostic Report.
             Start: 07/01/2008
      N458 = Incomplete/invalid Diagnostic Report.
             Start: 07/01/2008
      N459 = Missing Discharge Summary.
             Start: 07/01/2008
      N460 = Incomplete/invalid Discharge Summary.
             Start: 07/01/2008
      N461 = Missing Nursing Notes.
             Start: 07/01/2008
      N462 = Incomplete/invalid Nursing Notes.
             Start: 07/01/2008
      N463 = Missing support data for claim.
             Start: 07/01/2008
      N464 = Incomplete/invalid support data for
             claim.
             Start: 07/01/2008
      N465 = Missing Physical Therapy Notes/Report.
             Start: 07/01/2008
      N466 = Incomplete/invalid Physical Therapy
             Notes/Report.
             Start: 07/01/2008
      N467 = Missing Report of Tests and Analysis
             Report.
             Start: 07/01/2008
      N468 = Incomplete/invalid Report of Tests and
             Analysis Report.
             Start: 07/01/2008
      N469 = Alert: Claim/Service(s) subject to
             appeal process, see section 935 of
             Medicare Prescription Drug, Improvement,
             and Modernization Act of 2003 (MMA).
             Start: 07/01/2008
      N470 = This payment will complete the
             mandatory
             medical reimbursement limit.
             Start: 07/01/2008
      N471 = Missing/incomplete/invalid HIPPS Rate
             Code.
             Start: 07/01/2008
      N472 = Payment for this service has been
             issued
             to another provider.
             Start: 07/01/2008
      N473 = Missing certification.
             Start: 07/01/2008
      N474 = Incomplete/invalid certification
             Start: 07/01/2008
      N475 = Missing completed referral form.
             Start: 07/01/2008
      N476 = Incomplete/invalid completed referral
             form
             Start: 07/01/2008
      N477 = Missing Dental Models.
             Start: 07/01/2008
      N478 = Incomplete/invalid Dental Models
             Start: 07/01/2008
      N479 = Missing Explanation of Benefits
             (Coordination of Benefits or Medicare
             Secondary Payer).
             Start: 07/01/2008
      N480 = Incomplete/invalid Explanation of
             Benefits (Coordination of Benefits or
             Medicare Secondary Payer).
             Start: 07/01/2008
      N481 = Missing Models.
             Start: 07/01/2008
      N482 = Incomplete/invalid Models
             Start: 07/01/2008
      N483 = Missing Periodontal Charts.
             Start: 07/01/2008
      N484 = Incomplete/invalid Periodontal Charts
             Start: 07/01/2008
      N485 = Missing Physical Therapy Certification.
             Start: 07/01/2008
      N486 = Incomplete/invalid Physical Therapy
             Certification.
             Start: 07/01/2008
      N487 = Missing Prosthetics or Orthotics
             Certification.
             Start: 07/01/2008
      N488 = Incomplete/invalid Prosthetics or
             Orthotics Certification
             Start: 07/01/2008
      N489 = Missing referral form.
             Start: 07/01/2008
      N490 = Incomplete/invalid referral form
             Start: 07/01/2008
      N491 = Missing/Incomplete/Invalid Exclusionary
             Rider Condition.
             Start: 07/01/2008
      N492 = Alert: A network provider may bill the
             member for this service if the member
             requested the service and agreed in
             writing, prior to receiving the service,
             to be financially responsible for the
             billed charge.
             Start: 07/01/2008
      N493 = Missing Doctor First Report of Injury.
             Start: 07/01/2008
      N494 = Incomplete/invalid Doctor First Report
             of Injury.
             Start: 07/01/2008
      N495 = Missing Supplemental Medical Report.
             Start: 07/01/2008
      N496 = Incomplete/invalid Supplemental Medical
             Report.
             Start: 07/01/2008
      N497 = Missing Medical Permanent Impairment or
             Disability Report.
             Start: 07/01/2008
      N498 = Incomplete/invalid Medical Permanent
             Impairment or Disability Report.
             Start: 07/01/2008
      N499 = Missing Medical Legal Report.
             Start: 07/01/2008
      N500 = Incomplete/invalid Medical Legal
             Report.
             Start: 07/01/2008
      N501 = Missing Vocational Report.
             Start: 07/01/2008
      N502 = Incomplete/invalid Vocational Report.
             Start: 07/01/2008
      N503 = Missing Work Status Report.
             Start: 07/01/2008
      N504 = Incomplete/invalid Work Status Report.
             Start: 07/01/2008
      N505 = Alert: This response includes only
             services that could be estimated in real
             time. No estimate will be provided for
             the services that could not be estimated
             in real time.
             Start: 11/01/2008
      N506 = Alert: This is an estimate of the
             member's liability based on the
             information available at the time the
             estimate was processed. Actual coverage
             and member liability amounts will be
             determined when the claim is processed.
             This is not a pre-authorization or a
             guarantee of payment.
             Start: 11/01/2008
      N507 = Plan distance requirements have not
             been met.
             Start: 11/01/2008
      N508 = Alert: This real time claim
             adjudication response represents the
             the member responsibility to the
             provider for services reported.  The
             member will receive an Explanation of
             Benefits electronically or in the mail.
             Contact the insurer if there are any
             questions.
             Start: 11/01/2008
      N509 = Alert: A current inquiry shows the
             member's Consumer Spending Account
             contains sufficient funds to cover the
             member liability for this claim/service.
             Actual payment from the Consumer
             Spending Account will depend on the
             availability of funds and determination
             of eligible services at the time of
             payment processing.
             Start: 11/01/2008
      N510 = Alert: A current inquiry shows the
             members Consumer Spending Account does
             not contain sufficient funds to cover
             the member's liability for this
             claim/service. Actual payment from the
             Consumer Spending Account will depend on
             the availability of funds and
             determination of eligible services at
             the time of payment processing.
             Start: 11/01/2008
      N511 = Alert: Information on the availability
             of Consumer Spending Account funds to
             cover the member liability on this
             claim/service is not available at this
             time.
             Start: 11/01/2008
      N512 = Alert: This is the initial remit of a
             non-NCPDP claim originally submitted
             real-time without change to the
             adjudication.
             Start: 11/01/2008
      N513 = Alert: This is the initial remit of a
             non-NCPDP claim originally submitted
             real-time with a change to the
             adjudication.
             Start: 11/01/2008
      N514 = Consult plan benefit
             documents/guidelines for information
             about restrictions for this service.
             Start: 11/01/2008
             Stop: 01/01/2011
             Notes: Consider using N130
      N515 = Alert: Submit this claim to the
             patient's other insurer for potential
             payment of supplemental benefits. We did
             not forward the claim information. (use
             N387 instead)
             Start: 11/01/2008
             Stop: 10/1/2009
      N516 = Records indicate a mismatch between the
             submitted NPI and EIN.
             Start: 03/01/2009
      N517 = Resubmit a new claim with the requested
             information.
             Start: 03/01/2009
      N518 = No separate payment for accessories
             when furnished for use with oxygen
             equipment.
             Start: 03/01/2009
      N519 = Invalid combination of HCPCS modifiers.
             Start: 07/01/2009
      N520 = Alert: Payment made from a Consumer
             Spending Account.
             Start: 07/01/2009
      N521 = Mismatch between the submitted provider
             information and the provider information
             stored in our system.
             Start: 11/01/2009
      N522 = Duplicate of a claim processed, or to
             be processed, as a crossover claim.
             Start: 11/01/2009
      N523 = The limitation on outlier payments
             defined by this payer for this service
             period has been met. The outlier payment
             otherwise applicable to this claim has
             not been paid.
             Start: 03/01/2010
      N524 = Based on policy this payment
             constitutes payment in full.
             Start: 03/01/2010
      N525 = These services are not covered when
             performed within the global period of
             another service.
             Start: 03/01/2010
      N526 = Not qualified for recovery based on
             employer size.
             Start: 03/01/2010
      N527 = We processed this claim as the primary
             payer prior to receiving the recovery
             demand.
             Start: 03/01/2010
      N528 = Patient is entitled to benefits for
             Institutional Services only.
             Start: 03/01/2010
      N529 = Patient is entitled to benefits for
             Professional Services only.
             Start: 03/01/2010
      N530 = Not Qualified for Recovery based on
             enrollment information.
             Start: 03/01/2010 |
      N531 = Not qualified for recovery based on
             direct payment of premium.
             Start: 03/01/2010
      N532 = Not qualified for recovery based on
             disability and working status.
             Start: 03/01/2010
      N533 = Services performed in an Indian Health
             Services facility under a self-insured
             tribal Group Health Plan.
             Start: 07/01/2010
      N534 = This is an individual policy, the
             employer does not participate in plan
             sponsorship.
             Start: 07/01/2010
      N535 = Payment is adjusted when procedure is
             performed in this place of service based
             on the submitted procedure code and
             place of service.
             Start: 07/01/2010
      N536 = We are not changing the prior payer's
             determination of patient responsibility,
             which you may collect, as this service
             is not covered by us.
             Start: 07/01/2010
      N537 = We have examined claims history and no
             records of the services have been found.
             Start: 07/01/2010
      N538 = A facility is responsible for payment
             to outside providers who furnish these
             services/supplies/drugs to its
             patients/residents.
             Start: 07/01/2010
      N539 = Alert: We processed appeals/waiver
             requests on your behalf and that request
             has been denied.
             Start: 07/01/2010
      N540 = Payment adjusted based on the
             interrupted stay policy.
             Start: 11/01/2010
      N541 = Mismatch between the submitted
             insurance type code and the information
             stored in our system.
             Start: 11/01/2010
      N542 = Missing income verification.
             Start: 03/08/2011
      N543 = Incomplete/invalid income verification
             Start: 03/08/2011
      N544 = Alert: Although this was paid, you have
             billed with a referring/ordering
             provider that does not match our system
             record. Unless, corrected, this will not
             be paid in the future.
             Start: 07/01/2011
      N545 = Payment reduced based on status as an
             unsuccessful eprescriber per the
             Electronic Prescribing (eRx) Incentive
             Program.
             Start: 07/01/2011
      N546 = Payment represents a previous reduction
             based on the Electronic Prescribing
             (eRx) Incentive Program.
             Start: 07/01/2011
      N547 = A refund request (Frequency Type Code
             8) was processed previously.
             Start: 03/06/2012
      N548 = Alert: Patient's calendar year
             deductible has been met.
             Start: 03/06/2012
      N549 = Alert: Patient's calendar year out-of-
             pocket maximum has been met.
             Start: 03/06/2012
      N550 = Alert: You have not responded to
             requests to revalidate your
             provider/supplier enrollment
             information. Your failure to revalidate
             your enrollment information will result
             in a payment hold in the near future.
             Start: 03/06/2012
      N551 = Payment adjusted based on the
             Ambulatory
             Surgical Center (ASC) Quality Reporting
             Program.
             Start: 03/06/2012
      N552 = Payment adjusted to reverse a previous
             withhold/bonus amount.
             Start: 03/06/2012
      N553 = Payment adjusted based on a Low Income
             Subsidy (LIS) retroactive coverage or
             status change.
             Start: 03/06/2012
             Stop:  11/1/2012
      N554 = Missing/Incomplete/Invalid Family
             Planning Indicator
             Start: 07/01/2012
      N555 = Missing medication list.
             Start: 07/01/2012
      N556 = Incomplete/invalid medication list.
             Start: 07/01/2012
      N557 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the specimen was collected.
             Start: 07/01/2012
      N558 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the equipment was received.
             Start: 07/01/2012
      N559 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the Ordering Physician is located.
             Start: 07/01/2012
      N560 = The pilot program requires an interim or
             final claim within 60 days of the Notice
             of Admission. A claim was not received.
             Start: 11/01/2012
      N561 = The bundled claim originally submitted
             for this episode of care includes
             related readmissions. You may resubmit
             the original claim to receive a
             corrected payment based on this
             readmission.
             Start: 11/01/2012
      N562 = The provider number of your incoming
             claim does not match the provider number
             on the processed Notice of Admission
             (NOA) for this bundled payment.
             Start: 11/01/2012
      N563 = Missing required provider/supplier
             issuance of advance patient notice of
             non-coverage. The patient is not liable
             for payment for this service.
             Start: 11/01/2012
             Notes: Related to M39
      N564 = Patient did not meet the inclusion
             criteria for the demonstration project
             or pilot program.
             Start: 11/01/2012
      N565 = Alert: This procedure code requires a
             modifier. Future claims containing this
             procedure code must include an
             appropriate modifier for the claim to be
             processed.
             Start: 11/01/2012
      N566 = Alert: This procedure code requires
             functional reporting. Future claims
             containing this procedure code must
             include an applicable non-payable code
             and appropriate modifiers for the claim
             to be processed.
             Start: 11/01/2012



 CLM_RRB_EXCLSN_IND_TB                   Claim RRB Exclusion Indicator Table

      Y = Exclude RRB beneficiary services from the prior authorization
          program
      Blank = Subject RRB beneficiary services to prior authorization



 CLM_SRVC_CLSFCTN_TYPE_TB                Claim Service Classification Type Table

          For facility type code 1 thru 6, and 9

       1 = Inpatient (including Part A)
       2 = Hospital based or Inpatient (Part B only)
           or home health visits under Part B
       3 = Outpatient (HHA-A also)
       4 = Other (Part B) -- (Includes HHA medical and
           other health services not under a plan of
           treatment, hospital or SNF for diagnostic
           clinical laboratory services for "nonpatients,"
           and referenced diagnostic services.  For HHAs
           under PPS, indicates an osteoporosis claim.)
       5 = Intermediate care - level I
       6 = Intermediate care - level II
       7 = Subacute Inpatient (revenue code 019X required)
           (formerly Intermediate care - level III)
           NOTE:  17X & 27X are discontinued effective
           10/1/05.
       8 = Swing beds (used to indicate billing for
           SNF level of care in a hospital with an
           approved swing bed agreement)
       9 = Reserved for national assignment

         For facility type code 7

       1 = Rural Health Clinic (RHC)
       2 = Hospital based or independent renal
           dialysis facility
       3 = Free-standing provider based federally
           qualified health center (FQHC) (eff 10/91)
       4 = Other Rehabilitation Facility (ORF) and
           Community Mental Health Center (CMHC)
           (eff 10/91 - 3/97); ORF only (eff. 4/97)
       5 = Comprehensive Rehabilitation Center
             (CORF)
       6 = Community Mental Health Center (CMHC) (eff 4/97)
       7-8 = Reserved for national assignment
       9 = Other

         For facility type code 8

       1 = Hospice (non-hospital based)
       2 = Hospice (hospital based)
       3 = Ambulatory surgical center in hospital
           outpatient department
       4 = Freestanding birthing center
       5 = Critical Access Hospital (eff. 10/99)
           formerly Rural primary care hospital
           (eff. 10/94)
       6-8 = Reserved for national use
       9 = Other



 CLM_TRANS_TB                            Claim Transaction Table

       0 = Religious NonMedical Health Care Institutions (RNHCI)
           bill (prior to 8/00, Christian Science bill), SNF bill,
           or state buy-in
       1 = Psychiatric hospital facility bill or dummy psychiatric
       2 = Tuberculosis hospital facility bill
       3 = General care hospital facility bill or dummy LRD
       4 = Regular SNF bill
       5 = Home health agency bill (HHA)
       6 = Outpatient hospital bill
       C = CORF bill - type of OP bill in the HHA bill format
           (obsoleted 7/98)
       H = Hospice bill



 CLM_VAL_TB                              Claim Value Table

       01 = Most Common Semi-Private Rate - to
            provide for the recording of hospital's
            most common semi-private rate.
       02 = Hospital Has No Semi-Private Rooms -
            Entering this code requires $0.00
            amount.
       03 = Reserved for national assignment.
       04 = Inpatient professional component
            charges which are combined billed -
            For use only by some all inclusive
            rate hospitals. (Eff 9/93)
       05 = Professional component included in
            charges and also billed separately to
            carrier - For use on Medicare and
            Medicaid bills if the state requests
            this information.
       06 = Medicare blood deductible - Total
            cash blood deductible (Part A blood
            deductible).
       07 = Medicare cash deductible (term 9/30/93)
            Reserved for national assignment.
       08 = Medicare Part A lifetime reserve amount
            in first calendar year - Lifetime reserve
            amount charged in the year of admission.
            (not stored in NCH until 2/93)
       09 = Medicare Part A coinsurance amount in
            the first calendar year - Coinsurance
            amount charged in the year of admission.
            (not stored in NCH until 2/93)
       10 = Medicare Part A lifetime reserve amount
            in the second calendar year - Lifetime
            reserve amount charged in the year of
            discharge where the bill spans two
            calendar years.
            (in NCH until 2/93)
       11 = Medicare Part A coinsurance amount in
            the second calendar year - Coinsurance
            amount charged in the year of discharge
            where the bill spans two calendar years
            (not stored in NCH until 2/93)
       12 = Amount is that portion of
            higher priority EGHP insurance payment
            made on behalf of aged bene
            provider applied to Medicare
            covered services on this bill.
            Six zeroes indicate provider
            claimed conditional Medicare payment.
       13 = Amount is that portion of higher
            priority EGHP insurance payment made on
            behalf of ESRD bene provider
            applied to Medicare covered services
            on this bill. Six zeroes indicate
            the provider claimed conditional
            Medicare payment.
       14 = That portion of payment from higher
            priority no fault auto/other
            liability insurance made on behalf of bene
            provider applied to Medicare covered
            services on this bill. Six zeroes indicate
            provider claimed conditional payment
       15 = That portion of a payment from a
            higher priority WC plan made on behalf
            of a bene that the provider applied to
            Medicare covered services on this bill. Six
            zeroes indicate the provider claimed
            conditional Medicare payment.
       16 = That portion of a payment from
            higher priority PHS or other federal
            agency made on behalf of a
            bene the provider applied
            to Medicare covered services on this
            bill. Six zeroes indicate
            provider claimed conditional Medicare
            payment.
       17 = Operating Outlier amount - Providers do
            not report this.  For payer internal use
            only.  Indicates the amount of day or
            cost outlier payment to be made.
            (Do not include any PPS capital outlier
            payment in this entry). Obsolete
       18 = Operating Disproportionate share amount -
            Providers do not report this.  For
            payer internal use only.  Indicates the
            disproportionate share amount applicable
            to the bill.  Use the amount provided by
            the disproportionate share field in PRICER.
            (Do not include any PPS capital DSH adjust-
            ment in this entry).  Obsolete
       19 = Operating Indirect medical education amount -
            Providers do not report this.  For
            payer internal use only.  Indicates the
            indirect medical education amount applicable
            to the bill.  (Do not include PPS capital
            IME adjustment in this entry). Obsolete
       20 = Total payment sent provider for capital
            under PPS, including HSP, FSP, outlier,
            old capital, DSH adjustment, IME
            adjustment, and any exception amount.
            (used 10/1/91 - 3/1/92 for provider
            reporting.  Payer only code eff 9/93.)
            Obsolete
       21 = Catastrophic - Medicaid - Eligibility
            requirements to be determined at state
            level.  (Medicaid specific/deleted 9/93)
       22 = Surplus - Medicaid - Eligibility
            requirements to be determined at state
            level. (Medicaid specific/deleted 9/93)
       23 = Recurring monthly income - Medicaid -
            Eligibility requirements to be
            determined at state level. (Medicaid
            specific/deleted 9/93)
       24 = Medicaid rate code - Medicaid -
            Eligibility requirements to be
            determined at state level. (Medicaid
            specific/deleted 9/93)
       25 = Offset to the Patient Payment Amount
            (Prescription Drugs) - Prescription
            drugs paid for out of a long-term
            care facility resident/patient's fund
            in the billing period submitted (State-
            ment Covers Period).
       26 - Prescription Drugs Offset to Patient
            (Payment Amount - Hearing and Ear Services)
            Hearing and ear services paid for out of
            a long term care facility resident/patient's
            funds in the billing period submitted
            (Statement covers period).
       27 = Offset to the Patient (Payment Amount - Vision
            and Eye Services) - Vision and eye services paid
            for out of a long term care facility resident/
            patient's funds in the billing period submitted
            (Statement Covers Period).
       28 = Offset to the Patient (Payment Amount - Dental
            Services) - Dental services paid for out of a
            long term care facility resident/patient's funds
            in the billing period submitted (Statement
            Covers Period).
       29 = Offset to the Patient (Payment Amount - Chiro-
            practic Services) - Chiropratic services paid
            for out of a long term care facility resident/
            patient's funds in the billing period submitted
            (Statement Covers Period).
       30 = Preadmission Testing - the code used to reflect
            the charges for preadmission outpatient diag-
            nostic services in preparation for a previously
            scheduled admission.
       31 = Patient liability amount - Amount
            shown is that which you or the PRO
            approved to charge the bene for
            noncovered accommodations, diagnostic
            procedures or treatments.
       32 = Multiple patient ambulance transport -
            The number of patients transported during
            one ambulance ride to the same destination.
            (eff. 4/1/2003)
       33 = Offset to the Patient Payment Amount (Podiatric
            Services) -- Podiatric services paid out of
            a long-term care facility resident/patient's
            funds in the billing period submitted.
       34 = Offset to the Patient Payment Amount (Medical
            Services) -- Other medical services paid out of
            a long-term care facility resident/patient's
            funds in the billing period submitted.
       35 = Offset to the Patient Payment Amount (Health
            Insurance Premiums) -- Other medical services
            paid out of a long-term care facility resident/
            patient's funds in the billing period submitted.
       37 = Pints of blood furnished - Total
            number of pints of whole blood or units
            of packed red cells furnished to the
            patient. (eff 10/93)
       38 = Blood deductible pints - The number
            of unreplaced pints of whole blood or
            units of packed red cells furnished for
            which the patient is responsible.
            (eff 10/93)
       39 = Pints of blood replaced - The total
            number of pints of whole blood or units
            of packed red cells furnished to the
            patient that have been replaced by or
            on behalf of the patient. (eff 10/93)
       40 = New coverage not implemented by HMO -
            amount shown is for inpatient charges
            covered by HMO (eff 3/92).
            (use this code when the bill includes
            inpatient charges for newly covered
            services which are not paid by HMO.)
       41 = Amount is that portion of
            a payment from higher priority Black Lung
            federal program made on behalf of
            bene the provider applied
            to Medicare covered services on this
            bill. Six zeroes indicate the
            provider claimed conditional Medicare
            payment.
       42 = Amount is that portion of a payment
            from higher priority VA made on behalf
            of bene the provider applied
            to Medicare covered services on this
            bill. Six zeroes indicate the
            provider claimed conditional Medicare
            payment.
       43 = Disabled bene under age 65 with
            LGHP - Amount is that portion of
            a payment from a higher priority LGHP
            made on behalf of a disabled Medicare
            bene the provider applied to
            Medicare covered services on this bill.
       44 = Amount provider agreed to accept from
            primary payer when amount less than charges
            but more than payment received -
            When a lesser amount is received and the
            received amount is less than charges, a
            Medicare secondary payment is due.
       45 = Accident Hour - The hour the accident occurred
            that necessitated medical treatment.
       46 = Number of grace days - Following the
            date of the PRO/UR determination, this
            is the number of days determined by the
            PRO/UR to be necessary to arrange for
            the patient's post-discharge care.
            (eff 10/93)
       47 = Any liability insurance - Amount
            is that portion from a higher priority
            liability insurance made on behalf of
            Medicare bene the provider
            is applying to Medicare covered
            services on this bill. (Eff 9/93)
       48 = Hemoglobin reading - The patient's most
            recent hemoglobin reading taken before
            the start of the billing period (eff.
            1/3/2006). Prior to 1/3/2006 defined as
            the latest hemoglobin reading taken during
            the billing cycle.
       49 = Hematocrit reading - The patient's most
            recent hematocrit reading taken before the
            start of the billing period (eff. 1/3/2006).
            Prior to 1/3/2006 defined as hematocrit
            reading taken during the billing cycle.
       50 = Physical therapy visits - Indicates
            the number of physical therapy
            visits from onset (at billing provider)
            through this billing period.
       51 = Occupational therapy visits - Indicates
            the number of occupational therapy
            visits from onset (at the billing
            provider) through this billing period.
       52 = Speech therapy visits - Indicates
            the number of speech therapy
            visits from onset (at billing provider)
            through this billing period.
       53 = Cardiac rehabilitation - Indicates
            the number of cardiac rehabilitation
            visits from onset (at billing
            provider) through this billing period.
       54 = New birth weight in grams - Actual birth
            weight or weight at time of admission for
            an extramural birth.  Required on all claims
            with type of admission of '4' and on other
            claims as required by law.
       55 = Eligibility Threshold for Charity Care - code
            identifies the corresponding value amount at
            which a health care facility determines the
            eligibility threshold of charity care.
       56 = Hours skilled nursing provided - The
            number of hours skilled nursing
            provided during the billing period.  Count
            only hours spent in the home.
       57 = Home health visit hours - The number
            of home health aide services provided
            during the billing period.  Count only
            the hours spent in the home.
       58 = Arterial blood gas - Arterial blood
            gas value at beginning of each reporting
            period for oxygen therapy. This
            value or value 59 will be required on
            the initial bill for oxygen therapy and
            on the fourth month's bill.
       59 = Oxygen saturation - Oxygen saturation
            at the beginning of each reporting
            period for oxygen therapy.  This value or
            value 58 will be required on the
            initial bill for oxygen therapy and on
            the fourth month's bill.
       60 = HHA branch MSA - MSA in which HHA
            branch is located.
       61 = Location of HHA service or hospice
            service - the balanced budget act
            (BBA) requires that the geographic
            location of where the service was
            provided be furnished instead of the
            geographic location of the provider.

            NOTE: HHA claims with a thru date on or
            before 12/31/05, the value code amount
            field reflects the MSA code (followed by zeroes
            to fill the field).  HHA claims with a
            thru date after 12/31/05, the value code
            amount field reflects the CBSA code.

       62 = Number of Part A home health visits
            accrued during a period of continuous
            care - necessitated by the change in
            payment basis under HH PPS (eff. 10/00)
       63 = Number of Part B home health visits
            accrued during a period of continuous
            care - necessitated by the change in
            payment basis under HH PPS (eff. 10/00)
       64 = Amount of home health payments attributed
            to the Part A trust fund in a period
            of continuous care - necessitated by the
            change in payment basis under HH PPS
            (eff. 10/00)
       65 = Amount of home health payments attributed
            to the Part B trust fund in a period
            of continuous care - necessitated by the
            change in payment basis under HH PPS
            (eff. 10/00)
       66 = Medicare Spend-down Amount -- The dollar
            amount that was used to meet th4e recipient's
            spend-down liability for this claim.
       67 = Peritoneal dialysis - The number of
            hours of peritoneal dialysis provided
            during the billing period (only the
            hours spent in the home).
            (eff. 10/97)
       68 = EPO drug - Number of units of EPO
            administered relating to the billing
            period.
       69 = State Charity Care Percent - code
            indicates the percentage of charity
            care eligibility for the patient.
       70 = Interest amount - (Providers do not
            report this.)  Report the amount
            applied to this bill.
       71 = Funding of ESRD networks - (Providers
            do not report this.)  Report the
            amount the Medicare payment was
            reduced to help fund the ESRD networks.
       72 = Flat rate surgery charge - Code
            indicates the amount of the charge for
            outpatient surgery where the hospital
            has such a charging structure.
       73 = Drug deductible - (For internal use by
            third party payers only).  Report the
            amount of the drug deductible to be
            applied to the claim.
       74 = Drug coinsurance - (For internal use
            by third party payers only).  Report
            the amount of drug coinsurance to be
            applied to the claim.
       75 = Gramm/Rudman/Hollings - (Providers do
            not report this.)  Report the amount of
            the sequestration applied to this bill.
       76 = Report provider's percentage of
            billed charges interim rate during
            billing period.  Applies to OP
            hospital, SNF and HHA claims
            where interim rate is applicable.
            Report to left of dollar/cents delimiter.
            (TP payers internal use only)
       77 = New Technology Add-on Payment Amount -
            Amount of payments made for discharges
            involving approved new technologies. If
            the total covered costs of the discharge
            exceed the DRG payment for the case
            (including adjustments for IME and
            disporportionate share hospitals (DSH) but
            excluding outlier payments) an add-on
            amount is made indicating a new technology
            was used in the treatment of the beneficiary.
            (eff. 4/1/03, under Inpatient PPS)
       78 = Payer code - This codes is set
            aside for payer use only.  Providers
            do not report these codes.
       79 = Payer code - This code is set
            aside for payer use only.  Providers
            do not report these codes.
       80 = Covered days - the number of days covered by the
            primary payer as qualified by the payer.
       81 = Non-covered Days - days of care not covered
            by the primary payer.
       82 = Co-insurance Days - The inpatient Medicare days
            occurring after the 60th day and before the
            91st day or inpatient SNF/Swing bed days
            occurring after the 20th and before the 101st
            day in a single spell of illness.
       83 = Lifetime Reserve Days - Under Medicare, each
            beneficiary has a lifetime reserve of 60
            additional days of inpatient hospital services
            after using 90 days of inpatient hospital
            services during a spell of illness.
       84 = Medicare Lifetime Reserve Amount in the third
           or greater calendar years'.  Eff. 1/7/2013
       85 = Medicare Coinsurance Amount in the third
            or greater calendar years'.  Eff. 1/7/2013
       86 = Invoice Cost (term. 3/2020)
       87 = Gene Therapy Invoice Cost (eff. 4/2020)
       88 = Allogeneic Stem Cell Transplant - Number of Related
            Donors Evaluation (eff. 7/2020)
       89 = Allogeneic Stem Cell Transplant - Total All-
            inclusive Donor Charges (eff. 7/2020)
       90 = Cell Therapy Invoice Cost (eff. 4/2020)
       91 - 99 = Reserved for national assignment.
       A0 = Special Zip Code Reporting - five digit
            zip code of the location from which the
            beneficiary is initially placed on board
            the ambulance. (eff. 9/01)
       A1 = Deductible Payer A - The amount assumed by
            the provider to be applied to the patient's
            deductible amount to the invovling the
            indicated payer. (eff. 10/93)
            - Prior value 07
       A2 = Coinsurance Payer A - The amount assumed
            by the provider to be applied to the
            patient's Part B coinsurance amount
            involving the indicated payer. (eff 10/93)
       A3 = Estimated Responsibility Payer A - The amount
            estimated by the provider to be paid by the
            indicated payer.
       A4 = Self-administered drugs administered in an
            emergency situation - Ordinarily the only
            noncovered self-administered drug
            paid for under Medicare in an emergency
            situation is insulin administered to a
            patient in a diabetic coma. (eff 7/97)
       A5 = Covered self-administered drugs -- The amount
            included in covered charges for self-admini-
            strable drugs administered  to the patient be-
            cause the drug was not self-administered  in the
            form and situation in which it was furnished to
            the patient.
       A6 = Covered self-administered drugs -Diagnostic
            study and Other --- the amount included in
            covered charges for self-administrable drugs
            administered to the patient because the drug
            was necessary for diagnostic study or other
            reasons.  For use with Revenue Center 0637.
       A7 = Copayment A -- The amount assumed by the pro-
            vider to be applied toward the patient's co-
            payment amount involving the indicated payer.
       A8 = Patient Weight -- Weight of patient in kilograms.
            Report this data only when the health plan has
            a predefined change in reimbursement that is
            affected by weight.
       A9 = Patient Height - Height of patient in centimeters
            Report this data only when the health plan has
            a predefined change in reimbursement that is
            affected by height.
       AA = Regulatory Surcharges, Assessments, Allowances
            or Health Care Related Taxes (Payer A) -- The
            amount of regulatory surcharges, assessments,
            allowances or health care related taxes per-
            taining to the indicated payer (eff. 10/2003).
       AB = Other Assessments or Allowances (Payer A) --
            The amount of other assessments or allowances
            pertaining to the indicated payer. (eff. 10/2003).
       B1 = Deductible Payer B - The amount
            assumed by the provider to be applied
            to the patient's deductible amount
            involving the indicated payer. (eff 10/93)
            - Prior value 07
       B2 = Coinsurance Payer B - the amount assumed
            by the provider to be applied to the
            patient's Part B coinsurance amount
            involving the indicated payer. (eff 10/93)
       B3 = Estimated Responsibility Payer B - The
            amount estimated by the provider to be
            paid by the indicated payer.
       B7 = Copayment B -- The amount assumed by the pro-
            vider to be applied toward the patient's co-
            payment amount involving the indicated payer.
       BA = Regulatory Surcharges, Assessments, Allowances
            or Health Care Related Taxes (Payer B) -- The
            amount of regulatory surcharges, assessments,
            allowances or health care related taxes per-
            taining to the indicated payer (eff. 10/2003).
       BB = Other Assessments or Allowances (Payer B) --
            The amount of other assessments or allowances
            pertaining to the indicated payer. (eff. 10/2003).
       C1 = Deductible Payer C - The amount
            assumed by the provider to be applied
            to the patient's deductible amount
            involving the indicated payer. (eff 10/93)
            - Prior value 07
       C2 = Coinsurance Payer C - The amount assumed
            by the provider to be applied to the
            patient's Part B coinsurance amount
            involving the indicated payer. (eff 10/93)
       C3 = Estimated Responsibility Payer C - The
       C7 = Copayment C -- The amount assumed by the pro-
            vider to be applied toward the patient's co-
            payment amount involving the indicated payer.
       CA = Regulatory Surcharges, Assessments, Allowances
            or Health Care Related Taxes (Payer C) -- The
            amount of regulatory surcharges, assessments,
            allowances or health care related taxes per-
            taining to the indicated payer (eff. 10/2003).
       CB = Other Assessments or Allowances (Payer C) --
            The amount of other assessments or allowances
            pertaining to the indicated payer. (eff. 10/2003).
       D3 = Estimated Responsibility Patient - The
            amount estimated by the provider to be
            paid by the indicated patient.
       D4 = Clinical Trial Number Assigned by NLM/NIH -
            Eight digit numeric National Library of
            Medicine/National Institute of Health clinical
            trial registry number or a default number of
            '99999999' if the trial does not have an
            8-digit registry number. (Eff. 10/1/07)
       D5 = Last Kt/V Reading - result of last Kt/V
            reading.  For in-center hemodialysis patients,
            this is the last reading taken during the
            billing period.   For peritoneal dialysis
            patients (and home hemodialysis patients), this
            may be before the current billing period but
            should be within 4 months of the date of
            service. (eff. 7/1/10)
       FC = Patient Paid Amount - The amount the provider
            has received from the patient toward payment
            of this bill (7/1/08).
       FD = Credit Received from the Manufacturer for a
            Replaced Medical Device - the amount the
            provider has received from a medical device
            manufacturer as credit for a replaced device.
            (eff. 7/1/08)
       G8 = Facility Where Inpatient Hospice Service Is
            Delivered - MSA or Core Based Statistical Area
            (CBSA) number (or rural state code) of the
            facility where inpatient hospice is delivered.
            (Eff. 1/1/08)
       Q0 = ACO Payment Adjustment Amount (Pioneer Reduction)-
            the amount that would have been paid if not for
            the Pioneer reduction. (eff. 1/2014)
       Q1 = ACO Payment Reduction Amount (Pioneer Reduction)-
            the actual amount of the Pioneer reduction.
            (eff. 1/2014)
       Q4 = Pennsylvania (PA) Rural Health Exclusion - Physician
            Services Claim Reimbursement
       Q5 = EHR Reduction
       Q7 = ISLET Add-On Payment Amount (eff. 10/2016)
       Q8 = Total Transitional Drug Add-On Payment Adjustment
            (TDAPA) Amount  (eff. 1/2018)
       Q9 = Medicare Advantage (MA) Plan Amount (eff. 10/2014)
       QB = OCM+ Payment Adjustment Amount (payer only)
            (eff. 1/2020)
       QN = First APC device offset
       QO = Second APC device offset
       QP = Placeholder reserved for future use
       QQ = Terminated procedure with pass-through device OR
            condition for device credit present
       QR = First APC pass-through drug or biological offset
       QS = Second APC pass-through drug or biological offset
       QT = Third APC pass-through drug or biological offset
       QU = Reserved for future use
       QV = Home Health Value Based Purchasing (HHVBP) adjustment
            amount (negative or positive) - eff. 4/2018
       QW = Reserved for future use
       XX = Total Charge Amount for all Part A visits
            on RIC 'U' claims - for Home Health claims
            containing both Part A and Part B services
            this code identifies the total charge amount
            for the Part A visits (based on revenue
            center codes 042X, 043X, 044X, 055X, 056X,
            & 057X).  Code created internally in the
            CWFMQA system (eff. 10/31/01 with HHPPS).
       XY = Total Charge Amount for all Part B visits
            on RIC 'U' claims - for Home Health claims
            containing both Part A and Part B services
            this code identifies the total charge amount
            for the Part B visits (based on revenue
            center codes 042X, 043X, 044X, 055X, 056X,
            & 057X).  Code created internally in the
            CWFMQA system (eff. 10/31/01 with HHPPS).
       XZ = Total Charge Amount for all Part B non-
            visit charges on the RIC 'U' claims - for
            Home Health claims containing both Part A
            & Part B services, this code identifies the
            total charge amount for the Part B non-visit
            charges.  Code created internally in the
            CWFMQA system (eff. 10/31/01 with HHPPS).
       Y1 = Part A demo payment - Portion of the
            payment designated as reimbursement for
            Part A services under the demonstration.
            This amount is instead of the traditional
            prospective DRG payment (operating and
            capital) as well as any outlier payments
            that might have been applicable in the
            absence of the demonstration.  No deductible
            or coinsurance has been applied. Payments
            for operating IME and DSH which are pro-
            cessed in the traditional manner are also
            not included in this amount.

       Y2 = Part B demo payment - Portion of the
            payment designated as reimbursement for
            Part B services under the demonstration.
            No deductible or coinsurance has been
            applied.
       Y3 = Part B coinsurance - Amount of Part B
            coinsurance applied by the intermediary
            to this demo claim. For demonstration
            claims this will be a fixed copayment
            unique to each hospital and DRG (or
            DRG/procedure group).
       Y4 = Conventional Provider Payment Amount
            for Non-Demonstration Claims - This
            the amount Medicare would have reim-
            bursed the provider for Part A services
            if there had been no demonstration.  This
            should include the prospective DRG payment
            (both capital as well as operational) as
            well as any outlier payment, which would be
            applicable.  It does not include any pass
            through amounts such as that for direct
            medical education nor interim payments for
            operating IME and DSH.
       Y5 = Part B deductible, applicable for a Model 4
            demonstration 64 claims



 CLM_WC_IND_TB                           Workers' Compensation Indicator Table

      Y = The diagnosis codes on the claims are related to the diagnosis
          codes on the MSP auxiliary file in CWF.

      Spaces



 CMS_PRVDR_SPCLTY_TB                     CMS Provider Specialty Table


      00 = Carrier wide
      01 = General practice
      02 = General surgery
      03 = Allergy/immunology
      04 = Otolaryngology
      05 = Anesthesiology
      06 = Cardiology
      07 = Dermatology
      08 = Family practice
      09 = Interventional Pain Management (IPM) (eff. 4/1/03)
      09 = Gynecology (osteopaths only)
           (discontinued 5/92 use code 16)
      10 = Gastroenterology
      11 = Internal medicine
      12 = Osteopathic manipulative therapy
      13 = Neurology
      14 = Neurosurgery
      15 = Speech Language Pathologists
      15 = Obstetrics (osteopaths only)
           (discontinued 5/92 use code 16)
      16 = Obstetrics/gynecology
      17 = Hospice and Palliative Care
      17 = Ophthalmology, otology, laryngology,
           rhinology (osteopaths only)
           (discontinued 5/92 use codes 18 or 04
           depending on percentage of practice)
      18 = Ophthalmology
      19 = Oral surgery (dentists only)
      20 = Orthopedic surgery
      21 = Cardiac Electrophysiology
      21 = Pathologic anatomy, clinical
           pathology (osteopaths only)
           (discontinued 5/92 use code 22)
      22 = Pathology
      23 = Sports medicine
      23 = Peripheral vascular disease, medical
           or surgical (osteopaths only)
           (discontinued 5/92 use code 76)
      24 = Plastic and reconstructive surgery
      25 = Physical medicine and rehabilitation
      26 = Psychiatry
      27 = Geriatric Psychiatry Colorectal Surgery
      27 = Psychiatry, neurology (osteopaths
           only) (discontinued 5/92 use code 86)
      28 = Colorectal surgery (formerly
           proctology)
      29 = Pulmonary disease
      30 = Diagnostic radiology
      31 = Intensive Cardiac Rehabilitation
      31 = Roentgenology, radiology (osteopaths
           only) (discontinued 5/92 use code 30)
      32 = Anesthesiologist Assistants (eff. 4/1/03--previously
           grouped with Certified Registered Nurse Anesthetists
           (CRNA))
      32 = Radiation therapy (osteopaths only)
           (discontinued 5/92 use code 92)
      33 = Thoracic surgery
      34 = Urology
      35 = Chiropractic
      36 = Nuclear medicine
      37 = Pediatric medicine
      38 = Geriatric medicine
      39 = Nephrology
      40 = Hand surgery
      41 = Optometry (revised 10/93 to
           mean optometrist)
      42 = Certified nurse midwife (eff 1/87)
      43 = CRNA (eff. 1/87) (Anesthesiologist Assistants
           were removed from this specialty 4/1/03)
      44 = Infectious disease
      45 = Mammography screening center
      46 = Endocrinology (eff 5/92)
      47 = Independent Diagnostic Testing Facility
           (IDTF) (eff. 6/98)
      48 = Podiatry
      49 = Ambulatory surgical center
           (formerly miscellaneous)
      50 = Nurse practitioner
      51 = Medical supply company with
           certified orthotist (certified by
           American Board for Certification in
           Prosthetics And Orthotics)
      52 = Medical supply company with
           certified prosthetist
           (certified by American Board for
           Certification In Prosthetics And
           Orthotics)
      53 = Medical supply company with
           certified prosthetist-orthotist
           (certified by American Board for
           Certification in Prosthetics
           and Orthotics)
      54 = Medical supply company not included
           in 51, 52, or 53.  (Revised 10/93
           to mean medical supply company for DMERC)
      55 = Individual certified orthotist
      56 = Individual certified prosthetist
      57 = Individual certified prosthetist-orthotist
      58 = Individuals not included in 55, 56, or 57,
           (revised 10/93  to mean medical supply company
           with registered pharmacist)
      59 = Ambulance service supplier, e.g.,
           private ambulance companies, funeral homes, etc.
      60 = Public health or welfare agencies
           (federal, state, and local)
      61 = Voluntary health or charitable agencies (e.g.
           National Cancer Society, National Heart
           Association, Catholic Charities)
      62 = Psychologist (billing independently)
      63 = Portable X-ray supplier
      64 = Audiologist (billing independently)
      65 = Physical therapist (private practice added 4/1/03)
           (independently practicing removed 4/1/03)
      66 = Rheumatology (eff 5/92)
           Note: during 93/94 DMERC also used this to mean
           medical supply company with
           respiratory therapist
      67 = Occupational therapist (private practice added 4/1/03)
           (independently practicing removed 4/1/03)
      68 = Clinical psychologist
      69 = Clinical laboratory (billing independently)
      70 = Multispecialty clinic or group practice
      71 = Registered Dietician/Nutrition Professional (eff. 1/1/02)
      72 = Pain Management (eff. 1/1/02)
      73 = Mass Immunization Roster Biller (eff. 4/1/03)
      74 = Radiation Therapy Centers (added to differentiate
           them from Independent Diagnostic Testing Facilities
           (IDTF --eff. 4/1/03)
      74 = Occupational therapy (GPPP)
           (not to be assigned after 5/92)
      75 = Slide Preparation Facilities (added to differentiate
           them from Independent Diagnostic Testing Facilites
           (IDTFs -- eff. 4/1/03)
      75 = Other medical care (GPPP) (not to
           assigned after 5/92)
      76 = Peripheral vascular disease
           (eff 5/92)
      77 = Vascular surgery (eff 5/92)
      78 = Cardiac surgery (eff 5/92)
      79 = Addiction medicine (eff 5/92)
      80 = Licensed clinical social worker
      81 = Critical care (intensivists)
           (eff 5/92)
      82 = Hematology (eff 5/92)
      83 = Hematology/oncology (eff 5/92)
      84 = Preventive medicine (eff 5/92)
      85 = Maxillofacial surgery (eff 5/92)
      86 = Neuropsychiatry (eff 5/92)
      87 = All other suppliers (e.g. drug and
           department stores) (note: DMERC used
           87 to mean department store from 10/93
           through 9/94; recoded eff 10/94 to A7;
           NCH cross-walked DMERC reported 87 to A7.
      88 = Unknown supplier/provider specialty
           (note: DMERC used 87 to mean grocery
           store from 10/93 - 9/94; recoded eff
           10/94 to A8; NCH cross-walked DMERC
           reported 88 to A8.
      89 = Certified clinical nurse specialist
      90 = Medical oncology (eff 5/92)
      91 = Surgical oncology (eff 5/92)
      92 = Radiation oncology (eff 5/92)
      93 = Emergency medicine (eff 5/92)
      94 = Interventional radiology (eff 5/92)
      95 = Competative Acquisition Program (CAP)
           Vendor (eff. 07/01/06). Prior to
           07/01/06, known as Independent
           physiological laboratory (eff. 5/92)
      96 = Optician (eff 10/93)
      97 = Physician assistant (eff 5/92)
      98 = Gynecologist/oncologist (eff 10/94)
      99 = Unknown physician specialty
      A0 = Hospital (eff 10/93) (DMERCs only)
      A1 = SNF (eff 10/93) (DMERCs only)
      A2 = Intermediate care nursing facility
           (eff 10/93) (DMERCs only)
      A3 = Nursing facility, other (eff 10/93)
           (DMERCs only)
      A4 = HHA (eff 10/93) (DMERCs only)
      A5 = Pharmacy (eff 10/93) (DMERCs only)
      A6 = Medical supply company with respiratory
           therapist (eff 10/93) (DMERCs only)
      A7 = Department store (for DMERC use:
           eff 10/94, but cross-walked from
           code 87 eff 10/93)
      A8 = Grocery store (for DMERC use:
           eff 10/94, but cross-walked from
           code 88 eff 10/93)
      A9 = Indian Health Service (IHS), tribe and
           tribal organizations (non-hospital or
           non-hospital based facilities.  DMERCs shall
           process claims submitted by IHS, tribe and
           non-tribal organizations for DMEPOS and drugs
           covered by the DMERCs. (eff. 1/2005)
      B1 = Supplier of oxygen and/or oxygen related
           equipment (eff. 10/2/07)
      B2 = Pedorthic Personnel (eff. 10/2/07)
      B3 = Medical Supply Company with Pedorthic Personnel
           (eff. 10/2/07)
      B4 = Rehabilitation Agency (eff. 10/2/07)
      B5 = Ocularist
      C0 = Sleep medicine
      C1 = Centralized Flu
      C4 = Non-Provider Convener Participants in the BPCI Advanced
           Model (eff. 7/2019)
      C5 = Dentist (eff. 7/2016)
      D5 = Opiod Treatment Progrm (eff. 1/2020)



 CTGRY_EQTBL_BENE_IDENT_TB               Category Equatable Beneficiary Identification Code (BIC) Table

       NCH BIC              SSA Categories
       -------              --------------

       A  = A;J1;J2;J3;J4;M;M1;T;TA
       B  = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6;
            TB(F);TD(F);TE(F);TW(F)
       B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M)
            TD(M);TE(M);TW(M)
       B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2
            W7;TG(F);TL(F);TR(F);TX(F)
       B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M)
            TL(M);TR(M);TX(M)
       B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4
            W8;TH(F);TM(F);TS(F);TY(F)
       BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9
            WC;TJ(F);TN(F);TT(F);TZ(F)
       BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF
            WJ;TK(F);TP(F);TU(F);TV(F)
       BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M)
            TY(M)
       BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M)
            TZ(M)
       BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M)
            TV(M)
       C1 = C1;TC
       C2 = C2;T2
       C3 = C3;T3
       C4 = C4;T4
       C5 = C5;T5
       C6 = C6;T6
       C7 = C7;T7
       C8 = C8;T8
       C9 = C9;T9
       F1 = F1;TF
       F2 = F2;TQ
       F3-F8 = Equatable only to itself (e.g., F3 IS
               equatable to F3)
       CA-CZ = Equatable only to itself.  (e.g., CA is
               only equatable to CA)

            ---------------------------------------
                       RRB Categories

       10 = 10
       11 = 11
       13 = 13;17
       14 = 14;16
       15 = 15
       43 = 43
       45 = 45
       46 = 46
       80 = 80
       83 = 83
       84 = 84;86
       85 = 85



 END_REC_TB                              End of Record Code Table

      EOR = End of record/segment
      EOC = End of claim



 FI_CLM_ACTN_TB                          Fiscal Intermediary Claim Action Table

      1 = Original debit action (includes non-
          adjustment RTI correction items) - it
          will always be a 1 in regular bills.
      2 = Cancel by credit adjustment - used
          only in credit/debit pairs (under HHPPS,
          updates the RAP).
      3 = Secondary debit adjustment - used only
          in credit/debit pairs (under HHPPS, would
          be the final claim or an adjustment on
          a LUPA).
      4 = Cancel only adjustment (under HHPPS,
          RAP/final claim/LUPA).
      5 = Force action code 3
      6 = Force action code 2
      8 = Benefits refused (for inpatient bills,
          an 'R' nonpayment code must also be
          present
      9 = Payment requested (used on bills that
          replace previously-submitted benefits-
          refused bills, action code 8.  In such
          cases a debit/credit pair is not re-
          quired.  For inpatient bills, a 'P'
          should be entered in the nonpayment
          code.)



 FI_NUM_TB                               Fiscal Intermediary Number / Medicare Administrative Contractor Table

       00010 = Alabama BC - Alabama (term. 05/2009)
               (replaced with MAC #10101 -- see below)
       00011 = Alabama BC - Iowa (term. 10/2007)
               replaced by MAC # 03401 -- see below)
       00011 = Cahaba - (RHHI) (term. 06/2011)
               replaced by MAC # 03401  -- see below)
       00012 = Iowa  (terminated)
               replaced by MAC # 05101 -- see below)
       00012 = Arizona - Noridian - J3 A MAC (AZA)
               (term. 05/2008)
       00020 = Arkansas BC - Arkansas
       00021 = Arkansas BC - Rhode Island
               (term. 05/2009)
       00030 = Arizona BC (term. 09/2007)
               (replaced by MAC # 03101 -- see below)
       00040 = California BC (term. 11/2000)
       00041 = California - Oakland BC (terminated)
       00050 = New Mexico BC/CO (term. 06/89)
       00050 = Colorado BC (terminated)
       00060 = Connecticut BC (term. 06/99)
       00070 = Delaware BC - (term. 02/98)
       00080 = Florida BC (term. 03/88)
       00080 = District of Columbia BC (terminated)
       00090 = Florida BC (term. 02/2009)
               (replaced with MAC #09101 -- see below)

       00100 = Georgia - Atlantic BC (terminated)
       00101 = Georgia BC (term. 05/2009)
               (replaced with MAC #10201 -- see below)
       00110 = Idaho BC (terminated)
       00121 = Illinois - HCSC (term. 08/98)
       00122 = Illinois - BC (terminated)
       00123 = Michigan - HCSC (term. 08/98)
       00130 = Indiana BC/Administar Federal (term. 7/22/2012)
               (replaced with MAC # 08101 -- see below)
       00131 = Illinois - Anthem
       00140 = Iowa - Wellmark (term. 05/2000)
       00141 = Iowa - Souix City BC (terminated)
       00150 = Kansas BC (term. 02/2008)
               (replaced with MAC # 05201 -- see below)
       00160 = Kentucky - Anthem (term. 4/30/2011)
               (replaced with MAC # 15101 -- see below)
       00170 = Louisiana - Baton Rouge BC (terminated)
       00171 = Louisiana - New Orleans BC (terminated)
       00180 = Maine BC  (term. 05/2009)
               (replaced with MAC #14004 & 14101  -- see below)
       00180 = Connecticut, Maine, Massachusetts,
               New Hampshire, Rhode Island (Maine RHHI)
               (term. 05/2009)
               (replaced with MAC #14004 & 14101  -- see below)
       00181 = Massachusetts - Maine BC (term. 05/2009)
       00190 = Carefirst of Maryland (term. 09/2005)
       00191 = District of Columbia - Maryland BC (terminated)

       00200 = Massachusetts BC (term. 7/97)
       00210 = Michigan BC (term. 9/94)
       00220 = Minnesota BC (term. 07/99)
       00230 = Mississippi BC
       00230 = Trispan Health Services (LA-MS) (term. 09/2009)
               (previously also MOA)
       00231 = Mississippi BC - Louisiana (term. 09/1992)
       00232 = Mississippi BC
       00233 = Louisiana, Mississippi (J7 Interim)
               (eff 10/01/2009)
       00234 = PBSI J7 A TEMP ROLLUP AK,LA,MS
               (terminated)
       00240 = Kansas City BC - Missouri (terminated)
       00241 = Missouri BC (term. 9/92)
       00242 = Missouri (terminated)
               (replaced with MAC # 05301 --see below)
       00242 = BCBS of MS (MOA) (term. 04/2008)
               (replaced with MAC # 05301 --see below)
       00250 = Montana BC (term. 11/2006)
               (replaced by MAC # 03201 -- see below)
       00260 = Nebraska BC (term. 11/2007)
               (replaced with MAC # 05401 --see below)
       00270 = New Hampshire BC - New Hampshire, Vermont
               (term. 06/2009)
               (replaced with MAC #14501 -- see below)
       00280 = New Jersey BC (term. 07/2000)
       00290 = New Mexico BC - (term. 11/1995)
       00291 = New Mexico BC - Colorado (terminated)

       00300 = New York - Albany BC (terminated)
       00301 = New York - Buffalo BC (terminated)
       00302 = New York - Jamestown BC (terminated)
       00303 = New York - New York City BC (terminated)
       00304 = New York - Rochester BC (terminated)
       00305 = New York - Syracuse BC (terminated)
       00306 = New York - Utica BC (terminated)
       00307 = New York - Watertown BC (terminated)
       00308 = Empire BC - New York, Connecticut, Delaware
               (term. 11/2008)
               (replaced with MAC # 12101, 13201 & 13101 -- see below)
       00310 = North Carolina BC (term. 09/2002)
       00312 (terminated)
       00320 = North Dakota BC - North Dakota (term. 12/1/2006)
               (replaced with MAC # 03301 -- see
               below)
       00322 = North Dakota BC - Washington & Alaska
       00323 = North Dakota BC - Idaho, Oregon & Utah
               (term. 11/2006)
               (replaced with MAC # 03501 --see below)
       00325 = Noridian - Idaho, Oregon
       00326 = J2 Rollup (Merge into a single CICS region)
               (temporary)  (terminated)
       00330   NA (terminated)
       00331 = Canton BC - Ohio (terminated)
       00332 = Administar - Ohio
               Anthem - Ohio
       00333 = Cleveland BC - Ohio (terminated)
               Ohio-Administar
       00334 = Columbus BC - Ohio (terminated)
       00335 = Lima BC - Ohio (terminated)
       00337 = Toledo BC - Ohio (terminated)
       00338 = Youngstown BC - Ohio (terminated)
       00340 = Oklahoma BC (term. 02/2008)
               (replaced with MAC # 04301 -- see below)
       00350 = Regence - Oregon, Idaho, Utah
               (term. 11/2005)
       00351 = Oregon BC/ID. (term. 09/88)
       00355 = Regence CWF - Oregon (term. 09/2004)
       00360 = Allentown BC - Pennsylvania (terminated)
       00361 = Harrisburg BC - Pennsylvania (terminated)
       00361 = Independence BC - Pennsylvania (terminated)
       00362 = Independence BC - terminated 8/97
       00363 = Pennsylvania/Highmark - Veritus
               (term. 07/2008)
       00364 = Wilkes Barre BC - Pennsylvania (terminated)
       00366 = Highmark (MD & DC) - Part A (eff. 10/2005)
               (term. 07/2008)
       00370 = Rhode Island BC
               (term. 03/2004)
               (replaced with MAC #14401 - see below)
       00380 = South Carolina BC - South Carolina
               (term. 01/2011)
               (replaced with MAC #11004 & 11201 - see below)
       00380 = Palmetto GBA - AL, AR, GA, FL, IL, IN, KY,
               LA, MS, MN, NC, OK, OH, SC, TN, TX
               (term. 01/2011)
       00381   NA (terminated)
       00382 = South Carolina BC - North Carolina
               (term. 10/2010)
               (replaced with MAC #11501 - see below)
       00388 = Palmetto Drugs (terminated)
       00390 = Riverbend BC - New Jersey, Tennessee
               (term. 08/2009)
               (replaced with MAC # 12001 & 10301 -- see below)
       00392 = Memphis BC - Tennessee (terminated)

       00400 = Texas BC - Colorado, New Mexico, Texas
               (term. 05/2008)
               (replaced with MAC #04101, 04201, 04401 -- see below)
       00401   NA (terminated)
       00410 = Utah BC (term. 09/2000)
       00423 = Trigon - Virginia, West Virginia (term. 07/1999)
       00424 = Roanoke BC - Virginia (terminated)
       00425 = Virginia BC - West Virginia (term. 08/1992)
       00430 = Premera BC - Washington, Alaska
               (term. 09/2004)
       00440 = Bluefield BC - West Virginia (terminated)
       00441 = West Virginia BC (term. 11/1990)
       00443 = Parkersburg BC - West Virginia (terminated)
       00444 = Wheeling BC - West Virginia (terminated)
       00450 = Wisconsin BC - Wisconsin
       00450 = Michigan, Minnesota, New Jersey, New York,
               Wisconsin (RHHI)
       00452 = Wisconsin BC - Michigan (term. 7/22/2012)
               (replaced with MAC # 08201 -- see below)
       00453 = Wisconsin BC - Virginia & West Virginia
               (term. 05/2011)
               (replaced with MAC #11301 & 11401 - see below)
       00454 = Wisconsin BC - California, Hawaii, Nevada (RHHI)
               (term. 08/2008)
               (replaced by MAC #01101, 01201 & 01301 -- see below)
       00456 = United Government Services, LLC (CAR)
               (eff 08/15/2008)
       00460 = Wyoming BC
               (term. 10/2006)
               (replaced by MAC # 03601 -- see below)
       00468 = N Carolina BC/CPRTIVA (terminated)
       00470 = Puerto Rico BC (terminated)

       00993 = BC/BS Assoc.
       17120 = Hawaii Medical Service (term. 06/99)
       18390 = Inter-County (terminated)
       19050 = Kaiser Foundation (terminated)
       20330 = New York State Dept of Health (terminated)
       21230 = Community Health Association (term. 05/1969)
       22400 = Puerto Rico - Cooperative De Saluda
               (term. 01/1970)
       50050 = Travelers - Long Beach, California (terminated)
       50051 = Travelers - Los Angeles, California (terminated)
       50052 = Travelers - Pomona, California (terminated)
       50053 = Travelers - San Francisco, California (terminated)
       50070 = Travelers - Hartford, Connecticut (terminated)
       50072 = Travelers - Hamden, Connecticut (terminated)
       50100 = Travelers - Jacksonville, Florida (terminated)
       50101 = Travelers - Miama, Florida (terminated)
       50102 = Travelers - Tampa, Florida (terminated)
       50110 = Travelers - Atlanta, Georgia (terminated)
       50333 = Travelers; Connecticut United Healthcare
               (term. 07/2000)
       50334 = Travelers; Syracuse, New York (terminated)
       50390 = Travelers; Erie, Pennsylvania (terminated)
       50391 = Travelers; Pittsburgh, PA (terminated)
       50392 = Travelers; Wyomissing, PA (terminated)
       50393 = Travelers; Philadelphia, PA (terminated)
       50410 = Travelers; Providence, Rhode Island (terminated)

       51050 = Aetna-Los Angeles - California (terminated)
       51051 = Aetna California - terminated 6/97
       51070 = Aetna Connecticut - terminated 6/97
       51100 = Aetna Florida - terminated 6/97
       51140 = Aetna Illinois - terminated 6/97
       51220 = Aetna-Worcester - Massachusetts
       51290 = Aetna-Reno, Nevada (terminated)
       51390 = Aetna Pennsylvania - terminated 6/97
       51440 = Aetna-Nashville, Tennessee (terminated)
       51441 = Aetna-Memphis, Tennessee (terminated)
       51490 = Aetna-Newport News - Virginia (terminated)
       51500 = Seattle, Washington (terminated)
       52280 = NE - Mutual of Omaha
       53310 = Prudential-New Jersey (terminated)
       56360 = Nationwide-Ohio (terminated)
       57400 = Puerto Rico - Cooperativa (term.02/2009)
               (replaced with MAC # 09201)
       61000 = Aetna (term. 06/97)
       80883 = Contractor ID for Inpatient & Outpatient
               Risk Adjustment Data (data not sent through
               CWF; but through Palmetto)
       99990 = SSA (terminated)

       ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          Medicare Administrative Contractor Numbers

       JURISDICTION 1 - PART A MACs

       01001 = J1 Roll-up
       01101 = California (eff. 8/15/2008)
               (replaces FI #00454)
       01201 = Hawaii (eff. 8/15/2008)
               (replaces FI #00454)
       01301 = Nevada (eff. 8/15/2008)
               (replaces FI #00454)
       01901 = Palmetto GBA J1
               (Mutual of Omaha Legacy)

       JURISDICTION 2 - Part A MACs

       02001 = JF Roll-up(2/3)
       02101 = Alaska (eff 02/01/2012)
       02201 = Idaho (eff 02/01/2012)
       02301 = Oregon (eff 02/01/2012)
       02401 = Washington (eff 02/01/2012)

       JURISDICTION 3 - Part A MACs

       03001 = JF Roll-up(2/3)
               (Orig. J3 term. 09/2007)
       03101 = Arizona (eff. 10/1/2007)
               (replaces FI #00030)
       03201 = Montana (eff. 12/1/2006)
               (replaces FI #00250)
       03301 = N. Dakota (eff. 12/1/2006)
               (replaces FI #00320)
       03401 = S. Dakota (eff. 3/1/2007)
               (replaces FI #00011)
       03501 = Utah  (eff. 12/1/2006)
               (replaces FI #00323)
       03601 = Wyoming (eff. 11/1/2006)
               (replaces FI #00460)

       JURISDICTION 4 - Part A MACs

       04001 = J4 Roll-up
       04101 = Colorado (eff. 6/1/2008) (terminated)
               (replaces FI #00400)
       04201 = New Mexico (eff. 6/16/2008)
               (replaces FI #00400)
       04301 = Oklahoma (eff. 3/1/2008)
               (replaces FI #00340)
       04401 = Texas (eff. 6/16/2008)
               (replaces FI #00400)
       04901 = Trailblazer Health Enterprises
               (Mutual of Omaha Legacy)

       JH Roll-up (4/7)
       04111 = Colorado (eff. 10/29/2012)
               (CR 7812)
       04211 = New Mexico (eff. 10/29/2012)
       04311 = Oklahoma   (eff. 10/29/2012)
       04411 = Texas      (eff. 10/29/2012)
       04911 = WPS (Mutual of Omaha Legacy)
                          (eff. 10/29/2012)

       JURISDICTION 5 - Part A MACs

       05001 = J5 Roll-up
       05101 = Iowa (eff. 5/1/2008)
               (replaces FI #00012)
       05201 = Kansas (eff. 03/01/2008)
               (replaces FI #00150)
       05301 = W. Missouri (eff. 5/1/2008)
               (replaces FI #00242)
       05392 = E. Missouri (eff. 6/1/2008)
       05402 = Nebraska (eff. 12/1/2007)
               (replaces FI #00260)
       05902 = WPS J5 (Mutual of Omaha Legacy)

       06001 = J6 Roll-up
       06004 = (HHH D RHHI)
       06101 = Illinois
       06201 = Minnesota
       06301 = Wisconsin

       07001 = JH Roll-up (4/7)
       07101 = Arkansas (eff. 08/20/2012) (CR7812)
       07201 = Louisiana (eff. 08/20/2012)
       07301 = Mississippi (eff. 08/20/2012)

       JURISDICTION 8 - PART A MACs

       08001 = J8 Roll-up
       08101 = Indiana, WPS J8 (eff. 07/23/2012)
               (replaces FI #00130)
       08201 = Michigan, WPS J8(eff. 07/23/2012)
               (replaces FI #00452)

       JURISDICTION 9 - PART A MACs

       09001 = J9 Roll-up
       09101 = Florida (eff. 2/13/2009)
               (replaces FI #00090)
       09201 = Puerto Rico (eff. 03/02/2009)
               (replaces FI #57400)
       09301 = Virgin Island (eff. 03/02/2009)
               (replaces FI #57400)

       JURISDICTION 10 - PART A MACs

       10001 = J10 Roll-up
       10101 = Alabama (eff. 5/18/2009)
               (replaces FI #00010)
       10201 = Georgia (eff. 05/04/2009)
               (replaces FI #00101)
       10301 = Tennessee (eff. 8/3/2009)
               (replaces FI #00390)

       JURISDICTION 11 - PART A MACs

       11001 = J11 Roll-up
       11003 = J11 Roll-up (Shared CICS Region - 11301 & 11401)
       11004 = Region C (HHH C RHHI) (eff. 1/24/2011)
               (replaces FI #00380)
       11201 = South Carolina (eff. 1/24/2011)
               (replaces FI #00380)
       11301 = Virginia (eff. 5/16/2011)
               (replaces FI #00453)
       11401 = West Virginia (eff. 5/16/2011)
               (replaces FI #00453)
       11501 = North Carolina (eff. 10/01/2010)
               (replaces FI #00390)

       JURISDICTION 12 - PART A MACs

       12001 = J12 Roll-up
       12101 = Delaware (eff. 11/14/2008)
               (replaces FI # 00308)
       12201 = District of Columbia (eff. 08/01/2008)
       12301 = Maryland (eff. 08/01/2008)
       12401 = New Jersey (eff. 9/1/2008)
               (replaces FI # 00390)
       12501 = Pennsylvania (eff. 08/01/2008)
       12901 = Novitas Solutions J12
               (Mutual of Omaha Legacy)

       JURISDICTION 13 - PART A MACs

       13001 = J13 Roll-up
       13101 = Connecticut (eff. 8/1/2008)
               (replaces FI #00308)
       13201 = NGS-New York (eff. 7/18/2008)
               (replaces FI #00308)
       13282 = NGS-New York (eff. 9/1/2008)
               (replaces FI #00308)
       13292 = NGS-New York (eff. 7/18/2008)
               (replaces FI #00308)

       JURISDICTION 14 - PART A MACs

       14001 = J14 Roll-up
       14003 = J11 Roll-up (Shared CICS Region)
       14004 = Region A (HHH A RHHI) (eff.5/15/2009)
               (replaces FI #00180)
       14101 = Maine (eff. 5/15/2009)
               (replaces FI #00180)
       14201 = Massachusetts (eff. 5/15/2009)
               (replaces FI #00181)
       14301 = New Hampshire (eff. 6/15/2009)
               (replaces FI #00270)
       14401 = Rhode Island (eff. 6/1/2009)
               (replaces FI #00370)
       14501 = Vermont (eff. 6/5/2009)
               (replaces FI #00270)

       JURISDICTION 15 - PART A MACs

       15001 = J15 Roll-up
       15004 = CGS Government Services (HHH B RHHI)
               (eff. 06/13/2011)
       15101 = Kentucky (eff. 10/17/2011)
               (replaces FI #00160)
       15201 = Ohio (eff. 10/17/2011)
               (replaces FI #00160)
       52280 = Mutual of Omaha (NT)
               Note: Nebraska - 00260 (NE) & 52280 (NT)



 FI_RQST_CLM_CNCL_RSN_TB                 Claim Cancel Reason Code Table

      C = Coverage Transfer
      D = Duplicate Billing
      H = Other or blank
      L = Combining two beneficiary master records
      P = Plan Transfer
      S = Scramble
      ************For Action Code 4 *******************
      *********Effective with HHPPS - 10/00************
      A = RAP/Final claim/LUPA is cancelled by Interme-
      diary.  Does not delete episode.  Do not set
      cancellation indicator.
      B = RAP/Final claim/LUPA is cancelled by Interme-
      diary.  Does not delete episode.  Set
      cancellation indicator to 1.
      E = RAP/Final claim/LUPA is cancelled by Interme-
      diary.  Remove episode.
      F = RAP/Final claim/LUPA is cancelled by Provider.
      Remove episode.



 GEO_SSA_STATE_TB                        State Table

       01 = Alabama
       02 = Alaska
       03 = Arizona
       04 = Arkansas
       05 = California
       06 = Colorado
       07 = Connecticut
       08 = Delaware
       09 = District of Columbia
       10 = Florida
       11 = Georgia
       12 = Hawaii
       13 = Idaho
       14 = Illinois
       15 = Indiana
       16 = Iowa
       17 = Kansas
       18 = Kentucky
       19 = Louisiana
       20 = Maine
       21 = Maryland
       22 = Massachusetts
       23 = Michigan
       24 = Minnesota
       25 = Mississippi
       26 = Missouri
       27 = Montana
       28 = Nebraska
       29 = Nevada
       30 = New Hampshire
       31 = New Jersey
       32 = New Mexico
       33 = New York
       34 = North Carolina
       35 = North Dakota
       36 = Ohio
       37 = Oklahoma
       38 = Oregon
       39 = Pennsylvania
       40 = Puerto Rico
       41 = Rhode Island
       42 = South Carolina
       43 = South Dakota
       44 = Tennessee
       45 = Texas
       46 = Utah
       47 = Vermont
       48 = Virgin Islands
       49 = Virginia
       50 = Washington
       51 = West Virginia
       52 = Wisconsin
       53 = Wyoming
       54 = Africa
       55 = California
       56 = Canada & Islands
       57 = Central America and West Indies
       58 = Europe
       59 = Mexico
       60 = Oceania
       61 = Philippines
       62 = South America
       63 = U.S. Possessions
       64 = American Samoa
       65 = Guam
       66 = Commonwealth of the Northern Marianas Islands
       67 = Texas
       68 = Florida (eff. 10/2005)
       69 = Florida (eff. 10/2005)
       70 = Kansas (eff. 10/2005)
       71 = Louisiana (eff. 10/2005)
       72 = Ohio (eff. 10/2005)
       73 = Pennsylvania (eff. 10/2005)
       74 = Texas (eff. 10/2005)
       80 = Maryland (eff. 8/2000)
       97 = Northern Marianas
       98 = Guam
       99 = With 000 county code is American Samoa;
            otherwise unknown
       A0 = California (eff. 4/2019)
       A1 = California (eff. 4/2019)
       A2 = Florida (eff. 4/2019)
       A3 = Louisianna (eff. 4/2019)
       A4 = Michigan (eff. 4/2019)
       A5 = Mississippi (eff. 4/2019)
       A6 = Ohio (eff. 4/2019)
       A7 = Pennsylvania (eff. 4/2019)
       A8 = Tennessee (eff. 4/2019)
       A9 = Texas (eff. 4/2019)
       B0 = Kentucky (eff. 4/2020)
       B1 = West Virginia (eff. 4/2020)
       B2 = California (eff. 4/2020)



 MCO_OPTN_TB                             MCO Option Table

      *****For lock-in beneficiaries****
      A = HCFA to process all provider bills
      B = MCO to process only in-plan
      C = MCO to process all Part A and Part B bills

      ***** For non-lock-in beneficiaries*****
      1 = HCFA to process all provider bills
      2 = MCO to process only in-plan Part A and
          Part B bills
      4 = Cost Plan-Chronic Care Organizations (eff. 10/2005)



 NCH_CLM_BIC_MDFY_TB                     NCH Claim BIC Modify H Code Table

      H = BIC submitted by CWF = HA, HB or HC
      blank = No HA, HB or HC BIC present



 NCH_CLM_TYPE_TB                         NCH Claim Type Table

       10 = HHA claim
       20 = Non swing bed SNF claim
       30 = Swing bed SNF claim
       40 = Outpatient claim
       50 = Hospice claim
       60 = Inpatient claim
       61 = Inpatient 'Full-Encounter' claim
       62 = Medicare Advantage IME/GME Claims
       63 = Medicare Advantage (no-pay) claims
       64 = Medicare Advantage (paid as FFS) claims
       71 = RIC O local carrier non-DMEPOS claim
       72 = RIC O local carrier DMEPOS claim
       81 = RIC M DMERC non-DMEPOS claim
       82 = RIC M DMERC DMEPOS claim

      NOTE:  In the data element NCH_CLM_TYPE_CD
      (derivation rules) the numbers for these claim
      types need to be changed - dictionary reflects
      61 for all three.



 NCH_COND_TRLR_IND_TB                    NCH Condition Trailer Indicator Table

      C = Condition code trailer present



 NCH_DEMO_TRLR_IND_TB                    NCH Demonstration Trailer Indicator Table

      D = Demo trailer present



 NCH_DGNS_E_TRLR_IND_TB                  NCH Diagnosis E Trailer Indicator Code Table

      Valid Value:
      W = NCH Diagnosis E Code trailer



 NCH_DGNS_TRLR_IND_TB                    NCH Diagnosis Trailer Indicator Table

      Y = Diagnosis code trailer present



 NCH_EDIT_DISP_TB                        NCH Edit Disposition Table

       00 = No MQA errors
       10 = Possible duplicate
       20 = Utilization error
       30 = Consistency error
       40 = Entitlement error
       50 = Identification error
       60 = Logical duplicate
       70 = Systems duplicate



 NCH_EDIT_TB                             NCH EDIT TABLE

      A0X1 = (C) PHYSICIAN-SUPPLIER ZIP CODE
      A000 = (C) REIMB > $100,000 OR UNITS > 150
      A002 = (C) CLAIM IDENTIFIER (CAN)
      A003 = (C) BENEFICIARY IDENTIFICATION (BIC)
      A004 = (C) PATIENT SURNAME BLANK
      A005 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
      A006 = (C) DATE OF BIRTH IS NOT NUMERIC
      A007 = (C) INVALID GENDER (0, 1, 2)
      A008 = (C) INVALID QUERY-CODE (WAS CORRECTED)
      A009 = (C) TYPE OF BILL RECEIVED IS 41A, 41B, OR 41D
      A010 = (C) DISPOSITION CODE VS. ACTION/ENTRY CODE
      A023 = (C) PORTABLE X-RAY WITHOUT MODIFIER
      A025 = (C) FOR OV 4, TOB MUST = 13,83,85,73
      A031 = (C) HOSPITAL CLAIMS--CLAIM SHOWS SERVICES WERE PAID
                 BY AN HMO AND CODITION CODE '04' IS NOT PRESENT.
                 (TOB '11' & '12')
      A041 = (C) HHA CLAIMS--TOB 32X OR 33X WITH >4 VISITS; DATE
                 OF SERVICE > 9/30/00 AND LUPA IND IS PRESENT.
                 BYPASS FOR NON-PAYMENT CODE B, C, Q, T-Y.
      A1X1 = (C) PERCENT ALLOWED INDICATOR
      A1X2 = (C) DT>97273,DG1=7611,DG<>103,163,1589
      A1X3 = (C) DT>96365,DIAG=V725
      A1X4 = (C) INVALID DIAGNOSTIC CODES
      C050 = (U) HOSPICE - SPELL VALUE INVALID
      D102 = (C) DME DATE OF BIRTH INVALID
      D2X2 = (C) DME SCREEN SAVINGS INVALID
      D2X3 = (C) DME SCREEN RESULT INVALID
      D2X4 = (C) DME DECISION IND INVALID
      D2X5 = (C) DME WAIVER OF PROV LIAB INVALID
      D3X1 = (C) DME NATIONAL DRUG CODE INVALID
      D4X1 = (C) DME BENE RESIDNC STATE CODE INVALID
      D4X2 = (C) DME OUT OF DMERC SERVICE AREA
      D4X3 = (C) DME STATE CODE INVALID
      D5X1 = (C) TOS INVALID FOR DME HCPCS
      D5X2 = (C) DME HCPCS NOC & NOC DESCRIP MISSING
      D5X3 = (C) DME INVALID USE OF MS MODIFIER
      D5X4 = (C) TOS9 NDC REQD WHEN HCPCS OMITTED
      D5X5 = (C) TOS9 NDC REQD FOR Q0127-130 HCPCS
      D5X6 = (C) TOS9 NDC/DIAGNOSIS CODE INVALID
      D5X7 = (C) ANTI-EMETIC/ANTI-CANCER DRUG W/0 CANCER
                 DIAGNOSIS
      D5X8 = (C) TWO ANTI-EMETIC DRUGS PRESENT ON SAME CLAIM
                 WITH IDENTICAL DATES OF SERVICE.
      D6X1 = (C) DME SUPPLIER NUMBER MISSING
      D7X1 = (C) DME PURCHASE ALLOWABLE INVALID
      D919 = (C) CAPPED/PEN PUMPS,NUM OF SRVCS > 1
      D921 = (C) SHOE HCPC W/O MOD RT,LT REQ U=2/4/6
      D922 = (C) THERAPEUTIC SHOE CODES 'A5505-A5501'
                 W/MODIFIER 'LT' OR 'RT' MUST HAVE
                 UNITS = '001'
      XXXX = (D) SYS DUPL: HOST/BATCH/QUERY-CODE
      Y001 = (C) HCPCS R0075/UNITS>1/SERVICES=1
      Y002 = (C) HCPCS R0075/UNITS=1/SERVICES>1
      Y003 = (C) HCPCS R0075/UNITS=SERVICES
      Y010 = (C) TOB=13X/14X AND T.C.>$7,500
      Y011 = (C) INP CLAIM/REIM > $350,000
      Z001 = (C) RVNU 820-859 REQ COND CODE 71-76
      Z002 = (C) CC M2 PRESENT/REIMB > $150,000
      Z003 = (C) CC M2 PRESENT/UNITS > 150
      Z004 = (C) CC M2 PRESENT/UNITS & REIM < MAX
      Z005 = (C) REIMB>99999 AND REIMB<150000
      Z006 = (C) UNITS>99 AND UNITS<150
      Z007 = (C) TOB VS TOTAL CHARGE
      Z008 = (C) TOB VS TOTAL CHARGE W/O 20/21
                 CONDITION CODE
      Z237 = (E) HOSPICE OVERLAP - DATE ZERO
      0011 = (C) ACTION CODE INVALID
      0012 = (C) IME/GME CLAIM -- '04' OR '69'
                 CONDITION CODE
      0013 = (C) CABG/PCOE/MPPD AND INVALID ADMIT DATE
      0014 = (C) DEMO NUM INVALID
      0015 = (C) ESRD PLAN VS DEMO NUM
      0016 = (C) INVALID VA CLAIM
      0017 = (C) DEMO=38 W/O CONTRACTOR #80881/80882
      0018 = (C) DEMO=31,ACT CD<>1/5 OR ENT CD<>1/5
      0019 = (C) DEMO 07/08 WITH CONDITION CODE B1
      0020 = (C) CANCEL ONLY CODE INVALID
      0021 = (C) DEMO COUNT > 1
      0022 = (C) TOB '32X' OR '33X' W/DATES OF SERVICE >9/30/00
                 AND HAS CANCEL ONLY CODE OTHER THAN A,B,E,F
      0023 = (C) DEMO '46' AND HCPCS INCONSISTENT
      0301 = (C) INVALID HI CLAIM NUMBER
      0302 = (C) BENE IDEN CDE (BIC) INVAL OR BLK
      04A1 = (C) PATIENT SURNAME BLANK (PHYS/SUP)
      04B1 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
      0401 = (C) BILL TYPE/PROVIDER INVALID
      0402 = (C) BILL TYPE/REV CODE/PROVR RANGE
      0403 = (C) TOB '41X'/PRVDR # 1990-1999) OR TOB '51X'/
                 PRVDR #6990-6999, TRANS CODE SHOULD BE
                 '0' OR '3'
      0406 = (C) MAMMOGRAPHY WITH NO HCPCS 76092 OR SEX NOT F
      0407 = (C) RESPITE CARE BILL TYPE NOT 34X,NO REV 66
      0408 = (C) REV CODE 403 /TYPE 71X/ PROV3800-974
      041A = (C) TOB '11A' OR '11D' AND DEMO #'07' OR '08'
                 NOT PRESENT
      0410 = (C) IMMUNO DRUG OCCR-36,NO REV-25 OR 636
      0412 = (C) BILL TYPE XX5 HAS ACCOM. REV. CODES
      0413 = (C) CABG/PCOE BUT TOB = HHA,OUT,HOS
      0414 = (C) VALU CD 61,MSA AMOUNT MISSING
      0415 = (C) HOME HEALTH INCORRECT ALPHA RIC
      0416 = (C) REVENUE CENTER '0022', TOB MUST BE
                 '18X' OR '21X'
      0417 = (C) REVENUE CENTER '0023', TOB MUST BE '32X'
                 OR '33X'
      0418 = (C) HHA--TOB '3X5' AND DATES OF SERVICE
                 >9/30/00
      0419 = (C) HHA--RIC 'W' MUST HAVE VALUE CODE '63'/
                 RIC 'V' MUST HAVE VALUE CODE '62' AND
                 RIC 'U' MUST HAVE VALUE CODES '62' AND
                 '63' PRESENT FOR DATES OF SERVICE >
                 9/30/00.
      0420 = (C) HHA W/O REVENUE CODE '0023'
      0421 = (C) START DATE MISSING
      0422 = (C) COB VS. OVERRIDE CODE
      05X4 = (C) UPIN REQUIRED FOR TYPE-OF-SERVICE
      05X5 = (C) UPIN REQUIRED FOR DME
      0501 = (C) REFFERING UPIN REQUIRED FOR CLINICAL LAB
      0502 = (C) REFERRING UPIN INVALID
      0601 = (C) GENDER INVALID
      0701 = (C) CONTRACTOR/POS 1-2 PROVIDER NUM INVALID
      0702 = (C) PROVIDER NUMBER VS. TOB
      0703 = (C) MAMMOGRAPHY FOR NOT FEMALE
      0704 = (C) INVALID CONT FOR CABG DEMO
      0705 = (C) INVALID CONT FOR PCOE DEMO
      0706 = (C) REVENUE CENTER CODE MAMMOGRAPHY AND
                 BENEFICIARY <35
      0901 = (C) INVALID DISP CODE OF 02
      0902 = (C) INVALID DISP CODE OF SPACES
      0903 = (C) INVALID DISP CODE
      1001 = (C) PROF REVIEW/ACT CODE/BILL TYPE
      13X2 = (C) MULTIPLE ITEMS FOR SAME SERVICE
      1301 = (C) LINE COUNT NOT NUMERIC OR > 13
      1302 = (C) RECORD LENGTH INVALID
      1401 = (C) INVALID MEDICARE STATUS CODE
      1501 = (C) ADMIT DATE/START DATE/ENTRY CODE INVALID
      1502 = (C) ADMIT DATE/START CARE DATE > STAY FROM DATE
      1503 = (C) ADMIT DATE INVALID WITH THRU DATE
      1504 = (C) ADM/FROM/THRU DATE > TODAYS DATE
      1505 = (C) HCPCS W SERVICE DATES > 09-30-94
      1601 = (C) INVESTIGATION IND INVALID
      1701 = (C) SPLIT IND INVALID
      1801 = (C) PAY-DENY CODE INVALID
      1802 = (C) HEADER AMT/LINE ITEMS DENIED
      1803 = (C) MSP COST AVD/ALL MSP LI NOT SAME
      1901 = (C) AB CROSSOVER IND INVALID
      2001 = (C) HOSPICE OVERRIDE INVALID
      2101 = (C) HMO-OVERRIDE/PATIENT-STAT INVALID
      2102 = (C) PATIENT STATUS VS. TOB
      2103 = (C) HIPPS RATE/CMG CODE VS. PATIENT STATUS
      2201 = (C) FROM DATE/HCPCS YR INVALID
      2202 = (C) STAY-FROM DATE > THRU-DATE
      2203 = (C) THRU DATE INVALID
      2204 = (C) FROM DATE BEFORE EFFECTIVE DATE
      2205 = (C) DATE YEARS DIFFERENT ON OUTPAT
      2207 = (C) MAMMOGRAPHY BEFORE 1991
      2208 = (C) TOB '21X', REV CODE 0022 FROM DATE
                 < 06-03-98
      2209 = (C) HHA WITH OVERLAPPING DATES JUNE/JULY,
                 SEPT/OCT
      2210 = (C) TOB 41X, SERVICE DATES 6/30/00,
                 EXCEP/NONEXCEP IND = 1,2
      2212 = (C) TOB 51X WITH SERVICE DATES >6/30/00
      2213 = (C) TOB 32X OR 33X, SERVICE >9/30/00 DAYS
                 CAN NOT = 60
      2215 = (C) DEMO 37 WITH VALUE CODES 'A2', 'B2', 'C2'
      2216 = (C) DEMO 37 OR CONDITION CODE 78 AND CHARGES
                 SUB TO DED > 0
      2301 = (C) DOCUMENT CNTL OR UTIL DYS INVALID
      2302 = (C) COVERED DAYS INVALID OR INCONSIST
      2303 = (C) COST REPORT DAYS > ACCOMIDATION
      2304 = (C) UTIL DAYS = ZERO ON PATIENT BILL
      2305 = (C) LATE CHARGE BILL WITH DATA FIELD PRESENT
      2306 = (C) UTIL DYS/NOPAY/REIMB INCONSISTENT
      2307 = (C) COND=40,UTL DYS >0/VAL CDE A1,08,09
      2308 = (C) NOPAY = R WHEN UTIL DAYS = ZERO
      2401 = (C) NON-UTIL DAYS INVALID
      2501 = (C) CLAIM RCV DT OR COINSURANCE INVAL
      2502 = (C) COIN+LR>UTIL DAYS/RCPT DTE>CUR DTE
      2503 = (C) COIN/TR TYP/UTIL DYS/RCPT DTE>PD/DEN
      2504 = (C) COINSURANCE AMOUNT EXCESSIVE
      2505 = (C) COINSURANCE RATE > ALLOWED AMOUNT
      2506 = (C) COINSURANCE DAYS/AMOUNT INCONSIST
      2507 = (C) COIN+LR DAYS > TOTAL DAYS FOR YR
      2508 = (C) COINSURANCE DAYS INVALID FOR TRAN
      2601 = (C) CLAIM PAID DT INVALID OR LIFE RES
      2602 = (C) LR-DAYS, NO VAL 08,10/PD/DEN>CUR+27
      2603 = (C) LIFE RESERVE > RATE FOR CAL YEAR
      2604 = (C) PPS BILL, NO DAY OUTLIER
      2605 = (C) LIFE RESERVE RATE > DAILY RATE AVR.
      28XA = (C) UTIL DAYS > FROM TO BENEF EXH
      28XB = (C) BENEFITS EXH DATE > FROM DATE
      28XC = (C) BENEFITS EXH DATE/INVALID TRANS TYPE
      28XD = (C) OCCUR 23 WITH SPAN 70 ON INPAT HOSP
      28XE = (C) MULTI BENE EXH DATE (OCCR A3,B3,C3)
      28XF = (C) ACE DATE ON SNF (NOPAY =B, C, N, W)
      28XG = (C) SPAN CD 70+4+6+9 NOT = NONUTIL DAYS
      28XM = (C) OCC CD 42 DATE NOT = SRVCE THRU DTE
      28XN = (C) INVALID OCC CODE
      28XO = (C) AN 'N' NO-PAY CODE IS PRESENT AND OCCURRENCE
                 CODE '23' OR '42' IS NOT PRESENT AND THE
                 DATE ASSOCIATED WITH CODE IS MISSING OR NOT
                 EQUAL TO THRU DATE.
      28XP = (C) THE OCCURRENCE CODE 23 DATE DOES NOT EQUAL THE
                 THRU DATE
      28X0 = (C) BENE EXH DATE OUTSIDE SERVICE DATES
      28X1 = (C) OCCUR DATE INVALID
      28X2 = (C) OCCUR = 20 AND TRANS = 4
      28X3 = (C) OCCUR 20 DATE < ADMIT DATE
      28X4 = (C) OCCUR 20 DATE > ADMIT + 12
      28X5 = (C) OCCUR 20 AND ADMIT NOT = FROM
      28X6 = (C) OCCUR 20 DATE < BENE EXH DATE
      28X7 = (C) OCCUR 20 DATE+UTIL-COIN>COVERAGE
      28X8 = (C) OCCUR 22 DATE < FROM OR > THRU
      28X9 = (C) UTIL > FROM - THRU LESS NCOV
      33X1 = (C) QUAL STAY DATES INVALID (SPAN=70)
      33X2 = (C) QS FROM DATE NOT < THRU (SPAN=70)
      33X3 = (C) QS DAYS/ADMISSION ARE INVALID
      33X4 = (C) QS THRU DATE > ADMIT DATE (SPAN=70)
      33X5 = (C) SPAN 70 INVALID FOR DATE OF SERVICE
      33X6 = (C) TOB=18/21/28/51,COND=WO,HMO<>90091
      33X7 = (C) TOB<>18/21/28/51,COND=WO
      33X8 = (C) TOB=18/21/28/51,CO=WO,ADM DT<97001
      33X9 = (C) TOB=32X SPAN 70 OR OCCR BO PRESENT
      33#A = (C) MULTIPLE PET SCANS
      33#B = (C) MULITIPLE PET SCANS W/O MODIFIER 26
                 OR TC
      3401 = (C) DEMO ID = 04 AND RIC NOT = 1 OR 2
      34X2 = (C) DEMO ID = 04 AND COND WO NOT SHOWN
      34#3 = (C) CONDITION CODE = W0 AND DEMO NOT = 04
      35X1 = (C) 60, 61, 66 & NON-PPS / 65 & PPS
      35X2 = (C) COND = 60 OR 61 AND NO VALU 17
      35X3 = (C) PRO APPROVAL COND C3,C7 REQ SPAN M0
      35#3 = (C) (SECOND CONDITION) CONDITION CODE = C3
                 REQUIRES SPAN CODE 76 OR 77
      35#4 = (C) CONDITION CODE = 69 AND TOB NOT 11X
      36X1 = (C) SURG DATE < STAY FROM/ > STAY THRU
      36#1 = (C) SURGICAL DATE = ZEROES OR < FROM OR >
                 THRU DATES
      3701 = (C) ASSIGN CODE INVALID
      3705 = (C) 1ST CHAR OF IDE# IS NOT ALPHA
      3706 = (C) INVALID IDE NUMBER-NOT IN FILE
      3710 = (C) NUM OF IDE# > REV 0624
      3715 = (C) NUM OF IDE# < REV 0624
      3720 = (C) IDE AND LINE ITEM NUMBER > 2
      3801 = (C) AMT BENE PD INVALID
      3XA/ = (C) COLORECTAL/PROSTATE SCREENING BILLED
                 MULTIPLE TIMES
      4001 = (C) BLOOD PINTS FURNISHED INVALID
      4002 = (C) BLOOD FURNISHED/REPLACED INVALID
      4003 = (C) BLOOD FURNISHED/VERIFIED/DEDUCT
      4201 = (C) BLOOD PINTS UNREPLACED INVALID
      4202 = (C) BLOOD PINTS UNREPLACED/BLOOD DED
      4203 = (C) INVALID CPO PROVIDER NUMBER
      4301 = (C) BLOOD DEDUCTABLE INVALID
      4302 = (C) BLOOD DEDUCT/FURNISHED PINTS
      4303 = (C) BLOOD DEDUCT > UNREPLACED BLOOD
      4304 = (C) BLOOD DEDUCT > 3 - REPLACED
      4501 = (C) PRIMARY DIAGNOSIS INVALID
      4502 = (C) SERVICE DATES > CURRENT DATE
      46#A = (C) MSP VET AND VET AT MEDICARE
      46#B = (C) MULTIPLE COIN VALU CODES (A2,B2,C2)
      46#C = (C) COIN VALUE (A2,B2,C2) ON INP/SNF
      46#G = (C) VALU CODE 20 INVALID
      46#L = (C) BLOOD FURNISHED < BLOOD REPLACED
      46#N = (C) VALUE CODE 37,38,39 INVALID
      46#O = (C) VALUE CDE 37,38,39 AMOUNT NOT > 00
      46#P = (C) BLD UNREP VS REV CDS AND/OR UNITS
      46#Q = (C) VALUE CDE 37=39 AND 38 IS PRESENT
      46#R = (C) BLD FIELDS VS REV CDE 380,381,382
      46#S = (C) VALU CODE 39, AND 37 IS NOT PRESENT
      46#T = (C) CABG/PCOE/MPPD,VC<>Y1,Y2,Y3,Y4,VA NOT>0
      46#U = (C) MSP VALUES ON CABG/PCOE/MPPD (INP)
                 TOB '32X'/'33X' MUST HAVE VALUE 62/64
                 OR 63/65 (HHA)
      46#V = (C) TOB '32X'/'33X' VISITS IN 62/63 NOT =
                 REVENUE CODE 42X-44X, 55X-57X
      46#W = (C) CONDITION CODE =30/78 AND WITH VALUE
                 CODE = A1, B1, C1
      46#1 = (C) VALUE AMOUNT INVALID
      46#2 = (C) VALU 06 AND BLD-DED-PTS IS ZERO
      46#3 = (C) VALU 06 AND TTL-CHGS=NC-CHGS(001)
      46#4 = (C) VALU (A1,B1,C1): AMT > DEDUCT
      46#5 = (C) DEDUCT VALUE (A1,B1,C1) ON SNF BILL
      46#6 = (C) VALU 17 AND NO COND CODE 60 OR 61
      46#7 = (C) OUTLIER(VAL 17) > REIMB + VAL6-16
      46#8 = (C) MULTI CASH DED VALU CODES (A1,B1,C1)
      46X9 = (C) DEMO ID=03,REQUIRED HCPCS NOT SHOWN
      4600 = (C) CAPITAL TOTAL NOT = CAP VALUES
      4601 = (C) CABG/PCOE, MSP CODE PRESENT
      4603 = (C) DEMO ID = 03 AND RIC NOT=6,7
      4604 = (C) DEMO = 03 WITH DATES OF SERVICE
                 > 09/31/01
      4901 = (C) PCOE/CABG,DEN CD NOT D
      4902 = (C) PCOE/CABG BUT DME
      50#1 = (C) RVCD=54,TOB<>13,23,32,33,34,83,85
      50#2 = (C) REV CD=054X,MOD NOT = QM,QN
      5051 = (E) EDB: NOMATCH ON 3 CHARACTERISTICS
      5052 = (E) EDB: NOMATCH ON MASTER-ID RECORD
      5053 = (E) EDB: NOMATCH ON CLAIM-NUMBER
      51#A = (C) HCPCS EYEWARE & REV CODE NOT 274
      51#C = (C) HCPCS REQUIRES DIAG CODE OF CANCER
      51#D = (C) HCPCS REQUIRES UNITS > ZERO
      51#E = (C) HCPCS REQUIRES REVENUE CODE 636/294
      51#F = (C) INV BILL TYP/ANTI-CAN DRUG HCPCS
      51#G = (C) HCPCS REQUIRES DIAG OF HEMOPHILL1A
      51#H = (C) TOB 21X/P82=2/3/4;REV CD<9001,>9044
      51#I = (C) TOB 21X/P82<>2/3/4:REV CD>8999<9045
      51#J = (C) TOB 21X/REV CD: SVC-FROM DT INVALID
      51#K = (C) TOB 21X/P82=2/3/4,REV CD = NNX
      51#L = (C) REV 0762/UNT>48,TOB NOT=12,13,85,83
      51#M = (C) 21X,RC>9041/<9045,RC<>4/234
      51#N = (C) 21X,RC>9032/<9042,RC<>4/234
      51#O = (C) TWO ANTI-EMETIC/ANTI-CANCER DRUGS
                 ON SAME CLAIM
      51#P = (C) HHA/OUTPATIENT RC DATE OF SRVC MISSING
      51#Q = (C) NO RC 0636 OR DTE INVALID
      51#R = (C) DEMO ID=01,RIC NOT=2
      51#S = (C) DEMO ID=01,RUGS<>2,3,4 OR BILL<>21
      51#V = (C) TOB 72X W HCPCS 'J1955' MISSING REVENUE
                 CENTER 636
      51#W = (C) TOB 12X, 13X, 22X, 23X, 34X, 74X, 75X,
                 83X, HCPCS '97504', '97116', PRESENT
                 ON SAME DAY
      51#X = (C) TOB '32X-34X' REQUIRE HCPCS FOR REVENUE
                 CODE '29X', '60X', '636'
      51X0 = (C) REV CENTER CODE INVALID
      51X1 = (C) REV CODE CHECK
      51X2 = (C) REV CODE INCOMPATIBLE BILL TYPE
      51X3 = (C) UNITS MUST BE > 0
      51X4 = (C) INP:CHGS/YR-RATE,ETC; OUTP:PSYCH>YR
      51X5 = (C) REVENUE NON-COVERED > TOTAL CHRGE
      51X6 = (C) REV TOTAL CHARGES EQUAL ZERO
      51X7 = (C) REV CDE 403 WTH NO BILL 14 23 71 85
      51X8 = (C) MAMMOGRAPHY SUBMISSION INVALID
      51X9 = (C) HCPCS/REV CODE/BILL TYPE
      5100 = (U) TRANSITION SPELL / SNF
      5160 = (U) LATE CHG HSP BILL STAY DAYS > 0
      5166 = (U) PROVIDER NE TO 1ST WORK PRVDR
      5167 = (U) PROVIDER 1 NE 2: FROM DT < START DT
      5168 = (E) CLAIM IN HOSPICE WITH 2ND START DATE
                 PRESENT
      5169 = (U) PROVIDER NE TO WORK PROVIDER
      5170 = (E) OCCURRENCE CODE = 42 AND < DOLBA
      5177 = (U) PROVIDER NE TO WORK PROVIDER
      5178 = (U) HOSPICE BILL THRU < DOLBA
      5181 = (U) HOSP BILL OCCR 27 DISCREPANCY
      5200 = (E) ENTITLEMENT EFFECTIVE DATE
      5201 = (U) HOSP DATE DIFFERENCE NE 60 OR 90
      5202 = (E) ENTITLEMENT HOSPICE EFFECTIVE DATE
      5202 = (U) HOSPICE TRAILER ERROR
      5203 = (E) ENTITLEMENT HOSPICE PERIODS
      5203 = (U) HOSPICE START DATE ERROR
      5204 = (U) HOSPICE DATE DIFFERENCE NE 90
      5205 = (U) HOSPICE DATE DISCREPANCY
      5206 = (U) HOSPICE DATE DISCREPANCY
      5207 = (U) HOSPICE THRU > TERM DATE 2ND
      5208 = (U) HOSPICE PERIOD NUMBER BLANK
      5209 = (U) HOSPICE DATE DISCREPANCY
      5210 = (E) ENTITLEMENT FRM/TRU/END DATES
      5211 = (E) ENTITLEMENT DATE DEATH/THRU
      5212 = (E) ENTITLEMENT DATE DEATH/THRU
      5213 = (E) ENTITLEMENT DATE DEATH MBR
      5220 = (E) ENTITLEMENT FROM/EFF DATES
      5225 = (E) ENT INP PPS SPAN 70 DATES
      5232 = (E) ENTL HMO NO HMO OVERRIDE CDE
      5233 = (E) ENTITLEMENT HMO PERIODS
      5234 = (E) ENTITLEMENT HMO NUMBER NEEDED
      5235 = (E) ENTITLEMENT HMO HOSP+NO CC07
      5236 = (E) ENTITLEMENT HMO HOSP + CC07
      5237 = (E) ENTITLEMENT HOSP OVERLAP
      5238 = (U) HOSPICE CLAIM OVERLAP > 90
      5239 = (U) HOSPICE CLAIM OVERLAP > 60
      524Z = (E) HOSP OVERLAP NO OVD NO DEMO
      5240 = (U) HOSPICE DAYS STAY+USED > 90
      5241 = (U) HOSPICE DAYS STAY+USED > 60
      5242 = (C) INVALID CARRIER FOR RRB
      5243 = (C) HMO=90091,INVALID SERVICE DTE
      5244 = (E) DEMO CABG/PCOE MISSING ENTL
      5245 = (C) INVALID CARRIER FOR NON RRB
      525Z = (E) HMO/HOSP 6/7 NO OVD NO DEMO
      5250 = (U) HOSPICE DOEBA/DOLBA
      5255 = (U) HOSPICE DAYS USED
      5256 = (U) HOSPICE DAYS USED > 999
      526Y = (E) HMO/HOSP DEMO 5/15 REIMB > 0
      526Z = (E) HMO/HOSP DEMO 5/15 REIMB = 0
      5270 = (C) CONDITION CODE = 30 AND HMO REQUIRES
                 MODIFIER = 'QV' OR 'KZ'/DED IND
      5271 = (C) RISK HMO NOT PRESENT AND MOD 'KZ'/
                 OR CONDITION CODE 78 PRESENT
      527Y = (E) HMO/HOSP DEMO OVD=1 REIMB > 0
      527Z = (E) HMO/HOSP DEMO OVD=1 REIMB = 0
      5299 = (U) HOSPICE PERIOD NUMBER ERROR
      52#K = (C) HCPCS VS DIAGNOSIS
      52#L = (C) HCPCS VS MODIFIER
      52#M = (C) HCPCS VS DATES OF SERVICE
      52#N = (C) TOB '71X' OR '73X' WITH REVENUE
                 CENTER CODE 0403 MISSING REVENUE
                 CENTER CODE 0521
      52#O = (C) REVENUE CENTER CODE 0022/0024 WITH
                 CHARGES >0
      52#P = (C) REVENUE CENTER CODE 010X-021X MINUS
                 18X <> 0022
      52#Q = (C) REVENUE CENTER CODE 0022 AND HIPPS
                 MISSING
      52#R = (C) REVENUE CENTER CODE 0022 MISSING DATE
                 OF SERVICE
      52#T = (C) REVENUE CENTER CODE 0022 MISSING REVENUE
                 CENTER CODE 042X-044X
      5320 = (U) BILL > DOEBA AND IND-1 = 2
      5350 = (U) HOSPICE DOEBA/DOLBA SECONDARY
      5355 = (U) HOSPICE DAYS USED SECONDARY
      5362 = (C) MAMMOGRAPHY AND BENE <35
      5378 = (C) SERVICE DATE < AGE 50
      5379 = (C) HCPCS 'G0160' PRESENT MORE THAN
                 ONCE
      5381 = (C) HCPCS 'G0161' PRESENT MORE THAN
                 ONCE
      5382 = (C) HCPCS 'G0102-03' AND BENE <50
      538Q = (C) SERVICE DATES WITHIN ALIEN RECORD
      5397 = (C) DEMO '37' AND NOT CAT 74
      5398 = (C) HCPCS 'G9001-G9005 & G9009-G9011 >1
                 OR 2 ARE PRESENT
      5399 = (U) HOSPICE PERIOD NUM MATCH
      539A = (C) HCPCS 'G9008' PRESENT MORE THAN ONCE
      539C = (C) HCPCS 'G9013-G9015' PRESENT MORE THAN
                 ONCE OR 2 PRESENT
      5410 = (U) INPAT DEDUCTABLE
      5425 = (U) PART B DEDUCTABLE CHECK
      5430 = (U) PART B DEDUCTABLE CHECK
      5450 = (U) PART B COMPARE MED EXPENSE
      5460 = (U) PART B COMPARE MED EXPENSE
      5499 = (U) MED EXPENSE TRAILER MISSING
      5500 = (U) FULL DAYS/SNF-HOSP FULL DAYS
      5510 = (U) COIN DAYS/SNF COIN DAYS
      5515 = (U) FULL DAYS/COIN DAYS
      5516 = (U) SNF FULL DAYS/SNF COIN DAYS
      5520 = (U) LIFE RESERVE DAYS
      5530 = (U) UTIL DAYS/LIFE PSYCH DAYS
      5540 = (U) HH VISITS NE AFT PT B TRLR
      5550 = (E) SNF LESS THAN PT A EFF DATE
      5600 = (D) LOGICAL DUPE, COVERED
      5601 = (D) LOGICAL DUPE, QRY-CDE, RIC 123
      5602 = (D) LOGICAL DUPE, PANDE C, E OR I
      5603 = (D) LOGICAL DUPE, COVERED
      5604 = (D) LOGICAL DUPE, DATES
      5605 = (D) POSS DUPE, OUTPAT REIMB
      5606 = (D) POSS DUPE, HOME HEALTH COVERED U
      5623 = (U) NON-PAY CODE IS P
      57X1 = (C) PROVIDER SPECIALITY CODE INVALID
      57X2 = (C) PHYS THERAPY/PROVIDER SPEC INVAL
      57X3 = (C) PLACE/TYPE/SPECIALTY/REIMB IND
      57X4 = (C) SPECIALTY CODE VS. HCPCS INVALID
      57X5 = (C) HCPCS 98940-2 MODIFIER NOT = 'AT'
      5700 = (U) LINKED TO THREE SPELLS
      5701 = (C) DEMO ID=02,RIC NOT = 5
      5702 = (C) DEMO ID=02,INVALID PROVIDER NUM
      58X1 = (C) PROVIDER TYPE INVALID
      58X9 = (C) TYPE OF SERVICE INVALID
      5802 = (C) REIMB > $150,000
      5803 = (C) UNITS/VISITS > 150
      5804 = (C) UNITS/VISITS > 99
      5805 = (C) OUTPATIENT CHARGE > $150,000
      5806 = (C) REVENUE CENTER CODE '042X-044X'
                 WITHOUT MODIFIER 'GN-GP'
      58#4 = (C) REVENUE CENTER CODE MISSING REQUIRED
                 HCPCS OR MODIFIER
      59XA = (C) PROST ORTH HCPCS/FROM DATE
      59XB = (C) HCPCS/FROM DATE/TYPE P OR I
      59XC = (C) HCPCS Q0036,37,42,43,46/FROM DATE
      59XD = (C) HCPCS Q0038-41/FROM DATE/TYPE
      59XE = (C) HCPCS/MAMMOGRAPHY-RISK/ DIAGNOSIS
      59XG = (C) INVALID TOS FOR DME
      59XH = (C) HCPCS E0620/TYPE/DATE
      59XI = (C) HCPCS E0627-9/ DATE < 1991
      59XJ = (C) GLOBAL HCPCS TOS MUST = 2
      59XK = (C) HCPCS PEN PUMP AND TOS <>9
      59XL = (C) HCPCS 00104 - TOS/POS
      59X1 = (C) INVALID HCPCS/TOS COMBINATION
      59X2 = (C) ASC IND/TYPE OF SERVICE INVALID
      59X3 = (C) TOS INVALID TO MODIFIER
      59X4 = (C) KIDNEY DONOR/TYPE/PLACE/REIMB
      59X5 = (C) MAMMOGRAPHY FOR MALE
      59X6 = (C) DRUG AND NON DRUG BILL LINE ITEMS
      59X7 = (C) CAPPED-HCPCS/FROM DATE
      59X8 = (C) FREQUENTLY MAINTAINED HCPCS
      59X9 = (C) HCPCS E1220/FROM DATE/TYPE IS R
      5901 = (U) ERROR CODE OF Q
      5A#1 = (C) DEMO=37, UNITS >1 FOR 'G9001-05'
                 'G9007-11', G9013-G9015'
      60X1 = (C) ASSIGN IND INVALID
      6000 = (U) ADJUSTMENT BILL SPELL DATA
      6020 = (U) CURRENT SPELL DOEBA < 1990
      6030 = (U) ADJUSTMENT BILL SPELL DATA
      6035 = (U) ADJUSTMENT BILL THRU DTE/DOLBA
      61X1 = (C) PAY PROCESS IND INVALID
      61X2 = (C) DENIED CLAIM/NO DENIED LINE
      61X3 = (C) PAY PROCESS IND/ALLOWED CHARGES
      61X4 = (C) RATE MISSING OR NON-NUMERIC
      61#E = (C) PROVIDER PAYMENT INCONSISTENCIES
      61#F = (C) BENEFICIARY PAYMENT INCONSISTENCIES
      61#G = (C) PATIENT RESPONSIBILITY INCONSISTENCIES
      61#H = (C) MEDICARE PAYMENT INCONSISTENCIES
      61#I = (C) LINE DATE OF SERVICE < FROM DATE
                 > THRU DATE
      61#J = (C) DUPLICATE HCPCS CODE '55873'
      61#K = (C) HCPCS 'G0117-8' >2 OR BOTH PRESENT
      61#L = (C) REVENUE CENTER CODE 0024 > 2
      61#M = (C) REVENUE CENTER CODE 0024 VS PROVIDER
                 NUMBER
      61#N = (C) REVENUE CENTER CODE 0024 REQUIRES
                 VALID HIPPS RATE CMG CODE
      61#R = (C) HCPCS/TOB/REVENUE CENTER CODE
      61#S = (C) HCPCS 'G0247' REQUIRES 'G0245-6' TO
                 BE COVERED
      61#T = (C) HCPCS CODE '0245-0246' PRESENT MULTIPLE
                 TIMES
      61#0 = (C) REVENUE CENTER CODE VS SPAN CODE '74'
      61#6 = (C) PAYMENT METHOD INVALID
      61#7 = (C) ANSI CODE MISSING
      61#8 = (C) BLOOD CASH DEDUCTIBLE INCONSISTENCIES
      61#9 = (C) CASH DEDUCTIBLE INCONSISTENCIES
      6100 = (C) REV 0001 NOT PRESENT ON CLAIM
      6101 = (C) REV COMPUTED CHARGES NOT=TOTAL
      6102 = (C) REV COMPUTED NON-COVERED/NON-COV
      6103 = (C) REV TOTAL CHARGES < PRIMARY PAYER
      6105 = (C) REVE CODE 0001 > 1
      6106 = TOB 3X2 REVENUE CENTER CODE 0023 NOT =
                 TOTAL CHARGE
      6109 = (C) REIMBURSEMENT > 4 OR 6 TIMES
      62XA = (C) PSYC OT PT/REIM/TYPE
      62XC = (C) DEMO 37 WITH REIMBURSEMENT/DED IND
                 <>1
      62X1 = (C) DME/DATE/100% OR INVAL REIMB IND
      62X6 = (C) RAD PATH/PLACE/TYPE/DATE/DED
      62X8 = (C) KIDNEY DONO/TYPE/100%
      62X9 = (C) PNEUM VACCINE/TYPE/100%
      6201 = (C) TOTAL DEDUCT > CHARGES/NON-COV
      6203 = (U) HOSPICE ADJUSTMENT PERIOD/DATE
      6204 = (U) HOSPICE ADJUSTMENT THRU>DOLBA
      6260 = (U) HOSPICE ADJUSTMENT STAY DAYS
      6261 = (U) HOSPICE ADJUSTMENT DAYS USED
      6265 = (U) HOSPICE ADJUSTMENT DAYS USED
      6269 = (U) HOSPICE ADJUSTMENT PERIOD# (MAIN)
      63X1 = (C) DEDUCT IND INVALID
      63X2 = (C) DED/HCFA COINS IN PCOE/CABG
      6365 = (U) HOSPICE ADJUSTMENT SECONDARY DAYS
      6369 = (U) HOSPICE ADJUSTMENT PERIOD# (SECOND)
      64X1 = (C) PROVIDER IND INVALID
      6430 = (U) PART B DEDUCTABLE CHECK
      65X1 = (C) PAYSCREEN IND INVALID
      66?? = (D) POSS DUPE, CR/DB, DOC-ID
      66XX = (D) POSS DUPE, CR/DB, DOC-ID
      66X1 = (C) UNITS AMOUNT INVALID
      66X2 = (C) UNITS IND > 0; AMT NOT VALID
      66X3 = (C) UNITS IND = 0; AMT > 0
      66X4 = (C) MT INDICATOR/AMOUNT
      66X7 = (C) DEMO 37/HCPCS/UNITS
      6600 = (U) ADJUSTMENT BILL FULL DAYS
      6610 = (U) ADJUSTMENT BILL COIN DAYS
      6620 = (U) ADJUSTMENT BILL LIFE RESERVE
      6630 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
      67X1 = (C) UNITS INDICATOR INVALID
      67X2 = (C) CHG ALLOWED > 0; UNITS IND = 0
      67X3 = (C) TOS/HCPCS=ANEST, MTU IND NOT = 2
      67X4 = (C) HCPCS = AMBULANCE, MTU IND NOT = 1
      67X6 = (C) INVALID PROC FOR MT IND 2, ANEST
      67X7 = (C) INVALID UNITS IND WITH TOS OF BLOOD
      67X8 = (C) INVALID PROC FOR MT IND 4, OXYGEN
      6700 = (U) ADJUSTMENT BILL FULL/SNF DAYS
      6710 = (U) ADJUSTMENT BILL COIN/SNF DAYS
      68XA = (C) HCPCS G0117-8 >1 OR BOTH PRESENT
      68XB = (C) HCPCS CODE G0245-46 > 1
      68X1 = (C) INVALID HCPCS CODE
      68X2 = (C) MAMMOGRAPY/DATE/PROC NOT 76092
      68X3 = (C) TYPE OF SERVICE = G /PROC CODE
      68X4 = (C) HCPCS NOT VALID FOR SERVICE DATE
      68X5 = (C) MODIFIER NOT VALID FOR HCPCS, ETC
      68X6 = (C) TYPE SERVICE INVALID FOR HCPCS, ETC
      68X7 = (C) ZX MOD REQ FOR THER SHOES/INS/MOD.
      68X8 = (C) ANTI-EMETIC WITHOUT ANTI-CANCER DRUG
      6812 = (C) DEMO 37 WITH PRIMARY PAYER CODE
      69XA = (C) MODIFIER NOT VALID FOR HCPCS/GLOBAL
      69XB = (C) HCPCS CODE 97504/97116 PRESENT ON
                 SAME DAY
      69XC = (C) HCPCS CODE VS PAY PROCESS INDICATOR
      69X3 = (C) PROC CODE MOD = LL / TYPE = R
      69X6 = (C) PROC CODE MOD/NOT CAPPED
      69X8 = (C) SPEC CODE NURSE PRACT, MOD INVAL
      69X9 = (C) NURSE PRACTITIONER, MOD INVALID
      6901 = (C) KRON IND AND UTIL DYS EQUALS ZERO
      6902 = (C) KRON IND AND NO-PAY CODE B OR N
      6903 = (C) KRON IND AND INPATIENT DEDUCT = 0
      6904 = (C) KRON IND AND TRANS CODE IS 4
      6910 = (C) REV CODES ON HOME HEALTH
      6911 = (C) REV CODE 274 ON OUTPAT AND HH ONLY
      6912 = (C) REV CODE INVAL FOR PROSTH AND ORTHO
      6913 = (C) REV CODE INVAL FOR OXYGEN
      6914 = (C) REV CODE INVAL FOR DME
      6915 = (C) PURCHASE OF RENT DME INVAL ON DATES
      6916 = (C) PURCHASE OF RENT DME INVAL ON DATES
      6917 = (C) PURCHASE OF LIFT CHAIR INVAL > 91000
      6918 = (C) HCPCS INVALID ON DATE RANGES
      6919 = (C) DME OXYGEN ON HH INVAL BEFORE 7/1/89
      6920 = (C) HCPCS INVAL ON REV 270/BILL 32-33
      6921 = (C) HCPCS ON REV CODE 272 BILL TYPE 83X
      6922 = (C) HCPCS ON BILL TYPE 83X -NOT REV 274
      6923 = (C) RENTAL OF DME CUSTOMIZE AND REV 291
      6924 = (C) INVAL MODIFIER FOR CAPPED RENTAL
      6925 = (C) HCPCS ALLOWED ON BILL TYPES 32X-34X
      6929 = (U) ADJUSTMENT BILL LIFE RESERVE
      6930 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
      7000 = (U) INVALID DOEBA/DOLBA
      7002 = (U) LESS THAN 60/61 BETWEEN SPELLS
      7010 = (E) TOB 85X/ELECTN PRD: COND CD 07 REQD
      71X1 = (C) SUBMITTED CHARGES INVALID
      71X2 = (C) MAMMOGRPY/PROC CODE MOD TC,26/CHG
      71X3 = (C) HCPCS 76092 PAY INDICATOR <> A,R,S
                 & 76085 PAY INDICATOR A,R,S
      72X1 = (C) ALLOWED CHGS INVALID
      72X2 = (C) ALLOWED/SUBMITTED CHARGES/TYPE
      72X3 = (C) DENIED LINE/ALLOWED CHARGES
      7230 = (C) FRAMES >1, LENSES >2
      73X1 = (C) SS NUMBER INVALID
      73X2 = (C) CARRIER ASSIGNED PROV NUM MISSING
      74X1 = (C) LOCALITY CODE INVAL FOR CONTRACT
      76X1 = (C) PL OF SER INVAL ON MAMMOGRAPHY BILL
      77X1 = (C) PLACE OF SERVICE INVALID
      77X2 = (C) PHYS THERAPY/PLACE
      77X3 = (C) PHYS THERAPY/SPECIALTY/TYPE
      77X4 = (C) ASC/TYPE/PLACE/REIMB IND/DED IND
      77X6 = (C) TOS=F, PL OF SER NOT = 24
      7701 = (C) INCORRECT MODIFIER
      7777 = (D) POSS DUPE, PART B DOC-ID
      78XA = (C) MAMMOGRAPHY BEFORE 1991
      78XB = (C) ANTI-CANCER BEFORE 01/01/1998
      78X1 = (C) FROM DATE IMPOSSIBLE
      78X2 = (C) FROM DATE > CURRENT DATE OR
                 < 07/01/1966
      78X3 = (C) FROM DATE GREATER THAN THRU DATE
      78X4 = (C) FROM DATE > RCVD DATE/PAY-DENY
      78X5 = (C) FROM DATE > PAID DATE/TYPE/100%
      78X7 = (C) LAB EDIT/TYPE/100%/FROM DATE
      79X1 = (C) THRU DATE IMPOSSIBLE
      79X2 = (C) THRU DATE > CURRENT DATE
      79X3 = (C) THRU DATE>RECD DATE/NOT DENIED
      79X4 = (C) THRU DATE>PAID DATE/NOT DENIED
      8000 = (U) MAIN & 2NDARY DOEBA < 01/01/90
      8028 = (E) NO ENTITLEMENT
      8029 = (U) HH BEFORE PERIOD NOT PRESENT
      8030 = (U) HH BILL VISITS > PT A REMAINING
      8031 = (U) HH PT A REMAINING > 0
      8032 = (U) HH DOLBA+59 NOT GT FROM-DATE
      8050 = (U) HH QUALIFYING INDICATOR = 1
      8051 = (U) HH # VISITS NE AFT PT B APPLIED
      8052 = (U) HH # VISITS NE AFT TRAILER
      8053 = (U) HH BENEFIT PERIOD NOT PRESENT
      8054 = (U) HH DOEBA/DOLBA NOT > 0
      8060 = (U) HH QUALIFYING INDICATOR NE 1
      8061 = (U) HH DATE NE DOLBA IN AFT TRLR
      8062 = (U) HH NE PT-A VISITS REMAINING
      81X1 = (C) NUM OF SERVICES INVALID
      83X1 = (C) DIAGNOSIS INVALID
      8301 = (C) HCPCS/GENDER DIAGNOSIS
      8302 = (C) HCPCS G0101 V-CODE/SEX CODE
      8303 = (C) HCPCS/GENDER
      8304 = (C) BILL TYPE INVALID FOR G0123/4
      8305 = (C) HCPCS/SERVICE DATES/GENDER
      84X1 = (C) PAP SMEAR/DIAGNOSIS/GENDER/PROC
      84X2 = (C) INVALID DME START DATE
      84X3 = (C) INVALID DME START DATE W/HCPCS
      84X4 = (C) HCPCS G0101 V-CODE/SEX CODE
      84X5 = (C) HCPCS CODE WITH INV DIAG CODE
      84X6 = (C) HCPCS/GENDER
      84X7 = (C) HCPCS/SERVICE DATES/GENDER
      84X8 = (C) DUPLICATE HCPCS
      86X1 = (C) CLINICAL LAB HCPCS W/O CLINICAL
                 LAB ID
      86X2 = (C) NON-WAIVER HCPCS/PAY DENIAL CODE/
                 MODIFIER
      86X8 = (C) CLIA REQUIRES NON-WAIVER HCPCS
      88XX = (D) POSS DUPE, DOC-ID,UNITS,ENT,ALWD
      9000 = (U) DOEBA/DOLBA CALC
      9005 = (U) FULL/COINS HOSP DAYS CALC
      9010 = (U) FULL/COINS SNF DAYS CALC
      9015 = (U) LIFE RESERVE DAYS CALC
      9020 = (U) LIFE PSYCH DAYS CALC
      9030 = (U) INPAT DEDUCTABLE CALC
      9040 = (U) DATA INDICATOR 1 SET
      9050 = (U) DATA INDICATOR 2 SET
      91X1 = (C) PATIENT REIMB/PAY-DENY CODE
      92X1 = (C) PATIENT REIMB INVALID
      92X2 = (C) PROVIDER REIMB INVALID
      92X3 = (C) LINE DENIED/PATIENT-PROV REIMB
      92X4 = (C) MSP CODE/AMT/DATE/ALLOWED CHARGES
      92X5 = (C) CHARGES/REIMB AMT NOT CONSISTANT
      92X7 = (C) REIMB/PAY-DENY INCONSISTANT
      9201 = (C) UPIN REF NAME OR INITIAL MISSING
      9202 = (C) UPIN REF FIRST 3 CHAR INVALID
      9203 = (C) UPIN REF LAST 3 CHAR NOT NUMERIC
      93X1 = (C) CASH DEDUCTABLE INVALID
      93X2 = (C) DEDUCT INDICATOR/CASH DEDUCTIBLE
      93X3 = (C) DENIED LINE/CASH DEDUCTIBLE
      93X4 = (C) FROM DATE/CASH DEDUCTIBLE
      93X5 = (C) TYPE/CASH DEDUCTIBLE/ALLOWED CHGS
      9300 = (C) UPIN OTHER, NOT PRESENT
      9301 = (C) UPIN NME MIS/DED TOT LI>0 FR DEN CLM
      9302 = (C) UPIN OPERATING, FIRST 3 NOT NUMERIC
      9303 = (C) UPIN L 3 CH NT NUM/DED TOT LI>YR DED
      9351 = (C) OTHER UPIN PRESENT/MISSING OTHER FIELDS
      9352 = (C) OTHER UPIN INVALID
      9353 = (C) OTHER UPIN INVALID
      94A1 = (C) NON-COVERED FROM DATE INVALID
      94A2 = (C) NON-COVERED FROM > THRU DATE
      94A3 = (C) NON-COVERED THRU DATE INVALID
      94A4 = (C) NON-COVERED THRU DATE > ADMIT
      94A5 = (C) NON-COVERED THRU DATE/ADMIT DATE
      94C1 = (C) PR-PSYCH DAYS INVALID
      94C3 = (C) PR-PSYCH DAYS > PROVIDER LIMIT
      94F1 = (C) REIMBURSEMENT AMOUNT INVALID
      94F2 = (C) REIMBURSE AMT NOT 0 FOR HMO PAID
      94G1 = (C) NO-PAY CODE INVALID
      94G2 = (C) NO-PAY CODE SPACE/NON-COVERD=TOTL
      94G3 = (C) NO-PAY/PROVIDER INCONSISTANT
      94G4 = (C) NO PAY CODE = R & REIMB PRESENT
      94X1 = (C) BLOOD LIMIT INVALID
      94X2 = (C) TYPE/BLOOD DEDUCTIBLE
      94X3 = (C) TYPE/DATE/LIMIT AMOUNT
      94X4 = (C) BLOOD DED/TYPE/NUMBER OF SERVICES
      94X5 = (C) BLOOD/MSP CODE/COMPUTED LINE MAX
      9401 = (C) BLOOD DEDUCTIBLE AMT > 3
      9402 = (C) BLOOD FURNISHED > DEDUCTIBLE
      9403 = (C) DATE OF BIRTH MISSING ON PRO-PAY
      9404 = (C) INVALID GENDER CODE ON PRO-PAY
      9407 = (C) INVALID DIAGNOSIS
      9408 = (C) INVALID DRG NUMBER (GLOBAL)
      9409 = (C) HCFA DRG<>DRG ON BILL
      940X = (C) INVALID DRG
      9410 = (C) CABG/PCOE,INVALID DRG
      95X1 = (C) MSP CODE G/DATE BEFORE 1/1/87
      95X2 = (C) MSP AMOUNT APPLIED INVALID
      95X3 = (C) MSP AMOUNT APPLIED > SUB CHARGES
      95X4 = (C) MSP PRIMARY PAY/AMOUNT/CODE/DATE
      95X5 = (C) MSP CODE = G/DATE BEFORE 1987
      95X6 = (C) MSP CODE = X AND NOT AVOIDED
      95X7 = (C) MSP CODE VALID, CABG/PCOE
      96X1 = (C) OTHER AMOUNTS INVALID
      96X2 = (C) OTHER AMOUNTS > PAT-PROV REIMB
      97X1 = (C) OTHER AMOUNTS INDICATOR INVALID
      97X2 = (C) GRUDMAN SW/GRUDMAN AMT NOT > 0
      98X1 = (C) COINSURANCE INVALID
      98X3 = (C) MSP CODE/TYPE/COIN AMT/ALLOW/CSH
      98X4 = (C) DATE/MSP/TYPE/CASH DED/ALLOW/COI
      98X5 = (C) DATE/ALLOW/CASH DED/REIMB/MSP/TYP
      9801 = (C) REV CENTER CODE 0910 WITH SERVICE
                 DATE > 10/15/2004
      99XX = (D) POSS DUPE, PART B DOC-ID
      9901 = (C) REV CODE INVALID OR TRAILER CNT=0
      9902 = (C) ACCOMMODATION DAYS/FROM/THRU DATE
      9903 = (C) NO CLINIC VISITS FOR RHC
      9904 = (C) INCOMPATIBLE DATES/CLAIM TYPE
      991X = (C) NO DATE OF SERVICE
      9910 = (C) BLOOD DEDUCTIBLE NON NUMERIC
      9911 = (C) BLOOD DEDUCTIBLE PRESENT WITHOUT
                 BLOOD FURNISHED
      9920 = (C) CASH DEDUCTIBLE INVALID
      9930 = (C) COINSURANCE INVALID
      9931 = (C) OUTPAT COINSURANCE VALUES
      9933 = (C) RATE EXCEDES MAMMOGRAPHY LIMIT
      9934 = (C) HCPCS 76092 NON COVERED/76085 COVERED
      9940 = (C) PROVIDER PAYMENT INVALID
      9941 = (C) REIMBURSEMENT AMOUNT/COND/NON-PAYMENT/
                 PRIMARY PAYER
      9942 = (C) PATIENT DISTRIBUTION INVALID
      9944 = (C) STAY FROM>97273,DIAG<>V103,163,7612
      9945 = (C) HCPCS INVALID FOR SERVICE DATES
      9946 = (C) TOB INVALID FOR HCPCS
      9947 = (C) INVALID DATE FOR HCPCS
      9948 = (C) STAY FROM>96365,DIAG=V725
      9960 = (C) MED CHOICE BUT HMO DATA MISSING
      9965 = (C) HMO PRESENT BUT MED CHOICE MISSING
      9968 = (C) MED CHOICE NOT= HMO PLAN NUMBER
      9999 = (U) MAIN SPELL TRAILER NUMBER DOES NOT MATCH SPELL



 NCH_EDIT_TRLR_IND_TB                    NCH Edit Trailer Indicator Table

      E = Edit code trailer present



 NCH_MCO_TRLR_IND_TB                     NCH Managed Care Organization (MCO) Trailer Indicator Table

      M = MCO trailer present



 NCH_MQA_QUERY_PATCH_TB                  NCH MQA Query Patch Table

       Y = MQA changed bill query code on a action
           code 6 (force action code 2)
           bill to a zero. (Eff. 10/12/93)
       Z = MQA changed bill query code on a action
           code 4 (cancel only adjustment)
           bill to zero.  (Eff. 5/16/94)



 NCH_MQA_RIC_TB                          NCH MQA Record Identification Code Table

       1 = Inpatient
       2 = SNF
       3 = Hospice
       4 = Outpatient
       5 = Home Health Agency
       6 = Physician/Supplier
       7 = Durable Medical Equipment



 NCH_NEAR_LINE_REC_VRSN_TB               NCH Near Line Record Version Table

       A = Record format as of January 1991
       B = Record format as of April 1991
       C = Record format as of May 1991
       D = Record format as of January 1992
       E = Record format as of March 1992
       F = Record format as of May 1992
       G = Record format as of October 1993
       H = Record format as of September 1998
       I = Record format as of July 2000
       J = Record format as of January 2011
       K = Record format as of April 2013



 NCH_NEAR_LINE_RIC_TB                    NCH Near-Line Record Identification Code Table

       O = Part B physician/supplier claim
           record (processed by local carriers;
           can include DMEPOS services)
       V = Part A institutional claim record
           (inpatient (IP), skilled nursing
           facility (SNF), christian science
           (CS), home health agency (HHA), or
           hospice)
       W = Part B institutional claim record
           (outpatient (OP), HHA)
       U = Both Part A and B institutional home
           health agency (HHA) claim records --
           due to HHPPS and HHA A/B split.
           (effective 10/00)
       M = Part B DMEPOS claim record (processed
           by DME Regional Carrier) (effective 10/93)



 NCH_OCRNC_TRLR_IND_TB                   NCH Occurrence Trailer Indicator Table

      O = Occurrence code trailer present



 NCH_PATCH_TB                            NCH Patch Table

      01 = RRB Category Equatable BIC - changed (all
           claim types) -- applied during the Nearline
           'G' conversion to claims with NCH weekly
           process date before 3/91.   Prior to Version
           'H', patch indicator stored in redefined Claim
           Edit Group, 3rd occurrence, position 2.
      02 = Claim Transaction Code made consistent with
           NCH payment/edit RIC code (OP and HHA) --
           effective 3/94, CWFMQA began patch.  During
           'H' conversion, patch applied to claims with
           NCH weekly process date prior to 3/94.  Prior
           to version 'H', patch indicator stored in
           redefined Claim Edit Group, 4th occurrence,
           position 1.
      03 = Garbage/nonnumeric Claim Total Charge Amount
           set to zeroes (Instnl) --  during the Version
           'G' conversion, error occurred in the deriva-
           tion of this field where the claim was missing
           revenue center code = '0001'.   In 1994, patch
           was applied to the OP and HHA SAFs only. (This
           SAF patch indicator was stored in the redefined
           Claim Edit Group, 4th occurrence, position 2).
           During the 'H' ocnversion, patch applied to
           Nearline claims where garbage or nonnumeric
           values.
      04 = Incorrect bene residence SSA standard county
           code '999' changed (all claim types) --
           applied during the Nearline 'G' conversion and
           ongoing through 4/21/94, calling EQSTZIP
           routine to claims with NCH weekly process
           date prior to 4/22/94.  Prior to Version 'H'
           patch indicator stored in redefined Claim
           Edit Group, 3rd occurrence, position 4.
      05 = Wrong century bene birth date corrected (all
           claim types) -- applied during Nearline 'H'
           conversion to all history where century
           greater than 1700 and less than 1850; if
           century less than 1700, zeroes moved.
      06 = Inconsistent CWF bene medicare status code
           made consistent with age (all claim types) --
           applied during Nearline 'H' conversion to all
           history and patched ongoing.  Bene age is
           calculated to determine the correct value;
           if greater than 64, 1st position MSC ='1';
           if less than 65, 1st position MSC = '2'.
      07 = Missing CWF bene medicare status code derived
           (all claim types) -- applied during Nearline
           'H' conversion to all history and patched
           ongoing, except claims with unknown DOB and/
           or Claim From Date='0' (left blank).   Bene
           age is calculated to determine missing value;
           if greater than 64, MSC='10'; if less than
           65, MSC = '20'.
      08 = Invalid NCH primary payer code set to blanks
           (Instnl) -- applied during Version 'H' con-
           version to claims with NCH weekly process
           date 10/1/93-10/30/95, where MSP values =
           invalid '0', '1', '2', '3' or '4' (caused
           by erroneous logic in HCFA program code,
           which was corrected on 11/1/95).
      09 = Zero CWF claim accretion date replaced with
           NCH weekly process date (all claim types)
           -- applied during Version 'H' conversion to
           Instnl and DMERC claims; applied during
           Version 'G' conversion to non-institutional
           (non-DMERC) claims.  Prior to Version 'H',
           patch indicator stored in redefined claim
           edit group, 3rd occurrence, position 1.
      10 = Multiple Revenue Center 0001 (Outpatient,
           HHA and Hospice) -- patch applied to 1998 &
           1999 Nearline and SAFs to delete any revenue
           codes that followed the first '0001' revenue
           center code.   The edit was applied across all
           institutional claim types, including Inpatient/
           SNF (the problem was only found with OP/HHA/
           Hospice claims).  The problem was corrected
           6/25/99.
      11 = Truncated claim total charge amount in the
           fixed portion replaced with the total charge
           amount in the revenue center 0001 amount field
           -- service years 1998 & 1999 patched during
           quarterly merge.  The 1998 & 1999 SAFs were
           corrected when finalized in 7/99.  The patch
           was done for records with NCH Daily Process
           Date 1/4/99 - 5/14/99.
      12 = Missing claim-level HHA Total Visit Count --
           service years 1998, 1999 & 2000 patch applied
           during Version 'I' conversion of both the
           Nearline and SAFs.   Problem occurs in those
           claims recovered during the missing claims
           effort.
      13 = Inconsistent Claim MCO Paid Switch made consistent
           with criteria used to identify an inpatient
           encounter claim -- if MCO paid switch equal to blank
           or '0' and ALL conditions are met to indicate an
           inpatient encounter claim (bene enrolled in a risk
           MCO during the service period), change the switch to
           a '1'.  The patch was applied during the Version 'I'
           conversion, for claims back to 7/1/97 service thru date.

      14 = SNF claims incorrectly identified as Inpatient
           Encounter claims -- SNF claims matching the Inpatient
           encounter data criteria were incorrectly identified
           as Inpatient encounter claims (claim type code = '61'
           instead of '20' or '30').   NOTE:  if the SNF claims
           were identified the MCO paid switch was set to '1'.
           The patch was applied to correctly identify these
           claims as a '20' or '30'.  The MCO paid switch will
           be set to '0' as there is no way to recover the original
           value.  The problem occurred in claims with an NCH
           Weekly Process Date ranging from 7/7/2000 - 1/26/2001.
           The patch applied date is 03/30/2001.

      15 = HHA Part A claims with overlaid revenue center lines -
           During the Version 'I' conversion, NCH made each
           segment of a claim contains a maximum of 45 revenue
           lines.  During the month of June 2000 our CWFMQA had
           to be ready to except the new expanded format, but the
           NCH was not ready.  CWFMQA converted these 'I' claims
           back to Version 'H', a typo in the code caused the
           additional revenue lines to overlay some of the
           revenue lines on the base/initial record/segment.
           The problem occurred in claims with NCH Weekly Process
           dates from 6/16/00, 6/23/00, 6/30/00 and 7/7/00
           (both Version 'H' & 'I' files).

           In the Version 'I' files, the annual service year
           2000 files, service year 1999 and 1998 trickles were
           patched.  The 18-month service year 1999 was also
           patched (the service year 2000 SAF was created after
           the fix was applied).

           The patch applied date is 06/29/2001.



 NCH_PATCH_TRLR_IND_TB                   NCH Patch Trailer Indicator Table

      P = Patch code trailer present



 NCH_PRCDR_TRLR_IND_TB                   NCH Procedure Trailer Indicator Table

      Z = Procedure code trailer present



 NCH_REV_TRLR_IND_TB                     NCH Revenue Center Trailer Indicator Table

      R = Revenue code trailer present



 NCH_SPAN_TRLR_IND_TB                    NCH Span Trailer Indicator Table

      S = Span code trailer present



 NCH_STATE_SGMT_TB                       NCH State Segment Table

      NCH State Segment     State Codes
      -----------------     -----------------------
      B =                   01;02;03;04;06;07;08;09;
                            12;13;16;17;19;20;21;25;
                            27;28;29;30;32;35;37;38;
                            40;41;42;43;44;46;47;48;
                            50;51;53-99

      C =                   11;14;15;18;24;26;49;52

      D =                   11;14;15;18;24;26;31;34;
                            45;49;52

      E =                   22;23;31;34;36;45

      F =                   10;22;23;31;34;36;45

      G =                   10;22;23;36;39

      H =                   05;10;22;23;39

      I =                   05;10;39

      J =                   05;10;33;39

      K =                   05;33;39

      L =                   05;33;39

      M =                   05;33

      N =                   05;33

      O =                   33

      P =                   33

      Q =                   33

      R =                   33



 NCH_VAL_TRLR_IND_TB                     NCH Value Trailer Indicator Table

      V = Value code trailer present



 NG_ACO_IND_TB                           Next Generation (NG) Accountable Care Organization (ACO) Indicator Code Table

      0 = Base record (no enhancements)
      1 = Population Based Payments (PBP)
      2 = Telehealth
      3 = Post Discharge Home Health Visits
      4 = 3-Day SNF Waiver
      5 = Capitation
      6 = CEC Telehealth
      7 = Care Management Home Visits



 PMT_EDIT_RIC_TB                         Payment And Edit Record Identification Code Table

       C = Inpatient hospital, SNF
       D = Outpatient
       E = Religious Nonmedical Health Care Institutions (eff. 8/00);
           Christian Science, prior to 7/00
       F = Home Health Agency (HHA)
       G = Discharge notice
           (obsoleted 7/98)
       I = Hospice



 PRVDR_NUM_TB                            Provider Number Table

       -   First two positions are the GEO SSA State Code.

       -   Positions 3 and sometimes 4 are used as a
           category identifier.  The remaining positions
           are serial numbers.  The following blocks of numbers
           are reserved for the facilities indicated (NOTE:
           may have different meanings dependent on the Type
           of Bill (TOB):

       -   A 'V' in the 5th position identifies a VA demo.

           0001-0879   Short-term (general and specialty)
                       hospitals where TOB = 11X; ESRD
                       clinic where TOB = 72X
           0880-0899   Reserved for hospitals participating
                       in ORD demonstration projects where
                       TOB = 11X; ESRD clinic where TOB =
                       72X
           0900-0999   Multiple hospital component in a
                       medical complex (numbers retired)
                       where TOB = 11X; ESRD clinic where
                       TOB = 72X
           1000-1199   Reserved for future use
           1200-1224   Alcohol/drug hospitals (excluded
                       from PPS-numbers retired)
                       where TOB = 11X; ESRD clinic where
                       TOB = 72X
           1225-1299   Medical assistance facilities
                       (Montana project); ESRD clinic where
                       TOB = 72X
           1300-1399   Rural Primary Care Hospital (RCPH) -
                       eff. 10/97 changed to Critical Access
                       Hospitals (CAH)
           1400-1499   Continuation of 4900-4999 series (CMHC)
           1500-1799   Hospices
           1800-1989   Federally Qualified Health Centers
                       (FQHC) where TOB = 73X; SNF (IP PTB)
                       where TOB = 22X; HHA where TOB = 32X,
                       33X, 34X
           1990-1999   Christian Science Sanatoria
                       (hospital services) - eff. 7/00 changed
                       to Religious Nonmedical Health Care
                       Institutions (RNHCI)
           2000-2299   Long-term hospitals
           2300-2499   Chronic renal disease facilities
                       (hospital based)
           2500-2899   Non-hospital renal disease
                       treatment centers
           2900-2999   Independent special purpose renal
                       dialysis facility (1)
           3000-3024   Formerly tuberculosis hospitals
                       (numbers retired)
           3025-3099   Rehabilitation hospitals
           3100-3199   Continuation of Subunits of Nonprofit
                       and Proprietary Home Health Agencies
                       (7300-7399) Series (3) (eff. 4/96)
           3200-3299   Continuation of 4800-4899 series (CORF)
           3300-3399   Children's hospitals (excluded from PPS)
                       where TOB = 11X; ESRD clinic where TOB =
                       72X
           3400-3499   Continuation of rural health clinics
                       (provider-based) (3975-3999)
           3500-3699   Renal disease treatment centers
                       (hospital satellites)
           3700-3799   Hospital based special purpose renal
                       dialysis facility (1)
           3800-3974   Rural health clinics (free-standing)
           3975-3999   Rural health clinics (provider-based)
           4000-4499   Psychiatric hospitals
           4500-4599   Comprehensive Outpatient
                       Rehabilitation Facilities (CORF)
           4600-4799   Community Mental Health Centers (CMHC);
                       9/30/91 - 3/31/97 used for clinic OPT
                       where TOB = 74X
           4800-4899   Continuation of 4500-4599 series (CORF)
                        (eff. 10/95)
           4900-4999   Continuation of 4600-4799 series (CMHC)
                       (eff. 10/95); 9/30/91 - 3/31/97 used for
                       clinic OPT where TOB = 74X
           5000-6499   Skilled Nursing Facilities
           6500-6989   CMHC / Outpatient physical therapy services
                       where TOB = 74X; CORF where TOB =
                       75X
           6990-6999   Christian Science Sanatoria (skilled
                       nursing services) - eff. 7/00 Numbers
                       Reserved (formerly CS)
           7000-7299   Home Health Agencies (HHA) (2)
           7300-7399   Subunits of 'nonprofit' and
                       'proprietary' Home Health Agencies (3)
           7400-7799   Continuation of 7000-7299 series
           7800-7999   Subunits of state and local governmental
                       Home Health Agencies (3)
           8000-8499   Continuation of 7400-7799 series (HHA)
           8500-8899   Continuation of rural health
                       center (provider based) (3400-3499)
           8900-8999   Continuation of rural health
                       center (free-standing) (3800-3974)
           9000-9799   Continuation of 8000-8499 series (HHA)
                       (eff. 10/95)
           9800-9899   Transplant Centers (eff. 10/1/07)
           9900-9999   Reserved for future use (eff. 8/1/98)
                       NOTE: 10/95-7/98 this series was
                       assigned to HHA's but rescinded - no
                       HHA's were ever assigned a number
                       from this series.

           Exception:

           P001-P999   Organ procurement organization

       (1) These facilities (SPRDFS) will be assigned
           the same provider number whenever they
           are recertified.

       (2) The 6400-6499 series of provider numbers
           in Iowa (16), South Dakota (43) and Texas (45)
           have been used in reducing acute care costs (RACC)
           experiments.

       (3) In Virginia (49), the series 7100-7299 has
           been reserved for statewide subunit components
           of the Virginia state home health agencies.

       (4) Parent agency must have a number in the
           7000-7299, 7400-7799 or 8000-8499 series.

       NOTE:
         There is a special numbering system for units
         of hospitals that are excluded from prospective
         payment system (PPS) and hospitals with SNF
         swing-bed designation.  An alpha character in
         the third position of the provider number
         identifies the type of unit or swing-bed
         designation as follows:

           M = Psychiatric Unit in Critical Access Hospital
           R = Rehabilitation Unit in Critical Access Hospital
           S = Psychiatric unit (excluded from PPS)
           T = Rehabilitation unit (excluded from PPS)
           U = Swing-Bed Hospital Designation for Short-
               Term Hospitals
           V = Alcohol drug unit (prior to 10/87 only)
           W = Swing-Bed Hospital Designation for Long
               Term Care Hospitals
           Y = Swing-Bed Hospital Designation for
               Rehabilitation Hospitals
           Z = Swing Bed Designation for Critical Access
               Hospitals

         There is also a special numbering system for
         assigning emergency hospital identification
         numbers (non participating hospitals).  The
         sixth position of the provider number is as
         follows:

           E = Non-federal emergency hospital
           F = Federal emergency hospital



 PTNT_DSCHRG_STUS_TB                     Patient Discharge Status Table

       01 = Discharged to home/self care (routine
            charge).
       02 = Discharged/transferred to other short term
            general hospital for inpatient care.
       03 = Discharged/transferred to skilled
            nursing facility (SNF) with Medicare
            certification in anticipation of covered
            skilled care -- (For hospitals with an
            approved swing bed arrangement, use Code
            61 - swing bed.  For reporting discharges/
            transfers to a non-certified SNF, the
            hospital must use Code 04 - ICF.
       04 = Discharged/transferred to a facility that
            provides custodial or supportive care (includes
            intermediate care facilities (ICF).  Also used
            to designate patients that are dischared/trans-
            ferred to a nursing facility with neither
            Medicare nor Medicaid certification and for
            discharges/transfers to Assisted Living Facilities.
       05 = Discharged/transferred to a designated cancer
            center or children's hospital (eff. 10/09). Prior
            to 10/1/09, discharged/transferred to another type
            of institution for inpatient care (including
            distinct parts).  NOTE:  Effective 1/2005,
            psychiatric hospital or psychiatric distinct
            part unit of a hospital will no longer be
            identified by this code.  New code is '65'.
       06 = Discharged/transferred to home care of
            organized home health service organization
            in anticipation of covered skilled care.
       07 = Left against medical advice or discontinued
            care.
       08 = Discharged/transferred to home under
            care of a home IV drug therapy provider.
            (discontinued effective 10/1/05)
       09 = Admitted as an inpatient to this
            hospital (effective 3/1/91).  In situa-
            tions  where a patient is admitted before
            midnight of the third day following the
            day of an outpatient service, the out-
            patient services are considered inpatient.
       20 = Expired
       21 = Discharged/transferred to Court/Law
            Enforcement.
       30 = Still patient.
       40 = Expired at home (Hospice claims only).
       41 = Expired in a medical facility such as
            hospital, SNF, ICF, or freestanding
            hospice. (Hospice claims only)
       42 = Expired - place unknown (Hospice claims
            only)
       43 = Discharged/transferred to a federal hospital
            (eff. 10/1/03). Discharges and transfers to a
            government operated health facility such as a
            Department of Defense hospital, a Veteran's
            Administration hospital or a Veteran's Administration
            nursing facility. To be used whenever the destination
            at discharge is a federal health care facility,
            whether the patient lives there or not.
       50 = Hospice - home (eff. 10/96)
       51 = Hospice - medical facility (certified) providing
            hospice level of care
       61 = Discharged/transferred within this insti-
            tution to a hospital-based Medicare
            approved swing bed (eff. 9/01)
       62 = Discharged/transferred to an inpatient
            rehabilitation facility including distinct
            parts units of a hospital.
            (eff. 1/2002)
       63 = Discharged/transferred to a Medicare certified
            long term care hospital. (eff. 1/2002)
       64 = Discharged/transferred to a nursing facility
            certified under Medicaid but not certified under
            Medicare (eff. 10/2002)
       65 = Discharged/Transferred to a psychiatric
            hospital or psychiatric distinct unit of a
            hospital (these types of hospitals were
            pulled from patient/discharge status code
            '05' and given their own code). (eff. 1/2005).
       66 = Discharged/transferred to a Critical Access
            Hospital (CAH) (eff. 1/1/06)
       69 = Discharge/transfers to a Designated Disaster
            Alternative Care site (eff. 10/2013)
       70 = Discharged/transferred to another type of health
            care institution not defined elsewhere in code
            list.
       71 = Discharged/transferred/referred to another
            institution for outpatient services as
            specified by the discharge plan of care
            (eff. 9/01) (discontinued effective 10/1/05)
       72 = Discharged/transferred/referred to this
            institution for outpatient services as
            specified by the discharge plan of care
            (eff. 9/01) (discontinued effective 10/1/05)
       81 = Discharged to home or self-care with a planned
            acute care hospital inpatient (eff. 10/2013)
       82 = Discharged/transferred to a short term general hospital
            for inpatient care readmission (eff. 10/2013)
       83 = Discharged/transferred to a skilled nursing facility
            (SNF) with Medicare (eff. 10/2013)
       84 = Discharged/transferred to a facility that provides
            custodial supportative care with a planned acute
            care hospital inpatient readmission certification
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       85 = Discharged/transferred to a designated cancer center or
            children's hospital with a planned acute care hospital
            inpatient readmission (eff. 10/2013)
       86 = Discharged/transferred to home under care of organized
            home health service organization with a planned acute
            care hospital inpatient readmission (eff. 10/2013)
       87 = Discharged/transferred to court/law enforcement with a
            planned acute care hospital inpatient readmission (eff.
            10/2013)
       88 = Discharged/transferred to a Federal health care facility
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       89 = Discharged/transferred to a hospital-based Medicare approved
            swing bed with a planned acute care hosptial inpatient
            readmission (eff. 10/2013)
       90 = Discharged/transferred to an inpatient rehabilitation
            facility (IRF) including rehabilitation distinct units of
            a hospital with a planned acute care hospital inpatient
            readmission (eff. 10/2013)
       91 = Discharged/transferred to a Medicare certified Long Term
            Care Hospital (LTCH) with a planned acute care hospital
            inpatient readmission (eff. 10/2013)
       92 = Discharged/transferred to a nursing facility certified
            under Medicaid but not certified under Medicare with a
            planned acute care hospital inpatient readmission (eff.
            10/2013)
       93 = Discharged/transferred to a psychiatric hospital or
            psychiatric distinct part unit of a hospital with a
            planned acute care hospital inpatient readmission
            (eff. 10/2013)
       94 = Discharged/transferred to a critical access hospital (CAH)
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       95 = Discharged/transferred to another type of health care
            institution not defined elsewhere in this code list with a
            planned acute care hospital inpatient readmission. (eff. 10/2013)



 REV_CNTR_ANSI_TB                        Revenue Center ANSI Code Table

      *******EXPLANATION OF CLAIM ADJUSTMENT GROUP CODES*******
      **************POSITIONS 1 & 2 OF ANSI CODE***************
      CO = Contractual Obligations -- this group code should
      be used when a contractual agreement between the
      payer and payee, or a regulatory requirement, re-
      sulted in an adjustment.  Generally, these adjust-
      ments are considered a write-off for the provider
      and are not billed to the patient.

      CR = Corrections and Reversals -- this group code should
      be used for correcting a prior claim.  It applies
      when there is a change to a previously adjudicated
      claim.

      OA = Other Adjustments -- this group code should be used
      when no other group code applies to the adjustment.

      PI = Payer Initiated Reductions -- this group code should
      be used when, in the opinion of the payer, the adjust-
      ment is not the responsibility of the patient, but
      there is no supporting contract between the provider
      and the payer (i.e., medical review or professional
      review organization adjustments).

      PR = Patient Responsibility -- this group should be used
      when the adjustment represents an amount that should
      be billed to the patient or insured.  This group
      would typically be used for deductible and copay
      adjustments.

      ***********Claim Adjustment Reason Codes***************
      ***********POSITIONS 3 through 5 of ANSI CODE**********

      1 = Deductible Amount
      2 = Coinsurance Amount
      3 = Co-pay Amount
      4 = The procedure code is inconsistent with the modifier
      used or a required modifier is missing.
      5 = The procedure code/bill type is inconsistent with the
      place of service.
      6 = The procedure code is inconsistent with the patient's
      age.
      7 = The procedure code is inconsistent with the patient's
      gender.
      8 = The procedure code is inconsistent with the provider
      type.
      9 = The diagnosis is inconsistent with the patient's age.
      10 = The diagnosis is inconsistent with the patient's
      gender.
      11 = The diagnosis is inconsistent with the procedure.
      12 = The diagnosis is inconsistent with the provider type.
      13 = the date of death precedes the date of service.
      14 = The date of birth follows the date of service.
      15 = Claim/service adjusted because the submitted auth-
      orization number is missing, invalid, or does not
      apply to the billed services or provider.
      16 = Claim/service lacks information which is needed for
      adjudication.
      17 = Claim/service adjusted because requested information
      was not provided or was insufficient/incomplete.
      18 = Duplicate claim/service.
      19 = Claim denied because this is a work-related injury/
      illness and thus the liability of the Worker's Com-
      pensation Carrier.
      20 = Claim denied because this injury/illness is covered
      by the liability carrier.
      21 = Claim denied because this injury/illness is the
      liability of the no-fault carrier.
      22 = Claim adjusted because this care may be covered by
      another payer per coordination of benefits.
      23 = Claim adjusted because charges have been paid by
      another payer.
      24 = Payment for charges adjusted.  Charges are covered
      under a capitation agreement/managed care plan.
      25 = Payment denied.  Your Stop loss deductible has not
      been met.
      26 = Expenses incurred prior to coverage.
      27 = Expenses incurred after coverage terminated.
      28 = Coverage not in effect at the time the service was
      provided.
      29 = The time limit for filing has expired.
      30 = Claim/service adjusted because the patient has not met
      the required eligibility, spend down, waiting, or
      residency requirements.
      31 = Claim denied as patient cannot be identified as our
      insured.
      32 = Our records indicate that this dependent is not an
      eligible dependent as defined.
      33 = Claim denied.  Insured has no dependent coverage.
      34 = Claim denied.  Insured has no coverage for newborns.
      35 = Benefit maximum has been reached.
      36 = Balance does not exceed copayment amount.
      37 = Balance does not exceed deductible amount.
      38 = Services not provided or authorized by designated
      (network) providers.
      39 = Services denied at the time authorization/pre-certi-
      fication was requested.
      40 = Charges do not meet qualifications for emergency/urgent
      care.
      41 = Discount agreed to in Preferred Provider contract.
      42 = Charges exceed our fee schedule or maximum allowable
      amount.
      43 = Gramm-Rudman reduction.
      44 = Prompt-pay discount.
      45 = Charges exceed your contracted/legislated fee arrange-
      ment.
      46 = This (these) service(s) is(are) not covered.
      47 = This (these) diagnosis(es) is(are) not covered,
      missing, or are invalid.
      48 = This (these) procedure(s) is(are) not covered.
      49 = These are non-covered services because this is a
      routine exam or screening procedure done in conjunc-
      tion with a routine exam.
      50 = These are non-covered services because this is not
      deemed a 'medical necessity' by the payer.
      51 = These are non-covered services because this a pre-
      existing condition.
      52 = The referring/prescribing/rendering provider is not
      eligible to refer/prescribe/order/perform the service
      billed.
      53 = Services by an immediate relative or a member of the
      same household are not covered.
      54 = Multiple physicians/assistants are not covered in this
      case.
      55 = Claim/service denied because procedure/treatment is
      deemed experimental/investigational by the payer.
      56 = Claim/service denied because procedure/treatment has
      not been deemed 'proven to be effective' by payer.
      57 = Claim/service adjusted because the payer deems the
      information submitted does not support this level of
      service, this many services, this length of service, or
      this dosage.
      58 = Claim/service adjusted because treatment was deemed by
      the payer to have been rendered in an inappropriate
      or invalid place of service.
      59 = Charges are adjusted based on multiple surgery rules or
      concurrent anesthesia rules.
      60 = Charges for outpatient services with the proximity to
      inpatient services are not covered.
      61 = Charges adjusted as penalty for failure to obtain second
      surgical opinion.
      62 = Claim/service denied/reduced for absence of, or exceeded,
      precertification/authorization.
      63 = Correction to a prior claim. INACTIVE
      64 = Denial reversed per Medical Review. INACTIVE
      65 = Procedure code was incorrect.  This payment reflects the
      correct code. INACTIVE
      66 = Blood Deductible.
      67 = Lifetime reserve days. INACTIVE
      68 = DRG weight. INACTIVE
      69 = Day outlier amount.
      70 = Cost outlier amount.
      71 = Primary Payer amount.
      72 = Coinsurance day. INACTIVE
      73 = Administrative days. INACTIVE
      74 = Indirect Medical Education Adjustment.
      75 = Direct Medical Education Adjustment.
      76 = Disproportionate Share Adjustment.
      77 = Covered days. INACTIVE
      78 = Non-covered days/room charge adjustment.
      79 = Cost report days. INACTIVE
      80 = Outlier days. INACTIVE
      81 = Discharges. INACTIVE
      82 = PIP days. INACTIVE
      83 = Total visits. INACTIVE
      84 = Capital adjustments. INACTIVE
      85 = Interest amount. INACTIVE
      86 = Statutory adjustment. INACTIVE
      87 = Transfer amounts.
      88 = Adjustment amount represents collection against
      receivable created in prior overpayment.
      89 = Professional fees removed from charges.
      90 = Ingredient cost adjustment.
      91 = Dispensing fee adjustment.
      92 = Claim paid in full. INACTIVE
      93 = No claim level adjustment. INACTIVE
      94 = Process in excess of charges.
      95 = Benefits adjusted.  Plan procedures not followed.
      96 = Non-covered charges.
      97 = Payment is included in allowance for another
      service/procedure.
      98 = The hospital must file the Medicare claim for this
      inpatient non-physician service. INACTIVE
      99 = Medicare Secondary Payer Adjustment Amount. INACTIVE
      100 = Payment made to patient/insured/responsible party.
      101 = Predetermination: anticipated payment upon comple-
      tion of services or claim ajudication.
      102 = Major medical adjustment.
      103 = Provider promotional discount (i.e. Senior citizen
      discount).
      104 = Managed care withholding.
      105 = Tax withholding.
      106 = Patient payment option/election not in effect.
      107 = Claim/service denied because the related or qualifying
      claim/service was not paid or identified on the claim.
      108 = Claim/service reduced because rent/purchase guidelines
      were not met.
      109 = Claim not covered by this payer/contractor.  You must
      send the claim to the correct payer/contractor.
      110 = Billing date predates service date.
      111 = Not covered unless the provider accepts assignment.
      112 = Claim/service adjusted as not furnished directly
      to the patient and/or not documented.
      113 = Claim denied because service/procedure was provided
      outside the United States or as a result of war.
      114 = Procedure/PRODuct not approved by the Food and Drug
      Administration.
      115 = Claim/service adjusted as procedure postponed or
      canceled.
      116 = Claim/service denied.  The advance indemnification
      notice signed by the patient did not comply with
      requirements.
      117 = Claim/service adjusted because transportation is only
      covered to the closest facility that can provide
      the necessary care.
      118 = Charges reduced for ESRD network support.
      119 = Benefit maximum for this time period has been reached.
      120 = Patient is covered by a managed care plan. INACTIVE
      121 = Indemnification adjustment.
      122 = Psychiatric reduction.
      123 = Payer refund due to overpayment.  INACTIVE
      124 = Payer refund amount - not our patient. INACTIVE
      125 = Claim/service adjusted due to a submission/billing
      error(s).
      126 = Deductible - Major Medical.
      127 = Coinsurance - Major Medical.
      128 = Newborn's services are covered in the mother's
      allowance.
      129 = Claim denied - prior processing information appears
      incorrect.
      130 = Paper claim submission fee.
      131 = Claim specific negotiated discount.
      132 = Prearranged demonstration project adjustment.
      133 = The disposition of this claim/service is pending
      further review.
      134 = Technical fees removed from charges.
      135 = Claim denied.  Interim bills cannot be processed.
      136 = Claim adjusted.  Plan procedures of a prior payer
      were not followed.
      137 = Payment/Reduction for Regulatory Surcharges, Assess-
      ments, Allowances or Health Related Taxes.
      138 = Claim/service denied.  Appeal procedures not
      followed or time limits not met.
      139 = Contracted funding agreement - subscriber is employed
      by the provider of services.
      140 = Patient/Insured health identification number and name
      do not match.
      141 = Claim adjustment because the claim spans eligible
      and ineligible periods of coverage.
      142 = Claim adjusted by the monthly Medicaid patient
      liability amount.
      A0 = Patient refund amount
      A1 = Claim denied charges.
      A2 = Contractual adjustment.
      A3 = Medicare Secondary Payer liability met. INACTIVE
      A4 = Medicare Claim PPS Capital Day Outlier Amount.
      A5 = Medicare Claim PPS Capital Cost Outlier Amount.
      A6 = Prior hospitalization or 30 day transfer requirement
      not met.
      A7 = Presumptive Payment Adjustment.
      A8 = Claim denied; ungroupable DRG.
      B1 = Non-covered visits.
      B2 = Covered visits. INACTIVE
      B3 = Covered charges. INACTIVE
      B4 = Late filing penalty.
      B5 = Claim/service adjusted because coverage/program
      guidelines were not met or were exceeded.
      B6 = This service/procedure is adjusted when performed/
      billed by this type of provider, by this type of
      facility, or by a provider of this specialty.
      B7 = This provider was not certified/eligible to be
      paid for this procedure/service on this date of
      service.
      B8 = Claim/service not covered/reduced because alter-
      native services were available, and should have
      been utilized.
      B9 = Services not covered because the patient is en-
      rolled in a Hospice.
      B10 = Allowed amount has been reduced because a com-
      ponent of the basic procedure/test was paid.  The
      beneficiary is not liable for more than the charge
      limit for the basic procedure/test.
      B11 = The claim/service has been transferred to the
      proper payer/processor for processing.  Claim/
      service not covered by this payer/processor.
      B12 = Services not documented in patients' medical re-
      cords.
      B13 = Previously paid.  Payment for this claim/service
      may have been provided in a previous payment.
      B14 = Claim/service denied because only one visit or
      consultation per physician per day is covered.
      B15 = Claim/service adjusted because this procedure/
      service is not paid separately.
      B16 = Claim/service adjusted because 'New Patient'
      qualifications were not met.
      B17 = Claim/service adjusted because this service was
      not prescribed by a physician, not prescribed
      prior to delivery, the prescription is incomplete,
      or the prescription is not current.
      B18 = Claim/service denied because this procedure code/
      modifier was invalid on the date of service or
      claim submission.
      B19 = Claim/service adjusted because of the finding of a
      Review Organization.  INACTIVE
      B20 = Charges adjusted because procedure/service was
      partially or fully furnished by another provider.
      B21 = The charges were reduced because the service/care
      was partially furnished by another physician.
      INACTIVE
      B22 = This claim/service is adjusted based on the
      diagnosis.
      B23 = Claim/service denied because this provider has
      failed an aspect of a proficiency testing program.
      W1 = Workers Compensation State Fee Schedule Adjustment.



 REV_CNTR_APC_BUFR_TB                    Revenue Center Ambulatory Payment Classification (APC) Buffer Code Table

      00 = No composite group assigned
      01 = First composite group on claim
      02 = Second composite group on claim
      NN = nth composite group on claim
        ---------------------------------
      00    =     N/A in this case
      01-99 =    1st composite - 99th composite
      A1-A9 =  100th composite - 108th composite
      B1-B9 =  109th composite - 117th composite
      C1-C9 =  118th composite - 126th composite
      D1-D9 =  127th composite - 135th composite
      E1-E9 =  136th composite - 144th composite
      F1-F9 =  145th composite - 153rd composite
      G1-G9 =  154th composite - 162nd composite
      H1-H9 =  163rd composite - 171st composite
      I1-I9 =  172nd composite - 180th composite
      J1-J9 =  181st composite - 189th composite
      K1-K9 =  190th composite - 198th composite
      L1-L9 =  199th composite - 207th composite
      M1-M9 =  208th composite - 216th composite
      N1-N9 =  217th composite - 225th composite
      O1-O9 =  226th composite - 234th composite
      P1-P9 =  235th composite - 243rd composite
      Q1-Q9 =  244th composite - 252nd composite
      R1-R9 =  253rd composite - 261st composite
      S1-S9 =  262nd composite - 270th composite
      T1-T9 =  271st composite - 279th composite
      U1-U9 =  280th composite - 288th composite
      V1-V9 =  289th composite - 297th composite
      W1-W9 =  298th composite - 306th composite
      X1-X9 =  307th composite - 315th composite
      Y1-Y9 =  316th composite - 324th composite
      Z1-Z9 =  325th composite - 333rd composite

      AA-AZ =  334th composite - 359th composite
      BA-BZ =  360th composite - 385th composite
      CA-CZ =  386th composite - 411th composite
      DA-DZ =  412th composite - 437th composite
      EA-EZ =  438th composite - 463rd composite
      FA-FZ =  464th composite - 489th composite
      GA-GZ =  490th composite - 515th composite
      HA-HZ =  516th composite - 541st composite
      IA-IZ =  542nd composite - 567th composite
      JA-JZ =  568th composite - 593rd composite
      KA-KZ =  594th composite - 619th composite
      LA-LZ =  620th composite - 645th composite
      MA-MZ =  646th composite - 671st composite
      NA-NZ =  672nd composite - 697th composite
      OA-OZ =  698th composite - 723rd composite
      PA-PZ =  724th composite - 749th composite
      QA-QZ =  750th composite - 775th composite
      RA-RZ =  776th composite - 801st composite
      SA-SZ =  802nd composite - 827th composite
      TA-TZ =  828th composite - 853rd composite
      UA-UZ =  854th composite - 879th composite
      VA-VZ =  880th composite - 905th composite
      WA-WZ =  906th composite - 931st composite
      XA-XZ =  932nd composite - 957th composite
      ZA-ZZ =  958th composite - 983rd composite



 REV_CNTR_APC_TB                         Revenue Center Ambulatory Payment Classification (APC)

      0000 = Code used when Payment Method Indicator
      equals 'N9'
      0001 = Photochemotherapy
      0002 = Fine needle Biopsy/Aspiration
      0003 = Bone Marrow Biopsy/Aspiration
      0004 = Level I Needle Biopsy/ Aspiration Except
      Bone Marrow
      0005 = Level II Needle Biopsy /Aspiration Except
      Bone Marrow
      0006 = Level I Incision & Drainage
      0007 = Level II Incision & Drainage
      0008 = Level III Incision & Drainage
      0009 = Nail Procedures
      0010 = Level I Destruction of Lesion
      0011 = Level II Destruction of Lesion
      0012 = Level I Debridement & Destruction
      0013 = Level II Debridement & Destruction
      0014 = Level III Debridement & Destruction
      0015 = Level IV Debridement & Destruction
      0016 = Level V Debridement & Destruction
      0017 = Level VI Debridement & Destruction
      0018 = Biopsy Skin, Subcutaneous Tissue or Mucous Membrane
      0019 = Level I Excision/ Biopsy
      0020 = Level II Excision/ Biopsy
      0021 = Level III Excision/ Biopsy
      0022 = Level IV Excision/ Biopsy
      0023 = Exploration Penetrating Wound
      0024 = Level I Skin Repair
      0025 = Level II Skin Repair
      0026 = Level III Skin Repair
      0027 = Level IV Skin Repair
      0028 = Level I Incision/Excision Breast
      0029 = Incision/Excision Breast (obsolete 12/00);
      Level II Incision/Excision Breast (effective 1/01)
      0030 = Breast Reconstruction/Mastectomy
      0031 = Hyperbaric Oxygen (obsolete 1/01)
      0032 = Placement Transvenous Catheters/Arterial Cutdown
      0033 = Partial Hospitalization
      0040 = Arthrocentesis & Ligament/Tendon Injection
      0041 = Arthroscopy
      0042 = Arthroscopically-Aided Procedures
      0043 = Closed Treatment Fracture Finger/Toe/Trunk
      0044 = Closed Treatment Fracture/Dislocation Except
      Finger/Toe/Trunk
      0045 = Bone/Joint Manipulation Under Anesthesia
      0046 = Open/Percutaneous Treatment Fracture or Dislocation
      0047 = Arthroplasty without Prosthesis
      0048 = Arthroplasty with Prosthesis
      0049 = Level I Musculoskeletal Procedures Except Hand
      and Foot
      0050 = Level II Musculoskeletal Procedures Except Hand
      and Foot
      0051 = Level III Musculoskeletal Procedures Except Hand
      and Foot
      0052 = Level IV Musculoskeletal Procedures Except Hand
      and Foot
      0053 = Level I Hand Musculoskeletal Procedures
      0054 = Level II Hand Musculoskeletal Procedures
      0055 = Level I Foot Musculoskeletal Procedures
      0056 = Level II Foot Musculoskeletal Procedures
      0057 = Bunion Procedures
      0058 = Level I Strapping and Cast Application
      0059 = Level II Strapping and Cast Application
      0060 = Manipulation Therapy
      0070 = Thoracentesis/Lavage Procedures
      0071 = Level I Endoscopy Upper Airway
      0072 = Level II Endoscopy Upper Airway
      0073 = Level III Endoscopy Upper Airway
      0074 = Level IV Endoscopy Upper Airway
      0075 = Level V Endoscopy Upper Airway
      0076 = Endoscopy Lower Airway
      0077 = Level I Pulmonary Treatment
      0078 = Level II Pulmonary Treatment
      0079 = Ventilation Initiation and Management
      0080 = Diagnostic Cardiac Catheterization
      0081 = Non-Coronary Angioplasty or Atherectomy
      0082 = Coronary Atherectomy
      0083 = Coronary Angiosplasty
      0084 = Level I Electrophysiologic Evaluation
      0085 = Level II Electrophysiologic Evaluation
      0086 = Ablate Heart Dysrhythm Focus
      0087 = Cardiac Electrophysiologic Recording/Mapping
      0088 = Thrombectomy
      0089 = Level I Implantation/Removal/Revision of
      Pacemaker, AICD Vascular Device (obsolete 12/00);
      Insertion/Replacement of Permanent Pacemaker and
      Electrodes (eff. 1/01)
      0090 = Level II Implantation/Removal/Revision of
      Pacemaker AICD Vascular Device (obsolete 12/00);
      Insertion/Replacement of Permanent Pacemaker
      and Pulse Generator
      0091 = Level I Vascular Ligation
      0092 = Level II Vascular Ligation
      0093 = Vascular Repair/Fistula Construction
      0094 = Resuscitation and Cardioversion
      0095 = Cardiac Rehabilitation
      0096 = Non-Invasive Vascular Studies
      0097 = Cardiovascular Stress Test (obsolete 12/00);
      Cardiac Monitoring for 30 days (eff. 1/01)
      0098 = Injection of Sclerosing Solution
      0099 = Continuous Cardiac Monitoring (obsolete 12/00);
      Electrocardiograms (eff. 1/01)
      0100 = Stress test and continuous ECG
      0101 = Tilt Table Evaluation
      0102 = Electronic Analysis of Pacemakers/other Devices
      0103 = Miscellaneous Vascular Procedures (eff. 1/01)
      0104 = Transcatheter Placement of Intracoronary Stents
      (eff. 1/01)
      0105 = Revision/Removal of Pacemakers, AICD or Vascular
      (eff. 1/01)
      0106 = Insertion/Replacement/Repair of Pacemaker
      Electrode (eff. 1/01)
      0107 = Insertion of Cardioverter-Defibrillator
      (eff. 1/01)
      0108 = Insertion/Replacement/Repair of Cardioverter-
      Defibrillator Leads (eff. 1/01)
      0109 = Bone Marrow Harvesting and Bone Marrow/Stem Cell
      Transplant (obsolete 12/00); Removal of Implanted
      Devices (eff. 1/01)
      0110 = Transfusion
      0111 = Blood PRODuct Exchange
      0112 = Extracorporeal Photopheresis
      0113 = Excision Lymphatic System
      0114 = Thyroid/Lymphadenectomy Procedures
      0115 = Cannula/Access Device Procedures
      (eff. 1/01)
      0116 = Chemotherapy Administration by Other Technique
      Except Infusion
      0117 = Chemotherapy Administration by Infusion Only
      0118 = Chemotherapy Administration by Both Infusion and
      Other Technique
      0119 = Implantation of Devices (eff. 1/01)
      0120 = Infusion Therapy Except Chemotherapy
      0121 = Level I Tube changes and Repositioning
      0122 = Level II Tube changes and Repositioning
      0123 = Bone Marrow Harvesting and Bone Marrow/Stem
      Cell Transplant
      0124 = Revision of Implanted Infusion Pump
      (eff. 1/01)
      0130 = Level I Laparoscopy
      0131 = Level II Laparoscopy
      0132 = Level III Laparoscopy
      0140 = Esophageal Dilation without Endoscopy
      0141 = Upper GI Procedures
      0142 = Small Intestine Endoscopy
      0143 = Lower GI Endoscopy
      0144 = Diagnostic Anoscopy
      0145 = Therapeutic Anoscopy
      0146 = Level I Sigmoidoscopy
      0147 = Level II Sigmoidoscopy
      0148 = Level I Anal/Rectal Procedure
      0149 = Level II Anal/Rectal Procedure
      0150 = Level III Anal/Rectal Procedure
      0151 = Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
      0152 = Percutaneous Biliary Endoscopic Procedures
      0153 = Peritoneal and Abdominal Procedures
      0154 = Hernia/Hydrocele Procedures
      0157 = Colorectal Cancer Screening: Barium Enema
      (Not subject to National coinsurance)
      0158 = Colorectal Cancer Screening: Colonoscopy
      Not subject to National coinsurance.  Minimum
      unadjusted coinsurance is 25% of the payment rate.
      Payment rate is lower of the HOPD payment rate or
      the Ambulatory Surgical Center payment.
      0159 = Colorectal Cancer Screening: Flexible Sigmoidoscopy
      Not subject to National coinsurance.  Minimum
      unadjusted coinsurance is 25% of the payment rate.
      Payment rate is lower of the HOPD payment rate or
      the Ambulatory Surgical Center payment.
      0160 = Level I Cystourethroscopy and other Genitourinary
      Procedures
      0161 = Level II Cystourethroscopy and other Genitourinary
      Procedures
      0162 = Level III Cystourethroscopy and other Genitourinary
      Procedures
      0163 = Level IV Cystourethroscopy and other Genitourinary
      Procedures
      0164 = Level I  Urinary and Anal Procedures
      0165 = Level II  Urinary and Anal Procedures
      0166 = Level I Urethral Procedures
      0167 = Level II Urethral Procedures
      0168 = Level III Urethral Procedures
      0169 = Lithotripsy
      0170 = Dialysis for Other Than ESRD Patients
      0180 = Circumcision
      0181 = Penile Procedures
      0182 = Insertion of Penile Prosthesis
      0183 = Testes/Epididymis Procedures
      0184 = Prostate Biopsy
      0190 = Surgical Hysteroscopy
      0191 = Level I Female RePRODuctive Procedures
      0192 = Level II Female RePRODuctive Procedures
      0193 = Level III Female RePRODuctive Procedures
      0194 = Level IV Female RePRODuctive Procedures
      0195 = Level V Female RePRODuctive Procedures
      0196 = Dilatation & Curettage
      0197 = Infertility Procedures
      0198 = Pregnancy and Neonatal Care Procedures
      0199 = Vaginal Delivery
      0200 = Therapeutic Abortion
      0201 = Spontaneous Abortion
      0210 = Spinal Tap
      0211 = Level I Nervous System Injections
      0212 = Level II Nervous System Injections
      0213 = Extended EEG Studies and Sleep Studies
      0214 = Electroencephalogram
      0215 = Level I Nerve and Muscle Tests
      0216 = Level II Nerve and Muscle Tests
      0217 = Level III Nerve and Muscle Tests
      0220 = Level I Nerve Procedures
      0221 = Level II Nerve Procedures
      0222 = Implantation of Neurological Device
      0223 = Level I Revision/Removal Neurological Device
      (obsolete 12/00); Implantation of Pain
      Management Device (eff. 1/01)
      0224 = Level II Revision/Removal Neurological Device
      (obsolete 12/00); Implantation of Reservoir/
      Pump/Shunt (eff. 1/01)
      0225 = Implantation of Neurostimulator Electrodes
      0226 = Implantation of Drug Infusion Reservior
      (eff. 1/01)
      0227 = Implantation of Drug Infusion Device
      (eff. 1/01)
      0228 = Creation of Lumbar Subarachnoid Shunt
      (eff. 1/01)
      0229 = Transcatherter Placement of Intravascular Shunts
      (eff. 1/01)
      0230 = Level I Eye Tests
      0231 = Level II Eye Tests
      0232 = Level I Anterior Segment Eye
      0233 = Level II Anterior Segment Eye
      0234 = Level III Anterior Segment Eye Procedures
      0235 = Level I Posterior Segment Eye Procedures
      0236 = Level II Posterior Segment Eye Procedures
      0237 = Level III Posterior Segment Eye Procedures
      0238 = Level I Repair and Plastic Eye Procedures
      0239 = Level II Repair and Plastic Eye Procedures
      0240 = Level III Repair and Plastic Eye Procedures
      0241 = Level IV Repair and Plastic Eye Procedures
      0242 = Level V Repair and Plastic Eye Procedures
      0243 = Strabismus/Muscle Procedures
      0244 = Corneal Transplant
      0245 = Cataract Procedures without IOL Insert
      0246 = Cataract Procedures with IOL Insert
      0247 = Laser Eye Procedures Except Retinal
      0248 = Laser Retinal Procedures
      0250 = Nasal Cauterization/Packing
      0251 = Level I ENT Procedures
      0252 = Level II ENT Procedures
      0253 = Level III ENT Procedures
      0254 = Level IV ENT Procedures
      0256 = Level V ENT Procedures
      0257 = Implantation of Cochlear Device (obsolete 1/01)
      0258 = Tonsil and Adenoid Procedures
      0260 = Level I Plain Film Except Teeth
      0261 = Level II Plain Film Except Teeth Including Bone
      Density Measurement
      0262 = Plain Film of Teeth
      0263 = Level I Miscellaneous Radiology Procedures
      0264 = Level II Miscellaneous Radiology Procedures
      0265 = Level I Diagnostic Ultrasound Except Vascular
      0266 = Level II Diagnostic Ultrasound Except Vascular
      0267 = Vascular Ultrasound
      0268 = Guidance Under Ultrasound
      0269 = Echocardiogram Except Transesophageal
      0270 = Transesophageal Echocardiogram
      0271 = Mammography
      0272 = Level I Fluoroscopy
      0273 = Level II Fluoroscopy
      0274 = Myelography
      0275 = Arthrography
      0276 = Level I Digestive Radiology
      0277 = Level II Digestive Radiology
      0278 = Diagnostic Urography
      0279 = Level I Diagnostic Angiography and Venography
      Except Extremity
      0280 = Level II Diagnostic Angiography and Venography
      Except Extremity
      0281 = Venography of Extremity
      0282 = Level I Computerized Axial Tomography
      0283 = Level II Computerized Axial Tomography
      0284 = Magnetic Resonance Imaging
      0285 = Positron Emission Tomography (PET)
      0286 = Myocardial Scans
      0290 = Standard Non-Imaging Nuclear Medicine
      0291 = Level I Diagnostic Nuclear Medicine Excluding
      Myocardial Scans
      0292 = Level II Diagnostic Nuclear Medicine Excluding
      Myocardial Scans
      0294 = Level I Therapeutic Nuclear Medicine
      0295 = Level II Therapeutic Nuclear Medicine
      0296 = Level I Therapeutic Radiologic Procedures
      0297 = Level II Therapeutic Radiologic Procedures
      0300 = Level I Radiation Therapy
      0301 = Level II Radiation Therapy
      0302 = Level III Radiation Therapy
      0303 = Treatment Device Construction
      0304 = Level  I Therapeutic Radiation Treatment
      Preparation
      0305 = Level II Therapeutic Radiation Treatment
      Preparation
      0310 = Level III Therapeutic Radiation Treatment
      Preparation
      0311 = Radiation Physics Services
      0312 = Radioelement Applications
      0313 = Brachytherapy
      0314 = Hyperthermic Therapies
      0320 = Electroconvulsive Therapy
      0321 = Biofeedback and Other Training
      0322 = Brief Individual Psychotherapy
      0323 = Extended Individual Psychotherapy
      0324 = Family Psychotherapy
      0325 = Group Psychotherapy
      0330 = Dental Procedures
      0340 = Minor Ancillary Procedures
      0341 = Immunology Tests
      0342 = Level I Pathology
      0343 = Level II Pathology
      0344 = Level III Pathology
      0345 = Transfusion Laboratory Procedures Level I
      (eff. 1/01)
      0346 = Transfusion Laboratory Procedures Level II
      (eff. 1/01)
      0347 = Transfusion Laboratory Procedures Level III
      (eff. 1/01)
      0348 = Fertility Laboratory Procedures
      (eff. 1/01)
      0349 = Miscellaneous Laboratory Procedures
      (eff. 1/01)
      0354 = Administration of Influenza Vaccine (Not
      subject to national coinsurance)
      0355 = Level I Immunizations
      0356 = Level II Immunizations
      0357 = Level III Immunizations (obsolete 1/01)
      0358 = Level IV Immunizations (obsolete 1/01)
      0359 = Injections
      0360 = Level I Alimentary Tests
      0361 = Level II Alimentary Tests
      0362 = Fitting of Vision Aids
      0363 = Otorhinolaryngologic Function Tests
      0364 = Level I Audiometry
      0365 = Level II Audiometry
      0366 = Electrocardiogram (ECG) (obsolete 1/01)
      0367 = Level I Pulmonary Test
      0368 = Level II Pulmonary Test
      0369 = Level III Pulmonary Test
      0370 = Allergy Tests
      0371 = Allergy Injections
      0372 = Therapeutic Phlebotomy
      0373 = Neuropsychological Testing
      0374 = Monitoring Psychiatric Drugs
      0600 = Low Level Clinic Visits
      0601 = Mid Level Clinic Visits
      0602 = High Level Clinic Visits
      0603 = Interdisciplinary Team Conference (obsolete 1/01)
      0610 = Low Level Emergency Visits
      0611 = Mid Level Emergency Visits
      0612 = High Level Emergency Visits
      0620 = Critical Care
      0701 = Strontium (eligible for pass-through payments)
      (obsolete 12/00); SR 89 chloride, per mCi
      (eff. 1/01)
      0702 = Samariam (eligible for pass-through payments)
      (obsolete 12/00); SM 153 lexidronam, 50 mCi
      (eff. 1/01)
      0704 = IN 111 Satumomab Pendetide (eligible for pass-
      through payments)
      0705 = Tc99 Tetrofosmin (eligible for pass-through
      payments)
      0725 = Leucovorin Calcium (eligible for pass-through
      payments)
      0726 = Dexrazoxane Hydrochloride (eligible for pass-
      through payments)
      0727 = Injection, Etidronate Disodium (eligible for
      pass-through payments)
      0728 = Filgrastim (G-CSF) (eligible for pass-through
      payments)
      0730 = Pamidronate Disodium (eligible for pass-through
      payments)
      0731 = Sargramostim (GM-CSF) (eligible for pass-through
      payments)
      0732 = Mesna (eligible for pass-through payments)
      0733 = Non-ESRD Epoetin Alpha (eligible for pass-
      through payments)
      0750 = Dolasetron Mesylate 10 mg (eligible for pass-
      through payments)
      0754 = Metoclopramide HCL (eligible for pass-through
      payments)
      0755 = Thiethylperazine Maleate (eligible for pass-through
      payments)
      0761 = Oral Substitute for IV Antiemtic (eligible for pass-
      through payments)
      0762 = Dronabinol (elibible for pass-through payments)
      0763 = Dolasetron Mesylate 100 mg Oral (eligible for
      pass-through payments)
      0764 = Granisetron HCL, 100 mcg (eligible for pass-
      through payments)
      0765 = Granisetron HCL, 1mg Oral (eligible for pass-
      through payments)
      0768 = Ondansetron Hydrochloride per 1 mg Injection
      (eligible for pass-through payments)
      0769 = Ondansetron Hydrochloride 8 mg oral
      (eligible for pass-through payments)
      0800 = Leuprolide Acetate per 3.75 mg (eligible for
      pass-through payments)
      0801 = Cyclophosphamide (eligible for pass-through
      payments)
      0802 = Etoposide (eligible for pass-through payments)
      0803 = Melphalan (eligible for pass-through payments)
      0807 = Aldesleukin single use vial (eligible for pass-
      through payments)
      0809 = BCG (Intravesical) one vial (eligible for pass-
      through payments)
      0810 = Goserelin Acetate Implant, per 3.6 mg (eligible for
      pass-through payments)
      0811 = Carboplatin 50 mg (eligible for pass-through
      payments)
      0812 = Carmustine 100 mg (eligible for pass-through
      payments)
      0813 = Cisplatin 10 mg (eligible for pass-through
      payments)
      0814 = Asparaginase, 10,000 units (eligible for pass-
      through payments)
      0815 = Cyclophosphamide 100 mg (eligible for pass-
      through payments)
      0816 = Cyclophosphamide, Lyophilized 100 mg (eligible
      for pass-through payments)
      0817 = Cytrabine 100 mg (eligible for pass-through
      payments)
      0818 = Dactinomycin 0.5 mg (eligible for pass-through
      payments)
      0819 = Dacarbazine 100 mg (eligible for pass-through
      payments)
      0820 = Daunorubicin HCI 10 mg (eligible for pass-through
      payments)
      0821 = Daunorubicin Citrate, Liposomal Formulation, 10 mg
      (eligible for pass-through payments)
      0822 = Diethylstibestrol Diphosphate 250 mg
      (eligible for pass-through payments)
      0823 = Docetaxel 20 mg (eligible for pass-through
      payments)
      0824 = Etoposide 10 mg (eligible for pass-through
      payments)
      0826 = Methotrexate Oral 2.5 mg (eligible for pass-through
      payments)
      0827 = Floxuridine injection 500mg
      0828 = Gemcitabine HCL 200 mg (eligibile for pass-
      through payments)
      0830 = Irinotecan 20 mg (eligible for pass-through
      payments)
      0831 = Ifosfamide injection 1 gm (eligible for pass-through
      payments)
      0832 = Idarubicin HCL injection 5 mg (eligible for pass-
      through payments)
      0833 = Interferon Alfacon-1, 1 mcg
      (eligible for pass-through payments)
      0834 = Interferon,  Alfa-2A, Recombinant 3 million units
      (eligible for pass-through payments)
      0836 = Interferon,  Alfa-2B, Recombinant, 1 million units
      (eligible for pass-through payments)
      0838 = Interferon, Gamma 1-B injection, 3 million units
      (eligible for pass-through payments)
      0839 = Mechlorethamine HCL injection 10 mg
      (eligible for pass-through payments)
      0840 = Melphalan HCL 50 mg (eligible for pass-
      through payments)
      0841 = Methotrexate sodium injection 5 mg (eligible for
      pass-through payments)
      0842 = Fludarabine Phosphate injection 50 mg (eligible for
      pass-through payments)
      0843 = Pegaspargase, single dose vial (eligible for
      pass-through payments)
      0844 = Pentostatin injection, 10 mg (eligible for pass-
      through payments)
      0847 = Doxorubicin HCL 10 mg (eligible for pass-through
      payments)
      0849 = Rituximab, 100 mg (eligible for pass-through
      payments)
      0850 = Streptozocin injection, 1 gm (eligible for pass-
      through payments)
      0851 = Thiotepa injection, 15 mg (eligible for pass-through
      payments)
      0852 = Topotecan 4 mg (eligible for pass-through payments)
      0853 = Vinblastine Sulfate injection, 1 mg (eligible for
      pass-through payments)
      0854 = Vincristine Sulfate 1 mg (eligible for pass-through
      payments)
      0855 = Vinorelbine Tartrate per 10 mg (eligible for pass-
      through payments)
      0856 = Porfimer Sodium 75 mg (eligible for pass-through
      payments)
      0857 = Bleomycin Sulfate injection 15 units (eligible for
      pass-through payments)
      0858 = Cladribine, 1mg (eligible for pass-through payments)
      0859 = Fluorouracil injection 500 mg
      0860 = Plicamycin (mithramycin) injection, 2.5 mg
      0861 = Leuprolide Acetate 1 mg (eligible for pass-through
      payments)
      0862 = Mitomycin, 5mg (eligible for pass-through payments)
      0863 = Paclitaxel, 30mg (eligible for pass-through payments)
      0864 = Mitoxantrone HCl,  per 5mg (eligible for pass-through
      payments)
      0865 = Interferon alfa-N3, 250,000 IU (eligible for pass-
      through payments)
      0884 = Rho (D) Immune Globulin, Human one dose pack
      (eligible for pass-through payments)
      0886 = Azathioprine,  50 mg oral
      (Not subject to national coinsurance)
      0887 = Azathioprine, Parenteral 100 mg, 20 ml each injection
      (Not subject to national coinsurance)
      0888 = Cyclosporine, Oral 100 mg
      (Not subject to national coinsurance)
      0889 = Cyclosporine, Parenteral
      (Not subject to national coinsurance)
      0890 = Lymphocyte Immune Globulin 250 mg
      (Not subject to national coinsurance)
      0891 = Tacrolimus per 1 mg oral
      (Not subject to national coinsurance)
      0892 = Daclizumab, Parenteral, 25 mg (obsolete 1/01)
      (eligible for pass-through payments)
      0900 = Injection, Alglucerase per 10 units
      (eligible for pass-through payments)
      0901 = Alpha I, Proteinase Inhibitor, Human per 10mg
      (eligible for pass-through payments)
      0902 = Botulinum Toxin, Type A per unit
      (eligible for pass-through payments)
      0903 = CMV Immune Globulin (obsolete 12/00);
      Cytomegalovirus imm IV, vial
      (eligible for pass-through payments) (eff. 1/01)
      0905 = Immune Globulin per 500 mg
      (eligible for pass-through payments)
      0906 = RSV-ivig 50 mg
      (eligible for pass-through payments)
      0907 = Ganciclovir Sodium 500 mg injection
      (Not subject to national coinsurance)
      0908 = Tetanus Immune Globulin, injection up to 250 units
      (Not subject to national coinsurance)
      0909 = Interferon Beta - 1a   33 mcg (eligible for pass-
      through payments)
      0910 = Interferon Beta - 1b   0.25 mg (eligible for pass-
      through payments)
      0911 = Streptokinase per 250,000 iu
      (Not subject to national coinsurance)
      0913 = Ganciclovir long act implant 4.5  mg (eligible for
      pass-through payments)
      0914 = Reteplase, 37.6 mg
      (Not subject to national coinsurance)
      0915 = Alteplase injection,recombinant, 10mg
      (Not subject to national coinsurance)
      0916 = Imiglucerase per unit (eligible for pass-through
      payments)
      0917 = Dipyridamole, 10mg / Adenosine 6MG
      (Not subject to national coinsurance) (obsolete 1/01)
      Pharmalogic stresses (eff. 1/01)
      0918 = Brachytherapy Seeds, Any type, Each (eligible
      for pass-through payments) (obsolete 4/01)
      0925 = Factor VIII (Antihemophilic Factor, Human) per iu
      (eligible for pass-through payments)
      0926 = Factor VIII (Antihemophilic Factor, Porcine) per  iu
      (eligible for pass-through payments)
      0927 = Factor VIII (Antihemophilic Factor, Recombinant)
      per iu (eligible for pass-through payments)
      0928 = Factor IX,  Complex (eligible for pass-through
      payments)
      0929 = Other Hemophilia Clotting Factors per iu (eligible
      for pass-through payments) (obsolete 1/01)
      Anti-inhibitor per iu (eff. 1/01)
      0930 = Antithrombin III (Human) per iu (eligible for pass-
      through payments)
      0931 = Factor IX (Antihemophilic Factor, Purified, Non-
      Recombinant) (eligible for pass-through payments)
      0932 = Factor IX (Antihemophilic Factor, Recombinant)
      (eligible for pass-through payments)
      0949 = Plasma, Pooled Multiple Donor, Solvent/Detergent
      Treated, Frozen (not subject to national coinsurance)
      0950 = Blood (Whole) For Transfusion (not subject to
      national coinsurance)
      0952 = Cryoprecipitate (not subject to national coinsurance)
      0953 = Fibrinogen Unit (not subject to national coinsurance)
      0954 = Leukocyte Poor Blood (not subject to national
      coinsurance)
      0955 = Plasma, Fresh Frozen (not subject to national
      coinsurance)
      0956 = Plasma Protein Fraction (not subject to national
      coinsurance)
      0957 = Platelet Concentrate (not subject to national
      coinsurance)
      0958 = Platelet Rich Plasma (not subject to national
      coinsurance)
      0959 = Red Blood Cells (not subject to national coinsurance)
      0960 = Washed Red Blood Cells (not subject to national
      coinsurance)
      0961 = Infusion, Albumin (Human) 5%, 500 ml
      (not subject to national coinsurance)
      0962 = Infusion, Albumin (Human) 25%, 50 ml
      (not subject to national coinsurance)
      0970 = New Technology - Level I     ($0 - $50)
      (not subject to national coinsurance)
      0971 = New Technology - Level II    ($50 - $100)
      (not subject to national coinsurance)
      0972 = New Technology - Level III    ($100 - $200)
      (not subject to national coinsurance)
      0973 = New Technology - Level IV   ($200 - $300)
      (not subject to national coinsurance)
      0974 = New Technology - Level V    ($300 - $500)
      (not subject to national coinsurance)
      0975 = New Technology - Level VI   ($500 - $750)
      (not subject to national coinsurance)
      0976 = New Technology - Level VII   ($750 - $1000)
      (not subject to national coinsurance)
      0977 = New Technology - Level VIII  ($1000 - $1250)
      (not subject to national coinsurance)
      0978 = New Technology - Level IX    ($1250 - $1500)
      (not subject to national coinsurance)
      0979 = New Technology - Level X     ($1500 - $1750)
      (not subject to national coinsurance)
      0980 = New Technology - Level XI    ($1750 - $2000)
      (not subject to national coinsurance)
      0981 = New Technology - Level XII   ($2000 - $2500)
      (not subject to national coinsurance)
      0982 = New Technology - Level XIII   ($2500 - $3500)
      (not subject to national coinsurance)
      0983 = New Technology - Level XIV  ($3500 - $5000)
      (not subject to national coinsurance)
      0984 = New Technology - Level XV   ($5000 - $6000)
      (not subject to national coinsurance)
      0987 = New Device Technology - Level I ($0 - $250)
      (eff. 1/01)
      0988 = New Device Technology - Level II ($250 - $500)
      (eff. 1/01)
      0989 = New Device Technology - Level III ($500 - $750)
      (eff. 1/01)
      0990 = New Device Technology - Level IV ($750 - $1000)
      (eff. 1/01)
      0991 = New Device Technology - Level V ($1000 - $1500)
      (eff. 1/01)
      0992 = New Device Technology - Level VI ($1500 - $2000)
      (eff. 1/01)
      0993 = New Device Technology - Level VII ($2000 - $3000)
      (eff. 1/01)
      0994 = New Device Technology - Level VIII ($3000 - $4000)
      (eff. 1/01)
      0995 = New Device Technology - Level IX ($4000 - $5000)
      (eff. 1/01)
      0996 = New Device Technology - Level X ($5000 - $7000)
      (eff. 1/01)
      0997 = New Device Technology - Level XI ($7000 - $9000)
      (eff. 1/01)
      1000 = Perclose Closer Prostar Arterial Vascular
      Closure (eff. 1/01)
      1001 = AcuNav-diagnostic ultrasound ca (eff. 1/01)
      1002 = Cochlear Implant System (eff. 1/01)
      1003 = Cath, ablation, livewire TC (eff. 1/01)
      1004 = Fast-Cath, Swartz, SAFL, CSTA (eff. 1/01)
      1006 = ARRAY post chamb IOL (eff. 1/01)
      1007 = Ams 700 penile prosthesis (eff. 1/01)
      1008 = Urolume-implant urethral stent (eff. 1/01)
      1009 = Plasma, cryoprecipitate-reduced, unit
      (eff. 1/01)
      1010 = Blood, L/R CMV-neg (eff. 1/01)
      1011 = Platelets, L/R, CMV-neg (eff. 1/01)
      1012 = Platelet concentrate, L/R, irradiated, unit
      (eff. 1/01)
      1013 = Platelet concentrate, L/R, unit (eff. 1/01)
      1014 = Platelets, aph/pher, L/R, unit (eff. 1/01)
      1016 = Blood, L/R, froz/deglycerol/washed (eff. 1/01)
      1017 = Platelets, aph/pher, L/R CMV-neg, unit
      (eff. 1/01)
      1018 = Blood, L/R, irradiated (eff. 1/01)
      1019 = Platelets, aph/pher, L/R, irradiated, unit
      (eff. 1/01)
      1024 = Quinupristin 150 mg/dalfopriston 350 mg
      (eff. 1/01)
      1025 = Marinr CS catheter (eff. 1/01)
      1026 = RF Perfrmr cath 5F RF Marinr (eff. 1/01)
      1027 = Magic x/short, radius 14m (eff. 1/01)
      1028 = Prcis Twst trnsvg anch sys (eff. 1/01)
      1029 = CRE guided balloon dil cath (eff. 1/01)
      1030 = Cthtr:Mrshal, Blu Max Utr Dmnd (eff. 1/01)
      1033 = Sonicath mdl 37-410 (eff. 1/01)
      1034 = SURPASS, Long30 SURPASS-cath (eff. 1/01)
      1035 = Cath, Ultra ICE (eff. 1/01)
      1036 = R port/reservior impl dev (eff. 1/01)
      1037 = Vaxcelchronic dialysis cath (eff. 1/01)
      1038 = UltraCross Imaging Cath (eff. 1/01)
      1039 = Wallstent/RP:Trach (eff. 1/01)
      1040 = Wallstent/RP TIPS -- 20/40/60 (eff. 1/01)
      1042 = Wallstent, UltraFlex: Bil (eff. 1/01)
      1045 = I-131 MIBG (ioben-sulfate) 0.5mCi
      (eff. 1/01)
      1047 = Navi-Star, Noga-Star cath (eff. 1/01)
      1048 = NeuroCyberneticPros: gen (eff. 1/01)
      1051 = Oasis Thrombectomy Cath (eff. 1/01)
      1053 = EnSite 3000 catheter (eff. 1/01)
      1054 = Hydrolyser Thromb Cath 6/7F (eff. 1/01)
      1055 = Transesoph 210, 210-S Cath (eff. 1/01)
      1056 = Thermachoice II Cath (eff. 1/01)
      1057 = Micromark Tissue Marker (eff. 1/01)
      1059 = Carticel, auto cult-chndr cyte (eff. 1/01)
      1060 = ACS multi-link tristor stent (eff. 1/01)
      1061 = ACS Viking Guiding cath (eff. 1/01)
      1063 = EndoTak Endurance EZ,RX leads (eff. 1/01)
      1067 = Megalink biliary stent (eff. 1/01)
      1068 = Pulsar DDD pmkr (eff. 1/01)
      1069 = Discovery DR, pmaker
      1071 = Pulsar Max, Pulsar SR pmkr (eff. 1/01)
      1072 = Guidant: blln dil cath (eff. 1/01)
      1073 = Gynecare Morcellator (eff. 1/01)
      1074 = RX/OTW Viatrac-peri dil cath (eff. 1/01)
      1075 = Guidant: lead (eff. 1/01)
      1076 = Ventak minisc defib (eff. 1/01)
      1077 = Ventak VR Prizm VR, sc defib (eff. 1/01)
      1078 = Ventak: Prizm, AVIIIDR defib
      1079 = CO 57/58 0.5 mCi (eff. 1/01)
      1084 = Denileukin diftitox, 300 mcg (eff. 1/01)
      1086 = Temozolomide, 5 mg (eff. 1/01)
      1087 = I-123 per uCi capsule (eff. 1/01)
      1089 = CO 57, 0.5 mCi (eff. 1/01)
      1090 = IN 111 Chloride, per mCi (eff. 1/01)
      1091 = IN 111 Oxyquinoline, per 5 mCi (eff. 1/01)
      1092 = IN 111 Pentetate, per 1.5 mCi (eff. 1/01)
      1094 = TC 99M Albumin aggr, per vial
      1095 = TC 99M Depreotide, per vial (eff. 1/01)
      1096 = TC 99M Exametazime, per dose (eff. 1/01)
      1097 = TC 99M Mebrofenin, per vial (eff. 1/01)
      1098 = TC 99M Pentetate, per vial (eff. 1/01)
      1099 = TC 99M Pyrophosphate, per vial (eff. 1/01)
      1100 = Medtronic AVE GT1 guidewire (eff. 1/01)
      1101 = Medtronic AVE, AVE Z2 cath (eff. 1/01)
      1102 = Synergy Neurostim Genrtr (eff. 1/01)
      1103 = Micro Jewell Defibrillator (eff. 1/01)
      1104 = RF ConductorAblative Cath (eff. 1/01)
      1105 = Sigman 300VDD pacmkr (eff. 1/01)
      1106 = SynergyEZ Pt Progmr (eff. 1/01)
      1107 = Torqr, Solist cath (eff. 1/01)
      1108 = Reveal Cardiac Recorder (eff. 1/01)
      1109 = Implantable anchor: Ethicon (eff. 1/01)
      1110 = Stable Mapper, cath electrd (eff. 1/01)
      1111 = AneuRxAort-Uni-llicstnt & cath (eff. 1/01)
      1112 = AneuRx Stent graft/del cath (eff. 1/01)
      1113 = Tlnt Endo Sprng Stnt Grft Sys (eff. 1/01)
      1114 = TalntSprgStnt + Graf endo pros (eff. 1/01)
      1115 = 5038S, 5038, 5038L pace lead (eff. 1/01)
      1116 = CapSureSP pacing lead (eff. 1/01)
      1117 = Ancure Endograft Del Sys (eff. 1/01)
      1118 = Sigma300DR LegIIDR, pacemkr (eff. 1/01)
      1119 = Sprint6932, 6943 defib lead (eff. 1/01)
      1120 = Sprint6942, 6945 defi lead (eff. 1/01)
      1121 = Gem defibrillator (eff. 1/01)
      1122 = TC 99M arcitumomab per dose (eff. 1/01)
      1123 = Gem II VR defibrillator (eff. 1/01)
      1124 = InterStim Test Stim Kit (eff. 1/01)
      1125 = Kappa 400SR, Ttopaz II SR pmkr (eff. 1/01)
      1126 = Kappa 700 DR pacemkr (eff. 1/01)
      1127 = Kappa 700SR, pmkr sgl chamber (eff. 1/01)
      1128 = Kappa 700D, Ruby IID pmkr (eff. 1/01)
      1129 = Kappa 700VDD, pacmkr (eff. 1/01)
      1130 = Sigma 200D, LGCY IID sc pmkr (eff. 1/01)
      1131 = Sigma 200DR pmker (eff. 1/01)
      1132 = Sigma 200SR Leg II:sc pac (eff. 1/01)
      1133 = Sigma SR, Vita SR, pmaker (eff. 1/01)
      1134 = Sigma 300D pmker (eff. 1/01)
      1135 = Entity DR 5326L/R, DC, pmkr (eff. 1/01)
      1136 = Affinity DR 5330L/R, DC, pmkr (eff. 1/01)
      1137 = CardioSEAL implant syst (eff. 1/01)
      1143 = AddVent mod 2060BL, VDD (eff. 1/01)
      1144 = Afnty SP 5130, Integrity SR, pmkr (eff. 1/01)
      1145 = Angio-Seal 6fr, 8fr (eff. 1/01)
      1147 = AV Plus DX 1368: lead (eff. 1/01)
      1148 = Contour MD sc defib (eff. 1/01)
      1149 = Entity DC 5226R-pmker (eff. 1/01)
      1151 = Passiveplus DXlead, 10mdls (eff. 1/01)
      1152 = LifeSite Access System (eff. 1/01)
      1153 = Regency SC+ 2402L pmkr (eff. 1/01)
      1154 = SPL:SPOI, 0204- defib lead (eff. 1/01)
      1155 = Repliform 8 sq cm (eff. 1/01)
      1156 = Tr 1102TrSR+ 2260L, 2264L, 5131 (eff. 1/01)
      1157 = Trilogy DCT 23/8L pmkr (eff. 1/01)
      1158 = TVL lead SV01, SV02, SV04 (eff. 1/01)
      1159 = TVL RV02, RV06, RV07: lead (eff. 1/01)
      1160 = TVL-ADX 1559: lead (eff. 1/01)
      1161 = Tendril DX, 1338 pacing lead (eff. 1/01)
      1162 = TempoDr, TrilogyDR+ DC pmkr (eff. 1/01)
      1163 = Tendril SDX, 1488T pacing lead (eff. 1/01)
      1164 = Iodine-125 brachytx seed (eff. 1/01)
      1166 = Cytarabine liposomal, 10 mg (eff. 1/01)
      1167 = Epirubicin hcl, 2 mg (eff. 1/01)
      1171 = Autosuture site marker stple (eff. 1/01)
      1172 = Spacemaker dissect ballon (eff. 1/01)
      1173 = Cor stntS540, S670, o-wire stn (eff. 1/01)
      1174 = Bard brachytx needle (eff. 1/01)
      1178 = Busulfan IV, 6 mg (eff. 1/01)
      1180 = Vigor SR, SC, pmkr (eff. 1/01)
      1181 = Meridian SSI, SC pmkr (eff. 1/01)
      1182 = Pulsar SSI, SC, pmkr (eff. 1/01)
      1183 = Jade IIS, Sigma 300S, SC, pmkr (eff. 1/01)
      1184 = Sigma 200S, SC, pmkr (eff. 1/01)
      1188 = I 131, per mCi (eff. 1/01)
      1200 = TC 99M Sodium Clucoheptonate, per vial
      (eff. 1/01)
      1201 = TC 99M succimer, per vial (eff. 1/01)
      1202 = TC 99M Sulfur Colloid, per dose (eff. 1/01)
      1203 = Verteporfin for Injection (eff. 1/01)
      1205 = TC 99M Disofenin, per vial (eff. 1/01)
      1207 = Octreotide acetate depot 1 mg (eff. 1/01)
      1302 = SQ01:lead (eff. 1/01)
      1303 = CapSure Fix 6940/4068-110, lead (eff. 1/01)
      1304 = Sonicath mdl 37-416,-418 (eff. 1/01)
      1305 = Apligraf (eff. 1/01)
      1306 = NeuroCyberneticsPros: lead (eff. 1/01)
      1311 = Trilogy DR + DAO pmkr (eff. 1/01)
      1312 = Magic WALLSTENT stent-mini (eff. 1/01)
      1313 = Magic medium, radius 31mm (eff. 1/01)
      1314 = Magic WALLSTENT stent-Long (eff. 1/01)
      1315 = Vigor DR, Meridian DR pmkr (eff. 1/01)
      1316 = Meridian DDD pmkr (eff. 1/01)
      1317 = Discovery SR, pmkr (eff. 1/01)
      1318 = Meridian SR pmkr (eff. 1/01)
      1319 = Wallstent/RP Enteral--60mm (eff. 1/01)
      1320 = Wallstent/RP lliac Del Sys (eff. 1/01)
      1325 = Pallidium - 103 seed (eff. 1/01)
      1326 = Angio-jet rheolytic thromb cath (eff. 1/01)
      1328 = ANS Renew NS trnsmtr (eff. 1/01)
      1333 = PALMZA Corinthian bill stent (eff. 1/01)
      1334 = Crown, Mini-crown,CrossLC (eff. 1/01)
      1335 = Mesh, Prolene (eff. 1/01)
      1336 = Constant Flow Imp Pump (eff. 1/01)
      1337 = IsoMed 8472-20/35/60 (eff. 1/01)
      1348 = I 131 per mCi solution (eff. 1/01)
      1350 = Prosta/OncoSeed, RAPID strand, I-125 (eff. 1/01)
      1351 = CapSure (Fix) pacing lead (eff. 1/01)
      1352 = Gem II defib (eff. 1/01)
      1353 = Itrel Interstm neurostim + ext (eff. 1/01)
      1354 = Kappa 400DR, Diamond II 820 DR (eff. 1/01)
      1355 = Kappa 600 DR, Vita DR (eff. 1/01)
      1356 = Profile MD V-186HV3 sc defib (eff. 1/01)
      1357 = Angstrom MD V-190HV3 sc defib (eff. 1/01)
      1358 = Affinity DC 5230R-Pacemaker (eff. 1/01)
      1359 = Pulsar, Pulsar Max DR, pmkr  (eff. 1/01)
      1363 = Gem DR, DC, defib (eff. 1/01)
      1364 = Photon DR V-230HV3 DC defib (eff. 1/01)
      1365 = Guidewire, Hi-Torque 14/18/35 (eff. 1/01)
      1366 = Guidewire, PTCA, Hi-Torque (eff. 1/01)
      1367 = Guidewire, Hi-Torque Crosslt (eff. 1/01)
      1369 = ANS Renew Stim Sys recvr (eff. 1/01)
      1370 = Tension-Free Vaginal Tape (eff. 1/01)
      1371 = Symp Nitinol Transhep Bil Sys (eff. 1/01)
      1372 = Cordis Nitinol bil Stent (eff. 1/01)
      1375 = Stent, corornary, NIR (eff. 1/01)
      1376 = ANS Renew Stim Sys lead (eff. 1/01)
      1377 = Specify 3988 neuro lead (eff. 1/01)
      1378 = InterStim Tx 3080/3886 lead (eff. 1/01)
      1379 = Pisces-Quad 3887 lead (eff. 1/01)
      1400 = Diphenhydramine hcl 50 mg (eff. 1/01)
      1401 = Prochlorperazine maleate 5 mg (eff. 1/01)
      1402 = Promethazine hcl 12.5 mg oral (eff. 1/01)
      1403 = Chlorpromazine hcl 10mg oral (eff. 1/01)
      1404 = Trimethobenzamide hcl 250mg (eff. 1/01)
      1405 = Thiethylperazine maleate 10 mg (eff. 1/01)
      1406 = Perphenazine 4 mg oral (eff. 1/01)
      1407 = Hydroxyzine pamoate 25 mg (eff. 1/01)
      1409 = Factor via recombinant, per 1.2 mg (eff. 1/01)
      1410 = Prosorba column (eff. 1/01)
      1411 = Herculink, OTW SDS bil stent (eff. 1/01)
      1420 = StapleTac2 Bone w/Dermis (eff. 1/01)
      1421 = StapleTac2 Bone w/o Dermis (eff. 1/01)
      1450 = Orthosphere Arthroplasty (eff. 1/01)
      1451 = Orthosphere Arthroplasty Kity (eff. 1/01)
      1500 = Atherectomy sys, peripheral (eff. 1/01)
      1600 = TC 99M sestamibi, per syringe (eff. 1/01)
      1601 = TC 99M medronate, per dose (eff. 1/01)
      1602 = TC 99M apcitide, per vial (eff. 1/01)
      1603 = TL 201, mCi (eff. 1/01)
      1604 = IN 111 capromab pendetide, per dose (eff. 1/01)
      1605 = Abciximab injection, 10 mg (eff. 1/01)
      1606 = Anistreplase, 30 u (eff. 1/01)
      1607 = Eptifibatide injection, 5 mg (eff. 1/01)
      1608 = Etanercept injection, 25 mg (eff. 1/01)
      1609 = Rho(D) Immune globulin h, sd 100 iu (eff. 1/01)
      1611 = Hylan G-F 20 injection, 16 mg (eff. 1/01)
      1612 = Daclizumab, parenteral, 25 mg (eff. 1/01)
      1613 = Trastuzumab, 10 mg (eff. 1/01)
      1614 = Valrubicin, 200 mg (eff. 1/01)
      1615 = Basiliximab, 20 mg (eff. 1/01)
      1616 = Histrelin Acetate, 0.5 mg (eff. 1/01)
      1617 = Lepirdin, 50 mg (eff. 1/01)
      1618 = Von Willebrand factor, per iu (eff. 1/01)
      1619 = Ga 67, per mCi (eff. 1/01)
      1620 = TC 99M Bicisate, per vial (eff. 1/01)
      1621 = Xe 133, per mCi (eff. 1/01)
      1622 = TC 99M Mertiatide, per vial (eff. 1/01)
      1623 = TC 99M Gluceptate (eff. 1/01)
      1624 = P32 sodium, per mCi (eff. 1/01)
      1625 = IN 111 Pentetreotide, per mCi (eff. 1/01)
      1626 = TC 99M Oxidronate, per vial (eff. 1/01)
      1627 = TC-99 labeled red blood cell, per test (eff. 1/01)
      1628 = P32 phosphate chromic,per mCi (eff. 1/01)
      1700 = Authen Mick TP brachy needle (eff. 1/01)
      (obsolete 4/01)
      1701 = Medtec MT-BT-5201-25 ndl (eff. 1/01)
      (obsolete 4/01)
      1702 = WWMT brachytx needle (eff. 1/01)
      (obsolete 4/01)
      1703 = Mentor Prostate Brachy (eff. 1/01)
      (obsolete 4/01)
      1704 = MT-BT-5001-25/5051-25 (eff. 1/01)
      (obsolete 4/01)
      1705 = Best Flexi Brachy Needle (eff. 1/01)
      (obsolete 4/01)
      1706 = Indigo Prostate Seeding Ndl (eff. 1/01)
      (obsolete 4/01)
      1707 = Varisource Implt Ndl (eff. 1/01)
      (obsolete 4/01)
      1708 = UroMed Prostate Seed Ndl (eff. 1/01)
      (obsolete 4/01)
      1709 = Remington Brachytx Needle (eff. 1/01)
      (obsolete 4/01)
      1710 = US Biopsy Prostate Needle (eff. 1/01)
      (obsolete 4/01)
      1711 = MD Tech brachytx needle (eff. 1/01)
      (obsolete 4/01)
      1712 = Imagyn brachytx needle (eff. 1/01)
      (obsolete 4/01)
      1713 = Anchor/screw bn/bn,tis/bn (eff. 4/01)
      1714 = Cath, trans atherectomy, dir (eff. 4/01)
      1715 = Brachytherapy needle (eff. 4/01)
      1716 = Brachytx seed, Gold 198 (eff. 4/01)
      1717 = Brachytx seed, HDR Ir-192 (eff. 4/01)
      1718 = Brachytx seed, Iodine 125 (eff. 4/01)
      1719 = Brachytx seed, Non-HDR Ir-192 (eff. 4/01)
      1720 = Brachytx, Palladium 103 (eff. 4/01)
      1721 = AICD, dual chamber (eff. 4/01)
      1722 = AICD, single chamber (eff. 4/01)
      1723 = Cath, ablation, non-cardiac (eff. 4/01)
      1724 = Cath, trans atherec, rotation (eff. 4/01)
      1725 = Cath, translumin non-laser (eff. 4/01)
      1726 = Cath, bal dil, non-vascular (eff. 4/01)
      1727 = Cath, bal tis, dis, nonvas (eff. 4/01)
      1728 = Cath, brachytx seed adm (eff. 4/01)
      1729 = Cath, drainage, biliary (eff. 4/01)
      1730 = Cath, EP, 19 or fewer elect (eff. 4/01)
      1731 = Cath, EP, 20 or more elect (eff. 4/01)
      1732 = Cath, EP, diag/abl, 3D/vect (eff. 4/01)
      1733 = Cath, EP, other than temp (eff. 4/01)
      1750 = Cath, hemodialysis, long-term (eff. 4/01)
      1751 = Cath, inf pr/cent/midline (eff. 4/01)
      1752 = Cath, hemodialysis, short-term (eff. 4/01)
      1753 = Cath, intravas ultrasound (eff. 4/01)
      1754 = Catheter, intradiscal (eff. 4/01)
      1755 = Catheter, intraspinal (eff. 4/01)
      1756 = Cath, pacing, transesoph (eff. 4/01)
      1757 = Cath, thrombectomy/embolect (eff. 4/01)
      1758 = Cath, ureteral (eff. 4/01)
      1759 = Cath, intra echocardiography (eff. 4/01)
      1760 = Closure dev, vasc, imp/insert (eff. 4/01)
      1762 = Conn tiss, human (inc fascia) (eff. 4/01)
      1763 = Conn tiss, non-human (eff. 4/01)
      1764 = Event recorder, cardiac (eff. 4/01)
      1767 = Generator, neurostim, imp (eff. 4/01)
      1768 = Graft, vascular (eff. 4/01)
      1769 = Guide wire (eff. 4/01)
      1770 = Imaging coil, MR insertable (eff. 4/01)
      1771 = Rep dev, urinary , w/sling (eff. 4/01)
      1772 = Infusion pump, programmable (eff. 4/01)
      1773 = Retrieval dev, insert (eff. 4/01)
      1776 = Joint device (implantable) (eff. 4/01)
      1777 = Lead, AICD, endo single coil (eff. 4/01)
      1778 = Lead, neurostimulator (eff. 4/01)
      1779 = Lead, pmkr, transvenous VDD (eff. 4/01)
      1780 = Lens, intraocular (eff. 4/01)
      1781 = Mesh (implantable) (eff. 4/01)
      1782 = Morcellator (eff. 4/01)
      1784 = Ocular dev, intraop, det ret (eff. 4/01)
      1785 = Pmkr, dual, rate-resp (eff. 4/01)
      1786 = Pmkr, single, rate-resp (eff. 4/01)
      1787 = Patient progr, neurostim (eff. 4/01)
      1788 = Port, indwelling, imp (eff. 4/01)
      1789 = Prosthesis, breast, imp. (eff. 4/01)
      1790 = Iridium 192 HDR (eff. 1/01)
      (obsolete 4/01)
      1791 = OncoSeed, Rapid Strand I-125 (eff. 1/01)
      (obsolete 4/01)
      1792 = UroMed I-125 Brachy seed (eff. 1/01)
      (obsolete 4/01)
      1793 = Bard InterSource P-103 seed (eff. 1/01)
      (obsolete 4/01)
      1794 = Bard IsoSeed P-103 seed (eff. 1/01)
      (obsolete 4/01)
      1795 = Bard BrachySource I-125 (eff. 1/01)
      (obsolete 4/01)
      1796 = Source Tech Med I-125 (eff. 1/01)
      (obsolete 4/01)
      1797 = Draximage I-125 seed (eff. 1/01)
      (obsolete 4/01)
      1798 = Syncor I-125 PharmaSeed (eff. 1/01)
      (obsolete 4/01)
      1799 = I-Plant I-125 Brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1800 = Pd-103 brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1801 = IoGold I-125 brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1802 = Iridium 192 brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1803 = Best Iodine 125 brachytx seeds (eff. 1/01)
      (obsolete 4/01)
      1804 = Best Palladium 103 seeds (eff. 1/01)
      (obsolete 4/01)
      1805 = IsoStar Iodine-125 seeds (eff. 1/01)
      (obsolete 4/01)
      1806 = Gold 198 (eff. 1/01)
      (obsolete 4/01)
      1810 = D114S Dilatation Cath (eff. 1/01)
      (obsolete 4/01)
      1811 = Surgical Dynamics Anchors (eff. 1/01)
      (obsolete 4/01)
      1812 = OBL Anchors (eff. 1/01)
      (obsolete 4/01)
      1813 = Prosthesis, penile, inflatab (eff. 4/01)
      1815 = Pros, urinary sph, imp (eff. 4/01)
      1816 = Receiver/transmitter, neuro (eff. 4/01)
      1817 = Septal defect imp sys (eff. 4/01)
      1850 = Repliform 14/21 sq cm (eff. 1/01)
      (obsolete 4/01)
      1851 = Repliform 24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      1852 = TransCyte, per 247 sq cm (eff. 1/01)
      (obsolete 4/01)
      1853 = Suspend, per 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      1854 = Suspend, per 24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      1855 = Suspend, per 36 sq cm (eff. 1/01)
      (obsolete 4/01)
      1856 = Suspend, per 48 sq cm (eff. 1/01)
      (obsolete 4/01)
      1857 = Suspend, per 84 sq cm (eff. 1/01)
      (obsolete 4/01)
      1858 = DuraDerm, per 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      1859 = DuraDerm, per 21/24 sq cm (eff. 1/01)
      (obsolete 4/01)
      1860 = DuraDerm, per 48 sq cm (eff. 1/01)
      (obsolete 4/01)
      1861 = DuraDerm, per 36 sq cm (eff. 1/01)
      (obsolete 4/01)
      1862 = DuraDerm, per 72 sq cm (eff. 1/01)
      (obsolete 4/01)
      1863 = DuraDerm, per 84 sq cm (eff. 1/01)
      (obsolete 4/01)
      1864 = SpermaTex, per 13/44 sq cm (eff. 1/01)
      (obsolete 4/01)
      1865 = FasLata, per 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      1866 = FasLata, per 24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      1867 = FasLata, per 36/48 sq cm (eff. 1/01)
      (obsolete 4/01)
      1868 = FasLata, per 96 sq cm (eff. 1/01)
      (obsolete 4/01)
      1869 = Gore Thyroplasty Dev (eff. 1/01)
      (obsolete 4/01)
      1870 = DermMatrix, per 16 sq cm (eff. 1/01)
      (obsolete 4/01)
      1871 = DermMatrix, 32 or 64 sq cm (eff. 1/01)
      (obsolete 4/01)
      1872 = Dermagraft, per 37.5 sq cm (eff. 1/01)
      (obsolete 4/01)
      1873 = Bard 3DMax Mesh (eff. 1/01)
      (obsolete 4/01)
      1874 = Stent, coated/cov w/del sys (eff. 4/01)
      1875 = Stent, coated/cov w/o del sys (eff. 4/01)
      1876 = Stent, non-coated/no-cov w/del (eff. 4/01)
      1877 = Stent, non-coated/cov w/o del (eff. 4/01)
      1878 = Martl for vocal cord (eff. 4/01)
      1879 = Tissue marker, imp (eff. 4/01)
      1880 = Vena cava filter (eff. 4/01)
      1881 = Dialysis access system (eff. 4/01)
      1882 = AICD, other than sing/dual (eff. 4/01)
      1883 = Adapt/ext, pacing/neuro lead (eff. 4/01)
      1885 = Cath, translumin angio laser (eff. 4/01)
      1887 = Catheter, guiding (eff. 4/01)
      1891 = Infusion pump, non-prog, perm (eff. 4/01)
      1892 = Intro/sheath , fixed, peel-away (eff. 4/01)
      1893 = Intro/sheath, fixed, non-peel (eff. 4/01)
      1894 = Intro/sheath, non-laser (eff. 4/01)
      1895 = Lead, AICD, endo dual coil (eff. 4/01)
      1896 = Lead, AICD, non sing/dual (eff. 4/01)
      1897 = Lead, neurostim test kit (eff. 4/01)
      1898 = Lead, pmkr, other than trans (eff. 4/01)
      1899 = Lead, pmkr/AICD combination (eff. 4/01)
      1929 = Maverick PTCA Cath (eff. 1/01) (obsolete 4/01)
      1930 = Coyote Dil Cath, 20/30/40mm (eff. 1/01)
      (obsolete 4/01)
      1931 = Talon Dil Cath (eff. 1/01) (obsolete 4/01)
      1932 = Scimed remedy Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1933 = Opti-Plast XL/Centurion Cath (eff. 1/01)
      (obsolete 4/01)
      1934 = Ultraverse 3.5F Bal Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1935 = Workhorse PTA Bal Cath (eff. 1/01)
      (obsolete 4/01)
      1936 = Uromax Ultra Bal Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1937 = Synergy Balloon Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1938 = Uroforce Bal Dil Cath (eff. 1/01) (obsolete 4/01)
      1939 = Raptur, Ninja PTCA Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1940 = PowerFlex, OPTA 5/LP Bal Cath (eff. 1/01)
      (obsolete 4/01)
      1941 = Jupiter PTA Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1942 = Cordis Maxi LD PTA Bal Cath (eff. 1/01)
      (obsolete 4/01)
      1943 = RXCrossSail OTW OpenSail (eff. 1/01)
      (obsolete 4/01)
      1944 = Rapid Exchange Bil Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1945 = Savvy PTA Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1946 = R1s Rapid Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1947 = Gazelle Bal Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1948 = Pursuit Balloon Cath (eff. 1/01)
      (obsolete 4/01)
      1949 = Oracle Megasonics Cath (eff. 1/01)
      (obsolete 4/01)
      1979 = Visions PV/Avanar US Cath (eff. 1/01)
      (obsolete 4/01)
      1980 = Atlantis SR Coronary Cath (eff. 1/01)
      (obsolete 4/01)
      1981 = PTCA Catheters (eff. 1/01)
      (obsolete 4/01)
      2000 = Orbiter ST Steerable Cath (eff. 1/01)
      (obsolete 4/01)
      2001 = Constellation Diag Cath (eff. 1/01)
      (obsolete 4/01)
      2002 = Irvine 5F Inquiry Diag EP Cath (eff. 1/01)
      (obsolete 4/01)
      2003 = Irvine 6F Inquiry Diag EP Cath (eff. 1/01)
      (obsolete 4/01)
      2004 = Biosense EP Cath -- Octapolar (eff. 1/01)
      (obsolete 4/01)
      2005 = Biosense EP Cath -- Hexapolar (eff. 1/01)
      (obsolete 4/01)
      2006 = Biosense EP Cath -- Decapolar (eff. 1/01)
      (obsolete 4/01)
      2007 = Irvine 6F Luma-Cath EP Cath (eff. 1/01)
      (obsolete 4/01)
      2008 = 7F Luma-Cath EP Cath 81910-15 (eff. 1/01)
      (obsolete 4/01)
      2009 = Irvine 7F Luma-Cath EP Cath (eff. 1/01)
      (obsolete 4/01)
      2010 = Fixed Curve EP Cath (eff. 1/01)
      (obsolete 4/01)
      2011 = Deflectable Tip Cath--Quad (eff. 1/01)
      (obsolete 4/01)
      2012 = Celsius Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2013 = Celsius Large Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2014 = Celsius II Asym Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2015 = Celsius II Sym Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2016 = Navi-Star DS, Navi-Star Ther (eff. 1/01)
      (obsolete 4/01)
      2017 = Navi-Star Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2018 = Polaris T Ablation Cath (eff. 1/01)
      (obsolete 4/01)
      2019 = EP Deflectable Cath (eff. 1/01)
      (obsolete 4/01)
      2020 = Blazer II XP Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2021 = SilverFlex EP Cath (eff. 1/01)
      (obsolete 4/01)
      2022 = CP Chilli Cooled Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2023 = Chilli Cld AblnCath-std, lg (eff. 1/01)
      (obsolete 4/01)
      2100 = CP CS Reference Cath (eff. 1/01)
      (obsolete 4/01)
      2102 = CP Radii 7F EP Cath (eff. 1/01)
      (obsolete 4/01)
      2103 = CP Radii 7F EP Cath w/Track (eff. 1/01)
      (obsolete 4/01)
      2104 = Lasso Deflectable Cath (eff. 1/01)
      (obsolete 4/01)
      2151 = Veripath Guiding Cath (eff. 1/01)
      (obsolete 4/01)
      2152 = Cordis Vista Brite Tip Cath (eff. 1/01)
      (obsolete 4/01)
      2153 = Bard Viking Cath (eff. 1/01)
      (obsolete 4/01)
      2200 = Arrow-Trerotola PTD Cath (eff. 1/01)
      (obsolete 4/01)
      2300 = Varisource Stnd Catheters (eff. 1/01)
      (obsolete 4/01)
      2597 = Clinicath/kit 16/18 sgl/dbl (eff. 1/01)
      (obsolete 4/01)
      2598 = Clinicath 18/20/24-G single (eff. 1/01)
      (obsolete 4/01)
      2599 = Clinicath 16/18-G-double (eff. 1/01)
      (obsolete 4/01)
      2601 = Bard DL Ureteral Cath (eff. 1/01)
      (obsolete 4/01)
      2602 = Vitesse Laser Cath 1.4/1.7mm (eff. 1/01)
      (obsolete 4/01)
      2603 = Vitesse Laser Cath 2.0mm (eff. 1/01)
      (obsolete 4/01)
      2604 = Vitesse E Laser Cath 2.0mm (eff. 1/01)
      (obsolete 4/01)
      2605 = Extreme Laser Catheter (eff. 1/01)
      (obsolete 4/01)
      2606 = SpineCath XL Catheter (eff. 1/01)
      (obsolete 4/01)
      2607 = SpineCath Intradiscal Cath (eff. 1/01)
      (obsolete 4/01)
      2608 = Scimed 6F Wiseguide Cath (eff. 1/01)
      (obsolete 4/01)
      2609 = Flexima Bil Draingage Cath (eff. 1/01)
      (obsolete 4/01)
      2610 = FlexTipPlus Intraspinal Cath (eff. 1/01)
      (obsolete 4/01)
      2611 = AlgoLine Intraspinal Cath (eff. 1/01)
      (obsolete 4/01)
      2612 = InDura Catheter (eff. 1/01)
      (obsolete 4/01)
      2615 = Sealant, pulmonary, liquid (eff. 4/01)
      2616 = Brachytx seed, Yttrium-90 (eff. 4/01)
      2617 = Stent, non-cor, tem w/o del (eff. 4/01)
      2618 = Probe, cryoablation (eff. 4/01)
      2619 = Pmkr, dual, non rate-resp (eff. 4/01)
      2620 = Pmkr, single, non rate-resp (eff. 4/01)
      2621 = Pmkr, other than single/dual (eff. 4/01)
      2622 = Prosthesis, penile, non-inf (eff. 4/01)
      2625 = Stent, non-cor , tem w/del sys (eff. 4/01)
      2626 = Infusion pump, non-prog, temp (eff. 4/01)
      2627 = Cath, suprapubic/cystoscopic (eff. 4/01)
      2628 = Catheter, occlusion (eff. 4/01)
      2629 = Intro/sheath, laser (eff. 4/01)
      2630 = Cath, EP, temp-controlled (eff. 4/01)
      2631 = Rep dev, urinary, w/o sling (eff. 4/01)
      2700 = MycroPhylax Plus CS defib (eff. 1/01)
      (obsolete 4/01)
      2701 = Phylax XM SC defib (eff. 1/01)
      (obsolete 4/01)
      2702 = Ventak Prizm 2VR Defib (eff. 1/01)
      (obsolete 4/01)
      2703 = Ventak Prizm VR HE Defib (eff. 1/01)
      (obsolete 4/01)
      2704 = Ventak Mini IV + Defib (eff. 1/01)
      (obsolete 4/01)
      2801 = Defender IV DR 612 DC defib (eff. 1/01)
      (obsolete 4/01)
      2802 = Phylax AV DC defib (eff. 1/01)
      (obsolete 4/01)
      2803 = Ventak Prizm DR HE Defib (eff. 1/01)
      (obsolete 4/01)
      2804 = Ventak Prizm 2 DR Defib (eff. 1/01)
      (obsolete 4/01)
      2805 = Jewel AF 7250 Defib (eff. 1/01)
      (obsolete 4/01)
      2806 = GEM VR 7227 Defib (eff. 1/01)
      (obsolete 4/01)
      2807 = Contak CD 1823 (eff. 1/01)
      (obsolete 4/01)
      2808 = Contak TR 1241 (eff. 1/01)
      (obsolete 4/01)
      3001 = Kainox SL/RV defib lead (eff. 1/01)
      (obsolete 4/01)
      3002 = EasyTrak Defib Lead (eff. 1/01)
      (obsolete 4/01)
      3003 = Endotak SQ Array XP lead (eff. 1/01)
      (obsolete 4/01)
      3004 = Intervene Defib lead (eff. 1/01)
      (obsolete 4/01)
      3400 = Siltex Spectrum, Contour Prof (eff. 1/01)
      (obsolete 4/01)
      3401 = Saline-Filled Spectrum (eff. 1/01)
      (obsolete 4/01)
      3500 = Mentor alpha I Inf Penile Pros (eff. 1/01)
      (obsolete 4/01)
      3510 = AMS 800 Urinary Pros (eff. 1/01)
      (obsolete 4/01)
      3551 = Choice/PT Graphix/Luge/Trooper (eff. 1/01)
      (obsolete 4/01)
      3552 = Hi-Torque Whisper (eff. 1/01)
      (obsolete 4/01)
      3553 = Cordis guidewires (eff. 1/01)
      (obsolete 4/01)
      3554 = Jindo guidewire (eff. 1/01)
      (obsolete 4/01)
      3555 = Wholey Hi-Torque Plus GW (eff. 1/01)
      (obsolete 4/01)
      3556 = Wave/FlowWire Guidewire (eff. 1/01)
      (obsolete 4/01)
      3557 = HyTek guidewire (eff. 1/01)
      (obsolete 4/01)
      3800 = SynchroMed EL infusion pump (eff. 1/01)
      (obsolete 4/01)
      3801 = Arrow/Microject PCAQ Sys (eff. 1/01)
      (obsolete 4/01)
      3851 = Elastic UV IOL AA-4203T/TF/TL (eff. 1/01)
      (obsolete 4/01)
      4000 = Opus G 4621, 4624 SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4001 = Opus S 4121/4124 SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4002 = Talent 113 SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4003 = Kairos SR SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4004 = Actros SR, Actros SLR SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4005 = Philos SR/SR-B SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4006 = Pulsar Max II SR pmkr (eff. 1/01)
      (obsolete 4/01)
      4007 = Marathon SR pmkr (eff. 1/01)
      (obsolete 4/01)
      4008 = Discovery II SSI pmkr (eff. 1/01)
      (obsolete 4/01)
      4009 = Discovery II SR pmkr (eff. 1/01)
      (obsolete 4/01)
      4300 = Integrity AFx DR 5342 pmkr (eff. 1/01)
      (obsolete 4/01)
      4301 = Integrity AFx DR 5346 pmkr (eff. 1/01)
      (obsolete 4/01)
      4302 = Affinity VDR 5430 DR (eff. 1/01)
      (obsolete 4/01)
      4303 = Brio 112 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4304 = Brio 212, Talent 213/223 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4305 = Brio 222 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4306 = Brio 220 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4307 = Kairos DR DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4308 = Inos2, Inos2+ DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4309 = Actros DR,D,DR-A, SLR DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4310 = Actros DR-B DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4311 = Philos DR/DR-B/SLR DC (eff. 1/01)
      (obsolete 4/01)
      4312 = Pulsar Max II DR pmkr (eff. 1/01)
      (obsolete 4/01)
      4313 = Marathon DR pmkr (eff. 1/01)
      (obsolete 4/01)
      4314 = Momentum DR pmkr (eff. 1/01)
      (obsolete 4/01)
      4315 = Selection AFm pmkr (eff. 1/01)
      (obsolete 4/01)
      4316 = Discovery II DR (eff. 1/01)
      (obsolete 4/01)
      4317 = Discovery II DDD (eff. 1/01)
      (obsolete 4/01)
      4600 = Snynox, Polyrox, Elox, Retrox (eff. 1/01)
      (obsolete 4/01)
      4602 = Tendril SDX, 1488K pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4603 = Oscor/Flexion pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4604 = CrystallineActFix, CapsureFix (eff. 1/01)
      (obsolete 4/01)
      4605 = CapSure Epi pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4606 = Flextend pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4607 = FinelineII/EZ, ThinlineII/EZ (eff. 1/01)
      (obsolete 4/01)
      5000 = BX Velocity w/Hepacoat (eff. 1/01)
      (obsolete 4/01)
      5001 = Memotherm Bil Stent, sm, med (eff. 1/01)
      (obsolete 4/01)
      5002 = Memotherm Bil Stent, large (eff. 1/01)
      (obsolete 4/01)
      5003 = Memotherm Bil Stent, x-large (eff. 1/01)
      (obsolete 4/01)
      5004 = PalmazCorinthian IQ Bil Stent (eff. 1/01)
      (obsolete 4/01)
      5005 = PalmazCorinthian IQ Trans/Bil (eff. 1/01)
      (obsolete 4/01)
      5006 = PalmazTran Bil Stent Sys-Med (eff. 1/01)
      (obsolete 4/01)
      5007 = PalmazTran XL Bil Stent--40mm (eff. 1/01)
      (obsolete 4/01)
      5008 = PalmazTran XL Bil Stent--50mm (eff. 1/01)
      (obsolete 4/01)
      5009 = VistaFlex Biliary Stent (eff. 1/01)
      (obsolete 4/01)
      5010 = Rapid Exchange Bil Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5011 = IntraStent, IntraStent LP (eff. 1/01)
      (obsolete 4/01)
      5012 = IntraStent DoubleStrut LD (eff. 1/01)
      (obsolete 4/01)
      5013 = IntraStent DoubleStrut XS (eff. 1/01)
      (obsolete 4/01)
      5014 = AVE Bridge Stent Sys-10/17/28 (eff. 1/01)
      (obsolete 4/01)
      5015 = AVE/X3 Bridge Sys, 40-100 (eff. 1/010
      (obsolete 4/01)
      5016 = Biliary stent single use cov (eff. 1/01)
      (obsolete 4/01)
      5017 = WallstentRP Bil--20/40/60/68mm (eff. 1/01)
      (obsolete 4/01)
      5018 = WallstentRP Bil--80/94mm (eff. 1/01)
      (obsolete 4/01)
      5019 = Flexima Bil Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5020 = Smart Nitinol Stent--20mm (eff. 1/01)
      (obsolete 4/01)
      5021 = Smart Nitinol Stent--40/60mm (eff. 1/01)
      (obsolete 4/01)
      5022 = Smart Nitinol Stent--80mm (eff. 1/01)
      (obsolete 4/01)
      5023 = BX Velocity Stent--8/13mm (eff. 1/01)
      (obsolete 4/01)
      5024 = BX Velocity Stent 18mm (eff. 1/01)
      (obsolete 4/01)
      5025 = BX Velocity Stent 23 mm (eff. 1/01)
      (obsolete 4/01)
      5026 = BX Velocity Stent 28/33mm (eff. 1/01)
      (obsolete 4/01)
      5027 = BX Velocity Stent w/Hep--8/13mm (eff. 1/01)
      (obsolete 4/01)
      5028 = BX Velocity Stent w/Hep--18mm (eff. 1/01)
      (obsolete 4/01)
      5029 = BX Velocity Stent w/Hep--23mm (eff. 1/01)
      (obsolete 4/01)
      5030 = Stent, coronary, S660 9/12mm (eff. 1/01)
      (obsolete 4/01)
      5031 = Stent, coronary, S660 15/18mm (eff. 1/01)
      (obsolete 4/01)
      5032 = Stent, coronary, S660 24/30mm (eff. 1/01)
      (obsolete 4/01)
      5033 = Niroyal Stent Sys, 9mm (eff. 1/01)
      (obsolete 4/01)
      5034 = Niroyal Stent Sys, 12/15mm (eff. 1/01)
      (obsolete 4/01)
      5035 = Niroyal Stent Sys, 18mm (eff. 1/01)
      (obsolete 4/01)
      5036 = Niroyal Stent Sys, 25mm (eff. 1/01)
      (obsolete 4/01)
      5037 = Niroyal Stent Sys, 31mm (eff. 1/01)
      (obsolete 4/01)
      5038 = BX Velocity Stent w/Raptor (eff. 1/01)
      (obsolete 4/01)
      5039 = IntraCoil Periph Stent--40mm (eff. 1/01)
      (obsolete 4/01)
      5040 = IntraCoil Periph Stent--60mm (eff. 1/01)
      (obsolete 4/01)
      5041 = BeStent Over-the-Wire 24/30mm (eff. 1/01)
      (obsolete 4/01)
      5042 = BeStent Over-the-Wire 18mm (eff. 1/01)
      (obsolete 4/01)
      5043 = BeStent Over-the-Wire 15mm (eff. 1/01)
      (obsolete 4/01)
      5044 = BeStent Over-the-Wire 9/12mm (eff. 1/01)
      (obsolete 4/01)
      5045 = Multilink Tetra Cor Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5046 = Radius 20mm cor stent (eff. 1/01)
      (obsolete 4/01)
      5047 = Niroyal Elite Cor Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5048 = GR II Coronary Stent (eff. 1/01)
      (obsolete 4/01)
      5130 = Wilson-Cook Colonic Z-Stent (eff. 1/01)
      (obsolete 4/01)
      5131 = Bard Colorectal Stent-60mm (eff. 1/01)
      (obsolete 4/01)
      5132 = Bard Colorectal Stent-80mm (eff. 1/01)
      (obsolete 4/01)
      5133 = Bard Colorectal Stent-100mm (eff. 1/01)
      (obsolete 4/01)
      5134 = Enteral Wallstent-90mm (eff. 1/01)
      (obsolete 4/01)
      5279 = Contour/Percuflex Stent (eff. 1/01)
      (obsolete 4/01)
      5280 = Inlay Dbl Ureteral Stent (eff. 1/01)
      (obsolete 4/01)
      5281 = Wallgraft Trach Sys 70mm (eff. 1/01)
      (obsolete 4/01)
      5282 = Wallgraft Trach Sys 20/30/50 (eff. 1/01)
      (obsolete 4/01)
      5283 = Wallstent/RP TIPS--80mm (eff. 1/01)
      (obsolete 4/01)
      5284 = Wallstent TrachUltraFlex (eff. 1/01)
      (obsolete 4/01)
      5600 = Closure dev, VasoSeal ES (eff. 1/01)
      (obsolete 4/01)
      5601 = VasoSeal Model 1000 (eff. 1/01)
      (obsolete 4/01)
      6001 = Composix Mesh 8/21 in (eff. 1/01)
      (obsolete 4/01)
      6002 = Composix Mesh 32 in (eff. 1/01)
      (obsolete 4/01)
      6003 = Composix Mesh 48 in (eff. 1/01)
      (obsolete 4/01)
      6004 = Composix Mesh 80 in (eff. 1/01)
      (obsolete 4/01)
      6005 = Composix Mesh 140 in (eff. 1/01)
      (obsolete 4/01)
      6006 = Composix Mesh 144 in (eff. 1/01)
      (obsolete 4/01)
      6012 = Pelvicol Collagen 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      6013 = Pelvicol Collagen 21/24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      6014 = Pelvicol Collagen 36 sq cm (eff. 1/01)
      (obsolete 4/01)
      6015 = Pelvicol Collagen 48 sq cm (eff. 1/01)
      (obsolete 4/01)
      6016 = Pelvicol Collagen 96 sq cm (eff. 1/01)
      (obsolete 4/01)
      6017 = Gore-Tex DualMesh 75/96 sq cm (eff. 1/01)
      (obsolete 4/01)
      6018 = Gore-Tex DualMesh 150 sq cm (eff. 1/01)
      (obsolete 4/01)
      6019 = Gore-Tex DualMesh 285 sq cm (eff. 1/01)
      (obsolete 4/01)
      6020 = Gore-Tex DualMesh 432 sq cm (eff. 1/01)
      (obsolete 4/01)
      6021 = Gore-Tex DualMesh 600 sq cm (eff. 1/01)
      (obsolete 4/01)
      6022 = Gore-Tex DualMesh 884 sq cm (eff. 1/01)
      (obsolete 4/01)
      6023 = Gore-TexPlus 1mm, 75/96 sq cm (eff. 1/01)
      (obsolete 4/01)
      6024 = Gore-TexPlus 1mm, 150 sq cm (eff. 1/01)
      (obsolete 4/01)
      6025 = Gore-TexPlus 1mm, 285 sq cm (eff. 1/01)
      (obsolete 4/01)
      6026 = Gore-TexPlus 1mm, 432 sq cm (eff. 1/01)
      (obsolete 4/01)
      6027 = Gore-TexPlus 1mm, 600 sq cm (eff. 1/01)
      (obsolete 4/01)
      6028 = Gore-TexPlus 1mm, 884 sq cm (eff. 1/01)
      (obsolete 4/01)
      6029 = Gore-TexPlus 2mm, 150 sq cm (eff. 1/01)
      (obsolete 4/01)
      6030 = Gore-TexPlus 2mm, 285 sq cm (eff. 1/01)
      (obsolete 4/01)
      6031 = Gore-TexPlus 2mm, 432 sq cm (eff. 1/01)
      (obsolete 4/01)
      6032 = Gore-TexPlus 2mm, 600 sq cm (eff. 1/01)
      (obsolete 4/01)
      6033 = Gore-TexPlus 2mm, 884 sq cm (eff. 1/01)
      (obsolete 4/01)
      6034 = Bard ePTFE: 150 sq cm-2mm
      (obsolete 4/01)
      6035 = Bard ePTFE: 150sqcm-1mm,75-2mm (eff. 1/01)
      (obsolete 4/01)
      6036 = Bard ePTFE: 50/75sqcm-1,2mm (eff. 1/01)
      (obsolete 4/01)
      6037 = Bard ePTFE: 300 sq cm-1,2mm (eff. 1/01)
      (obsolete 4/01)
      6038 = Bard ePTFE: 600 sq cm-1mm (eff. 1/01)
      (obsolete 4/01)
      6039 = Bard ePTFE: 884sq cm-1mm (eff. 1/01)
      (obsolete 4/01)
      6040 = Bard ePTFE: 600sq cm-2mm (eff. 1/01)
      (obsolete 4/01)
      6041 = Bard ePTFE: 884sq cm -2mm (eff. 1/01)
      (obsolete 4/01)
      6050 = Female Sling Sys w/wo Matrl (eff. 1/01)
      (obsolete 4/01)
      6051 = Stratasis Sling, 20/40 cm (eff. 1/01)
      (obsolete 4/01)
      6052 = Stratasis Sling, 60 cm (eff. 1/01)
      (obsolete 4/01)
      6053 = Surgisis Soft Graft (eff. 1/01)
      (obsolete 4/01)
      6054 = Surgisis Enhanced Graft (eff. 1/01)
      (obsolete 4/01)
      6055 = Surgisis Enhanced Tissue (eff. 1/01)
      (obsolete 4/01)
      6056 = Surgisis Soft Tissue Graft (eff. 1/01)
      (obsolete 4/01)
      6057 = Surgisis Hernia Graft (eff. 1/01)
      (obsolete 4/01)
      6058 = SurgiPro Hernia Plug, med/lg (eff. 1/01)
      (obsolete 4/01)
      6080 = Male Sling Sys w/wo Matrial (eff. 1/01)
      (obsolete 4/01)
      6200 = Exxcel Soft ePTFE vas graft (ef. 1/01)
      (obsolete 4/01)
      6201 = Impra Venaflo--10/20cm (eff. 1/01)
      (obsolete 4/01)
      6202 = Impra Venaflo--30/40 cm (eff. 1/01)
      (obsolete 4/01)
      6203 = Impra Venaflo--50 cm, vt45 (eff. 1/01)
      (obsolete 4/01)
      6204 = Impra Venaflo--stepped (eff. 1/01)
      (obsolete 4/01)
      6205 = Impra Carboflo--10cm (eff. 1/01)
      (obsolete 4/01)
      6206 = Impra Carboflo--20 cm (eff. 1/01)
      (obsolete 4/01)
      6207 = Impra Carboflo--30/35/40cm (eff. 1/01)
      (obsolete 4/01)
      6208 = Impra Carboflo--40/50cm (eff. 1/01)
      (obsolete 4/01)
      6209 = Impra Carboflo--ctrflex (eff. 1/01)
      (obsolete 4/01)
      6210 = Exxcel ePTFE vas graft (eff. 1/01)
      (obsolete 4/01)
      6300 = Vanguard III Endovas Graft (eff. 1/01)
      (obsolete 4/01)
      6500 = Preface Guiding Sheath (eff. 1/01)
      (obsolete 4/01)
      6501 = Soft Tip Sheaths (eff. 1/01)
      (obsolete 4/01)
      6502 = Perry Exchange Dilator (eff. 1/01)
      (obsolete 4/01)
      6525 = Spectranetics Laser Sheath (eff. 1/01)
      (obsolete 4/01)
      6600 = Micro Litho Flex Probes (eff. 1/01)
      (obsolete 4/01)
      6650 = Fast-Cath Guiding Introducer (eff. 1/01)
      (obsolete 4/01)
      6651 = Seal-Away Guding Introducer (eff. 1/01)
      (obsolete 4/01)
      6652 = Bard Excalibur Introducer (eff. 1/01)
      (obsolete 4/01)
      6700 = Focal Seal-L (eff. 1/01)
      (obsolete 4/01)
      7000 = Amifostine, 500 mg (eligible for pass-through
      payments)
      7001 = Amphotericin B lipid complex, 50 mg, Inj
      (eligible for pass-through payments)
      7002 = Clonidine, HCl, 1 MG (eligible for pass-
      through payments) (obsolete 1/01)
      7003 = Epoprostenol, 0.5 MG, inj (eligible for pass-
      through payments)
      7004 = Immune globulin intravenous human 5g, inj
      (eligible for pass-through payments)
      7005 = Gonadorelin hcI, 100 mcg (eligible for pass-
      through payments)
      7007 = Milrinone lacetate, per 5 ml, inj (not subject
      to national coinsurance)
      7010 = Morphine sulfate concentrate (preservative free)
      per 10 mg (eligible for pass-through payments)
      7011 = Oprelevekin, inj, 5 mg (eligible for pass-through
      payments)
      7012 = Pentamidine isethionate, 300 mg (eligible for
      pass-through payments) (obsolete 1/01)
      7014 = Fentanyl citrate, inj, up to 2 ml (eligible for
      pass-through payments)
      7015 = Busulfan, oral 2 mg (eligible for pass-through
      payments)
      7019 = Aprotinin, 10,000 kiu (eligible for pass-through
      payments)
      7021 = Baclofen, intrathecal, 50 mcg (eligible for pass-
      through payments) (obsolete 1/01)
      7022 = Elliotts B Solution, per ml (eligible for pass-
      through payments)
      7023 = Treatment for bladder calculi, I.e. Renacidin
      per 500 ml (eligible for pass-through payments)
      7024 = Corticorelin ovine triflutate, 0.1 mg
      (eligible for pass-through payments)
      7025 = Digoxin immune FAB (Ovine), 10 mg
      (eligible for pass-through payments)
      7026 = Ethanolamine oleate, 1000 ml
      (eligible for pass-through payments)
      7027 = Fomepizole, 1.5 G
      (eligible for pass-through payments)
      7028 = Fosphenytoin, 50 mg
      (eligible for pass-through payments)
      7029 = Glatiramer acetate, 25 mg
      (eligible for pass-through payments)
      7030 = Hemin, 1 mg
      (eligible for pass-through payments)
      7031 = Octreotide Acetate, 500 mcg
      (eligible for pass-through payments)
      7032 = Sermorelin acetate, 0.5 mg
      (eligible for pass-through payments)
      7033 = Somatrem, 5 mg
      (eligible for pass-through payments)
      7034 = Somatropin, 1 mg
      (eligible for pass-through payments)
      7035 = Teniposide, 50 mg
      (eligible for pass-through payments)
      7036 = Urokinase, inj, IV, 250,000 I.U.
      (not subject to national coinsurance)
      7037 = Urofollitropin, 75 I.U.
      (eligible for pass-through payments)
      7038 = Muromonab-CD3, 5 mg
      (eligible for pass-through payments)
      7039 = Pegademase bovine inj 25 I.U.
      (eligible for pass-through payments)
      7040 = Pentastarch 10% inj, 100 ml
      (eligible for pass-through payments)
      7041 = Tirofiban HCL, 0.5 mg
      (not subject to national coinsurance)
      7042 = Capecitabine, oral 150 mg
      (eligible for pass-through payments)
      7043 = Infliximab, 10 MG (eligible for pass-through
      payments)
      7045 = Trimetrexate Glucoronate (eligible for pass-
      through payments)
      7046 = Doxorubicin Hcl Liposome (eligible for pass-
      through payments)
      7047 = Droperidol/fentanyl inj (eff. 1/01)
      7048 = Alteplase, 1 mg (eff. 1/01)
      7049 = Filgrastim 480 mcg injection (eff. 1/01)
      7315 = Sodium hyaluronate, 20 mg (eff. 1/01)
      8099 = Spectranetics Lead Lock Dev (eff. 1/01)
      (obsolete 4/01)
      8100 = Adhesion barrier, ADCON-L (eff. 1/01)
      (obsolete 4/01)
      8102 = SurgiVision Esoph Coil (eff. 1/01)
      (obsolete 4/01)
      9000 = Na chromate Cr51, per 0.25mCi (eff. 1/01)
      9001 = Linezolid inj, 200mg (eff. 1/01)
      9002 = Tenecteplase, 50mg/vial (eff. 1/01)
      9003 = Palivizumab, per 50 mg (eff. 1/01)
      9004 = Gemtuzumab ozogamicin inj, 5mg (eff. 1/01)
      9005 = Reteplase inj, half-kit, 18.8 mg/vial (eff. 1/01)
      9006 = Tacrolimus inj, per 5 mg (1 amp) (eff. 1/01)
      9007 = Baclofen Intrathecal kit-1amp (eff. 1/01)
      9008 = Baclofen Refill Kit--500mcg (eff. 1/01)
      9009 = Baclofen Refill Kit--2000mcg (eff. 1/01)
      9010 = Baclofen Refill Kit--4000mcg (eff. 1/01)
      9011 = Caffeine Citrate, inj, 1ml (eff. 1/01)
      9012 = Arsenic Trioxide, 1mg/kg (eff. 4/01)
      9013 = Co 57 Cobaltous Cl, 1 ml (eff. 4/01)
      9100 = Iodinated I-131 Albumin (eff. 1/01)
      9102 = 51 Na chromate, 50mCi (eff. 1/01)
      9103 = Na lothalamate I-125, 10uCi (eff. 1/01)
      9104 = Anti-thymocyte globin, 25 mg (eff. 1/01)
      9105 = Hep B immun glob, per 1 ml (eff. 1/01)
      9106 = Sirolimus 1 mg/ml (eff. 1/01)
      9107 = Tinzaparin sodium, 2ml vial (eff. 1/01)
      9108 = Thyrotropin Alfa, 1.1 mg (eff. 1/01)
      9109 = Tirofiban hydrachloride 6.25 mg (eff. 1/01)
      9217 = Leuprolide acetate for depot suspension,
      7.5 mg (eff. 1/01)
      9500 = Platelets, irrad, ea unit (eff. 1/01)
      9501 = Platelets, pheresis, ea unit (eff. 1/01)
      9502 = Platelets, pher/irrad, ea unit (eff. 1/01)
      9503 = Fresh frozen plasma, ea unit (eff. 1/01)
      9504 = RBC, deglycerolized, ea unit (eff. 1/01)
      9505 = RBC, irradiated, ea unit (eff. 1/01)
      9998 = Enoxaparin (eff. 1/01)



 REV_CNTR_CNSLDTD_BLG_TB                 Revenue Center Consolidated Billing Table

      1 = Home Health Consolidated Billing Override Code
      2 = SNF Consolidated Billing Override Code



 REV_CNTR_DDCTBL_COINSRNC_TB             Revenue Center Deductible Coinsurance Code

       0 = Charges are subject to deductible
           and coinsurance
       1 = Charges are not subject to deductible
       2 = Charges are not subject to coinsurance
       3 = Charges are not subject to deductible
           or coinsurance
       4 = No charge or units associated with this
           revenue center code.  (For multiple
           HCPCS per single revenue center code)

       For revenue center code 0001, the following
       MSP override values may be present:

       M = Override code; EGHP services involved
           (eff 12/90 for non-institutional claims;
           10/93 for institutional claims)
       N = Override code; non-EGHP services involved
           (eff 12/90 for non-institutional claims;
           10/93 for institutional claims)
       X = Override code: MSP cost avoided
           (eff 12/90 for non-institutional claims;
           10/93 for institutional claims)



 REV_CNTR_DSCNT_IND_TB                   Revenue Center Discount Indicator Table

      *DISCOUNTING FORMULAS*
      1 = 1.0
      2 = (1.0+D(U-1))/U
      3 = T/U
      4 = (1+D)/U
      5 = D
      6 = TD/U
      7 = D(1+D)/U
      8 = 2.0/U

      NOTE:  VALUES D, U & T REPRESENT THE FOLLOWING:
      D = Discounting fraction (currently 0.5)
      U = Number of units
      T = Terminated procedure discount (currently 0.5)



 REV_CNTR_DUP_CLM_CHK_IND_TB             Revenue Center Duplicate Claim Check Indcator Table

       1 = Suspect duplicate review performed



 REV_CNTR_NDC_QTY_QLFR_TB                Revenue Center NDC Qualifier Code Table

      Valid Values:
      F2 = International Unit
      GR = Gram
      ML = Milliliter
      UN = Unit



 REV_CNTR_PACKG_IND_TB                   Revenue Center Packaging Indicator Table

      0 = Not packaged
      1 = Packaged service (service indicator N)
      2 = Packaged as part of partial hospitalization
          per diem or daily mental health service
          per diem
      3 = Artificial charges for surgical procedure
          (eff. 7/2004)



 REV_CNTR_PMT_MTHD_IND_TB                Revenue Center Payment Method Indicator Table

      NOTE: Prior to 10/2005, this table contained the
      valid values for both the payment indicator and
      status indicator.  Effective 10/2005, the payment
      indicator codes will remain in this table and the
      status indicator code values will be reflected in
      the new table: REV_CNTR_STUS_IND_TB. Both the
      payment indicator and status indicator values have
      been expanded to 2-btyes.

      1 =  Paid standard hospital OPPS amount
           (status indicators K, S,T,V,X)
      2 =  Services not paid under OPPS (status
           indicator A, or no HCPCS code and not
           certain revenue center codes)
      3 =  Not paid (status indicator M,W,Y,E) or not
           paid under OPPS (status indicator B,C & Z)
      4 =  Paid at reasonable cost (status  indica-
           tor F,L)
      5 =  Additional payment for drug or biological
           (status indicator G)
      6 =  Additional payment for device (status
           indicator H)
      7 =  Additional payment for new drug or new
           biological (status indicator J)
      8 =  Paid partial hospitalization per diem
           (status indicator P)
      9 =  No additional payment, payment included
           in line items with APCs (status indicator
           N, or no HCPCS code and certain revenue
           center codes, or HCPCS codes G0176
           (activity therapy), G0129 (occupational
           therapy) or G0177 (partial hospitalization
           program services)
      A2 = Surgical procedure on ASC list in CY 2007;
           payment based on OPPS payment relative weight
      B5 = Alternative code may be available; no payment
           made
      D5 = Deleted/discontinued code; no payment made
      F4 = Corneal tissue acquisition, hepatitis B vaccine;
           paid at reasonable cost
      G2 = Non-office based surgical procedure added in CY 2008
           or later; payment based on OPPS relative payment
           weight
      H2 = Brachytherapy source paid separately when provided
           intregal to a surgical procedure on an ASC lists;
           payment based on OPPS rates
      J7 = OPPS pass-through device paid when separately provided
           intregal to a surgical procedure on ASC list; pay-
           ment contractor priced
      J8 = Device-intensive procedure; paid at adjusted rate
      K2 = Drugs and biologicals paid separately when provided
           intregal to a surgical procedure on ASC list; pay-
           ment based on OPPS rate
      K7 = Unclassified drugs and biologicals; payment contractor
           priced
      L1 = Influenza vaccine; pneumoccocal vaccine.  Packaged
           item/service, no separate payment made
      L6 = New Technology Intarocular Lens (NTIOL); special
           payment
      N1 = Package service/item; no separate payment made
      P2 = Office-based surgical procedure added to ASC list
           in CY 2008 or later with MPFS non-facility PE RUVs
           payment based on OPPS relative payment weight.
      P3 = Office-based surgical procedure added to ASC list
           in CY 2008 or later with MPFS non-facility PE RUVs
           payment based on MPFS nonfacility PE RUVs.
      R2 = Office-based surgical procedure added to ASC list
           in CY 2008 or later without MPFS non-facility PE
           RVUs payment based on OPPS relative payment weight.
      Z2 = Radioloty or diagnostic service paid separately
           when provided intregal to a surgical procedure on
           an ASC list; payment based on OPPS relative payment
           weight.
      Z3 = Radioloty or diagnostic service paid separately
           when provided intregal to a surgical procedure on
           an ASC list; payment based on MFPS nonfacility PE
           RVUs.

      *********VALUES PRIOR TO 10/3/2005**************
      ****************Service Indicator**************
      **************** 1st position *****************

      A = Services not paid under OPPS
      C = Inpatient procedurel pass-through
      E = Noncovered items or services
      F = Corneal tissue acquistion
      G = Current drug or biological pass-through
      H = Device pass-through
      J = New drug or new biological pass-through
      N = Packaged incidental service
      P = Partial hospitalization services
      S = Significant procedure not subject to
          multiple procedure discounting
      T = Significant procedure subject to multiple
          procedure discounting
      V = Medical visit to clinic or emergency
          department
      X = Ancillary service

      **********Payment Indicator**************
      ********** 2nd position *****************
      1 = Paid standard hospital OPPS amount
          (service indicators S,T,V,X)
      2 = Services not paid under OPPS (service
          indicator A, or no HCPCS code and not
          certain revenue center codes)
      3 = Not paid (service indicators C & E)
      4 = Acquisition cost paid (service indica-
          tor F)
      5 = Additional payment for current drug or
          biological (service indicator G)
      6 = Additional payment for device (service
          indicator H)
      7 = Additional payment for new drug or new
          biological (service indicator J)
      8 = Paid partial hospitalization per diem
          (service indicator P)
      9 = No additional payment, payment included
          in line items with APCs (service
          indicator N, or no HCPCS code and certain
          revenue center codes, or HCPCS codes Q0082
          (activity therapy), G0129 (occupational
          therapy) or G0172 (partial hospitalization
          training)



 REV_CNTR_PRICNG_IND_TB                  Revenue Center Pricing Indicator Table

      A = A valid HCPCS code not subject to a fee schedule payment.
      Reimbursement is calculated on provider submitted
      charges.

      B = A valid HCPCS code subject to the fee schedule payment.
      for the provider billed charges. NOTE: There is an excep-
      tion for Critical Access Hospitals (provider numbers
      XX1300-XX1399) with reimbursement method 'J' (all-
      inclusive method) and dates of service on or after
      7/1/01.  In these situations, reimbursement for pro-
      fessional services (revenue codes 96X, 97X, 98X) is
      always at the fee schedule amount of logic is not
      applicable.

      C = Unlisted Rehabilitation Carrier Priced HCPCS

      D = a valid radiology HCPCS code subject to the Radiology
      Pricer and the rate is reflected as zeroes on the HCPCS
      file and cost report.  The Radiology Pricer treates this
      HCPCS as a non-covered service.  Reimbursement is cal-
      culated on provider submitted charges.

      E = A valid ASC HCPCS code subject to the ASC Pricer. The
      rate is reflected as zeroes on the HCPCS file.  The
      ASC Pricer determines the ASC payment rate and is re-
      ported on the cost report.

      F = A valid ESRD HCPCS code subject to the parameter rate.
      Reimbursement is the lesser of provider submitted
      charges or the fee schedule amount for non-dialysis
      HCPCS.  Reimbursement is calculated on the provider
      file rates for dialysis HCPCS.

      NOTE: The ESRD Pricing Indicator is used when process-
      ing the ESRD claim. The non-ESRD pricing indicator
      is used only for Inpatient claims as follows: valid
      Hemophilia HCPCS for inpatient claim only and code is
      summed to parameter rate.

      G = A valid HCPCS, code is subject to a fee schedule, but
      the rate is no longer present on the HCPCS file.
      Reimbursement is calculated on provider submitted
      charges.

      H = A valid DME HCPCS, code is subject to a fee schedule.
      The rates are reflected under the DME segment.  Reim-
      bursement is calculated either on a fee schedule, pro-
      vider submitted charges or the lesser of provider
      submitted, or the fee schedule depending on the cate-
      gory of DME.

      I = A valid DME category 5 HCPCS, HCPCS is not found on
      the DME history record, but a match was found on HIC,
      category and generic code.  Claim must be reviewed by
      Medical Review before payment can be calculated.

      J = A valid DME HCPCS, no DME history is present, and a
      prescription is required before delivery.  Claim must
      be reviewed by Medical Review.

      K = A valid DME HCPCS, prescribed has been reviewed, and
      fee schedule payment is approved as prescription was
      present before delivery.

      L = A valid TENS HCPCS, rental period is six months or
      greater and must be reviewed by Medical Review. This
      code will be automatically set by the system.

      M = A valid TENS HCPCS, Medical Review has approved the
      rental charge in excess of five months. This must be
      set by Medical Review.  This must be set by Medical
      Review when approved for payment.

      N = Paid based on the fee amount for non ESRD TOB's.
          NOTE: Fee amount is paid regardless of charges.

      Q = Manual pricing

      R = A valid radiology HCPCS code and is subject to
      APC.  The rate is reported on the cost report.
      Reimbursement is calculated on provider submitted
      charges.

      S = Valid influenza/PPV HCPCS.  A fee amount is not
      applicable.  The amount payable is present in the
      covered charge field.  This amount is not subject
      to the coinsurance and deductible.  This charge is
      subject to the provider's reimbursement rate.

      T = Valid HCPCS.  A fee amount is present.  The amount
      payable should be the lower of the billed charge or
      fee amount.  The system should compute the fee amount
      by multiplying the covered units times the rate.
      The fee amount is not subject to coinsurance and
      deductible or provider's reimbursement rate.

      U = Valid ambulance HCPCS. A fee amount is present.
      The amount payable is a blended amount based on  a
      percentage of the fee schedule and a percentage of
      the reasonable cost.  The fee amount is subject to
      coinsurance and deductible.

      X = Unclassified drug as subject to manual pricing.



 REV_CNTR_PRIOR_AUTHRZTN_TB              Revenue Center Prior Authorization Indicator Table

      A = Part A
      B = Part B
      D = DME
      H = Home Health and Hospice
      + 3 digit number



 REV_CNTR_PWK_TB                         Revenue Center Paperwork Table


      P1 = one iteration is present
      P2 = two iterations are present
      P3 = three iterations are present
      P4 = four iterations are present
      P5 = five iterations are present
      P6 = six iterations are present
      P7 = seven iterations are present
      P8 = eight iterations are present
      P9 = nine iterations are present
      P0 = ten iterations are present



 REV_CNTR_STUS_IND_TB                    Revenue Center Status Indicator Table

      A =  Services not paid under OPPS; paid by MACs under a fee
           schedule or payment system other than OPPS
      B =  Non-allowed item or service for OPPS
      C =  Inpatient procedure; not paid under OPPS
      D =  Discontinued Codes - not paid under OPPS or any other
           Medicare payment system
      E1 = Non-allowed item or service - not paid by Medicare when
           submitted on outpatient claims (any outpatient bill
           type)
      E2 = Non-allowed item or service for which pricing information
           and claims data is not available - not paid by Medicare
           when submitted on outpatient claims (any outpatient
           bill type)
      F =  Corneal tissue acquisition and certain CRNA
           services and Hepatitis B vaccines
      G =  Drug/bilogical pass-through
      H =  Device pass-through
      J1 = Hospital Part B services paid through a comprehensive
           APC -- Paid under OPPS; all covered Part B services on
           on the claim are packaged with the primary "J1" service
           service for the claim, except services with OPPS status
           indicator of "F","G", "H", "L" and "U"; ambulance
           services; diagnostic and screening mammography; rehab-
           ilitation therapy services; new technology services;
           self-administered drugs; all preventive services; and
           certain Part B inpatient services.
      J2 = Hospital Part B services that may be paid through a
           comprehensize APC - Paid under OPPS; Addendum B displays
           APC assignments when services are separately payable
      K =  Non pass-through drug/biological, radio-
           pharmaceutical agent, certain brachytherapy
           sources.  Paid under OPPS; separate APC payment
      L =  Flu/PPV vaccines - Not paid under OPPS. Paid at
           reasonable cost; not subject to deductible or
           coinsurance
      M =  Service not billable to MAC; Not paid under OPPS
      N =  Items and services packaged into APC rates
           Paid under OPPS; payment is packaged into payment
           for other services.  Therefore, there is no separate
           APC payment
      P =  Partial Hospitalization; Paid under OPPS; per diem
           APC payment
      Q1 = STV - Packaged Codes - Paid under OPPS; Addendum B
           displays APC assignments when services are
           separately paybable
      Q2 = T - Packaged Codes - Paid under OPPS; Addendum B
           displays APC assignments when services are
           separately paybable
      Q3 = Codes that may be paid through a composite APC
      Q4 = Conditionally packaged laboratory tests
           Paid under OPPS or CLFS
      R =  Blood and blood products; Paid under OPPS; separate
           APC payment
      S =  Significant procedure not subject to multiple
           procedure discounting - Paid under OPPS; separate
           APC payment
      T =  Significant procedure subject to multiple
           procedure discounting; Paid under OPPS; separate
           APC payment
      U =  Brachytherapy Sources - Paid under OPPS; separate
           APC payment
      V =  Medical visit to clinic or emergency department -
           Paid under OPPS; separate APC payment
      W =  Invalid HCPCS or invalid revenue code with blank
           HCPCS (terminated)
      X =  Ancillary service (terminated)
      Y =  Non-implantable DME, Therapeutic shoes
      Z =  Valid revenue with blank HCPCS and no other SI
           assigned (terminated)



 REV_CNTR_TB                             Revenue Center Table

       0001 = Total charge
       0022 = SNF claim paid under PPS submitted as TOB 21X,
              effective for cost reporting periods begin-
              ning on or after 7/1/98 (dates of service after
              6/30/98).  NOTE:  This code may appear multiple
              times on a claim to identify different HIPPS
              Rate Code/assessment periods.
       0023 = Home Health services paid under PPS submitted as
              TOB 32X and 33X, effective 10/00.  This code may
              appear multiple times on a claim to identify
              different HIPPS/Home Health Resource Groups (HRG).
       0024 = Inpatient Rehabilitation Facility services paid
              under PPS submitted as TOB 11X, effective for
              cost reporting periods beginning on or after
              1/1/2002 (dates of service after 12/31/01).
              This code may appear only once on a claim.
       0100 = All inclusive rate-room and board plus ancillary
       0101 = All inclusive rate-room and board
       0110 = Private medical or general-general classification
       0111 = Private medical or general-medical/surgical/GYN
       0112 = Private medical or general-OB
       0113 = Private medical or general-pediatric
       0114 = Private medical or general-psychiatric
       0115 = Private medical or general-hospice
       0116 = Private medical or general-detoxification
       0117 = Private medical or general-oncology
       0118 = Private medical or general-rehabilitation
       0119 = Private medical or general-other
       0120 = Semi-private 2 bed (medical or general)
              general classification
       0121 = Semi-private 2 bed (medical or general)
              medical/surgical/GYN
       0122 = Semi-private 2 bed (medical or general)-OB
       0123 = Semi-private 2 bed (medical or general)-pediatric
       0124 = Semi-private 2 bed (medical or general)-psychiatric
       0125 = Semi-private 2 bed (medical or general)-hospice
       0126 = Semi-private 2 bed (medical or general)
              detoxification
       0127 = Semi-private 2 bed (medical or general)-oncology
       0128 = Semi-private 2 bed (medical or general)
              rehabilitation
       0129 = Semi-private 2 bed (medical or general)-other
       0130 = Semi-private 3 and 4 beds-general classification
       0131 = Semi-private 3 and 4 beds-medical/surgical/GYN
       0132 = Semi-private 3 and 4 beds-OB
       0133 = Semi-private 3 and 4 beds-pediatric
       0134 = Semi-private 3 and 4 beds-psychiatric
       0135 = Semi-private 3 and 4 beds-hospice
       0136 = Semi-private 3 and 4 beds-detoxification
       0137 = Semi-private 3 and 4 beds-oncology
       0138 = Semi_private 3 and 4 beds-rehabilitation
       0139 = Semi-private 3 and 4 beds-other
       0140 = Private (deluxe)-general classification
       0141 = Private (deluxe)-medical/surgical/GYN
       0142 = Private (deluxe)-OB
       0143 = Private (deluxe)-pediatric
       0144 = Private (deluxe)-psychiatric
       0145 = Private (deluxe)-hospice
       0146 = Private (deluxe)-detoxification
       0147 = Private (deluxe)-oncology
       0148 = Private (deluxe)-rehabilitation
       0149 = Private (deluxe)-other
       0150 = Room&Board ward (medical or general)
              general classification
       0151 = Room&Board ward (medical or general)
              medical/surgical/GYN
       0152 = Room&Board ward (medical or general)-OB
       0153 = Room&Board ward (medical or general)-pediatric
       0154 = Room&Board ward (medical or general)-psychiatric
       0155 = Room&Board ward (medical or general)-hospice
       0156 = Room&Board ward (medical or general)-detoxification
       0157 = Room&Board ward (medical or general)-oncology
       0158 = Room&Board ward (medical or general)-rehabilitation
       0159 = Room&Board ward (medical or general)-other
       0160 = Other Room&Board-general classification
       0164 = Other Room&Board-sterile environment
       0167 = Other Room&Board-self care
       0169 = Other Room&Board-other
       0170 = Nursery-general classification
       0171 = Nursery-newborn
              level I (routine)
       0172 = Nursery-premature
              newborn-level II (continuing care)
       0173 = Nursery-newborn-level III (intermediate care)
              (eff 10/96)
       0174 = Nursery-newborn-level IV (intensive care)
              (eff 10/96)
       0175 = Nursery-neonatal ICU (obsolete eff 10/96)
       0179 = Nursery-other
       0180 = Leave of absence-general classification
       0182 = Leave of absence-patient convenience charges
              billable
       0183 = Leave of absence-therapeutic leave
       0184 = Leave of absence-ICF mentally retarded-any reason
              (obsolete)
       0185 = Leave of absence-nursing home (hospitalization)
       0189 = Leave of absence-other leave of absence
       0190 = Subacute care - general classification
              (eff. 10/97)
       0191 = Subacute care - level I (eff. 10/97)
       0192 = Subacute care - level II (eff. 10/97)
       0193 = Subacute care - level III (eff. 10/97)
       0194 = Subacute care - level IV (eff. 10/97)
       0199 = Subacute care - other (eff 10/97)
       0200 = Intensive care-general classification
       0201 = Intensive care-surgical
       0202 = Intensive care-medical
       0203 = Intensive care-pediatric
       0204 = Intensive care-psychiatric
       0206 = Intensive care-post ICU; redefined as
              intermediate ICU (eff 10/96)
       0207 = Intensive care-burn care
       0208 = Intensive care-trauma
       0209 = Intensive care-other intensive care
       0210 = Coronary care-general classification
       0211 = Coronary care-myocardial infraction
       0212 = Coronary care-pulmonary care
       0213 = Coronary care-heart transplant
       0214 = Coronary care-post CCU; redefined as
              intermediate CCU (eff 10/96)
       0219 = Coronary care-other coronary care
       0220 = Special charges-general classification
       0221 = Special charges-admission charge
       0222 = Special charges-technical support charge
       0223 = Special charges-UR service charge
       0224 = Special charges-late discharge, medically
              necessary
       0229 = Special charges-other special charges
       0230 = Incremental nursing charge rate-general
              classification
       0231 = Incremental nursing charge rate-nursery
       0232 = Incremental nursing charge rate-OB
       0233 = Incremental nursing charge rate-ICU (include
              transitional care)
       0234 = Incremental nursing charge rate-CCU (include
              transitional care)
       0235 = Incremental nursing charge rate-hospice
       0239 = Incremental nursing charge rate-other
       0240 = All inclusive ancillary-general classification
       0241 = All inclusive ancillary-basic
       0242 = All inclusive ancillary-comprehensive
       0243 = All inclusive ancillary-specialty
       0249 = All inclusive ancillary-other inclusive ancillary
       0250 = Pharmacy-general classification
       0251 = Pharmacy-generic drugs
       0252 = Pharmacy-nongeneric drugs
       0253 = Pharmacy-take home drugs
       0254 = Pharmacy-drugs incident to other diagnostic service-
              subject to payment limit
       0255 = Pharmacy-drugs incident to radiology-
              subject to payment limit
       0256 = Pharmacy-experimental drugs
       0257 = Pharmacy-non-prescription
       0258 = Pharmacy-IV solutions
       0259 = Pharmacy-other pharmacy
       0260 = IV therapy-general classification
       0261 = IV therapy-infusion pump
       0262 = IV therapy-pharmacy services (eff 10/94)
       0263 = IV therapy-drug supply/delivery (eff 10/94)
       0264 = IV therapy-supplies (eff 10/94)
       0269 = IV therapy-other IV therapy
       0270 = Medical/surgical supplies-general classification
              (also see 062X)
       0271 = Medical/surgical supplies-nonsterile supply
       0272 = Medical/surgical supplies-sterile supply
       0273 = Medical/surgical supplies-take home supplies
       0274 = Medical/surgical supplies-prosthetic/orthotic
              devices
       0275 = Medical/surgical supplies-pace maker
       0276 = Medical/surgical supplies-intraocular lens
       0277 = Medical/surgical supplies-oxygen-take home
       0278 = Medical/surgical supplies-other implants
       0279 = Medical/surgical supplies-other devices
       0280 = Oncology-general classification
       0289 = Oncology-other oncology
       0290 = DME (other than renal)-general classification
       0291 = DME (other than renal)-rental
       0292 = DME (other than renal)-purchase of new DME
       0293 = DME (other than renal)-purchase of used DME
       0294 = DME (other than renal)-related to and listed as DME
       0299 = DME (other than renal)-other
       0300 = Laboratory-general classification
       0301 = Laboratory-chemistry
       0302 = Laboratory-immunology
       0303 = Laboratory-renal patient (home)
       0304 = Laboratory-non-routine dialysis
       0305 = Laboratory-hematology
       0306 = Laboratory-bacteriology & microbiology
       0307 = Laboratory-urology
       0309 = Laboratory-other laboratory
       0310 = Laboratory pathological-general classification
       0311 = Laboratory pathological-cytology
       0312 = Laboratory pathological-histology
       0314 = Laboratory pathological-biopsy
       0319 = Laboratory pathological-other
       0320 = Radiology diagnostic-general classification
       0321 = Radiology diagnostic-angiocardiography
       0322 = Radiology diagnostic-arthrography
       0323 = Radiology diagnostic-arteriography
       0324 = Radiology diagnostic-chest X-ray
       0329 = Radiology diagnostic-other
       0330 = Radiology therapeutic-general classification
       0331 = Radiology therapeutic-chemotherapy injected
       0332 = Radiology therapeutic-chemotherapy oral
       0333 = Radiology therapeutic-radiation therapy
       0335 = Radiology therapeutic-chemotherapy IV
       0339 = Radiology therapeutic-other
       0340 = Nuclear medicine-general classification
       0341 = Nuclear medicine-diagnostic
       0342 = Nuclear medicine-therapeutic
       0343 = Nuclear medicine-diagnostic radiopharmaceuticals
       0344 = Nuclear medicine-therapeutic radiopharmaceuticals
       0349 = Nuclear medicine-other
       0350 = Computed tomographic (CT) scan-general
              classification
       0351 = CT scan-head scan
       0352 = CT scan-body scan
       0359 = CT scan-other CT scans
       0360 = Operating room services-general classification
       0361 = Operating room services-minor surgery
       0362 = Operating room services-organ transplant,
              other than kidney
       0367 = Operating room services-kidney transplant
       0369 = Operating room services-other operating room
              services
       0370 = Anesthesia-general classification
       0371 = Anesthesia-incident to RAD and
              subject to the payment limit
       0372 = Anesthesia-incident to other diagnostic service
              and subject to the payment limit
       0374 = Anesthesia-acupuncture
       0379 = Anesthesia-other anesthesia
       0380 = Blood-general classification
       0381 = Blood-packed red cells
       0382 = Blood-whole blood
       0383 = Blood-plasma
       0384 = Blood-platelets
       0385 = Blood-leukocytes
       0386 = Blood-other components
       0387 = Blood-other derivatives (cryopricipatates)
       0389 = Blood-other blood
       0390 = Blood storage and processing-general
              classification
       0391 = Blood storage and processing-blood
              administration
       0392 = Blood storage and processing - storage
              and processing
       0399 = Blood storage and processing-other
       0400 = Other imaging services-general classification
       0401 = Other imaging services-diagnostic mammography
       0402 = Other imaging services-ultrasound
       0403 = Other imaging services-screening mammography
              (eff 1/1/91)
       0404 = Other imaging services-positron emission
              tomography (eff 10/94)
       0409 = Other imaging services-other
       0410 = Respiratory services-general classification
       0412 = Respiratory services-inhalation services
       0413 = Respiratory services-hyperbaric oxygen therapy
       0419 = Respiratory services-other
       0420 = Physical therapy-general classification
       0421 = Physical therapy-visit charge
       0422 = Physical therapy-hourly charge
       0423 = Physical therapy-group rate
       0424 = Physical therapy-evaluation or re-evaluation
       0429 = Physical therapy-other
       0430 = Occupational therapy-general classification
       0431 = Occupational therapy-visit charge
       0432 = Occupational therapy-hourly charge
       0433 = Occupational therapy-group rate
       0434 = Occupational therapy-evaluation or re-evaluation
       0439 = Occupational therapy-other (may include
              restorative therapy)
       0440 = Speech language pathology-general classification
       0441 = Speech language pathology-visit charge
       0442 = Speech language pathology-hourly charge
       0443 = Speech language pathology-group rate
       0444 = Speech language pathology-evaluation or
              re-evaluation
       0449 = Speech language pathology-other
       0450 = Emergency room-general classification
       0451 = Emergency room-emtala emergency medical screening
              services (eff 10/96)
       0452 = Emergency room-ER beyond emtala screening
              (eff 10/96)
       0456 = Emergency room-urgent care (eff 10/96)
       0459 = Emergency room-other
       0460 = Pulmonary function-general classification
       0469 = Pulmonary function-other
       0470 = Audiology-general classification
       0471 = Audiology-diagnostic
       0472 = Audiology-treatment
       0479 = Audiology-other
       0480 = Cardiology-general classification
       0481 = Cardiology-cardiac cath lab
       0482 = Cardiology-stress test
       0483 = Cardiology-Echocardiology
       0489 = Cardiology-other
       0490 = Ambulatory surgical care-general classification
       0499 = Ambulatory surgical care-other
       0500 = Outpatient services-general classification
       0509 = Outpatient services-other
       0510 = Clinic-general classification
       0511 = Clinic-chronic pain center
       0512 = Clinic-dental center
       0513 = Clinic-psychiatric
       0514 = Clinic-OB-GYN
       0515 = Clinic-pediatric
       0516 = Clinic-urgent care clinic (eff 10/96)
       0517 = Clinic-family practice clinic (eff 10/96)
       0519 = Clinic-other
       0520 = Free-standing clinic-general classification
       0521 = Free-standing clinic-Clinic visit by a
              member to RHC/FQHC (eff. 7/1/06). Prior to
              7/1/06 - Rural Health-Clinic
       0522 = Free-standing clinic-Home visit by RHC/FQHC
              practitioner (eff. 7/1/06).  Prior to
              7/1/06 - Rural Health-Home
       0523 = Free-standing clinic-family practice
       0524 = Free-standing clinic - visit by RHC/FQHC
              practitioner to a member in a covered Part
              A stay at the SNF. (eff. 7/1/06)
       0525 = Free-standing clinic - visit by RHC/FQHC
              practitioner to a member in a SNF (not in
              a covered Part A stay) or NF or ICF MR or
              other residential facility. (eff. 7/1/06)
       0526 = Free-standing clinic-urgent care (eff 10/96)
       0527 = Free-standing clinic-RHC/FQHC visiting nurse
              service(s) to a member's home when in a home
              health shortage area. (eff. 7/1/06)
       0528 = Free-standing clinic-visit by RHC/FQHC
              practitioner to other non RHC/FQHC site
              (e.g. scene of accident).  (eff. 7/1/06)
       0529 = Free-standing clinic-other
       0530 = Osteopathic services-general classification
       0531 = Osteopathic services-osteopathic therapy
       0539 = Osteopathic services-other
       0540 = Ambulance-general classification
       0541 = Ambulance-supplies
       0542 = Ambulance-medical transport
       0543 = Ambulance-heart mobile
       0544 = Ambulance-oxygen
       0545 = Ambulance-air ambulance
       0546 = Ambulance-neo-natal ambulance
       0547 = Ambulance-pharmacy
       0548 = Ambulance-telephone transmission EKG
       0549 = Ambulance-other
       0550 = Skilled nursing-general classification
       0551 = Skilled nursing-visit charge
       0552 = Skilled nursing-hourly charge
       0559 = Skilled nursing-other
       0560 = Medical social services-general classification
       0561 = Medical social services-visit charge
       0562 = Medical social services-hourly charges
       0569 = Medical social services-other
       0570 = Home health aid (home health)-general
              classification
       0571 = Home health aid (home health)-visit charge
       0572 = Home health aid (home health)-hourly charge
       0579 = Home health aid (home health)-other
       0580 = Other visits (home health)-general
              classification (under HHPPS, not allowed
              as covered charges)
       0581 = Other visits (home health)-visit charge
              (under HHPPS, not allowed as covered charges)
       0582 = Other visits (home health)-hourly charge
              (under HHPPS, not allowed as covered charges)
       0583 = Other visits (home health) - assessments
              (under HHPPS, not allow as covered charges)
       0589 = Other visits (home health)-other
              (under HHPPS, not allowed as covered charges)
       0590 = Units of service (home health)-general
              classification (under HHPPS, not allowed
              as covered charges)
       0599 = Units of service (home health)-other
              (under HHPPS, not allowed as covered charges)
              (obsolete)
       0600 = Oxygen/Home Health-general classification
       0601 = Oxygen/Home Health-stat or port equip/supply
              or count
       0602 = Oxygen/Home Health-stat/equip/under 1 LPM
       0603 = Oxygen/Home Health-stat/equip/over 4 LPM
       0604 = Oxygen/Home Health-stat/equip/portable add-on
       0609 = Oxygen/Home Health - Other (Obsolete)
       0610 = Magnetic resonance technology (MRT)-general
              classification
       0611 = MRT/MRI-brain (including brainstem)
       0612 = MRT/MRI-spinal cord (including spine)
       0614 = MRT/MRI-other
       0615 = MRT/MRA-Head and Neck
       0616 = MRT/MRA-Lower Extremities
       0618 = MRT/MRA-other
       0619 = MRT/Other MRT
       0620 = Reserved (Use 0270 for general classification)
       0621 = Medical/surgical supplies-incident to radiology-
              subject to the payment limit - extension of 027X
       0622 = Medical/surgical supplies-incident to other
              diagnostic service-subject to the payment limit -
              extension of 027X
       0623 = Medical/surgical supplies-surgical dressings
              (eff 1/95) - extension of 027X
       0624 = Medical/surgical supplies-medical investigational
              devices and procedures with FDA approved IDE's
              (eff 10/96) - extension of 027X
       0630 = Reserved (eff. 1/98)
       0631 = Drugs requiring specific identification-single drug
              source (eff 9/93)
       0632 = Drugs requiring specific identification-multiple drug
              source (eff 9/93)
       0633 = Drugs requiring specific identification-restrictive
              prescription (eff 9/93)
       0634 = Drugs requiring specific identification-EPO under
              10,000 units
       0635 = Drugs requiring specific identification-EPO 10,000
              units or more
       0636 = Drugs requiring specific identification-detailed
              coding (eff 3/92)
       0637 = Self-administered drugs administered in an
              emergency situation - not requiring detailed
              coding
       0640 = Home IV therapy-general classification
              (eff 10/94)
       0641 = Home IV therapy-nonroutine nursing
              (eff 10/94)
       0642 = Home IV therapy-IV site care, central line
              (eff 10/94)
       0643 = Home IV therapy-IV start/change peripheral line
              (eff 10/94)
       0644 = Home IV therapy-nonroutine nursing, peripheral line
              (eff 10/94)
       0645 = Home IV therapy-train patient/caregiver, central
              line (eff 10/94)
       0646 = Home IV therapy-train disabled patient, central
              line (eff 10/94)
       0647 = Home IV therapy-train patient/caregiver, peripheral
              line (eff 10/94)
       0648 = Home IV therapy-train disabled patient, peripheral
              line (eff 10/94)
       0649 = Home IV therapy-other IV therapy services
              (eff 10/94)
       0650 = Hospice services-general classification
       0651 = Hospice services-routine home care
       0652 = Hospice services-continuous home care-1/2

       0655 = Hospice services-inpatient care
       0656 = Hospice services-general inpatient care
              (non-respite)
       0657 = Hospice services-physician services
       0658 = Hospice services-Hospice Room & Board -
              Nursing Facility
       0659 = Hospice services-other
       0660 = Respite care (HHA)-general classification
              (eff 9/93)
       0661 = Respite care (HHA)-hourly charge/skilled nursing
              (eff 9/93)
       0662 = Respite care (HHA)-hourly charge/home health aide/
              homemaker (eff 9/93)
       0663 = Respite care-daily respite care
       0669 = Respite care-other respite care
       0670 = OP special residence charges - general
              classification
       0671 = OP special residence charges - hospital based
       0672 = OP special residence charges - contracted
       0679 = OP special residence charges - other special
              residence charges
       0680 = Trauma Response-not used
       0681 = Trauma response-Level I Trauma
       0682 = Trauma response-Level II Trauma
       0683 = Trauma response-Level III Trauma
       0684 = Trauma response-Level IV Trauma
       0689 = Trauma response-Other trauma response
       0690 = Pre-hospice/Palliative Care Services - general
              (eff. 7/1/17)
       0691 = Pre-hospice/Palliative Care Services - visit
              (eff. 7/1/17)
       0692 = Pre-hospice/Palliative Care Services - hourly
              (eff. 7/1/17)
       0693 = Pre-hospice/Palliative Care Services - evaluation
              (eff. 7/1/17)
       0694 = Pre-hospice/Palliative Care Services - consultation &
              education (eff. 7/1/17)
       0695 = Pre-hospice/Palliative Care Services - Inpatient
              (eff. 7/1/17)
       0696 = Pre-hospice/Palliative Care Services - Physician
              (eff. 7/1/17)
       0699 = Pre-hospice/Palliative Care Services - Other
              (eff. 7/1/17)
       0700 = Cast room-general classification
       0709 = Cast room-other (obsolete)
       0710 = Recovery room-general classification
       0719 = Recovery room-other (obsolete)
       0720 = Labor room/delivery-general classification
       0721 = Labor room/delivery-labor
       0722 = Labor room/delivery-delivery
       0723 = Labor room/delivery-circumcision
       0724 = Labor room/delivery-birthing center
       0729 = Labor room/delivery-other
       0730 = EKG/ECG-general classification
       0731 = EKG/ECG-Holter moniter
       0732 = EKG/ECG-telemetry (include fetal monitering until
              9/93)
       0739 = EKG/ECG-other
       0740 = EEG-general classification
       0749 = EEG (electroencephalogram)-other (Obsolete)
       0750 = Gastro-intestinal services-general classification
       0759 = Gastro-intestinal services-other (Obsolete)
       0760 = Treatment or observation room-general
              classification
       0761 = Treatment or observation room-treatment room
              (eff 9/93)
       0762 = Treatment or observation room-observation room
              (eff 9/93)
       0769 = Treatment or observation room-other
       0770 = Preventative care services-general classification
              (eff 10/94)
       0771 = Preventative care services-vaccine administration
              (eff 10/94)
       0779 = Preventative care services-other (eff 10/94) (Obsolete)
       0780 = Telemedicine - general classification
              (eff 10/97)
       0789 = Telemedicine - telemedicine (eff 10/97) (Obsolete)
       0790 = Extra-Corporeal Shock Wave Therapy (ESWT) - general
              classification - formerly Lithotripsy
       0799 = Lithotripsy-other (Obsolete)
       0800 = Inpatient renal dialysis-general classification
       0801 = Inpatient renal dialysis-inpatient hemodialysis
       0802 = Inpatient renal dialysis-inpatient peritoneal
              (non-CAPD)
       0803 = Inpatient renal dialysis-inpatient CAPD
       0804 = Inpatient renal dialysis-inpatient CCPD
       0809 = Inpatient renal dialysis-other inpatient dialysis
       0810 = Organ acquisition-general classification
       0811 = Organ acquisition-living donor (eff 10/94);
              prior to 10/94, defined as living donor kidney
       0812 = Organ acquisition-cadaver donor (eff 10/94);
              prior to 10/94, defined as cadaver donor kidney
       0813 = Organ acquisition-unknown donor (eff 10/94)
              prior to 10/94, defined as unknown donor kidney
       0814 = Organ acquisition - unsuccessful organ search-
              donor bank charges (eff 10/94); prior to 10/94,
              defined as other kidney acquisition
       0815 = Allogeneic Stem Cell Acquisition/Donor Services
       0816 = Organ acquisition-other heart acquisition
              (obsolete, eff 10/94)
       0817 = Organ acquisition-donor-liver
              (obsolete, eff 10/94)
       0819 = Organ acquisition-other donor (eff 10/94);
              prior to 10/94, defined as other
       0820 = Hemodialysis OP or home dialysis-general
              classification
       0821 = Hemodialysis OP or home dialysis-hemodialysis-
              composite or other rate
       0822 = Hemodialysis OP or home dialysis-home supplies
       0823 = Hemodialysis OP or home dialysis-home equipment
       0824 = Hemodialysis OP or home dialysis-maintenance/100%
       0825 = Hemodialysis OP or home dialysis-support services
       0826 = Hemodialysis OP or home dialysis- Hemo short
              (eff. 7/1/17)
       0829 = Hemodialysis OP or home dialysis-other
       0830 = Peritoneal dialysis OP or home-general
              classification
       0831 = Peritoneal dialysis OP or home-peritoneal-
              composite or other rate
       0832 = Peritoneal dialysis OP or home-home supplies
       0833 = Peritoneal dialysis OP or home-home equipment
       0834 = Peritoneal dialysis OP or home-maintenance/100%
       0835 = Peritoneal dialysis OP or home-support services
       0839 = Peritoneal dialysis OP or home-other
       0840 = CAPD outpatient-general classification
       0841 = CAPD outpatient-CAPD/composite or other rate
       0842 = CAPD outpatient-home supplies
       0843 = CAPD outpatient-home equipment
       0844 = CAPD outpatient-maintenance/100%
       0845 = CAPD outpatient-support services
       0849 = CAPD outpatient-other
       0850 = CCPD outpatient-general classification
       0851 = CCPD outpatient-CCPD/composite or other rate
       0852 = CCPD outpatient-home supplies
       0853 = CCPD outpatient-home equipment
       0854 = CCPD outpatient-maintenance/100%
       0855 = CCPD outpatient-support services
       0859 = CCPD outpatient-other
       0860 = Magnetoencephalography (MEG) - general
              classification
       0861 = Magnetoencephalography (MEG) - MEG
       0880 = Miscellaneous dialysis-general classification
       0881 = Miscellaneous dialysis-ultrafiltration
       0882 = Miscellaneous dialysis-home dialysis aide visit
              (eff 9/93)
       0889 = Miscellaneous dialysis-other
       0890 = Other donor bank-general classification; changed to
              reserved for national assignment (eff 4/94)
       0891 = Other donor bank-bone; changed to
              reserved for national assignment (eff 4/94)
       0892 = Other donor bank-organ (other than kidney); changed
              to reserved for national assignment (eff 4/94)
              (term. 3/2020)
       0892 = Special Processed Drugs  - FDA Approved Gene
              Therapy (eff. 4/2020)
       0893 = Other donor bank-skin; changed to
              reserved for national assignment (eff 4/94)
       0899 = Other donor bank-other; changed to
              reserved for national assignment (eff 4/94)
       0900 = Behavior Health Treatment/Services - general
              classification (eff. 10/2004); prior to
              10/2004 defined as Psychiatric/psychological
              treatments-general classification
       0901 = Behavior Health Treatment/Services - electroshock
              treatment (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-electroshock treatment
       0902 = Behavior Health Treatment/Services - milieu
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-milieu therapy
       0903 = Behavior Health Treatment/Services - play
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-play therapy
       0904 = Behavior Health Treatment/Services - activity
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-activity therapy
       0905 = Behavior Health Treatment/Services - intensive
              outpatient services-psychiatric (eff. 10/2004)
       0906 = Behavior Health Treatment/Services - intensive
              outpatient services-chemical dependency
              (eff. 10/2004)
       0907 = Behavior Health Treatment/Services - community
              behavioral health program-day treatment
              (eff. 10/2004)
       0909 = Reserved for National Use (eff. 10/2004); prior
              to 10/2004 defined as Psychiatric/psychological
              treatments-other
       0910 = Behavioral Health Treatment/Services-Reserved for
              National Assignment (eff. 10/2004); prior to
              10/2004 defined as Psychiatric/psychological
              services-general classification
       0911 = Behavioral Health Treatment/Services-rehabilitation
              (eff. 10/2004); prior to 10/2004 defined as
              Psychiatric/psychological services-rehabilitation
       0912 = Behavioral Health Treatment/Services-partial
              hospitalization-less intensive (eff. 10/2004);
              prior to 10/2004 defined as Psychiatric/
              psychological services-less intensive
       0913 = Behavioral Health Treatment/Services-partial
              hospitalization-intensive (eff. 10/2004);
              prior to 10/2004 defined as Psychiatric/
              psychological services-intensive
       0914 = Behavioral Health Treatment/Services-indivi-
              dual therapy (eff. 10/2004); prior to
              10/2004 defined as Psychiatric/psychological
              services-individual therapy
       0915 = Behavioral Health Treatment/Services-group
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological services-
              group therapy
       0916 = Behavioral Health Treatment/Services-family
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological services-
              family therapy
       0917 = Behavioral Health Treatment/Services-bio
              feedback (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological services-
              bio feedback
       0918 = Behavioral Health Treatment/Services-testing
              (eff. 10/2004); prior to 10/2004 defined as
              Psychiatric/psychological services-testing
       0919 = Behavioral Health Treatment/Services-other
              (eff. 10/2004); prior to 10/2004 defined as
              Psychiatric/psychological services-other
       0920 = Other diagnostic services-general classification
       0921 = Other diagnostic services-peripheral vascular lab
       0922 = Other diagnostic services-electromyelogram
       0923 = Other diagnostic services-pap smear
       0924 = Other diagnostic services-allergy test
       0925 = Other diagnostic services-pregnancy test
       0929 = Other diagnostic services-other
       0931 = Medical Rehabilitation Day Program - Half Day
       0932 = Medical Rehabilitation Day Program - Full Day
       0940 = Other therapeutic services-general classification
       0941 = Other therapeutic services-recreational therapy
       0942 = Other therapeutic services-education/training
              (include diabetes diet training)
       0943 = Other therapeutic services-cardiac rehabilitation
       0944 = Other therapeutic services-drug rehabilitation
       0945 = Other therapeutic services-alcohol
              rehabilitation
       0946 = Other therapeutic services-routine complex
              medical equipment
       0947 = Other therapeutic services-ancillary complex
              medical equipment (eff 3/92)
       0948 = Other therapeutic services- pulmonary rehab
       0949 = Other therapeutic services-other
       0951 = Professional Fees-athletic training (extension
              of 094X)
       0952 = Professional Fees-kinesiotherapy (extension
              of 094X)
       0953 = Chemical Dependency (eff. 4/2013)
       0960 = Professional fees-general classification
       0961 = Professional fees-psychiatric
       0962 = Professional fees-ophthalmology
       0963 = Professional fees-anesthesiologist (MD)
       0964 = Professional fees-anesthetist (CRNA)
       0969 = Professional fees-other
              NOTE:  097X is an extension of 096X
       0971 = Professional fees-laboratory
       0972 = Professional fees-radiology diagnostic
       0973 = Professional fees-radiology therapeutic
       0974 = Professional fees-nuclear medicine
       0975 = Professional fees-operating room
       0976 = Professional fees-respiratory therapy
       0977 = Professional fees-physical therapy
       0978 = Professional fees-occupational therapy
       0979 = Professional fees-speech pathology
              NOTE:  098X is an extension of 096X & 097X
       0981 = Professional fees-emergency room
       0982 = Professional fees-outpatient services
       0983 = Professional fees-clinic
       0984 = Professional fees-medical social services
       0985 = Professional fees-EKG
       0986 = Professional fees-EEG
       0987 = Professional fees-hospital visit
       0988 = Professional fees-consultation
       0989 = Professional fees-private duty nurse
       0990 = Patient convenience items-general classification
       0991 = Patient convenience items-cafeteria/guest tray
       0992 = Patient convenience items-private linen service
       0993 = Patient convenience items-telephone/telecom
       0994 = Patient convenience items-tv/radio
       0995 = Patient convenience items-nonpatient room rentals
       0996 = Patient convenience items-late discharge charge
       0997 = Patient convenience items-admission kits
       0998 = Patient convenience items-beauty shop/barber
       0999 = Patient convenience items-other
       1000 = Behavioral Health Accommodations -
              general classification
       1001 = Behavioral Health Accommodations -
              residential treatment -Psychiatric
       1002 = Behavioral Health Accommodations -
              residential treatment - chemical
              dependency
       1003 = Behavioral Health Accommodations -
              supervised living
       1004 = Behavioral Health Accommodations -
              halfway house
       1005 = Behavioral Health Accommodations -
              group home
       2100 = Alternative Therapy Services - general
              classification
       2101 = Alternative Therapy Services -
              Acupuncture
       2102 = Alternative Therapy Services -
              Acupressure
       2103 = Alternative Therapy Services -
              massage
       2104 = Alternative Therapy Services -
              reflexology
       2105 = Alternative Therapy Services -
              biofeedback
       2106 = Alternative Therapy Services -
              hypnosis
       2109 = Alternative Therapy Services -
              other alternative therapy service
       3100 = Adult Care - Reserved
       3101 = Adult Care - adult day care, medical
              and social hourly
       3102 = Adult Care - adult day care, social-
              hourly
       3103 = Adult Care - adult day care, medical
              and social - daily
       3104 = Adult Care - adult day care, social -
              daily
       3105 = Adult Care - adult foster care daily
       3109 = Adult Care - other adult care

       NOTE: Following Revenue Codes reported
       for NHCMQ (RUGS) demo claims effective
       2/96.

       9000 = RUGS-no MDS assessment available
       9001 = Reduced physical functions-
              RUGS PA1/ADL index of 4-5
       9002 = Reduced physical functions-
              RUGS PA2/ADL index of 4-5
       9003 = Reduced physical functions-
              RUGS PB1/ADL index of 6-8
       9004 = Reduced physical functions-
              RUGS PB2/ADL index of 6-8
       9005 = Reduced physical functions-
              RUGS PC1/ADL index of 9-10
       9006 = Reduced physical functions-
              RUGS PC2/ADL index of 9-10
       9007 = Reduced physical functions-
              RUGS PD1/ADL index of 11-15
       9008 = Reduced physical functions-
              RUGS PD2/ADL index of 11-15
       9009 = Reduced physical functions-
              RUGS PE1/ADL index of 16-18
       9010 = Reduced physical functions-
              RUGS PE2/ADL index of 16-18
       9011 = Behavior only problems-
              RUGS BA1/ADL index of 4-5
       9012 = Behavior only problems-
              RUGS BA2/ADL index of 4-5
       9013 = Behavior only problems-
              RUGS BB1/ADL index of 6-10
       9014 = Behavior only problems-
              RUGS BB2/ADL index of 6-10
       9015 = Impaired cognition-
              RUGS IA1/ADL index of 4-5
       9016 = Impaired cognition-
              RUGS IA2/ADL index of 4-5
       9017 = Impaired cognition-
              RUGS IB1/ADL index of 6-10
       9018 = Impaired cognition-
              RUGS IB2/ADL index of 6-10
       9019 = Clinically complex-
              RUGS CA1/ADL index of 4-5
       9020 = Clinically complex-
              RUGS CA2/ADL index of 4-5d
       9021 = Clinically complex-
              RUGS CB1/ADL index of 6-10
       9022 = Clinically complex-
              RUGS CB2/ADL index of 6-10d
       9023 = Clinically complex-
              RUGS CC1/ADL index of 11-16
       9024 = Clinically complex-
              RUGS CC2/ADL index of 11-16d
       9025 = Clinically complex-
              RUGS CD1/ADL index of 17-18
       9026 = Clinically complex-
              RUGS CD2/ADL index of 17-18d
       9027 = Special care-
              RUGS SSA/ADL index of 7-13
       9028 = Special care-
              RUGS SSB/ADL index of 14-16
       9029 = Special care-
              RUGS SSC/ADL index of 17-18
       9030 = Extensive services-
              RUGS SE1/1 procedure
       9031 = Extensive services-
              RUGS SE2/2 procedures
       9032 = Extensive services-
              RUGS SE3/3 procedures
       9033 = Low rehabilitation-
              RUGS RLA/ADL index of 4-11
       9034 = Low rehabilitation-
              RUGS RLB/ADL index of 12-18
       9035 = Medium rehabilitation-
              RUGS RMA/ADL index of 4-7
       9036 = Medium rehabilitation-
              RUGS RMB/ADL index of 8-15
       9037 = Medium rehabilitation-
              RUGS RMC/ADL index of 16-18
       9038 = High rehabilitation-
              RUGS RHA/ADL index of 4-7
       9039 = High rehabilitation-
              RUGS RHB/ADL index of 8-11
       9040 = High rehabilitation-
              RUGS RHC/ADL index of 12-14
       9041 = High rehabilitation-
              RUGS RHD/ADL index of 15-18
       9042 = Very high rehabilitation-
              RUGS RVA/ADL index of 4-7
       9043 = Very high rehabilitation-
              RUGS RVB/ADL index of 8-13
       9044 = Very high rehabilitation-
              RUGS RVC/ADL index of 14-18

       ***Changes effective for providers entering***
       **RUGS Demo Phase III as of 1/1/97 or later**

       9019 = Clinically complex-
              RUGS CA1/ADL index of 11
       9020 = Clinically complex-
              RUGS CA2/ADL index of 11D
       9021 = Clinically complex-
              RUGS CB1/ADL index of 12-16
       9022 = Clinically complex-
              RUGS CB2/ADL index of 12-16D
       9023 = Clinically complex-
              RUGS CC1/ADL index of 17-18
       9024 = Clinically complex-
              RUGS CC2/ADL index of 17-18D
       9025 = Special care-
              RUGS SSA/ADL index of 14
       9026 = Special care-
              RUGS SSB/ADL index of 15-16
       9027 = Special care-
              RUGS SSC/ADL index of 17-18
       9028 = Extensive services-
              RUGS SE1/ADL index 7-18/1 procedure
       9029 = Extensive services-
              RUGS SE2/ADL index 7-18/2 procedures
       9030 = Extensive services-
              RUGS SE3/ADL index 7-18/3 procedures
       9031 = Low rehabilitation-
              RUGS RLA/ADL index of 4-13
       9032 = Low rehabilitation-
              RUGS RLB/ADL index of 14-18
       9033 = Medium rehabilitation-
              RUGS RMA/ADL index of 4-7
       9034 = Medium rehabilitation-
              RUGS RMB/ADL index of 8-14
       9035 = Medium rehabilitation-
              RUGS RMC/ADL index of 15-18
       9036 = High rehabilitation-
              RUGS RHA/ADL index of 4-7
       9037 = High rehabilitation-
              RUGS RHB/ADL index of 8-12
       9038 = High rehabilitation-
              RUGS RHC/ADL index of 13-18
       9039 = Very High rehabilitation-
              RUGS RVA/ADL index of 4-8
       9040 = Very high rehabilitation-
              RUGS RVB/ADL index of 9-15
       9041 = Very high rehabilitation-
              RUGS RVC/ADL index of 16
       9042 = Very high rehabilitation-
              RUGS RUA/ADL index of 4-8
       9043 = Very high rehabilitation-
              RUGS RUB/ADL index of 9-15
       9044 = Ultra high rehabilitation-
              RUGS RUC/ADL index of 16-18



 REV_CNTR_THRPY_CAP_IND_CD_TB            Revenue Center Therapy CAP Indicator Code Table

      A = Hospital outpatient claims are subject to the
          therapy cap for this date of service (this indicator
          will be used on institutional claims only).

      B = Critical Access Hospital outpatient claims are
          subject to the therapy cap for this date of service
          (this indicator will be used on institutional claims
          only).  Note:  Currently, Critical Access Hospital
          claims are not subject to any therapy cap policies.
          Indicator B is created here to prepare for possible
          future legislation to include these claims.

      C = The therapy cap exceptions process, as indicated
          by the submission of the KX modifier, no longer
          applies for this date of service (this indicator
          will be used on both institutional and professional
          claims).

      D = The $3700 threshold for review therapy services
          no longer applies for this date of service (this
          indicator will be used on both institutional and
          professional claims).



 RP_IND_TB                               Claim Representative Payee (RP) Indicator Code Table

      R = bypass representative payee
      Space



 RSDL_PMT_IND_TB                         Claim Residual Payment Indicator Code Table

      X = Residual Payment
      Space



                                                           QUERY: RIFQQ11, RIFQQ21 ON DB2T
                                   *******END OF TOC APPENDIX FOR RECORD: FI_OP_CLM_REC********


1
  TABLE OF CODES APPENDIX FOR RECORD: FI_OP_CLM_REC,  STATUS: PROD, VERSION: 20014
  PRINTED: 01/24/2020,  USER: F43D,  DATA SOURCE: CA REPOSITORY ON DB2T


 BENE_CWF_LOC_TB                         Beneficiary Common Working File Location Table

       B = Mid-Atlantic
       C = Southwest
       D = Northeast
       E = Great Lakes
       F = Great Western
       G = Keystone
       H = Southeast
       I = South
       J = Pacific



 BENE_IDENT_TB                           Beneficiary Identification Code (BIC) Table

       Social Security Administration:

       A  = Primary claimant
       B  = Aged wife, age 62 or over (1st
            claimant)
       B1 = Aged husband, age 62 or over (1st
            claimant)
       B2 = Young wife, with a child in her care
            (1st claimant)
       B3 = Aged wife (2nd claimant)
       B4 = Aged husband (2nd claimant)
       B5 = Young wife (2nd claimant)
       B6 = Divorced wife, age 62 or over (1st
            claimant)
       B7 = Young wife (3rd claimant)
       B8 = Aged wife (3rd claimant)
       B9 = Divorced wife (2nd claimant)
       BA = Aged wife (4th claimant)
       BD = Aged wife (5th claimant)
       BG = Aged husband (3rd claimant)
       BH = Aged husband (4th claimant)
       BJ = Aged husband (5th claimant)
       BK = Young wife (4th claimant)
       BL = Young wife (5th claimant)
       BN = Divorced wife (3rd claimant)
       BP = Divorced wife (4th claimant)
       BQ = Divorced wife (5th claimant)
       BR = Divorced husband (1st claimant)
       BT = Divorced husband (2nd claimant)
       BW = Young husband (2nd claimant)
       BY = Young husband (1st claimant)
       C1-C9,CA-CZ = Child (includes minor, student
                     or disabled child)
       D  = Aged widow, 60 or over (1st claimant)
       D1 = Aged widower, age 60 or over (1st
            claimant)
       D2 = Aged widow (2nd claimant)
       D3 = Aged widower (2nd claimant)
       D4 = Widow (remarried after attainment of
            age 60) (1st claimant)
       D5 = Widower (remarried after attainment of
            age 60) (1st claimant)
       D6 = Surviving divorced wife, age 60 or over
            (1st claimant)
       D7 = Surviving divorced wife (2nd claimant)
       D8 = Aged widow (3rd claimant)
       D9 = Remarried widow (2nd claimant)
       DA = Remarried widow (3rd claimant)
       DD = Aged widow (4th claimant)
       DG = Aged widow (5th claimant)
       DH = Aged widower (3rd claimant)
       DJ = Aged widower (4th claimant)
       DK = Aged widower (5th claimant)
       DL = Remarried widow (4th claimant)
       DM = Surviving divorced husband (2nd
            claimant)
       DN = Remarried widow (5th claimant)
       DP = Remarried widower (2nd claimant)
       DQ = Remarried widower (3rd claimant)
       DR = Remarried widower (4th claimant)
       DS = Surviving divorced husband (3rd
            claimant)
       DT = Remarried widower (5th claimant)
       DV = Surviving divorced wife (3rd claimant)
       DW = Surviving divorced wife (4th claimant)
       DX = Surviving divorced husband (4th
            claimant)
       DY = Surviving divorced wife (5th claimant)
       DZ = Surviving divorced husband (5th
            claimant)
       E  = Mother (widow) (1st claimant)
       E1 = Surviving divorced mother (1st
            claimant)
       E2 = Mother (widow) (2nd claimant)
       E3 = Surviving divorced mother (2nd
            claimant)
       E4 = Father (widower) (1st claimant)
       E5 = Surviving divorced father (widower)
            (1st claimant)
       E6 = Father (widower) (2nd claimant)
       E7 = Mother (widow) (3rd claimant)
       E8 = Mother (widow) (4th claimant)
       E9 = Surviving divorced father (widower)
            (2nd claimant)
       EA = Mother (widow) (5th claimant)
       EB = Surviving divorced mother (3rd
            claimant)
       EC = Surviving divorced mother (4th
            claimant)
       ED = Surviving divorced mother (5th
            claimant
       EF = Father (widower) (3rd claimant)
       EG = Father (widower) (4th claimant)
       EH = Father (widower) (5th claimant)
       EJ = Surviving divorced father (3rd
            claimant)
       EK = Surviving divorced father (4th
            claimant)
       EM = Surviving divorced father (5th
            claimant)
       F1 = Father
       F2 = Mother
       F3 = Stepfather
       F4 = Stepmother
       F5 = Adopting father
       F6 = Adopting mother
       F7 = Second alleged father
       F8 = Second alleged mother
       J1 = Primary prouty entitled to HIB
            (less than 3 Q.C.) (general fund)
       J2 = Primary prouty entitled to HIB
            (over 2 Q.C.) (RSI trust fund)
       J3 = Primary prouty not entitled to HIB
            (less than 3 Q.C.) (general fund)
       J4 = Primary prouty not entitled to HIB
            (over 2 Q.C.) (RSI trust fund)
       K1 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (1st claimant)
       K2 = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (1st claimant)
       K3 = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (1st
            claimant)
       K4 = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (1st
            claimant)
       K5 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (2nd claimant)
       K6 = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (2nd claimant)
       K7 = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (2nd
            claimant)
       K8 = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (2nd
            claimant)
       K9 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (3rd claimant)
       KA = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (3rd claimant)
       KB = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (3rd
            claimant)
       KC = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (3rd
            claimant)
       KD = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (4th claimant)
       KE = Prouty wife entitled to HIB (over 2 Q.C
            (4th claimant)
       KF = Prouty wife not entitled to HIB (less
            than 3 Q.C.)(4th claimant)
       KG = Prouty wife not entitled to HIB (over
            2 Q.C.)(4th claimant)
       KH = Prouty wife entitled to HIB (less than
            3 Q.C.)(5th claimant)
       KJ = Prouty wife entitled to HIB (over 2
            Q.C.) (5th claimant)
       KL = Prouty wife not entitled to HIB (less
            than 3 Q.C.)(5th claimant)
       KM = Prouty wife not entitled to HIB (over
            2 Q.C.) (5th claimant)
       M  = Uninsured-not qualified for deemed HIB
       M1 = Uninsured-qualified but refused HIB
       T  = Uninsured-entitled to HIB under deemed
            or renal provisions
       TA = MQGE (primary claimant)
       TB = MQGE aged spouse (first claimant)
       TC = MQGE disabled adult child (first claimant)
       TD = MQGE aged widow(er) (first claimant)
       TE = MQGE young widow(er) (first claimant)
       TF = MQGE parent (male)
       TG = MQGE aged spouse (second claimant)
       TH = MQGE aged spouse (third claimant)
       TJ = MQGE aged spouse (fourth claimant)
       TK = MQGE aged spouse (fifth claimant)
       TL = MQGE aged widow(er) (second claimant)
       TM = MQGE aged widow(er) (third claimant)
       TN = MQGE aged widow(er) (fourth claimant)
       TP = MQGE aged widow(er) (fifth claimant)
       TQ = MQGE parent (female)
       TR = MQGE young widow(er) (second claimant)
       TS = MQGE young widow(er) (third claimant)
       TT = MQGE young widow(er) (fourth claimant)
       TU = MQGE young widow(er) (fifth claimant)
       TV = MQGE disabled widow(er) fifth claimant
       TW = MQGE disabled widow(er) first claimant
       TX = MQGE disabled widow(er) second claimant
       TY = MQGE disabled widow(er) third claimant
       TZ = MQGE disabled widow(er) fourth claimant
       T2-T9 = Disabled child (second to ninth
               claimant)
       W  = Disabled widow, age 50 or over (1st
            claimant)
       W1 = Disabled widower, age 50 or over (1st
            claimant)
       W2 = Disabled widow (2nd claimant)
       W3 = Disabled widower (2nd claimant)
       W4 = Disabled widow (3rd claimant)
       W5 = Disabled widower (3rd claimant)
       W6 = Disabled surviving divorced wife (1st
            claimant)
       W7 = Disabled surviving divorced wife (2nd
            claimant)
       W8 = Disabled surviving divorced wife (3rd
            claimant)
       W9 = Disabled widow (4th claimant)
       WB = Disabled widower (4th claimant)
       WC = Disabled surviving divorced wife (4th
            claimant)
       WF = Disabled widow (5th claimant)
       WG = Disabled widower (5th claimant)
       WJ = Disabled surviving divorced wife (5th
            claimant)
       WR = Disabled surviving divorced husband
            (1st claimant)
       WT = Disabled surviving divorced husband
            (2nd claimant)

       Railroad Retirement Board:

          NOTE:
          Employee:  a Medicare beneficiary who is
                     still working or a worker who
                     died before retirement
          Annuitant: a person who retired under the
                     railroad retirement act on or
                     after 03/01/37
          Pensioner: a person who retired prior to
                     03/01/37 and was included in the
                     railroad retirement act

       10 = Retirement - employee or annuitant
       80 = RR pensioner (age or disability)
       14 = Spouse of RR employee or annuitant
            (husband or wife)
       84 = Spouse of RR pensioner
       43 = Child of RR employee
       13 = Child of RR annuitant
       17 = Disabled adult child of RR annuitant
       46 = Widow/widower of RR employee
       16 = Widow/widower of RR annuitant
       86 = Widow/widower of RR pensioner
       43 = Widow of employee with a child in her care
       13 = Widow of annuitant with a child in her care
       83 = Widow of pensioner with a child in her care
       45 = Parent of employee
       15 = Parent of annuitant
       85 = Parent of pensioner
       11 = Survivor joint annuitant
            (reduced benefits taken to insure benefits
            for surviving spouse)



 BENE_MDCR_STUS_TB                       CWF Beneficiary Medicare Status Table

       10 = Aged without ESRD
       11 = Aged with ESRD
       20 = Disabled without ESRD
       21 = Disabled with ESRD
       31 = ESRD only



 BENE_PRMRY_PYR_TB                       Beneficiary Primary Payer Table

       A = Working aged bene/spouse with employer
           group health plan (EGHP)
       B = End stage renal disease (ESRD) beneficiary
           in the 18 month coordination period with
           an employer group health plan
       C = Conditional payment by Medicare; future
           reimbursement expected
       D = Automobile no-fault (eff. 4/97; Prior
           to 3/94, also included any liability
           insurance)
       E = Workers' compensation
       F = Public Health Service or other federal
           agency (other than Dept. of Veterans
           Affairs)
       G = Working disabled bene (under age 65
           with LGHP)
       H = Black Lung
       I = Dept. of Veterans Affairs
       J = Any liability insurance
           (eff. 3/94 - 3/97)
       L = Any liability insurance (eff. 4/97)
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       M = Override code:  EGHP services involved
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       N = Override code:  non-EGHP services involved
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       BLANK = Medicare is primary payer (not sure
               of effective date: in use 1/91, if
               not earlier)

                    ***Prior to 12/90***

       Y = Other secondary payer investigation
           shows Medicare as primary payer
       Z = Medicare is primary payer

       NOTE:  Values C, M, N, Y, Z and BLANK
              indicate Medicare is primary payer.
              (values Z and Y were used prior to
              12/90.  BLANK was suppose to be
              effective after 12/90, but may have
              been used prior to that date.)



 BENE_RACE_TB                            Beneficiary Race Table

       0 = Unknown
       1 = White
       2 = Black
       3 = Other
       4 = Asian
       5 = Hispanic
       6 = North American Native



 BENE_SEX_IDENT_TB                       Beneficiary Sex Identification Table

       1 = Male
       2 = Female
       0 = Unknown



 CLM_ADJ_RSN_TB                          Claim Adjustment Reason Code

      1   = Deductible Amount
            Start: 01/01/1995
      2   = Coinsurance Amount
            Start: 01/01/1995
      3   = Co-payment Amount
            Start: 01/01/1995
      4   = The procedure code is inconsistent with the
            modifier used or a required modifier is
            missing. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 01/01/1995
      5   = The procedure code/bill type is
            inconsistent with the place of service.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      6   = The procedure/revenue code is inconsistent
            with the patient's age. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      7   = The procedure/revenue code is inconsistent
            with the patient's gender. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      8   = The procedure code is inconsistent with the
            provider type/specialty (taxonomy). Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      9   = The diagnosis is inconsistent with the
            patient's age. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      10  = The diagnosis is inconsistent with the
            patient's gender. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      11  = The diagnosis is inconsistent with the
            procedure. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
            Last Modified: 09/20/2009
      12  = The diagnosis is inconsistent with the
            provider type. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      13  = The date of death precedes the date of
            service.
            Start: 01/01/1995
      14  = The date of birth follows the date of
            service.
            Start: 01/01/1995
      15  = The authorization number is missing,
            invalid, or does not apply to the billed
            services or provider.
            Start: 01/01/1995
      16  = Claim/service lacks information which is
            needed for adjudication. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject
            Reason Code, or Remittance Advice Remark
            Code that is not an ALERT.)
            Start: 01/01/1995
      17  = Requested information was not provided or
            was insufficient/incomplete. At least one
            Remark Code must be provided (may be
            comprised of either the Remittance Advice
            Remark Code or NCPDP Reject Reason Code.)
            Start: 01/01/1995
            Stop: 07/01/2009
      18  = Duplicate claim/service. This change
            effective 1/1/2013: Exact duplicate claim/
            service (Use only with Group Code OA)
            Start: 01/01/1995
      19  = This is a work-related injury/illness and
            thus the liability of the Worker's
            Compensation Carrier.
            Start: 01/01/1995
      20  = This injury/illness is covered by the
            liability carrier.
            Start: 01/01/1995
      21  = This injury/illness is the liability of
            the no-fault carrier.
            Start: 01/01/1995
      22  = This care may be covered by another payer
            per coordination of benefits.
            Start: 01/01/1995
      23  = The impact of prior payer(s) adjudication
            including payments and/or adjustments.
            (Use only with Group Code OA)
            Start: 01/01/1995
      24  = Charges are covered under a capitation
            agreement/managed care plan.
            Start: 01/01/1995
      25  = Payment denied. Your Stop loss deductible
            has not been met.
            Start: 01/01/1995
            Stop: 04/01/2008
      26  = Expenses incurred prior to coverage.
            Start: 01/01/1995
      27  = Expenses incurred after coverage terminated
            Start: 01/01/1995
      28  = Coverage not in effect at the time the
            service was provided.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Redundant to codes 26&27.
      29  = The time limit for filing has expired.
            Start: 01/01/1995
      30  = Payment adjusted because the patient has
            not met the required eligibility, spend
            down, waiting, or residency requirements.
            Start: 01/01/1995
            Stop: 02/01/2006
      31  = Patient cannot be identified as our insured
            Start: 01/01/1995
      32  = Our records indicate that this dependent is
            not an eligible dependent as defined.
            Start: 01/01/1995
      33  = Insured has no dependent coverage.
            Start: 01/01/1995
      34  = Insured has no coverage for newborns.
            Start: 01/01/1995
      35  = Lifetime benefit maximum has been reached.
            Start: 01/01/1995
      36  = Balance does not exceed co-payment amount.
            Start: 01/01/1995
            Stop: 10/16/2003
      37  = Balance does not exceed deductible.
            Start: 01/01/1995
            Stop: 10/16/2003
      38  = Services not provided or authorized by
            designated (network/primary care) providers.
            Start: 01/01/1995
            Stop: 01/01/2013
      39  = Services denied at the time authorization/
            pre-certification was requested.
            Start: 01/01/1995
      40  = Charges do not meet qualifications for
            emergent/urgent care. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      41  = Discount agreed to in Preferred Provider
            contract.
            Start: 01/01/1995
            Stop: 10/16/2003
      42  = Charges exceed our fee schedule or maximum
            allowable amount. (Use CARC 45)
            Start: 01/01/1995
            Stop: 06/01/2007
      43  = Gramm-Rudman reduction.
            Start: 01/01/1995
            Stop: 07/01/2006
      44  = Prompt-pay discount.
            Start: 01/01/1995
      45  = Charge exceeds fee schedule/maximum
            allowable or contracted/legislated fee
            arrangement. (Use Group Codes PR or CO
            depending upon liability). This change
            effective 7/1/2013: Charge exceeds fee
            schedule/maximum allowable or contracted/
            legislated fee arrangement. (Use only with
            Group Codes PR or CO depending upon
            liability)
            Start: 01/01/1995
      46  = This (these) service(s) is (are) not
            covered.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 96.
      47  = This (these) diagnosis(es) is (are) not
            covered, missing, or are invalid.
            Start: 01/01/1995
            Stop: 02/01/2006
      48  = This (these) procedure(s) is (are) not
            covered.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 96.
      49  = These are non-covered services because this
            is a routine exam or screening procedure
            done in conjunction with a routine exam.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      50  = These are non-covered services because this
            is not deemed a 'medical necessity' by the
            payer. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 01/01/1995
      51  = These are non-covered services because this
            is a pre-existing condition. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      52  = The referring/prescribing/rendering
            provider is not eligible to refer/prescribe
            /order/perform the service billed.
            Start: 01/01/1995
            Stop: 02/01/2006
      53  = Services by an immediate relative or a
            member of the same household are not
            covered.
            Start: 01/01/1995
      54  = Multiple physicians/assistants are not
            covered in this case. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      55  = Procedure/treatment is deemed experimental/
            investigational by the payer. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      56  = Procedure/treatment has not been deemed
            'proven to be effective' by the payer.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      57  = Payment denied/reduced because the payer
            deems the information submitted does not
            support this level of service, this many
            services, this length of service, this
            dosage, or this day's supply.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Split into codes 150, 151, 152, 153
            and 154.
      58  = Treatment was deemed by the payer to have
            been rendered in an inappropriate or
            invalid place of service. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      59  = Processed based on multiple or concurrent
            procedure rules. (For example multiple
            surgery or diagnostic imaging, concurrent
            anesthesia.) Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      60  = Charges for outpatient services are not
            covered when performed within a period of
            time prior to or after inpatient services.
            Start: 01/01/1995
      61  = Penalty for failure to obtain second
            surgical opinion. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      62  = Payment denied/reduced for absence of,
            or exceeded, pre-certification/
            authorization.
            Start: 01/01/1995
            Stop: 04/01/2007
      63  = Correction to a prior claim.
            Start: 01/01/1995
            Stop: 10/16/2003
      64  = Denial reversed per Medical Review.
            Start: 01/01/1995
            Stop: 10/16/2003
      65  = Procedure code was incorrect. This payment
            reflects the correct code.
            Start: 01/01/1995
            Stop: 10/16/2003
      66  = Blood Deductible.
            Start: 01/01/1995
      67  = Lifetime reserve days. (Handled in QTY,
            QTY01=LA)
            Start: 01/01/1995
            Stop: 10/16/2003
      68  = DRG weight. (Handled in CLP12)
            Start: 01/01/1995
            Stop: 10/16/2003
      69  = Day outlier amount.
            Start: 01/01/1995
      70  = Cost outlier - Adjustment to compensate for
            additional costs.
            Start: 01/01/1995
      71  = Primary Payer amount.
            Start: 01/01/1995
            Stop: 06/30/2000
            Notes: Use code 23.
      72  = Coinsurance day. (Handled in QTY, QTY01=CD)
            Start: 01/01/1995
            Stop: 10/16/2003
      73  = Administrative days.
            Start: 01/01/1995
            Stop: 10/16/2003
      74  = Indirect Medical Education Adjustment.
            Start: 01/01/1995
      75  = Direct Medical Education Adjustment.
            Start: 01/01/1995
      76  = Disproportionate Share Adjustment.
            Start: 01/01/1995
      77  = Covered days. (Handled in QTY, QTY01=CA)
            Start: 01/01/1995
            Stop: 10/16/2003
      78  = Non-Covered days/Room charge adjustment.
            Start: 01/01/1995
      79  = Cost Report days. (Handled in MIA15)
            Start: 01/01/1995
            Stop: 10/16/2003
      80  = Outlier days. (Handled in QTY, QTY01=OU)
            Start: 01/01/1995
            Stop: 10/16/2003
      81  = Discharges.
            Start: 01/01/1995
            Stop: 10/16/2003
      82  = PIP days.
            Start: 01/01/1995
            Stop: 10/16/2003
      83  = Total visits.
            Start: 01/01/1995
            Stop: 10/16/2003
      84  = Capital Adjustment. (Handled in MIA)
            Start: 01/01/1995
            Stop: 10/16/2003
      85  = Patient Interest Adjustment (Use Only Group
            code PR)
            Start: 01/01/1995
            Notes: Only use when the payment of
            interest is the responsibility of the
            patient.
      86  = Statutory Adjustment.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Duplicative of code 45.
      87  = Transfer amount.
            Start: 01/01/1995
            Stop: 01/01/2012
      88  = Adjustment amount represents collection
            against receivable created in prior
            overpayment.
            Start: 01/01/1995
            Stop: 06/30/2007
      89  = Professional fees removed from charges.
            Start: 01/01/1995
      90  = Ingredient cost adjustment. Note: To be
            used for pharmaceuticals only.
            Start: 01/01/1995
      91  = Dispensing fee adjustment.
            Start: 01/01/1995
      92  = Claim Paid in full.
            Start: 01/01/1995
            Stop: 10/16/2003
      93  = No Claim level Adjustments.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: As of 004010, CAS at the claim level
            is optional.
      94  = Processed in Excess of charges.
            Start: 01/01/1995
      95  = Plan procedures not followed.
            Start: 01/01/1995
      96  = Non-covered charge(s). At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT.) Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      97  = The benefit for this service is included in
            the payment/allowance for another service/
            procedure that has already been adjudicated.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      98  = The hospital must file the Medicare claim
            for this inpatient non-physician service.
            Start: 01/01/1995
            Stop: 10/16/2003
      99  = Medicare Secondary Payer Adjustment Amount.
            Start: 01/01/1995
            Stop: 10/16/2003
      100 = Payment made to patient/insured/responsible
            party/employer.
            Start: 01/01/1995
      101 = Predetermination: anticipated payment upon
            completion of services or claim
            adjudication.
            Start: 01/01/1995
      102 = Major Medical Adjustment.
            Start: 01/01/1995
      103 = Provider promotional discount (e.g., Senior
            citizen discount).
            Start: 01/01/1995
      104 = Managed care withholding.
            Start: 01/01/1995
      105 = Tax withholding.
            Start: 01/01/1995
      106 = Patient payment option/election not in
            effect.
            Start: 01/01/1995
      107 = The related or qualifying claim/service was
            not identified on this claim. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      108 = Rent/purchase guidelines were not met.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      109 = Claim/service not covered by this payer/
            contractor. You must send the claim/service
            to the correct payer/contractor.
            Start: 01/01/1995
      110 = Billing date predates service date.
            Start: 01/01/1995
      111 = Not covered unless the provider accepts
            assignment.
            Start: 01/01/1995
      112 = Service not furnished directly to the
            patient and/or not documented.
            Start: 01/01/1995
      113 = Payment denied because service/procedure
            was provided outside the United States or
            as a result of war.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use Codes 157, 158 or 159.
      114 = Procedure/product not approved by the Food
            and Drug Administration.
            Start: 01/01/1995
      115 = Procedure postponed, canceled, or delayed.
            Start: 01/01/1995
      116 = The advance indemnification notice signed
            by the patient did not comply with
            requirements.
            Start: 01/01/1995
      117 = Transportation is only covered to the
            closest facility that can provide the
            necessary care.
            Start: 01/01/1995
      118 = ESRD network support adjustment.
            Start: 01/01/1995
      119 = Benefit maximum for this time period or
            occurrence has been reached.
            Start: 01/01/1995
      120 = Patient is covered by a managed care plan.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 24.
      121 = Indemnification adjustment - compensation
            for outstanding member responsibility.
            Start: 01/01/1995
      122 = Psychiatric reduction.
            Start: 01/01/1995
      123 = Payer refund due to overpayment.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Refer to implementation guide for
            proper handling of reversals.
      124 = Payer refund amount - not our patient.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Refer to implementation guide for
            proper handling of reversals.
      125 =  Submission/billing error(s). At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 01/01/1995
      126 = Deductible -- Major Medical
            Start: 02/28/1997
            Stop: 04/01/2008
            Notes: Use Group Code PR and code 1.
      127 = Coinsurance -- Major Medical
            Start: 02/28/1997
            Stop: 04/01/2008
            Notes: Use Group Code PR and code 2.
      128 = Newborn's services are covered in the
            mother's Allowance.
            Start: 02/28/1997
      129 = Prior processing information appears
            incorrect. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 02/28/1997
      130 = Claim submission fee.
            Start: 02/28/1997
      131 = Claim specific negotiated discount.
            Start: 02/28/1997
      132 = Prearranged demonstration project
            adjustment.
            Start: 02/28/1997
      133 = The disposition of the claim/service is
            pending further review. This change
            effective 1/1/2013: The disposition of the
            claim/service is pending further review.
            (Use only with Group Code OA)
            Start: 02/28/1997
      134 = Technical fees removed from charges.
            Start: 10/31/1998
      135 = Interim bills cannot be processed.
            Start: 10/31/1998
      136 = Failure to follow prior payer's coverage
            rules. (Use Group Code OA). This change
            effective 7/1/2013: Failure to follow prior
            payer's coverage rules. (Use only with
            Group Code OA)
            Start: 10/31/1998
      137 = Regulatory Surcharges, Assessments,
            Allowances or Health Related Taxes.
            Start: 02/28/1999
      138 = Appeal procedures not followed or time
            limits not met.
            Start: 06/30/1999
      139 = Contracted funding agreement - Subscriber
            is employed by the provider of services.
            Start: 06/30/1999
      140 = Patient/Insured health identification
            number and name do not match.
            Start: 06/30/1999
      141 = Claim spans eligible and ineligible periods
            of coverage.
            Start: 06/30/1999
            Stop: 07/01/2012
      142 = Monthly Medicaid patient liability amount.
            Start: 06/30/2000
      143 = Portion of payment deferred.
            Start: 02/28/2001
      144 = Incentive adjustment, e.g. preferred
            product/service.
            Start: 06/30/2001
      145 = Premium payment withholding
            Start: 06/30/2002
            Stop: 04/01/2008
            Notes: Use Group Code CO and code 45.
      146 = Diagnosis was invalid for the date(s) of
            service reported.
            Start: 06/30/2002
      147 = Provider contracted/negotiated rate expired
            or not on file.
            Start: 06/30/2002
      148 = Information from another provider was not
            provided or was insufficient/incomplete.
            At least one Remark Code must be provided
            (may be comprised of either the NCPDP
            Reject Reason Code, or Remittance Advice
            Remark Code that is not an ALERT.)
            Start: 06/30/2002
      149 = Lifetime benefit maximum has been reached
            for this service/benefit category.
            Start: 10/31/2002
      150 = Payer deems the information submitted does
            not support this level of service.
            Start: 10/31/2002
      151 = Payment adjusted because the payer deems
            the information submitted does not support
            this many/frequency of services.
            Start: 10/31/2002
      152 = Payer deems the information submitted does
            not support this length of service. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 10/31/2002
      153 = Payer deems the information submitted does
            not support this dosage.
            Start: 10/31/2002
      154 = Payer deems the information submitted does
            not support this day's supply.
            Start: 10/31/2002
      155 = Patient refused the service/procedure.
            Start: 06/30/2003
      156 = Flexible spending account payments. Note:
            Use code 187.
            Start: 09/30/2003
            Stop: 10/01/2009
      157 = Service/procedure was provided as a result
            of an act of war.
            Start: 09/30/2003
      158 = Service/procedure was provided outside of
            the United States.
            Start: 09/30/2003
      159 = Service/procedure was provided as a result
            of terrorism.
            Start: 09/30/2003
      160 = Injury/illness was the result of an
            activity that is a benefit exclusion.
            Start: 09/30/2003
      161 = Provider performance bonus
            Start: 02/29/2004
      162 = State-mandated Requirement for Property and
            Casualty, see Claim Payment Remarks Code
            for specific explanation.
            Start: 02/29/2004
      163 = Attachment referenced on the claim was not
            received.
            Start: 06/30/2004
      164 = Attachment referenced on the claim was not
            received in a timely fashion.
            Start: 06/30/2004
      165 = Referral absent or exceeded.
            Start: 10/31/2004
      166 = These services were submitted after this
            payers responsibility for processing claims
            under this plan ended.
            Start: 02/28/2005
      167 = This (these) diagnosis(es) is (are) not
            covered. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Payment Information REF), if present.
            Start: 06/30/2005
      168 = Service(s) have been considered under the
            patient's medical plan. Benefits are not
            available under this dental plan.
            Start: 06/30/2005
      169 = Alternate benefit has been provided.
            Start: 06/30/2005
      170 = Payment is denied when performed/billed by
            this type of provider. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
      171 = Payment is denied when performed/billed by
            this type of provider in this type of
            facility. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 06/30/2005
      172 = Payment is adjusted when performed/billed
            by a provider of this specialty. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 06/30/2005
      173 = Service was not prescribed by a physician.
            This change effective 7/1/2013: Service/
            equipment was not prescribed by a
            physician.
            Start: 06/30/2005
      174 = Service was not prescribed prior to
            delivery.
            Start: 06/30/2005
      175 = Prescription is incomplete.
            Start: 06/30/2005
      176 = Prescription is not current.
            Start: 06/30/2005
      177 = Patient has not met the required
            eligibility requirements.
            Start: 06/30/2005
      178 = Patient has not met the required spend
            down requirements.
            Start: 06/30/2005
      179 = Patient has not met the required waiting
            requirements. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF)
            , if present.
            Start: 06/30/2005
      180 = Patient has not met the required residency
            requirements.
            Start: 06/30/2005
      181 = Procedure code was invalid on the date of
            service.
            Start: 06/30/2005
      182 = Procedure modifier was invalid on the date
            of service.
            Start: 06/30/2005
      183 = The referring provider is not eligible to
            refer the service billed. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
      184 = The prescribing/ordering provider is not
            eligible to prescribe/order the service
            billed. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 06/30/2005
      185 = The rendering provider is not eligible to
            perform the service billed. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
            Last Modified: 09/20/2009
      186 = Level of care change adjustment.
            Start: 06/30/2005
      187 = Consumer Spending Account payments
            (includes but is not limited to Flexible
            Spending Account, Health Savings Account,
            Health Reimbursement Account, etc.)
            Start: 06/30/2005
      188 = This product/procedure is only covered when
            used according to FDA recommendations.
            Start: 06/30/2005
      189 = 'Not otherwise classified' or 'unlisted'
            procedure code (CPT/HCPCS) was billed when
            there is a specific procedure code for this
            procedure/service
            Start: 06/30/2005
      190 = Payment is included in the allowance for a
            Skilled Nursing Facility (SNF) qualified
            stay.
            Start: 10/31/2005
      191 = Not a work related injury/illness and thus
            not the liability of the workers'
            compensation carrier Note: If adjustment is
            at the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF)
            Start: 10/31/2005
      192 = Non standard adjustment code from paper
            remittance. Note: This code is to be used
            by providers/payers providing Coordination
            of Benefits information to another payer in
            the 837 transaction only. This code is only
            used when the non-standard code cannot be
            reasonably mapped to an existing Claims
            Adjustment Reason Code, specifically
            Deductible, Coinsurance and Co-payment.
            Start: 10/31/2005
      193 = Original payment decision is being
            maintained. Upon review, it was determined
            that this claim was processed properly.
            Start: 02/28/2006
      194 = Anesthesia performed by the operating
            physician, the assistant surgeon or the
            attending physician.
            Start: 02/28/2006
      195 = Refund issued to an erroneous priority
            payer for this claim/service.
            Start: 02/28/2006
      196 = Claim/service denied based on prior payer's
            coverage determination.
            Start: 06/30/2006
            Stop: 02/01/2007
            Notes: Use code 136.
      197 = Precertification/authorization/notification
            absent.
            Start: 10/31/2006
      198 = Precertification/authorization exceeded.
            Start: 10/31/2006
      199 = Revenue code and Procedure code do not
            match.
            Start: 10/31/2006
      200 = Expenses incurred during lapse in coverage
            Start: 10/31/2006
      201 = Workers' Compensation case settled. Patient
            is responsible for amount of this claim/
            service through WC 'Medicare set aside
            arrangement' or other agreement. (Use group
            code PR). This change effective 7/1/2013:
            Workers Compensation case settled. Patient
            is responsible for amount of this claim/
            service through WC 'Medicare set aside
            arrangement' or other agreement. (Use only
            with Group Code PR)
            Start: 10/31/2006
      202 = Non-covered personal comfort or convenience
            services.
            Start: 02/28/2007
      203 = Discontinued or reduced service.
            Start: 02/28/2007
      204 = This service/equipment/drug is not covered
            under the patient's current benefit plan
            Start: 02/28/2007
      205 = Pharmacy discount card processing fee
            Start: 07/09/2007
      206 = National Provider Identifier - missing.
            Start: 07/09/2007
      207 = National Provider identifier - Invalid
            format
            Start: 07/09/2007
      208 = National Provider Identifier - Not matched.
            Start: 07/09/2007
      209 = Per regulatory or other agreement. The
            provider cannot collect this amount from
            the patient. However, this amount may be
            billed to subsequent payer. Refund to
            patient if collected. (Use Group code OA)
            This change effective 7/1/2013: Per
            regulatory or other agreement. The provider.
            cannot collect this amount from the patient
            However, this amount may be billed to
            subsequent payer. Refund to patient if
            collected. (Use only with Group code OA)
            Start: 07/09/2007
      210 = Payment adjusted because pre-certification/
            authorization not received in a timely fashion
            Start: 07/09/2007
      211 = National Drug Codes (NDC) not eligible for
            rebate, are not covered.
            Start: 07/09/2007
      212 = Administrative surcharges are not covered
            Start: 11/05/2007
      213 = Non-compliance with the physician self
            referral prohibition legislation or payer
            policy.
            Start: 01/27/2008
      214 = Workers' Compensation claim adjudicated as
            non-compensable. This Payer not liable for
            claim or service/treatment. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            Workers' Compensation only
            Start: 01/27/2008
      215 = Based on subrogation of a third party
            settlement
            Start: 01/27/2008
      216 = Based on the findings of a review
            organization
            Start: 01/27/2008
      217 = Based on payer reasonable and customary
            fees. No maximum allowable defined by
            legislated fee arrangement. (Note: To be
            used for Property and Casualty only)
            Start: 01/27/2008
      218 = Based on entitlement to benefits. Note:
            If adjustment is at the Claim Level, the
            payer must send and the provider should
            refer to the 835 Insurance Policy Number
            Segment (Loop 2100 Other Claim Related
            Information REF qualifier 'IG') for the
            jurisdictional regulation. If adjustment is
            at the Line Level, the payer must send and
            the provider should refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment information REF)
            To be used for Workers' Compensation only
            Start: 01/27/2008
      219 = Based on extent of injury. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF).
            Start: 01/27/2008
      220 = The applicable fee schedule/fee database
            does not contain the billed code. Please
            resubmit a bill with the appropriate fee
            schedule/fee database code(s) that best
            describe the service(s) provided and
            supporting documentation if required.
            (Note: To be used for Property and Casualty
            only)
            Start: 01/27/2008
      221 = Workers' Compensation claim is under
            investigation. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). This change
            effective 7/1/2013: Claim is under
            investigation. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). (Note: To be used
            by Property & Casualty only)
            Start: 01/27/2008
      222 = Exceeds the contracted maximum number of
            hours/days/units by this provider for this
            period. This is not patient specific. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 06/01/2008
      223 = Adjustment code for mandated federal, state
            or local law/regulation that is not already
            covered by another code and is mandated
            before a new code can be created.
            Start: 06/01/2008
      224 = Patient identification compromised by
            identity theft. Identity verification
            required for processing this and future
            claims.
            Start: 06/01/2008
      225 = Penalty or Interest Payment by Payer (Only
            used for plan to plan encounter reporting
            within the 837)
            Start: 06/01/2008
      226 = Information requested from the Billing/
            Rendering Provider was not provided or was
            insufficient/incomplete. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.) This change effective
            7/1/2013: Information requested from the
            Billing/Rendering Provider was not provided
            or not provided timely or was insufficient/
            incomplete. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 09/21/2008
      227 = Information requested from the patient/
            insured/responsible party was not provided
            or was insufficient/incomplete. At least
            one Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 09/21/2008
      228 = Denied for failure of this provider,
            another provider or the subscriber to
            supply requested information to a previous
            payer for their adjudication
            Start: 09/21/2008
      229 = Partial charge amount not considered by
            Medicare due to the initial claim Type of
            Bill being 12X. Note: This code can only
            be used in the 837 transaction to convey
            Coordination of Benefits information when
            the secondary payer's cost avoidance policy
            allows providers to bypass claim submission
            to a prior payer. Use Group Code PR. This
            change effective 7/1/2013: Partial charge
            amount not considered by Medicare due to
            the initial claim Type of Bill being 12X.
            Note: This code can only be used in the
            837 transaction to convey Coordination of
            Benefits information when the secondary
            payer's cost avoidance policy allows
            providers to bypass claim submission to a
            prior payer. (Use only with Group Code PR)
            Start: 01/25/2009
      230 = No available or correlating CPT/HCPCS code
            to describe this service. Note: Used only
            by Property and Casualty.
            Start: 01/25/2009
      231 = Mutually exclusive procedures cannot be
            done in the same day/setting. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 07/01/2009
      232 = Institutional Transfer Amount. Note -
            Applies to institutional claims only and
            explains the DRG amount difference when the
            patient care crosses multiple institutions.
            Start: 11/01/2009
      233 = Services/charges related to the treatment
            of a hospital-acquired condition or
            preventable medical error.
            Start: 01/24/2010
      234 = This procedure is not paid separately. At
            least one Remark Code must be provided
            (may be comprised of either the NCPDP
            Reject Reason Code, or Remittance Advice
            Remark Code that is not an ALERT.)
            Start: 01/24/2010
      235 = Sales Tax
            Start: 06/06/2010
      236 = This procedure or procedure/modifier
            combination is not compatible with another
            procedure or procedure/modifier combination
            provided on the same day according to the
            National Correct Coding Initiative. This
            change effective 7/1/2013: This procedure
            or procedure/modifier combination is not
            compatible with another procedure or
            procedure/modifier combination provided on
            the same day according to the National
            Correct Coding Initiative or workers
            compensation state regulations/ fee
            schedule requirements.
            Start: 01/30/2011
      237 = Legislated/Regulatory Penalty. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 06/05/2011
      238 = Claim spans eligible and ineligible periods
            of coverage, this is the reduction for the
            ineligible period (use Group Code PR). This
            change effective 7/1/2013: Claim spans
            eligible and ineligible periods of coverage
            , this is the reduction for the ineligible
            period. (Use only with Group Code PR)
            Start: 03/01/2012
      239 = Claim spans eligible and ineligible periods
            of coverage. Rebill separate claims.
            Start: 03/01/2012
      240 = The diagnosis is inconsistent with the
            patient's birth weight. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/03/2012
      241 = Low Income Subsidy (LIS) Co-payment Amount
            Start: 06/03/2012
      242 = Services not provided by network/primary
            care providers.
            Start: 06/03/2012
      243 = Services not authorized by network/primary
            care providers.
            Start: 06/03/2012
      244 = Payment reduced to zero due to litigation.
            Additional information will be sent
            following the conclusion of litigation.
            To be used for Property & Casualty only.
            Start: 09/30/2012
      245 = Provider performance program withhold.
            Start: 09/30/2012
      246 = This non-payable code is for required
            reporting only.
            Start: 09/30/2012
      247 = Deductible for Professional service
            rendered in an Institutional setting and
            billed on an Institutional claim.
            Start: 09/30/2012
            Notes: For Medicare Bundled Payment use
            only, under the Patient Protection and
            Affordable Care Act (PPACA).
      248 = Coinsurance for Professional service
            rendered in an Institutional setting and
            billed on an Institutional claim.
            Start: 09/30/2012
            Notes: For Medicare Bundled Payment use
            only, under the Patient Protection and
            Affordable Care Act (PPACA).
      249 = This claim has been identified as a
            readmission. (Use only with Group Code CO)
            Start: 09/30/2012
      250 = The attachment content received is
            inconsistent with the expected content.
            Start: 09/30/2012
      251 = The attachment content received did not
            contain the content required to process
            this claim or service.
            Start: 09/30/2012
      252 = An attachment is required to adjudicate
            this claim/service. At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT).
            Start: 09/30/2012
      A0  = Patient refund amount.
            Start: 01/01/1995
      A1  = Claim/Service denied. At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT.)
            Start: 01/01/1995
      A2  = Contractual adjustment.
            Start: 01/01/1995
            Stop: 01/01/2008
            Notes: Use Code 45 with Group Code 'CO' or
            use another appropriate specific adjustment
            code.
      A3  = Medicare Secondary Payer liability met.
            Start: 01/01/1995
            Stop: 10/16/2003
      A4  = Medicare Claim PPS Capital Day Outlier
            Amount.
            Start: 01/01/1995
            Stop: 04/01/2008
      A5  = Medicare Claim PPS Capital Cost Outlier
            Amount.
            Start: 01/01/1995
      A6  = Prior hospitalization or 30 day transfer
            requirement not met.
            Start: 01/01/1995
      A7  = Presumptive Payment Adjustment
            Start: 01/01/1995
      A8  = Ungroupable DRG.
            Start: 01/01/1995
      B1  = Non-covered visits.
            Start: 01/01/1995
      B2  = Covered visits.
            Start: 01/01/1995
            Stop: 10/16/2003
      B3  = Covered charges.
            Start: 01/01/1995
            Stop: 10/16/2003
      B4  = Late filing penalty.
            Start: 01/01/1995
      B5  = Coverage/program guidelines were not met
            or were exceeded.
            Start: 01/01/1995
      B6  = This payment is adjusted when performed/
            billed by this type of provider, by this
            type of provider in this type of facility,
            or by a provider of this specialty.
            Start: 01/01/1995
            Stop: 02/01/2006
      B7  = This provider was not certified/eligible
            to be paid for this procedure/service on
            this date of service. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      B8  = Alternative services were available, and
            should have been utilized. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      B9  = Patient is enrolled in a Hospice.
            Start: 01/01/1995
      B10 = Allowed amount has been reduced because a
            component of the basic procedure/test was
            paid. The beneficiary is not liable for
            more than the charge limit for the basic
            procedure/test.
            Start: 01/01/1995
      B11 = The claim/service has been transferred to
            the proper payer/processor for processing.
            Claim/service not covered by this payer/
            processor.
            Start: 01/01/1995
      B12 = Services not documented in patients'
            medical records.
            Start: 01/01/1995
      B13 = Previously paid. Payment for this claim/
            service may have been provided in a
            previous payment.
            Start: 01/01/1995
      B14 = Only one visit or consultation per
            physician per day is covered.
            Start: 01/01/1995
      B15 = This service/procedure requires that a
            qualifying service/procedure be received
            and covered. The qualifying other service/
            procedure has not been received/adjudicated
            . Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      B16 = 'New Patient' qualifications were not met.
            Start: 01/01/1995
      B17 = Payment adjusted because this service was
            not prescribed by a physician, not
            prescribed prior to delivery, the
            prescription is incomplete, or the
            prescription is not current.
            Start: 01/01/1995
            Stop: 02/01/2006
      B18 = This procedure code and modifier were
            invalid on the date of service.
            Start: 01/01/1995
            Stop: 03/01/2009
      B19 = Claim/service adjusted because of the
            finding of a Review Organization.
            Start: 01/01/1995
            Stop: 10/16/2003
      B20 = Procedure/service was partially or fully
            furnished by another provider.
            Start: 01/01/1995
      B21 = The charges were reduced because the
            service/care was partially furnished by
            another physician.
            Start: 01/01/1995
            Stop: 10/16/2003
      B22 = This payment is adjusted based on the
            diagnosis.
            Start: 01/01/1995
      B23 = Procedure billed is not authorized per
            your Clinical Laboratory Improvement
            Amendment (CLIA) proficiency test.
            Start: 01/01/1995
      D1  = Claim/service denied. Level of subluxation
            is missing or inadequate.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D2  = Claim lacks the name, strength, or dosage
            of the drug furnished.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D3  = Claim/service denied because information to
            indicate if the patient owns the equipment
            that requires the part or supply was
            missing.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D4  = Claim/service does not indicate the period
            of time for which this will be needed.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D5  = Claim/service denied. Claim lacks
            individual lab codes included in the test.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D6  = Claim/service denied. Claim did not include
            patient's medical record for the service.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D7  = Claim/service denied. Claim lacks date of
            patient's most recent physician visit.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D8  = Claim/service denied. Claim lacks
            indicator that 'x-ray is available for
            review.'
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D9  = Claim/service denied. Claim lacks invoice
            or statement certifying the actual cost
            of the lens, less discounts or the type of
            intraocular lens used.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D10 = Claim/service denied. Completed physician
            financial relationship form not on file.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D11 = Claim lacks completed pacemaker
            registration form.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D12 = Claim/service denied. Claim does not
            identify who performed the purchased
            diagnostic test or the amount you were
            charged for the test.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D13 = Claim/service denied. Performed by a
            facility/supplier in which the ordering/
            referring physician has a financial
            interest.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D14 = Claim lacks indication that plan of
            treatment is on file.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D15 = Claim lacks indication that service was
            supervised or evaluated by a physician.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D16 = Claim lacks prior payer payment information
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code âN4ã.
      D17 = Claim/Service has invalid non-covered days.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D18 = Claim/Service has missing diagnosis
            information.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D19 = Claim/Service lacks Physician/Operative or
            other supporting documentation
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D20 = Claim/Service missing service/product
            information.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D21 = This (these) diagnosis(es) is (are) missing
            or are invalid
            Start: 01/01/1995
            Stop: 06/30/2007
      D22 = Reimbursement was adjusted for the reasons
            to be provided in separate correspondence.
            (Note: To be used for Workers' Compensation
            only) - Temporary code to be added for time
            frame only until 01/01/2009. Another code
            to be established and/or for 06/2008
            meeting for a revised code to replace or
            strategy to use another existing code
            Start: 01/27/2008
            Stop: 01/01/2009
      D23 = This dual eligible patient is covered by
            Medicare Part D per Medicare Retro-
            Eligibility. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 11/01/2009
            Stop: 01/01/2012
      W1  = Workers' compensation jurisdictional fee
            schedule adjustment. Note: If adjustment
            is at the Claim Level, the payer must send
            and the provider should refer to the 835
            Class of Contract Code Identification
            Segment (Loop 2100 Other Claim Related
            Information REF). If adjustment is at the
            Line Level, the payer must send and the
            provider should refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment information REF).
            Start: 02/29/2000
      W2  = Payment reduced or denied based on workers'
            compensation jurisdictional regulations or
            payment policies, use only if no other code
            is applicable. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            Workers' Compensation only.
            Start: 10/17/2010
      W3  = The Benefit for this Service is included
            in the payment/allowance for another
            service/procedure that has been performed
            on the same day. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present. For use by Property and
            Casualty only.
            Start: 09/30/2012
      W4  = Workers' Compensation Medical Treatment
            Guideline Adjustment.
            Start: 09/30/2012
      Y1  = Payment denied based on Medical Payments
            Coverage (MPC) or Personal Injury
            Protection (PIP) Benefits jurisdictional
            regulations or payment policies, use only
            if no other code is applicable. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            P&C Auto only.
            Start: 09/30/2012
      Y2  = Payment adjusted based on Medical Payments
            Coverage (MPC) or Personal Injury
            Protection (PIP) Benefits jurisdictional
            regulations or payment policies, use only
            if no other code is applicable. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            P&C Auto only.
            Start: 09/30/2012
      Y3  = Medical Payments Coverage (MPC) or Personal
            Injury Protection (PIP) Benefits
            jurisdictional fee schedule adjustment.
            Note: If adjustment is at the Claim Level,
            the payer must send and the provider should
            refer to the 835 Class of Contract Code
            Identification Segment (Loop 2100 Other
            Claim Related Information REF). If
            adjustment is at the Line Level, the payer
            must send and the provider should refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            information REF). To be used for P&C Auto
            only.
            Start: 09/30/2012



 CLM_BENE_ID_TYPE_TB                     Claim Beneficiary Identifier Type Table

       M = MBI
       H = HICN



 CLM_BILL_TYPE_TB                        Claim Bill Type Table

       11 = Hospital-inpatient (Part A)
       12 = Hospital-inpatient or home health visits (Part B only)
       13 = Hospital-outpatient (HHA-A also) (under OPPS 13X
            must be used for ASC claims submitted for OPPS
            payment -- eff. 7/00)
       14 = Hospital-Laboratory Services Provided to
            Non-patients
       15 = Hospital-intermediate care - level I (obsolete)
       16 = Hospital-intermediate care - level II (obsolete)
       17 = Hospital-intermediate care - level III (obsolete)
       18 = Hospital-swing beds
       19 = Reserved for national assignment
       21 = SNF-inpatient (including Part A)
       22 = SNF-inpatient or home health visits (Part B only)
       23 = SNF-outpatient (HHA-A also)
       24 = SNF-other (Part B) - (obsolete)
       25 = SNF-intermediate care - level I (obsolete)
       26 = SNF-intermediate care - level II (obsolete)
       27 = SNF-intermediate care - level III (obsolete)
       28 = SNF-swing beds
       29 = SNF-reserved for national assignment
       31 = HHA-inpatient (including Part A) (obsolete)
       32 = HHA-Home Health Services under a Plan of Treatment
            (name revised 10/2013)
       33 = HHA-outpatient (plan of treatment under Part A,
            including DME under Part A) (term. 10/2013)
       34 = HHA-other (for medical and surgical services not
            under a plan of treatment) (obsolete)
       35 = HHA-intermediate care - level I (obsolete)
       36 = HHA-intermediate care - level II (obsolete)
       37 = HHA-intermediate care - level III (obsolete)
       38 = HHA-swing beds (obsolete)
       39 = HHA-reserved for national assignment
       41 = Religious Nonmedical Health Care Institution (RNHCI)
            hospital-inpatient (including Part A) (all references
            to Christian Science (CS) is obsolete eff. 8/00 and
            replaced with RNHCI)
       42 = RNHCI hospital-inpatient or home health visits (Part B only)
       43 = RNHCI hospital-outpatient (HHA-A also)
       44 = RNHCI hospital-other (Part B) - (obsolete)
       45 = RNHCI hospital-intermediate care - level I (obsolete)
       46 = RNHCI hospital-intermediate care - level II (obsolete)
       47 = RNHCI hospital-intermediate care - level III (obsolete)
       48 = RNHCI hospital-swing beds (obsolete)
       49 = RNHCI hospital-reserved for national assignment
       51 = CS extended care-inpatient (including Part A) OBSOLETE
            eff. 7/00 - implementation of Religious Nonmedical
            Health Care Institutions (RNHCI)
       52 = RNHCI extended care-inpatient or home health visits
            (Part B only) (eff. 7/00) - OBSOLETE; prior to 7/00
            Christian Science (CS)
       53 = RNHCI extended care-outpatient (HHA-A also) (eff. 7/00);
            OBSOLETE - prior to 7/00 referenced CS
       54 = RNHCI extended care-other (Part B)(eff. 7/00)- OBSOLETE;
            prior to 7/00 referenced CS
       55 = RNHCI extended care-intermediate care - level I (eff. 7/00)
            OBSOLETE - prior to 7/00 referenced CS
       56 = RNHCI extended care-intermediate care - level II (eff. 7/00)
            OBSOLETE - prior to 7/00 referenced CS
       57 = RNHCI extended care-intermediate care - level III (eff. 7/00)
            OBSOLETE - prior to 7/00 referenced CS
       58 = RNHCI extended care-swing beds (eff. 7/00)- OBSOLETE
            prior to 7/00 referenced CS
       59 = RNHCI extended care-reserved for national assignment
            (eff. 7/00) - OBSOLETE; prior to 7/00 referenced CS
       61 = Intermediate care-inpatient (including Part A)
            OBSOLETE
       62 = Intermediate care-inpatient or home health visits (Part B only)
            OBSOLETE
       63 = Intermediate care-outpatient (HHA-A also) - OBSOLETE
       64 = Intermediate care-other (Part B)- OBSOLETE
       65 = Intermediate care-intermediate care - level I
       66 = Intermediate care-intermediate care - level II
       67 = Intermediate care-intermediate care - level III - OBSOLETE
       68 = Intermediate care-swing beds - OBSOLETE
       69 = Reserved for national assignment
       71 = Clinic-rural health
       72 = Clinic-hospital based or independent renal dialysis facility
       73 = Clinic-Freestanding
       74 = Clinic-ORF only (eff 4/97);
            ORF and CMHC (10/91 - 3/97)
       75 = Clinic-CORF
       76 = Clinic-CMHC (eff 4/97)
       77 = Clinic-Federally Qualified Health Center (FQHC)
            eff. 4/2010
       78 = Clinic-reserved for national assignment
       79 = Clinic-other
       81 = Hospice (non-hospital based)
       82 = Hospice (hospital based)
       83 = Ambulatory Aurgical Center
            (Discontinued for Hospitals Subject to Outpatient PPS;
             hospitals must use 13X for ASC claims submitted for OPPS
             payment -- eff. 7/00)
       84 = Freestanding Birthing Center
       85 = Critical Access Hospital (eff. 10/94)
       86 = Residential Facility (eff. 4/1/2010)
       87 = Reserved for national assignment
       88 = Reserved for national assignment
       89 = Special facility or ASC surgery-other
       91 = Reserved for national assignment
       92 = Reserved for national assignment
       93 = Reserved for national assignment
       94 = Reserved for national assignment
       95 = Reserved for national assignment
       96 = Reserved for national assignment
       97 = Reserved for national assignment
       98 = Reserved for national assignment
       99 = Reserved for national assignment



 CLM_CARE_IMPRVMT_MODEL_TB               Claim Care Improvement Model Table


      61 = CLAIM CARE IMPROVEMENT MODEL 1
      62 = CLAIM CARE IMPROVEMENT MODEL 2
      63 = CLAIM CARE IMPROVEMENT MODEL 3
      64 = CLAIM CARE IMPROVEMENT MODEL 4



 CLM_DGNS_VRSN_TB                        Claim Diagnosis Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_DISP_TB                             Claim Disposition Table

       01 = Debit accepted
       02 = Debit accepted (automatic adjustment)
            applicable through 4/4/93
       03 = Cancel accepted
       61 = *Conversion code: debit accepted
       62 = *Conversion code: debit accepted
             (automatic adjustment)
       63 = *Conversion code: cancel accepted

          *Used only during conversion period:
                1/1/91 - 2/21/91



 CLM_EXCPTD_NEXCPTD_TRTMT_TB             Claim Excepted/Nonexcepted Treatment Table

      0 = No Entry
      1 = Excepted
      2 = Nonexcepted



 CLM_FAC_TYPE_TB                         Claim Facility Type Table

       1 = Hospital
       2 = Skilled nursing facility (SNF)
       3 = Home health agency (HHA)
       4 = Religious Nonmedical (Hospital)
           (eff. 8/1/00); prior to 8/00 referenced Christian
           Science (CS)
       5 = Religious Nonmedical (Extended Care)
           (eff. 8/1/00); prior to 8/00 referenced CS
           (discontinued effective 10/1/05)
       6 = Intermediate care
       7 = Clinic or hospital-based renal dialysis facility
       8 = Special facility or ASC surgery
       9 = Reserved



 CLM_FPS_MSN_CD_TB                       Claim FPS MSN Code Table

      Section 1 Ambulance
      1.1   = Payment for transportation is allowed
              only to the closest facility that can
              provide the necessary care.
      1.10  = Air ambulance is not covered since you
              were not taken to the airport by
              ambulance.
      1.11  = The information provided does not support
              the need for an air ambulance.
              The approved amount is based on ground
              ambulance.
      1.2   = Payment is denied because the ambulance
              company is not approved by Medicare.
      1.3   = Ambulance service to a funeral home is
              not covered.
      1.4   = Transportation in a vehicle other than
              an ambulance is not covered.
      1.5   = Transportation to a facility to be closer
              to home or family is not covered.
      1.6   = This service is included in the allowance
              for the ambulance transportation.
      1.7   = Ambulance services to or from a doctor's
              office are not covered.
      1.8   = This service is denied because you
              refused to be transported.
      1.9   = Payment for ambulance services does not
              include mileage when you were not in the
              ambulance.

      Section 10 Foot Care	
      10.1  = Shoes are only covered as part of a leg
              brace.

      Section 11 Transfer of Claims or Parts of Claims
      11.1  = Your claim has been forwarded to the
              correct Medicare contractor for
              processing. You will receive a notice
              from them.
      11.10 = We have identified you as a Railroad
              Retirement Board (RRB) Medicare
              beneficiary. You must send your claim
              for these services for processing to the
              RRB carrier Palmetto GBA, at PO Box
              10066, Augusta, GA 30999.
      11.11 = This claim/service is not payable under
              our claims jurisdiction. We have notified
              your provider to send your claim for
              these services to the United Mine
              Workers of America for processing.
      11.2  = This information is being sent to
              Medicaid. They will review it to see if
              additional benefits can be paid.
      11.3  = Our records show that you are enrolled in
              a Medicare health plan. Your provider
              must bill this service to the plan.
      11.4  = Our records show that you are enrolled in
              a Medicare health plan. Your claim was
              sent to the plan for processing.
      11.5  = This claim will need to be submitted to
              (another carrier, a Durable Medical
              Equipment Medicare Administrative
              Contractor (DME MAC), or Medicaid agency)
      11.6  = We have asked your provider to submit
              this claim to the proper Medicare
              Administrative Contractor (MAC). That
              MAC is (name and address).
              NOTE: Due to different systems'
              capabilities, DMACs may omit the final
              sentence in this message, "That MAC is
              (name and address)," whenever this
              message is used. Part A and Part B MACs
              are expected to use the complete message.
              This instruction also applies to the
              Spanish translation of the message.
      11.7  = This claim/service is not payable under
              our claims jurisdiction area. We have
              notified your provider that they must
              forward the claim/service to the correct
              carrier for processing.
      11.8  = This claim will need to be submitted to
              the Region B Durable Medical Equipment
              Regional Carrier.
      11.9  = This claim/service is not payable under
              our claims jurisdiction. We have
              notified your provider to send your
              claim for these services to the Railroad
              Retirement Board Medicare carrier.

      Section 12 Hearing Aids	
      12.1  = Hearing aids are not covered.

      Section 13 Skilled Nursing Facility
      13.1  = No qualifying hospital stay dates were
              shown for this skilled nursing facility
              stay.
      13.10 = Medicare Part B doesn't pay for items or
              services provided by this type of
              healthcare provider since our records
              show that you were receiving Medicare
              Part A benefits in a skilled nursing
              facility on this date.
      13.11 = You have ___ days(s) remaining of your
              total 100 days of skilled nursing
              facility benefits for this benefit period
      13.12 = Medicare Part B doesn't pay separately
              for this item/service. Payment for this
              item/service should be included in
              another Medicare benefit. The hospital/
              nursing facility must bill for this
              Medicare service.
      13.2  = Skilled nursing facility benefits are
              only available after a hospital stay of
              at least 3 days.
      13.3  = Information provided does not support the
              need for skilled nursing facility care.
      13.4  = Information provided does not support the
              need for continued care in a skilled
              nursing facility.
      13.5  = You were not admitted to the skilled
              nursing facility within 30 days of your
              hospital discharge.
      13.6  = Rural primary care skilled nursing
              facility benefits are only available
              after a hospital stay of at least 2 days.
      13.7  = Normally, care is not covered when
              provided in a bed that is not certified
              by Medicare. However, since you received
              covered care, we have decided that you
              will not have to pay the facility for
              anything more than Medicare coinsurance
              and noncovered items.
      13.8  = The skilled nursing facility should file
              a claim for Medicare benefits because
              you were an inpatient.
      13.9  = Medicare Part B does not pay for this
              item or service since our records show
              that you were in a skilled nursing
              facility on this date.

      Section 14 Laboratory
      14.1  = The laboratory is not approved for this
              type of test.
      14.10 = Medicare does not allow a separate
              payment for EKG readings.
      14.11 = A travel allowance is paid only when a
              covered specimen collection fee is billed
      14.12 = Payment for transportation can only be
              made if an X-ray or EKG is performed.
      14.13 = The laboratory was not approved for this
              test on the date it was performed.
      14.2  = Medicare approved less for this
              individual test because it can be done
              as part of a complete group of tests.
      14.3  = Services or items not approved by the
              Food and Drug Administration are not
              covered.
      14.4  = Payment denied because the claim did not
              show who performed the test and/or the
              amount charged.
      14.5  = Payment denied because the claim did not
              show if the test was purchased by the
              physician or if the physician performed
              the test.
      14.6  = This test must be billed by the
              laboratory that did the work.
      14.7  = This service is paid at 100% of the
              Medicare approved amount.
      14.8  = Payment cannot be made because the
              physician has a financial relationship
              with the laboratory.
      14.9  = Medicare cannot pay for this service for
              the diagnosis shown on the claim.

      Section  Medical Necessity
      15.1  = The information provided does not support
              the need for this many services or items.
      15.10 = Medicare does not pay for more than one
              assistant surgeon for this procedure.
      15.11 = Medicare does not pay for an assistant
              surgeon for this procedure/surgery.
      15.12 = Medicare does not pay for two surgeons
              for this procedure.
      15.13 = Medicare does not pay for team surgeons
              for this procedure.
      15.14 = Medicare does not pay for acupuncture.
      15.15 = Payment has been reduced because
              information provided does not support the
              need for this item as billed.
      15.16 = Your claim was reviewed by our medical
              staff.
      15.17 = We have approved this service at a
              reduced level.
      15.18 = Medicare does not cover this service at
              home.
      15.19 = Local Coverage Determinations (LCDs) help
              Medicare decide what is covered. An LCD
              was used for your claim. You can compare
              your case to the LCD, and send
              information from your doctor if you
              think it could change our decision.
              Call 1-800-MEDICARE (1-800-633-4227) for
              a copy of the LCD.
      15.2  = The information provided does not support
              the need for this equipment.
      15.20 = The following policies were used when we
              made this decision: _____
      15.21 = The information provided does not support
              the need for this many services or items
              in this period of time but you do not
              have to pay this amount.
      15.22 = The information provided does not support
              the need for this many services or items
              in this period of time so Medicare will
              not pay for this item or service.
      15.3  = The information provided does not support
              the need for the special features of this
              equipment.
      15.4  = The information provided does not support
              the need for this service or item.
      15.5  = The information provided does not support
              the need for similar services by more
              than one doctor during the same time
              period.
      15.6  = The information provided does not support
              the need for this many services or items
              within this period of time.
      15.7  = The information provided does not support
              the need for more than one visit a day.
      15.8  = The information provided does not support
              the level of service as shown on the
              claim.
      15.9  = The Quality Improvement Organization did
              not approve this service.
      15.96 = Medicare does not pay for this
              investigational device(s).
      15.97 = Medicare cannot pay for this
              investigational device because the
              approved period for the investigational
              device in the FDA clinical trial has not
              begun.
      15.98 = Medicare cannot pay for this
              investigational device because the
              approved period for the investigational
              device in the FDA clinical trial has
              expired.
      15.99 = Medicare does not pay for this many
              services on the same day. You cannot be
              billed for this service.

      Section 16 Miscellaneous
      16.1  = The service cannot be approved because
              the date on the claim shows it was billed
              before it was provided.
      16.10 = Medicare does not pay for this item or
              service.
      16.11 = Payment was reduced for late filing.  You
              cannot be billed for the reduction.
      16.12 = Outpatient mental health services are
              paid at 50% of the approved charges.
      16.13 = The code(s) your provider used is/are not
              valid for the date of service billed.
      16.14 = The attached check replaces your previous
              check (#____) dated (______).
      16.15 = The attached check replaces your previous
              check.
      16.16 = As requested, this is a duplicate copy of
              your Medicare Summary Notice.
              See "Message Expiration Date" and
              "Message Notes" columns ------->
      16.17 = Medicare only pays for these services if
              you get them with total parenteral
              nutrition.
      16.18 = Medicare won't pay for services provided
              before certified parenteral/enteral
              nutrition therapy started.
      16.19 = The amount Medicare pays for a
              parenteral/enteral nutrition supply is
              based on the level of care you need
              (based on your diagnosis).
      16.2  = This service cannot be paid when provided
              in this location/facility.
      16.20 = The approved payment for calories/grams
              is the most Medicare may allow for the
              diagnosis stated.
      16.21 = The procedure code was changed to reflect
              the actual service rendered.
      16.22 = Medicare does not pay for services when
              no charge is indicated.
      16.23 = This check is for the amount you overpaid
      16.24 = Services provided aboard a ship are
              covered only when the ship is of United
              States registry and is in United States
              waters. In addition, the service must be
              provided by a doctor licensed to practice
              in the United States.
      16.25 = Medicare does not pay for this much
              equipment, or this many services or
              supplies.
      16.26 = Medicare does not pay for services or
              items related to a procedure that has not
              been approved or billed.
      16.27 = This service is not covered since our
              records show you were in the hospital at
              this time.
      16.28 = Medicare does not pay for services or
              equipment that you have not received.
      16.29 = Payment is included in another service
              you have received.
      16.3  = The claim did not show that this service
              or item was prescribed by your doctor.
      16.30 = Services billed separately on this claim
              have been combined under this procedure.
      16.31 = You are responsible to pay the primary
              physician care the agreed monthly charge.
      16.32 = Medicare does not pay separately for this
              service.
      16.33 = Your payment includes interest because
              Medicare exceeded processing time limits.
      16.34 = You should not be billed for this service
              . You are only responsible for any
              deductible and coinsurance amounts listed
              in the "You May Be Billed" column.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes."
      16.35 = You do not have to pay this amount.
      16.36 = If you have already paid it, you are
              entitled to a refund from this provider.
      16.37 = Please see the back of this notice.
              See "Message Expiration Date" and
              "Message Notes" columns
      16.38 = Charges are not incurred for leave of
              absence days.
      16.39 = Only one provider can be paid for this
              service per calendar month. Payment has
              already been made to another provider for
              this service.
      16.4  = This service requires prior approval by
              the Quality Improvement Organization.
      16.40 = Only one inpatient service per day is
              allowed.
      16.41 = Payment is being denied because you
              refused to request reimbursement under
              your Medicare benefits.
      16.42 = The provider's determination of
              noncoverage is correct.
      16.43 = This service cannot be approved without a
              treatment plan and supervision of a
              doctor.
      16.44 = Routine care is not covered.
      16.45 = You cannot be billed separately for this
              item or service. You do not have to pay
              this amount.
      16.46 = Medicare payment limits do not affect a
              Native American's right to free care at
              Indian Health Institutions.
      16.47 = When deductible is applied to outpatient
              psychiatric services, you may be billed
              for up to the approved amount. The "You
              May Be Billed" column will tell you the
              correct amount to pay your provider.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed" when your MAC
              implements the new MSN design.
      16.48 = Medicare does not pay for this item or
              service for this condition.
      16.49 = This claim/service is not covered because
              alternative services were available, and
              should have been utilized.
      16.5  = This service cannot be approved without a
              treatment plan by a physical or
              occupational therapist.
      16.50 = The doctor or supplier may not bill more
              than the Medicare allowed amount.
      16.51 = This service is not covered prior to July
              1, 2001.
      16.52 = This service was denied because coverage
              for this service is provided only after a
              documented failed trial of pelvic muscle
              exercise training.
      16.53 = The amount Medicare paid the provider for
              this claim is ($______).
      16.54 = This service is not covered prior to
              January 1, 2002.
      16.55 = The provider billed this charge as
              non-covered.
      16.56 = Claim denied because information from the
              Social Security Administration indicates
              that you have been deported.
      16.57 = Medicare Part B does not pay for this
              item or service since our records show
              that you were in a Medicare health plan
              on this date. Your provider must bill
              this service to the Medicare health plan.
      16.58 = The provider billed this charge as
              non-covered. You do not have to pay this
              amount.
      16.59 = Medicare doesn't pay for missed
              appointments.
      16.6  = This item or service cannot be paid
              unless the provider accepts assignment.
      16.60 = Want to see your MSN right away? Access
              your Original Medicare claims directly at
              www.MyMedicare.gov, usually within 24
              hours after Medicare processes the claim.
              You can also order duplicate MSNs, track
              your preventive services, and print an
              "On the Go" report to share with your
              provider.
      16.61 = Outpatient mental health services are
              paid at 55% of the approved amount.
      16.62 = Outpatient mental health services are
              paid at 60% of the approved amount
      16.63 = Outpatient mental health services are
              paid at 65% of the approved amount.
      16.64 = IMPORTANT:  Starting in March 2010,
              Medicare will begin to mail Part A and
              Part B MSNs in the same envelope when
              possible.
      16.66 = Medicare doesn't pay for DMEPOS items or
              services when provided by a hospital or
              physician if there is no matching date of
              discharge or date of service.
      16.67 = Medicare doesn't pay for services or
              items when provided by a hospital when
              there is no matching date of discharge.
      16.7  = Your provider must complete and submit
              your claim.
      16.71 = Your provider must complete and submit
              your claim.
      16.72 = This claim was denied because it was
              Submitted with a non-affirmative prior
              authorization request.
      16.73 = This claim has received a payment
              reduction because it did not first go
              through the prior authorization process.
      16.74 = This claim is denied because there is no
              record of a prior authorization request
              to support this record.
      16.76 = This service/item was not covered because
              you have exceeded the lifetime limit for
              getting this service/item.
      16.77 = This service/item was not covered because
              it was not provided as part of a
              qualifying trial/study.
      16.8  = Payment is included in another service
              received on the same day.
      16.9  = This allowance has been reduced by the
              amount previously paid for a related
              procedure.
      16.98 = The amount you paid to the provider for
              this claim was more than the required
              payment. You should be receiving a refund
              of $______ from your provider, which is
              the difference between what you paid and
              what you should have paid.
      16.99 = The amount owed you is $________.
              Medicare no longer routinely issues
              payment under $1 This amount due will be
              included on a future check issued to you.
              If you want this money issued immediately
              , please contact us at the address and
              phone number shown at the bottom of this
              page.

      Section 17 Non Physician Services	
      17.1  = Services performed by a private duty
              nurse are not covered.
      17.10 = The allowance has been reduced because
              the anesthesiologist medically directed
              concurrent procedures.
      17.11 = This item or service cannot be paid as
              billed.
      17.12 = This service is not covered when provided
              by an independent therapist.
      17.13 = Each year, Medicare pays for a limited
              amount of physical therapy and speech-
              language pathology services and a
              separate amount of occupational therapy
              services. Medically necessary therapy
              over these limits is covered when
              approved by Medicare.
      17.14 = Charges for maintenance therapy are not
              covered.
      17.15 = This service cannot be paid unless
              certified by your physician every (___)
              days.
      17.16 = The hospital should file a claim for
              Medicare benefits because these services
              were performed in a hospital setting.
      17.17 = Medicare already paid for an initial
              visit for this service with this
              physician, another physician in his group
              practice, or a provider. Your doctor or
              provider must use a different code to
              bill for subsequent visits.
      17.18 = ($) has been applied during this calendar
              year (CCYY) towards the ($) limit on
              outpatient physical therapy and speech-
              language pathology benefits.
      17.19 = ($) has been applied during this calendar
              year (CCYY) towards the ($) limit on
              outpatient occupational therapy benefits.
      17.2  = This anesthesia service must be billed by
              a doctor.
      17.21 = The items or service was denied because
              Medicare can't pay for services ordered
              by or referred by this provider at this
              time" for this message number.
      17.25 = Medicare does not pay for services of a
              nurse practitioner/clinical nurse
              specialist for this place and/or date of
              service.
      17.3  = This service was denied because you did
              not receive it under the direct
              supervision of a doctor.
      17.33 = Medicare does not pay for services by a
              noncertified nonphysician practitioner.
      17.4  = Services performed by an audiologist are
              not covered except for diagnostic
              procedures.
      17.5  = Your provider's employer must file this
              claim and agree to accept assignment.
      17.6  = Full payment was not made for this
              service(s) because the yearly limit has
              been met.
      17.7  = This service must be performed by a
              licensed clinical social worker.
      17.8  = Payment was denied because the maximum
              benefit allowance has been reached.
      17.9  = Medicare (Part A/Part B) pays for this
              service. The provider must bill the
              correct Medicare contractor.

      Section 18 Preventive Care	
      18.1  = Routine examinations and related services
              aren't covered.
      18.10 = Expired
      18.11 = Expired
      18.12 = Screening mammograms are covered annually
              for women 40 years of age and older.
      18.13 = This service isn't covered for people
              under 50 years old.
      18.14 = Service is being denied because it has
              not been (12/24/48) months since your
              last (test/procedure) of this kind.
      18.15 = Medicare only covers this procedure for
              people considered to be at high risk for
              colorectal cancer.
      18.16 = This service is being denied because
              payment has already been made for a
              similar procedure within a set time frame
      18.17 = Medicare pays for a screening Pap test
              and a screening pelvic examination once
              every 2 years unless high risk factors
              are present.
      18.18 = Medicare does not pay for this service
              separately since payment of it is
              included in our allowance for other
              services you received on the same day.
      18.19 = This service isn't covered until after
              your 50th birthday.
      18.2  = This immunization and/or preventive care
              is not covered.
      18.20 = Expired
      18.21 =	
      18.22 = This service was denied because Medicare
              only allows the Welcome to Medicare
              preventive visit within the first 12
              months you have Part B coverage.
      18.23 = You pay 25% of the Medicare-approved
              amount for this service.
      18.24 = This service was denied. Medicare doesn't
              cover an Annual Wellness Visit within the
              first 12 months of your Medicare Part B
              coverage. Medicare does cover a one-time
              Welcome to Medicare preventive visit with
              in the first 12 months.
      18.25 = Your Annual Wellness Visit has been
              approved. You will qualify for another
              Annual Wellness Visit 12 months after the
              date of this visit.
      18.26 = This service was denied because it
              occurred too soon after your last covered
              Annual Wellness Visit. Medicare only
              covers one Annual Wellness Visit within
              a 12 month period.
      18.27 = This service was denied because it
              occurred too soon after your Initial
              Preventive Physical Exam.
      18.3  = Screening mammography is not covered for
              women under 35 years of age.
      18.4  = This service is being denied because it
              has not been (__) months since your last
              examination of this kind.
      18.5  = Medicare will pay for another screening
              mammogram in 12 months.
      18.6  = A screening mammography is covered only
              once for women age 35 - 39.
      18.7  = Screening pap tests are covered only once
              every 24 months unless high risk factors
              are present.
      18.8  = Deleted during EOMB-MSN transition.
      18.9  = Deleted during EOMB-MSN transition.
      18.94 = Medicare pays for screening Pap smear
              and/or screening pelvic examination
              (including a clinical breast examination)
              only once every 2 years unless high risk
              factors are present.

      Section 19 Hospital Based Physician Services
      19.1  = Services of a hospital-based specialist
              are not covered unless there is an
              agreement between the hospital and the
              specialist.
      19.2  = Payment was reduced because this service
              was performed in a hospital outpatient
              setting rather than a provider's office.
      19.3  = Only one hospital visit or consultation
              per provider is allowed per day.

      Section 2 Blood
      2.1  = The first three pints of blood used in
              each year are not covered.
      2.2  = Charges for replaced blood are not covered

      Section 20 Benefit Limits
      20.1  = You have used all of your benefit days
              for this period.
      20.10 = This service was denied because Medicare
              only pays up to 10 hours of diabetes
              education training during the initial
              12-month period. Our records show you
              have already obtained 10 hours of
              training.
      20.11 = This service was denied because Medicare
              pays for two hours of follow-up diabetes
              education training during a calendar year
              . Our records show you have already
              obtained two hours of training for this
              calendar year.
      20.12 = This service was denied because Medicare
              only covers this service once a lifetime.
      20.13 = This service was denied because Medicare
              only pays up to three hours of medical
              nutrition therapy during a calendar year.
              Our records show you have already
              received three hours of medical nutrition
              therapy.
      20.14 = This service was denied because Medicare
              only pays two hours of follow-up for
              medical nutrition therapy during a
              calendar year. Our records show you have
              already received two hours of follow-up
              services for this calendar year.
      20.2  = You have reached your limit of 190 days
              of psychiatric hospital services.
      20.3  = You have reached your limit of 60
              lifetime reserve days.
      20.4  = (__) of the Benefit Days Used were
              charged to your Lifetime Reserve Day
              benefit.
      20.5  = These services cannot be paid because
              your benefits are exhausted at this time.
      20.6  = Days used has been reduced by the primary
              group insurer's payment.
      20.7  = You have (___) day(s) remaining of your
              190-day psychiatric limit.
      20.8  = Days are being subtracted from your total
              inpatient hospital benefits for this
              benefit period.
      20.9  = Services after (mm/dd/yy) cannot be paid
              because your benefits were exhausted.
      20.91 = This service was denied. Medicare covers
              a one-time initial preventative physical
              exam (Welcome to Medicare physical exam)
              if you get it within the first 12 months
              of the effective date of your Medicare
              Part B coverage.

      Section 21 Restrictions to Coverage
      21.1  = Services performed by an immediate
              relative or a member of the same
              household are not covered.
      21.10 = A surgical assistant is not covered for
              this place and/or date of service.
      21.11 = This service was not covered by Medicare
              at the time you received it.
      21.12 = This hospital service was not covered
              because the attending physician was not
              eligible to receive Medicare benefits at
              the time the service was performed.
      21.13 = This surgery was not covered because the
              attending physician was not eligible to
              receive Medicare benefits at the time the
              service was performed.
      21.14 = Medicare cannot pay for this
              investigational device because the FDA
              clinical trial period has not begun.
      21.15 = Medicare cannot pay for this
              investigational device because the FDA
              clinical trial period has ended.
      21.16 = Medicare does not pay for this
              investigational device.
      21.17 = Your provider submitted noncovered
              charges. You are responsible for paying
              these charges.
      21.18 = This item or service is not covered when
              performed or ordered by this provider.
      21.19 = This provider decided to dropout of
              Medicare. No payment can be made for
              this service. You are responsible for
              this charge. Under Federal law, your
              doctor cannot charge you more than the
              limiting charge amount.
      21.2  = The provider of this service is not
              eligible to receive Medicare payments.
      21.20 = This provider decided to dropout of
              Medicare. No payment can be made for
              this service. You are responsible for
              this charge.
      21.21 = This service was denied because Medicare
              only covers this service under certain
              circumstances.
      21.22 = Medicare does not pay for this service
              because it is considered investigational
              and/or experimental in these
              circumstances.
      21.23 = Your claim is being denied because the
              physician noted on the claim has been
              deceased for more than 15 months.
      21.24 = This service is not covered for patients
              over age 60.
      21.25 = This service was denied because Medicare
              only covers this service in certain
              settings.
      21.26 = Claim denied because services were
              provided by an Opt-Out physician or
              practitioner. No Medicare payment may be
              made.
      21.27 = Services provided by a Medicare
              sanctioned/excluded provider. No
              Medicare payment may be made.
      21.3  = This provider was not covered by
              Medicare when you received this service.
      21.30 = The provider decided to drop out of
              Medicare. No payment can be made for this
              service. You are responsible for this
              charge.
      21.31 = This service was not covered by Medicare
              at the time you recieved it.
      21.32 = This service was denied because Medicare
              only covers this service under certain
              circumstances.
      21.4  = Services provided outside the United
              States are not covered. See your
              Medicare Handbook for services received
              in Canada and Mexico.
      21.5  = Services needed as a result of war are
              not covered.
      21.6  = This item or service is not covered when
              performed, referred or ordered by this
              provider.
      21.7  = This service should be included on your
              inpatient bill.
      21.8  = Services performed using equipment that
              has not been approved by the Food and
              Drug Administration are not covered.
      21.9  = Payment cannot be made for unauthorized
              service outside the managed care plan.

      Section 22 Split Claims
      22.1  = Your claim was separated for processing.
              The remaining services may appear on a
              separate notice.

      Section 23 Surgery
      23.1  = The cost of care before and after the
              surgery or procedure is included in the
              approved amount for that service.
      23.10 = Payment has been reduced because this
              procedure was terminated before
              anesthesia was started.
      23.11 = Payment cannot be made because the
              surgery was canceled or postponed.
      23.12 = Payment has been reduced because the
              surgery was canceled after you were
              prepared for surgery.
      23.13 = Because you were prepared for surgery and
              anesthesia was started, full payment is
              being made even though the surgery was
              canceled.
      23.14 = The assistant surgeon must file a
              separate claim for this service.
      23.15 = The approved amount is less because the
              payment is divided between two doctors.
      23.16 = An additional amount is not allowed for
              this service when it is performed on both
              the left and right sides of the body.
      23.17 = Medicare won't cover these services
              because they are not considered medically
              necessary.
      23.2  = Cosmetic surgery and related services are
              not covered.
      23.3  = Medicare does not pay for surgical
              supports except primary dressings for
              skin grafts.
      23.4  = A separate charge is not allowed because
              this service is part of the major
              surgical procedure.
      23.5  = Payment has been reduced because a
              different doctor took care of you before
              and/or after the surgery.
      23.6  = This surgery was reduced because it was
              performed with another surgery on the
              same day.
      23.7  = Payment cannot be made for an assistant
              surgeon in a teaching hospital unless a
              resident doctor was not available.
      23.8  = This service is not payable because it is
              part of the total maternity care charge.
      23.9  = Payment has been reduced because the
              charges billed did not include post-
              operative care.

      Section 24 'Help Stop Fraud' messages
      24.1  = Protect your Medicare number as you would
              a credit card number.
      24.10 = Always read the front and back of your
              Medicare Summary Notice.
      24.11 = Beware of Medicare scams, such as offers
              of free milk or cheese for your Medicare
              number.
      24.12 = Read your Medicare Summary Notice
              carefully for accuracy of dates, services
              , and amounts billed to Medicare.
      24.13 = Be sure you understand anything you are
              asked to sign.
      24.14 = Be sure any equipment or services you
              received were ordered by your doctor.
      24.15 = Review your Medicare Summary Notice and
              report items and services that you did
              not receive to Medicare's Fraud Hotline
              at 1-866-417-2078.
              FLORIDA - SPECIFIC MESSAGE
      24.16 = Report items and services that you did
              not receive to Medicare's Fraud Hotline
              at 1-866-417-2078.
              FLORIDA - SPECIFIC MESSAGE
      24.19 = You may see some claims that have been
              adjusted. For an explanation see the
              General Information section
              See Expiration Date and Message Notes
              ------->
      24.2  = Beware of telemarketers or advertisements
              offering free or discounted Medicare
              items and services.
      24.22 = You can make a difference!  Last year,
              tax-payers saved $4 billion-the largest
              sum ever recovered in a single year-
              thanks in large part to people who came
              forward and reported suspicious activity.
              See "Message Implementation Date" and
              "Message Notes" columns. ---->
      24.3  = Beware of door-to-door solicitors
              offering free or discounted Medicare
              items or services.
      24.4  = Only your physician can order medical
              equipment for you.
      24.5  = Always review your Medicare Summary
              Notice for correct information about the
              items or services you received.
      24.6  = Do not sell your Medicare number or
              Medicare Summary Notice.
      24.7  = Do not accept free medical equipment you
              don't need.
      24.8  = Beware of advertisements that read,
              "This item is approved by Medicare", or
              "No out-of-pocket expenses."
      24.9  = Be informed - Read your Medicare Summary
              Notice.
              See "Message Expiration Date" and
              "Message Notes" columns ----->

      Section 25 Time Limit for filing
      25.1  = This claim was denied because it was
              filed after the time limit.
      25.2  = You can be billed only 20% of the charges
              that would have been approved.
      25.3  = The time limit for filing your claim has
              expired, therefore appeal rights are not
              applicable for this claim.

      Section 26 Vision	
      26.1  = Eye refractions are not covered.
      26.2  = Eyeglasses or contact lenses are only
              covered after cataract surgery or if the
              natural lens of your eye is missing.
      26.3  = Only one pair of eyeglasses or contact
              lenses is covered after cataract surgery
              with lens implant.
      26.4  = This service is not covered when
              performed by this provider.
      26.5  = This service is covered only in
              conjunction with cataract surgery.
      26.6  = Payment was reduced because the service
              was terminated early.

      Section 27 Hospice
      27.1  = This service is not covered because you
              are enrolled in a hospice.
      27.10 = The documentation indicates that the
              service level of continuous home care
              wasn't reasonable and necessary.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.11 = The provider has billed in error for the
              routine home care items or services
              received.
      27.12 = The documentation indicates that your
              respite level of care exceeded five
              consecutive days. Therefore, payment
              for every day beyond the 5th day will be
              paid at the routine home care rate.
      27.13 = According to Medicare hospice
              requirements, this service is not covered
              because the service was provided by a
              non-attending physician.
      27.2  = Medicare will not pay for inpatient
              respite care when it exceeds five
              consecutive days at a time.
      27.3  = The physician certification requesting
              hospice services was not received timely.
      27.4  = The documentation received indicates that
              the general inpatient care level of
              services were not necessary for care
              related to the terminal illness.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.5  = Payment for the day of discharge from the
              hospital will be made to the hospice
              agency at the routine home care rate.
      27.6  = The documentation indicates the level of
              care was at the respite level not the
              general inpatient level of care.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.7  = According to Medicare hospice
              requirements, the hospice election
              consent was not signed timely.
      27.8  = The documentation submitted does not
              support that your illness is terminal.
      27.9  = The documentation indicates your
              inpatient level of care was not
              reasonable and necessary. Therefore,
              payment will be adjusted to the routine
              home care rate.
      27.99 = Medicare allows your doctor to charge for
              developing a plan of treatment for your
              home health or hospice services.

      Section 28 Mandatory	
      28.1  = Because you have Medicaid, your provider
              must agree to accept assignment.

      Section 29 MSP	
      29.1  = Secondary payment cannot be made because
              the primary insurer information was
              either missing or incomplete.
      29.10 = These services cannot be paid because you
              received them on or before you received
              a liability insurance payment for this
              injury or illness.
      29.11 = Our records show that an automobile
              medical, liability, or no-fault insurance
              plan is primary for these services.
              Submit this claim to the primary payer.
      29.12 = Our records show that these services may
              be covered under the Black Lung Program.
              Contact the U.S. Department of Labor,
              Federal Black Lung Program, P.O. Box 8302
              , London, KY 40742-8302
      29.13 = Medicare does not pay for these services
              because they are payable by another
              government agency. Submit this claim to
              that agency.
      29.14 = Medicare's secondary payment is ($______)
              . This is the difference between the
              primary insurer's approved amount of
              ($______) and the primary insurer's paid
              amount of ($______).
      29.15 = Medicare's secondary payment is ($______)
              . This is the difference between
              Medicare's approved amount of ($______)
              and the primary insurer's paid amount of
              ($______).
      29.16 = Your primary insurer approved and paid (
              $______) on this claim. Therefore, no
              secondary payment will be made by
              Medicare.
      29.17 = Your provider agreed to accept ($______)
              as payment in full on this (claim/service
              ). Your primary insurer has already paid
              ($______) so Medicare's payment is the
              difference between the two amounts.
      29.18 = The amount listed in the "You May Be
              Billed" column assumes that your primary
              insurer paid the provider. If your
              primary insurer paid you, then you are
              responsible to pay the provider the
              amount your primary insurer paid to you
              plus the amount in the "You May Be Billed
              " column.
              This message should be revised to read
              "If your primary insurer paid you for
              this claim, you are responsible to pay
              that amount to your provider plus the
              amount in the "Maximum You May Be Billed"
              column."
              See "Message Implementation Date" and
              "Message Notes" columns.
      29.19 = If your primary insurer paid your
              provider for this claim, you now only
              need to pay your provider the difference
              between the amount charged and the amount
              your primary insurer paid.
      29.2  = No payment was made because your primary
              insurer's payment satisfied the
              provider's bill.
      29.20 = If your primary insurer paid your
              provider for this claim, you only need to
              pay the difference between the amount
              your provider agreed to accept and the
              amount your primary insurer paid.
      29.21 = If your primary insurer made payment on
              this claim, you may be billed the
              difference between the amount charged and
              your primary insurer's payment.
      29.22 = If your primary insurer paid the provider
              , you need to pay the provider the
              difference between the limiting charge
              amount and the amount the primary
              insurer paid your provider.
      29.23 = No payment can be made because payment
              was already made by either worker's
              compensation or the Federal Black Lung
              Program.
      29.24 = No payment can be made because payment
              was already made by another government
              entity.
      29.25 = Medicare paid all covered services not
              paid by other insurer.
      29.26 = The primary payer is _________.
      29.27 = Your primary group's payment satisfied
              Medicare deductible and coinsurance.
      29.28 = Your responsibility on this claim has
              been reduced by the amount paid by your
              primary insurer.
      29.29 = Your provider is allowed to collect a
              total of ($______) on this claim. Your
              primary insurer paid ($_____) and
              Medicare paid ($______). You are
              responsible for the unpaid portion of
              ($______).
      29.3  = Medicare benefits are reduced because
              some of these expenses have been paid by
              your primary insurer.
      29.30 = ($______) of the money approved by your
              primary insurer has been credited to your
              Medicare Part B (A) deductible. You do
              not have to pay this amount.
      29.31 = Resubmit this claim with the missing or
              correct information.
      29.32 = Medicare's secondary payment is ($______)
              . This is the difference between
              Medicare's limiting charge amount of
              ($______) and the primary insurer's paid
              amount of ($______).
      29.33 = Your claim has been denied by Medicare
              because you may have funds set aside from
              your settlement to pay for your future
              medical expenses and prescription drug
              treatment related to your injury(ies).
      29.34 = The claim for this item/service was
              submitted by your complementary insurer
              on your behalf.
      29.35 = Per statute, Medicare only accepts claims
              from your complementary insurer when
              Medicare is the primary payer.
      29.71 = Medicare benefits are being paid on the
              condition that if you receive payment
              from liability insurance, an automobile
              medical insurance policy or plan, or any
              other no-fault insurance, you must repay
              Medicare.
      29.4  = In the future, if you send claims to
              Medicare for secondary payment, please
              send them to (carrier MSP address).
      29.5  = Our records show that Medicare is your
              secondary payer. This claim must be sent
              to your primary insurer first.
      29.6  = Our records show that Medicare is your
              secondary payer. Services provided
              outside your prepaid health plan are not
              covered. We will pay this time only
              since you were not previously notified.
      29.7  = Medicare cannot pay for this service
              because it was furnished by a provider
              who is not a member of your employer
              prepaid health plan. Our records show
              that you were informed of this rule.
      29.8  = This claim is denied because the
              service(s) may be covered by the worker's
              compensation plan. Ask your provider to
              submit a claim to that plan.
      29.9  = Since your primary insurance benefits
              have been exhausted, Medicare will be
              primary on this accident related service.

      Section 3 Chiropractic
      3.1   = This service is covered only when recent
              x-rays support the need for the service.
      3.7   = Medicare does not pay for this unless a
              sympton or sign of a problem is stated
              on the claim.
      3.18  = This represents an adjustment of a
              previously processed claim. If an
              underpayment was made, the attached
              check pays the total claim allowed minus
              the amount originally paid. If an
              overpayment requiring a refund was made
              and a refund has not already been
              submitted, you will be contacted by
              letter from the Medicare claims office.

      Section 30 Reasonable Charge and Fee Schedule
      30.1  = The approved amount is based on a special
              payment method.
      30.2  = The facility fee allowance is greater
              than the billed amount.
      30.3  = Your doctor did not accept assignment for
              this service. Under Federal law, your
              doctor cannot charge more than ($______)
              . If you have already paid more than
              this amount, you are entitled to a refund
              from the provider.
      30.4  = A change in payment methods has resulted
              in a reduced or zero payment for this
              procedure.
      30.41 = What Medicare pays for a service or item
              may be higher than the billed amount.
              This amount is correct. Medicare pays
              this provider less than the billed amount
              on other claims since payment rates are
              set in advance for certain services and
              averaged out over an entire year.
      30.5  = This amount is the difference in billed
              amount and Medicare approved amount.

      Section 31 Adjustments	
      31.1  = This is a adjustment to a previously
              processed claim and/or deductible record.
      31.10 = This is an adjustment to a previously
              processed charge (s). This notice may
              not reflect the charges as they were
              originally submitted.
      31.11 = The previous notice we sent stated that
              your doctor could not charge more than
              ($______). This additional payment
              allows your doctor to bill you the full
              amount charged.
      31.12 = The previous notice we sent stated the
              amount you could be charged for this
              service. This additional payment changed
              that amount. Your doctor cannot charge
              you more than ($______).
      31.13 = The Medicare paid amount has been reduced
              by ($______) previously paid for this
              claim.
      31.14 = This payment is the result of an
              Administrative Law Judge's decision.
      31.15 = An adjustment was made based on a
              redetermination.
      31.16 = An adjustment was made based on a
              reconsideration.
      31.17 = This is an internal adjustment.  No
              action is required on your part.
      31.18 = This adjustment has resulted in an
              overpayment to your provide/supplier.
              Your provider/supplier has been requested
              to repay $________ to Medicare. You do
              not have to pay this amount.
      31.19 = If you do not agree with the Medicare
              approved amount(s), you may ask for a
              reconsideration. You must request a
              reconsideration within 180 days of the
              date of receipt of this notice. You may
              present any new evidence which could
              affect your decision. Call us at the
              number in the Customer Service block if
              you need more information about the
              reconsideration process.
              This message should be revised to read,
              "If you disagree with the Medicare-
              approved amount, you may ask for a
              redetermination within 120 days of
              receipt of this notice. Call
              1-800-MEDICARE if you need information
              on the redetermination process." when
              your MAC implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes" colums. ----->
      31.2  = A payment adjustment was made based on a
              telephone review.
      31.3  = This notice is being sent to you as the
              result of a reopening request.
      31.4  = This notice is being sent to you as the
              result of a fair hearing request.
      31.5  = If you do not agree with the Medicare
              approved amount(s) and $100 or more is
              in dispute (less deductible and
              coinsurance), you may ask for a hearing.
              You must request a hearing within 6
              months of the date of this notice. To
              meet the limit you may combine amounts
              on other claims that have been reviewed.
              At the hearing, you may present any new
              evidence which could affect the decision.
              Call us at the number in the Customer
              Service block if you need more
              information about the hearing process.
      31.6  = A payment adjustment was made based on a
              Quality Improvement Organization request.
      31.7  = This claim was previously processed under
              an incorrect Medicare claim number or
              name. Our records have been corrected.
      31.8  = This claim was adjusted to reflect the
              correct provider.
      31.9  = This claim was adjusted because there
              was an error in billing.
      31.95 = Per our telephone call, no payment can be
              made on your review request. The approved
              amount is the total allowance we can make
              for this service.
      31.96 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not separately pay for these charges
              because the cost of related care before
              and after the surgery/procedure is part
              of the approved amount for the surgery/
              procedure.
      31.97 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not pay for this many services
              within this period of time.
      31.98 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not pay for routine foot care.
      31.99 = As a result of the Hearing Officer's
              decision, no additional payment can be
              made.

      Section  Overpayments/Offsets	
      32.1  = ($______) of this payment has been
              withheld to recover a previous
              overpayment.
      32.2  = You should not be billed separately by
              your physician(s) for services provided
              during this inpatient stay.
      32.3  = Medicare has paid $_______ for hospital
              and doctor services. You shouldn't be
              billed separately by your doctor(s) for
              services you got during this inpatient
              stay.

      Section 33 Ambulatory Surgical Centers	
      33.1  = The ambulatory surgical center must bill
              for this service.

      Section 34 Patient Paid/Split Payments	
      34.1  = Of the total ($______) paid on this claim
              , we are paying you ($______) because
              you paid your provider more than your
              20% coinsurance on Medicare approved
              services. The remaining ($______) was
              paid to the provider.
      34.2  = The amount in the "You May Be Billed"
              column has been reduced by the amount
              you paid the provider at the time the
              services were rendered.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes" columns. ------>
      34.3  = After applying Medicare guidelines and
              the amount you paid to the provider at
              the time the services were rendered, our
              records indicate you are entitled to a
              refund. Please contact your provider.
      34.4  = We are paying you ($______) because the
              amount you paid the provider was more
              than you may be billed for Medicare
              approved charges.
      34.5  = The amount owed you is ($______).
              Medicare does not routinely issue checks
              for amounts under $1.00. This amount due
              will be included in your next check.
              If you want this money issued immediately
              , please contact us at the address or
              phone number in the Customer Service
              Information box.
              The last sentence of this message should
              be revised to read, "If you want this
              money issued immediately, please call
              1-800-MEDICARE (1-800-633-4227)." when
              your MAC implements the new MSN design.
               See "Message Implementation Date" and
               Message Notes" columns.
      34.6  = Your check includes ($_____) which was
              withheld on a prior claim.
      34.7  = This check includes an amount less than
              $1.00 that was withheld on a prior claim.
      34.8  = The amount you paid the provider for this
              claim was more than the required payment.
              You should be receiving a refund of
              ($_____) from your provider, which is
              the difference between what you paid and
              what you should have paid.
      34.9  = If you already paid the supplier/provider
              , the supplier/provider must refund any
              amount that exceeds the Medicare approved
              amount.

      Section 35 Supplemental Coverage/Medigap
      35.1  = This information is being sent to your
              private insurer(s). Send any questions
              regarding your benefits to them.
      35.2  = We have sent your claim to your Medigap
              insurer. Send any questions regarding
              your benefits to them.
      35.3  = A copy of this notice will not be
              forwarded to your Medigap insurer because
              the Medigap information submitted on the
              claim was incomplete or invalid. Please
              submit a copy of this notice to your
              Medigap insurer.
      35.4  = A copy of this notice will not be
              forwarded to your Medigap insurer because
              your provider does not participate in the
              Medicare program. Please submit a copy
              of this notice to your Medigap insurer.
      35.5  = We did not send this claim to your
              private insurer. They have indicated no
              additional payment can be made. Send any
              questions regarding your benefits to them
      35.6  = Your supplemental policy is not a Medigap
              policy under Federal and State law or
              regulation. It is your responsibility to
              file a claim directly with your insurer.
      35.7  = Please do not submit this notice to them
              (add-on to other messages as appropriate).

      Section 36 Limitation of Liability
      36.1  = Our records show that you were informed
              in writing, before receiving the service
              that Medicare would not pay. You are
              liable for this charge. If you do not
              agree with this statement, you may ask
              for a review.
      36.2  = You didn't know this service isn't
              covered so you don't have to pay. If you
              paid and do not receive a refund from
              your provider, you have 6 months to send
              a copy of this notice, your provider's
              bill, and proof that you paid to the
              address on the last page of this notice.
              Future services of this type won't be
              paid.
      36.3  = Your provider was told that you're owed
              a refund for this service. If you don't
              get a refund within 30 days of getting
              this notice, send a copy of this notice
              to the address on the last page. Refunds
              may be delayed if your provider appeals
              this decision.
      36.4  = You are getting a refund because your
              provider didn't tell you in writing that
              Medicare wouldn't pay for this service.
              In the future, you will have to pay for
              the service.
      36.5  = You are getting a refund because your
              provider didn't tell you in writing that
              Medicare would approve a reduced level/
              amount of services. In the future, you
              will have to pay for the service.
      36.6  = Medicare is paying this claim, this time
              only, because it appears that neither you
              nor the provider knew that the service(s)
              would be denied. You will have to pay for
              future services of this type.
      36.7  = This code is for informational/reporting
              purposes only. You should not be charged
              for this code. If there is a charge, you
              do not have to pay the amount.

      Section 37 Deductible/Coinsurance
      37.1  = This approved amount has been applied
              toward your deductible.
      37.10 = You have now met ($______) of your
              ($______) Part A deductible for this
              benefit period.
      37.11 = You have met the Part B deductible for
              (year).
      37.12 = You have met the Part A deductible for
              this benefit period.
      37.13 = You have met the blood deductible for
              (year).
      37.14 = You have met ($______) pint(s) of your
              blood deductible for (year).
      37.15 = After your deductible and coinsurance
              were applied, the amount Medicare paid
              was reduced due to Federal, State and
              local rules.
      37.16 = You have now met $_______ of your
              $_______ Part B deductible for calendar
              year ____.
      37.17 = The "Maximum You May Be Billed" column
              includes $_______ for your Part B
              deductible, $_______ for your Part B
              coinsurance, $_______ for your Part A
              deductible, and $_______ for your Part A
              coinsurance and/or lifetime reserve
              coinsurance.
              *If your MAC will implement the new MSN
              design AFTER 07/01/13, use the following
              language for this message from 07/01/13
              until your MAC DOES implement the new MSN
              design: The "You May Be Billed" column
              includes $_______ for your Part B
              deductible, $_______ for your Part B
              coinsurance, $_______ for your Part A
              deductible, and $_______ for your Part A
              coinsurance and/or lifetime reserve
              coinsurance.
      37.2  = ($______) of this approved amount has
              been applied toward your deductible.
      37.3  = ($______) was applied to your inpatient
              deductible.
      37.4  = ($______) was applied to your inpatient
              coinsurance.
      37.5  = ($______) was applied to your skilled
              nursing facility coinsurance.
      37.6  = ($______) was applied to your blood
              deductible.
      37.7  = Part B cash deductible does not apply to
              these services.
      37.8  = This coinsurance amount reflects the
              amount that you are required to pay for
              outpatient mental health treatment
              services under the Medicare program.
      37.9  = You have now met ($______) of your
              ($______) Part B deductible for (year).

      Section 38 General Information	
      38.1  = Discontinued 2002
      38.10 = Compare the services you receive with
              those that appear on your Medicare
              Summary Notice. If you have questions,
              call your doctor or provider. If you feel
              further investigation is needed due to
              possible fraud or abuse, call the phone
              number in the Customer Service
              Information Box.
              The last sentence of this message should
              be revised to read, "If you feel further
              investigation is needed due to possible
              fraud or abuse, call 1-800-MEDICARE
              (1-800-633-4227)." when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              Message Notes" columns. ----->
      38.11 = Preventive Messages:

              January - Cervical Health

              January is cervical health month. The
              Pap test is the most effective way to
              screen for cervical cancer. Medicare
              helps pay for screening Pap tests every
              two years. For more information on Pap
              tests, call your Medicare carrier.

              January - National Glaucoma Awareness
              Month (Optional)
              Glaucoma may cause blindness. Medicare
              helps pay for a yearly dilated eye exam
              for people at high risk for Glaucoma.
              African-Americans over 50 and people with
              diabetes or a family history of glaucoma
              are at higher risk. Talk to your doctor
              to learn if this exam is right for you.

              February - General Preventive Services
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              March - National Colorectal Cancer
              Awareness Month
              Colorectal cancer is the second leading
              cancer killer in the United States.
              Medicare helps pay for colorectal cancer
              screening tests. Talk to your doctor
              about screening options that are right
              for you.

              April - General Preventive Services
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              May - National Osteoporosis Month
              Do you know how strong your bones are?
              Medicare helps pay for bone mass
              measurement tests to measure the strength
              of bones for people at risk of
              osteoporosis. Talk to your doctor to
              learn if this test is right for you.

              May - Breast Cancer Awareness (to
              coordinate with Mother's Day) - Optional
              Early detection is the best protection
              from breast cancer. Get a mammogram.
              Not just once, but for a lifetime.
              Medicare helps pay for screening
              mammograms.

              June - General Preventive Services
              Message:
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              July- Glaucoma Awareness
              Glaucoma may cause blindness. Medicare
              helps pay for a yearly dilated eye exam
              for people at high risk for Glaucoma.
              African-American people over 50, and
              people with diabetes or a family history
              of glaucoma are at higher risk. Talk to
              your doctor to learn if this exam is
              right for you.

              August - National Immunization Awareness
              Month (Contractors may elect to print
              this message during a different month of
              their choosing, but the message about
              the pneumococcal shot must be printed one
              month of each year.)
              Get a pneumococcal shot. You may only
              need it once in a lifetime. Contact your
              health care provider about getting this
              shot. You pay nothing if your health
              care provider accepts Medicare assignment
              	
              September - Cold and Flu Campaign
              During this flu season, get your flu shot
              . Contact your health care provider for
              the flu shot. Get the flu shot, not the
              flu. You pay nothing if your health care
              provider accepts Medicare assignment.

              September - Prostate Cancer Awareness
              Month - Optional
              Prostate cancer is the second leading
              cause of cancer deaths in men. Medicare
              covers prostate screening tests once
              every 12 months for men with Medicare who
              are over age 50.

              October - Breast Cancer Awareness Month
              Early detection is your best protection.
              Schedule your mammogram today, and
              remember that Medicare helps pay for
              screening mammograms.

              October - Continuation of Cold/Flu
              Campaign (optional)
              If you have not received your flu shot,
              it is not too late. Please contact your
              health care provider about getting the
              flu shot.

              November - American Diabetes Month
              Medicare covers expanded benefits to help
              control diabetes

      Section 38 General Information
      38.12 = If you appeal this drug claim
              determination, send it to the Medicare
              contractor who processed your doctor's
              claim for giving you the drug.
      38.13 = If you aren't due a payment check from
              Medicare, your Medicare Summary Notices
              (MSN) will now be mailed to you on a
              quarterly basis. You will no longer get
              a monthly statement in the mail for these
              types of MSNs. You will now get a
              statement every 90 days summarizing all
              of your Medicare claims. Your provider
              may send you a bill that you may need to
              pay before you get your MSN. When you
              get your MSN, look to see if you paid
              more than the MSN says is due. If you
              paid more, call your provider about a
              refund. If you have any questions about
              the bill from your provider, you should
              call your provider.
      38.14 = Have limited income?  Social Security
              can help with prescription drug costs.
              For more information on Extra Help with
              prescription drug costs and how to apply,
              visit www.socialsecurity.gov on the web
              or call 1-800-772-1213. TTY users should
              call 1-800-325-0778.
      38.15 = If the coinsurance amount you paid is
              more than the amount shown on your notice
              , you are entitled to a refund. Please
              contact your provider.
      38.18 = ALERT:  Coverage by Medicare will be
              limited for outpatient physical therapy
              (PT), speech-language pathology (SLP),
              and occupational therapy (OT) services
              for services received on January 1, 2006
              through December 31, 2007. The limits are
              $1,740 in 2006 and $1780 in 2007 for PT
              and SLP combined and $1,740 in 2006 and
              $1780 in 2007 for OT. Medicare pays up
              to 80 percent of the limits after the
              deductible has been met. These limits
              don't apply to certain therapy approved
              by Medicare or to therapy you get at
              hospital outpatient departments, unless
              you are a resident of and occupy a
              Medicare-certified bed in a skilled
              nursing facility. If you have questions,
              please call 1-800-MEDICARE.
              You have the right to request an itemized
              statement which details each Medicare
              item or service which you have received
              from your physician, hospital, or any
              other health supplier or health
              professional. Please contact them
              directly, in writing, if you would like
              an itemized statement.
              Beneficiaries needing or receiving home
              health care may qualify for the new Home
              Health Independence Demonstration and
              have the freedom to leave home more often
              while remaining eligible for Medicare
              home health services. To qualify, you
              must meet several criteria, have a
              permanent disabling condition, and live
              in Colorado, Massachusetts, or Missouri.
              For more information, ask your home
              health agency about the "Home Health
              Independence Demonstration"; call 1(800)
              MEDICARE (1-800-633-4227); or visit our
              website at: www.cms.hhs.gov/researchers/
              demos/homehealthindependence.asp
      38.18 = ALERT:  Coverage by Medicare will be
              limited for outpatient physical therapy
              (PT), speech-language pathology (SLP),
              and occupational therapy (OT) services
              for services received on January 1, 2006
              through December 31, 2007. The limits are
              $1,740 in 2006 and $1780 in 2007 for PT
              and SLP combined and $1,740 in 2006 and
              $1780 in 2007 for OT. Medicare pays up
              to 80 percent of the limits after the
              deductible has been met. These limits
              don't apply to certain therapy approved
              by Medicare or to therapy you get at
              hospital outpatient departments, unless
              you are a resident of and occupy a
              Medicare-certified bed in a skilled
              nursing facility. If you have questions,
              please call 1-800-MEDICARE.
      38.19 = Medicare Open Enrollment is from October
              15 to December 7. This is when you can
              compare and change your health and drug
              plan coverage. If you're happy with your
              current plan, you don't have to do
              anything. Call 1-800-MEDICARE (1 800-633-
              4227) for more information.
      38.2  = Discontinued
      38.20 = You have the right to request an itemized
              statement which details each Medicare
              item or service you have received from a
              physician, hospital, or any other
              healthcare provider or supplier. Contact
              your provider to get an itemized
              statement.
      38.22 = Planning to retire? Does your current
              insurance pay before Medicare pays? Call
              Medicare within the 6 months before you
              retire to update your records. Make sure
              your health care bills get paid correctly
      38.23 = Save tax dollars by getting your
              "Medicare & You" handbook electronically.
              Visit www.mymedicare.gov to sign up.
      38.24 = Please have your complete Medicare number
              with you when you call so your record
              can be located. To protect your privacy,
              this MSN doesn't include your entire
              number.
      38.25 = This item or service is being denied.
              Medicare won't pay for a Medical
              Nutrition Therapy service and Diabetes
              Self Management Training item or service
              performed on the same date for the same
              person with Medicare.
      38.26 = Your claims may have been adjusted since
              Medicare changed how it pays for certain
              services in 2010. You can compare claims
              that have been changed to previous
              statements you received in the past.
              Your provider may owe you a refund or
              you may have to pay more coinsurance.
              Call your provider or 1-800-MEDICARE.
      38.27 = Get a pneumococcal shot. You may only
              need it once in a lifetime. Contact your
              health care provider about getting this
              shot. You pay nothing if your health
              care provider accepts Medicare assignment
      38.28 = Early detection is your best protection.
              Schedule your mammogram today, and
              remember that Medicare helps pay for
              screening mammograms.
      38.3  = If you change your address, contact the
              Social Security Administration by calling
              1-800-772-1213.
      38.31 = To report a change of address, call
              Social Security at 1-800-772-1213. TTY
              users should call 1-800-325-0778.
      38.32 = Welcome to your new Medicare Summary
              Notice! It has clear language, larger
              print, and a personal summary of your
              claims and deductibles. This improved
              notice better explains how to get help
              with your questions, report fraud, or
              file an appeal. It also includes
              important information from Medicare!
      38.4  = You're at high risk for complications
              from the flu and it's very important
              that you get vaccinated. Please contact
              your healthcare provider about getting
              the flu vaccine.
      38.5  = If you haven't gotten your flu vaccine,
              it isn't too late. Please contact your
              health care provider about getting the
              vaccine.
      38.6  = January is cervical cancer prevention
              month.
      38.7  = The Pap test is the most effective way
              to screen for cervical cancer.
      38.8  = Medicare helps pay for screening Pap
              tests once every two years.
      38.9  = Colorectal cancer is the second leading
              cancer killer in the United States.
              Medicare helps pay for screening tests
              that can find polyps before they become
              cancerous and find cancer early when
              treatment may work best. Medicare helps
              pay for screening tests. Talk to your
              doctor about the screening options that
              are right for you.

      Section 4 End-Stage Renal Disease (ESRD)
      4.1   = This charge is more than Medicare pays
              for maintenance treatment of renal
              disease.
      4.10  = No more than ($______) can be paid for
              these supplies each month.
      4.11  = The amount listed in the "You May Be
              Billed" column is based on the Medicare
              approved amount. You are not responsible
              for the difference between the amount
              charged and the approved amount.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
      4.12  = This service has been denied/rejected
              since payment was made to your End Stage
              Renal Disease (ESRD) dialysis facility.
      4.18  = Medicare cannot pay more than $_____ each
              month for these supplies. The provider
              cannot bill you for the supplies over
              this limit.
      4.2   = This service is covered up to (insert
              appropriate number) months after
              transplant and release from the
              hospital.
      4.3   = Prescriptions for immunosuppressive drugs
              are limited to a 30-day supply.
      4.4   = Only one supplier per month may be paid
              for these supplies/services.
      4.5   = Medicare pays the professional part of
              this charge to the hospital.
      4.6   = Payment has been reduced by the number
              of days you were not in the usual place
              of treatment.
      4.7   = Payment for all equipment and supplies
              is made through your dialysis center.
              They will bill Medicare for these
              services.
      4.8   = This service cannot be paid because you
              did not choose an option for your
              dialysis equipment and supplies.
      4.9   = Payment was reduced or denied because the
              monthly maximum allowance for this home
              dialysis equipment and supplies has been
              reached.

      Section 41 Home Health Messages
      41.1  = Medicare will only pay for this service
              when it is provided in addition to other
              services.
      41.10 = Patients eligible to receive home health
              benefits from another government agency
              are not eligible to receive Medicare
              benefits for the same service.
      41.11 = The doctor's orders for home health
              services were incomplete.
      41.12 = According to the medical record, the
              provider has billed in error for these
              items/services.
      41.13 = The provider has billed for services/
              items not documented in your record.
      41.14 = This service/item was billed incorrectly.
      41.15 = The information provided indicates that
              you are able to perform personal care
              activities on your own.
      41.16 = To receive Medicare payment, you must
              have a signed doctor's order before you
              receive the services.
      41.2  = This service must be performed by a nurse
              who has the required psychiatric nurse
              credentials.
      41.3  = The medical information did not support
              the need for continued services.
      41.4  = Medicare considers this item to be
              inappropriate for home use.
      41.5  = Medicare does not pay for comfort or
              convenience items.
      41.6  = This item was not furnished under a plan
              of care established by your physician.
      41.7  = This item is not considered by Medicare
              to be a prosthetic and/or orthotic device
      41.8  = The information provided indicates that
              your illness or injury doesn't restrict
              your ability to leave your home, except
              with the assistance of another individual
              or the aid of a supportive device (such
              as crutches, a cane, a wheelchair, or a
              walker).
      41.9  = Services exceeded those ordered by your
              physician.

      Section 42 Religious Nonmedical Health Care
      Institutions
      42.1  = You received medical care at a facility
              other than a religious nonmedical health
              care institution but that care did not
              revoke your election to receive benefits
              for religious nonmedical health care.
      42.2  = Since you received medical care at a
              facility other than a religious
              nonmedical health care institution,
              benefits for religious nonmedical health
              care services have been revoked for these
              services unless you file a new election.
      42.3  = This service is not covered since you did
              not elect to receive religious
              nonmedical health care services instead
              of regular Medicare services.
      42.4  = This service is not covered because you
              received medical health care services
              which revoked your election to religious
              nonmedical health care services.
      42.5  = This service is not covered because you
              requested in writing that your election
              to religious nonmedical health care
              services be revoked.

      Section 5 Number/Name/Enrollment
      5.1   = Our records show that you do not have
              Medicare entitlement under the number
              shown on this notice. If you do not
              agree, please contact your local Social
              Security office.
      5.2   = The name or Medicare number was incorrect
              or missing. Please check your Medicare
              card. If the information on this notice
              is different from your card, contact your
              provider.
      5.3   = Our records show that the date of death
              was before the date of service.
      5.4   = If you cash the enclosed check, you are
              legally obligated to make payment for
              these services. If you do not wish to
              assume this obligation, please return
              this check.
      5.5   = Our records show you did not have Part A
              (B) coverage when you received this
              service. If you disagree, please contact
              us at the customer service number shown
              on this notice.
      5.6   = The name or Medicare number was incorrect
              or missing. Ask your provider to use the
              name or number shown on this notice for
              future claims.
      5.7   = Medicare payment may not be made for the
              item or service because on the date of
              service you were not lawfully present in
              the United States.

      Section 6 Drugs	
      6.1   = This drug is covered only when Medicare
              pays for the transplant.
      6.2   = Drugs not specifically classified as
              effective by the Food and Drug
              Administration are not covered.
      6.3   = Payment cannot be made for oral drugs
              that do not have the same active
              ingredients as they would have if given
              by injection.
      6.4   = Medicare does not pay for an oral
              anti-emetic drug that is not administered
              for use immediately before, at, or within
              48 hours after administration of a
              Medicare covered chemotherapy drug.
      6.5   = Medicare cannot pay for this injection
              because one or more requirements for
              coverage were not met.

      Section 43 Demonstration Project Messages
      60.1  = In partnership with physicians in your
              area, ____________ is participating in a
              Medicare demonstration project that uses
              a simplified payment method to combine
              all hospital and physician care related
              to your hospital service.
      2/18/13= Even though this service is being paid
              in accordance with the rules and
              guidelines under the Competitive Bidding
              Demonstration, future claims may be
              denied when this item is provided to this
              patient by a non-demonstration supplier.
              If you would like more information
              egarding this project, you may contact
              1-888-289-0710.
      60.11 = These services are covered by a
              demonstration project or payment model
              pilot. It will pay for all services
              related to this hospital stay. If you
              have already paid a provider for any of
              these services, you should receive a
              refund.
      60.12 = Your co-payment under this demonstration
              is the lesser of 20% of the Medicare
              allowed amount or 20% of the allowed
              amount under your drug discount card.
      60.13 = This claim is being processed under a
              demonstration project. Services cannot
              be covered because you do not reside in
              one of the demonstration areas.
      60.14 = This claim is being processed under a
              demonstration project. Services cannot
              be covered because your doctor does not
              have a practice in one of the
              demonstration areas.
      60.15 = Beginning April 1, 2005 through March 31,
              2007, Medicare will cover additional
              chiropractic services. For more
              information, talk to your chiropractor,
              call 1-800-MEDICARE, or go to
              http://www.cms.hhs.gov/researchers/demos
              /eccs/default.asp.
      60.16 = This claim is being processed under a
              demonstration or payment model pilot.
              All hospital and doctor services related
              to your hospital stay have been combined
              into a single payment. You may have to
              pay any unmet deductible and coinsurance
              amounts.
      60.2  = The total Medicare approved amount for
              your hospital service is ($______).
              ($______) is the Part A Medicare amount
              for hospital services and ($_______) is
              the Part B Medicare amount for physician
              services (of which Medicare pays 80
              percent). You are responsible for any
              deductible and coinsurance amounts
              represented.
      60.3  = Medicare has paid ($______) for hospital
              and physician services. Your Part A
              deductible is ($______). Your Part A
              coinsurance is ($______) Your Part B
              coinsurance is ($______).
      60.4  = This claim is being processed under a
              demonstration project.
      60.5  = This claim is being processed under a
              demonstration project. If you would like
              more information about this project,
              please contact 1-888-289-0710.
      60.6  = A claim has been submitted on your behalf
              indicating that you are participating in
              the Medicare Coordinated Care
              Demonstration project. However, our
              records indicate that you are not
              currently enrolled or your enrollment
              has not yet been approved for the
              demonstration.
      60.7  = A claim has been submitted on your behalf
              indicating that you are participating in
              the Medicare Coordinated Care
              Demonstration project. However, our
              records indicate that either you have
              terminated your election to participate
              in the demonstration project or the dates
              of service are outside the demonstration
              participation dates.
      60.8  = The approved amount is based on the
              maximum allowance for this item under the
              DMEPOS Competitive Bidding Demonstration.
      60.9  = Our records indicate that this patient
              began using this service(s) prior to the
              current round of the DMEPOS Competitive
              Bidding Demonstration. Therefore, the
              approved amount is based on the allowance
              in effect prior to this round of bidding
              for this item.

      Section 7 Duplicate Bills
      7.1   = This is a duplicate of a charge already
              submitted.
      7.15  = Medicare records show that payment for
              this service has already been made by
              another contractor.
      7.2   = This is a duplicate of a claim processed
              by another contractor. You should
              receive a Medicare Summary Notice from
              them.
      7.3   = This service/item is a duplicate of a
              previously processed service. You may
              only appeal the decision that this
              service/item is a duplicate. The appeals
              information on this notice only applies
              to the duplicate service issue.
      7.4   = The claim for the billing fee was denied
              because it was submitted past the allowed
              time frame.
      7.7   = Your physician has elected to participate
              in the Competitive Acquisition Program
              for these drugs. Claims for these drugs
              must be billed by the appropriate drug
              vendor instead of your physician.
      7.8   = Your physician has elected to participate
              in the Competitive Acquisition Program
              (CAP) for Medicare Part B drugs. Medicare
              cannot pay for the administration of the
              drug(s) being billed because these
              drug(s) are not available from the CAP
              vendor.

      Section 8 Durable Medical Equipment (DME)
      8.1   = Your supplier is responsible for the
              servicing and repair of your rented
              equipment.
      8.2   = To receive Medicare payment, you must
              have a doctor's prescription before you
              rent or purchase this equipment.
      8.10  = Payment is included in the approved
              amount for other equipment.
      8.11  = The purchase allowance has been reached.
              If you continue to rent this piece of
              equipment, the rental charges are your
              responsibility.
      8.12  = The approved charge is based on the
              amount of oxygen prescribed by the doctor
      8.13  = Monthly rental payments can be made for
              up to 15 months from the first paid
              rental month or until the equipment is
              no longer needed, whichever comes first.
      8.14  = Your equipment supplier must furnish and
              service this item for as long as you
              continue to need it. Medicare will pay
              for maintenance and/or servicing for
              every 6 month period after the end of
              the 15th paid rental month.
      8.15  = Maintenance and/or servicing of this item
              is not covered until 6 months after the
              end of the 15th paid rental month.
      8.16  = Monthly allowance includes payment for
              oxygen and supplies.
      8.17  = Payment for this item is included in the
              monthly rental payment amount.
      8.18  = Payment is denied because the supplier
              did not have a written order from your
              doctor prior to delivery of this item.
      8.19  = Sales tax is included in the approved
              amount for this item.
      8.2   = To receive Medicare payment, you must
              have a doctor's prescription before you
              rent or purchase this equipment.
      8.20  = Medicare does not pay for this equipment
              or item.
      8.21  = Medicare won't cover this item without a
              new, revised or renewed certificate of
              medical necessity.
      8.22  = No further payment can be made because
              the cost of repairs has added up to the
              purchase price of this item.
      8.23  = No payment can be made because the item
              has reached the 15-month limit.
              Separate payments can be made for
              maintenance or servicing every 6 months.
      8.24  = The claim doesn't show that you own the
              equipment requiring these parts or
              supplies.
      8.25  = Payment cannot be made until you tell
              your supplier whether you want to rent
              or buy this equipment.
      8.26  = Payment is reduced by 25% beginning the
              4th month of rental.
      8.27  = Payment is limited to 13 monthly rental
              payments because you have decided to
              purchase this equipment.
      8.28  = Maintenance, servicing, replacement, or
              repair of this item is not covered.
      8.29  = Payment is allowed only for the seat lift
              mechanism, not the entire chair.
      8.3   = This equipment is not covered because its
              primary use is not for medical purposes.
      8.30  = This item is not covered because the
              doctor did not complete the certificate
              of medical necessity.
      8.31  = Payment is denied because blood gas tests
              cannot be performed by a durable medical
              equipment supplier.
      8.32  = This item can only be rented for 2 months
              . If the item is still needed, it must
              be purchased.
      8.33  = This is the next to last payment for this
              item.
      8.34  = This is the last payment for this item.
      8.35  = This item is not covered when oxygen is
              not being used.
      8.36  = Payment is denied because the certificate
              of medical necessity on file was not in
              effect for this date of service.
      8.37  = An oxygen recertification form was sent
              to the physician.
      8.38  = This item must be rented for 2 months
              before purchasing it.
      8.39  = This is the 10th month of rental payment.
              Your supplier should offer you the choice
              of changing the rental to a purchase
              agreement.
      8.4   = Payment can't be made for equipment
              that's the same or similar to equipment
              already being used.
      8.40  = We have previously paid for the purchase
              of this item.
      8.41  = Payment for the amount of oxygen supplied
              has been reduced or denied because the
              monthly limit has been reached.
      8.42  = Standby equipment is not covered.
      8.43  = Payment has been denied because this
              equipment cannot deliver the liters per
              minute prescribed by your doctor.
      8.44  = Payment is based on a standard item
              because information did not support the
              need for a deluxe or more expensive item.
      8.45  = Payment for electric wheelchairs is
              allowed only if the purchase decision is
              made in the first or tenth month of
              rental.
      8.46  = Payment is included in the allowance for
              another item or service provided at the
              same time.
      8.47  = Supplies or accessories used with
              noncovered equipment are not covered.
      8.48  = Payment for this drug is denied because
              the need for the equipment has not been
              established.
      8.49  = This allowance has been reduced because
              part of this item was paid on another
              claim.
      8.5   = Rented equipment that is no longer needed
              or used is not covered.
      8.50  = Medicare can't pay for this drug/
              equipment because our records show that
              your supplier isn't licensed to dispense
              prescription drugs, and, therefore, can't
              assure the safety and effectiveness of
              the drug/equipment.
      8.51  = You are not liable for any additional
              charge as a result of receiving an
              upgraded item.
      8.52  = You signed an Advanced Beneficiary Notice
              (ABN). You are responsible for the
              difference between the upgrade amount and
              the Medicare payment.
      8.53  = This item or service was denied because
              the upgrade information was invalid.
      8.54  = If a supplier knew that Medicare wouldn't
              pay and you paid, you might get a refund
              unless you signed a notice in advance.
              Refunds may be delayed if the provider
              appeals. Call your supplier if you don't
              hear anything within 30 days.
      8.55  = Medicare will process your first claim
              but, from now on, you must use a
              Medicare-enrolled supplier and put the
              supplier ID number on your claim. For a
              list of Medicare-enrolled suppliers call
              1-800-MEDICARE or visit www.medicare.gov/
              supplier
      8.56  = Medicare can't process this claim because
              you were already notified that you must
              use a supplier who has a Medicare
              supplier identification number, and this
              supplier doesn't have one.
      8.57  = Your equipment supplier must furnish and
              service this item for as long as you
              continue to need it. Medicare will pay
              for maintenance and/or servicing for
              every 3-month period after the end of
              the 15th paid rental month.
      8.58  = No payment can be made because the item
              has reached the 15-month limit. Separate
              payments can be made for maintenance or
              servicing every 3 months.
      8.59  = Durable Medical Equipment Regional
              Carriers only pay for Epoetin Alfa and
              Darbepoetin Alfa for Method II End Stage
              Renal Disease home dialysis patients.
      8.6   = A partial payment has been made because
              the purchase allowance has been reached.
              No further rental payments can be made.
      8.60  = Payment is denied because there is no
              hospital stay/surgery on file for
              implantation of the Durable Medical
              Equipment (DME) or prosthetic device.
      8.61  = This supplier isn't located in your
              competitive bidding area, but is required
              to accept the same price as a supplier
              in your area. This supplier may not
              charge you more than 20% of the bid price
              , plus any unmet deductibles.
      8.62  = This supplier didn't win a contract for
              furnishing this item in the competitive
              bidding area where you received it. This
              supplier isn't allowed to charge you for
              this item unless you signed a written
              notice agreeing to pay before you got
              the item.
      8.63  = This supplier isn't located in your
              competitive bidding area, but is located
              in a different competitive bidding area.
              This supplier won a contract under
              national competitive bidding in their
              area. They must accept the bid price from
              your area as payment in full, and may not
              charge you more than 20% of the bid
              price for your area, plus any unmet
              deductibles.
      8.64  = Monthly payments can be made for 13
              months, or until the equipment is no
              longer needed, whichever comes first.
              After the 13th month, your supplier must
              transfer title of this equipment to you.
      8.65  = Medicare will pay for medically necessary
              maintenance and/or servicing as needed
              after the end of the 13th paid rental
              month.
      8.66  = Medicare has paid for 36 months of rental
              for your oxygen equipment. Your supplier
              must transfer title of this equipment to
              you. No further rental payments will be
              made. We will continue to pay for
              delivery of oxygen contents, as
              appropriate, and necessary maintenance of
              your equipment.
      8.67  = Medicare has already paid for 36 months
              of rental for your oxygen equipment. The
              supplier should have transferred the
              title for the equipment to you. The
              supplier may not collect any more money
              from you for this equipment, and must
              provide you with a refund of any money
              you have already paid.
      8.68  = Medicare will pay for you to rent oxygen
              for up to 36 months (or until you no
              longer need the equipment). After
              Medicare makes 36 payments, your supplier
              will transfer the title of the equipment
              to you, and you will own the equipment.
      8.69  = Medicare will pay to maintain and service
              your oxygen equipment. This will start
              six months after the supplier transfers
              the title of the equipment to you.
      8.7   = This equipment is covered only if rented.
      8.70  = The Medicare-approved amount is based on
              the bid price for this item under the
              DMEPOS competitive bidding program.
      8.71  = Our records show that you began using
              this item before the current round of
              competitive bidding and you decided to
              keep getting this item from your current
              supplier. The Medicare-approved amount
              is based on the bid price for this item.
      8.72  = This item must be provided by a contract
              supplier under the DMEPOS competitive
              bidding program. You should not be billed
              for this item or service. You do not have
              to pay this amount. There are no Medicare
              appeal rights related to this item.	
      8.73  = The claim for this service was processed
              according to rules of the DMEPOS
              competitive bidding program.
      8.74  = You signed an Advanced Beneficiary Notice
              (ABN) saying that you wanted to get this
              item from a non-winning supplier under
              the DMEPOS Competitive Bidding Program.
              Therefore, Medicare will not pay for this
              item. You must pay the supplier in full.
      8.75  = Our records show that you began using
              this item before competitive bidding
              started for this item in your area.
              Because you decided to keep getting this
              item from your current supplier, this
              item will be paid at the standard payment
              amount and not at the bid price.
      8.76  = This item or service is not covered
              because the claim shows that it was not
              given in a skilled nursing facility or a
              nursing facility. The claim for this item
              or service was processed according to the
              rules of the DMEPOS competitive bidding
              program.
      8.78  = Medicare has paid for 36 months for your
              oxygen equipment. Your supplier is
              required to provide the oxygen equipment
              and related supplies, at no charge, for
              the remainder of the equipment's 5 year
              lifetime.
      8.79  = Medicare has paid 36 months of rental for
              your oxygen equipment. The supplier may
              not collect any more money from you for
              this equipment, and must refund any money
              you have already paid.
      8.8   = This equipment is covered only if
              purchased.
      8.80  = Medicare will pay for rental of this
              equipment for 36 months (or until you no
              longer need the equipment). After 36
              months, Medicare will continue to pay for
              delivery of liquid or gaseous contents,
              as long as it is still medically
              necessary.
      8.81  = If the provider/supplier should have
              known that Medicare would not pay for the
              denied items or services and did not
              tell you in writing before providing them
              that Medicare probably would deny payment
              , you may be entitled to a refund of any
              amounts you paid. However, if the
              provider/supplier requests a review of
              this claim within 30 days, a refund is
              not required until we complete our review
              . If you paid for this service and do not
              hear anything about a refund within the
              next 30 days, contact your provider/
              supplier.
      8.9   = Payment has been reduced by the amount
              already paid for the rental of this
              equipment.
      8.90  = You live in a Competitive Bidding Area.
              This is a Competitive Bidding item.
              The Medicare approved amount is based on
              the bid price for this item under the
              DMEPOS competitive bidding program.
      8.91  = Our records show that you began using
              this item before the DMEPOS Competitive
              Bidding program began and you decided to
              keep renting this item from your current
              supplier. The Medicare-approved amount is
              based on the bid price for this item for
              the area where you live.
      8.92  = You live in a Competitive Bidding Area
              and this item must be provided by a
              Medicare-contract supplier under the
              DMEPOS competitive bidding program.
              Medicare won't pay for this item and you
              shouldn't be billed for this item or
              service. You don't have to pay this
              amount. Medicare appeal rights don't
              apply to this item.
      8.93  = Medicare only pays 36 monthly payments
              for your oxygen. After 36 months, the
              supplier is still responsible for
              providing you with that equipment for 5
              years. You shouldn't pay any more
              copayments.
      8.95  = Our records show that you began using
              this item before the DMEPOS Competitive
              Bidding program started for this item in
              your area. Because you decided to keep
              renting this item from your current
              supplier, this item will be paid at the
              standard payment amount and not at the
              bid price.
      8.96  = This item or service isn't covered
              because the claim shows that it wasn't
              provided in a skilled nursing facility or
              nursing facility. The claim for this item
              or service was processed according to the
              rules of the DMEPOS competitive bidding
              program.
      8.97  = Starting January 1, 2011, you may have to
              use certain Medicare-contracted suppliers
              to get certain medical equipment and
              supplies. Visit www.medicare.gov or call
              1-800-MEDICARE for details

      Section 9 Failure to Furnish Information
      9.1   = The information we requested was not
              received.
      9.2   = This item or service was denied because
              information required to make payment was
              missing.
      9.3   = Please ask your provider to submit a new,
              complete claim to us.
      9.4   = This item or service was denied because
              information required to make payment was
              incorrect.
      9.5   = Our records show your doctor did not
              order this supply or amount of supplies.
      9.6   = Please ask your provider to resubmit this
              claim with a breakdown of the charges or
              services.
      9.7   = We have asked your provider to resubmit
              the claim with the missing or correct
              information.
      9.8   = The hospital has been asked to submit
              additional information, you should not be
              billed at this time.
      9.9   = This service is not covered unless the
              supplier/provider files an electronic
              media claim (EMC).

      Section 96 Jurisdiction-Specific	
      96.10 = Go paperless, go green! If you live in
              CT or NY you can stop getting paper
              Medicare Summary Notices (MSNs) in the
              mail, and get Electronic MSNs (eMSNs)
              online instead. To sign up, go to
              www.mymedicare.gov or call 1-800-
              MEDICARE (1-800-633-4227).
              * See Message Notes ----------->

      Section 97 FISS Part A	
      97.xx = The entire range of 97.xx messages
              have been blocked off for FISS/Part A
              usage.

      Section 99 Florida-Specific	
      99.xx = The entire range of 99.xx messages have
              been blocked off for Florida usage.



 CLM_FREQ_TB                             Claim Frequency Table

       0 = Non-payment/zero claims
       1 = Admit thru discharge claim
       2 = Interim - first claim
       3 = Interim - continuing claim (not valid for
           PPS claims)
       4 = Interim - last claim (not valid for PPS claims)
       5 = Late charge(s) only claim
       6 = Reserved for national assignment; Adjustment of prior claim.
           Obsolete
       7 = Replacement of prior claim;
           eff 10/93, provider debit
       8 = Void/cancel prior claim
           eff 10/93, provider cancel
       9 = Final claim -- used in an HH PPS
           episode to indicate the claim
           should be processed like debit/
           credit adjustment to RAP (initial
           claim) (eff. 10/00)
       A = Admission election notice - used when hospice
           or Religious Nonmedical Health Care Institution
           is submitting the HCFA-1450 as an
           admission notice - hospice NOE only
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
           is reported on them.
       B = Hospice/Medicare Coordinated Care Demonstration/
           RNCHI - Termination/Revocation Notice - hospice
           NOE only  (eff 9/93)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
           is reported on them.
       C = Hospice change of provider notice
           - hospice NOE only (eff 9/93)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
       D = Hospice/Medicare Coordinated Care Demonstration/
           RNHCI - void/cancel
           -  hospice NOE only  (eff 9/93)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
       E = Hospice change of ownership
           - hospice NOE only  (eff 1/97)
           NOTE:  This value is not present in the NCH
           claims data because when they are used the
           transaction does not represent a claim.  This
           frequency code is used on hospice notices of
           election.  Their purpose is to create a hospice
           benefit period in CWF.  No paymentor utilization
       F = Beneficiary initiated adjustment claim
           (eff 10/93)
       G = CWF initiated adjustment claim (eff 10/93)
       H = CMS initiated adjustment claim (eff 10/93)
       I = Intermediary adjustment claim (other than PRO
           or provider) - used to identify a
           debit adjustment initiated by CMS or
           an intermediary (other than QIO or Provider)
           - eff 10/93, used to identify intermediary
           initiated adjustment only
       J = Other adjustment request (eff 10/93)
       K = OIG initiated adjustment (eff 10/93)
       M = MSP initiated adjustment (eff 10/93)
       N = Reserved for national assignment
       O = Nonpayment/Zero claims
       P = Adjustment required by Quality Improvement
           Organization (QIO) -- formerly Peer Review
           Organization (PRO)
       Q = Claim Submitted for Reconsideration Outside of
           Timely Limits
       X = Replacement of Prior Abbreviated Encounter Submission
           (used by Medicare Advantage contractor or other plan
           required to submit encounter data);
           Special adjustment processing - used for QA editing (eff 8/92)
           Obsolete
       Z = New Abbreviated Encounter Submission (TOB '11Z') used
           for MCO enrollee hospital discharges 7/1/97 - 12/31/98;
           not stored in the NCH.  Exception:  Problem in
           startup months may have resulted in this abbreviated
           UB-92 being erroneously stored in the NCH.



 CLM_HIPPS_TB                            Claim SNF, HHA & IRF Health Insurance PPS Table

      **********************************************************
      Please refer to the CMS website for the latest information
      on the HIPPS Codes.  The URL is
      http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/
      ProspMedicareFeeSvcPmtGen/HIPPSCodes.html
      (paste into browser address bar without any spaces)
      **********************************************************



 CLM_MASS_ADJSTMT_IND_CD_TB              Claim Mass Adjustment Indicator Code Table

      M = Mass Adjustment (MPFS)
      O = Mass Adjustment (Other)



 CLM_MCO_PD_TB                           Claim MCO Paid Switch Code Table

      1 = MCO has paid the provider for a claim
      BLANK or 0 = MCO has not paid the provider
                   for a claim



 CLM_MDCD_INFO_TB                        Claim Medicaid Information Table

      164 = Number of attachments submitted
      166 = Abortion/sterilization code
      167 = Child Health Assurance Program Referral Code
      168 = Civilian Health and Medical Program of the
            Uniformed Services Code



 CLM_MDCR_NPMT_RSN_TB                    Claim Medicare Non-Payment Reason Table

      Valid Values effective 1/2011 (2-byte values are replacing
      the character values)
       A = Covered worker's compensation (Obsolete)
       B = Benefit exhausted
       C = Custodial care - noncovered care
           (includes all 'beneficiary at fault'
           waiver cases) (Obsolete)
       E = HMO out-of-plan services not emergency
           or urgently needed (Obsolete)
       E = MSP cost avoided - IRS/SSA/HCFA Data
           Match (eff. 7/00)
       F = MSP cost avoid HMO Rate Cell (eff. 7/00)
       G = MSP cost avoided Litigation Settlement
           (eff. 7/00)
       H = MSP cost avoided Employer Voluntary
           Reporting (eff. 7/00)
       J = MSP cost avoid Insurer Voluntary
           Reporting (eff. 7/00)
       K = MSP cost avoid Initial Enrollment
           Questionnaire (eff. 7/00)
       N = All other reasons for nonpayment
       P = Payment requested
       Q = MSP cost avoided Voluntary Agreement
           (eff. 7/00)
       R = Benefits refused, or evidence not
           submitted
       T = MSP cost avoided - IEQ contractor
           (eff. 9/76) (obsolete 6/30/00)
       U = MSP cost avoided - HMO rate cell
           adjustment (eff. 9/76) (Obsolete 6/30/00)
       V = MSP cost avoided - litigation
           settlement (eff. 9/76) (Obsolete 6/30/00)
       W = Worker's compensation (Obsolete)
       X = MSP cost avoided - generic
       Y = MSP cost avoided - IRS/SSA data
           match project (obsolete 6/30/00)
       Z = Zero reimbursement RAPs -- zero reimbursement
           made due to medical review intervention or
           where provider specific zero payment has been
           determined. (effective with HHPPS - 10/00)
       00 = MSP cost avoided - COB Contractor
       12 = MSP cost avoided - BCBS Voluntary Agreements
       13 = MSP cost avoided - Office of Personnel Management
       14 = MSP cost avoided - Workman's Compensation (WC) Datamatch
       15 = MSP cost avoided - Workman's Compensation Insurer Voluntary
            Data Sharing Agreements (WC VDSA) (eff. 4/2006)
       16 = MSP cost avoided - Liability Insurer VDSA (eff. 4/2006)
       17 = MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006)
       18 = MSP cost avoided - Pharmacy Benefit Manager Data
            Sharing Agreement (eff. 4/2006)
       19 = MSP cost avoided - Worker's Compensation Medicare Set-Aside
            Arrangement
       21 = MSP cost avoided - MIR Group Heqalth Plan (eff. 1/2009)
       22 = MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009)
       25 = MSP cost avoided - Recovery Audit Contractor - California
            (eff. 10/2005)
       26 = MSP cost avoided - Recovery Audit Contractor - Florida
            (eff. 10/2005)
       39 = MSP cost avoided - GHP Recovery
       41 = MSP cost avoided - NGHP Non-ORM
       42 = MSP cost avoided - NGHP ORM Recovery
       43 = MSP cost avoided - COBC/Medicare Part C/Medicare Advantage

      Prior to 1/2011, the character values below were used to
      represent the 2-byte values

      NOTE: Effective 4/1/02, the Medicare nonpayment reason
      code was expanded to a 2-byte field.  The NCH instituted
      a crosswalk from the 2-byte code to a 1-byte character
      code. Below are the character codes (found in NCH &
      NMUD). At some point, NMUD will carry the 2-byte code
      but NCH will continue to have the 1-byte character
      code.

      ! = MSP cost avoided - COB Contractor ('00' 2-byte code)
      @ = MSP cost avoided - BC/BS Voluntary Agreements
          ('12' 2-byte code)
      # = MSP cost avoided - Office of Personnel Management
          ('13' 2-byte code)
      $ = MSP cost avoided - Workman's Compensation (WC) Datamatch
          ('14' 2-byte code)
      * = MSP cost avoided - Workman's Compensation Insurer
          Voluntary Data Sharing Agreements (WC VDSA)
          ('15' 2-byte code) (eff. 4/2006)
      ( = MSP cost avoided - Liability Insurer VDSA
          ('16' 2-byte code) (eff. 4/2006)
      ) = MSP cost avoided - No-Fault Insurer VDSA
          ('17' 2-byte code) (eff. 4/2006)
      + = MSP cost avoided - Pharmacy Benefit Manager Data
          Sharing Agreement ('18' 2-byte code) (eff. 4/2006)
      < = MSP cost avoided - MIR Group Health Plan
          ('21' 2-byte code) (eff. 1/2009)
      > = MSP cost avoided - MIR non-Group Health Plan
          ('22' 2-byte code) (eff. 1/2009)
      % = MSP cost avoided - Recovery Audit Contractor -
          - California ('25' 2-byte code) (eff. 10/2005)
      & = MSP cost avoided - Recovery Audit Contractor -
          Florida ('26' 2-byte code) (eff. 10/2005)



 CLM_OCRNC_SPAN_TB                       Claim Occurrence Span Table

       70 = Qualifying Stay Dates for SNF Use
            Only - the from/through dates of at
            least a 3-day inpatient hospital stay
            that qualifies the resident for Medicare
            payment of SNF services billed.  Code
            can only be used by SNF for billing.
       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 noncovered
            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 noncovered care
            for which hospital may charge
            bene. The FI or PRO must have
            approved such charges in advance.
            patient must be notified in writing
            3 days prior to noncovered period
       77 = Provider liability (utilization charged) -
            The from/thru dates of period of noncovered
            care for which the provider is liable.
            Eff 3/92, 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 = Provider Liability (non-utilization) (Payer code) -
            Eff 3/92, from/thru dates of
            period of noncovered care where
            bene is not charged with utilization,
            deductible, or coinsurance.
            and provider is liable.
            Eff 9/93, noncovered period of care
            due to lack of medical necessity.
       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  (CR7716) - eff. 7/2/12
       82 - 99 = Reserved for state assignment
       M0 = QIO/UR approved stay dates - Eff 10/93,
            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 noncovered care
            that is denied due to lack of medical
            necessity or custodial care for which the
            provider is liable. (eff. 10/01)
       M2 = Dates of Inpatient Respite Care -- from/thru
            dates of a period of inpatient respite care
            for hospice patients. (eff. 10/00)
       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.



 CLM_OP_ESRD_MTHD_REIMBRSMT_TB           Claim Outpatient ESRD Method of Reimbursement Table

      0 = Not ESRD
      1 = Method 1 - Home supplies purchased
      through a facility
      2 = Method 2 - Home supplies purchased
      from a supplier.



 CLM_OP_RFRL_TB                          Claim Outpatient Referral Table

         * For Outpatient Claims:  Effective 3/91 *

       1 = Non-Health Care Facility Point of Origin
           (Physician Referral) - The patient presents
           to this facility an order from a physician
           for services or seeks scheduled services
           for which an order is not required (e.g.
           mammography).  Includes non-emergent self
           referrals.  NOTE:  Includes patients coming
           from home, a physician's office or work-
           place.
       2 = Clinical referral - The patient was
           referred to this facility for outpatient
           or referenced diagnostic services
           by this facility's clinic or other
           outpatient department physician
       3 = Reserved for national assignment.
           (eff. 10/1/07).
           Prior to 10/1/07, HMO referral - The patient
           referenced diagnostic services by a
           HMO physician.
       4 = Transfer from a hospital (Different
           Facility) - The patient was admitted to
           this facility as a hospital transfer from
           an acute care facility where he or she was
           an outpatient. NOTE: Excludes Transfers from
           Hospital Inpatient in the same facility (see
           code D).
       5 = Transfer from a SNF for Intermediate Care
           Facility (ICF) - The patient was referred
           to this facility for outpatient or referenced
           diagnostic services by a physician of the SNF
           or ICF where he or she was a resident.
       6 = Transfer from another health care
           facility - The patient was referred to
           this facility for services by (a
           physician of) another type of health
           care facility not defined elsewhere in
           this code list where he or she was an
           outpatient.
       7 = Emergency room - The patient received un-
           scheduled services in tis facility's
           emergency department and discharged without
           an inpatient admission.  Includes self
           referrals in emergency situations that
           require immediate medical attention.
           OBSOLETE - 7/1/10
       8 = Court/law enforcement - The patient was
           referred to this facility upon the
           direction of a court of law, or upon
           the request of a law enforcement
           agency representative for outpatient
           or referenced diagnostic services.
       9 = Information not available - For
           Medicare outpatient claims this is
           not a valid code.
       A = Reserved for National Assignment. (eff. 10/1/07)
           Prior to 10/07, defined as: Transfer from a
           Critical Access Hospital (CAH) -- The patient
           was referred to this facility for outpatient
           or referenced diagnostic services by
           (a physician of) the CAH were the patient
           is an inpatient.
       B = Transfer from Another Home Health Agency -
           The patient was admitted to this home health
           agency as a transfer from another home health
           agency. Discontinued 7/1/10 - replaced with
           condition code 47.
       C = Readmission to Same Home Health Agency - The
           patient was readmitted to this home health
           agency as a transfer from another home health
           agency. Discontinued 7/1/10
       D = Transfer from hospital inpatient in the same
           facility resulting in separate claim to the
           payer.
       E = Transfer from Ambulatory Surgery Center - The
           patient received outpatient services in this
           facility for outpatient or referenced diagnostic
           services from an ambulatory surgery center.
           (eff. 10/1/2007)
       F = Transfer from Hospice and is under a Hospice
           plan of care or enrolled in a Hospice program -
           the patient was referred to this facility for
           outpatient or referenced diagnostic services
           from a hospice.
           (eff. 10/1/2007)



 CLM_OP_SRVC_TYPE_TB                     Claim Outpatient Service Type Table

       0 = Blank
       1 = Emergency - The patient required
           immediate medical intervention as a
           result of severe, life threatening, or
           potentially disabling conditions.
           Generally, the patient was admitted
           through the emergency room.
       2 = Urgent - The patient required immediate
           attention for the care and treatment
           of a physical or mental disorder.
           Generally, the patient was admitted to
           the first available and suitable
           accommodation.
       3 = Elective - The patient's condition
           permitted adequate time to schedule the
           availability of suitable accommodations.
       4 = Newborn - Use of this code necessitates the use of special
           Point of Origin codes
       5 = Trauma Center - visits to a trauma center/hospital as
           licensed or designated by the State or local government
           authority authorized to do so, or as verified by the
           American College of Surgeons and involving a trauma
           activation.
       6 THRU 8 =  Reserved.
       9 =  Unknown - Information not available.



 CLM_OP_TRANS_TYPE_TB                    Claim Outpatient Transaction Type Table

      A = Outpatient Psychiatric Hospital
      B = Outpatient TB Hospital
      C = Outpatient General Care Hospital
      D = Outpatient SNF
      E = Home Health Agency
      F = Comprehensive Health Care
      G = Clinical Rehab Agency
      H = Rural Health Clinic
      I = Satellite Dialysis Facility
      J = Limited Care Facility
      0 = Christian Science SNF
      1 = Psychiatric Hospital Facility
      2 = TB Hospital Facility
      3 = General Care Hospital
      4 = Regulary SNF
      Spaces = Home Health/Hospice



 CLM_PPS_IND_TB                          Claim PPS Indicator Table

      ***Effective NCH weekly process date 10/3/97 - 5/29/98***

      0 = not PPS bill (claim contains no PPS indicator)
      2 = PPS bill ( claim contains PPS indicator)

      ***Effective NCH weekly process date 6/5/98***

      0 = not applicable (claim contains neither PPS
      nor deemed insured MQGE status indicators)
      1 = Deemed insured MQGE (claim contains deemed
      insured MQGE indicator but not PPS indicator)
      2 = PPS bill ( claim contains PPS indicator but no
      deemed insured MQGE status indicator)
      3 = Both PPS and deemed insured MQGE (contains both
      PPS and deemed insured MQGE indicators)



 CLM_PRCDR_VRSN_TB                       Claim Procedure Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_PRCR_RTRN_TB                        Claim Pricer Return Code Table

      *******Home Health Pricer Return Codes************
      *****TOB 32X or 33X, DOS 10/1/2000 and after******

      Home Health Payment Return Codes:
      00 = Final payment where no outlier applies
      01 = Final payment where outlier applies
      03 = Initial percentage payment, 0%
      04 = Initial percentage payment, 50%
      05 = Initial percentage payment, 60%
      06 = LUPA payment only
      07 = Final payment, SCIC
      08 = Final payment, SCIC with outlier
      09 = Final payment, PEP
      11 = Final payment, PEP with outlier
      12 = Final payment, SCIC within PEP
      13 = FInal payment, SCIS within PEP with outlier

      Home Health Error Return Codes:
      10 = Invalid TOB
      15 = Invalid PEP Days
      16 = Invalid HRG Days, >60
      20 = PEP indicator invalid
      25 = Med review indicator invalid
      30 = Invalid MSA code
      35 = Invalid Initial Payment Indicator
      40 = Dates < October 1, 2000 or invalid
      70 = Invalid HRG Code
      75 = No HRG present in 1st occurrence
      80 = Invalid Revenue code
      85 = No revenue code present on HH final claim/
           adjustment

      *********Hospice Pricer Return Codes************
      **************TOB 81X or 82X********************

      Hospice Payment Return Codes:
      00 = Home rate returned

      Hospice Error Return Codes:
      10 = Bad units
      20 = Bad units2 < 8
      30 = Bad MSA code
      40 = Bad hospice wage index from MSA file
      50 = Bad bene wage index from MSA file
      51 = Bad provider number

      *************SNF Pricer Return Codes*********
      *******************TOB 21X*******************

      SNF Payment return codes:
      00 = RUG III group rate returned

      SNF Error return codes:
      20 = Bad RUG code
      30 = Bad MSA code
      40 = Thru date < July 1, 1998 or invalid
      50 = Invalid Federal blend for that year
      60 = Invalid Federal blend
      61 = Federal blend = 0 and SNF thru date < January
           1, 2000

      ****Inpatient Hospital Pricer Return Codes******
      ******************TOB 11X***********************

      Inpatient Hospital Payment return codes:
      00 = Paid normal DRG payment
      01 = Paid as a day outlier (Note: day outlier no longer
           being paid as of 10/1/97)
      02 = Paid as a cost outlier
      03 = Transfer paid on a per diem basis up to and
           including the ful DRG
      05 = Transfer paid on a per diem basis up to and
           including the full DRG which also qualified
           for a cost outlier payment
      06 = Provider refused cost outlier
      10 = DRG is 209, 210, or 211 and post-acute transfer
      12 = Post-acute transfer with specific DRGs.  The
           following DRG's: 14, 113, 236, 263, 264, 429,
           483
      14 = Paid normal DRG payment with per diem days =
           or > GM ALOS
      16 = Paid as a cost outlier with per diem days = or
           > GM ALOS

      Inpatient Hospital Error return codes:
      51 = No provider specific information found
      52 = Invalid MSA# in provider file
      53 = Waiver state - not calculated by PPS
      54 = DRG < 001 or > 511, or = 214, 215, 221, 222, 438,
           456, 457, 458
      55 = Discharge date < provider effective start date or
           discharge date < MSA effective start date for PPS
      56 = Invalid length of stay
      57 = Review code invalid (Not 00, 03, 06, 07, 09)
      58 = Total charges not numeric
      61 = Lifetime reserve days not numeric or BILL-LTR-DAYS
           > 60
      62 = Invalid number of covere days
      65 = PAY-CODE not = A, B or C on provider specific file
           for capital
      67 = Cost outlier with LOS > covered days

      ************Outpatient PPS Pricer Return Codes******

      Outpatient PPS Payment return codes:
      01 = Line processed to payment
      20 = Line processed but payment = 0 bene deductible
           = > adjusted payment

      Outpatient PPS Error return codes:
      30 = Missing, deleted or invalid APC
      38 = Missing or invalid discount factor
      40 = Invalid service indicator passed by the OCE
      41 = Service indicator invalid for OPPS PRICER
      42 = APC = '00000' or (packaging flag = 1 or 2)
      43 = Payment indicator not = to 1 or 5 thru 9
      44 = Service indicator = 'H' but payment indicator
           not = to 6
      45 = Packaging flag not = to 0
      46 = Line item denial/reject flag not = to 0
           or line item denial/reject flag = to 1 and (APC
           not = 0033 or 0034 or 0322 or 0323 or 0324 or 0325
           or 0373 or 0374)) or line item action flag not = to
           1
      47 = Line item action flag = 2 or 3
      48 = Payment adjustment flag not valid
      49 = Site of service flag not = to 0 or (APC 0033 is not
           on the claim and service indicator = 'P' or APC =
           0322, 0325, 0373, 0374)
      50 = Wage index not located
      51 = Wage index equals zero
      52 = Provider specific file wage index reclassification
           code invalid or missing
      53 = Service from date not numeric or < 20000801
      54 = Service from date < provider effective date
           or service from date > provider termination date

      ***Inpatient Rehab Facility (IRF) Pricer Return Codes***

      IRF Payment return codes:
      00 = Paid normal CMG payment without outlier
      01 = Paid normal CMG payment with outlier
      02 = Transfer paid on a per diem basis without outlier
      03 = Transfer paid on a per diem basis with outlier
      04 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- without outlier
      05 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- with outlier
      06 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           without outlier
      07 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           with outlier
      10 = Paid normal CMG payment with penalty without
           outlier
      11 = Paid normal CMG payment with penalty with
           outlier
      12 = Transfer paid on a per diem basis with penalty
           without outlier
      13 = Transfer paid on a per diem basis with penalty
           with outlier
      14 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- with penalty
           without outlier
      15 = Blended CMG payment -- 2/3 Federal PPS rate +
           1/3 provider specific rate -- with penalty
           with outlier
      16 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           with penalty without outlier
      17 = Blended transfer payment -- 2/3 Federal PPS
           transfer rate + 1/3 provider specific rate --
           with penalty with outlier

      IRF Error return codes:
      50 = Provider specific rate not numeric
      51 = Provider record terminated
      52 = Invalid wage index
      53 = Waiver state - not calculated by PPS
      54 = CMG on claim not found in table
      55 = Discharge date < provider effective start
           date or discharge date < MSA effective start
           date for PPS
      56 = Invalid length of stay
      57 = Provider specific rate zero when blended payment
           requested
      58 = Total covered charges not numeric
      59 = Provider specific record not found
      60 = MSA wage index record not found
      61 = Lifetime reserve days not numeric or
           BILL-LTR-DAYS > 60
      62 = Invalid number of covered days
      65 = Operating cost-to-charge ratio not numeric
      67 = Cost outlier with LOS > covered days or cost
           outlier threshold calculation
      72 = Invalid blend indicator (not 3 or 4)
      73 = Discharged before provider FY begin date
      74 = Provider FY begin date not in 2002

      *Long Term Care Hospital (LTCH) Pricer Return Codes*

      LTCH Payment return codes:
      00 = Normal DRG payment without outlier
      01 = Normal DRG payment with outlier
      02 = Short stay payment without outlier
      03 = Short stay payment with outlier
      04 = Blend year 1 - 80% facility rate plus 20%
           normal DRG payment without outlier
      05 = Blend year 1 - 80% facility rate plus 20%
           normal DRG payment with outlier
      06 = Blend year 1 - 80% facility rate plus 20%
           short stay payment without outlier
      07 = Blend year 1 - 80% facility rate plus 20%
           short stay payment with outlier
      08 = Blend year 2 - 60% facility rate plus 40%
           normal DRG payment without outlier
      09 = Blend year 2 - 60% facility rate plus 40%
           normal DRG payment with outlier
      10 = Blend year 2 - 60% facility rate plus 40%
           short stay payment without outlier
      11 = Blend year 2 - 60% facility rate plus 40%
           short stay payment with outlier
      12 = Blend year 3 - 40% facility rate plus 60%
           normal DRG payment without outlier
      13 = Blend year 3 - 40% facility rate plus 60%
           normal DRG payment with outlier
      14 = Blend year 3 - 40% facility rate plus 60%
           short stay payment without outlier
      15 = Blend year 3 - 40% facility rate plus 60%
           short stay payment with outlier
      16 = Blend year 4 - 20% facility rate plus 80%
           normal DRG payment without outlier
      17 = Blend year 4 - 20% facility rate plus 80%
           normal DRG payment with outlier
      18 = Blend year 4 - 20% facility rate plus 80%
           short stay payment without outlier
      19 = Blend year 4 - 20% facility rate plus 80%
           short stay payment with outilier

      LTCH Error return codes:
      50 = Provider specific rate not numeric
      51 = Provider record terminated
      52 = Invalid wage index
      53 = Waiver state - not calculated by PPS
      54 = DRG on claim not found in table
      55 = Discharge date < provider effective start date
           or discharge date < MSA effective start date
           for PPS
      56 = Invalid length of stay
      57 = Provider specific rate zero when blended payment
           requested
      58 = Total covered charges not numeric
      59 = Provider specific record not found
      60 = MSA wage index record not found
      61 = Lifetime reserve days not numeric or BILL-LTR-DAYS
           > 60
      62 = Invalid number of covered days
      65 = Operating cost-to-charge ratio not numeric
      67 = Cost outlier with LOS > covered days or cost
           outlier threshold calculation
      72 = Invalid blend indicator (not 1 thru 5)
      73 = Discharged before provider FY begin date
      74 = Provider FY begin date not in 2002

      ***End Stage Renal Disease (ESRD) Pricer Return Codes***

      ESRD Payment return codes:
      00 = ESRD PPS payment calculated
      01 = ESRD facility rate > zero

      ESRD Error return codes:
      50 = ESRD facility rate not numeric
      52 = Provider type not = '40' or '41'
      53 = Special payment indicator not = '1'
           or blank
      54 = Date of birth not numeric or = zero
      55 = Patient weight not numeric or = zero
      56 = Patient height not numeric or = zero
      57 = Revenue center code not in range
      58 = Condition code not = '73' or '74' or blank
      60 = MSA wage adjusted rate record not found
      98 = Claim through date before 4/1/2005 or not numeric



 CLM_PRVDR_VLDTN_TB                      Claim Provider Validation Code Table

      RP = Rendering Provider
      OP = Operating Physician
      CP = Ordering/Referring Physician
      AP = Attending Physician
      FA = Facility



 CLM_PTNT_RLTNSHP_TB                     Claim Patient Relationship Table

       01 = Spouse
       04 = Grandparent
       05 = Grandchild
       07 = Niece/Nephew
       10 = Foster child
       15 = Ward of the court
       17 = Step child
       18 = Patient is insured
       19 = Natural child/insured financial responsibility
       20 = Employee
       21 = Unknown
       22 = Handicapped dependent
       23 = Sponsored dependent
       24 = Minor dependent of a minor dependent
       32 = Mother
       33 = Father
       39 = Organ donor
       40 = Cadaver donor
       41 = Injured plaintiff
       43 = Natural child/insured does not have financial responsibility



 CLM_PTNT_RSN_VISIT_VRSN_TB              Claim Patient Reason for Visit Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_PWK_TB                              Claim Paperwork Code Table


      P1 = one iteration is present
      P2 = two iterations are present
      P3 = three iterations are present
      P4 = four iterations are present
      P5 = five iterations are present
      P6 = six iterations are present
      P7 = seven iterations are present
      P8 = eight iterations are present
      P9 = nine iterations are present
      P0 = ten iterations are present



 CLM_QUERY_TB                            Claim Query Table

       0 = Credit adjustment
       1 = Interim bill
       2 = Home Health Agency (HHA) benefits
           exhausted (obsolete 7/98)
       3 = Final bill
       4 = Discharge notice (obsolete 7/98)
       5 = Debit adjustment



 CLM_RAC_ADJSTMT_TB                      Recovery Audit Contractor (RAC) Adjustment Indicator Table

      R = RAC adjusted claim
      Spaces



 CLM_RLT_COND_TB                         Claim Related Condition Table

       01 = Military service related - Medical
            condition incurred during military
            service.
       02 = Employment related - Patient alleged
            that the medical condition causing this
            episode of care was due to environment/
            events resulting from employment.
       03 = Patient covered by insurance not
            reflected here - Indicates that patient
            or patient representative has stated
            that coverage may exist beyond that
            reflected on this bill.
       04 = Information Only Bill - Health Maintenance
            Organization (HMO) enrollee - Medicare bene-
            ficiary is enrolled in an HMO.  Eff 9/93, hospital
            must also expect to receive payment from HMO.
       05 = Lien has been filed - Provider has
            filed legal claim for recovery of funds
            potentially due a patient as a result
            of legal action initiated by or on
            behalf of the patient.
       06 = ESRD patient in 1st 30 months of entitlement
            covered by employer group health insurance -
            indicates Medicare may be secondary
            insurer.  Eff 3/1/96, ESRD patient in 1st
            30 months of entitlement covered by employer
            group health insurance.
       07 = Treatment of nonterminal condition for
            hospice patient - The patient is a
            hospice enrollee, but the provider is
            not treating a terminal condition and
            is requesting Medicare reimbursement.
       08 = Beneficiary would not provide information
            concerning other insurance coverage.
       09 = Neither patient nor spouse is employed
            - Code indicates that in response to
            development questions, the patient and
            spouse have denied employment.
       10 = Patient and/or spouse is employed but
            no EGHP coverage exists or (eff 9/93)
            other employer sponsored/provided
            health insurance covering patient.
       11 = The disabled beneficiary and/or family
            member has no group coverage from a LGHP
            or (eff 9/93) other employer
            sponsored/provided health insurance
            covering patient.
       12 = Payer code - Reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.
       13 = Payer code - Reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.
       14 = Payer code - Reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.
       15 = Payer code - reserved for internal
            use only by third party payers.  CMS
            will assign as needed.  Providers will
            not report them.  Prior to 3/07, clean
            claim (eff 10/92) OBSOLETE
       16 = Payer code - reserved for internal
            use only by third party payers.   CMS
            will assign as needed.   Providers will
            not report them.  Prior to 3/07. SNF
            transition exemption - An exemption from
            the post-hospital requirement applies
            for this SNF stay for the qualifying
            stay dates are more than 30 days prior
            to the admission date. OBSOLETE
       17 = Patient is homeless (eff. 3/07). Prior to
            3/07, code indicated Patient is over 100 years
            old - patient was over 100 years old at the
            date of admission.
       18 = Maiden name retained - A dependent
            spouse entitled to benefits who does
            not use her husband's last name.
       19 = Child retains mother's name - A
            patient who is a dependent child
            entitled to CHAMPVA benefits that does
            not have father's last name.
       20 = Bene requested billing - Provider
            realizes the services on this bill are at a
            noncovered level of care or otherwise excluded
            from coverage, but the bene has requested
            formal determination
       21 = Billing for denial notice - The SNF or HHA
            realizes services are at a noncovered level of
            care or excluded, but requests a Medicare denial
            in order to bill medicaid or other insurer
       22 = Patient on multiple drug regimen - A
            patient who is receiving multiple
            intravenous drugs while on home IV
            therapy
       23 = Homecaregiver available - The patient
            has a caregiver available to assist him
            or her during self-administration of an
            intravenous drug
       24 = Home IV patient also receiving HHA
            services - the patient is under care
            of HHA while receiving home IV drug
            therapy services
       25 = Patient is Non-U.S. resident
       26 = VA eligible patient chooses to
            receive services in Medicare certified
            facility rather than a VA facility
            (eff 3/92)
       27 = Patient referred to a sole community
            hospital for a diagnostic laboratory
            test - (sole community hospital only).
            (eff 9/93)
       28 = Patient and/or spouse's EGHP is
            secondary to Medicare -
            Qualifying EGHP for employers who have
            fewer than 20 employees. (eff 9/93)
       29 = Disabled beneficiary and/or family
            member's LGHP is secondary to
            Medicare - Qualifying LGHP for
            employer having fewer than 100 full and
            part-time employees
       30 = Qualifying Clinical Trials - Non-research
            services provided to all patients, in-
            cluding managed care enrollees, enrolled
            in a Qualified Clinical Trial.
       31 = Patient is student (full time - day) -
            Patient declares that he or she is
            enrolled as a full time day student.
       32 = Patient is student (cooperative/work
            study program)
       33 = Patient is student (full time - night)
            - Patient declares that he or she is
            enrolled as a full time night student.
       34 = Patient is student (part time) -
            Patient declares that he or she is
            enrolled as a part time student.
       36 = General care patient in a special
            unit - Patient is temporarily placed in
            special care unit bed because no
            general care beds were available.
       37 = Ward accommodation is patient's
            request - Patient is assigned to ward
            accommodations at patient's request.
       38 = Semi-private room not available -
            Indicates that either private or ward
            accommodations were assigned because
            semi-private accomodations were not
            available.
       39 = Private room medically necessary -
            Patient needed a private room for
            medical reasons.
       40 = Same day transfer - Patient
            transferred to another facility
            before midnight of the day of admission.
       41 = Partial hospitalization - Eff 3/92,
            indicates claim is for partial
            hospitalization services.  For OP
            services, this includes a variety
            of psych programs.
       42 = Continuing Care Not Related to Inpatient
            Admission - continuing care not related
            to the condition or diagnosis for which
            the beneficiary received inpatient
            hospital services. (eff. 10/01)
       43 = Continuing Care Not Provided Within
            Prescribed Postdischarge Window -
            continuing care was related to the
            inpatient admission but the prescribed
            care was not provided within the post-
            discharge window.(eff. 10/01)
       44 = Inpatient Admission Changed to Outpatient -
            For use on outpatient claims only, when the
            physician ordered inpatient services, but
            upon internal review performed before the
            claim was initially submitted, the hospital
            determined the services did not meet its
            inpatient criteria. (eff. 4/1/04)
       45 = Ambiguous Gender Category - claim indicates
            patient has ambiguous gender characteristics
            (e.g. transgendered or hermaphordite).
       46 = Nonavailability statement on file for
            CHAMPUS claim for nonemergency IP care
            for CHAMPUS bene residing within the
            catchment area (usually a 40 mile
            radius) of a uniform services hospital.
       47 = Transfer from another Home Health Agency.
            (eff. 7/1/10)
       48 = Psychiatric Residential Treatment Centers for
            Children and Adolescents (RTCs)
       49 = Product Replacement within Product Lifecycle-
            replacement of a product earlier than the
            anticipated lifecycle due to an indication
            that the product is not functioning properly
            (eff. 4/2006)
       50 = Product Replacement for Known Recall of
            a Product - Manufacturer or FDA has iden-
            tified the product for recall and therefore
            replacement. (eff. 4/2006)
       51 = Reserved for national assignment.
       52 = Used to indicate a discharge due to the patient's
            unavailability/inability to receive hospice services
            from the hospice which has been responsible for
            the patient. (effective 7/2/12 - CR7677)
       53 = Reserved for national assignment.
       54 = No skilled HH visits in billing period (eff. 7/2016)
       55 = SNF bed not available - The patient's
            SNF admission was delayed more than 30
            days after hospital discharge because
            a SNF bed was not available.
       56 = Medical appropriateness - Patient's
            SNF admission was delayed more than 30
            days after hospital discharge because
            physical condition made it inappropriate
            to begin active care within that period
       57 = SNF readmission - Patient previously
            received Medicare covered SNF care
            within 30 days of the current SNF
            admission.
       58 = Payment of SNF claims for beneficiaries
            disenrolling from terminating M+C plans
            plans who have not met the 3-day hospital
            stay requirement (eff. 10/1/00)
       59 = Non-primary ESRD facility - code indicates
            that ESRD beneficiary received non-scheduled
            or emergency dialysis services at a facility
            other than his/her primary ESRD dialysis
            facility.
       60 = Operating cost day outlier - A hospital
            being paid under a prospective payment
            system (PPS) is reporting this stay as a
            day outlier.
       61 = Operating cost cost outlier - A hospital
            is being paid under a prospective payment
            system (PPS) is requesting additional payment
            for this stay as a cost outlier.
       62 = Payer Code - providers do not report this code.
            PIP bill - This bill is a periodic interim
            payment bill. Obsolete
       63 = Payer Code - providers do not report this code.
            PRO denial received before batch
            clearance report - The HCSSACL receipt date
            is used on PRO adjustment if the PRO's
            notification is before orig bill's acceptance
            report. (Payer only code eff 9/93)
       64 = Payer Code - providers do not report this code.
            Other than cleam claim - the claim is not a
            'clean claim'. Obsolete
       65 = Payer Code - Providers do not report this code.
            Non-PPS code - The bill is not a prospective
            payment system bill.  Obsolete
       66 = Outlier not claimed - Bill may meet
            the criteria for cost outlier, but the
            hospital did not claim the cost outlier
            (PPS)
       67 = Beneficiary elects not to use LTR days
       68 = Beneficiary elects to use LTR days
       69 = IME/DGME/N&AH Payment Only - providers
            request for supplemental IME/DGME/N&AH payment for
            each discharge of MCO enrollee, beginning 1/1/98,
            from teaching hospitals (facilities with approved
            medical residency training program); not
            stored in NCH.  Exception:  problem in
            startup year may have resulted in this
            special IME payment request being erroneously
            stored in NCH.  If present, disregard claim
            as condition code '69' is not valid NCH
            claim.
       70 = Self-administered EPO - Billing is
            for a home dialysis patient who self
            administers EPO.
       71 = Full care in unit - Billing is for a
            patient who received staff assisted
            dialysis services in a hospital or
            renal dialysis facility.
       72 = Self care in unit - Billing is for a
            patient who managed his own dialysis
            services without staff assistance in a
            hospital or renal dialysis facility.
       73 = Self care training - Billing is for
            special dialysis services where the
            patient and helper (if necessary) were
            learning to perform dialysis.
       74 = Home - Billing is for a patient who
            received dialysis services at home.
       75 = Home 100% reimbursement -
            (not to be used for services after 4/15/90)
            The billing is for home dialsis patient using
            a dialysis machine that was purchased
            under the 100% program.
       76 = Back-up facility - Billing is for a
            patient who received dialysis services
            in a back-up facility.
       77 = Provider accepts or is obligated/
            required due to contractual agreement
            or law to accept payment by a primary
            payer as payment in full - Medicare
            pays nothing.
       78 = New coverage not implemented by HMO -
            eff 3/92, indicates newly covered
            service under Medicare for which HMO
            does not pay.
       79 = CORF services provided off site -
            Code indicates that physical therapy,
            occupational therapy, or speech path-
            ology services were provided off site.
       80 = Home Dialysis - Nursing Facility - Home
            dialysis furnished in a SNF or nursing
            facility.  (eff. 4/4/05)
       81 - 99 = Reserved for state assignment.
       85 = Delayed Recertification of Hospice Terminal
            Illness (eff. 1/2017)
       A0 = TRICARE External Partnership Program -
            This code identifies TRICARE claims submitted
            under the External Partnership Program.
       A0 = Special Zip Code Reporting - five digit
            zip code of the location from which the
            beneficiary is initially placed on board
            the ambulance. (eff. 9/01) Obsolete
       A0 = CHAMPUS external partnership program
            special program indicator code. (eff 10/93)
            (obsolete)
       A1 = EPSDT/CHAP - Early and periodic
            screening diagnosis and treatment
            special program indicator code. (eff 10/93)
       A2 = Physically handicapped children's
            program - Services provided receive
            special funding through Title 8 of
            the Social Security Act or the CHAMPUS
            program for the handicapped. (eff 10/93)
       A3 = Special federal funding - Designed for
            uniform use by state uniform billing
            committees.
            Special program indicator code (eff 10/93)
       A4 = Family planning - Designed for
            uniform use by state uniform billing
            committees.
            Special program indicator code (eff 10/93)
       A5 = Disability - Designed for uniform
            use by state uniform billing
            committees.
            Special program indicator code (eff 10/93)
       A6 = PPV/Medicare 100% Payment - Identifies that
            pneumococcal pneumonia 100% payment
            vaccine (PPV) services should be
            reimbursed under a special Medicare
            program provision.
            Special program indicator code (eff 10/93)
       A7 = Induced abortion to avoid danger to
            woman's life. (terminated)
            Special program indicator code (eff 10/93)
       A7 = Hospital services provided in a mobile facility
            or with portable units (eff. 4/2020)
       A8 = Induced abortion - Victim of rape/
            incest.
            Special program indicator code (eff 10/93)
       A9 = Second opinion surgery - Services
            requested to support second opinion
            on surgery.  Part B deductible and
            coinsurance do not apply.
            Special program indicator code (eff 10/93)
       AA = Abortion Performed due to Rape (eff. 10/1/02)
       AB = Abortion Performed due to Incest (eff. 10/1/02)
       AC = Abortion Performed due to Serious Fetal
            Genetic Defect, Deformity or Abnormality
            (eff. 10/1/02)
       AD = Abortion Performed due to a Life Endangering
            Physical Condition Caused by, arising from
            or exacerbated by the Pregnancy itself
            (eff. 10/1/02)
       AE = Abortion Performed due to physical health of
            mother that is not life endangering (eff.
            10/1/02)
       AF = Abortion Performed due to emotional/
            psychological health of mother (eff. 10/1/02)
       AG = Abortion performed due to social economic
            reasons (eff. 10/1/02)
       AH = Elective Abortion (eff. 10/1/02)
       AI = Sterilization (eff. 10/1/02)
       AJ = Payer Responsible for copayment (4/1/03)
       AK = Air Ambulance Required - For ambulance
            claims.  Time needed to transport poses a
            threat. (eff. 10/16/03)
       AL = Specialized Treatment/bed Unavailable -
            For ambulance claims. Specialized treatment
            bed unavailable. Transported to alternate
            facility. (eff. 10/16/03)
       AM = Non-emergency Medically Necessary Stretcher
            Transport Required - For ambulance claims.
            Non-emergency medically necessary stretcher
            transport required. (eff. 10/16/03)
       AN = Preadmission Screening Not Required - person
            meets the criteria for an exemption from
            preadmission screening. (eff. 1/1/04)
       B0 = Medicare Coordinated Care Demonstration
            Program - patient is a participant in
            a Medicare Coordinated Care Demonstration
            (eff. 10/01)
       B1 = Beneficiary ineligible for demonstration
            program (eff. 10/01).
       B2 = Critical Access Hospital Ambulance Attestation -
            Attestation by CAH that it meets the criteria
            for exemption from the Ambulance Fee Schedule
       B3 = Pregnancy Indicator - Indicates the patient is
            pregnant. Required when mandated by law.
            (eff. 10/16/03)
       B4 = Admission Unrelated to Discharge - Admission
            unrelated to discharge on same day.  This
            code is for discharges starting on January
            1, 2004.
       B5 = Special program indicator
            Reserved for national assignment.
       B6 = Special program indicator
            Reserved for national assignment.
       B7 = Special program indicator
            Reserved for national assignment.
       B8 = Special program indicator
            Reserved for national assignment.
       B9 = Special program indicator
            Reserved for national assignment.
       BP = Gulf Oil Spill of 2010 - The code identifies
            claims where the provision of all services
            on the claim are related, in whole or in
            part, to an illness, injury, or condition
            that was caused by or exacerbated by the
            effects, direct or indirect, of the 2010 oil
            spill in the Gulf of Mexico and/or circum-
            stances related to such spill, including but
            not limited to subsequent clean-up activites.
       C0 = Reserved for national assignment.
       C1 = Approved as billed - The services
            provided for this billing period have
            been reviewed by the QIO/UR or
            intermediary and are fully approved
            including any day or cost outlier. (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to type of bills other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C2 = Automatic approval as billed based on
            focused review.  (No longer used for
            Medicare)
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to type of bills other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C3 = Partial approval - The services
            provided for this billing period have
            been reviewed by the QIO/UR or
            intermediary and some portion has been
            denied (days or services). (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to type of bills other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C4 = Admission/services denied - Indicates
            that all of the services were denied
            by the QIO/UR.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C5 = Postpayment review applicable - QIO/UR
            review to take place after payment.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C6 = Admission preauthorization - The
            QIO/UR authorized this admission/
            service but has not reviewed the
            services provided.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C7 = Extended authorization - the QIO has
            authorized these services for an
            extended length of time but has not
            reviewed the services provided.
            QIO approval indicator services (eff 10/93)
            NOTE: Beginning July 2005, this code is
            relevant to types of bill other than inpatient
            (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
       C8 = Reserved for national assignment.
            QIO approval indicator services (eff 10/93)
       C9 = Reserved for national assignment.
            QIO approval indicator services (eff 10/93)
       D0 = Changes to service dates.
            Change condition (eff 10/93)
       D1 = Changes in charges.
            Change condition (eff 10/93)
       D2 = Changes in revenue codes/HCPCS/HIPPS
            Rate Code
            Change condition (eff 10/93)
       D3 = Second or subsequent interim
            PPS bill.
            Change condition (eff 10/93)
       D4 = Change in ICD-9-CM diagnosis and/or
            procedure code
            Change condition (eff 10/93)
       D5 = Cancel only to correct a beneficiary
            claim account number or provider
            identification number.
            change condition (eff 10/93)
       D6 = Cancel only to repay a duplicate
            payment or OIG overpayment (includes
            cancellation of an OP bill containing
            services required to be included on the
            IP bill). Change condition eff 10/93.
       D7 = Change to make Medicare the secondary
            payer.
            Change condition (eff 10/93)
       D8 = Change to make Medicare the primary
            payer.
            Change condition (eff 10/93)
       D9 = Any other change.
            Change condition (eff 10/93)
       DR = Disaster Relief (eff. 10/2005) - Code used
            to facilitate claims processing and track
            services and items provided to victims of
            Hurricane Katrina and any future disasters.
       E0 = Change in patient status.
            Change condition (eff 10/93)
       EY = National Emphysema Treatment Trial (NETT)
            or Lung Volume Reduction Surgery (LVRS)
            clinical study (eff. 11/97) Obsolete
       G0 = Multiple medical visits occur on the same
            day in the same revenue center but visits
            are distinct and constitute independent
            visits (allows for payment under outpatient
            PPS -- eff. 7/3/00).
       H0 = Delayed Filing, Statement of Intent
            Submitted -- statement of intent was sub-
            mitted within the qualifying period to
            specifically identify  the existence of
            another third party liability situation.
            (eff. 9/01)
       H2 = Discharge by a Hospice Provider for Cause
            (eff. 1/1/09).
       M0 = Reserved for national assignment.
       M0 = All inclusive rate for outpatient services.
            (payer only code). Obsolete
       M1 = Reserved for national assignment.
       M1 = Roster billed influenza virus vaccine.
            (payer only code)
            Eff 10/96, also includes pneumoccocal
            pneumonia vaccine (PPV)  Obsolete
       M2 = Reserved for national assignment.
       M2 = HH override code - home health total
            reimbursement exceeds the $150,000 cap
            or the number of total visits exceeds the
            150 limitation. (eff 4/3/95) Obsolete
            (payer only code)
       M6 = Pennsylvania (PA) Rural Health Model (PARHM)
            (payer only code)
       P1 = Do Not Resuscitate Order (DNR) - for
            public health reporting only - code
            indicates that a DNR order was written at
            the time of or within the first 24 hours
            of the patient's admission to the hospital
            and is clearly documented in the patient's
            medical record.
       P7 = Direct Inpatient Admission from Emergency
            Room - for public health reporting only
            when required by state or federal law or
            regulations.  Code indicates that patient
            was admitted directly from this facility's
            emergency room department.  (eff. 7/1/10)
       W0 = United Mine Workers of America (UMWA)
            SNF demonstration indicator (eff 1/97);
            but no claims transmitted until 2/98)
       W2 = Duplicate of Original Bill - code indicates
            bill is exact duplicate of the original bill
            submitted. (eff. 10/1/08)
       W3 = Level I Appeal - code indicates bill is
            submitted for reconsideration; the Level
            of appeal/reconsideration (I) is specified/
            defined by the payer. (eff. 10/1/08)
       W4 = Level II Appeal - Code indicates bill is
            submitted for reconsideration; the Level of
            appeal/reconsideration (II) is specified/
            defined by the payer. (eff. 10/1/08)
       W5 = Level III Appeal - Code indicates bill is
            submitted for reconsideration; the Level of
            appeal/reconsideration (III) is specified/
            defined by the payer.  (eff. 10/1/08)
       XX = Transgender/Hermaphrodite Beneficiaries
            (eff. 1/2/07) Obsolete



 CLM_RLT_OCRNC_TB                        Claim Related Occurrence Table


       01 = Auto accident - The date of an auto
            accident.
       02 = No-fault insurance involved, including
            auto accident/other - The date of an
            accident where the state has applicable
            no-fault liability laws, (i.e., legal
            basis for settlement without admission
            or proof of guilt).
       03 = Accident/tort liability - The date of
            an accident resulting from a third
            party's action that may involve a civil
            court process in an attempt to require
            payment by the third party, other than
            no-fault liability.
       04 = Accident/employment related - The
            date of an accident relating to the
            patient's employment.
       05 = Accident/No medical liability coverage -
            code indicating accident related injury
            for which there is no medical payment or
            third payrt liability coverage. Provide
            the date of accident/injury.
       05 = Other accident - The date of an accident
            not described by the codes 01 thru 04.
            (obsolete)
       06 = Crime victim - Code indicating the
            date on which a medical condition
            resulted from alleged criminal action
            committed by one or more parties.
       07 = Reserved for national assignment.
       08 = Reserved for national assignment.
       09 = Start of Infertility Treatment Cycle -
            code indicating the start date of
            infertility treatment cycle.
       10 = Last Menstrual Period - code indicating
            the date of the last mentrual period;
            ONLY applies when patient is being
            treated for maternity related condi-
            tions.
       11 = Onset of symptoms/illness - The date
            the patient first became aware of
            symptoms/illness.
       12 = Date of onset for a chronically
            dependent individual - Code indicates
            the date the patient/bene became
            a chronically dependent individual.
       13 = Reserved for national assignment.
       14 = Reserved for national assignment.
       15 = Reserved for national assignment.
       16 = Date of Last Therapy - code denotes
            last day of therapy services (e.g.,
            physical therapy, occupational therapy,
            speech therapy).
       17 = Date outpatient occupational therapy
            plan established or last reviewed -
            Code indicating the date an occupational
            therapy plan was established or
            last reviewed (eff 3/93)
       18 = Date of retirement (patient/bene)
            - Code indicates the date of retirement
            for the patient/bene.
       19 = Date of retirement spouse -
            Code indicates the date of retirement
            for the patient's spouse.
       20 = Guarantee of payment began - The date
            on which the provider began claiming
            Medicare payment under the guarantee
            of payment provision.
       21 = UR notice received - Code indicating
            the date of receipt by the hospital & SNF
            of the UR committee's finding that the
            admission or future stay was not
            medically necessary.
       22 = Active care ended - The date on which
            a covered level of care ended in a SNF
            or general hospital, or date active care
            ended in a psychiatric or tuberculosis
            hospital or date on which patient was
            released on a trial basis from a resi-
            dential facility.  Code is not required
            if code "21" is used.
       23 = Cancellation of Hospice benefits - The
            date the RHHI cancelled the hospice benefit.
            (eff. 10/00).  NOTE: this will be different
            than the revocation of the hospice benefit
            by beneficiaries.
            Benefits exhausted - The last date
            for which benefits can be paid.
            (term 9/30/93; replaced by code A3)
       24 = Date insurance denied - The date the
            insurer's denial of coverage was
            received by a higher priority payer.
       25 = Date benefits terminated by primary
            payer - The date on which coverage
            (including worker's compensation benefits
            or no-fault coverage) is no longer
            available to the patient.
       26 = Date skilled nursing facility (SNF)
            bed available - The date on which a SNF
            bed became available to a hospital
            inpatient who required only SNF level of
            care.
       27 = Date of Hospice Certification or Re-Certifi-
            cation -- code indicates the date of certifi-
            cation or recertification of the hospice
            benefit period, beginning with the first two
            initial benefit periods of 90 days each and
            the subsequent 60-day benefit periods.
            (eff. 9/01)
       27 = Date home health plan established or
            last reviewed - Code indicating the
            date a home health plan of treatment
            was established or last reviewed. (Obsolete)
            not used by hospital unless owner of facility
       28 = Date comprehensive outpatient rehabi-
            litation plan established or last re-
            viewed - Code indicating the date a
            comprehensive outpatient rehabilitation
            plan was established or last reviewed.
            not used by hospital unless owner of facility
       29 = Date OPT plan established or last
            reviewed - the date a plan of treatment
            was established for outpatient physical
            therapy.
            Not used by hospital unless owner of facility
       30 = Date speech pathology plan treatment
            established or last reviewed - The date
            a speech pathology plan of treatment
            was established or last reviewed.
            Not used by hospital unless owner of facility
       31 = Date bene notified of intent
            to bill (accommodations) - The date of
            the notice provided to the patient by
            the hospital stating that he no longer
            required a covered level of IP care.
       32 = Date bene notified of intent
            to bill (procedures or treatment) - The
            date of the notice provided to the patient
            by the hospital stating requested care
            (diagnostic procedures or treatments) is
            not considered reasonable or necessary.
       33 = First day of the Medicare coordination
            period for ESRD bene - During
            which Medicare benefits are secondary
            to benefits payable under an EGHP.
            Required only for ESRD beneficiaries.
       34 = Date of election of extended care
            facilities - The date the guest elected
            to receive extended care services (used
            by Religious Nonmedical Health Care
            Institutions only).
       35 = Date treatment started for physical
            therapy - Code indicates the date
            services were initiated by the billing
            provider for physical therapy.
       36 = Date of discharge for the IP
            hospital stay when patient
            received a transplant procedure
            - Hospital is billing for
            immunosuppressive drugs.
       37 = The date of discharge
            for the IP hospital stay when
            patient received a noncovered
            transplant procedure - Hospital
            is billing for immunosuppresive drugs.
       38 = Date treatment started for home IV
            therapy - Date the patient was first
            treated in his home for IV therapy.
       39 = Date discharged on a continuous
            course of IV therapy - Date the patient
            was discharged from the hospital on a
            continuous course of IV therapy.
       40 = Scheduled date of admission - The
            date on which a patient will be admitted
            as an inpatient to the hospital.
            (This code may only be used on an
            outpatient claim.)
       41 = Date of First Test for Pre-admission
            Testing - The date on which the first
            outpatient diagnostic test was
            performed as part of a pre-admission
            testing (PAT) program.  This code may
            only be used if a date of admission
            was scheduled prior to the administration
            of the test(s). (eff. 10/01)
       42 = Date of discharge/termination of hospice
            care - for the final bill for hospice
            care.  Eff 5/93, definition revised to
            apply only to date patient revoked
            hospice election.
       43 = Scheduled Date of Canceled Surgery -
            date which ambulatory surgery was
            scheduled. (eff. 9/01)
       44 = Date treatment started for occupational
            therapy - Code indicates the date
            services were initiated by the billing
            provider for occupational therapy.
       45 = Date treatment started for speech
            therapy - Code indicates the date
            services were initiated by the billing
            provider for speech therapy.
       46 = Date treatment started for cardiac
            rehabilitation - Code indicates the
            date services were initiated by the
            billing provider for cardiac
            rehabilitation.
       47 = Date Cost Outlier Status Begins - code
            indicates that this is the first day
            the cost outlier threshold is reached.
            For Medicare purposes, a bene must have
            regular coinsurance and/or lifetime
            reserve days available beginning on this
            date to allow coverage of additional daily
            charges for the purpose of making cost
            outlier payments. (eff. 9/01)
       48 = Payer code - Code reserved for
            internal use only by third party
            payers.  HCFA assigns as needed for
            your use.  Providers will not report it.
       49 = Payer code - Code reserved for
            internal use only by third party
            payers.  HCFA assigns as needed for
            your use.  Providers will not report it.
       50 = Assessment Date - code indicating an
            assessment date as defined by the
            assessment instrument applicable to this
            provider type (e.g. Minimum Data Set (MDS)
            for skilled nursing).  eff. 1/1/11
       51 = Date of Last Kt/V Reading - for in-center
            hemodialysis patients, this is the date
            of the last reading taken during the
            billing period.   For peritoneal dialysis
            patients (and home hemodialysis patients),
            this date may be before the current billing
            period but should be within 4 months of the
            date of service.  eff. 7/1/10
       52 = Medical Certification/recertification
            date - the date of the most recent non-
            hospice medical certification or recerti-
            fication of the patient.  Use occurrence
            code 27 for Date of Hospice Certification
            or Recertification.  eff. 1/1/11
       54 = Physician Follow-up Date - Last date of a
            physician follow-up with the patient.
            eff. 1/1/11
       55 = Used to report date of death.
            NOTE: The date of death will be present when
            the patient discharge status code is
            20, 40, 41 or 42.
       A1 = Birthdate, Insured A - The birthdate of
            the individual in whose name the insurance
            is carried. (Eff 10/93)
       A2 = Effective date, Insured A policy - A
            code indicating the first date insurance
            is in force. (eff 10/93)
       A3 = Benefits exhausted - Code indicating
            the last date for which benefits are
            available and after which no payment
            can be made to payer A.  (eff 10/93)
       A4 = Split Bill Date - date patient became
            eligible due to medically needy spend
            down (sometimes referred to as "Split
            Bill Date").
       B1 = Birthdate, Insured B - The birthdate of
            the individual in whose name the insurance
            is carried. (eff 10/93)
       B2 = Effective date, Insured B policy - A
            code indicating the first date insurance
            is in force. (eff 10/93)
       B3 = Benefits exhausted - code indicating
            the last date for which benefits are
            available and after which no payment
            can be made to payer B.  (eff 10/93)
       C1 = Birthdate, Insured C - The birthdate of
            the individual in whose name the insurance
            is carried. (eff 10/93)
       C2 = Effective date, Insured C policy - A
            code indicating the first date insurance
            is in force. (eff 10/93) Obsolete
       C3 = Benefits exhausted - Code indicating
            the last date for which benefits are
            available and after which no payment
            can be made to payer C.  (eff 10/93)
            Obsolete



 CLM_RMTNC_ADVC_TB                       Claim Remittance Advice Code Table

       M1 =   X-ray not taken within the past 12 months
              or near enough to the start of treatment.
              Start: 01/01/1997
       M2 =   Not paid separately when the patient is
              an inpatient.
              Start: 01/01/1997
       M3 =   Equipment is the same or similar to
              equipment already being used.
              Start: 01/01/1997
       M4 =   Alert: This is the last monthly
              installment payment for this durable
              medical equipment.
              Start: 01/01/1997
       M5 =   Monthly rental payments can continue
              until the earlier of the 15th month from
              the first rental month, or the month when
              the equipment is no longer needed.
              Start: 01/01/1997
       M6 =   Alert: You must furnish and service this
              item for any period of medical need for
              the remainder of the reasonable useful
              lifetime of the equipment.
              Start: 01/01/1997
       M7 =   No rental payments after the item is
              purchased, or after the total of issued
              rental payments equals the purchase
              price.
              Start: 01/01/1997
       M8 =   We do not accept blood gas tests results
              when the test was conducted by a medical
              supplier or taken while the patient is on
              oxygen.
              Start: 01/01/1997
       M9 =   Alert: This is the tenth rental month.
              You must offer the patient the choice of
              changing the rental to a purchase
              agreement.
              Start: 01/01/1997 |
      M10 =   Equipment purchases are limited to the
              first or the tenth month of medical
              necessity.
              Start: 01/01/1997
      M11 =   DME, orthotics and prosthetics must be
              billed to the DME carrier who services
              the patient's zip code.
              Start: 01/01/1997
      M12 =   Diagnostic tests performed by a
              physician
              must indicate whether purchased services
              are included on the claim.
              Start: 01/01/1997
      M13 =   Only one initial visit is covered per
              specialty per medical group.
              Start: 01/01/1997 |
      M14 =   No separate payment for an injection
              administered during an office visit, and
              no payment for a full office visit if the
              patient only received an injection.
              Start: 01/01/1997
      M15 =   Separately billed services/tests have
              been bundled as they are considered
              components of the same procedure.
              Separate payment is not allowed.
              Start: 01/01/1997
      M16 =   Alert: Please see our web site,
              mailings,
              or bulletins for more details concerning
              this policy/procedure/decision.
              Start: 01/01/1997 |
              Notes: (Reactivated 4/1/04, Modified
              11/18/05, 4/1/07)
      M17 =   Alert: Payment approved as you did not
              know, and could not reasonably have been
              expected to know, that this would not
              normally have been covered for this
              patient. In the future, you will be
              liable for charges for the same
              service(s) under the same or similar
              conditions.
              Start: 01/01/1997
      M18 =   Certain services may be approved for
              home
              use. Neither a hospital nor a Skilled
              Nursing Facility (SNF) is considered to
              be a patient's home.
              Start: 01/01/1997
      M19 =   Missing oxygen certification/
              recertification.
              Start: 01/01/1997
      M20 =   Missing/incomplete/invalid HCPCS.
              Start: 01/01/1997
      M21 =   Missing/incomplete/invalid place of
              residence for this service/item provided
              in a home.
              Start: 01/01/1997
      M22 =   Missing/incomplete/invalid number of
              miles traveled.
              Start: 01/01/1997
      M23 =   Missing invoice.
              Start: 01/01/1997
      M24 =   Missing/incomplete/invalid number of
              doses per vial.
              Start: 01/01/1997 |
      M25 =   The information furnished does not
              substantiate the need for this level
              of service. If you believe the service
              should have been fully covered as billed,
              or if you did not know and could not
              reasonably have been expected to know
              that we would not pay for this level of
              service, or if you notified the patient
              in writing in advance that we would not
              pay for this level of service and he/she
              agreed in writing to pay, ask us to
              review your claim within 120 days of the
              date of this notice. If you do not
              request an appeal, we will, upon
              application from the patient, reimburse
              him/her for the amount you have collected
              from him/her in excess of any deductible
              and coinsurance amounts. We will recover
              the reimbursement from you as an
              overpayment.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 6/30/03,
              8/1/05, 11/5/07, 11/1/10)
      M26 =   The information furnished does not
              substantiate the need for this level of
              service. If you have collected any amount
              from the patient for this level of
              service /any amount that exceeds the
              limiting charge for the less extensive
              service, the law requires you to refund
              that amount to the patient within 30 days
              of receiving this notice.= The
              requirements for refund are in 1824(I) of
              the Social Security Act and 42CFR411.408.
              The section specifies that physicians who
              knowingly and willfully fail to make
              appropriate refunds may be subject to
              civil monetary penalties and/or exclusion
              from the program. If you have any
              questions about this notice, please
              contact this office.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 6/30/03,
              8/1/05, 11/5/07. Also refer to N356)
      M27 =   Alert: The patient has been relieved of
              liability of payment of these items and
              services under the limitation of
              liability provision of the law. The
              provider is ultimately liable for the
              patient's waived charges, including any
              charges for coinsurance, since the items
              or services were not reasonable and
              necessary or constituted custodial care,
              and you knew or could reasonably have
              been expected to know, that they were
              not covered. You may appeal this
              determination. You may ask for an appeal
              regarding both the coverage
              determination and the issue of whether
              you exercised due care. The appeal
              request must be filed within 120 days of
              the date you receive this notice. You
              must make the request through this
              office.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 8/1/05,
              4/1/07, 8/1/07)
      M28 =   This does not qualify for payment under
              Part B when Part A coverage is exhausted
              or not otherwise available.
              Start: 01/01/1997
      M29 =   Missing operative note/report.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03, 7/1/2008)
              Related to N233
      M30 =   Missing pathology report.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 2/28/03)
              Related to N236
      M31 =   Missing radiology report.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 2/28/03) Related
              to N240
      M32 =   Alert: This is a conditional payment
              made pending a decision on this service
              by the patient's primary payer. This
              payment may be subject to refund upon
              your receipt of any additional payment
              for this service from another payer. You
              must contact this office immediately
              upon receipt of an additional payment
              for this service.
              Start: 01/01/1997 |
              Notes: (Modified 4/1/07)
      M33 =   Missing/incomplete/invalid UPIN for the
              ordering/referring/performing provider.
              Start: 01/01/1997 | Stop: 08/01/2004
              Notes: Consider using M68
      M34 =   Claim lacks the CLIA certification
              number.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA120
      M35 =   Missing/incomplete/invalid pre-
              operative
              photos or visual field results.
              Start: 01/01/1997 | Stop: 02/05/2005
              Notes: Consider using N178
      M36 =   This is the 11th rental month. We
              cannot
              pay for this until you indicate that the
              patient has been given the option of
              changing the rental to a purchase.
              Start: 01/01/1997
      M37 =   Not covered when the patient is under
              age 35.
              Start: 01/01/1997 |
              Notes: (Modified 3/8/11)
      M38 =   The patient is liable for the charges
              for this service as you informed the
              patient in writing before the service
              was furnished that we would not pay for
              it, and the patient agreed to pay.
              Start: 01/01/1997
      M39 =   The patient is not liable for payment
              for this service as the advance notice
              of non-coverage you provided the patient
              did not comply with program
              requirements.
              Start: 01/01/1997 |
              Notes: (Modified 2/1/04, 4/1/07,
              11/1/09, 11/1/12) Related to N563
      M40 =   Claim must be assigned and must be
              filed
              by the practitioner's employer.
              Start: 01/01/1997
      M41 =   We do not pay for this as the patient
              has no legal obligation to pay for this.
              Start: 01/01/1997
      M42 =   The medical necessity form must be
              personally signed by the attending
              physician.
              Start: 01/01/1997
      M43 =   Payment for this service previously
              issued to you or another provider by
              another carrier/intermediary.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using Reason Code 23
      M44 =   Missing/incomplete/invalid condition
              code.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M45 =   Missing/incomplete/invalid occurrence
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to
              N299
      M46 =   Missing/incomplete/invalid occurrence
              span code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to
              N300
      M47 =   Missing/incomplete/invalid internal or
              document control number.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M48 =   Payment for services furnished to
              hospital inpatients (other than
              professional services of physicians) can
              only be made to the hospital. You must
              request payment from the hospital rather
              than the patient for this service.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using M97
      M49 =   Missing/incomplete/invalid value
              code(s)
              or amount(s).
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M50 =   Missing/incomplete/invalid revenue
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M51 =   Missing/incomplete/invalid procedure
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to N301
      M52 =   Missing/incomplete/invalid "from"
              date(s) of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M53 =   Missing/incomplete/invalid days or
              units
              of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M54 =   Missing/incomplete/invalid total
              charges.
              Start: 01/01/1997 |
      M55 =   We do not pay for self-administered
              anti-emetic drugs that are not
              administered with a covered oral
              anti-cancer drug.
              Start: 01/01/1997
      M56 =   Missing/incomplete/invalid payer
              identifier.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M57 =   Missing/incomplete/invalid provider
              identifier.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      M58 =   Missing/incomplete/invalid claim
              information. Resubmit claim after
              corrections.
              Start: 01/01/1997 | Stop: 02/05/2005
      M59 =   Missing/incomplete/invalid "to" date(s)
              of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M60 =   Missing Certificate of Medical
              Necessity.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 6/30/03)
              Related to N227
      M61 =   We cannot pay for this as the approval
              period for the FDA clinical trial has
              expired.
              Start: 01/01/1997
      M62 =   Missing/incomplete/invalid treatment
              authorization code.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M63 =   We do not pay for more than one of
              these
              on the same day.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using M86
      M64 =   Missing/incomplete/invalid other
              diagnosis.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M65 =   One interpreting physician charge can
              be submitted per claim when a purchased
              diagnostic test is indicated.
              Please submit a separate claim for each
              interpreting physician.
              Start: 01/01/1997
      M66 =   Our records indicate that you billed
              diagnostic tests subject to price
              limitations and the procedure code
              submitted includes a professional
              component. Only the technical component
              is subject to price limitations.
              Please submit the technical and
              professional components of this service
              as separate line items.
              Start: 01/01/1997
      M67 =   Missing/incomplete/invalid other
              procedure code(s).
              Start: 01/01/1997
              Notes: (Modified 12/2/04) Related to
              N302
      M68 =   Missing/incomplete/invalid attending,
              ordering, rendering, supervising or
              referring physician identification.
              Start: 01/01/1997
              Stop: 06/02/2005
      M69 =   Paid at the regular rate as you did not
              submit documentation to justify the
              modified procedure code.
              Start: 01/01/1997 |
              Notes: (Modified 2/1/04)
      M70 =   Alert: The NDC code submitted for this
              service was translated to a HCPCS code
              for processing, but please continue to
              submit the NDC on future claims for this
              item.
              Start: 01/01/1997 |
              Notes: (Modified 4/1/2007, 8/1/07)
      M71 =   Total payment reduced due to overlap of
              tests billed.
              Start: 01/01/1997
      M72 =   Did not enter full 8-digit date
              (MM/DD/CCYY).
              Start: 01/01/1997 |
              Stop: 10/16/2003
              Notes: Consider using MA52
      M73 =   The HPSA/Physician Scarcity bonus can
              only be paid on the professional
              component of this service. Rebill as
              separate professional and technical
              components.
              Start: 01/01/1997
              Notes: (Modified 8/1/04)
      M74 =   This service does not qualify for a
              HPSA/Physician Scarcity bonus payment.
              Start: 01/01/1997
              Notes: (Modified 12/2/04)
      M75 =   Multiple automated multichannel tests
              performed on the same day combined for
              payment.
              Start: 01/01/1997
              Notes: (Modified 11/5/07)
      M76 =   Missing/incomplete/invalid diagnosis or
              condition.
              Start: 01/01/1997
              Notes: (Modified 2/28/03)
      M77 =   Missing/incomplete/invalid place of
              service.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: (Modified 2/28/03)
      M78 =   Missing/incomplete/invalid HCPCS
              modifier.
              Start: 01/01/1997
              Stop: 05/18/2006
              Notes: (Modified 2/28/03,) Consider
              using Reason Code 4
      M79 =   Missing/incomplete/invalid charge.
              Start: 01/01/1997
              Notes: (Modified 2/28/03)
      M80 =   Not covered when performed during the
              same session/date as a previously
              processed service for the patient.
              Start: 01/01/1997
              Notes: (Modified 10/31/02)
      M81 =   You are required to code to the highest
              level of specificity.
              Start: 01/01/1997
              Notes: (Modified 2/1/04)
      M82 =   Service is not covered when patient is
              under age 50.
              Start: 01/01/1997
      M83 =   Service is not covered unless the
              patient is classified as at high risk.
              Start: 01/01/1997
      M84 =   Medical code sets used must be the
              codes
              in effect at the time of service
              Start: 01/01/1997
              Notes: (Modified 2/1/04)
      M85 =   Subjected to review of physician
              evaluation and management services.
              Start: 01/01/1997
      M86 =   Service denied because payment already
              made for same/similar procedure within
              set time frame.
              Start: 01/01/1997
      M87 =   Claim/service(s) subjected to CFO-CAP
              prepayment review.
              Start: 01/01/1997
      M88 =   We cannot pay for laboratory tests
              unless billed by the laboratory that did
              the work.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using Reason Code B20
      M89 =   Not covered more than once under age
              40.
              Start: 01/01/1997
      M90 =   Not covered more than once in a 12
              month
              period.
              Start: 01/01/1997
      M91 =   Lab procedures with different CLIA
              certification numbers must be billed on
              separate claims.
              Start: 01/01/1997
      M92 =   Services subjected to review under the
              Home Health Medical Review Initiative.
              Start: 01/01/1997 | Stop: 08/01/2004
      M93 =   Information supplied supports a break
              in
              therapy. A new capped rental period
              began with delivery of this equipment.
              Start: 01/01/1997
      M94 =   Information supplied does not support a
              break in therapy. A new capped rental
              period will not begin.
              Start: 01/01/1997
      M95 =   Services subjected to Home Health
              Initiative medical review/cost report
              audit.
              Start: 01/01/1997
      M96 =   The technical component of a service
              furnished to an inpatient may only be
              billed by that inpatient facility. You
              must contact the inpatient facility for
              technical component reimbursement. If
              not already billed, you should bill us
              for the professional component only.
              Start: 01/01/1997
      M97 =   Not paid to practitioner when provided
              to patient in this place of service.
              Payment included in the reimbursement
              issued the facility.
              Start: 01/01/1997
      M98 =   Begin to report the Universal Product
              Number on claims for items of this type.
              We will soon begin to deny payment for
              items of this type if billed without the
              correct UPN.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M99
      M99 =   Missing/incomplete/invalid Universal
              Product Number/Serial Number.
              Start: 01/01/1997
      M100 =  We do not pay for an oral anti-emetic
              drug that is not administered for use
              immediately before, at, or within 48
              hours of administration of a covered
              chemotherapy drug.
              Start: 01/01/1997
      M101 =  Begin to report a G1-G5 modifier with
              this HCPCS. We will soon begin to deny
              payment for this service if billed
              without a G1-G5 modifier.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M78
      M102 =  Service not performed on equipment
              approved by the FDA for this purpose.
              Start: 01/01/1997
      M103 =  Information supplied supports a break
              in therapy.  However, the medical info-
              mation we have for this patient does not
              support the need for this item
              as billed. We have approved payment for
              this item at a reduced level, and a new
              capped rental period will begin with the
              delivery of this equipment.
              Start: 01/01/1997
      M104 =  Information supplied supports a break
              in therapy. a new capped rental period
              will begom wieth delivery of the
              equipment.  This is the maximum approved
              under the fee schedule for this item or
              service.
              Start: 01/01/1997
      M105 =  Information supplied does not support a
              break in therapy. The medical
              information we have for this patient
              does not support the need for this item
              as billed. We have approved payment for
              this item at a reduced level, and a new
              capped rental period will not begin.
              Start: 01/01/1997
      M106 =  Information supplied does not support a
              break in therapy. A new capped rental
              period will not begin. This is the
              maximum approved under the fee schedule
              for this item or service.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using MA 31
      M107 =  Payment reduced as 90-day rolling
              average hematocrit for ESRD patient
              exceeded 36.5%.
              Start: 01/01/1997
      M108 =  Missing/incomplete/invalid provider
              identifier for the provider who
              interpreted the diagnostic test.
              Start: 01/01/1997 | Stop: 06/02/2005
      M109 =  We have provided you with a bundled
              payment for a teleconsultation. You must
              send 25 percent of the teleconsultation
              payment to the referring practitioner.
              Start: 01/01/1997
      M110 =  Missing/incomplete/invalid provider
              identifier for the provider from whom
              you purchased interpretation services.
              Start: 01/01/1997 | Stop: 06/02/2005
      M111 =  We do not pay for chiropractic
              manipulative treatment when the patient
              refuses to have an x-ray taken.
              Start: 01/01/1997
      M112 =  Reimbursement for this item is based on
              the single payment amount required under
              the DMEPOS Competitive Bidding Program
              for the area where the patient resides.
              Start: 01/01/1997
      M113 =  Our records indicate that this patient
              began using this item/service prior to
              the current contract period for the
              DMEPOS Competitive Bidding Program.
              Start: 01/01/1997
      M114 =  This service was processed in
              accordance with rules and guidelines
              under the DMEPOS Competitive Bidding
              Program or a Demonstration Project.
              For more information regarding these
              these projects, contact your local
              contractor.
              Start: 01/01/1997
      M115 =  This item is denied when provided to
              this patient by a non-contract or non-
              demonstration supplier.
              Start: 01/01/1997
      M116 =  Processed under a demonstration project
              or program. Project or program is
              ending and additional services may not
              be paid under this project or program.
              Start: 01/01/1997
      M117 =  Not covered unless submitted via
              electronic claim.
              Start: 01/01/1997
      M118 =  Letter to follow containing further
              information.
              Start: 01/01/1997
              Stop: 01/01/2011
      M119 =  Missing/incomplete/invalid/
              deactivated/withdrawn National Drug
              Code (NDC).
              Start: 01/01/1997
      M120 =  Missing/incomplete/invalid provider
              identifier for the substituting
              physician who furnished the service(s)
              under a reciprocal billing or locum
              tenens arrangement.
              Start: 01/01/1997
              Stop: 06/02/2005
      M121 =  We pay for this service only when
              performed with a covered cryosurgical
              ablation.
              Start: 01/01/1997
      M122 =  Missing/incomplete/invalid level of
              subluxation.
              Start: 01/01/1997
      M123 =  Missing/incomplete/invalid name,
              strength, or dosage of the drug
              furnished.
              Start: 01/01/1997
      M124 =  Missing indication of whether the
              patient owns the equipment that
              requires the part or supply.
              Start: 01/01/1997
              Notes: Related to N230
      M125 =  Missing/incomplete/invalid information
              on the period of time for which the
              service/supply/equipment will be
              needed.
              Start: 01/01/1997 |
      M126 =  Missing/incomplete/invalid individual
              lab codes included in the test.
              Start: 01/01/1997 |
      M127 =  Missing patient medical record for this
              service.
              Start: 01/01/1997 |
              Notes: Related to N237
      M128 =  Missing/incomplete/invalid date of the
              patient's last physician visit.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      M129 =  Missing/incomplete/invalid indicator of
              x-ray availability for review.
              Start: 01/01/1997
      M130 =  Missing invoice or statement certifying
              the actual cost of the lens, less
              discounts, and/or the type of
              intraocular lens used.
              Start: 01/01/1997
              Notes: Related to N231
      M131 =  Missing physician financial
              relationship form.
              Start: 01/01/1997
              Notes: Related to N239
      M132 =  Missing pacemaker registration form.
              Start: 01/01/1997
              Notes: Related to N235
      M133 =  Claim did not identify who performed
              the purchased diagnostic test or the
              amount you were charged for the test.
              Start: 01/01/1997
      M134 =  Performed by a facility/supplier in
              which the provider has a financial
              interest.
              Start: 01/01/1997
      M135 =  Missing/incomplete/invalid plan of
              treatment.
              Start: 01/01/1997
      M136 =  Missing/incomplete/invalid indication
              that the service was supervised or
              evaluated by a physician.
              Start: 01/01/1997
      M137 =  Part B coinsurance under a
              demonstration project or pilot program.
              Start: 01/01/1997
      M138 =  Patient identified as a demonstration
              participant but the patient was not
              enrolled in the demonstration at the
              time services were rendered. Coverage
              is limited to demonstration
              participants.
              Start: 01/01/1997
      M139 =  Denied services exceed the coverage
              limit for the demonstration.
              Start: 01/01/1997
      M140 =  Service not covered until after the
              patient's 50th birthday, i.e., no
              coverage prior to the day after the
              50th birthday
              Start: 01/01/1997
              Stop:  1/30/2004
              Notes: Consider using M82
      M141 =  Missing physician certified plan of
              care.
              Start: 01/01/1997
              Notes: Related to N238
      M142 =  Missing American Diabetes Association
              Certificate of Recognition.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: Related to N226
      M143 =  The provider must update license
              information with the payer.
              Start: 01/01/1997 |
      M144 =  Pre-/post-operative care payment is
              included in the allowance for the
              surgery/procedure.
              Start: 01/01/1997
      MA01 =  Alert: If you do not agree with what we
              approved for these services, you may
              appeal our decision. To make sure that
              we are fair to you, we require another
              individual that did not process your
              initial claim to conduct the appeal.
              However, in order to be eligible for an
              appeal, you must write to us within 120
              days of the date you received this
              notice, unless you have a good reason
              for being late.
              Start: 01/01/1997
              8/1/05, 4/1/07)
      MA02 =  Alert: If you do not agree with this
              determination, you have the right to
              appeal. You must file a written request
              for an appeal within 180 days of the
              date you receive this notice.
              Start: 01/01/1997
      MA03 =  If you do not agree with the approved
              amounts and $100 or more is in dispute
              (less deductible and coinsurance), you
              may ask for a hearing within six months
              of the date of this notice. To meet the
              $100, you may combine amounts on other
              claims that have been denied, including
              reopened appeals if you received a
              revised decision. You must appeal each
              claim on time.
              Start: 01/01/1997
              Stop: 10/01/2006
              Last Modified: 11/18/2005
              Notes: Consider using MA02 (Modified
              10/31/02, 6/30/03, 8/1/05, 11/18/05)
      MA04 =  Secondary payment cannot be considered
              without the identity of or payment
              information from the primary payer. The
              information was either not reported or
              was illegible.
              Start: 01/01/1997
      MA05 =  Incorrect admission date patient status
              or type of bill entry on claim.
              Start: 01/01/1997
              Stop: 10/16/2003
              Notes: Consider using MA30, MA40 or
              MA43
      MA06 =  Missing/incomplete/invalid beginning
              and/or ending date(s).
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using MA31
      MA07 =  Alert: The claim information has also
              been forwarded to Medicaid for review.
              Start: 01/01/1997
      MA08 =  Alert: Claim information was not
              forwarded because the supplemental
              coverage is not with a Medigap plan,
              or you do not participate in Medicare.
              Start: 01/01/1997
      MA09 =  Claim submitted as unassigned but
              processed as assigned. You agreed to
              accept assignment for all claims.
              Start: 01/01/1997
      MA10 =  Alert: The patient's payment was in
              excess of the amount owed. You must
              refund the overpayment to the patient.
              Start: 01/01/1997
      MA11 =  Payment is being issued on a
              conditional basis. If no-fault
              insurance, liability insurance,
              Workers' Compensation, Department of
              Veterans Affairs, or a group health
              plan for employees and dependents also
              covers this claim, a refund may be due
              us. Please contact us if the patient is
              covered by any of these sources.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M32
      MA12 =  You have not established that you have
              the right under the law to bill for
              services furnished by the person(s)
              that furnished this (these) service(s).
              Start: 01/01/1997
      MA13 =  Alert: You may be subject to penalties
              if you bill the patient for amounts not
              reported with the PR (patient
              responsibility) group code.
              Start: 01/01/1997
      MA14 =  Alert: The patient is a member of an
              employer-sponsored prepaid health plan.
              Services from outside that health plan
              are not covered. However, as you were
              not previously notified of this, we are
              paying this time. In the future, we
              will not pay you for non-plan services.
              Start: 01/01/1997
      MA15 =  Alert: Your claim has been separated to
              expedite handling. You will receive a
              separate notice for the other services
              reported.
              Start: 01/01/1997 |
      MA16 =  The patient is covered by the Black
              Lung Program. Send this claim to the
              Department of Labor, Federal Black Lung
              Program, P.O. Box 828, Lanham-Seabrook
              MD 20703.
              Start: 01/01/1997
      MA17 =  We are the primary payer and have paid
              at the primary rate. You must contact
              the patient's other insurer to refund
              any excess it may have paid due to its
              erroneous primary payment.
              Start: 01/01/1997
      MA18 =  Alert: The claim information is also
              being forwarded to the patient's
              supplemental insurer. Send any
              questions regarding supplemental
              benefits to them.
              Start: 01/01/1997
      MA19 =  Alert: Information was not sent to the
              Medigap insurer due to
              incorrect/invalid information you
              submitted concerning that insurer.
              Please verify your information and
              submit your secondary claim directly to
              that insurer.
              Start: 01/01/1997
      MA20 =  Skilled Nursing Facility (SNF) stay not
              covered when care is primarily related
              to the use of an urethral catheter for
              convenience or the control of
              incontinence.
              Start: 01/01/1997
      MA21 =  SSA records indicate mismatch with name
              and sex.
              Start: 01/01/1997
      MA22 =  Payment of less than $1.00 suppressed.
              Start: 01/01/1997
      MA23 =  Demand bill approved as result of
              medical review.
              Start: 01/01/1997
      MA24 =  Christian Science Sanitarium/ Skilled
              Nursing Facility (SNF) bill in the same
              benefit period.
              Start: 01/01/1997 |
      MA25 =  A patient may not elect to change a
              hospice provider more than once in a
              benefit period.
              Start: 01/01/1997
      MA26 =  Alert: Our records indicate that you
              were previously informed of this rule.
              Start: 01/01/1997 |
      MA27 =  Missing/incomplete/invalid entitlement
              number or name shown on the claim.
              Start: 01/01/1997 |
      MA28 =  Alert: Receipt of this notice by a
              physician or supplier who did not
              accept assignment is for information
              only and does not make the physician or
              supplier a party to the determination.
              No additional rights to appeal this
              decision, above those rights already
              provided for by regulation/instruction,
              are conferred by receipt of this
              notice.
              Start: 01/01/1997 |
      MA29 =  Missing/incomplete/invalid provider
              name, city, state, or zip code.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA30 =  Missing/incomplete/invalid type of
              bill.
              Start: 01/01/1997 |
      MA31 =  Missing/incomplete/invalid beginning
              and ending dates of the period billed.
              Start: 01/01/1997 |
      MA32 =  Missing/incomplete/invalid number of
              covered days during the billing period.
              Start: 01/01/1997 |
      MA33 =  Missing/incomplete/invalid noncovered
              days during the billing period.
              Start: 01/01/1997 |
      MA34 =  Missing/incomplete/invalid number of
              coinsurance days during the billing
              period.
              Start: 01/01/1997
      MA35 =  Missing/incomplete/invalid number of
              lifetime reserve days.
              Start: 01/01/1997 |
      MA36 =  Missing/incomplete/invalid patient
              name.
              Start: 01/01/1997 |
      MA37 =  Missing/incomplete/invalid patient's
              address.
              Start: 01/01/1997 |
      MA38 =  Missing/incomplete/invalid birth date.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA39 =  Missing/incomplete/invalid gender.
              Start: 01/01/1997 |
      MA40 =  Missing/incomplete/invalid admission
              date.
              Start: 01/01/1997 |
      MA41 =  Missing/incomplete/invalid admission
              type.
              Start: 01/01/1997 |
      MA42 =  Missing/incomplete/invalid admission
              source.
              Start: 01/01/1997 |
      MA43 =  Missing/incomplete/invalid patient
              status.
              Start: 01/01/1997 |
      MA44 =  Alert: No appeal rights. Adjudicative
              decision based on law.
              Start: 01/01/1997
      MA45 =  Alert: As previously advised, a portion
              or all of your payment is being held in
              a special account.
              Start: 01/01/1997
      MA46 =  The new information was considered but
              additional payment will not be issued.
              Start: 01/01/1997 |
      MA47 =  Our records show you have opted out of
              Medicare, agreeing with the patient not
              to bill Medicare for
              services/tests/supplies furnished. As
              result, we cannot pay this claim. The
              patient is responsible for payment.
              Start: 01/01/1997
      MA48 =  Missing/incomplete/invalid name or
              address of responsible party or primary
              payer.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: (Modified 2/28/03)
      MA49 =  Missing/incomplete/invalid six-digit
              provider identifier for home health
              agency or hospice for physician(s)
              performing care plan oversight
              services.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using MA76
      MA50 =  Missing/incomplete/invalid
              Investigational Device Exemption number
              for FDA-approved clinical trial
              services.
              Start: 01/01/1997 |
      MA51 =  Missing/incomplete/invalid CLIA
              certification number for laboratory
              services billed by physician office
              laboratory.
              Start: 01/01/1997 |
              Stop: 02/05/2005
              Notes: Consider using MA120
      MA52 =  Missing/incomplete/invalid date.
              Start: 01/01/1997 | Stop: 06/02/2005
      MA53 =  Missing/incomplete/invalid Competitive
              Bidding Demonstration Project
              identification.
              Start: 01/01/1997 |
      MA54 =  Physician certification or election
              consent for hospice care not received
              timely.
              Start: 01/01/1997
      MA55 =  Not covered as patient received medical
              health care services, automatically
              revoking his/her election to receive
              religious non-medical health care
              services.
              Start: 01/01/1997
      MA56 =  Our records show you have opted out of
              Medicare, agreeing with the patient not
              to bill Medicare for
              services/tests/supplies furnished. As
              result, we cannot pay this claim. The
              patient is responsible for payment, but
              under  Federal law, you cannot charge
              the patient more than the limiting
              charge amount.
              Start: 01/01/1997
      MA57 =  Patient submitted written request to
              revoke his/her election for religious
              non-medical health care services.
              Start: 01/01/1997
      MA58 =  Missing/incomplete/invalid release of
              information indicator.
              Start: 01/01/1997 |
      MA59 =  Alert: The patient overpaid you for
              these services. You must issue the
              patient a refund within 30 days for the
              difference between his/her payment and
              the total amount shown as patient
              responsibility on this notice.
              Start: 01/01/1997 |
      MA60 =  Missing/incomplete/invalid patient
              relationship to insured.
              Start: 01/01/1997 |
      MA61 =  Missing/incomplete/invalid social
              security number or health insurance
              claim number.
              Start: 01/01/1997 |
      MA62 =  Alert: This is a telephone review
              decision.
              Start: 01/01/1997 |
      MA63 =  Missing/incomplete/invalid principal
              diagnosis.
              Start: 01/01/1997 |
      MA64 =  Our records indicate that we should be
              the third payer for this claim. We
              cannot process this claim until we have
              received payment information from the
              primary and secondary payers.
              Start: 01/01/1997
      MA65 =  Missing/incomplete/invalid admitting
              diagnosis.
              Start: 01/01/1997 |
      MA66 =  Missing/incomplete/invalid principal
              procedure code.
              Start: 01/01/1997 |
              Notes: Related to N303
      MA67 =  Correction to a prior claim.
              Start: 01/01/1997
      MA68 =  Alert: We did not crossover this claim
              because the secondary insurance
              information on the claim was incomplete.
              Please supply complete information or
              use the PLANID of the insurer to assure
              correct and timely routing of the claim.
              Start: 01/01/1997 |
      MA69 =  Missing/incomplete/invalid remarks.
              Start: 01/01/1997
      MA70 =  Missing/incomplete/invalid provider
              representative signature.
              Start: 01/01/1997 |
      MA71 =  Missing/incomplete/invalid provider
              representative signature date.
              Start: 01/01/1997 |
      MA72 =  Alert: The patient overpaid you for
              these assigned services. You must issue
              the patient a refund within 30 days for
              the difference between his/her payment
              to you and the total of the amount
              shown as patient responsibility and as
              paid to the patient on this notice.
              Start: 01/01/1997 |
      MA73 =  Informational remittance associated
              with a Medicare demonstration. No
              payment issued under fee-for-service
              Medicare as patient has elected managed
              care.
              Start: 01/01/1997
      MA74 =  This payment replaces an earlier
              payment for this claim that was either
              lost, damaged or returned.
              Start: 01/01/1997
      MA75 =  Missing/incomplete/invalid patient or
              authorized representative signature.
              Start: 01/01/1997
      MA76 =  Missing/incomplete/invalid provider
              identifier for home health agency or
              hospice when physician is performing
              care plan oversight services.
              Start: 01/01/1997
      MA77 =  Alert: The patient overpaid you. You
              must issue the patient a refund within
              30 days for the difference between the
              patient's payment less the total of our
              and other payer payments and the amount
              shown as patient responsibility on this
              notice.
              Start: 01/01/1997
      MA78 =  The patient overpaid you. You must
              issue the patient a refund within 30
              days for the difference between our
              allowed amount total and the amount
              paid by the patient.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using MA59
      MA79 =  Billed in excess of interim rate.
              tart: 01/01/1997
      MA80 =  Informational notice. No payment issued
              for this claim with this notice.
              Payment issued to the hospital by its
              intermediary for all services for this
              encounter under a demonstration
              project.
              Start: 01/01/1997
      MA81 =  Missing/incomplete/invalid
              provider/supplier signature.
              Start: 01/01/1997 |
      MA82 =  Missing/incomplete/invalid
              provider/supplier billing
              number/identifier or billing name,
              address, city, state, zip code, or
              phone number.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA83 =  Did not indicate whether we are the
              primary or secondary payer.
              Start: 01/01/1997 |
      MA84 =  Patient identified as participating in
              the National Emphysema Treatment Trial
              but our records indicate that this
              patient is either not a participant,
              or has not yet been approved for this
              phase of the study. Contact Johns
              Hopkins University, the study coordinator,
              to resolve if there was a discrepancy.
              Start: 01/01/1997
      MA85 =  Our records indicate that a primary
              payer exists (other than ourselves);
              however, you did not complete or enter
              accurately the insurance
              plan/group/program name or
              identification number. Enter the PlanID
              when effective.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA86 =  Missing/incomplete/invalid group or
              policy number of the insured for the
              primary coverage.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA87 =  Missing/incomplete/invalid insured's
              name for the primary payer.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA88 =  Missing/incomplete/invalid insured's
              address and/or telephone number for the
              primary payer.
              Start: 01/01/1997 |
      MA89 =  Missing/incomplete/invalid patient's
              relationship to the insured for the
              primary payer.
              Start: 01/01/1997 |
      MA90 =  Missing/incomplete/invalid employment
              status code for the primary insured.
              Start: 01/01/1997
      MA91 =  This determination is the result of the
              appeal you filed.
              Start: 01/01/1997
      MA92 =  Missing plan information for other
              insurance.
              Start: 01/01/1997
              Notes: Related to N245
              N245
      MA93 =  Non-PIP (Periodic Interim Payment)
              claim.
              Start: 01/01/1997
      MA94 =  Did not enter the statement "Attending
              physician not hospice employee" on the
              claim form to certify that the
              rendering physician is not an employee
              of the hospice.
              Start: 01/01/1997
              Notes: (Reactivated 4/1/04, Modified
              8/1/05)
      MA95 =  A not otherwise classified or unlisted
              procedure code(s) was billed but a
              narrative description of the procedure
              was not entered on the claim. Refer to
              item 19 on the HCFA-1500.
              Start: 01/01/1997
              Stop:  01/01/2004
              Notes: (Deactivated 2/28/2003)
              (Erroneous description corrected
              9/2/2008) Consider using M51
      MA96 =  Claim rejected. Coded as a Medicare
              Managed Care Demonstration but patient
              is not enrolled in a Medicare managed
              care plan.
              Start: 01/01/1997
      MA97 =  Missing/incomplete/invalid Medicare
              Managed Care Demonstration contract
              number or clinical trial registry
              number.
              Start: 01/01/1997 |
      MA98 =  Claim Rejected. Does not contain the
              correct Medicare Managed Care
              Demonstration contract number for this
              beneficiary.
              Start: 01/01/1997 |
              Stop: 10/16/2003
              Notes: Consider using MA97
      MA99 =  Missing/incomplete/invalid Medigap
              information.
              Start: 01/01/1997 |
      MA100 = Missing/incomplete/invalid date of
              current illness or symptoms
              Start: 01/01/1997 |
      MA101 = A Skilled Nursing Facility (SNF) is
              responsible for payment of outside
              providers who furnish these
              services/supplies to residents.
              Start: 01/01/1997
              Stop: 01/01/2011
              Notes: Consider using N538
      MA102 = Missing/incomplete/invalid name or
              provider identifier for the
              rendering/referring/ ordering/
              supervising provider.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using M68
      MA103 = Hemophilia Add On.
              Start: 01/01/1997
      MA104 = Missing/incomplete/invalid date the
              patient was last seen or the provider
              identifier of the attending physician.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M128 or M57
      MA105 = Missing/incomplete/invalid provider
              number for this place of service.
              Start: 01/01/1997
              Stop: 06/02/2005
      MA106 = PIP (Periodic Interim Payment) claim.
              Start: 01/01/1997
      MA107 = Paper claim contains more than three
              separate data items in field 19.
              Start: 01/01/1997
      MA108 = Paper claim contains more than one data
              item in field 23.
              Start: 01/01/1997
      MA109 = Claim processed in accordance with
              ambulatory surgical guidelines.
              Start: 01/01/1997
      MA110 = Missing/incomplete/invalid information
              on whether the diagnostic test(s) were
              performed by an outside entity or if no
              purchased tests are included on the
              claim.
              Start: 01/01/1997
      MA111 = Missing/incomplete/invalid purchase
              price of the test(s) and/or the
              performing laboratory's name and
              address.
              Start: 01/01/1997
      MA112 = Missing/incomplete/invalid group
              practice information.
              Start: 01/01/1997
      MA113 = Incomplete/invalid taxpayer
              identification number (TIN) submitted
              by you per the Internal Revenue
              Service. Your claims cannot be
              processed without your correct TIN, and
              you may not bill the patient pending
              correction of your TIN. There are no
              appeal rights for unprocessable claims,
              but you may resubmit this claim after
              you have notified this office of your
              correct TIN.
              Start: 01/01/1997
      MA114 = Missing/incomplete/invalid information
              on where the services were furnished.
              Start: 01/01/1997
      MA115 = Missing/incomplete/invalid physical
              location (name and address, or PIN)
              where the service(s) were rendered in a
              Health Professional Shortage Area
              (HPSA).
              Start: 01/01/1997
      MA116 = Did not complete the statement
              'Homebound' on the claim to validate
              whether laboratory services were
              performed at home or in an institution.
              Start: 01/01/1997
              Notes: (Reactivated 4/1/04)
      MA117 = This claim has been assessed a $1.00
              user fee.
              Start: 01/01/1997
      MA118 = Coinsurance and/or deductible amounts
              apply to a claim for services or
              supplies furnished to a Medicare-
              eligible veteran through a facility of
              the Department of Veterans Affairs. No
              Medicare payment issued.
              Start: 01/01/1997
      MA119 = Provider level adjustment for late
              claim filing applies to this claim.
              Start: 01/01/1997
              Stop: 05/01/2008
              Notes: Consider using Reason Code B4
      MA120 = Missing/incomplete/invalid CLIA
              certification number.
              Start: 01/01/1997
      MA121 = Missing/incomplete/invalid x-ray date.
              Start: 01/01/1997
      MA122 = Missing/incomplete/invalid initial
              treatment date.
              Start: 01/01/1997
      MA123 = Your center was not selected to
              participate in this study, therefore,
              we cannot pay for these services.
              Start: 01/01/1997
      MA124 = Processed for IME only.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using Reason Code 74
      MA125 = Per legislation governing this program,
              payment constitutes payment in full.
              Start: 01/01/1997
      MA126 = Pancreas transplant not covered unless
              kidney transplant performed.
              Start: 10/12/2001
      MA127 = Reserved for future use.
              Start: 10/12/2001
              Stop:  06/02/2005
      MA128 = Missing/incomplete/invalid FDA approval
              number.
              Start: 10/12/2001
      MA129 = This provider was not certified for
              this procedure on this date of service.
              Start: 10/12/2001
              Stop:  01/31/2004
              Notes: Consider using MA120 and Reason
              Code B7
      MA130 = Your claim contains incomplete and/or
              invalid information, and no appeal
              rights are afforded because the claim
              is unprocessable. Please submit a new
              claim with the complete/correct
              information.
              Start: 10/12/2001
      MA131 = Physician already paid for services in
              conjunction with this demonstration
              claim. You must have the physician
              withdraw that claim and refund the
              payment before we can process your
              claim.
              Start: 10/12/2001
      MA132 = Adjustment to the pre-demonstration
              rate.
              Start: 10/12/2001
      MA133 = Claim overlaps inpatient stay. Rebill
              only those services rendered outside
              the inpatient stay.
              Start: 10/12/2001
      MA134 = Missing/incomplete/invalid provider
              number of the facility where the patient resides.
              Start: 10/12/2001
      N1 = Alert: You may appeal this decision in
           writing within the required time limits
           following receipt of this notice by
           following the instructions included in
           your contract or plan benefit
           documents.
           Start: 01/01/2000
      N2 = This allowance has been made in
           accordance with the most appropriate
           course of treatment provision of the
           plan.
           Start: 01/01/2000
      N3 = Missing consent form.
           Start: 01/01/2000
           Notes: Related to N228
      N4 = Missing/Incomplete/Invalid prior Insurance
           Carrier(s) EOB.
           Start: 01/01/2000
      N5 = EOB received from previous payer. Claim
           not on file.
           Start: 01/01/2000
      N6 = Under FEHB law (U.S.C. 8904(b)), we
           cannot pay more for covered care than
           the amount Medicare would have allowed
           if the patient were enrolled in
           Medicare Part A and/or Medicare Part B.
           Start: 01/01/2000
      N7 = Processing of this claim/service has
           included consideration under Major
           Medical provisions.
           Start: 01/01/2000
      N8 = Crossover claim denied by previous
           payer and complete claim data not
           forwarded. Resubmit this claim to this
           payer to provide adequate data for
           adjudication.
           Start: 01/01/2000
      N9 = Adjustment represents the estimated
           amount a previous payer may pay.
           Start: 01/01/2000
      N10 = Payment based on the findings of a
            review organization/professional
            consult/manual adjudication/medical or
            dental advisor.
            Start: 01/01/2000
      N11 = Denial reversed because of medical
            review.
            Start: 01/01/2000
      N12 = Policy provides coverage supplemental
            to Medicare. As the member does not
            appear to be enrolled in the applicable
            part of Medicare, the member is
            responsible for payment of the portion
            of the charge that would have been
            covered by Medicare.
            Start: 01/01/2000 |
      N13 = Payment based on professional/technical
            component modifier(s).
            Start: 01/01/2000
      N14 = Payment based on a contractual amount
            or agreement, fee schedule, or maximum
            allowable amount.
            Start: 01/01/2000 |
            Stop: 10/01/2007
            Notes: Consider using Reason Code 45
      N15 = Services for a newborn must be billed
            separately.
            Start: 01/01/2000
      N16 = Family/member Out-of-Pocket maximum has
            been met. Payment based on a higher
            percentage.
            Start: 01/01/2000
      N17 = Per admission deductible.
            Start: 01/01/2000
            Stop: 08/01/2004
            Notes: Consider using Reason Code 1
      N18 = Payment based on the Medicare allowed
            amount.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using N14
      N19 = Procedure code incidental to primary
            procedure.
            Start: 01/01/2000
      N20 = Service not payable with other service
            rendered on the same date.
            Start: 01/01/2000
      N21 = Alert: Your line item has been
            separated into multiple lines to
            expedite handling.
            Start: 01/01/2000
      N22 = This procedure code was added/changed
             because it more accurately describes
             the services rendered.
             Start: 01/01/2000
      N23 = Alert: Patient liability may be
            affected due to coordination of
            benefits with other carriers and/or
            maximum benefit provisions.
            Start: 01/01/2000
      N24 = Missing/incomplete/invalid Electronic
            Funds Transfer (EFT) banking
            information.
            Start: 01/01/2000
      N25 = This company has been contracted by
             your benefit plan to provide
             administrative claims payment services
             only. This company does not assume
             financial risk or obligation with
             respect to claims processed on behalf
             of your benefit plan.
             Start: 01/01/2000
      N26 = Missing itemized bill/statement.
             Start: 01/01/2000
             Related to N232
      N27 = Missing/incomplete/invalid treatment
            number.
            Start: 01/01/2000
            Last Modified: 02/28/2003
            Notes: (Modified 2/28/03)
      N28 = Consent form requirements not
            fulfilled.
            Start: 01/01/2000
      N29 = Missing documentation/orders/
            notes/summary/report/chart.
            Start: 01/01/2000
            Notes: Related to N225
      N30 = Patient ineligible for this service.
            Start: 01/01/2000 | Last Modified: 06/30/2003
      N31 = Missing/incomplete/invalid prescribing
            provider identifier.
            Start: 01/01/2000
      N32 = Claim must be submitted by the provider
            who rendered the service.
            Start: 01/01/2000
      N33 = No record of health check prior to
            initiation of treatment.
            Start: 01/01/2000
      N34 = Incorrect claim form/format for this
            service.
            Start: 01/01/2000
      N35 = Program integrity/utilization review
            decision.
            Start: 01/01/2000
      N36 = Claim must meet primary payer's
            processing requirements before we can
            consider payment.
            Start: 01/01/2000
      N37 = Missing/incomplete/invalid tooth
            number/letter.
            Start: 01/01/2000
      N38 = Missing/incomplete/invalid place of
            service.
            Start: 01/01/2000
            Stop: 02/05/2005
            Notes: Consider using M77
      N39 = Procedure code is not compatible with
            tooth number/letter.
            Start: 01/01/2000
      N40 = Missing radiology film(s)/image(s).
            Start: 01/01/2000
            Notes: Related to N242
      N41 = Authorization request denied.
            Start: 01/01/2000 |
            Stop: 10/16/2003
            Notes: Consider using Reason Code 39
      N42 = No record of mental health assessment.
            Start: 01/01/2000
      N43 = Bed hold or leave days exceeded.
            Start: 01/01/2000
      N44 = Payer's share of regulatory surcharges,
            assessments, allowances or health
            care-related taxes paid directly to the
            regulatory authority.
            Start: 01/01/2000 |
            Stop: 10/16/2003
            Notes: Consider using Reason Code 137
      N45 = Payment based on authorized amount.
            Start: 01/01/2000
      N46 = Missing/incomplete/invalid admission
            hour.
            Start: 01/01/2000
      N47 = Claim conflicts with another inpatient
            stay.
            Start: 01/01/2000
      N48 = Claim information does not agree with
            information received from other
            insurance carrier.
            Start: 01/01/2000
      N49 = Court ordered coverage information
            needs validation.
            Start: 01/01/2000
      N50 = Missing/incomplete/invalid discharge
            information.
            Start: 01/01/2000
      N51 = Electronic interchange agreement not on
            file for provider/submitter.
            Start: 01/01/2000
      N52 = Patient not enrolled in the billing
            provider's managed care plan on the
            date of service.
            Start: 01/01/2000
      N53 = Missing/incomplete/invalid point of
            pick-up address.
            Start: 01/01/2000
            Notes: (Modified 2/28/03)
      N54 = Claim information is inconsistent with
            pre-certified/authorized services.
            Start: 01/01/2000
      N55 = Procedures for billing with
            group/referring/performing providers
            were not followed.
            Start: 01/01/2000
      N56 = Procedure code billed is not
            correct/valid for the services billed
            or the date of service billed.
            Start: 01/01/2000
      N57 = Missing/incomplete/invalid prescribing
            date.
            Start: 01/01/2000
            Notes: Related to N304
      N58 = Missing/incomplete/invalid patient
            liability amount.
            Start: 01/01/2000
      N59 = Please refer to your provider manual
            for additional program and provider
            information.
            Start: 01/01/2000
      N60 = A valid NDC is required for payment of
            drug claims effective October 02.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using M119
      N61 = Rebill services on separate claims.
            Start: 01/01/2000
      N62 = Dates of service span multiple rate
            periods. Resubmit separate claims.
            Start: 01/01/2000
      N63 = Rebill services on separate claim
            lines.
            Start: 01/01/2000
      N64 = The "from" and "to" dates must be
            different.
            Start: 01/01/2000
      N65 = Procedure code or procedure rate count
            cannot be determined, or was not on
            file, for the date of service/provider.
            Start: 01/01/2000
      N66 = Missing/incomplete/invalid
            documentation.
            Start: 01/01/2000
            Stop: 02/05/2005
            Notes: Consider using N29 or N225.
      N67 = Professional provider services not paid
            separately. Included in facility
            payment under a demonstration project.
            Apply to that facility for payment, or
            resubmit your claim if: the facility
            notifies you the patient was excluded
            from this demonstration; or if you
            furnished these services in another
            location on the date of the patient's
            admission or discharge from a
            demonstration hospital. If services
            were furnished in a facility not
            involved in the demonstration on the
            same date the patient was discharged
            from or admitted to a demonstration facility,
            you must report the provider
            ID number for the non-demonstration
            facility on the new claim.
            Start: 01/01/2000
      N68 = Prior payment being cancelled as we
            were subsequently notified this patient
            was covered by a demonstration project
            in this site of service. Professional
            services were included in the payment
            made to the facility. You must contact
            the facility for your payment. Prior
            payment made to you by the patient or
            another insurer for this claim must be
            refunded to the payer within 30 days.
            Start: 01/01/2000
      N69 = PPS (Prospective Payment System) code
            changed by claims processing system.
            Start: 01/01/2000
      N70 = Consolidated billing and payment
            applies.
            Start: 01/01/2000
      N71 = Your unassigned claim for a drug or
            biological, clinical diagnostic
            laboratory services or ambulance
            service was processed as an assigned
            claim. You are required by law to
            accept assignment for these types of
            claims.
            Start: 01/01/2000
      N72 = PPS (Prospective Payment System) code
            changed by medical reviewers. Not
            supported by clinical records.
            Start: 01/01/2000
      N73 = A Skilled Nursing Facility is
            responsible for payment of outside
            providers who furnish these services/
            supplies under arrangement to
            its residents.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using MA101 or N200
      N74 = Resubmit with multiple claims, each
            claim covering services provided in
            only one calendar month.
            Start: 01/01/2000
      N75 = Missing/incomplete/invalid tooth
            surface information.
            Start: 01/01/2000
      N76 = Missing/incomplete/invalid number of
            riders.
            Start: 01/01/2000
      N77 = Missing/incomplete/invalid designated
            provider number.
            Start: 01/01/2000
      N78 = The necessary components of the child
            and teen checkup (EPSDT) were not
            completed.
            Start: 01/01/2000
      N79 = Service billed is not compatible with
            patient location information.
            Start: 01/01/2000
      N80 = Missing/incomplete/invalid prenatal
            screening information.
            Start: 01/01/2000 |
      N81 = Procedure billed is not compatible with
            tooth surface code.
            Start: 01/01/2000
      N82 = Provider must accept insurance payment
            as payment in full when a third party
            payer contract specifies full
            reimbursement.
            Start: 01/01/2000
      N83 = No appeal rights. Adjudicative decision
            based on the provisions of a
            demonstration project.
            Start: 01/01/2000
      N84 = Alert: Further installment payments are
            forthcoming.
            Start: 01/01/2000 |
      N85 = Alert: This is the final installment
            payment.
            Start: 01/01/2000 | Last Modified: 04/01/2007
            Notes: (Modified 4/1/07, 8/1/07)
      N86 = A failed trial of pelvic muscle
            exercise training is required in order
            for biofeedback training for the
            treatment of urinary incontinence to be
            covered.
            Start: 01/01/2000
      N87 = Home use of biofeedback therapy is not
            covered.
            Start: 01/01/2000
      N88 = Alert: This payment is being made
            conditionally. An HHA episode of care
            notice has been filed for this patient.
            When a patient is treated under a HHA
            episode of care, consolidated billing
            requires that certain therapy services
            and supplies, such as this, be included
            in the HHA's payment. This payment will
            need to be recouped from you if we
            establish that the patient is
            concurrently receiving treatment under
            a HHA episode of care.
            Start: 01/01/2000
      N89 = Alert: Payment information for this
            claim has been forwarded to more than
            one other payer, but format limitations
            permit only one of the secondary payers
            to be identified in this remittance
            advice.
            Start: 01/01/2000
      N90 = Covered only when performed by the
            attending physician.
            Start: 01/01/2000
      N91 = Services not included in the appeal
            review.
            Start: 01/01/2000
      N92 = This facility is not certified for
            digital mammography.
            Start: 01/01/2000
      N93 = A separate claim must be submitted for
            each place of service. Services
            furnished at multiple sites may not be
            billed in the same claim.
            Start: 01/01/2000
      N94 = Claim/Service denied because a more
            specific taxonomy code is required for
            adjudication.
            Start: 01/01/2000
      N95 = This provider type/provider specialty
            may not bill this service.
            Start: 07/31/2001
      N96 = Patient must be refractory to
            conventional therapy (documented
            behavioral, pharmacologic and/or
            surgical corrective therapy) and be an
            appropriate surgical candidate such
            that implantation with anesthesia can
            occur.
            Start: 08/24/2001
      N97 = Patients with stress incontinence,
            urinary obstruction, and specific
            neurologic diseases (e.g., diabetes
            with peripheral nerve involvement)
            which are associated with secondary
            manifestations of the above three
            indications are excluded.
            Start: 08/24/2001
      N98 = Patient must have had a successful test
            stimulation in order to support
            subsequent implantation. Before a
            patient is eligible for permanent
            implantation, he/she must demonstrate a
            50 percent or greater improvement
            through test stimulation. Improvement
            is measured through voiding diaries.
            Start: 08/24/2001
      N99 = Patient must be able to demonstrate
            adequate ability to record voiding
            diary data such that clinical results
            of the implant procedure can be
            properly evaluated.
            Start: 08/24/2001
      N100 = PPS (Prospect Payment System) code
             corrected during adjudication.
             Start: 09/14/2001
      N101 = Additional information is needed in
             order to process this claim. Please
             resubmit the claim with the
             identification number of the provider
             where this service took place. The
             Medicare number of the site of service
             provider should be preceded with the
             letters 'HSP' and entered into item #32
             on the claim form. You may bill only one
             site of service provider number per
             claim.
             Start: 10/31/2001
             Stop: 01/31/2004
             Notes: Consider uisng MA105
      N102 = This claim has been denied without
             reviewing the medical record because
             the requested records were not received
             or were not received timely.
             Start: 10/31/2001
      N103 = Social Security records indicate that
             this patient was a prisoner when the
             service was rendered. This payer does
             not cover items and services furnished
             to an individual while he or she is in
             a Federal facility, or while he or she
             is in State or local custody under a
             penal authority, unless under State or
             local law, the individual is personally
             liable for the cost of his or her
             health care while incarcerated and the
             State or local government pursues such
             debt in the same way and with the same
             vigor as any other debt.
             Start: 10/31/2001
      N104 = This claim/service is not payable under
             our claims jurisdiction area. You can
             identify the correct Medicare
             contractor to process this
             claim/service through the CMS website
             at www.cms.gov.
             Start: 01/29/2002
      N105 = This is a misdirected claim/service for
             an RRB beneficiary. Submit paper claims
             to the RRB carrier: Palmetto GBA, P.O.
             Box 10066, Augusta, GA 30999. Call
             866-749-4301 for RRB EDI information
             for electronic claims processing.
             Start: 01/29/2002
      N106 = Payment for services furnished to
             Skilled Nursing Facility (SNF)
             inpatients (except for excluded
             services) can only be made to the SNF.
             You must request payment from the SNF
             rather than the patient for this
             service.
             Start: 01/31/2002
      N107 = Services furnished to Skilled Nursing
             Facility (SNF) inpatients must be
             billed on the inpatient claim. They
             cannot be billed separately as
             outpatient services.
             Start: 01/31/2002
      N108 = Missing/incomplete/invalid upgrade
             information.
             Start: 01/31/2002 |
             Last Modified: 02/28/2003
             Notes: (Modified 2/28/03)
      N109 = This claim/service was chosen for
             complex review and was denied after
             reviewing the medical records.
             Start: 02/28/2002
             Last Modified: 03/01/2009
             Notes: (Modified 3/1/2009)
      N110 = This facility is not certified for film
             mammography.
             Start: 02/28/2002
      N111 = No appeal right except duplicate
             claim/service issue. This service was
             included in a claim that has been
             previously billed and adjudicated.
             Start: 02/28/2002
      N112 = This claim is excluded from your
             electronic remittance advice.
             Start: 02/28/2002
      N113 = Only one initial visit is covered per
             physician, group practice or provider.
             Start: 04/16/2002
      N114 = During the transition to the Ambulance
             Fee Schedule, payment is based on the
             lesser of a blended amount calculated
             using a percentage of the reasonable
             charge/cost and fee schedule amounts,
             or the submitted charge for the
             service. You will be notified yearly
             what the percentages for the blended
             payment calculation will be.
             Start: 05/30/2002
      N115 = This decision was based on a Local
             Coverage Determination (LCD). An LCD
             provides a guide to assist in
             determining whether a particular item
             or service is covered. A copy of this
             policy is available at www.cms.gov/mcd,
             or if you do not have web access, you
             may contact the contractor to request a
             copy of the LCD.
             Start: 05/30/2002
      N116 = This payment is being made
             conditionally because the service was
             provided in the home, and it is
             possible that the patient is under a
             home health episode of care. When a
             patient is treated under a home health
             episode of care, consolidated billing
             requires that certain therapy services
             and supplies, such as this, be included
             in the home health agency's (HHA's)
             payment. This payment will need to be
             recouped from you if we establish that
             the patient is concurrently receiving
             treatment under an HHA episode of care.
             Start: 06/30/2002
      N117 = This service is paid only once in a
             patient's lifetime.
             Start: 07/30/2002
      N118 = This service is not paid if billed more
             than once every 28 days.
             Start: 07/30/2002
      N119 = This service is not paid if billed once
             every 28 days, and the patient has
             spent 5 or more consecutive days in any
             inpatient or Skilled /nursing Facility
             (SNF) within those 28 days.
             Start: 07/30/2002
      N120 = Payment is subject to home health
             prospective payment system partial
             episode payment adjustment. Patient was
             transferred/discharged/readmitted
             during payment episode.
             Start: 08/09/2002
      N121 = Medicare Part B does not pay for items
             or services provided by this type of
             practitioner for beneficiaries in a
             Medicare Part A covered Skilled Nursing
             Facility (SNF) stay.
             Start: 09/09/2002
      N122 = Add-on code cannot be billed by itself.
             Start: 09/12/2002
      N123 = This is a split service and represents
             a portion of the units from the
             originally submitted service.
             Start: 09/24/2002
      N124 = Payment has been denied for the/made
             only for a less extensive service/item
             because the information furnished does
             not substantiate the need for the (more
             extensive) service/item. The patient is
             liable for the charges for this
             service/item as you informed the
             patient in writing before the
             service/item was furnished that we
             would not pay for it, and the patient
             agreed to pay.
             Start: 09/26/2002
             "Payment has been (denied for the/made
             only for a less extensive) service/item
             because the information furnished does
             not substantiate the need for the (more
             extensive) service/item. If you have
             collected any amount from the patient,
             you must refund that amount to the
             patient within 30 days of receiving
             this notice.
             The requirements for a refund are in
             Ì1834(a)(18) of the Social Security Act
             (and in ÌÌ1834(j)(4) and 1879(h) by
             cross-reference to Ì1834(a)(18)).
             Section 1834(a)(18)(B) specifies that
             suppliers which knowingly and willfully
             fail to make appropriate refunds may be
             subject to civil money penalties and/or
             exclusion from the Medicare program. If
             you have any questions about this
             notice, please contact this office."
             Start: 09/26/2002
      N126 = Social Security Records indicate that
             this individual has been deported. This
             payer does not cover items and services
             furnished to individuals who have been
             deported.
             Start: 10/17/2002
      N127 = This is a misdirected claim/service for
             a United Mine Workers of America (UMWA)
             beneficiary. Please submit claims to
             them.
             Start: 10/31/2007
      N128 = This amount represents the prior to
             coverage portion of the allowance.
             Start: 10/31/2002
      N129 = Not eligible due to the patient's age.
             Start: 10/31/2002
      N130 = Consult plan benefit
             documents/guidelines for information
             about restrictions for this service.
             Start: 10/31/2002
      N131 = Total payments under multiple contracts
             cannot exceed the allowance for this
             service.
             Start: 10/31/2002
      N132 = Alert: Payments will cease for services
             rendered by this US Government debarred
             or excluded provider after the 30 day
             grace period as previously notified.
             Start: 10/31/2002
      N133 = Alert: Services for predetermination
             and services requesting payment are
             being processed separately.
             Start: 10/31/2002
      N134 = Alert: This represents your scheduled
             payment for this service. If treatment
             has been discontinued, please contact
             Customer Service.
             Start: 10/31/2002
      N135 = Record fees are the patient's
             responsibility and limited to the
             specified co-payment.
             Start: 10/31/2002
      N136 = Alert: To obtain information on the
             process to file an appeal in Arizona,
             call the Department's Consumer
             Assistance Office at (602) 912-8444
             or (800) 325-2548.
             Start: 10/31/2002
      N137 = Alert: The provider acting on the
             Member's behalf, may file an appeal with
             the Payer. The provider, acting on the
             Member's behalf, may file a complaint
             with the State Insurance Regulatory
             Authority without first filing an appeal,
             if the coverage decision involves an
             urgent condition for which care has not
             been rendered. The address may be
             obtained from the State Insurance
             Regulatory Authority.
             Start: 10/31/2002
      N138 = Alert: In the event you disagree with
             the Dental Advisor's opinion and have
             additional information relative to the
             case, you may submit radiographs to the
             Dental Advisor Unit at the subscriber's
             dental insurance carrier for a second
             Independent Dental Advisor Review.
             Start: 10/31/2002
      N139 = Alert: Under the Code of Federal
             Regulations, Chapter 32, Section 199.13
             a non-participating provider is not an
             appropriate appealing party. Therefore,
             if you disagree with the Dental
             Advisor's opinion, you may appeal the
             determination if appointed in writing,
             by the beneficiary, to act as his/her
             representative. Should you be appointed
             as a representative, submit a copy of
             this letter, a signed statement
             explaining the matter in which you
             disagree, and any radiographs and
             relevant information to the subscriber's
             Dental insurance carrier within 90 days
             from the date of this letter.
             Start: 10/31/2002
      N140 = Alert: You have not been designated as
             an authorized OCONUS provider therefore
             are not considered an appropriate
             appealing party. If the beneficiary has
             appointed you, in writing, to act as
             his/her representative and you disagree
             with the Dental Advisor's opinion, you
             may appeal by submitting a copy of this
             letter, a signed statement explaining
             the matter in which you disagree, and
             any relevant information to the
             subscriber's Dental insurance carrier
             within 90 days from the date of this
             letter.
             Start: 10/31/2002
      N141 = The patient was not residing in a
             long-term care facility during all or
             part of the service dates billed.
             Start: 10/31/2002
      N142 = The original claim was denied. Resubmit
             a new claim, not a replacement claim.
             Start: 10/31/2002
      N143 = The patient was not in a hospice
             program
             during all or part of the service dates
             billed.
             Start: 10/31/2002
      N144 = The rate changed during the dates of
             service billed.
             Start: 10/31/2002
      N145 = Missing/incomplete/invalid provider
             identifier for this place of service.
             Start: 10/31/2002
             Stop: 06/02/2005
      N146 = Missing screening document.
             Start: 10/31/2002
             Notes: Related to N243
      N147 = Long term care case mix or per diem
             rate cannot be determined because the
             patient ID number is missing, incomplete
             or invalid on the assignment request.
             Start: 10/31/2002
      N148 = Missing/incomplete/invalid date of last
             menstrual period.
             Start: 10/31/2002
      N149 = Rebill all applicable services on a
             single claim.
             Start: 10/31/2002
      N150 = Missing/incomplete/invalid model
             number.
             Start: 10/31/2002
      N151 = Telephone contact services will not be
             paid until the face-to-face contact
             requirement has been met.
             Start: 10/31/2002
      N152 = Missing/incomplete/invalid replacement
             claim information.
             Start: 10/31/2002
      N153 = Missing/incomplete/invalid room and
             board rate.
             Start: 10/31/2002
      N154 = Alert: This payment was delayed for
             correction of provider's mailing
             address.
             Start: 10/31/2002
      N155 = Alert: Our records do not indicate that
             other insurance is on file. Please
             submit other insurance information for
             our records.
             Start: 10/31/2002
      N156 = Alert: The patient is responsible for
             the difference between the approved
             treatment and the elective treatment.
             Start: 10/31/2002
      N157 = Transportation to/from this destination
             is not covered.
             Start: 02/28/2003
      N158 = Transportation in a vehicle other than
             an ambulance is not covered.
             Start: 02/28/2003
      N159 = Payment denied/reduced because mileage
             is not covered when the patient is not
             in the ambulance.
             Start: 02/28/2003
      N160 = The patient must choose an option
             before a payment can be made for this
              procedure/ equipment/ supply/ service.
              Start: 02/28/2003
      N161 = This drug/service/supply is covered
             only when the associated service is
             covered.
             Start: 02/28/2003
      N162 = Alert: Although your claim was paid,
             you have billed for a test/specialty
             not included in your laboratory
             Certification. Your failure to correct
             the laboratory certification information
             will result in a denial of payment in
             the near future.
             Start: 02/28/2003|
      N163 = Medical record does not support code
             billed per the code definition.
             Start: 02/28/2003
      N164 = Transportation to/from this destination
             is not covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N157
      N165 = Transportation in a vehicle other than
             an ambulance is not covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N158)
      N166 = Payment denied/reduced because mileage
             is not covered when the patient is not
             in the ambulance.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N159
      N167 = Charges exceed the post-transplant
             coverage limit.
             Start: 02/28/2003
      N168 = The patient must choose an option
              before
              a payment can be made for this
              procedure/ equipment/ supply/ service.
              Start: 02/28/2003
              Stop: 01/31/2004
              Notes: Consider using N160
      N169 = This drug/service/supply is covered
             only when the associated service is
             covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N161
      N170 = A new/revised/renewed certificate of
             medical necessity is needed.
             Start: 02/28/2003
      N171 = Payment for repair or replacement is
             not covered or has exceeded the purchase
             price.
             Start: 02/28/2003
      N172 = The patient is not liable for the
             denied/adjusted charge(s) for receiving
             any updated service/item.
             Start: 02/28/2003
      N173 = No qualifying hospital stay dates were
             provided for this episode of care.
             Start: 02/28/2003
      N174 = This is not a covered
             service/procedure/
             equipment/bed, however patient liability
             is limited to amounts shown in the
             adjustments under group 'PR'.
             Start: 02/28/2003
      N175 = Missing review organization approval.
             Start: 02/28/2003
             Notes: Related to N241
      N176 = Services provided aboard a ship are
             covered only when the ship is of United
             States registry and is in United States
             waters. In addition, a doctor licensed
             to practice in the United States must
             provide the service.
             Start: 02/28/2003
      N177 = Alert: We did not send this claim to
             patient's other insurer. They have
             indicated no additional payment can be
             made.
             Start: 02/28/2003
      N178 = Missing pre-operative photos or visual
             field results.
             Start: 02/28/2003
             Notes: Related to N244
      N179 = Additional information has been
             requested from the member. The charges
             will be reconsidered upon receipt of that
             information.
             Start: 02/28/2003
      N180 = This item or service does not meet the
             criteria for the category under which it
             was billed.
             Start: 02/28/2003
      N181 = Additional information is required from
             another provider involved in this service.
             Start: 02/28/2003
             Last Modified: 12/01/2006
             Notes: (Modified 12/1/06)
      N182 = This claim/service must be billed
             according to the schedule for this plan.
             Start: 02/28/2003
      N183 = Alert: This is a predetermination
             advisory message, when this service is
             submitted for payment additional
             documentation as specified in plan
             documents will be required to process
             benefits.
             Start: 02/28/2003
      N184 = Rebill technical and professional
             components separately.
             Start: 02/28/2003
      N185 = Alert: Do not resubmit this
             claim/service.
             Start: 02/28/2003
      N186 = Non-Availability Statement (NAS)
             required for this service. Contact the
             nearest Military Treatment Facility
             (MTF) for assistance.
              Start: 02/28/2003
      N187 = Alert: You may request a review in
             writing within the required time limits
             following receipt of this notice by
             following the instructions included in
             your contract or plan benefit documents.
             Start: 02/28/2003
      N188 = The approved level of care does not
             match the procedure code submitted.
             Start: 02/28/2003
      N189 = Alert: This service has been paid as a
             one-time exception to the plan's benefit
             restrictions.
             Start: 02/28/2003
      N190 = Missing contract indicator.
             Start: 02/28/2003
             Notes: Related to N229
      N191 = The provider must update insurance
             information directly with payer.
             Start: 02/28/2003
      N192 = Patient is a Medicaid/Qualified
             Medicare Beneficiary
             Start: 02/28/2003
      N193 = Specific federal/state/local program may
             cover this service through another payer.
             Start: 02/28/2003
      N194 = Technical component not paid if
             provider does not own the equipment
             used.
             Start: 02/25/2003
      N195 = The technical component must be billed
             separately.
             Start: 02/25/2003
      N196 = Alert: Patient eligible to apply for
             other coverage which may be primary.
             Start: 02/25/2003
      N197 = The subscriber must update insurance
             information directly with payer.
             Start: 02/25/2003
      N198 = Rendering provider must be affiliated
             with the pay-to provider.
             Start: 02/25/2003
      N199 = Additional payment/recoupment approved
             based on payer-initiated review/audit.
             Start: 02/25/2003
      N200 = The professional component must be
             billed separately.
             Start: 02/25/2003
      N201 = A mental health facility is responsible
             for payment of outside providers who
             furnish these services/supplies to residents.
             Start: 02/25/2003
             Stop: 01/01/2011
             Notes: Consider using N538
      N202 = Additional information/explanation will
             be sent separately
             Start: 06/30/2003
      N203 = Missing/incomplete/invalid anesthesia
             time/units
             Start: 06/30/2003
      N204 = Services under review for possible
             pre-existing condition. Send medical
             records for prior 12 months
             Start: 06/30/2003
      N205 = Information provided was illegible
             Start: 06/30/2003
      N206 = The supporting documentation does not
             match the information sent on the claim.
             Start: 06/30/2003
             Notes: (Modified 3/6/12)
      N207 = Missing/incomplete/invalid weight.
             Start: 06/30/2003
      N208 = Missing/incomplete/invalid DRG code
             Start: 06/30/2003
      N209 = Missing/incomplete/invalid taxpayer
             identification number (TIN).
             Start: 06/30/2003
      N210 = Alert: You may appeal this decision
             Start: 06/30/2003
      N211 = Alert: You may not appeal this decision
             Start: 06/30/2003
      N212 = Charges processed under a Point of
             Service benefit
             Start: 02/01/2004
      N213 = Missing/incomplete/invalid
             facility/discrete unit DRG/DRG exempt
             status information
             Start: 04/01/2004
      N214 = Missing/incomplete/invalid history of
             the related initial surgical
             procedure(s)
             Start: 04/01/2004
      N215 = Alert: A payer providing supplemental
             or secondary coverage shall not require
             a claims determination for this service
             from a primary payer as a condition of
             making its own claims determination.
             Start: 04/01/2004
      N216 = We do not offer coverage for this type
             of service or the patient is not
             enrolled in this portion of our benefit
             package
             Start: 04/01/2004
      N217 = We pay only one site of service per
             provider per claim
             Start: 08/01/2004
      N218 = You must furnish and service this item
             for as long as the patient continues to
             need it. We can pay for maintenance
             and/or servicing for the time period
             specified in the contract or coverage manual.
             Start: 08/01/2004
      N219 = Payment based on previous payer's
             allowed amount.
             Start: 08/01/2004
      N220 = Alert: See the payer's web site or
             contact the payer's Customer Service
             department to obtain forms and
             instructions for filing a provider
             dispute.
             Start: 08/01/2004
      N221 = Missing Admitting History and Physical
             report.
             Start: 08/01/2004
      N222 = Incomplete/invalid Admitting History
             and Physical report.
             Start: 08/01/2004
      N223 = Missing documentation of benefit to the
             patient during initial treatment period.
      N224 = Incomplete/invalid documentation of
             benefit to the patient during initial
             treatment period.
             Start: 08/01/2004
      N225 = Incomplete/invalid
             documentation/orders/notes/summary/
             report/chart.
             Start: 08/01/2004
      N226 = Incomplete/invalid American Diabetes
             Association Certificate of Recognition.
             Start: 08/01/2004
      N227 = Incomplete/invalid Certificate of
             Medical Necessity.
             Start: 08/01/2004
      N228 = Incomplete/invalid consent form.
             Start: 08/01/2004
      N229 = Incomplete/invalid contract indicator.
             Start: 08/01/2004
      N230 = Incomplete/invalid indication of
             whether the patient owns the equipment
             equipment that requires the part or
             or supply.
             Start: 08/01/2004
      N231 = Incomplete/invalid invoice or statement
             certifying the actual cost of the lens,
             less discounts, and/or the type of
             intraocular lens used.
             Start: 08/01/2004
      N232 = Incomplete/invalid itemized
             bill/statement.
             Start: 08/01/2004
      N233 = Incomplete/invalid operative
             note/report.
             Start: 08/01/2004
      N234 = Incomplete/invalid oxygen
             certification/re-certification.
             Start: 08/01/2004
      N235 = Incomplete/invalid pacemaker
             registration form.
             Start: 08/01/2004
      N236 = Incomplete/invalid pathology report.
             Start: 08/01/2004
      N237 = Incomplete/invalid patient medical
             record for this service.
             Start: 08/01/2004
      N238 = Incomplete/invalid physician certified
             plan of care
             Start: 08/01/2004
      N239 = Incomplete/invalid physician financial
             relationship form.
             Start: 08/01/2004
      N240 = Incomplete/invalid radiology report.
             Start: 08/01/2004
      N241 = Incomplete/invalid review organization
             approval.
             Start: 08/01/2004
      N242 = Incomplete/invalid radiology film(s)
             /image(s).
             Start: 08/01/2004
      N243 = Incomplete/invalid/not approved
             screening document.
             Start: 08/01/2004
      N244 = Incomplete/invalid pre-operative
             photos/visual field results.
             Start: 08/01/2004
      N245 = Incomplete/invalid plan information for
             other insurance
             Start: 08/01/2004
      N246 = State regulated patient payment
             limitations apply to this service.
             Start: 12/02/2004
      N247 = Missing/incomplete/invalid assistant
             surgeon taxonomy.
             Start: 12/02/2004
      N248 = Missing/incomplete/invalid assistant
             surgeon name.
             Start: 12/02/2004
      N249 = Missing/incomplete/invalid assistant
             surgeon primary identifier.
             Start: 12/02/2004
      N250 = Missing/incomplete/invalid assistant
             surgeon secondary identifier.
             Start: 12/02/2004
      N251 = Missing/incomplete/invalid attending
             provider taxonomy.
             Start: 12/02/2004
      N252 = Missing/incomplete/invalid attending
             provider name.
             Start: 12/02/2004
      N253 = Missing/incomplete/invalid attending
             provider primary identifier.
             Start: 12/02/2004
      N254 = Missing/incomplete/invalid attending
             provider secondary identifier.
             Start: 12/02/2004
      N255 = Missing/incomplete/invalid billing
             provider taxonomy.
             Start: 12/02/2004
      N256 = Missing/incomplete/invalid billing
             provider/supplier name.
             Start: 12/02/2004
      N257 = Missing/incomplete/invalid billing
             provider/supplier primary identifier.
             Start: 12/02/2004
      N258 = Missing/incomplete/invalid billing
             provider/supplier address.
             Start: 12/02/2004
      N259 = Missing/incomplete/invalid billing
             provider/supplier secondary identifier.
             Start: 12/02/2004
      N260 = Missing/incomplete/invalid billing
             provider/supplier contact information.
             Start: 12/02/2004
      N261 = Missing/incomplete/invalid operating
             provider name.
             Start: 12/02/2004
      N262 = Missing/incomplete/invalid operating
             provider primary identifier.
             Start: 12/02/2004
      N263 = Missing/incomplete/invalid operating
             provider secondary identifier.
             Start: 12/02/2004
      N264 = Missing/incomplete/invalid ordering
             provider name.
             Start: 12/02/2004
      N265 = Missing/incomplete/invalid ordering
             provider primary identifier.
             Start: 12/02/2004
      N266 = Missing/incomplete/invalid ordering
             provider address.
             Start: 12/02/2004
      N267 = Missing/incomplete/invalid ordering
             provider secondary identifier.
             Start: 12/02/2004
      N268 = Missing/incomplete/invalid ordering
             provider contact information.
             Start: 12/02/2004
      N269 = Missing/incomplete/invalid other
             provider name.
             Start: 12/02/2004
      N270 = Missing/incomplete/invalid other
             provider primary identifier.
             Start: 12/02/2004
      N271 = Missing/incomplete/invalid other
             provider secondary identifier.
             Start: 12/02/2004
      N272 = Missing/incomplete/invalid other payer
             attending provider identifier.
             Start: 12/02/2004
      N273 = Missing/incomplete/invalid other payer
             operating provider identifier.
             Start: 12/02/2004
      N274 = Missing/incomplete/invalid other payer
             other provider identifier.
             Start: 12/02/2004
      N275 = Missing/incomplete/invalid other payer
             purchased service provider identifier.
             Start: 12/02/2004
      N276 = Missing/incomplete/invalid other payer
             referring provider identifier.
             Start: 12/02/2004
      N277 = Missing/incomplete/invalid other payer
             rendering provider identifier.
             Start: 12/02/2004
      N278 = Missing/incomplete/invalid other payer
             service facility provider identifier.
             Start: 12/02/2004
      N279 = Missing/incomplete/invalid pay-to
             provider name.
             Start: 12/02/2004
      N280 = Missing/incomplete/invalid pay-to
             provider primary identifier.
             Start: 12/02/2004
      N281 = Missing/incomplete/invalid pay-to
             provider address.
             Start: 12/02/2004
      N282 = Missing/incomplete/invalid pay-to
             provider secondary identifier.
             Start: 12/02/2004
      N283 = Missing/incomplete/invalid purchased
             service provider identifier.
             Start: 12/02/2004
      N284 = Missing/incomplete/invalid referring
             provider taxonomy.
             Start: 12/02/2004
      N285 = Missing/incomplete/invalid referring
             provider name.
             Start: 12/02/2004
      N286 = Missing/incomplete/invalid referring
             provider primary identifier.
             Start: 12/02/2004
      N287 = Missing/incomplete/invalid referring
             provider secondary identifier.
             Start: 12/02/2004
      N288 = Missing/incomplete/invalid rendering
             provider taxonomy.
             Start: 12/02/2004
      N289 = Missing/incomplete/invalid rendering
             provider name.
             Start: 12/02/2004
      N290 = Missing/incomplete/invalid rendering
             provider primary identifier.
             Start: 12/02/2004
      N291 = Missing/incomplete/invalid rendering
             provider secondary identifier.
             Start: 12/02/2004
      N292 = Missing/incomplete/invalid service
             facility name.
             Start: 12/02/2004
      N293 = Missing/incomplete/invalid service
             facility primary identifier.
             Start: 12/02/2004
      N294 = Missing/incomplete/invalid service
             facility primary address.
             Start: 12/02/2004
      N295 = Missing/incomplete/invalid service
             facility secondary identifier.
             Start: 12/02/2004
      N296 = Missing/incomplete/invalid supervising
             provider name.
             Start: 12/02/2004
      N297 = Missing/incomplete/invalid supervising
             provider primary identifier.
             Start: 12/02/2004
      N298 = Missing/incomplete/invalid supervising
             provider secondary identifier.
             Start: 12/02/2004
      N299 = Missing/incomplete/invalid occurrence
             date(s).
             Start: 12/02/2004
      N300 = Missing/incomplete/invalid occurrence
             span date(s).
             Start: 12/02/2004
      N301 = Missing/incomplete/invalid procedure
             date(s).
             Start: 12/02/2004
      N302 = Missing/incomplete/invalid other
             procedure date(s).
             Start: 12/02/2004
      N303 = Missing/incomplete/invalid principal
             procedure date.
             Start: 12/02/2004
      N304 = Missing/incomplete/invalid dispensed
             date.
             Start: 12/02/2004
      N305 = Missing/incomplete/invalid accident
             date.
             Start: 12/02/2004
      N306 = Missing/incomplete/invalid acute
             manifestation date.
             Start: 12/02/2004
      N307 = Missing/incomplete/invalid adjudication
             or payment date.
             Start: 12/02/2004
      N308 = Missing/incomplete/invalid appliance
             placement date.
             Start: 12/02/2004
      N309 = Missing/incomplete/invalid assessment
             date.
             Start: 12/02/2004
      N310 = Missing/incomplete/invalid assumed or
             relinquished care date.
             Start: 12/02/2004
      N311 = Missing/incomplete/invalid authorized
             to return to work date.
             Start: 12/02/2004
      N312 = Missing/incomplete/invalid begin
             therapy date.
             Start: 12/02/2004
      N313 = Missing/incomplete/invalid
             certification revision date.
             Start: 12/02/2004
      N314 = Missing/incomplete/invalid diagnosis
             date.
             Start: 12/02/2004
      N315 = Missing/incomplete/invalid disability
             from date.
             Start: 12/02/2004
      N316 = Missing/incomplete/invalid disability
             to date.
             Start: 12/02/2004
      N317 = Missing/incomplete/invalid discharge
             hour.
             Start: 12/02/2004
      N318 = Missing/incomplete/invalid discharge or
             end of care date.
             Start: 12/02/2004
      N319 = Missing/incomplete/invalid hearing or
             vision prescription date.
             Start: 12/02/2004
      N320 = Missing/incomplete/invalid Home Health
             Certification Period.
             Start: 12/02/2004
      N321 = Missing/incomplete/invalid last
             admission period.
             Start: 12/02/2004
      N322 = Missing/incomplete/invalid last
             certification date.
             Start: 12/02/2004
      N323 = Missing/incomplete/invalid last contact
             date.
             Start: 12/02/2004
      N324 = Missing/incomplete/invalid last
             seen/visit date.
             Start: 12/02/2004
      N325 = Missing/incomplete/invalid last worked
             date.
             Start: 12/02/2004
      N326 = Missing/incomplete/invalid last x-ray
             date.
             Start: 12/02/2004
      N327 = Missing/incomplete/invalid other insured
             birth date.
             Start: 12/02/2004
      N328 = Missing/incomplete/invalid Oxygen
             Saturation Test date.
             Start: 12/02/2004
      N329 = Missing/incomplete/invalid patient
             birth date
             Start: 12/02/2004
      N330 = Missing/incomplete/invalid patient
             death date.
             Start: 12/02/2004
      N331 = Missing/incomplete/invalid physician
             order date.
             Start: 12/02/2004
      N332 = Missing/incomplete/invalid prior
             hospital discharge date.
             Start: 12/02/2004
      N333 = Missing/incomplete/invalid prior
             placement date.
             Start: 12/02/2004
      N334 = Missing/incomplete/invalid re-  evaluation
             date
             Start: 12/02/2004
      N335 = Missing/incomplete/invalid referral
             date.
             Start: 12/02/2004
      N336 = Missing/incomplete/invalid replacement
             date.
             Start: 12/02/2004
      N337 = Missing/incomplete/invalid secondary
             diagnosis date.
             Start: 12/02/2004
      N338 = Missing/incomplete/invalid shipped  date.
             Start: 12/02/2004
      N339 = Missing/incomplete/invalid similar
             illness or symptom date.
             Start: 12/02/2004
      N340 = Missing/incomplete/invalid subscriber
             birth date.
             Start: 12/02/2004
      N341 = Missing/incomplete/invalid surgery date.
             Start: 12/02/2004
      N342 = Missing/incomplete/invalid test
             performed date.
             Start: 12/02/2004
      N343 = Missing/incomplete/invalid
             Transcutaneous Electrical Nerve
             Stimulator (TENS) trial start date.
             Start: 12/02/2004
      N344 = Missing/incomplete/invalid
             Transcutaneous Electrical Nerve
             Stimulator (TENS) trial end date.
             Start: 12/02/2004
      N345 = Date range not valid with units
             submitted.
             Start: 03/30/2005
      N346 = Missing/incomplete/invalid oral cavity
             designation code.
             Start: 03/30/2005
      N347 = Your claim for a referred or purchased
             service cannot be paid because payment
             has already been made for this same
             service to another provider by a payment
             contractor representing the payer.
             Start: 03/30/2005
      N348 = You chose that this service/supply/drug
             would be rendered/supplied and billed by
             a different practitioner/supplier.
             Start: 08/01/2005
      N349 = The administration method and drug must
             be reported to adjudicate this service.
             Start: 08/01/2005
      N350 = Missing/incomplete/invalid description
             of service for a Not Otherwise Classified
             (NOC) code or for an Unlisted/By Report
             procedure.
             Start: 08/01/2005
      N351 = Service date outside of the approved
             treatment plan service dates.
             Start: 08/01/2005
      N352 = Alert: There are no scheduled payments
             for this service. Submit a claim for
             each patient visit.
             Start: 08/01/2005
      N353 = Alert: Benefits have been estimated,
             when the actual services have been
             rendered, additional payment will be
             considered based on the submitted claim.
             Start: 08/01/2005
      N354 = Incomplete/invalid invoice
             Start: 08/01/2005
            "Alert: The law permits exceptions to
             the refund requirement in two cases: -
             If you did not know, and could not have
             reasonably been expected to know, that
             we would not pay for this service; or -
             If you notified the patient in writing
             before providing the service that you
             believed that we were likely to deny the
             service, and the patient signed a
             statement agreeing to pay for the
             service.
             If you come within either exception, or
             if you believe the carrier was wrong in
             its determination that we do not pay for
             this service, you should request appeal
             of this determination within 30 days of
             the date of this notice. Your request
             for review should include any additional
             information necessary to support your
             position.
             If you request an appeal within 30 days
             of receiving this notice, you may delay
             refunding the amount to the patient
             until you receive the results of the
             review. If the review decision is
             favorable to you, you do not need to
             make any refund. If, however, the review
             is unfavorable, the law specifies that
             you must make the refund within 15 days
             of receiving the unfavorable review
             decision.
             The law also permits you to request an
             appeal at any time within 120 days of
             the date you receive this notice.
             However, an appeal request that is
             received more than 30 days after the
             date of this notice, does not permit you
             to delay making the refund. Regardless
             of when a review is requested, the
             patient will be notified that you have
             requested one, and will receive a copy
             of the determination.
             The patient has received a separate
             notice of this denial decision. The
             notice advises that he/she may be
             entitled to a refund of any amounts
             paid, if you should have known that we
             would not pay and did not tell him/her.
             It also instructs the patient to contact
             our office if he/she does not hear
             anything about a refund within 30 days"
             Start: 08/01/2005
      N356 = Not covered when performed with, or
             subsequent to, a non-covered service.
             Start: 08/01/2005
      N357 = Time frame requirements between this
             service/procedure/supply and a related
             service/procedure/supply have not been
             met.
             Start: 11/18/2005
      N358 = Alert: This decision may be reviewed if
             additional documentation as described in
             the contract or plan benefit documents
             is submitted.
             Start: 11/18/2005
      N359 = Missing/incomplete/invalid height.
             Start: 11/18/2005
      N360 = Alert: Coordination of benefits has not
             been calculated when estimating benefits
             for this pre-determination. Submit
             payment information from the primary
             payer with the secondary claim.
             Start: 11/18/2005
      N361 = Payment adjusted based on multiple
             diagnostic imaging procedure rules
             Start: 11/18/2005
             Stop: 10/01/2007
             Notes: (Modified 12/1/06)
             Consider using Reason Code 59
      N362 = The number of Days or Units of Service
             exceeds our acceptable maximum.
             Start: 11/18/2005
      N363 = Alert: in the near future we are
             implementing new policies/procedures
             that would affect this determination.
             Start: 11/18/2005
      N364 = Alert: According to our agreement, you
             must waive the deductible and/or
             coinsurance amounts.
             Start: 11/18/2005
      N365 = This procedure code is not payable.
             It is for reporting/information purposes
             only.
             Start: 04/01/2006
      N366 = Requested information not provided. The
             claim will be reopened if the
             information previously requested is
             submitted within one year after the date
             of this denial notice.
             Start: 04/01/2006
      N367 = Alert: The claim information has been
             forwarded to a Consumer Spending Account
             processor for review; for example,
             flexible spending account or health
             savings account.
             Start: 04/01/2006
             Last Modified: 07/01/2008
      N368 = You must appeal the determination of
             the previously adjudicated claim.
             Start: 04/01/2006
      N369 = Alert: Although this claim has been
             processed, it is deficient according to
             state legislation/regulation.
             Start: 04/01/2006
      N370 = Billing exceeds the rental months
             covered/approved by the payer.
             Start: 08/01/2006
      N371 = Alert: title of this equipment must be
             transferred to the patient.
             Start: 08/01/2006
      N372 = Only reasonable and necessary
             maintenance/service charges are covered.
             Start: 08/01/2006
      N373 = It has been determined that another
             payer paid the services as primary when
             they were not the primary payer.
             Therefore, we are refunding to the payer
             that paid as primary on your behalf.
             Start: 12/01/2006
      N374 = Primary Medicare Part A insurance has
             been exhausted and a Part B Remittance
             Advice is required.
             Start: 12/01/2006
      N375 = Missing/incomplete/invalid
             questionnaire/information required to
             determine dependent eligibility.
             Start: 12/01/2006
      N376 = Subscriber/patient is assigned to
             active military duty, therefore
             primary coverage may be TRICARE.
             Start: 12/01/2006
      N377 = Payment based on a processed
             replacement claim.
             Start: 12/01/2006
      N378 = Missing/incomplete/invalid prescription
             quantity.
             Start: 12/01/2006
      N379 = Claim level information does not match
             line level information.
             Start: 12/01/2006
      N380 = The original claim has been processed,
             submit a corrected claim.
             Start: 04/01/2007
      N381 = Consult our contractual agreement for
             restrictions/billing/payment information
             related to these charges.
             Start: 04/01/2007
      N382 = Missing/incomplete/invalid patient
             identifier.
             Start: 04/01/2007
      N383 = Not covered when deemed cosmetic.
             Start: 04/01/2007
             Last Modified: 03/08/2011
             Notes: (Modified 3/8/11)
      N384 = Records indicate that the referenced
             body part/tooth has been removed in a
             previous procedure.
             Start: 04/01/2007
      N385 = Notification of admission was not
             timely
             according to published plan procedures.
             Start: 04/01/2007
      N386 = This decision was based on a National
             Coverage Determination (NCD). An NCD
             provides a coverage determination as to
             whether a particular item or service is
             covered. A copy of this policy is
             available at www.cms.gov/mcd/search.asp.
             If you do not have web access, you may
             contact the contractor to request a copy
             of the NCD.
             Start: 04/01/2007
      N387 = Alert: Submit this claim to the
             patient's other insurer for potential
             payment of supplemental benefits. We did
             not forward the claim information.
             Start: 04/01/2007
      N388 = Missing/incomplete/invalid prescription
             number.
             Start: 08/01/2007
      N389 = Duplicate prescription number
             submitted.
             Start: 08/01/2007
      N390 = This service/report cannot be billed
             separately.
             Start: 08/01/2007
      N391 = Missing emergency department records.
             Start: 08/01/2007
      N392 = Incomplete/invalid emergency department
             records.
             Start: 08/01/2007
      N393 = Missing progress notes/report.
             Start: 08/01/2007
      N394 = Incomplete/invalid progress
             notes/report.
             Start: 08/01/2007
      N395 = Missing laboratory report.
             Start: 08/01/2007
      N396 = Incomplete/invalid laboratory report.
             Start: 08/01/2007
      N397 = Benefits are not available for
             incomplete service(s)/undelivered
             item(s).
             Start: 08/01/2007
      N398 = Missing elective consent form.
             Start: 08/01/2007
      N399 = Incomplete/invalid elective consent
             form.
             Start: 08/01/2007
      N400 = Alert: Electronically enabled providers
             should submit claims electronically.
             Start: 08/01/2007
      N401 = Missing periodontal charting.
             Start: 08/01/2007
      N402 = Incomplete/invalid periodontal
             charting.
             Start: 08/01/2007
      N403 = Missing facility certification.
             Start: 08/01/2007
      N404 = Incomplete/invalid facility
             certification.
             Start: 08/01/2007
      N405 = This service is only covered when the
             donor's insurer(s) do not provide
             coverage for the service.
             Start: 08/01/2007
      N406 = This service is only covered when the
             recipient's insurer(s) do not provide
             coverage for the service.
             Start: 08/01/2007
      N407 = You are not an approved submitter for
             this transmission format.
             Start: 08/01/2007
      N408 = This payer does not cover deductibles
             assessed by a previous payer.
             Start: 08/01/2007
      N409 = This service is related to an
             accidental injury and is not covered
             unless provided within a specific time
             frame from the date of the accident.
             Start: 08/01/2007
      N410 = Not covered unless the prescription
             changes.
             Start: 08/01/2007
      N411 = This service is allowed one time in a
             6-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N412 = This service is allowed 2 times in a
             12-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N413 = This service is allowed 2 times in a
             benefit year. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N414 = This service is allowed 4 times in a
             12-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N415 = This service is allowed 1 time in an
             18-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N416 = This service is allowed 1 time in a
             3-year period. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N417 = This service is allowed 1 time in a
             5-year period. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N418 = Misrouted claim. See the payer's claim
             submission instructions.
             Start: 08/01/2007
      N419 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             retroactive rate change.
             Start: 08/01/2007
      N420 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             Coordination of Benefits or Third Party
             Liability Recovery.
             Start: 08/01/2007
      N421 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             review organization decision.
             Start: 08/01/2007
      N422 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             payer's contract incentive program.
             Start: 08/01/2007
      N423 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             non standard program.
             Start: 08/01/2007
      N424 = Patient does not reside in the
             geographic area required for this type
             of payment.
             Start: 08/01/2007
      N425 = Statutorily excluded service(s).
             Start: 08/01/2007
      N426 = No coverage when self-administered.
             Start: 08/01/2007
      N427 = Payment for eyeglasses or contact
             lenses can be made only after cataract
             surgery.
             Start: 08/01/2007
      N428 = Not covered when performed in this
             place of surgery.
             Start: 08/01/2007
      N429 = Not covered when considered routine.
             Start: 08/01/2007
      N430 = Procedure code is inconsistent with the
             units billed.
             Start: 11/05/2007
      N431 = Not covered with this procedure.
             Start: 11/05/2007
      N432 = Adjustment based on a Recovery Audit.
             Start: 11/05/2007
      N433 = Resubmit this claim using only your
             National Provider Identifier (NPI)
             Start: 02/29/2008
      N434 = Missing/Incomplete/Invalid Present on
             Admission indicator.
             Start: 07/01/2008
      N435 = Exceeds number/frequency approved
             /allowed within time period without
             support documentation.
             Start: 07/01/2008
      N436 = The injury claim has not been accepted
             and a mandatory medical reimbursement
             has been made.
             Start: 07/01/2008
      N437 = Alert: If the injury claim is accepted,
             these charges will be reconsidered.
             Start: 07/01/2008
      N438 = This jurisdiction only accepts paper
             claims
             Start: 07/01/2008
      N439 = Missing anesthesia physical status
             report/indicators.
             Start: 07/01/2008
      N440 = Incomplete/invalid anesthesia physical
             status report/indicators.
             Start: 07/01/2008
      N441 = This missed appointment is not covered.
             Start: 07/01/2008
      N442 = Payment based on an alternate fee
             schedule.
             Start: 07/01/2008
      N443 = Missing/incomplete/invalid total time
             or begin/end time.
             Start: 07/01/2008
      N444 = Alert: This facility has not filed the
             Election for High Cost Outlier form with
             the Division of Workers' Compensation.
             Start: 07/01/2008
      N445 = Missing document for actual cost or
             paid amount.
             Start: 07/01/2008
      N446 = Incomplete/invalid document for actual
             cost or paid amount.
             Start: 07/01/2008
      N447 = Payment is based on a generic
             equivalent
             as required documentation was not
             provided.
             Start: 07/01/2008
      N448 = This drug/service/supply is not
             included
             in the fee schedule or
             contracted/legislated fee arrangement
             Start: 07/01/2008
      N449 = Payment based on a comparable
             drug/service/supply.
             Start: 07/01/2008
      N450 = Covered only when performed by the
             primary treating physician or the
             designee.
             Start: 07/01/2008
      N451 = Missing Admission Summary Report.
             Start: 07/01/2008
      N452 = Incomplete/invalid Admission Summary
             Report.
             Start: 07/01/2008
      N453 = Missing Consultation Report.
             Start: 07/01/2008
      N454 = Incomplete/invalid Consultation Report.
             Start: 07/01/2008
      N455 = Missing Physician Order.
             Start: 07/01/2008
      N456 = Incomplete/invalid Physician Order.
             Start: 07/01/2008
      N457 = Missing Diagnostic Report.
             Start: 07/01/2008
      N458 = Incomplete/invalid Diagnostic Report.
             Start: 07/01/2008
      N459 = Missing Discharge Summary.
             Start: 07/01/2008
      N460 = Incomplete/invalid Discharge Summary.
             Start: 07/01/2008
      N461 = Missing Nursing Notes.
             Start: 07/01/2008
      N462 = Incomplete/invalid Nursing Notes.
             Start: 07/01/2008
      N463 = Missing support data for claim.
             Start: 07/01/2008
      N464 = Incomplete/invalid support data for
             claim.
             Start: 07/01/2008
      N465 = Missing Physical Therapy Notes/Report.
             Start: 07/01/2008
      N466 = Incomplete/invalid Physical Therapy
             Notes/Report.
             Start: 07/01/2008
      N467 = Missing Report of Tests and Analysis
             Report.
             Start: 07/01/2008
      N468 = Incomplete/invalid Report of Tests and
             Analysis Report.
             Start: 07/01/2008
      N469 = Alert: Claim/Service(s) subject to
             appeal process, see section 935 of
             Medicare Prescription Drug, Improvement,
             and Modernization Act of 2003 (MMA).
             Start: 07/01/2008
      N470 = This payment will complete the
             mandatory
             medical reimbursement limit.
             Start: 07/01/2008
      N471 = Missing/incomplete/invalid HIPPS Rate
             Code.
             Start: 07/01/2008
      N472 = Payment for this service has been
             issued
             to another provider.
             Start: 07/01/2008
      N473 = Missing certification.
             Start: 07/01/2008
      N474 = Incomplete/invalid certification
             Start: 07/01/2008
      N475 = Missing completed referral form.
             Start: 07/01/2008
      N476 = Incomplete/invalid completed referral
             form
             Start: 07/01/2008
      N477 = Missing Dental Models.
             Start: 07/01/2008
      N478 = Incomplete/invalid Dental Models
             Start: 07/01/2008
      N479 = Missing Explanation of Benefits
             (Coordination of Benefits or Medicare
             Secondary Payer).
             Start: 07/01/2008
      N480 = Incomplete/invalid Explanation of
             Benefits (Coordination of Benefits or
             Medicare Secondary Payer).
             Start: 07/01/2008
      N481 = Missing Models.
             Start: 07/01/2008
      N482 = Incomplete/invalid Models
             Start: 07/01/2008
      N483 = Missing Periodontal Charts.
             Start: 07/01/2008
      N484 = Incomplete/invalid Periodontal Charts
             Start: 07/01/2008
      N485 = Missing Physical Therapy Certification.
             Start: 07/01/2008
      N486 = Incomplete/invalid Physical Therapy
             Certification.
             Start: 07/01/2008
      N487 = Missing Prosthetics or Orthotics
             Certification.
             Start: 07/01/2008
      N488 = Incomplete/invalid Prosthetics or
             Orthotics Certification
             Start: 07/01/2008
      N489 = Missing referral form.
             Start: 07/01/2008
      N490 = Incomplete/invalid referral form
             Start: 07/01/2008
      N491 = Missing/Incomplete/Invalid Exclusionary
             Rider Condition.
             Start: 07/01/2008
      N492 = Alert: A network provider may bill the
             member for this service if the member
             requested the service and agreed in
             writing, prior to receiving the service,
             to be financially responsible for the
             billed charge.
             Start: 07/01/2008
      N493 = Missing Doctor First Report of Injury.
             Start: 07/01/2008
      N494 = Incomplete/invalid Doctor First Report
             of Injury.
             Start: 07/01/2008
      N495 = Missing Supplemental Medical Report.
             Start: 07/01/2008
      N496 = Incomplete/invalid Supplemental Medical
             Report.
             Start: 07/01/2008
      N497 = Missing Medical Permanent Impairment or
             Disability Report.
             Start: 07/01/2008
      N498 = Incomplete/invalid Medical Permanent
             Impairment or Disability Report.
             Start: 07/01/2008
      N499 = Missing Medical Legal Report.
             Start: 07/01/2008
      N500 = Incomplete/invalid Medical Legal
             Report.
             Start: 07/01/2008
      N501 = Missing Vocational Report.
             Start: 07/01/2008
      N502 = Incomplete/invalid Vocational Report.
             Start: 07/01/2008
      N503 = Missing Work Status Report.
             Start: 07/01/2008
      N504 = Incomplete/invalid Work Status Report.
             Start: 07/01/2008
      N505 = Alert: This response includes only
             services that could be estimated in real
             time. No estimate will be provided for
             the services that could not be estimated
             in real time.
             Start: 11/01/2008
      N506 = Alert: This is an estimate of the
             member's liability based on the
             information available at the time the
             estimate was processed. Actual coverage
             and member liability amounts will be
             determined when the claim is processed.
             This is not a pre-authorization or a
             guarantee of payment.
             Start: 11/01/2008
      N507 = Plan distance requirements have not
             been met.
             Start: 11/01/2008
      N508 = Alert: This real time claim
             adjudication response represents the
             the member responsibility to the
             provider for services reported.  The
             member will receive an Explanation of
             Benefits electronically or in the mail.
             Contact the insurer if there are any
             questions.
             Start: 11/01/2008
      N509 = Alert: A current inquiry shows the
             member's Consumer Spending Account
             contains sufficient funds to cover the
             member liability for this claim/service.
             Actual payment from the Consumer
             Spending Account will depend on the
             availability of funds and determination
             of eligible services at the time of
             payment processing.
             Start: 11/01/2008
      N510 = Alert: A current inquiry shows the
             members Consumer Spending Account does
             not contain sufficient funds to cover
             the member's liability for this
             claim/service. Actual payment from the
             Consumer Spending Account will depend on
             the availability of funds and
             determination of eligible services at
             the time of payment processing.
             Start: 11/01/2008
      N511 = Alert: Information on the availability
             of Consumer Spending Account funds to
             cover the member liability on this
             claim/service is not available at this
             time.
             Start: 11/01/2008
      N512 = Alert: This is the initial remit of a
             non-NCPDP claim originally submitted
             real-time without change to the
             adjudication.
             Start: 11/01/2008
      N513 = Alert: This is the initial remit of a
             non-NCPDP claim originally submitted
             real-time with a change to the
             adjudication.
             Start: 11/01/2008
      N514 = Consult plan benefit
             documents/guidelines for information
             about restrictions for this service.
             Start: 11/01/2008
             Stop: 01/01/2011
             Notes: Consider using N130
      N515 = Alert: Submit this claim to the
             patient's other insurer for potential
             payment of supplemental benefits. We did
             not forward the claim information. (use
             N387 instead)
             Start: 11/01/2008
             Stop: 10/1/2009
      N516 = Records indicate a mismatch between the
             submitted NPI and EIN.
             Start: 03/01/2009
      N517 = Resubmit a new claim with the requested
             information.
             Start: 03/01/2009
      N518 = No separate payment for accessories
             when furnished for use with oxygen
             equipment.
             Start: 03/01/2009
      N519 = Invalid combination of HCPCS modifiers.
             Start: 07/01/2009
      N520 = Alert: Payment made from a Consumer
             Spending Account.
             Start: 07/01/2009
      N521 = Mismatch between the submitted provider
             information and the provider information
             stored in our system.
             Start: 11/01/2009
      N522 = Duplicate of a claim processed, or to
             be processed, as a crossover claim.
             Start: 11/01/2009
      N523 = The limitation on outlier payments
             defined by this payer for this service
             period has been met. The outlier payment
             otherwise applicable to this claim has
             not been paid.
             Start: 03/01/2010
      N524 = Based on policy this payment
             constitutes payment in full.
             Start: 03/01/2010
      N525 = These services are not covered when
             performed within the global period of
             another service.
             Start: 03/01/2010
      N526 = Not qualified for recovery based on
             employer size.
             Start: 03/01/2010
      N527 = We processed this claim as the primary
             payer prior to receiving the recovery
             demand.
             Start: 03/01/2010
      N528 = Patient is entitled to benefits for
             Institutional Services only.
             Start: 03/01/2010
      N529 = Patient is entitled to benefits for
             Professional Services only.
             Start: 03/01/2010
      N530 = Not Qualified for Recovery based on
             enrollment information.
             Start: 03/01/2010 |
      N531 = Not qualified for recovery based on
             direct payment of premium.
             Start: 03/01/2010
      N532 = Not qualified for recovery based on
             disability and working status.
             Start: 03/01/2010
      N533 = Services performed in an Indian Health
             Services facility under a self-insured
             tribal Group Health Plan.
             Start: 07/01/2010
      N534 = This is an individual policy, the
             employer does not participate in plan
             sponsorship.
             Start: 07/01/2010
      N535 = Payment is adjusted when procedure is
             performed in this place of service based
             on the submitted procedure code and
             place of service.
             Start: 07/01/2010
      N536 = We are not changing the prior payer's
             determination of patient responsibility,
             which you may collect, as this service
             is not covered by us.
             Start: 07/01/2010
      N537 = We have examined claims history and no
             records of the services have been found.
             Start: 07/01/2010
      N538 = A facility is responsible for payment
             to outside providers who furnish these
             services/supplies/drugs to its
             patients/residents.
             Start: 07/01/2010
      N539 = Alert: We processed appeals/waiver
             requests on your behalf and that request
             has been denied.
             Start: 07/01/2010
      N540 = Payment adjusted based on the
             interrupted stay policy.
             Start: 11/01/2010
      N541 = Mismatch between the submitted
             insurance type code and the information
             stored in our system.
             Start: 11/01/2010
      N542 = Missing income verification.
             Start: 03/08/2011
      N543 = Incomplete/invalid income verification
             Start: 03/08/2011
      N544 = Alert: Although this was paid, you have
             billed with a referring/ordering
             provider that does not match our system
             record. Unless, corrected, this will not
             be paid in the future.
             Start: 07/01/2011
      N545 = Payment reduced based on status as an
             unsuccessful eprescriber per the
             Electronic Prescribing (eRx) Incentive
             Program.
             Start: 07/01/2011
      N546 = Payment represents a previous reduction
             based on the Electronic Prescribing
             (eRx) Incentive Program.
             Start: 07/01/2011
      N547 = A refund request (Frequency Type Code
             8) was processed previously.
             Start: 03/06/2012
      N548 = Alert: Patient's calendar year
             deductible has been met.
             Start: 03/06/2012
      N549 = Alert: Patient's calendar year out-of-
             pocket maximum has been met.
             Start: 03/06/2012
      N550 = Alert: You have not responded to
             requests to revalidate your
             provider/supplier enrollment
             information. Your failure to revalidate
             your enrollment information will result
             in a payment hold in the near future.
             Start: 03/06/2012
      N551 = Payment adjusted based on the
             Ambulatory
             Surgical Center (ASC) Quality Reporting
             Program.
             Start: 03/06/2012
      N552 = Payment adjusted to reverse a previous
             withhold/bonus amount.
             Start: 03/06/2012
      N553 = Payment adjusted based on a Low Income
             Subsidy (LIS) retroactive coverage or
             status change.
             Start: 03/06/2012
             Stop:  11/1/2012
      N554 = Missing/Incomplete/Invalid Family
             Planning Indicator
             Start: 07/01/2012
      N555 = Missing medication list.
             Start: 07/01/2012
      N556 = Incomplete/invalid medication list.
             Start: 07/01/2012
      N557 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the specimen was collected.
             Start: 07/01/2012
      N558 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the equipment was received.
             Start: 07/01/2012
      N559 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the Ordering Physician is located.
             Start: 07/01/2012
      N560 = The pilot program requires an interim or
             final claim within 60 days of the Notice
             of Admission. A claim was not received.
             Start: 11/01/2012
      N561 = The bundled claim originally submitted
             for this episode of care includes
             related readmissions. You may resubmit
             the original claim to receive a
             corrected payment based on this
             readmission.
             Start: 11/01/2012
      N562 = The provider number of your incoming
             claim does not match the provider number
             on the processed Notice of Admission
             (NOA) for this bundled payment.
             Start: 11/01/2012
      N563 = Missing required provider/supplier
             issuance of advance patient notice of
             non-coverage. The patient is not liable
             for payment for this service.
             Start: 11/01/2012
             Notes: Related to M39
      N564 = Patient did not meet the inclusion
             criteria for the demonstration project
             or pilot program.
             Start: 11/01/2012
      N565 = Alert: This procedure code requires a
             modifier. Future claims containing this
             procedure code must include an
             appropriate modifier for the claim to be
             processed.
             Start: 11/01/2012
      N566 = Alert: This procedure code requires
             functional reporting. Future claims
             containing this procedure code must
             include an applicable non-payable code
             and appropriate modifiers for the claim
             to be processed.
             Start: 11/01/2012



 CLM_RRB_EXCLSN_IND_TB                   Claim RRB Exclusion Indicator Table

      Y = Exclude RRB beneficiary services from the prior authorization
          program
      Blank = Subject RRB beneficiary services to prior authorization



 CLM_SRVC_CLSFCTN_TYPE_TB                Claim Service Classification Type Table

          For facility type code 1 thru 6, and 9

       1 = Inpatient (including Part A)
       2 = Hospital based or Inpatient (Part B only)
           or home health visits under Part B
       3 = Outpatient (HHA-A also)
       4 = Other (Part B) -- (Includes HHA medical and
           other health services not under a plan of
           treatment, hospital or SNF for diagnostic
           clinical laboratory services for "nonpatients,"
           and referenced diagnostic services.  For HHAs
           under PPS, indicates an osteoporosis claim.)
       5 = Intermediate care - level I
       6 = Intermediate care - level II
       7 = Subacute Inpatient (revenue code 019X required)
           (formerly Intermediate care - level III)
           NOTE:  17X & 27X are discontinued effective
           10/1/05.
       8 = Swing beds (used to indicate billing for
           SNF level of care in a hospital with an
           approved swing bed agreement)
       9 = Reserved for national assignment

         For facility type code 7

       1 = Rural Health Clinic (RHC)
       2 = Hospital based or independent renal
           dialysis facility
       3 = Free-standing provider based federally
           qualified health center (FQHC) (eff 10/91)
       4 = Other Rehabilitation Facility (ORF) and
           Community Mental Health Center (CMHC)
           (eff 10/91 - 3/97); ORF only (eff. 4/97)
       5 = Comprehensive Rehabilitation Center
             (CORF)
       6 = Community Mental Health Center (CMHC) (eff 4/97)
       7-8 = Reserved for national assignment
       9 = Other

         For facility type code 8

       1 = Hospice (non-hospital based)
       2 = Hospice (hospital based)
       3 = Ambulatory surgical center in hospital
           outpatient department
       4 = Freestanding birthing center
       5 = Critical Access Hospital (eff. 10/99)
           formerly Rural primary care hospital
           (eff. 10/94)
       6-8 = Reserved for national use
       9 = Other



 CLM_TRANS_TB                            Claim Transaction Table

       0 = Religious NonMedical Health Care Institutions (RNHCI)
           bill (prior to 8/00, Christian Science bill), SNF bill,
           or state buy-in
       1 = Psychiatric hospital facility bill or dummy psychiatric
       2 = Tuberculosis hospital facility bill
       3 = General care hospital facility bill or dummy LRD
       4 = Regular SNF bill
       5 = Home health agency bill (HHA)
       6 = Outpatient hospital bill
       C = CORF bill - type of OP bill in the HHA bill format
           (obsoleted 7/98)
       H = Hospice bill



 CLM_VAL_TB                              Claim Value Table

       01 = Most Common Semi-Private Rate - to
            provide for the recording of hospital's
            most common semi-private rate.
       02 = Hospital Has No Semi-Private Rooms -
            Entering this code requires $0.00
            amount.
       03 = Reserved for national assignment.
       04 = Inpatient professional component
            charges which are combined billed -
            For use only by some all inclusive
            rate hospitals. (Eff 9/93)
       05 = Professional component included in
            charges and also billed separately to
            carrier - For use on Medicare and
            Medicaid bills if the state requests
            this information.
       06 = Medicare blood deductible - Total
            cash blood deductible (Part A blood
            deductible).
       07 = Medicare cash deductible (term 9/30/93)
            Reserved for national assignment.
       08 = Medicare Part A lifetime reserve amount
            in first calendar year - Lifetime reserve
            amount charged in the year of admission.
            (not stored in NCH until 2/93)
       09 = Medicare Part A coinsurance amount in
            the first calendar year - Coinsurance
            amount charged in the year of admission.
            (not stored in NCH until 2/93)
       10 = Medicare Part A lifetime reserve amount
            in the second calendar year - Lifetime
            reserve amount charged in the year of
            discharge where the bill spans two
            calendar years.
            (in NCH until 2/93)
       11 = Medicare Part A coinsurance amount in
            the second calendar year - Coinsurance
            amount charged in the year of discharge
            where the bill spans two calendar years
            (not stored in NCH until 2/93)
       12 = Amount is that portion of
            higher priority EGHP insurance payment
            made on behalf of aged bene
            provider applied to Medicare
            covered services on this bill.
            Six zeroes indicate provider
            claimed conditional Medicare payment.
       13 = Amount is that portion of higher
            priority EGHP insurance payment made on
            behalf of ESRD bene provider
            applied to Medicare covered services
            on this bill. Six zeroes indicate
            the provider claimed conditional
            Medicare payment.
       14 = That portion of payment from higher
            priority no fault auto/other
            liability insurance made on behalf of bene
            provider applied to Medicare covered
            services on this bill. Six zeroes indicate
            provider claimed conditional payment
       15 = That portion of a payment from a
            higher priority WC plan made on behalf
            of a bene that the provider applied to
            Medicare covered services on this bill. Six
            zeroes indicate the provider claimed
            conditional Medicare payment.
       16 = That portion of a payment from
            higher priority PHS or other federal
            agency made on behalf of a
            bene the provider applied
            to Medicare covered services on this
            bill. Six zeroes indicate
            provider claimed conditional Medicare
            payment.
       17 = Operating Outlier amount - Providers do
            not report this.  For payer internal use
            only.  Indicates the amount of day or
            cost outlier payment to be made.
            (Do not include any PPS capital outlier
            payment in this entry). Obsolete
       18 = Operating Disproportionate share amount -
            Providers do not report this.  For
            payer internal use only.  Indicates the
            disproportionate share amount applicable
            to the bill.  Use the amount provided by
            the disproportionate share field in PRICER.
            (Do not include any PPS capital DSH adjust-
            ment in this entry).  Obsolete
       19 = Operating Indirect medical education amount -
            Providers do not report this.  For
            payer internal use only.  Indicates the
            indirect medical education amount applicable
            to the bill.  (Do not include PPS capital
            IME adjustment in this entry). Obsolete
       20 = Total payment sent provider for capital
            under PPS, including HSP, FSP, outlier,
            old capital, DSH adjustment, IME
            adjustment, and any exception amount.
            (used 10/1/91 - 3/1/92 for provider
            reporting.  Payer only code eff 9/93.)
            Obsolete
       21 = Catastrophic - Medicaid - Eligibility
            requirements to be determined at state
            level.  (Medicaid specific/deleted 9/93)
       22 = Surplus - Medicaid - Eligibility
            requirements to be determined at state
            level. (Medicaid specific/deleted 9/93)
       23 = Recurring monthly income - Medicaid -
            Eligibility requirements to be
            determined at state level. (Medicaid
            specific/deleted 9/93)
       24 = Medicaid rate code - Medicaid -
            Eligibility requirements to be
            determined at state level. (Medicaid
            specific/deleted 9/93)
       25 = Offset to the Patient Payment Amount
            (Prescription Drugs) - Prescription
            drugs paid for out of a long-term
            care facility resident/patient's fund
            in the billing period submitted (State-
            ment Covers Period).
       26 - Prescription Drugs Offset to Patient
            (Payment Amount - Hearing and Ear Services)
            Hearing and ear services paid for out of
            a long term care facility resident/patient's
            funds in the billing period submitted
            (Statement covers period).
       27 = Offset to the Patient (Payment Amount - Vision
            and Eye Services) - Vision and eye services paid
            for out of a long term care facility resident/
            patient's funds in the billing period submitted
            (Statement Covers Period).
       28 = Offset to the Patient (Payment Amount - Dental
            Services) - Dental services paid for out of a
            long term care facility resident/patient's funds
            in the billing period submitted (Statement
            Covers Period).
       29 = Offset to the Patient (Payment Amount - Chiro-
            practic Services) - Chiropratic services paid
            for out of a long term care facility resident/
            patient's funds in the billing period submitted
            (Statement Covers Period).
       30 = Preadmission Testing - the code used to reflect
            the charges for preadmission outpatient diag-
            nostic services in preparation for a previously
            scheduled admission.
       31 = Patient liability amount - Amount
            shown is that which you or the PRO
            approved to charge the bene for
            noncovered accommodations, diagnostic
            procedures or treatments.
       32 = Multiple patient ambulance transport -
            The number of patients transported during
            one ambulance ride to the same destination.
            (eff. 4/1/2003)
       33 = Offset to the Patient Payment Amount (Podiatric
            Services) -- Podiatric services paid out of
            a long-term care facility resident/patient's
            funds in the billing period submitted.
       34 = Offset to the Patient Payment Amount (Medical
            Services) -- Other medical services paid out of
            a long-term care facility resident/patient's
            funds in the billing period submitted.
       35 = Offset to the Patient Payment Amount (Health
            Insurance Premiums) -- Other medical services
            paid out of a long-term care facility resident/
            patient's funds in the billing period submitted.
       37 = Pints of blood furnished - Total
            number of pints of whole blood or units
            of packed red cells furnished to the
            patient. (eff 10/93)
       38 = Blood deductible pints - The number
            of unreplaced pints of whole blood or
            units of packed red cells furnished for
            which the patient is responsible.
            (eff 10/93)
       39 = Pints of blood replaced - The total
            number of pints of whole blood or units
            of packed red cells furnished to the
            patient that have been replaced by or
            on behalf of the patient. (eff 10/93)
       40 = New coverage not implemented by HMO -
            amount shown is for inpatient charges
            covered by HMO (eff 3/92).
            (use this code when the bill includes
            inpatient charges for newly covered
            services which are not paid by HMO.)
       41 = Amount is that portion of
            a payment from higher priority Black Lung
            federal program made on behalf of
            bene the provider applied
            to Medicare covered services on this
            bill. Six zeroes indicate the
            provider claimed conditional Medicare
            payment.
       42 = Amount is that portion of a payment
            from higher priority VA made on behalf
            of bene the provider applied
            to Medicare covered services on this
            bill. Six zeroes indicate the
            provider claimed conditional Medicare
            payment.
       43 = Disabled bene under age 65 with
            LGHP - Amount is that portion of
            a payment from a higher priority LGHP
            made on behalf of a disabled Medicare
            bene the provider applied to
            Medicare covered services on this bill.
       44 = Amount provider agreed to accept from
            primary payer when amount less than charges
            but more than payment received -
            When a lesser amount is received and the
            received amount is less than charges, a
            Medicare secondary payment is due.
       45 = Accident Hour - The hour the accident occurred
            that necessitated medical treatment.
       46 = Number of grace days - Following the
            date of the PRO/UR determination, this
            is the number of days determined by the
            PRO/UR to be necessary to arrange for
            the patient's post-discharge care.
            (eff 10/93)
       47 = Any liability insurance - Amount
            is that portion from a higher priority
            liability insurance made on behalf of
            Medicare bene the provider
            is applying to Medicare covered
            services on this bill. (Eff 9/93)
       48 = Hemoglobin reading - The patient's most
            recent hemoglobin reading taken before
            the start of the billing period (eff.
            1/3/2006). Prior to 1/3/2006 defined as
            the latest hemoglobin reading taken during
            the billing cycle.
       49 = Hematocrit reading - The patient's most
            recent hematocrit reading taken before the
            start of the billing period (eff. 1/3/2006).
            Prior to 1/3/2006 defined as hematocrit
            reading taken during the billing cycle.
       50 = Physical therapy visits - Indicates
            the number of physical therapy
            visits from onset (at billing provider)
            through this billing period.
       51 = Occupational therapy visits - Indicates
            the number of occupational therapy
            visits from onset (at the billing
            provider) through this billing period.
       52 = Speech therapy visits - Indicates
            the number of speech therapy
            visits from onset (at billing provider)
            through this billing period.
       53 = Cardiac rehabilitation - Indicates
            the number of cardiac rehabilitation
            visits from onset (at billing
            provider) through this billing period.
       54 = New birth weight in grams - Actual birth
            weight or weight at time of admission for
            an extramural birth.  Required on all claims
            with type of admission of '4' and on other
            claims as required by law.
       55 = Eligibility Threshold for Charity Care - code
            identifies the corresponding value amount at
            which a health care facility determines the
            eligibility threshold of charity care.
       56 = Hours skilled nursing provided - The
            number of hours skilled nursing
            provided during the billing period.  Count
            only hours spent in the home.
       57 = Home health visit hours - The number
            of home health aide services provided
            during the billing period.  Count only
            the hours spent in the home.
       58 = Arterial blood gas - Arterial blood
            gas value at beginning of each reporting
            period for oxygen therapy. This
            value or value 59 will be required on
            the initial bill for oxygen therapy and
            on the fourth month's bill.
       59 = Oxygen saturation - Oxygen saturation
            at the beginning of each reporting
            period for oxygen therapy.  This value or
            value 58 will be required on the
            initial bill for oxygen therapy and on
            the fourth month's bill.
       60 = HHA branch MSA - MSA in which HHA
            branch is located.
       61 = Location of HHA service or hospice
            service - the balanced budget act
            (BBA) requires that the geographic
            location of where the service was
            provided be furnished instead of the
            geographic location of the provider.

            NOTE: HHA claims with a thru date on or
            before 12/31/05, the value code amount
            field reflects the MSA code (followed by zeroes
            to fill the field).  HHA claims with a
            thru date after 12/31/05, the value code
            amount field reflects the CBSA code.

       62 = Number of Part A home health visits
            accrued during a period of continuous
            care - necessitated by the change in
            payment basis under HH PPS (eff. 10/00)
       63 = Number of Part B home health visits
            accrued during a period of continuous
            care - necessitated by the change in
            payment basis under HH PPS (eff. 10/00)
       64 = Amount of home health payments attributed
            to the Part A trust fund in a period
            of continuous care - necessitated by the
            change in payment basis under HH PPS
            (eff. 10/00)
       65 = Amount of home health payments attributed
            to the Part B trust fund in a period
            of continuous care - necessitated by the
            change in payment basis under HH PPS
            (eff. 10/00)
       66 = Medicare Spend-down Amount -- The dollar
            amount that was used to meet th4e recipient's
            spend-down liability for this claim.
       67 = Peritoneal dialysis - The number of
            hours of peritoneal dialysis provided
            during the billing period (only the
            hours spent in the home).
            (eff. 10/97)
       68 = EPO drug - Number of units of EPO
            administered relating to the billing
            period.
       69 = State Charity Care Percent - code
            indicates the percentage of charity
            care eligibility for the patient.
       70 = Interest amount - (Providers do not
            report this.)  Report the amount
            applied to this bill.
       71 = Funding of ESRD networks - (Providers
            do not report this.)  Report the
            amount the Medicare payment was
            reduced to help fund the ESRD networks.
       72 = Flat rate surgery charge - Code
            indicates the amount of the charge for
            outpatient surgery where the hospital
            has such a charging structure.
       73 = Drug deductible - (For internal use by
            third party payers only).  Report the
            amount of the drug deductible to be
            applied to the claim.
       74 = Drug coinsurance - (For internal use
            by third party payers only).  Report
            the amount of drug coinsurance to be
            applied to the claim.
       75 = Gramm/Rudman/Hollings - (Providers do
            not report this.)  Report the amount of
            the sequestration applied to this bill.
       76 = Report provider's percentage of
            billed charges interim rate during
            billing period.  Applies to OP
            hospital, SNF and HHA claims
            where interim rate is applicable.
            Report to left of dollar/cents delimiter.
            (TP payers internal use only)
       77 = New Technology Add-on Payment Amount -
            Amount of payments made for discharges
            involving approved new technologies. If
            the total covered costs of the discharge
            exceed the DRG payment for the case
            (including adjustments for IME and
            disporportionate share hospitals (DSH) but
            excluding outlier payments) an add-on
            amount is made indicating a new technology
            was used in the treatment of the beneficiary.
            (eff. 4/1/03, under Inpatient PPS)
       78 = Payer code - This codes is set
            aside for payer use only.  Providers
            do not report these codes.
       79 = Payer code - This code is set
            aside for payer use only.  Providers
            do not report these codes.
       80 = Covered days - the number of days covered by the
            primary payer as qualified by the payer.
       81 = Non-covered Days - days of care not covered
            by the primary payer.
       82 = Co-insurance Days - The inpatient Medicare days
            occurring after the 60th day and before the
            91st day or inpatient SNF/Swing bed days
            occurring after the 20th and before the 101st
            day in a single spell of illness.
       83 = Lifetime Reserve Days - Under Medicare, each
            beneficiary has a lifetime reserve of 60
            additional days of inpatient hospital services
            after using 90 days of inpatient hospital
            services during a spell of illness.
       84 = Medicare Lifetime Reserve Amount in the third
           or greater calendar years'.  Eff. 1/7/2013
       85 = Medicare Coinsurance Amount in the third
            or greater calendar years'.  Eff. 1/7/2013
       86 = Invoice Cost (term. 3/2020)
       87 = Gene Therapy Invoice Cost (eff. 4/2020)
       88 = Allogeneic Stem Cell Transplant - Number of Related
            Donors Evaluation (eff. 7/2020)
       89 = Allogeneic Stem Cell Transplant - Total All-
            inclusive Donor Charges (eff. 7/2020)
       90 = Cell Therapy Invoice Cost (eff. 4/2020)
       91 - 99 = Reserved for national assignment.
       A0 = Special Zip Code Reporting - five digit
            zip code of the location from which the
            beneficiary is initially placed on board
            the ambulance. (eff. 9/01)
       A1 = Deductible Payer A - The amount assumed by
            the provider to be applied to the patient's
            deductible amount to the invovling the
            indicated payer. (eff. 10/93)
            - Prior value 07
       A2 = Coinsurance Payer A - The amount assumed
            by the provider to be applied to the
            patient's Part B coinsurance amount
            involving the indicated payer. (eff 10/93)
       A3 = Estimated Responsibility Payer A - The amount
            estimated by the provider to be paid by the
            indicated payer.
       A4 = Self-administered drugs administered in an
            emergency situation - Ordinarily the only
            noncovered self-administered drug
            paid for under Medicare in an emergency
            situation is insulin administered to a
            patient in a diabetic coma. (eff 7/97)
       A5 = Covered self-administered drugs -- The amount
            included in covered charges for self-admini-
            strable drugs administered  to the patient be-
            cause the drug was not self-administered  in the
            form and situation in which it was furnished to
            the patient.
       A6 = Covered self-administered drugs -Diagnostic
            study and Other --- the amount included in
            covered charges for self-administrable drugs
            administered to the patient because the drug
            was necessary for diagnostic study or other
            reasons.  For use with Revenue Center 0637.
       A7 = Copayment A -- The amount assumed by the pro-
            vider to be applied toward the patient's co-
            payment amount involving the indicated payer.
       A8 = Patient Weight -- Weight of patient in kilograms.
            Report this data only when the health plan has
            a predefined change in reimbursement that is
            affected by weight.
       A9 = Patient Height - Height of patient in centimeters
            Report this data only when the health plan has
            a predefined change in reimbursement that is
            affected by height.
       AA = Regulatory Surcharges, Assessments, Allowances
            or Health Care Related Taxes (Payer A) -- The
            amount of regulatory surcharges, assessments,
            allowances or health care related taxes per-
            taining to the indicated payer (eff. 10/2003).
       AB = Other Assessments or Allowances (Payer A) --
            The amount of other assessments or allowances
            pertaining to the indicated payer. (eff. 10/2003).
       B1 = Deductible Payer B - The amount
            assumed by the provider to be applied
            to the patient's deductible amount
            involving the indicated payer. (eff 10/93)
            - Prior value 07
       B2 = Coinsurance Payer B - the amount assumed
            by the provider to be applied to the
            patient's Part B coinsurance amount
            involving the indicated payer. (eff 10/93)
       B3 = Estimated Responsibility Payer B - The
            amount estimated by the provider to be
            paid by the indicated payer.
       B7 = Copayment B -- The amount assumed by the pro-
            vider to be applied toward the patient's co-
            payment amount involving the indicated payer.
       BA = Regulatory Surcharges, Assessments, Allowances
            or Health Care Related Taxes (Payer B) -- The
            amount of regulatory surcharges, assessments,
            allowances or health care related taxes per-
            taining to the indicated payer (eff. 10/2003).
       BB = Other Assessments or Allowances (Payer B) --
            The amount of other assessments or allowances
            pertaining to the indicated payer. (eff. 10/2003).
       C1 = Deductible Payer C - The amount
            assumed by the provider to be applied
            to the patient's deductible amount
            involving the indicated payer. (eff 10/93)
            - Prior value 07
       C2 = Coinsurance Payer C - The amount assumed
            by the provider to be applied to the
            patient's Part B coinsurance amount
            involving the indicated payer. (eff 10/93)
       C3 = Estimated Responsibility Payer C - The
       C7 = Copayment C -- The amount assumed by the pro-
            vider to be applied toward the patient's co-
            payment amount involving the indicated payer.
       CA = Regulatory Surcharges, Assessments, Allowances
            or Health Care Related Taxes (Payer C) -- The
            amount of regulatory surcharges, assessments,
            allowances or health care related taxes per-
            taining to the indicated payer (eff. 10/2003).
       CB = Other Assessments or Allowances (Payer C) --
            The amount of other assessments or allowances
            pertaining to the indicated payer. (eff. 10/2003).
       D3 = Estimated Responsibility Patient - The
            amount estimated by the provider to be
            paid by the indicated patient.
       D4 = Clinical Trial Number Assigned by NLM/NIH -
            Eight digit numeric National Library of
            Medicine/National Institute of Health clinical
            trial registry number or a default number of
            '99999999' if the trial does not have an
            8-digit registry number. (Eff. 10/1/07)
       D5 = Last Kt/V Reading - result of last Kt/V
            reading.  For in-center hemodialysis patients,
            this is the last reading taken during the
            billing period.   For peritoneal dialysis
            patients (and home hemodialysis patients), this
            may be before the current billing period but
            should be within 4 months of the date of
            service. (eff. 7/1/10)
       FC = Patient Paid Amount - The amount the provider
            has received from the patient toward payment
            of this bill (7/1/08).
       FD = Credit Received from the Manufacturer for a
            Replaced Medical Device - the amount the
            provider has received from a medical device
            manufacturer as credit for a replaced device.
            (eff. 7/1/08)
       G8 = Facility Where Inpatient Hospice Service Is
            Delivered - MSA or Core Based Statistical Area
            (CBSA) number (or rural state code) of the
            facility where inpatient hospice is delivered.
            (Eff. 1/1/08)
       Q0 = ACO Payment Adjustment Amount (Pioneer Reduction)-
            the amount that would have been paid if not for
            the Pioneer reduction. (eff. 1/2014)
       Q1 = ACO Payment Reduction Amount (Pioneer Reduction)-
            the actual amount of the Pioneer reduction.
            (eff. 1/2014)
       Q4 = Pennsylvania (PA) Rural Health Exclusion - Physician
            Services Claim Reimbursement
       Q5 = EHR Reduction
       Q7 = ISLET Add-On Payment Amount (eff. 10/2016)
       Q8 = Total Transitional Drug Add-On Payment Adjustment
            (TDAPA) Amount  (eff. 1/2018)
       Q9 = Medicare Advantage (MA) Plan Amount (eff. 10/2014)
       QB = OCM+ Payment Adjustment Amount (payer only)
            (eff. 1/2020)
       QN = First APC device offset
       QO = Second APC device offset
       QP = Placeholder reserved for future use
       QQ = Terminated procedure with pass-through device OR
            condition for device credit present
       QR = First APC pass-through drug or biological offset
       QS = Second APC pass-through drug or biological offset
       QT = Third APC pass-through drug or biological offset
       QU = Reserved for future use
       QV = Home Health Value Based Purchasing (HHVBP) adjustment
            amount (negative or positive) - eff. 4/2018
       QW = Reserved for future use
       XX = Total Charge Amount for all Part A visits
            on RIC 'U' claims - for Home Health claims
            containing both Part A and Part B services
            this code identifies the total charge amount
            for the Part A visits (based on revenue
            center codes 042X, 043X, 044X, 055X, 056X,
            & 057X).  Code created internally in the
            CWFMQA system (eff. 10/31/01 with HHPPS).
       XY = Total Charge Amount for all Part B visits
            on RIC 'U' claims - for Home Health claims
            containing both Part A and Part B services
            this code identifies the total charge amount
            for the Part B visits (based on revenue
            center codes 042X, 043X, 044X, 055X, 056X,
            & 057X).  Code created internally in the
            CWFMQA system (eff. 10/31/01 with HHPPS).
       XZ = Total Charge Amount for all Part B non-
            visit charges on the RIC 'U' claims - for
            Home Health claims containing both Part A
            & Part B services, this code identifies the
            total charge amount for the Part B non-visit
            charges.  Code created internally in the
            CWFMQA system (eff. 10/31/01 with HHPPS).
       Y1 = Part A demo payment - Portion of the
            payment designated as reimbursement for
            Part A services under the demonstration.
            This amount is instead of the traditional
            prospective DRG payment (operating and
            capital) as well as any outlier payments
            that might have been applicable in the
            absence of the demonstration.  No deductible
            or coinsurance has been applied. Payments
            for operating IME and DSH which are pro-
            cessed in the traditional manner are also
            not included in this amount.

       Y2 = Part B demo payment - Portion of the
            payment designated as reimbursement for
            Part B services under the demonstration.
            No deductible or coinsurance has been
            applied.
       Y3 = Part B coinsurance - Amount of Part B
            coinsurance applied by the intermediary
            to this demo claim. For demonstration
            claims this will be a fixed copayment
            unique to each hospital and DRG (or
            DRG/procedure group).
       Y4 = Conventional Provider Payment Amount
            for Non-Demonstration Claims - This
            the amount Medicare would have reim-
            bursed the provider for Part A services
            if there had been no demonstration.  This
            should include the prospective DRG payment
            (both capital as well as operational) as
            well as any outlier payment, which would be
            applicable.  It does not include any pass
            through amounts such as that for direct
            medical education nor interim payments for
            operating IME and DSH.
       Y5 = Part B deductible, applicable for a Model 4
            demonstration 64 claims



 CLM_WC_IND_TB                           Workers' Compensation Indicator Table

      Y = The diagnosis codes on the claims are related to the diagnosis
          codes on the MSP auxiliary file in CWF.

      Spaces



 CMS_PRVDR_SPCLTY_TB                     CMS Provider Specialty Table


      00 = Carrier wide
      01 = General practice
      02 = General surgery
      03 = Allergy/immunology
      04 = Otolaryngology
      05 = Anesthesiology
      06 = Cardiology
      07 = Dermatology
      08 = Family practice
      09 = Interventional Pain Management (IPM) (eff. 4/1/03)
      09 = Gynecology (osteopaths only)
           (discontinued 5/92 use code 16)
      10 = Gastroenterology
      11 = Internal medicine
      12 = Osteopathic manipulative therapy
      13 = Neurology
      14 = Neurosurgery
      15 = Speech Language Pathologists
      15 = Obstetrics (osteopaths only)
           (discontinued 5/92 use code 16)
      16 = Obstetrics/gynecology
      17 = Hospice and Palliative Care
      17 = Ophthalmology, otology, laryngology,
           rhinology (osteopaths only)
           (discontinued 5/92 use codes 18 or 04
           depending on percentage of practice)
      18 = Ophthalmology
      19 = Oral surgery (dentists only)
      20 = Orthopedic surgery
      21 = Cardiac Electrophysiology
      21 = Pathologic anatomy, clinical
           pathology (osteopaths only)
           (discontinued 5/92 use code 22)
      22 = Pathology
      23 = Sports medicine
      23 = Peripheral vascular disease, medical
           or surgical (osteopaths only)
           (discontinued 5/92 use code 76)
      24 = Plastic and reconstructive surgery
      25 = Physical medicine and rehabilitation
      26 = Psychiatry
      27 = Geriatric Psychiatry Colorectal Surgery
      27 = Psychiatry, neurology (osteopaths
           only) (discontinued 5/92 use code 86)
      28 = Colorectal surgery (formerly
           proctology)
      29 = Pulmonary disease
      30 = Diagnostic radiology
      31 = Intensive Cardiac Rehabilitation
      31 = Roentgenology, radiology (osteopaths
           only) (discontinued 5/92 use code 30)
      32 = Anesthesiologist Assistants (eff. 4/1/03--previously
           grouped with Certified Registered Nurse Anesthetists
           (CRNA))
      32 = Radiation therapy (osteopaths only)
           (discontinued 5/92 use code 92)
      33 = Thoracic surgery
      34 = Urology
      35 = Chiropractic
      36 = Nuclear medicine
      37 = Pediatric medicine
      38 = Geriatric medicine
      39 = Nephrology
      40 = Hand surgery
      41 = Optometry (revised 10/93 to
           mean optometrist)
      42 = Certified nurse midwife (eff 1/87)
      43 = CRNA (eff. 1/87) (Anesthesiologist Assistants
           were removed from this specialty 4/1/03)
      44 = Infectious disease
      45 = Mammography screening center
      46 = Endocrinology (eff 5/92)
      47 = Independent Diagnostic Testing Facility
           (IDTF) (eff. 6/98)
      48 = Podiatry
      49 = Ambulatory surgical center
           (formerly miscellaneous)
      50 = Nurse practitioner
      51 = Medical supply company with
           certified orthotist (certified by
           American Board for Certification in
           Prosthetics And Orthotics)
      52 = Medical supply company with
           certified prosthetist
           (certified by American Board for
           Certification In Prosthetics And
           Orthotics)
      53 = Medical supply company with
           certified prosthetist-orthotist
           (certified by American Board for
           Certification in Prosthetics
           and Orthotics)
      54 = Medical supply company not included
           in 51, 52, or 53.  (Revised 10/93
           to mean medical supply company for DMERC)
      55 = Individual certified orthotist
      56 = Individual certified prosthetist
      57 = Individual certified prosthetist-orthotist
      58 = Individuals not included in 55, 56, or 57,
           (revised 10/93  to mean medical supply company
           with registered pharmacist)
      59 = Ambulance service supplier, e.g.,
           private ambulance companies, funeral homes, etc.
      60 = Public health or welfare agencies
           (federal, state, and local)
      61 = Voluntary health or charitable agencies (e.g.
           National Cancer Society, National Heart
           Association, Catholic Charities)
      62 = Psychologist (billing independently)
      63 = Portable X-ray supplier
      64 = Audiologist (billing independently)
      65 = Physical therapist (private practice added 4/1/03)
           (independently practicing removed 4/1/03)
      66 = Rheumatology (eff 5/92)
           Note: during 93/94 DMERC also used this to mean
           medical supply company with
           respiratory therapist
      67 = Occupational therapist (private practice added 4/1/03)
           (independently practicing removed 4/1/03)
      68 = Clinical psychologist
      69 = Clinical laboratory (billing independently)
      70 = Multispecialty clinic or group practice
      71 = Registered Dietician/Nutrition Professional (eff. 1/1/02)
      72 = Pain Management (eff. 1/1/02)
      73 = Mass Immunization Roster Biller (eff. 4/1/03)
      74 = Radiation Therapy Centers (added to differentiate
           them from Independent Diagnostic Testing Facilities
           (IDTF --eff. 4/1/03)
      74 = Occupational therapy (GPPP)
           (not to be assigned after 5/92)
      75 = Slide Preparation Facilities (added to differentiate
           them from Independent Diagnostic Testing Facilites
           (IDTFs -- eff. 4/1/03)
      75 = Other medical care (GPPP) (not to
           assigned after 5/92)
      76 = Peripheral vascular disease
           (eff 5/92)
      77 = Vascular surgery (eff 5/92)
      78 = Cardiac surgery (eff 5/92)
      79 = Addiction medicine (eff 5/92)
      80 = Licensed clinical social worker
      81 = Critical care (intensivists)
           (eff 5/92)
      82 = Hematology (eff 5/92)
      83 = Hematology/oncology (eff 5/92)
      84 = Preventive medicine (eff 5/92)
      85 = Maxillofacial surgery (eff 5/92)
      86 = Neuropsychiatry (eff 5/92)
      87 = All other suppliers (e.g. drug and
           department stores) (note: DMERC used
           87 to mean department store from 10/93
           through 9/94; recoded eff 10/94 to A7;
           NCH cross-walked DMERC reported 87 to A7.
      88 = Unknown supplier/provider specialty
           (note: DMERC used 87 to mean grocery
           store from 10/93 - 9/94; recoded eff
           10/94 to A8; NCH cross-walked DMERC
           reported 88 to A8.
      89 = Certified clinical nurse specialist
      90 = Medical oncology (eff 5/92)
      91 = Surgical oncology (eff 5/92)
      92 = Radiation oncology (eff 5/92)
      93 = Emergency medicine (eff 5/92)
      94 = Interventional radiology (eff 5/92)
      95 = Competative Acquisition Program (CAP)
           Vendor (eff. 07/01/06). Prior to
           07/01/06, known as Independent
           physiological laboratory (eff. 5/92)
      96 = Optician (eff 10/93)
      97 = Physician assistant (eff 5/92)
      98 = Gynecologist/oncologist (eff 10/94)
      99 = Unknown physician specialty
      A0 = Hospital (eff 10/93) (DMERCs only)
      A1 = SNF (eff 10/93) (DMERCs only)
      A2 = Intermediate care nursing facility
           (eff 10/93) (DMERCs only)
      A3 = Nursing facility, other (eff 10/93)
           (DMERCs only)
      A4 = HHA (eff 10/93) (DMERCs only)
      A5 = Pharmacy (eff 10/93) (DMERCs only)
      A6 = Medical supply company with respiratory
           therapist (eff 10/93) (DMERCs only)
      A7 = Department store (for DMERC use:
           eff 10/94, but cross-walked from
           code 87 eff 10/93)
      A8 = Grocery store (for DMERC use:
           eff 10/94, but cross-walked from
           code 88 eff 10/93)
      A9 = Indian Health Service (IHS), tribe and
           tribal organizations (non-hospital or
           non-hospital based facilities.  DMERCs shall
           process claims submitted by IHS, tribe and
           non-tribal organizations for DMEPOS and drugs
           covered by the DMERCs. (eff. 1/2005)
      B1 = Supplier of oxygen and/or oxygen related
           equipment (eff. 10/2/07)
      B2 = Pedorthic Personnel (eff. 10/2/07)
      B3 = Medical Supply Company with Pedorthic Personnel
           (eff. 10/2/07)
      B4 = Rehabilitation Agency (eff. 10/2/07)
      B5 = Ocularist
      C0 = Sleep medicine
      C1 = Centralized Flu
      C4 = Non-Provider Convener Participants in the BPCI Advanced
           Model (eff. 7/2019)
      C5 = Dentist (eff. 7/2016)
      D5 = Opiod Treatment Progrm (eff. 1/2020)



 CTGRY_EQTBL_BENE_IDENT_TB               Category Equatable Beneficiary Identification Code (BIC) Table

       NCH BIC              SSA Categories
       -------              --------------

       A  = A;J1;J2;J3;J4;M;M1;T;TA
       B  = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6;
            TB(F);TD(F);TE(F);TW(F)
       B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M)
            TD(M);TE(M);TW(M)
       B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2
            W7;TG(F);TL(F);TR(F);TX(F)
       B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M)
            TL(M);TR(M);TX(M)
       B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4
            W8;TH(F);TM(F);TS(F);TY(F)
       BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9
            WC;TJ(F);TN(F);TT(F);TZ(F)
       BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF
            WJ;TK(F);TP(F);TU(F);TV(F)
       BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M)
            TY(M)
       BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M)
            TZ(M)
       BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M)
            TV(M)
       C1 = C1;TC
       C2 = C2;T2
       C3 = C3;T3
       C4 = C4;T4
       C5 = C5;T5
       C6 = C6;T6
       C7 = C7;T7
       C8 = C8;T8
       C9 = C9;T9
       F1 = F1;TF
       F2 = F2;TQ
       F3-F8 = Equatable only to itself (e.g., F3 IS
               equatable to F3)
       CA-CZ = Equatable only to itself.  (e.g., CA is
               only equatable to CA)

            ---------------------------------------
                       RRB Categories

       10 = 10
       11 = 11
       13 = 13;17
       14 = 14;16
       15 = 15
       43 = 43
       45 = 45
       46 = 46
       80 = 80
       83 = 83
       84 = 84;86
       85 = 85



 END_REC_TB                              End of Record Code Table

      EOR = End of record/segment
      EOC = End of claim



 FI_CLM_ACTN_TB                          Fiscal Intermediary Claim Action Table

      1 = Original debit action (includes non-
          adjustment RTI correction items) - it
          will always be a 1 in regular bills.
      2 = Cancel by credit adjustment - used
          only in credit/debit pairs (under HHPPS,
          updates the RAP).
      3 = Secondary debit adjustment - used only
          in credit/debit pairs (under HHPPS, would
          be the final claim or an adjustment on
          a LUPA).
      4 = Cancel only adjustment (under HHPPS,
          RAP/final claim/LUPA).
      5 = Force action code 3
      6 = Force action code 2
      8 = Benefits refused (for inpatient bills,
          an 'R' nonpayment code must also be
          present
      9 = Payment requested (used on bills that
          replace previously-submitted benefits-
          refused bills, action code 8.  In such
          cases a debit/credit pair is not re-
          quired.  For inpatient bills, a 'P'
          should be entered in the nonpayment
          code.)



 FI_NUM_TB                               Fiscal Intermediary Number / Medicare Administrative Contractor Table

       00010 = Alabama BC - Alabama (term. 05/2009)
               (replaced with MAC #10101 -- see below)
       00011 = Alabama BC - Iowa (term. 10/2007)
               replaced by MAC # 03401 -- see below)
       00011 = Cahaba - (RHHI) (term. 06/2011)
               replaced by MAC # 03401  -- see below)
       00012 = Iowa  (terminated)
               replaced by MAC # 05101 -- see below)
       00012 = Arizona - Noridian - J3 A MAC (AZA)
               (term. 05/2008)
       00020 = Arkansas BC - Arkansas
       00021 = Arkansas BC - Rhode Island
               (term. 05/2009)
       00030 = Arizona BC (term. 09/2007)
               (replaced by MAC # 03101 -- see below)
       00040 = California BC (term. 11/2000)
       00041 = California - Oakland BC (terminated)
       00050 = New Mexico BC/CO (term. 06/89)
       00050 = Colorado BC (terminated)
       00060 = Connecticut BC (term. 06/99)
       00070 = Delaware BC - (term. 02/98)
       00080 = Florida BC (term. 03/88)
       00080 = District of Columbia BC (terminated)
       00090 = Florida BC (term. 02/2009)
               (replaced with MAC #09101 -- see below)

       00100 = Georgia - Atlantic BC (terminated)
       00101 = Georgia BC (term. 05/2009)
               (replaced with MAC #10201 -- see below)
       00110 = Idaho BC (terminated)
       00121 = Illinois - HCSC (term. 08/98)
       00122 = Illinois - BC (terminated)
       00123 = Michigan - HCSC (term. 08/98)
       00130 = Indiana BC/Administar Federal (term. 7/22/2012)
               (replaced with MAC # 08101 -- see below)
       00131 = Illinois - Anthem
       00140 = Iowa - Wellmark (term. 05/2000)
       00141 = Iowa - Souix City BC (terminated)
       00150 = Kansas BC (term. 02/2008)
               (replaced with MAC # 05201 -- see below)
       00160 = Kentucky - Anthem (term. 4/30/2011)
               (replaced with MAC # 15101 -- see below)
       00170 = Louisiana - Baton Rouge BC (terminated)
       00171 = Louisiana - New Orleans BC (terminated)
       00180 = Maine BC  (term. 05/2009)
               (replaced with MAC #14004 & 14101  -- see below)
       00180 = Connecticut, Maine, Massachusetts,
               New Hampshire, Rhode Island (Maine RHHI)
               (term. 05/2009)
               (replaced with MAC #14004 & 14101  -- see below)
       00181 = Massachusetts - Maine BC (term. 05/2009)
       00190 = Carefirst of Maryland (term. 09/2005)
       00191 = District of Columbia - Maryland BC (terminated)

       00200 = Massachusetts BC (term. 7/97)
       00210 = Michigan BC (term. 9/94)
       00220 = Minnesota BC (term. 07/99)
       00230 = Mississippi BC
       00230 = Trispan Health Services (LA-MS) (term. 09/2009)
               (previously also MOA)
       00231 = Mississippi BC - Louisiana (term. 09/1992)
       00232 = Mississippi BC
       00233 = Louisiana, Mississippi (J7 Interim)
               (eff 10/01/2009)
       00234 = PBSI J7 A TEMP ROLLUP AK,LA,MS
               (terminated)
       00240 = Kansas City BC - Missouri (terminated)
       00241 = Missouri BC (term. 9/92)
       00242 = Missouri (terminated)
               (replaced with MAC # 05301 --see below)
       00242 = BCBS of MS (MOA) (term. 04/2008)
               (replaced with MAC # 05301 --see below)
       00250 = Montana BC (term. 11/2006)
               (replaced by MAC # 03201 -- see below)
       00260 = Nebraska BC (term. 11/2007)
               (replaced with MAC # 05401 --see below)
       00270 = New Hampshire BC - New Hampshire, Vermont
               (term. 06/2009)
               (replaced with MAC #14501 -- see below)
       00280 = New Jersey BC (term. 07/2000)
       00290 = New Mexico BC - (term. 11/1995)
       00291 = New Mexico BC - Colorado (terminated)

       00300 = New York - Albany BC (terminated)
       00301 = New York - Buffalo BC (terminated)
       00302 = New York - Jamestown BC (terminated)
       00303 = New York - New York City BC (terminated)
       00304 = New York - Rochester BC (terminated)
       00305 = New York - Syracuse BC (terminated)
       00306 = New York - Utica BC (terminated)
       00307 = New York - Watertown BC (terminated)
       00308 = Empire BC - New York, Connecticut, Delaware
               (term. 11/2008)
               (replaced with MAC # 12101, 13201 & 13101 -- see below)
       00310 = North Carolina BC (term. 09/2002)
       00312 (terminated)
       00320 = North Dakota BC - North Dakota (term. 12/1/2006)
               (replaced with MAC # 03301 -- see
               below)
       00322 = North Dakota BC - Washington & Alaska
       00323 = North Dakota BC - Idaho, Oregon & Utah
               (term. 11/2006)
               (replaced with MAC # 03501 --see below)
       00325 = Noridian - Idaho, Oregon
       00326 = J2 Rollup (Merge into a single CICS region)
               (temporary)  (terminated)
       00330   NA (terminated)
       00331 = Canton BC - Ohio (terminated)
       00332 = Administar - Ohio
               Anthem - Ohio
       00333 = Cleveland BC - Ohio (terminated)
               Ohio-Administar
       00334 = Columbus BC - Ohio (terminated)
       00335 = Lima BC - Ohio (terminated)
       00337 = Toledo BC - Ohio (terminated)
       00338 = Youngstown BC - Ohio (terminated)
       00340 = Oklahoma BC (term. 02/2008)
               (replaced with MAC # 04301 -- see below)
       00350 = Regence - Oregon, Idaho, Utah
               (term. 11/2005)
       00351 = Oregon BC/ID. (term. 09/88)
       00355 = Regence CWF - Oregon (term. 09/2004)
       00360 = Allentown BC - Pennsylvania (terminated)
       00361 = Harrisburg BC - Pennsylvania (terminated)
       00361 = Independence BC - Pennsylvania (terminated)
       00362 = Independence BC - terminated 8/97
       00363 = Pennsylvania/Highmark - Veritus
               (term. 07/2008)
       00364 = Wilkes Barre BC - Pennsylvania (terminated)
       00366 = Highmark (MD & DC) - Part A (eff. 10/2005)
               (term. 07/2008)
       00370 = Rhode Island BC
               (term. 03/2004)
               (replaced with MAC #14401 - see below)
       00380 = South Carolina BC - South Carolina
               (term. 01/2011)
               (replaced with MAC #11004 & 11201 - see below)
       00380 = Palmetto GBA - AL, AR, GA, FL, IL, IN, KY,
               LA, MS, MN, NC, OK, OH, SC, TN, TX
               (term. 01/2011)
       00381   NA (terminated)
       00382 = South Carolina BC - North Carolina
               (term. 10/2010)
               (replaced with MAC #11501 - see below)
       00388 = Palmetto Drugs (terminated)
       00390 = Riverbend BC - New Jersey, Tennessee
               (term. 08/2009)
               (replaced with MAC # 12001 & 10301 -- see below)
       00392 = Memphis BC - Tennessee (terminated)

       00400 = Texas BC - Colorado, New Mexico, Texas
               (term. 05/2008)
               (replaced with MAC #04101, 04201, 04401 -- see below)
       00401   NA (terminated)
       00410 = Utah BC (term. 09/2000)
       00423 = Trigon - Virginia, West Virginia (term. 07/1999)
       00424 = Roanoke BC - Virginia (terminated)
       00425 = Virginia BC - West Virginia (term. 08/1992)
       00430 = Premera BC - Washington, Alaska
               (term. 09/2004)
       00440 = Bluefield BC - West Virginia (terminated)
       00441 = West Virginia BC (term. 11/1990)
       00443 = Parkersburg BC - West Virginia (terminated)
       00444 = Wheeling BC - West Virginia (terminated)
       00450 = Wisconsin BC - Wisconsin
       00450 = Michigan, Minnesota, New Jersey, New York,
               Wisconsin (RHHI)
       00452 = Wisconsin BC - Michigan (term. 7/22/2012)
               (replaced with MAC # 08201 -- see below)
       00453 = Wisconsin BC - Virginia & West Virginia
               (term. 05/2011)
               (replaced with MAC #11301 & 11401 - see below)
       00454 = Wisconsin BC - California, Hawaii, Nevada (RHHI)
               (term. 08/2008)
               (replaced by MAC #01101, 01201 & 01301 -- see below)
       00456 = United Government Services, LLC (CAR)
               (eff 08/15/2008)
       00460 = Wyoming BC
               (term. 10/2006)
               (replaced by MAC # 03601 -- see below)
       00468 = N Carolina BC/CPRTIVA (terminated)
       00470 = Puerto Rico BC (terminated)

       00993 = BC/BS Assoc.
       17120 = Hawaii Medical Service (term. 06/99)
       18390 = Inter-County (terminated)
       19050 = Kaiser Foundation (terminated)
       20330 = New York State Dept of Health (terminated)
       21230 = Community Health Association (term. 05/1969)
       22400 = Puerto Rico - Cooperative De Saluda
               (term. 01/1970)
       50050 = Travelers - Long Beach, California (terminated)
       50051 = Travelers - Los Angeles, California (terminated)
       50052 = Travelers - Pomona, California (terminated)
       50053 = Travelers - San Francisco, California (terminated)
       50070 = Travelers - Hartford, Connecticut (terminated)
       50072 = Travelers - Hamden, Connecticut (terminated)
       50100 = Travelers - Jacksonville, Florida (terminated)
       50101 = Travelers - Miama, Florida (terminated)
       50102 = Travelers - Tampa, Florida (terminated)
       50110 = Travelers - Atlanta, Georgia (terminated)
       50333 = Travelers; Connecticut United Healthcare
               (term. 07/2000)
       50334 = Travelers; Syracuse, New York (terminated)
       50390 = Travelers; Erie, Pennsylvania (terminated)
       50391 = Travelers; Pittsburgh, PA (terminated)
       50392 = Travelers; Wyomissing, PA (terminated)
       50393 = Travelers; Philadelphia, PA (terminated)
       50410 = Travelers; Providence, Rhode Island (terminated)

       51050 = Aetna-Los Angeles - California (terminated)
       51051 = Aetna California - terminated 6/97
       51070 = Aetna Connecticut - terminated 6/97
       51100 = Aetna Florida - terminated 6/97
       51140 = Aetna Illinois - terminated 6/97
       51220 = Aetna-Worcester - Massachusetts
       51290 = Aetna-Reno, Nevada (terminated)
       51390 = Aetna Pennsylvania - terminated 6/97
       51440 = Aetna-Nashville, Tennessee (terminated)
       51441 = Aetna-Memphis, Tennessee (terminated)
       51490 = Aetna-Newport News - Virginia (terminated)
       51500 = Seattle, Washington (terminated)
       52280 = NE - Mutual of Omaha
       53310 = Prudential-New Jersey (terminated)
       56360 = Nationwide-Ohio (terminated)
       57400 = Puerto Rico - Cooperativa (term.02/2009)
               (replaced with MAC # 09201)
       61000 = Aetna (term. 06/97)
       80883 = Contractor ID for Inpatient & Outpatient
               Risk Adjustment Data (data not sent through
               CWF; but through Palmetto)
       99990 = SSA (terminated)

       ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          Medicare Administrative Contractor Numbers

       JURISDICTION 1 - PART A MACs

       01001 = J1 Roll-up
       01101 = California (eff. 8/15/2008)
               (replaces FI #00454)
       01201 = Hawaii (eff. 8/15/2008)
               (replaces FI #00454)
       01301 = Nevada (eff. 8/15/2008)
               (replaces FI #00454)
       01901 = Palmetto GBA J1
               (Mutual of Omaha Legacy)

       JURISDICTION 2 - Part A MACs

       02001 = JF Roll-up(2/3)
       02101 = Alaska (eff 02/01/2012)
       02201 = Idaho (eff 02/01/2012)
       02301 = Oregon (eff 02/01/2012)
       02401 = Washington (eff 02/01/2012)

       JURISDICTION 3 - Part A MACs

       03001 = JF Roll-up(2/3)
               (Orig. J3 term. 09/2007)
       03101 = Arizona (eff. 10/1/2007)
               (replaces FI #00030)
       03201 = Montana (eff. 12/1/2006)
               (replaces FI #00250)
       03301 = N. Dakota (eff. 12/1/2006)
               (replaces FI #00320)
       03401 = S. Dakota (eff. 3/1/2007)
               (replaces FI #00011)
       03501 = Utah  (eff. 12/1/2006)
               (replaces FI #00323)
       03601 = Wyoming (eff. 11/1/2006)
               (replaces FI #00460)

       JURISDICTION 4 - Part A MACs

       04001 = J4 Roll-up
       04101 = Colorado (eff. 6/1/2008) (terminated)
               (replaces FI #00400)
       04201 = New Mexico (eff. 6/16/2008)
               (replaces FI #00400)
       04301 = Oklahoma (eff. 3/1/2008)
               (replaces FI #00340)
       04401 = Texas (eff. 6/16/2008)
               (replaces FI #00400)
       04901 = Trailblazer Health Enterprises
               (Mutual of Omaha Legacy)

       JH Roll-up (4/7)
       04111 = Colorado (eff. 10/29/2012)
               (CR 7812)
       04211 = New Mexico (eff. 10/29/2012)
       04311 = Oklahoma   (eff. 10/29/2012)
       04411 = Texas      (eff. 10/29/2012)
       04911 = WPS (Mutual of Omaha Legacy)
                          (eff. 10/29/2012)

       JURISDICTION 5 - Part A MACs

       05001 = J5 Roll-up
       05101 = Iowa (eff. 5/1/2008)
               (replaces FI #00012)
       05201 = Kansas (eff. 03/01/2008)
               (replaces FI #00150)
       05301 = W. Missouri (eff. 5/1/2008)
               (replaces FI #00242)
       05392 = E. Missouri (eff. 6/1/2008)
       05402 = Nebraska (eff. 12/1/2007)
               (replaces FI #00260)
       05902 = WPS J5 (Mutual of Omaha Legacy)

       06001 = J6 Roll-up
       06004 = (HHH D RHHI)
       06101 = Illinois
       06201 = Minnesota
       06301 = Wisconsin

       07001 = JH Roll-up (4/7)
       07101 = Arkansas (eff. 08/20/2012) (CR7812)
       07201 = Louisiana (eff. 08/20/2012)
       07301 = Mississippi (eff. 08/20/2012)

       JURISDICTION 8 - PART A MACs

       08001 = J8 Roll-up
       08101 = Indiana, WPS J8 (eff. 07/23/2012)
               (replaces FI #00130)
       08201 = Michigan, WPS J8(eff. 07/23/2012)
               (replaces FI #00452)

       JURISDICTION 9 - PART A MACs

       09001 = J9 Roll-up
       09101 = Florida (eff. 2/13/2009)
               (replaces FI #00090)
       09201 = Puerto Rico (eff. 03/02/2009)
               (replaces FI #57400)
       09301 = Virgin Island (eff. 03/02/2009)
               (replaces FI #57400)

       JURISDICTION 10 - PART A MACs

       10001 = J10 Roll-up
       10101 = Alabama (eff. 5/18/2009)
               (replaces FI #00010)
       10201 = Georgia (eff. 05/04/2009)
               (replaces FI #00101)
       10301 = Tennessee (eff. 8/3/2009)
               (replaces FI #00390)

       JURISDICTION 11 - PART A MACs

       11001 = J11 Roll-up
       11003 = J11 Roll-up (Shared CICS Region - 11301 & 11401)
       11004 = Region C (HHH C RHHI) (eff. 1/24/2011)
               (replaces FI #00380)
       11201 = South Carolina (eff. 1/24/2011)
               (replaces FI #00380)
       11301 = Virginia (eff. 5/16/2011)
               (replaces FI #00453)
       11401 = West Virginia (eff. 5/16/2011)
               (replaces FI #00453)
       11501 = North Carolina (eff. 10/01/2010)
               (replaces FI #00390)

       JURISDICTION 12 - PART A MACs

       12001 = J12 Roll-up
       12101 = Delaware (eff. 11/14/2008)
               (replaces FI # 00308)
       12201 = District of Columbia (eff. 08/01/2008)
       12301 = Maryland (eff. 08/01/2008)
       12401 = New Jersey (eff. 9/1/2008)
               (replaces FI # 00390)
       12501 = Pennsylvania (eff. 08/01/2008)
       12901 = Novitas Solutions J12
               (Mutual of Omaha Legacy)

       JURISDICTION 13 - PART A MACs

       13001 = J13 Roll-up
       13101 = Connecticut (eff. 8/1/2008)
               (replaces FI #00308)
       13201 = NGS-New York (eff. 7/18/2008)
               (replaces FI #00308)
       13282 = NGS-New York (eff. 9/1/2008)
               (replaces FI #00308)
       13292 = NGS-New York (eff. 7/18/2008)
               (replaces FI #00308)

       JURISDICTION 14 - PART A MACs

       14001 = J14 Roll-up
       14003 = J11 Roll-up (Shared CICS Region)
       14004 = Region A (HHH A RHHI) (eff.5/15/2009)
               (replaces FI #00180)
       14101 = Maine (eff. 5/15/2009)
               (replaces FI #00180)
       14201 = Massachusetts (eff. 5/15/2009)
               (replaces FI #00181)
       14301 = New Hampshire (eff. 6/15/2009)
               (replaces FI #00270)
       14401 = Rhode Island (eff. 6/1/2009)
               (replaces FI #00370)
       14501 = Vermont (eff. 6/5/2009)
               (replaces FI #00270)

       JURISDICTION 15 - PART A MACs

       15001 = J15 Roll-up
       15004 = CGS Government Services (HHH B RHHI)
               (eff. 06/13/2011)
       15101 = Kentucky (eff. 10/17/2011)
               (replaces FI #00160)
       15201 = Ohio (eff. 10/17/2011)
               (replaces FI #00160)
       52280 = Mutual of Omaha (NT)
               Note: Nebraska - 00260 (NE) & 52280 (NT)



 FI_RQST_CLM_CNCL_RSN_TB                 Claim Cancel Reason Code Table

      C = Coverage Transfer
      D = Duplicate Billing
      H = Other or blank
      L = Combining two beneficiary master records
      P = Plan Transfer
      S = Scramble
      ************For Action Code 4 *******************
      *********Effective with HHPPS - 10/00************
      A = RAP/Final claim/LUPA is cancelled by Interme-
      diary.  Does not delete episode.  Do not set
      cancellation indicator.
      B = RAP/Final claim/LUPA is cancelled by Interme-
      diary.  Does not delete episode.  Set
      cancellation indicator to 1.
      E = RAP/Final claim/LUPA is cancelled by Interme-
      diary.  Remove episode.
      F = RAP/Final claim/LUPA is cancelled by Provider.
      Remove episode.



 GEO_SSA_STATE_TB                        State Table

       01 = Alabama
       02 = Alaska
       03 = Arizona
       04 = Arkansas
       05 = California
       06 = Colorado
       07 = Connecticut
       08 = Delaware
       09 = District of Columbia
       10 = Florida
       11 = Georgia
       12 = Hawaii
       13 = Idaho
       14 = Illinois
       15 = Indiana
       16 = Iowa
       17 = Kansas
       18 = Kentucky
       19 = Louisiana
       20 = Maine
       21 = Maryland
       22 = Massachusetts
       23 = Michigan
       24 = Minnesota
       25 = Mississippi
       26 = Missouri
       27 = Montana
       28 = Nebraska
       29 = Nevada
       30 = New Hampshire
       31 = New Jersey
       32 = New Mexico
       33 = New York
       34 = North Carolina
       35 = North Dakota
       36 = Ohio
       37 = Oklahoma
       38 = Oregon
       39 = Pennsylvania
       40 = Puerto Rico
       41 = Rhode Island
       42 = South Carolina
       43 = South Dakota
       44 = Tennessee
       45 = Texas
       46 = Utah
       47 = Vermont
       48 = Virgin Islands
       49 = Virginia
       50 = Washington
       51 = West Virginia
       52 = Wisconsin
       53 = Wyoming
       54 = Africa
       55 = California
       56 = Canada & Islands
       57 = Central America and West Indies
       58 = Europe
       59 = Mexico
       60 = Oceania
       61 = Philippines
       62 = South America
       63 = U.S. Possessions
       64 = American Samoa
       65 = Guam
       66 = Commonwealth of the Northern Marianas Islands
       67 = Texas
       68 = Florida (eff. 10/2005)
       69 = Florida (eff. 10/2005)
       70 = Kansas (eff. 10/2005)
       71 = Louisiana (eff. 10/2005)
       72 = Ohio (eff. 10/2005)
       73 = Pennsylvania (eff. 10/2005)
       74 = Texas (eff. 10/2005)
       80 = Maryland (eff. 8/2000)
       97 = Northern Marianas
       98 = Guam
       99 = With 000 county code is American Samoa;
            otherwise unknown
       A0 = California (eff. 4/2019)
       A1 = California (eff. 4/2019)
       A2 = Florida (eff. 4/2019)
       A3 = Louisianna (eff. 4/2019)
       A4 = Michigan (eff. 4/2019)
       A5 = Mississippi (eff. 4/2019)
       A6 = Ohio (eff. 4/2019)
       A7 = Pennsylvania (eff. 4/2019)
       A8 = Tennessee (eff. 4/2019)
       A9 = Texas (eff. 4/2019)
       B0 = Kentucky (eff. 4/2020)
       B1 = West Virginia (eff. 4/2020)
       B2 = California (eff. 4/2020)



 MCO_OPTN_TB                             MCO Option Table

      *****For lock-in beneficiaries****
      A = HCFA to process all provider bills
      B = MCO to process only in-plan
      C = MCO to process all Part A and Part B bills

      ***** For non-lock-in beneficiaries*****
      1 = HCFA to process all provider bills
      2 = MCO to process only in-plan Part A and
          Part B bills
      4 = Cost Plan-Chronic Care Organizations (eff. 10/2005)



 NCH_CLM_BIC_MDFY_TB                     NCH Claim BIC Modify H Code Table

      H = BIC submitted by CWF = HA, HB or HC
      blank = No HA, HB or HC BIC present



 NCH_CLM_TYPE_TB                         NCH Claim Type Table

       10 = HHA claim
       20 = Non swing bed SNF claim
       30 = Swing bed SNF claim
       40 = Outpatient claim
       50 = Hospice claim
       60 = Inpatient claim
       61 = Inpatient 'Full-Encounter' claim
       62 = Medicare Advantage IME/GME Claims
       63 = Medicare Advantage (no-pay) claims
       64 = Medicare Advantage (paid as FFS) claims
       71 = RIC O local carrier non-DMEPOS claim
       72 = RIC O local carrier DMEPOS claim
       81 = RIC M DMERC non-DMEPOS claim
       82 = RIC M DMERC DMEPOS claim

      NOTE:  In the data element NCH_CLM_TYPE_CD
      (derivation rules) the numbers for these claim
      types need to be changed - dictionary reflects
      61 for all three.



 NCH_COND_TRLR_IND_TB                    NCH Condition Trailer Indicator Table

      C = Condition code trailer present



 NCH_DEMO_TRLR_IND_TB                    NCH Demonstration Trailer Indicator Table

      D = Demo trailer present



 NCH_DGNS_E_TRLR_IND_TB                  NCH Diagnosis E Trailer Indicator Code Table

      Valid Value:
      W = NCH Diagnosis E Code trailer



 NCH_DGNS_TRLR_IND_TB                    NCH Diagnosis Trailer Indicator Table

      Y = Diagnosis code trailer present



 NCH_EDIT_DISP_TB                        NCH Edit Disposition Table

       00 = No MQA errors
       10 = Possible duplicate
       20 = Utilization error
       30 = Consistency error
       40 = Entitlement error
       50 = Identification error
       60 = Logical duplicate
       70 = Systems duplicate



 NCH_EDIT_TB                             NCH EDIT TABLE

      A0X1 = (C) PHYSICIAN-SUPPLIER ZIP CODE
      A000 = (C) REIMB > $100,000 OR UNITS > 150
      A002 = (C) CLAIM IDENTIFIER (CAN)
      A003 = (C) BENEFICIARY IDENTIFICATION (BIC)
      A004 = (C) PATIENT SURNAME BLANK
      A005 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
      A006 = (C) DATE OF BIRTH IS NOT NUMERIC
      A007 = (C) INVALID GENDER (0, 1, 2)
      A008 = (C) INVALID QUERY-CODE (WAS CORRECTED)
      A009 = (C) TYPE OF BILL RECEIVED IS 41A, 41B, OR 41D
      A010 = (C) DISPOSITION CODE VS. ACTION/ENTRY CODE
      A023 = (C) PORTABLE X-RAY WITHOUT MODIFIER
      A025 = (C) FOR OV 4, TOB MUST = 13,83,85,73
      A031 = (C) HOSPITAL CLAIMS--CLAIM SHOWS SERVICES WERE PAID
                 BY AN HMO AND CODITION CODE '04' IS NOT PRESENT.
                 (TOB '11' & '12')
      A041 = (C) HHA CLAIMS--TOB 32X OR 33X WITH >4 VISITS; DATE
                 OF SERVICE > 9/30/00 AND LUPA IND IS PRESENT.
                 BYPASS FOR NON-PAYMENT CODE B, C, Q, T-Y.
      A1X1 = (C) PERCENT ALLOWED INDICATOR
      A1X2 = (C) DT>97273,DG1=7611,DG<>103,163,1589
      A1X3 = (C) DT>96365,DIAG=V725
      A1X4 = (C) INVALID DIAGNOSTIC CODES
      C050 = (U) HOSPICE - SPELL VALUE INVALID
      D102 = (C) DME DATE OF BIRTH INVALID
      D2X2 = (C) DME SCREEN SAVINGS INVALID
      D2X3 = (C) DME SCREEN RESULT INVALID
      D2X4 = (C) DME DECISION IND INVALID
      D2X5 = (C) DME WAIVER OF PROV LIAB INVALID
      D3X1 = (C) DME NATIONAL DRUG CODE INVALID
      D4X1 = (C) DME BENE RESIDNC STATE CODE INVALID
      D4X2 = (C) DME OUT OF DMERC SERVICE AREA
      D4X3 = (C) DME STATE CODE INVALID
      D5X1 = (C) TOS INVALID FOR DME HCPCS
      D5X2 = (C) DME HCPCS NOC & NOC DESCRIP MISSING
      D5X3 = (C) DME INVALID USE OF MS MODIFIER
      D5X4 = (C) TOS9 NDC REQD WHEN HCPCS OMITTED
      D5X5 = (C) TOS9 NDC REQD FOR Q0127-130 HCPCS
      D5X6 = (C) TOS9 NDC/DIAGNOSIS CODE INVALID
      D5X7 = (C) ANTI-EMETIC/ANTI-CANCER DRUG W/0 CANCER
                 DIAGNOSIS
      D5X8 = (C) TWO ANTI-EMETIC DRUGS PRESENT ON SAME CLAIM
                 WITH IDENTICAL DATES OF SERVICE.
      D6X1 = (C) DME SUPPLIER NUMBER MISSING
      D7X1 = (C) DME PURCHASE ALLOWABLE INVALID
      D919 = (C) CAPPED/PEN PUMPS,NUM OF SRVCS > 1
      D921 = (C) SHOE HCPC W/O MOD RT,LT REQ U=2/4/6
      D922 = (C) THERAPEUTIC SHOE CODES 'A5505-A5501'
                 W/MODIFIER 'LT' OR 'RT' MUST HAVE
                 UNITS = '001'
      XXXX = (D) SYS DUPL: HOST/BATCH/QUERY-CODE
      Y001 = (C) HCPCS R0075/UNITS>1/SERVICES=1
      Y002 = (C) HCPCS R0075/UNITS=1/SERVICES>1
      Y003 = (C) HCPCS R0075/UNITS=SERVICES
      Y010 = (C) TOB=13X/14X AND T.C.>$7,500
      Y011 = (C) INP CLAIM/REIM > $350,000
      Z001 = (C) RVNU 820-859 REQ COND CODE 71-76
      Z002 = (C) CC M2 PRESENT/REIMB > $150,000
      Z003 = (C) CC M2 PRESENT/UNITS > 150
      Z004 = (C) CC M2 PRESENT/UNITS & REIM < MAX
      Z005 = (C) REIMB>99999 AND REIMB<150000
      Z006 = (C) UNITS>99 AND UNITS<150
      Z007 = (C) TOB VS TOTAL CHARGE
      Z008 = (C) TOB VS TOTAL CHARGE W/O 20/21
                 CONDITION CODE
      Z237 = (E) HOSPICE OVERLAP - DATE ZERO
      0011 = (C) ACTION CODE INVALID
      0012 = (C) IME/GME CLAIM -- '04' OR '69'
                 CONDITION CODE
      0013 = (C) CABG/PCOE/MPPD AND INVALID ADMIT DATE
      0014 = (C) DEMO NUM INVALID
      0015 = (C) ESRD PLAN VS DEMO NUM
      0016 = (C) INVALID VA CLAIM
      0017 = (C) DEMO=38 W/O CONTRACTOR #80881/80882
      0018 = (C) DEMO=31,ACT CD<>1/5 OR ENT CD<>1/5
      0019 = (C) DEMO 07/08 WITH CONDITION CODE B1
      0020 = (C) CANCEL ONLY CODE INVALID
      0021 = (C) DEMO COUNT > 1
      0022 = (C) TOB '32X' OR '33X' W/DATES OF SERVICE >9/30/00
                 AND HAS CANCEL ONLY CODE OTHER THAN A,B,E,F
      0023 = (C) DEMO '46' AND HCPCS INCONSISTENT
      0301 = (C) INVALID HI CLAIM NUMBER
      0302 = (C) BENE IDEN CDE (BIC) INVAL OR BLK
      04A1 = (C) PATIENT SURNAME BLANK (PHYS/SUP)
      04B1 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
      0401 = (C) BILL TYPE/PROVIDER INVALID
      0402 = (C) BILL TYPE/REV CODE/PROVR RANGE
      0403 = (C) TOB '41X'/PRVDR # 1990-1999) OR TOB '51X'/
                 PRVDR #6990-6999, TRANS CODE SHOULD BE
                 '0' OR '3'
      0406 = (C) MAMMOGRAPHY WITH NO HCPCS 76092 OR SEX NOT F
      0407 = (C) RESPITE CARE BILL TYPE NOT 34X,NO REV 66
      0408 = (C) REV CODE 403 /TYPE 71X/ PROV3800-974
      041A = (C) TOB '11A' OR '11D' AND DEMO #'07' OR '08'
                 NOT PRESENT
      0410 = (C) IMMUNO DRUG OCCR-36,NO REV-25 OR 636
      0412 = (C) BILL TYPE XX5 HAS ACCOM. REV. CODES
      0413 = (C) CABG/PCOE BUT TOB = HHA,OUT,HOS
      0414 = (C) VALU CD 61,MSA AMOUNT MISSING
      0415 = (C) HOME HEALTH INCORRECT ALPHA RIC
      0416 = (C) REVENUE CENTER '0022', TOB MUST BE
                 '18X' OR '21X'
      0417 = (C) REVENUE CENTER '0023', TOB MUST BE '32X'
                 OR '33X'
      0418 = (C) HHA--TOB '3X5' AND DATES OF SERVICE
                 >9/30/00
      0419 = (C) HHA--RIC 'W' MUST HAVE VALUE CODE '63'/
                 RIC 'V' MUST HAVE VALUE CODE '62' AND
                 RIC 'U' MUST HAVE VALUE CODES '62' AND
                 '63' PRESENT FOR DATES OF SERVICE >
                 9/30/00.
      0420 = (C) HHA W/O REVENUE CODE '0023'
      0421 = (C) START DATE MISSING
      0422 = (C) COB VS. OVERRIDE CODE
      05X4 = (C) UPIN REQUIRED FOR TYPE-OF-SERVICE
      05X5 = (C) UPIN REQUIRED FOR DME
      0501 = (C) REFFERING UPIN REQUIRED FOR CLINICAL LAB
      0502 = (C) REFERRING UPIN INVALID
      0601 = (C) GENDER INVALID
      0701 = (C) CONTRACTOR/POS 1-2 PROVIDER NUM INVALID
      0702 = (C) PROVIDER NUMBER VS. TOB
      0703 = (C) MAMMOGRAPHY FOR NOT FEMALE
      0704 = (C) INVALID CONT FOR CABG DEMO
      0705 = (C) INVALID CONT FOR PCOE DEMO
      0706 = (C) REVENUE CENTER CODE MAMMOGRAPHY AND
                 BENEFICIARY <35
      0901 = (C) INVALID DISP CODE OF 02
      0902 = (C) INVALID DISP CODE OF SPACES
      0903 = (C) INVALID DISP CODE
      1001 = (C) PROF REVIEW/ACT CODE/BILL TYPE
      13X2 = (C) MULTIPLE ITEMS FOR SAME SERVICE
      1301 = (C) LINE COUNT NOT NUMERIC OR > 13
      1302 = (C) RECORD LENGTH INVALID
      1401 = (C) INVALID MEDICARE STATUS CODE
      1501 = (C) ADMIT DATE/START DATE/ENTRY CODE INVALID
      1502 = (C) ADMIT DATE/START CARE DATE > STAY FROM DATE
      1503 = (C) ADMIT DATE INVALID WITH THRU DATE
      1504 = (C) ADM/FROM/THRU DATE > TODAYS DATE
      1505 = (C) HCPCS W SERVICE DATES > 09-30-94
      1601 = (C) INVESTIGATION IND INVALID
      1701 = (C) SPLIT IND INVALID
      1801 = (C) PAY-DENY CODE INVALID
      1802 = (C) HEADER AMT/LINE ITEMS DENIED
      1803 = (C) MSP COST AVD/ALL MSP LI NOT SAME
      1901 = (C) AB CROSSOVER IND INVALID
      2001 = (C) HOSPICE OVERRIDE INVALID
      2101 = (C) HMO-OVERRIDE/PATIENT-STAT INVALID
      2102 = (C) PATIENT STATUS VS. TOB
      2103 = (C) HIPPS RATE/CMG CODE VS. PATIENT STATUS
      2201 = (C) FROM DATE/HCPCS YR INVALID
      2202 = (C) STAY-FROM DATE > THRU-DATE
      2203 = (C) THRU DATE INVALID
      2204 = (C) FROM DATE BEFORE EFFECTIVE DATE
      2205 = (C) DATE YEARS DIFFERENT ON OUTPAT
      2207 = (C) MAMMOGRAPHY BEFORE 1991
      2208 = (C) TOB '21X', REV CODE 0022 FROM DATE
                 < 06-03-98
      2209 = (C) HHA WITH OVERLAPPING DATES JUNE/JULY,
                 SEPT/OCT
      2210 = (C) TOB 41X, SERVICE DATES 6/30/00,
                 EXCEP/NONEXCEP IND = 1,2
      2212 = (C) TOB 51X WITH SERVICE DATES >6/30/00
      2213 = (C) TOB 32X OR 33X, SERVICE >9/30/00 DAYS
                 CAN NOT = 60
      2215 = (C) DEMO 37 WITH VALUE CODES 'A2', 'B2', 'C2'
      2216 = (C) DEMO 37 OR CONDITION CODE 78 AND CHARGES
                 SUB TO DED > 0
      2301 = (C) DOCUMENT CNTL OR UTIL DYS INVALID
      2302 = (C) COVERED DAYS INVALID OR INCONSIST
      2303 = (C) COST REPORT DAYS > ACCOMIDATION
      2304 = (C) UTIL DAYS = ZERO ON PATIENT BILL
      2305 = (C) LATE CHARGE BILL WITH DATA FIELD PRESENT
      2306 = (C) UTIL DYS/NOPAY/REIMB INCONSISTENT
      2307 = (C) COND=40,UTL DYS >0/VAL CDE A1,08,09
      2308 = (C) NOPAY = R WHEN UTIL DAYS = ZERO
      2401 = (C) NON-UTIL DAYS INVALID
      2501 = (C) CLAIM RCV DT OR COINSURANCE INVAL
      2502 = (C) COIN+LR>UTIL DAYS/RCPT DTE>CUR DTE
      2503 = (C) COIN/TR TYP/UTIL DYS/RCPT DTE>PD/DEN
      2504 = (C) COINSURANCE AMOUNT EXCESSIVE
      2505 = (C) COINSURANCE RATE > ALLOWED AMOUNT
      2506 = (C) COINSURANCE DAYS/AMOUNT INCONSIST
      2507 = (C) COIN+LR DAYS > TOTAL DAYS FOR YR
      2508 = (C) COINSURANCE DAYS INVALID FOR TRAN
      2601 = (C) CLAIM PAID DT INVALID OR LIFE RES
      2602 = (C) LR-DAYS, NO VAL 08,10/PD/DEN>CUR+27
      2603 = (C) LIFE RESERVE > RATE FOR CAL YEAR
      2604 = (C) PPS BILL, NO DAY OUTLIER
      2605 = (C) LIFE RESERVE RATE > DAILY RATE AVR.
      28XA = (C) UTIL DAYS > FROM TO BENEF EXH
      28XB = (C) BENEFITS EXH DATE > FROM DATE
      28XC = (C) BENEFITS EXH DATE/INVALID TRANS TYPE
      28XD = (C) OCCUR 23 WITH SPAN 70 ON INPAT HOSP
      28XE = (C) MULTI BENE EXH DATE (OCCR A3,B3,C3)
      28XF = (C) ACE DATE ON SNF (NOPAY =B, C, N, W)
      28XG = (C) SPAN CD 70+4+6+9 NOT = NONUTIL DAYS
      28XM = (C) OCC CD 42 DATE NOT = SRVCE THRU DTE
      28XN = (C) INVALID OCC CODE
      28XO = (C) AN 'N' NO-PAY CODE IS PRESENT AND OCCURRENCE
                 CODE '23' OR '42' IS NOT PRESENT AND THE
                 DATE ASSOCIATED WITH CODE IS MISSING OR NOT
                 EQUAL TO THRU DATE.
      28XP = (C) THE OCCURRENCE CODE 23 DATE DOES NOT EQUAL THE
                 THRU DATE
      28X0 = (C) BENE EXH DATE OUTSIDE SERVICE DATES
      28X1 = (C) OCCUR DATE INVALID
      28X2 = (C) OCCUR = 20 AND TRANS = 4
      28X3 = (C) OCCUR 20 DATE < ADMIT DATE
      28X4 = (C) OCCUR 20 DATE > ADMIT + 12
      28X5 = (C) OCCUR 20 AND ADMIT NOT = FROM
      28X6 = (C) OCCUR 20 DATE < BENE EXH DATE
      28X7 = (C) OCCUR 20 DATE+UTIL-COIN>COVERAGE
      28X8 = (C) OCCUR 22 DATE < FROM OR > THRU
      28X9 = (C) UTIL > FROM - THRU LESS NCOV
      33X1 = (C) QUAL STAY DATES INVALID (SPAN=70)
      33X2 = (C) QS FROM DATE NOT < THRU (SPAN=70)
      33X3 = (C) QS DAYS/ADMISSION ARE INVALID
      33X4 = (C) QS THRU DATE > ADMIT DATE (SPAN=70)
      33X5 = (C) SPAN 70 INVALID FOR DATE OF SERVICE
      33X6 = (C) TOB=18/21/28/51,COND=WO,HMO<>90091
      33X7 = (C) TOB<>18/21/28/51,COND=WO
      33X8 = (C) TOB=18/21/28/51,CO=WO,ADM DT<97001
      33X9 = (C) TOB=32X SPAN 70 OR OCCR BO PRESENT
      33#A = (C) MULTIPLE PET SCANS
      33#B = (C) MULITIPLE PET SCANS W/O MODIFIER 26
                 OR TC
      3401 = (C) DEMO ID = 04 AND RIC NOT = 1 OR 2
      34X2 = (C) DEMO ID = 04 AND COND WO NOT SHOWN
      34#3 = (C) CONDITION CODE = W0 AND DEMO NOT = 04
      35X1 = (C) 60, 61, 66 & NON-PPS / 65 & PPS
      35X2 = (C) COND = 60 OR 61 AND NO VALU 17
      35X3 = (C) PRO APPROVAL COND C3,C7 REQ SPAN M0
      35#3 = (C) (SECOND CONDITION) CONDITION CODE = C3
                 REQUIRES SPAN CODE 76 OR 77
      35#4 = (C) CONDITION CODE = 69 AND TOB NOT 11X
      36X1 = (C) SURG DATE < STAY FROM/ > STAY THRU
      36#1 = (C) SURGICAL DATE = ZEROES OR < FROM OR >
                 THRU DATES
      3701 = (C) ASSIGN CODE INVALID
      3705 = (C) 1ST CHAR OF IDE# IS NOT ALPHA
      3706 = (C) INVALID IDE NUMBER-NOT IN FILE
      3710 = (C) NUM OF IDE# > REV 0624
      3715 = (C) NUM OF IDE# < REV 0624
      3720 = (C) IDE AND LINE ITEM NUMBER > 2
      3801 = (C) AMT BENE PD INVALID
      3XA/ = (C) COLORECTAL/PROSTATE SCREENING BILLED
                 MULTIPLE TIMES
      4001 = (C) BLOOD PINTS FURNISHED INVALID
      4002 = (C) BLOOD FURNISHED/REPLACED INVALID
      4003 = (C) BLOOD FURNISHED/VERIFIED/DEDUCT
      4201 = (C) BLOOD PINTS UNREPLACED INVALID
      4202 = (C) BLOOD PINTS UNREPLACED/BLOOD DED
      4203 = (C) INVALID CPO PROVIDER NUMBER
      4301 = (C) BLOOD DEDUCTABLE INVALID
      4302 = (C) BLOOD DEDUCT/FURNISHED PINTS
      4303 = (C) BLOOD DEDUCT > UNREPLACED BLOOD
      4304 = (C) BLOOD DEDUCT > 3 - REPLACED
      4501 = (C) PRIMARY DIAGNOSIS INVALID
      4502 = (C) SERVICE DATES > CURRENT DATE
      46#A = (C) MSP VET AND VET AT MEDICARE
      46#B = (C) MULTIPLE COIN VALU CODES (A2,B2,C2)
      46#C = (C) COIN VALUE (A2,B2,C2) ON INP/SNF
      46#G = (C) VALU CODE 20 INVALID
      46#L = (C) BLOOD FURNISHED < BLOOD REPLACED
      46#N = (C) VALUE CODE 37,38,39 INVALID
      46#O = (C) VALUE CDE 37,38,39 AMOUNT NOT > 00
      46#P = (C) BLD UNREP VS REV CDS AND/OR UNITS
      46#Q = (C) VALUE CDE 37=39 AND 38 IS PRESENT
      46#R = (C) BLD FIELDS VS REV CDE 380,381,382
      46#S = (C) VALU CODE 39, AND 37 IS NOT PRESENT
      46#T = (C) CABG/PCOE/MPPD,VC<>Y1,Y2,Y3,Y4,VA NOT>0
      46#U = (C) MSP VALUES ON CABG/PCOE/MPPD (INP)
                 TOB '32X'/'33X' MUST HAVE VALUE 62/64
                 OR 63/65 (HHA)
      46#V = (C) TOB '32X'/'33X' VISITS IN 62/63 NOT =
                 REVENUE CODE 42X-44X, 55X-57X
      46#W = (C) CONDITION CODE =30/78 AND WITH VALUE
                 CODE = A1, B1, C1
      46#1 = (C) VALUE AMOUNT INVALID
      46#2 = (C) VALU 06 AND BLD-DED-PTS IS ZERO
      46#3 = (C) VALU 06 AND TTL-CHGS=NC-CHGS(001)
      46#4 = (C) VALU (A1,B1,C1): AMT > DEDUCT
      46#5 = (C) DEDUCT VALUE (A1,B1,C1) ON SNF BILL
      46#6 = (C) VALU 17 AND NO COND CODE 60 OR 61
      46#7 = (C) OUTLIER(VAL 17) > REIMB + VAL6-16
      46#8 = (C) MULTI CASH DED VALU CODES (A1,B1,C1)
      46X9 = (C) DEMO ID=03,REQUIRED HCPCS NOT SHOWN
      4600 = (C) CAPITAL TOTAL NOT = CAP VALUES
      4601 = (C) CABG/PCOE, MSP CODE PRESENT
      4603 = (C) DEMO ID = 03 AND RIC NOT=6,7
      4604 = (C) DEMO = 03 WITH DATES OF SERVICE
                 > 09/31/01
      4901 = (C) PCOE/CABG,DEN CD NOT D
      4902 = (C) PCOE/CABG BUT DME
      50#1 = (C) RVCD=54,TOB<>13,23,32,33,34,83,85
      50#2 = (C) REV CD=054X,MOD NOT = QM,QN
      5051 = (E) EDB: NOMATCH ON 3 CHARACTERISTICS
      5052 = (E) EDB: NOMATCH ON MASTER-ID RECORD
      5053 = (E) EDB: NOMATCH ON CLAIM-NUMBER
      51#A = (C) HCPCS EYEWARE & REV CODE NOT 274
      51#C = (C) HCPCS REQUIRES DIAG CODE OF CANCER
      51#D = (C) HCPCS REQUIRES UNITS > ZERO
      51#E = (C) HCPCS REQUIRES REVENUE CODE 636/294
      51#F = (C) INV BILL TYP/ANTI-CAN DRUG HCPCS
      51#G = (C) HCPCS REQUIRES DIAG OF HEMOPHILL1A
      51#H = (C) TOB 21X/P82=2/3/4;REV CD<9001,>9044
      51#I = (C) TOB 21X/P82<>2/3/4:REV CD>8999<9045
      51#J = (C) TOB 21X/REV CD: SVC-FROM DT INVALID
      51#K = (C) TOB 21X/P82=2/3/4,REV CD = NNX
      51#L = (C) REV 0762/UNT>48,TOB NOT=12,13,85,83
      51#M = (C) 21X,RC>9041/<9045,RC<>4/234
      51#N = (C) 21X,RC>9032/<9042,RC<>4/234
      51#O = (C) TWO ANTI-EMETIC/ANTI-CANCER DRUGS
                 ON SAME CLAIM
      51#P = (C) HHA/OUTPATIENT RC DATE OF SRVC MISSING
      51#Q = (C) NO RC 0636 OR DTE INVALID
      51#R = (C) DEMO ID=01,RIC NOT=2
      51#S = (C) DEMO ID=01,RUGS<>2,3,4 OR BILL<>21
      51#V = (C) TOB 72X W HCPCS 'J1955' MISSING REVENUE
                 CENTER 636
      51#W = (C) TOB 12X, 13X, 22X, 23X, 34X, 74X, 75X,
                 83X, HCPCS '97504', '97116', PRESENT
                 ON SAME DAY
      51#X = (C) TOB '32X-34X' REQUIRE HCPCS FOR REVENUE
                 CODE '29X', '60X', '636'
      51X0 = (C) REV CENTER CODE INVALID
      51X1 = (C) REV CODE CHECK
      51X2 = (C) REV CODE INCOMPATIBLE BILL TYPE
      51X3 = (C) UNITS MUST BE > 0
      51X4 = (C) INP:CHGS/YR-RATE,ETC; OUTP:PSYCH>YR
      51X5 = (C) REVENUE NON-COVERED > TOTAL CHRGE
      51X6 = (C) REV TOTAL CHARGES EQUAL ZERO
      51X7 = (C) REV CDE 403 WTH NO BILL 14 23 71 85
      51X8 = (C) MAMMOGRAPHY SUBMISSION INVALID
      51X9 = (C) HCPCS/REV CODE/BILL TYPE
      5100 = (U) TRANSITION SPELL / SNF
      5160 = (U) LATE CHG HSP BILL STAY DAYS > 0
      5166 = (U) PROVIDER NE TO 1ST WORK PRVDR
      5167 = (U) PROVIDER 1 NE 2: FROM DT < START DT
      5168 = (E) CLAIM IN HOSPICE WITH 2ND START DATE
                 PRESENT
      5169 = (U) PROVIDER NE TO WORK PROVIDER
      5170 = (E) OCCURRENCE CODE = 42 AND < DOLBA
      5177 = (U) PROVIDER NE TO WORK PROVIDER
      5178 = (U) HOSPICE BILL THRU < DOLBA
      5181 = (U) HOSP BILL OCCR 27 DISCREPANCY
      5200 = (E) ENTITLEMENT EFFECTIVE DATE
      5201 = (U) HOSP DATE DIFFERENCE NE 60 OR 90
      5202 = (E) ENTITLEMENT HOSPICE EFFECTIVE DATE
      5202 = (U) HOSPICE TRAILER ERROR
      5203 = (E) ENTITLEMENT HOSPICE PERIODS
      5203 = (U) HOSPICE START DATE ERROR
      5204 = (U) HOSPICE DATE DIFFERENCE NE 90
      5205 = (U) HOSPICE DATE DISCREPANCY
      5206 = (U) HOSPICE DATE DISCREPANCY
      5207 = (U) HOSPICE THRU > TERM DATE 2ND
      5208 = (U) HOSPICE PERIOD NUMBER BLANK
      5209 = (U) HOSPICE DATE DISCREPANCY
      5210 = (E) ENTITLEMENT FRM/TRU/END DATES
      5211 = (E) ENTITLEMENT DATE DEATH/THRU
      5212 = (E) ENTITLEMENT DATE DEATH/THRU
      5213 = (E) ENTITLEMENT DATE DEATH MBR
      5220 = (E) ENTITLEMENT FROM/EFF DATES
      5225 = (E) ENT INP PPS SPAN 70 DATES
      5232 = (E) ENTL HMO NO HMO OVERRIDE CDE
      5233 = (E) ENTITLEMENT HMO PERIODS
      5234 = (E) ENTITLEMENT HMO NUMBER NEEDED
      5235 = (E) ENTITLEMENT HMO HOSP+NO CC07
      5236 = (E) ENTITLEMENT HMO HOSP + CC07
      5237 = (E) ENTITLEMENT HOSP OVERLAP
      5238 = (U) HOSPICE CLAIM OVERLAP > 90
      5239 = (U) HOSPICE CLAIM OVERLAP > 60
      524Z = (E) HOSP OVERLAP NO OVD NO DEMO
      5240 = (U) HOSPICE DAYS STAY+USED > 90
      5241 = (U) HOSPICE DAYS STAY+USED > 60
      5242 = (C) INVALID CARRIER FOR RRB
      5243 = (C) HMO=90091,INVALID SERVICE DTE
      5244 = (E) DEMO CABG/PCOE MISSING ENTL
      5245 = (C) INVALID CARRIER FOR NON RRB
      525Z = (E) HMO/HOSP 6/7 NO OVD NO DEMO
      5250 = (U) HOSPICE DOEBA/DOLBA
      5255 = (U) HOSPICE DAYS USED
      5256 = (U) HOSPICE DAYS USED > 999
      526Y = (E) HMO/HOSP DEMO 5/15 REIMB > 0
      526Z = (E) HMO/HOSP DEMO 5/15 REIMB = 0
      5270 = (C) CONDITION CODE = 30 AND HMO REQUIRES
                 MODIFIER = 'QV' OR 'KZ'/DED IND
      5271 = (C) RISK HMO NOT PRESENT AND MOD 'KZ'/
                 OR CONDITION CODE 78 PRESENT
      527Y = (E) HMO/HOSP DEMO OVD=1 REIMB > 0
      527Z = (E) HMO/HOSP DEMO OVD=1 REIMB = 0
      5299 = (U) HOSPICE PERIOD NUMBER ERROR
      52#K = (C) HCPCS VS DIAGNOSIS
      52#L = (C) HCPCS VS MODIFIER
      52#M = (C) HCPCS VS DATES OF SERVICE
      52#N = (C) TOB '71X' OR '73X' WITH REVENUE
                 CENTER CODE 0403 MISSING REVENUE
                 CENTER CODE 0521
      52#O = (C) REVENUE CENTER CODE 0022/0024 WITH
                 CHARGES >0
      52#P = (C) REVENUE CENTER CODE 010X-021X MINUS
                 18X <> 0022
      52#Q = (C) REVENUE CENTER CODE 0022 AND HIPPS
                 MISSING
      52#R = (C) REVENUE CENTER CODE 0022 MISSING DATE
                 OF SERVICE
      52#T = (C) REVENUE CENTER CODE 0022 MISSING REVENUE
                 CENTER CODE 042X-044X
      5320 = (U) BILL > DOEBA AND IND-1 = 2
      5350 = (U) HOSPICE DOEBA/DOLBA SECONDARY
      5355 = (U) HOSPICE DAYS USED SECONDARY
      5362 = (C) MAMMOGRAPHY AND BENE <35
      5378 = (C) SERVICE DATE < AGE 50
      5379 = (C) HCPCS 'G0160' PRESENT MORE THAN
                 ONCE
      5381 = (C) HCPCS 'G0161' PRESENT MORE THAN
                 ONCE
      5382 = (C) HCPCS 'G0102-03' AND BENE <50
      538Q = (C) SERVICE DATES WITHIN ALIEN RECORD
      5397 = (C) DEMO '37' AND NOT CAT 74
      5398 = (C) HCPCS 'G9001-G9005 & G9009-G9011 >1
                 OR 2 ARE PRESENT
      5399 = (U) HOSPICE PERIOD NUM MATCH
      539A = (C) HCPCS 'G9008' PRESENT MORE THAN ONCE
      539C = (C) HCPCS 'G9013-G9015' PRESENT MORE THAN
                 ONCE OR 2 PRESENT
      5410 = (U) INPAT DEDUCTABLE
      5425 = (U) PART B DEDUCTABLE CHECK
      5430 = (U) PART B DEDUCTABLE CHECK
      5450 = (U) PART B COMPARE MED EXPENSE
      5460 = (U) PART B COMPARE MED EXPENSE
      5499 = (U) MED EXPENSE TRAILER MISSING
      5500 = (U) FULL DAYS/SNF-HOSP FULL DAYS
      5510 = (U) COIN DAYS/SNF COIN DAYS
      5515 = (U) FULL DAYS/COIN DAYS
      5516 = (U) SNF FULL DAYS/SNF COIN DAYS
      5520 = (U) LIFE RESERVE DAYS
      5530 = (U) UTIL DAYS/LIFE PSYCH DAYS
      5540 = (U) HH VISITS NE AFT PT B TRLR
      5550 = (E) SNF LESS THAN PT A EFF DATE
      5600 = (D) LOGICAL DUPE, COVERED
      5601 = (D) LOGICAL DUPE, QRY-CDE, RIC 123
      5602 = (D) LOGICAL DUPE, PANDE C, E OR I
      5603 = (D) LOGICAL DUPE, COVERED
      5604 = (D) LOGICAL DUPE, DATES
      5605 = (D) POSS DUPE, OUTPAT REIMB
      5606 = (D) POSS DUPE, HOME HEALTH COVERED U
      5623 = (U) NON-PAY CODE IS P
      57X1 = (C) PROVIDER SPECIALITY CODE INVALID
      57X2 = (C) PHYS THERAPY/PROVIDER SPEC INVAL
      57X3 = (C) PLACE/TYPE/SPECIALTY/REIMB IND
      57X4 = (C) SPECIALTY CODE VS. HCPCS INVALID
      57X5 = (C) HCPCS 98940-2 MODIFIER NOT = 'AT'
      5700 = (U) LINKED TO THREE SPELLS
      5701 = (C) DEMO ID=02,RIC NOT = 5
      5702 = (C) DEMO ID=02,INVALID PROVIDER NUM
      58X1 = (C) PROVIDER TYPE INVALID
      58X9 = (C) TYPE OF SERVICE INVALID
      5802 = (C) REIMB > $150,000
      5803 = (C) UNITS/VISITS > 150
      5804 = (C) UNITS/VISITS > 99
      5805 = (C) OUTPATIENT CHARGE > $150,000
      5806 = (C) REVENUE CENTER CODE '042X-044X'
                 WITHOUT MODIFIER 'GN-GP'
      58#4 = (C) REVENUE CENTER CODE MISSING REQUIRED
                 HCPCS OR MODIFIER
      59XA = (C) PROST ORTH HCPCS/FROM DATE
      59XB = (C) HCPCS/FROM DATE/TYPE P OR I
      59XC = (C) HCPCS Q0036,37,42,43,46/FROM DATE
      59XD = (C) HCPCS Q0038-41/FROM DATE/TYPE
      59XE = (C) HCPCS/MAMMOGRAPHY-RISK/ DIAGNOSIS
      59XG = (C) INVALID TOS FOR DME
      59XH = (C) HCPCS E0620/TYPE/DATE
      59XI = (C) HCPCS E0627-9/ DATE < 1991
      59XJ = (C) GLOBAL HCPCS TOS MUST = 2
      59XK = (C) HCPCS PEN PUMP AND TOS <>9
      59XL = (C) HCPCS 00104 - TOS/POS
      59X1 = (C) INVALID HCPCS/TOS COMBINATION
      59X2 = (C) ASC IND/TYPE OF SERVICE INVALID
      59X3 = (C) TOS INVALID TO MODIFIER
      59X4 = (C) KIDNEY DONOR/TYPE/PLACE/REIMB
      59X5 = (C) MAMMOGRAPHY FOR MALE
      59X6 = (C) DRUG AND NON DRUG BILL LINE ITEMS
      59X7 = (C) CAPPED-HCPCS/FROM DATE
      59X8 = (C) FREQUENTLY MAINTAINED HCPCS
      59X9 = (C) HCPCS E1220/FROM DATE/TYPE IS R
      5901 = (U) ERROR CODE OF Q
      5A#1 = (C) DEMO=37, UNITS >1 FOR 'G9001-05'
                 'G9007-11', G9013-G9015'
      60X1 = (C) ASSIGN IND INVALID
      6000 = (U) ADJUSTMENT BILL SPELL DATA
      6020 = (U) CURRENT SPELL DOEBA < 1990
      6030 = (U) ADJUSTMENT BILL SPELL DATA
      6035 = (U) ADJUSTMENT BILL THRU DTE/DOLBA
      61X1 = (C) PAY PROCESS IND INVALID
      61X2 = (C) DENIED CLAIM/NO DENIED LINE
      61X3 = (C) PAY PROCESS IND/ALLOWED CHARGES
      61X4 = (C) RATE MISSING OR NON-NUMERIC
      61#E = (C) PROVIDER PAYMENT INCONSISTENCIES
      61#F = (C) BENEFICIARY PAYMENT INCONSISTENCIES
      61#G = (C) PATIENT RESPONSIBILITY INCONSISTENCIES
      61#H = (C) MEDICARE PAYMENT INCONSISTENCIES
      61#I = (C) LINE DATE OF SERVICE < FROM DATE
                 > THRU DATE
      61#J = (C) DUPLICATE HCPCS CODE '55873'
      61#K = (C) HCPCS 'G0117-8' >2 OR BOTH PRESENT
      61#L = (C) REVENUE CENTER CODE 0024 > 2
      61#M = (C) REVENUE CENTER CODE 0024 VS PROVIDER
                 NUMBER
      61#N = (C) REVENUE CENTER CODE 0024 REQUIRES
                 VALID HIPPS RATE CMG CODE
      61#R = (C) HCPCS/TOB/REVENUE CENTER CODE
      61#S = (C) HCPCS 'G0247' REQUIRES 'G0245-6' TO
                 BE COVERED
      61#T = (C) HCPCS CODE '0245-0246' PRESENT MULTIPLE
                 TIMES
      61#0 = (C) REVENUE CENTER CODE VS SPAN CODE '74'
      61#6 = (C) PAYMENT METHOD INVALID
      61#7 = (C) ANSI CODE MISSING
      61#8 = (C) BLOOD CASH DEDUCTIBLE INCONSISTENCIES
      61#9 = (C) CASH DEDUCTIBLE INCONSISTENCIES
      6100 = (C) REV 0001 NOT PRESENT ON CLAIM
      6101 = (C) REV COMPUTED CHARGES NOT=TOTAL
      6102 = (C) REV COMPUTED NON-COVERED/NON-COV
      6103 = (C) REV TOTAL CHARGES < PRIMARY PAYER
      6105 = (C) REVE CODE 0001 > 1
      6106 = TOB 3X2 REVENUE CENTER CODE 0023 NOT =
                 TOTAL CHARGE
      6109 = (C) REIMBURSEMENT > 4 OR 6 TIMES
      62XA = (C) PSYC OT PT/REIM/TYPE
      62XC = (C) DEMO 37 WITH REIMBURSEMENT/DED IND
                 <>1
      62X1 = (C) DME/DATE/100% OR INVAL REIMB IND
      62X6 = (C) RAD PATH/PLACE/TYPE/DATE/DED
      62X8 = (C) KIDNEY DONO/TYPE/100%
      62X9 = (C) PNEUM VACCINE/TYPE/100%
      6201 = (C) TOTAL DEDUCT > CHARGES/NON-COV
      6203 = (U) HOSPICE ADJUSTMENT PERIOD/DATE
      6204 = (U) HOSPICE ADJUSTMENT THRU>DOLBA
      6260 = (U) HOSPICE ADJUSTMENT STAY DAYS
      6261 = (U) HOSPICE ADJUSTMENT DAYS USED
      6265 = (U) HOSPICE ADJUSTMENT DAYS USED
      6269 = (U) HOSPICE ADJUSTMENT PERIOD# (MAIN)
      63X1 = (C) DEDUCT IND INVALID
      63X2 = (C) DED/HCFA COINS IN PCOE/CABG
      6365 = (U) HOSPICE ADJUSTMENT SECONDARY DAYS
      6369 = (U) HOSPICE ADJUSTMENT PERIOD# (SECOND)
      64X1 = (C) PROVIDER IND INVALID
      6430 = (U) PART B DEDUCTABLE CHECK
      65X1 = (C) PAYSCREEN IND INVALID
      66?? = (D) POSS DUPE, CR/DB, DOC-ID
      66XX = (D) POSS DUPE, CR/DB, DOC-ID
      66X1 = (C) UNITS AMOUNT INVALID
      66X2 = (C) UNITS IND > 0; AMT NOT VALID
      66X3 = (C) UNITS IND = 0; AMT > 0
      66X4 = (C) MT INDICATOR/AMOUNT
      66X7 = (C) DEMO 37/HCPCS/UNITS
      6600 = (U) ADJUSTMENT BILL FULL DAYS
      6610 = (U) ADJUSTMENT BILL COIN DAYS
      6620 = (U) ADJUSTMENT BILL LIFE RESERVE
      6630 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
      67X1 = (C) UNITS INDICATOR INVALID
      67X2 = (C) CHG ALLOWED > 0; UNITS IND = 0
      67X3 = (C) TOS/HCPCS=ANEST, MTU IND NOT = 2
      67X4 = (C) HCPCS = AMBULANCE, MTU IND NOT = 1
      67X6 = (C) INVALID PROC FOR MT IND 2, ANEST
      67X7 = (C) INVALID UNITS IND WITH TOS OF BLOOD
      67X8 = (C) INVALID PROC FOR MT IND 4, OXYGEN
      6700 = (U) ADJUSTMENT BILL FULL/SNF DAYS
      6710 = (U) ADJUSTMENT BILL COIN/SNF DAYS
      68XA = (C) HCPCS G0117-8 >1 OR BOTH PRESENT
      68XB = (C) HCPCS CODE G0245-46 > 1
      68X1 = (C) INVALID HCPCS CODE
      68X2 = (C) MAMMOGRAPY/DATE/PROC NOT 76092
      68X3 = (C) TYPE OF SERVICE = G /PROC CODE
      68X4 = (C) HCPCS NOT VALID FOR SERVICE DATE
      68X5 = (C) MODIFIER NOT VALID FOR HCPCS, ETC
      68X6 = (C) TYPE SERVICE INVALID FOR HCPCS, ETC
      68X7 = (C) ZX MOD REQ FOR THER SHOES/INS/MOD.
      68X8 = (C) ANTI-EMETIC WITHOUT ANTI-CANCER DRUG
      6812 = (C) DEMO 37 WITH PRIMARY PAYER CODE
      69XA = (C) MODIFIER NOT VALID FOR HCPCS/GLOBAL
      69XB = (C) HCPCS CODE 97504/97116 PRESENT ON
                 SAME DAY
      69XC = (C) HCPCS CODE VS PAY PROCESS INDICATOR
      69X3 = (C) PROC CODE MOD = LL / TYPE = R
      69X6 = (C) PROC CODE MOD/NOT CAPPED
      69X8 = (C) SPEC CODE NURSE PRACT, MOD INVAL
      69X9 = (C) NURSE PRACTITIONER, MOD INVALID
      6901 = (C) KRON IND AND UTIL DYS EQUALS ZERO
      6902 = (C) KRON IND AND NO-PAY CODE B OR N
      6903 = (C) KRON IND AND INPATIENT DEDUCT = 0
      6904 = (C) KRON IND AND TRANS CODE IS 4
      6910 = (C) REV CODES ON HOME HEALTH
      6911 = (C) REV CODE 274 ON OUTPAT AND HH ONLY
      6912 = (C) REV CODE INVAL FOR PROSTH AND ORTHO
      6913 = (C) REV CODE INVAL FOR OXYGEN
      6914 = (C) REV CODE INVAL FOR DME
      6915 = (C) PURCHASE OF RENT DME INVAL ON DATES
      6916 = (C) PURCHASE OF RENT DME INVAL ON DATES
      6917 = (C) PURCHASE OF LIFT CHAIR INVAL > 91000
      6918 = (C) HCPCS INVALID ON DATE RANGES
      6919 = (C) DME OXYGEN ON HH INVAL BEFORE 7/1/89
      6920 = (C) HCPCS INVAL ON REV 270/BILL 32-33
      6921 = (C) HCPCS ON REV CODE 272 BILL TYPE 83X
      6922 = (C) HCPCS ON BILL TYPE 83X -NOT REV 274
      6923 = (C) RENTAL OF DME CUSTOMIZE AND REV 291
      6924 = (C) INVAL MODIFIER FOR CAPPED RENTAL
      6925 = (C) HCPCS ALLOWED ON BILL TYPES 32X-34X
      6929 = (U) ADJUSTMENT BILL LIFE RESERVE
      6930 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
      7000 = (U) INVALID DOEBA/DOLBA
      7002 = (U) LESS THAN 60/61 BETWEEN SPELLS
      7010 = (E) TOB 85X/ELECTN PRD: COND CD 07 REQD
      71X1 = (C) SUBMITTED CHARGES INVALID
      71X2 = (C) MAMMOGRPY/PROC CODE MOD TC,26/CHG
      71X3 = (C) HCPCS 76092 PAY INDICATOR <> A,R,S
                 & 76085 PAY INDICATOR A,R,S
      72X1 = (C) ALLOWED CHGS INVALID
      72X2 = (C) ALLOWED/SUBMITTED CHARGES/TYPE
      72X3 = (C) DENIED LINE/ALLOWED CHARGES
      7230 = (C) FRAMES >1, LENSES >2
      73X1 = (C) SS NUMBER INVALID
      73X2 = (C) CARRIER ASSIGNED PROV NUM MISSING
      74X1 = (C) LOCALITY CODE INVAL FOR CONTRACT
      76X1 = (C) PL OF SER INVAL ON MAMMOGRAPHY BILL
      77X1 = (C) PLACE OF SERVICE INVALID
      77X2 = (C) PHYS THERAPY/PLACE
      77X3 = (C) PHYS THERAPY/SPECIALTY/TYPE
      77X4 = (C) ASC/TYPE/PLACE/REIMB IND/DED IND
      77X6 = (C) TOS=F, PL OF SER NOT = 24
      7701 = (C) INCORRECT MODIFIER
      7777 = (D) POSS DUPE, PART B DOC-ID
      78XA = (C) MAMMOGRAPHY BEFORE 1991
      78XB = (C) ANTI-CANCER BEFORE 01/01/1998
      78X1 = (C) FROM DATE IMPOSSIBLE
      78X2 = (C) FROM DATE > CURRENT DATE OR
                 < 07/01/1966
      78X3 = (C) FROM DATE GREATER THAN THRU DATE
      78X4 = (C) FROM DATE > RCVD DATE/PAY-DENY
      78X5 = (C) FROM DATE > PAID DATE/TYPE/100%
      78X7 = (C) LAB EDIT/TYPE/100%/FROM DATE
      79X1 = (C) THRU DATE IMPOSSIBLE
      79X2 = (C) THRU DATE > CURRENT DATE
      79X3 = (C) THRU DATE>RECD DATE/NOT DENIED
      79X4 = (C) THRU DATE>PAID DATE/NOT DENIED
      8000 = (U) MAIN & 2NDARY DOEBA < 01/01/90
      8028 = (E) NO ENTITLEMENT
      8029 = (U) HH BEFORE PERIOD NOT PRESENT
      8030 = (U) HH BILL VISITS > PT A REMAINING
      8031 = (U) HH PT A REMAINING > 0
      8032 = (U) HH DOLBA+59 NOT GT FROM-DATE
      8050 = (U) HH QUALIFYING INDICATOR = 1
      8051 = (U) HH # VISITS NE AFT PT B APPLIED
      8052 = (U) HH # VISITS NE AFT TRAILER
      8053 = (U) HH BENEFIT PERIOD NOT PRESENT
      8054 = (U) HH DOEBA/DOLBA NOT > 0
      8060 = (U) HH QUALIFYING INDICATOR NE 1
      8061 = (U) HH DATE NE DOLBA IN AFT TRLR
      8062 = (U) HH NE PT-A VISITS REMAINING
      81X1 = (C) NUM OF SERVICES INVALID
      83X1 = (C) DIAGNOSIS INVALID
      8301 = (C) HCPCS/GENDER DIAGNOSIS
      8302 = (C) HCPCS G0101 V-CODE/SEX CODE
      8303 = (C) HCPCS/GENDER
      8304 = (C) BILL TYPE INVALID FOR G0123/4
      8305 = (C) HCPCS/SERVICE DATES/GENDER
      84X1 = (C) PAP SMEAR/DIAGNOSIS/GENDER/PROC
      84X2 = (C) INVALID DME START DATE
      84X3 = (C) INVALID DME START DATE W/HCPCS
      84X4 = (C) HCPCS G0101 V-CODE/SEX CODE
      84X5 = (C) HCPCS CODE WITH INV DIAG CODE
      84X6 = (C) HCPCS/GENDER
      84X7 = (C) HCPCS/SERVICE DATES/GENDER
      84X8 = (C) DUPLICATE HCPCS
      86X1 = (C) CLINICAL LAB HCPCS W/O CLINICAL
                 LAB ID
      86X2 = (C) NON-WAIVER HCPCS/PAY DENIAL CODE/
                 MODIFIER
      86X8 = (C) CLIA REQUIRES NON-WAIVER HCPCS
      88XX = (D) POSS DUPE, DOC-ID,UNITS,ENT,ALWD
      9000 = (U) DOEBA/DOLBA CALC
      9005 = (U) FULL/COINS HOSP DAYS CALC
      9010 = (U) FULL/COINS SNF DAYS CALC
      9015 = (U) LIFE RESERVE DAYS CALC
      9020 = (U) LIFE PSYCH DAYS CALC
      9030 = (U) INPAT DEDUCTABLE CALC
      9040 = (U) DATA INDICATOR 1 SET
      9050 = (U) DATA INDICATOR 2 SET
      91X1 = (C) PATIENT REIMB/PAY-DENY CODE
      92X1 = (C) PATIENT REIMB INVALID
      92X2 = (C) PROVIDER REIMB INVALID
      92X3 = (C) LINE DENIED/PATIENT-PROV REIMB
      92X4 = (C) MSP CODE/AMT/DATE/ALLOWED CHARGES
      92X5 = (C) CHARGES/REIMB AMT NOT CONSISTANT
      92X7 = (C) REIMB/PAY-DENY INCONSISTANT
      9201 = (C) UPIN REF NAME OR INITIAL MISSING
      9202 = (C) UPIN REF FIRST 3 CHAR INVALID
      9203 = (C) UPIN REF LAST 3 CHAR NOT NUMERIC
      93X1 = (C) CASH DEDUCTABLE INVALID
      93X2 = (C) DEDUCT INDICATOR/CASH DEDUCTIBLE
      93X3 = (C) DENIED LINE/CASH DEDUCTIBLE
      93X4 = (C) FROM DATE/CASH DEDUCTIBLE
      93X5 = (C) TYPE/CASH DEDUCTIBLE/ALLOWED CHGS
      9300 = (C) UPIN OTHER, NOT PRESENT
      9301 = (C) UPIN NME MIS/DED TOT LI>0 FR DEN CLM
      9302 = (C) UPIN OPERATING, FIRST 3 NOT NUMERIC
      9303 = (C) UPIN L 3 CH NT NUM/DED TOT LI>YR DED
      9351 = (C) OTHER UPIN PRESENT/MISSING OTHER FIELDS
      9352 = (C) OTHER UPIN INVALID
      9353 = (C) OTHER UPIN INVALID
      94A1 = (C) NON-COVERED FROM DATE INVALID
      94A2 = (C) NON-COVERED FROM > THRU DATE
      94A3 = (C) NON-COVERED THRU DATE INVALID
      94A4 = (C) NON-COVERED THRU DATE > ADMIT
      94A5 = (C) NON-COVERED THRU DATE/ADMIT DATE
      94C1 = (C) PR-PSYCH DAYS INVALID
      94C3 = (C) PR-PSYCH DAYS > PROVIDER LIMIT
      94F1 = (C) REIMBURSEMENT AMOUNT INVALID
      94F2 = (C) REIMBURSE AMT NOT 0 FOR HMO PAID
      94G1 = (C) NO-PAY CODE INVALID
      94G2 = (C) NO-PAY CODE SPACE/NON-COVERD=TOTL
      94G3 = (C) NO-PAY/PROVIDER INCONSISTANT
      94G4 = (C) NO PAY CODE = R & REIMB PRESENT
      94X1 = (C) BLOOD LIMIT INVALID
      94X2 = (C) TYPE/BLOOD DEDUCTIBLE
      94X3 = (C) TYPE/DATE/LIMIT AMOUNT
      94X4 = (C) BLOOD DED/TYPE/NUMBER OF SERVICES
      94X5 = (C) BLOOD/MSP CODE/COMPUTED LINE MAX
      9401 = (C) BLOOD DEDUCTIBLE AMT > 3
      9402 = (C) BLOOD FURNISHED > DEDUCTIBLE
      9403 = (C) DATE OF BIRTH MISSING ON PRO-PAY
      9404 = (C) INVALID GENDER CODE ON PRO-PAY
      9407 = (C) INVALID DIAGNOSIS
      9408 = (C) INVALID DRG NUMBER (GLOBAL)
      9409 = (C) HCFA DRG<>DRG ON BILL
      940X = (C) INVALID DRG
      9410 = (C) CABG/PCOE,INVALID DRG
      95X1 = (C) MSP CODE G/DATE BEFORE 1/1/87
      95X2 = (C) MSP AMOUNT APPLIED INVALID
      95X3 = (C) MSP AMOUNT APPLIED > SUB CHARGES
      95X4 = (C) MSP PRIMARY PAY/AMOUNT/CODE/DATE
      95X5 = (C) MSP CODE = G/DATE BEFORE 1987
      95X6 = (C) MSP CODE = X AND NOT AVOIDED
      95X7 = (C) MSP CODE VALID, CABG/PCOE
      96X1 = (C) OTHER AMOUNTS INVALID
      96X2 = (C) OTHER AMOUNTS > PAT-PROV REIMB
      97X1 = (C) OTHER AMOUNTS INDICATOR INVALID
      97X2 = (C) GRUDMAN SW/GRUDMAN AMT NOT > 0
      98X1 = (C) COINSURANCE INVALID
      98X3 = (C) MSP CODE/TYPE/COIN AMT/ALLOW/CSH
      98X4 = (C) DATE/MSP/TYPE/CASH DED/ALLOW/COI
      98X5 = (C) DATE/ALLOW/CASH DED/REIMB/MSP/TYP
      9801 = (C) REV CENTER CODE 0910 WITH SERVICE
                 DATE > 10/15/2004
      99XX = (D) POSS DUPE, PART B DOC-ID
      9901 = (C) REV CODE INVALID OR TRAILER CNT=0
      9902 = (C) ACCOMMODATION DAYS/FROM/THRU DATE
      9903 = (C) NO CLINIC VISITS FOR RHC
      9904 = (C) INCOMPATIBLE DATES/CLAIM TYPE
      991X = (C) NO DATE OF SERVICE
      9910 = (C) BLOOD DEDUCTIBLE NON NUMERIC
      9911 = (C) BLOOD DEDUCTIBLE PRESENT WITHOUT
                 BLOOD FURNISHED
      9920 = (C) CASH DEDUCTIBLE INVALID
      9930 = (C) COINSURANCE INVALID
      9931 = (C) OUTPAT COINSURANCE VALUES
      9933 = (C) RATE EXCEDES MAMMOGRAPHY LIMIT
      9934 = (C) HCPCS 76092 NON COVERED/76085 COVERED
      9940 = (C) PROVIDER PAYMENT INVALID
      9941 = (C) REIMBURSEMENT AMOUNT/COND/NON-PAYMENT/
                 PRIMARY PAYER
      9942 = (C) PATIENT DISTRIBUTION INVALID
      9944 = (C) STAY FROM>97273,DIAG<>V103,163,7612
      9945 = (C) HCPCS INVALID FOR SERVICE DATES
      9946 = (C) TOB INVALID FOR HCPCS
      9947 = (C) INVALID DATE FOR HCPCS
      9948 = (C) STAY FROM>96365,DIAG=V725
      9960 = (C) MED CHOICE BUT HMO DATA MISSING
      9965 = (C) HMO PRESENT BUT MED CHOICE MISSING
      9968 = (C) MED CHOICE NOT= HMO PLAN NUMBER
      9999 = (U) MAIN SPELL TRAILER NUMBER DOES NOT MATCH SPELL



 NCH_EDIT_TRLR_IND_TB                    NCH Edit Trailer Indicator Table

      E = Edit code trailer present



 NCH_MCO_TRLR_IND_TB                     NCH Managed Care Organization (MCO) Trailer Indicator Table

      M = MCO trailer present



 NCH_MQA_QUERY_PATCH_TB                  NCH MQA Query Patch Table

       Y = MQA changed bill query code on a action
           code 6 (force action code 2)
           bill to a zero. (Eff. 10/12/93)
       Z = MQA changed bill query code on a action
           code 4 (cancel only adjustment)
           bill to zero.  (Eff. 5/16/94)



 NCH_MQA_RIC_TB                          NCH MQA Record Identification Code Table

       1 = Inpatient
       2 = SNF
       3 = Hospice
       4 = Outpatient
       5 = Home Health Agency
       6 = Physician/Supplier
       7 = Durable Medical Equipment



 NCH_NEAR_LINE_REC_VRSN_TB               NCH Near Line Record Version Table

       A = Record format as of January 1991
       B = Record format as of April 1991
       C = Record format as of May 1991
       D = Record format as of January 1992
       E = Record format as of March 1992
       F = Record format as of May 1992
       G = Record format as of October 1993
       H = Record format as of September 1998
       I = Record format as of July 2000
       J = Record format as of January 2011
       K = Record format as of April 2013



 NCH_NEAR_LINE_RIC_TB                    NCH Near-Line Record Identification Code Table

       O = Part B physician/supplier claim
           record (processed by local carriers;
           can include DMEPOS services)
       V = Part A institutional claim record
           (inpatient (IP), skilled nursing
           facility (SNF), christian science
           (CS), home health agency (HHA), or
           hospice)
       W = Part B institutional claim record
           (outpatient (OP), HHA)
       U = Both Part A and B institutional home
           health agency (HHA) claim records --
           due to HHPPS and HHA A/B split.
           (effective 10/00)
       M = Part B DMEPOS claim record (processed
           by DME Regional Carrier) (effective 10/93)



 NCH_OCRNC_TRLR_IND_TB                   NCH Occurrence Trailer Indicator Table

      O = Occurrence code trailer present



 NCH_PATCH_TB                            NCH Patch Table

      01 = RRB Category Equatable BIC - changed (all
           claim types) -- applied during the Nearline
           'G' conversion to claims with NCH weekly
           process date before 3/91.   Prior to Version
           'H', patch indicator stored in redefined Claim
           Edit Group, 3rd occurrence, position 2.
      02 = Claim Transaction Code made consistent with
           NCH payment/edit RIC code (OP and HHA) --
           effective 3/94, CWFMQA began patch.  During
           'H' conversion, patch applied to claims with
           NCH weekly process date prior to 3/94.  Prior
           to version 'H', patch indicator stored in
           redefined Claim Edit Group, 4th occurrence,
           position 1.
      03 = Garbage/nonnumeric Claim Total Charge Amount
           set to zeroes (Instnl) --  during the Version
           'G' conversion, error occurred in the deriva-
           tion of this field where the claim was missing
           revenue center code = '0001'.   In 1994, patch
           was applied to the OP and HHA SAFs only. (This
           SAF patch indicator was stored in the redefined
           Claim Edit Group, 4th occurrence, position 2).
           During the 'H' ocnversion, patch applied to
           Nearline claims where garbage or nonnumeric
           values.
      04 = Incorrect bene residence SSA standard county
           code '999' changed (all claim types) --
           applied during the Nearline 'G' conversion and
           ongoing through 4/21/94, calling EQSTZIP
           routine to claims with NCH weekly process
           date prior to 4/22/94.  Prior to Version 'H'
           patch indicator stored in redefined Claim
           Edit Group, 3rd occurrence, position 4.
      05 = Wrong century bene birth date corrected (all
           claim types) -- applied during Nearline 'H'
           conversion to all history where century
           greater than 1700 and less than 1850; if
           century less than 1700, zeroes moved.
      06 = Inconsistent CWF bene medicare status code
           made consistent with age (all claim types) --
           applied during Nearline 'H' conversion to all
           history and patched ongoing.  Bene age is
           calculated to determine the correct value;
           if greater than 64, 1st position MSC ='1';
           if less than 65, 1st position MSC = '2'.
      07 = Missing CWF bene medicare status code derived
           (all claim types) -- applied during Nearline
           'H' conversion to all history and patched
           ongoing, except claims with unknown DOB and/
           or Claim From Date='0' (left blank).   Bene
           age is calculated to determine missing value;
           if greater than 64, MSC='10'; if less than
           65, MSC = '20'.
      08 = Invalid NCH primary payer code set to blanks
           (Instnl) -- applied during Version 'H' con-
           version to claims with NCH weekly process
           date 10/1/93-10/30/95, where MSP values =
           invalid '0', '1', '2', '3' or '4' (caused
           by erroneous logic in HCFA program code,
           which was corrected on 11/1/95).
      09 = Zero CWF claim accretion date replaced with
           NCH weekly process date (all claim types)
           -- applied during Version 'H' conversion to
           Instnl and DMERC claims; applied during
           Version 'G' conversion to non-institutional
           (non-DMERC) claims.  Prior to Version 'H',
           patch indicator stored in redefined claim
           edit group, 3rd occurrence, position 1.
      10 = Multiple Revenue Center 0001 (Outpatient,
           HHA and Hospice) -- patch applied to 1998 &
           1999 Nearline and SAFs to delete any revenue
           codes that followed the first '0001' revenue
           center code.   The edit was applied across all
           institutional claim types, including Inpatient/
           SNF (the problem was only found with OP/HHA/
           Hospice claims).  The problem was corrected
           6/25/99.
      11 = Truncated claim total charge amount in the
           fixed portion replaced with the total charge
           amount in the revenue center 0001 amount field
           -- service years 1998 & 1999 patched during
           quarterly merge.  The 1998 & 1999 SAFs were
           corrected when finalized in 7/99.  The patch
           was done for records with NCH Daily Process
           Date 1/4/99 - 5/14/99.
      12 = Missing claim-level HHA Total Visit Count --
           service years 1998, 1999 & 2000 patch applied
           during Version 'I' conversion of both the
           Nearline and SAFs.   Problem occurs in those
           claims recovered during the missing claims
           effort.
      13 = Inconsistent Claim MCO Paid Switch made consistent
           with criteria used to identify an inpatient
           encounter claim -- if MCO paid switch equal to blank
           or '0' and ALL conditions are met to indicate an
           inpatient encounter claim (bene enrolled in a risk
           MCO during the service period), change the switch to
           a '1'.  The patch was applied during the Version 'I'
           conversion, for claims back to 7/1/97 service thru date.

      14 = SNF claims incorrectly identified as Inpatient
           Encounter claims -- SNF claims matching the Inpatient
           encounter data criteria were incorrectly identified
           as Inpatient encounter claims (claim type code = '61'
           instead of '20' or '30').   NOTE:  if the SNF claims
           were identified the MCO paid switch was set to '1'.
           The patch was applied to correctly identify these
           claims as a '20' or '30'.  The MCO paid switch will
           be set to '0' as there is no way to recover the original
           value.  The problem occurred in claims with an NCH
           Weekly Process Date ranging from 7/7/2000 - 1/26/2001.
           The patch applied date is 03/30/2001.

      15 = HHA Part A claims with overlaid revenue center lines -
           During the Version 'I' conversion, NCH made each
           segment of a claim contains a maximum of 45 revenue
           lines.  During the month of June 2000 our CWFMQA had
           to be ready to except the new expanded format, but the
           NCH was not ready.  CWFMQA converted these 'I' claims
           back to Version 'H', a typo in the code caused the
           additional revenue lines to overlay some of the
           revenue lines on the base/initial record/segment.
           The problem occurred in claims with NCH Weekly Process
           dates from 6/16/00, 6/23/00, 6/30/00 and 7/7/00
           (both Version 'H' & 'I' files).

           In the Version 'I' files, the annual service year
           2000 files, service year 1999 and 1998 trickles were
           patched.  The 18-month service year 1999 was also
           patched (the service year 2000 SAF was created after
           the fix was applied).

           The patch applied date is 06/29/2001.



 NCH_PATCH_TRLR_IND_TB                   NCH Patch Trailer Indicator Table

      P = Patch code trailer present



 NCH_PRCDR_TRLR_IND_TB                   NCH Procedure Trailer Indicator Table

      Z = Procedure code trailer present



 NCH_REV_TRLR_IND_TB                     NCH Revenue Center Trailer Indicator Table

      R = Revenue code trailer present



 NCH_SPAN_TRLR_IND_TB                    NCH Span Trailer Indicator Table

      S = Span code trailer present



 NCH_STATE_SGMT_TB                       NCH State Segment Table

      NCH State Segment     State Codes
      -----------------     -----------------------
      B =                   01;02;03;04;06;07;08;09;
                            12;13;16;17;19;20;21;25;
                            27;28;29;30;32;35;37;38;
                            40;41;42;43;44;46;47;48;
                            50;51;53-99

      C =                   11;14;15;18;24;26;49;52

      D =                   11;14;15;18;24;26;31;34;
                            45;49;52

      E =                   22;23;31;34;36;45

      F =                   10;22;23;31;34;36;45

      G =                   10;22;23;36;39

      H =                   05;10;22;23;39

      I =                   05;10;39

      J =                   05;10;33;39

      K =                   05;33;39

      L =                   05;33;39

      M =                   05;33

      N =                   05;33

      O =                   33

      P =                   33

      Q =                   33

      R =                   33



 NCH_VAL_TRLR_IND_TB                     NCH Value Trailer Indicator Table

      V = Value code trailer present



 NG_ACO_IND_TB                           Next Generation (NG) Accountable Care Organization (ACO) Indicator Code Table

      0 = Base record (no enhancements)
      1 = Population Based Payments (PBP)
      2 = Telehealth
      3 = Post Discharge Home Health Visits
      4 = 3-Day SNF Waiver
      5 = Capitation
      6 = CEC Telehealth
      7 = Care Management Home Visits



 PMT_EDIT_RIC_TB                         Payment And Edit Record Identification Code Table

       C = Inpatient hospital, SNF
       D = Outpatient
       E = Religious Nonmedical Health Care Institutions (eff. 8/00);
           Christian Science, prior to 7/00
       F = Home Health Agency (HHA)
       G = Discharge notice
           (obsoleted 7/98)
       I = Hospice



 PRVDR_NUM_TB                            Provider Number Table

       -   First two positions are the GEO SSA State Code.

       -   Positions 3 and sometimes 4 are used as a
           category identifier.  The remaining positions
           are serial numbers.  The following blocks of numbers
           are reserved for the facilities indicated (NOTE:
           may have different meanings dependent on the Type
           of Bill (TOB):

       -   A 'V' in the 5th position identifies a VA demo.

           0001-0879   Short-term (general and specialty)
                       hospitals where TOB = 11X; ESRD
                       clinic where TOB = 72X
           0880-0899   Reserved for hospitals participating
                       in ORD demonstration projects where
                       TOB = 11X; ESRD clinic where TOB =
                       72X
           0900-0999   Multiple hospital component in a
                       medical complex (numbers retired)
                       where TOB = 11X; ESRD clinic where
                       TOB = 72X
           1000-1199   Reserved for future use
           1200-1224   Alcohol/drug hospitals (excluded
                       from PPS-numbers retired)
                       where TOB = 11X; ESRD clinic where
                       TOB = 72X
           1225-1299   Medical assistance facilities
                       (Montana project); ESRD clinic where
                       TOB = 72X
           1300-1399   Rural Primary Care Hospital (RCPH) -
                       eff. 10/97 changed to Critical Access
                       Hospitals (CAH)
           1400-1499   Continuation of 4900-4999 series (CMHC)
           1500-1799   Hospices
           1800-1989   Federally Qualified Health Centers
                       (FQHC) where TOB = 73X; SNF (IP PTB)
                       where TOB = 22X; HHA where TOB = 32X,
                       33X, 34X
           1990-1999   Christian Science Sanatoria
                       (hospital services) - eff. 7/00 changed
                       to Religious Nonmedical Health Care
                       Institutions (RNHCI)
           2000-2299   Long-term hospitals
           2300-2499   Chronic renal disease facilities
                       (hospital based)
           2500-2899   Non-hospital renal disease
                       treatment centers
           2900-2999   Independent special purpose renal
                       dialysis facility (1)
           3000-3024   Formerly tuberculosis hospitals
                       (numbers retired)
           3025-3099   Rehabilitation hospitals
           3100-3199   Continuation of Subunits of Nonprofit
                       and Proprietary Home Health Agencies
                       (7300-7399) Series (3) (eff. 4/96)
           3200-3299   Continuation of 4800-4899 series (CORF)
           3300-3399   Children's hospitals (excluded from PPS)
                       where TOB = 11X; ESRD clinic where TOB =
                       72X
           3400-3499   Continuation of rural health clinics
                       (provider-based) (3975-3999)
           3500-3699   Renal disease treatment centers
                       (hospital satellites)
           3700-3799   Hospital based special purpose renal
                       dialysis facility (1)
           3800-3974   Rural health clinics (free-standing)
           3975-3999   Rural health clinics (provider-based)
           4000-4499   Psychiatric hospitals
           4500-4599   Comprehensive Outpatient
                       Rehabilitation Facilities (CORF)
           4600-4799   Community Mental Health Centers (CMHC);
                       9/30/91 - 3/31/97 used for clinic OPT
                       where TOB = 74X
           4800-4899   Continuation of 4500-4599 series (CORF)
                        (eff. 10/95)
           4900-4999   Continuation of 4600-4799 series (CMHC)
                       (eff. 10/95); 9/30/91 - 3/31/97 used for
                       clinic OPT where TOB = 74X
           5000-6499   Skilled Nursing Facilities
           6500-6989   CMHC / Outpatient physical therapy services
                       where TOB = 74X; CORF where TOB =
                       75X
           6990-6999   Christian Science Sanatoria (skilled
                       nursing services) - eff. 7/00 Numbers
                       Reserved (formerly CS)
           7000-7299   Home Health Agencies (HHA) (2)
           7300-7399   Subunits of 'nonprofit' and
                       'proprietary' Home Health Agencies (3)
           7400-7799   Continuation of 7000-7299 series
           7800-7999   Subunits of state and local governmental
                       Home Health Agencies (3)
           8000-8499   Continuation of 7400-7799 series (HHA)
           8500-8899   Continuation of rural health
                       center (provider based) (3400-3499)
           8900-8999   Continuation of rural health
                       center (free-standing) (3800-3974)
           9000-9799   Continuation of 8000-8499 series (HHA)
                       (eff. 10/95)
           9800-9899   Transplant Centers (eff. 10/1/07)
           9900-9999   Reserved for future use (eff. 8/1/98)
                       NOTE: 10/95-7/98 this series was
                       assigned to HHA's but rescinded - no
                       HHA's were ever assigned a number
                       from this series.

           Exception:

           P001-P999   Organ procurement organization

       (1) These facilities (SPRDFS) will be assigned
           the same provider number whenever they
           are recertified.

       (2) The 6400-6499 series of provider numbers
           in Iowa (16), South Dakota (43) and Texas (45)
           have been used in reducing acute care costs (RACC)
           experiments.

       (3) In Virginia (49), the series 7100-7299 has
           been reserved for statewide subunit components
           of the Virginia state home health agencies.

       (4) Parent agency must have a number in the
           7000-7299, 7400-7799 or 8000-8499 series.

       NOTE:
         There is a special numbering system for units
         of hospitals that are excluded from prospective
         payment system (PPS) and hospitals with SNF
         swing-bed designation.  An alpha character in
         the third position of the provider number
         identifies the type of unit or swing-bed
         designation as follows:

           M = Psychiatric Unit in Critical Access Hospital
           R = Rehabilitation Unit in Critical Access Hospital
           S = Psychiatric unit (excluded from PPS)
           T = Rehabilitation unit (excluded from PPS)
           U = Swing-Bed Hospital Designation for Short-
               Term Hospitals
           V = Alcohol drug unit (prior to 10/87 only)
           W = Swing-Bed Hospital Designation for Long
               Term Care Hospitals
           Y = Swing-Bed Hospital Designation for
               Rehabilitation Hospitals
           Z = Swing Bed Designation for Critical Access
               Hospitals

         There is also a special numbering system for
         assigning emergency hospital identification
         numbers (non participating hospitals).  The
         sixth position of the provider number is as
         follows:

           E = Non-federal emergency hospital
           F = Federal emergency hospital



 PTNT_DSCHRG_STUS_TB                     Patient Discharge Status Table

       01 = Discharged to home/self care (routine
            charge).
       02 = Discharged/transferred to other short term
            general hospital for inpatient care.
       03 = Discharged/transferred to skilled
            nursing facility (SNF) with Medicare
            certification in anticipation of covered
            skilled care -- (For hospitals with an
            approved swing bed arrangement, use Code
            61 - swing bed.  For reporting discharges/
            transfers to a non-certified SNF, the
            hospital must use Code 04 - ICF.
       04 = Discharged/transferred to a facility that
            provides custodial or supportive care (includes
            intermediate care facilities (ICF).  Also used
            to designate patients that are dischared/trans-
            ferred to a nursing facility with neither
            Medicare nor Medicaid certification and for
            discharges/transfers to Assisted Living Facilities.
       05 = Discharged/transferred to a designated cancer
            center or children's hospital (eff. 10/09). Prior
            to 10/1/09, discharged/transferred to another type
            of institution for inpatient care (including
            distinct parts).  NOTE:  Effective 1/2005,
            psychiatric hospital or psychiatric distinct
            part unit of a hospital will no longer be
            identified by this code.  New code is '65'.
       06 = Discharged/transferred to home care of
            organized home health service organization
            in anticipation of covered skilled care.
       07 = Left against medical advice or discontinued
            care.
       08 = Discharged/transferred to home under
            care of a home IV drug therapy provider.
            (discontinued effective 10/1/05)
       09 = Admitted as an inpatient to this
            hospital (effective 3/1/91).  In situa-
            tions  where a patient is admitted before
            midnight of the third day following the
            day of an outpatient service, the out-
            patient services are considered inpatient.
       20 = Expired
       21 = Discharged/transferred to Court/Law
            Enforcement.
       30 = Still patient.
       40 = Expired at home (Hospice claims only).
       41 = Expired in a medical facility such as
            hospital, SNF, ICF, or freestanding
            hospice. (Hospice claims only)
       42 = Expired - place unknown (Hospice claims
            only)
       43 = Discharged/transferred to a federal hospital
            (eff. 10/1/03). Discharges and transfers to a
            government operated health facility such as a
            Department of Defense hospital, a Veteran's
            Administration hospital or a Veteran's Administration
            nursing facility. To be used whenever the destination
            at discharge is a federal health care facility,
            whether the patient lives there or not.
       50 = Hospice - home (eff. 10/96)
       51 = Hospice - medical facility (certified) providing
            hospice level of care
       61 = Discharged/transferred within this insti-
            tution to a hospital-based Medicare
            approved swing bed (eff. 9/01)
       62 = Discharged/transferred to an inpatient
            rehabilitation facility including distinct
            parts units of a hospital.
            (eff. 1/2002)
       63 = Discharged/transferred to a Medicare certified
            long term care hospital. (eff. 1/2002)
       64 = Discharged/transferred to a nursing facility
            certified under Medicaid but not certified under
            Medicare (eff. 10/2002)
       65 = Discharged/Transferred to a psychiatric
            hospital or psychiatric distinct unit of a
            hospital (these types of hospitals were
            pulled from patient/discharge status code
            '05' and given their own code). (eff. 1/2005).
       66 = Discharged/transferred to a Critical Access
            Hospital (CAH) (eff. 1/1/06)
       69 = Discharge/transfers to a Designated Disaster
            Alternative Care site (eff. 10/2013)
       70 = Discharged/transferred to another type of health
            care institution not defined elsewhere in code
            list.
       71 = Discharged/transferred/referred to another
            institution for outpatient services as
            specified by the discharge plan of care
            (eff. 9/01) (discontinued effective 10/1/05)
       72 = Discharged/transferred/referred to this
            institution for outpatient services as
            specified by the discharge plan of care
            (eff. 9/01) (discontinued effective 10/1/05)
       81 = Discharged to home or self-care with a planned
            acute care hospital inpatient (eff. 10/2013)
       82 = Discharged/transferred to a short term general hospital
            for inpatient care readmission (eff. 10/2013)
       83 = Discharged/transferred to a skilled nursing facility
            (SNF) with Medicare (eff. 10/2013)
       84 = Discharged/transferred to a facility that provides
            custodial supportative care with a planned acute
            care hospital inpatient readmission certification
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       85 = Discharged/transferred to a designated cancer center or
            children's hospital with a planned acute care hospital
            inpatient readmission (eff. 10/2013)
       86 = Discharged/transferred to home under care of organized
            home health service organization with a planned acute
            care hospital inpatient readmission (eff. 10/2013)
       87 = Discharged/transferred to court/law enforcement with a
            planned acute care hospital inpatient readmission (eff.
            10/2013)
       88 = Discharged/transferred to a Federal health care facility
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       89 = Discharged/transferred to a hospital-based Medicare approved
            swing bed with a planned acute care hosptial inpatient
            readmission (eff. 10/2013)
       90 = Discharged/transferred to an inpatient rehabilitation
            facility (IRF) including rehabilitation distinct units of
            a hospital with a planned acute care hospital inpatient
            readmission (eff. 10/2013)
       91 = Discharged/transferred to a Medicare certified Long Term
            Care Hospital (LTCH) with a planned acute care hospital
            inpatient readmission (eff. 10/2013)
       92 = Discharged/transferred to a nursing facility certified
            under Medicaid but not certified under Medicare with a
            planned acute care hospital inpatient readmission (eff.
            10/2013)
       93 = Discharged/transferred to a psychiatric hospital or
            psychiatric distinct part unit of a hospital with a
            planned acute care hospital inpatient readmission
            (eff. 10/2013)
       94 = Discharged/transferred to a critical access hospital (CAH)
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       95 = Discharged/transferred to another type of health care
            institution not defined elsewhere in this code list with a
            planned acute care hospital inpatient readmission. (eff. 10/2013)



 REV_CNTR_ANSI_TB                        Revenue Center ANSI Code Table

      *******EXPLANATION OF CLAIM ADJUSTMENT GROUP CODES*******
      **************POSITIONS 1 & 2 OF ANSI CODE***************
      CO = Contractual Obligations -- this group code should
      be used when a contractual agreement between the
      payer and payee, or a regulatory requirement, re-
      sulted in an adjustment.  Generally, these adjust-
      ments are considered a write-off for the provider
      and are not billed to the patient.

      CR = Corrections and Reversals -- this group code should
      be used for correcting a prior claim.  It applies
      when there is a change to a previously adjudicated
      claim.

      OA = Other Adjustments -- this group code should be used
      when no other group code applies to the adjustment.

      PI = Payer Initiated Reductions -- this group code should
      be used when, in the opinion of the payer, the adjust-
      ment is not the responsibility of the patient, but
      there is no supporting contract between the provider
      and the payer (i.e., medical review or professional
      review organization adjustments).

      PR = Patient Responsibility -- this group should be used
      when the adjustment represents an amount that should
      be billed to the patient or insured.  This group
      would typically be used for deductible and copay
      adjustments.

      ***********Claim Adjustment Reason Codes***************
      ***********POSITIONS 3 through 5 of ANSI CODE**********

      1 = Deductible Amount
      2 = Coinsurance Amount
      3 = Co-pay Amount
      4 = The procedure code is inconsistent with the modifier
      used or a required modifier is missing.
      5 = The procedure code/bill type is inconsistent with the
      place of service.
      6 = The procedure code is inconsistent with the patient's
      age.
      7 = The procedure code is inconsistent with the patient's
      gender.
      8 = The procedure code is inconsistent with the provider
      type.
      9 = The diagnosis is inconsistent with the patient's age.
      10 = The diagnosis is inconsistent with the patient's
      gender.
      11 = The diagnosis is inconsistent with the procedure.
      12 = The diagnosis is inconsistent with the provider type.
      13 = the date of death precedes the date of service.
      14 = The date of birth follows the date of service.
      15 = Claim/service adjusted because the submitted auth-
      orization number is missing, invalid, or does not
      apply to the billed services or provider.
      16 = Claim/service lacks information which is needed for
      adjudication.
      17 = Claim/service adjusted because requested information
      was not provided or was insufficient/incomplete.
      18 = Duplicate claim/service.
      19 = Claim denied because this is a work-related injury/
      illness and thus the liability of the Worker's Com-
      pensation Carrier.
      20 = Claim denied because this injury/illness is covered
      by the liability carrier.
      21 = Claim denied because this injury/illness is the
      liability of the no-fault carrier.
      22 = Claim adjusted because this care may be covered by
      another payer per coordination of benefits.
      23 = Claim adjusted because charges have been paid by
      another payer.
      24 = Payment for charges adjusted.  Charges are covered
      under a capitation agreement/managed care plan.
      25 = Payment denied.  Your Stop loss deductible has not
      been met.
      26 = Expenses incurred prior to coverage.
      27 = Expenses incurred after coverage terminated.
      28 = Coverage not in effect at the time the service was
      provided.
      29 = The time limit for filing has expired.
      30 = Claim/service adjusted because the patient has not met
      the required eligibility, spend down, waiting, or
      residency requirements.
      31 = Claim denied as patient cannot be identified as our
      insured.
      32 = Our records indicate that this dependent is not an
      eligible dependent as defined.
      33 = Claim denied.  Insured has no dependent coverage.
      34 = Claim denied.  Insured has no coverage for newborns.
      35 = Benefit maximum has been reached.
      36 = Balance does not exceed copayment amount.
      37 = Balance does not exceed deductible amount.
      38 = Services not provided or authorized by designated
      (network) providers.
      39 = Services denied at the time authorization/pre-certi-
      fication was requested.
      40 = Charges do not meet qualifications for emergency/urgent
      care.
      41 = Discount agreed to in Preferred Provider contract.
      42 = Charges exceed our fee schedule or maximum allowable
      amount.
      43 = Gramm-Rudman reduction.
      44 = Prompt-pay discount.
      45 = Charges exceed your contracted/legislated fee arrange-
      ment.
      46 = This (these) service(s) is(are) not covered.
      47 = This (these) diagnosis(es) is(are) not covered,
      missing, or are invalid.
      48 = This (these) procedure(s) is(are) not covered.
      49 = These are non-covered services because this is a
      routine exam or screening procedure done in conjunc-
      tion with a routine exam.
      50 = These are non-covered services because this is not
      deemed a 'medical necessity' by the payer.
      51 = These are non-covered services because this a pre-
      existing condition.
      52 = The referring/prescribing/rendering provider is not
      eligible to refer/prescribe/order/perform the service
      billed.
      53 = Services by an immediate relative or a member of the
      same household are not covered.
      54 = Multiple physicians/assistants are not covered in this
      case.
      55 = Claim/service denied because procedure/treatment is
      deemed experimental/investigational by the payer.
      56 = Claim/service denied because procedure/treatment has
      not been deemed 'proven to be effective' by payer.
      57 = Claim/service adjusted because the payer deems the
      information submitted does not support this level of
      service, this many services, this length of service, or
      this dosage.
      58 = Claim/service adjusted because treatment was deemed by
      the payer to have been rendered in an inappropriate
      or invalid place of service.
      59 = Charges are adjusted based on multiple surgery rules or
      concurrent anesthesia rules.
      60 = Charges for outpatient services with the proximity to
      inpatient services are not covered.
      61 = Charges adjusted as penalty for failure to obtain second
      surgical opinion.
      62 = Claim/service denied/reduced for absence of, or exceeded,
      precertification/authorization.
      63 = Correction to a prior claim. INACTIVE
      64 = Denial reversed per Medical Review. INACTIVE
      65 = Procedure code was incorrect.  This payment reflects the
      correct code. INACTIVE
      66 = Blood Deductible.
      67 = Lifetime reserve days. INACTIVE
      68 = DRG weight. INACTIVE
      69 = Day outlier amount.
      70 = Cost outlier amount.
      71 = Primary Payer amount.
      72 = Coinsurance day. INACTIVE
      73 = Administrative days. INACTIVE
      74 = Indirect Medical Education Adjustment.
      75 = Direct Medical Education Adjustment.
      76 = Disproportionate Share Adjustment.
      77 = Covered days. INACTIVE
      78 = Non-covered days/room charge adjustment.
      79 = Cost report days. INACTIVE
      80 = Outlier days. INACTIVE
      81 = Discharges. INACTIVE
      82 = PIP days. INACTIVE
      83 = Total visits. INACTIVE
      84 = Capital adjustments. INACTIVE
      85 = Interest amount. INACTIVE
      86 = Statutory adjustment. INACTIVE
      87 = Transfer amounts.
      88 = Adjustment amount represents collection against
      receivable created in prior overpayment.
      89 = Professional fees removed from charges.
      90 = Ingredient cost adjustment.
      91 = Dispensing fee adjustment.
      92 = Claim paid in full. INACTIVE
      93 = No claim level adjustment. INACTIVE
      94 = Process in excess of charges.
      95 = Benefits adjusted.  Plan procedures not followed.
      96 = Non-covered charges.
      97 = Payment is included in allowance for another
      service/procedure.
      98 = The hospital must file the Medicare claim for this
      inpatient non-physician service. INACTIVE
      99 = Medicare Secondary Payer Adjustment Amount. INACTIVE
      100 = Payment made to patient/insured/responsible party.
      101 = Predetermination: anticipated payment upon comple-
      tion of services or claim ajudication.
      102 = Major medical adjustment.
      103 = Provider promotional discount (i.e. Senior citizen
      discount).
      104 = Managed care withholding.
      105 = Tax withholding.
      106 = Patient payment option/election not in effect.
      107 = Claim/service denied because the related or qualifying
      claim/service was not paid or identified on the claim.
      108 = Claim/service reduced because rent/purchase guidelines
      were not met.
      109 = Claim not covered by this payer/contractor.  You must
      send the claim to the correct payer/contractor.
      110 = Billing date predates service date.
      111 = Not covered unless the provider accepts assignment.
      112 = Claim/service adjusted as not furnished directly
      to the patient and/or not documented.
      113 = Claim denied because service/procedure was provided
      outside the United States or as a result of war.
      114 = Procedure/PRODuct not approved by the Food and Drug
      Administration.
      115 = Claim/service adjusted as procedure postponed or
      canceled.
      116 = Claim/service denied.  The advance indemnification
      notice signed by the patient did not comply with
      requirements.
      117 = Claim/service adjusted because transportation is only
      covered to the closest facility that can provide
      the necessary care.
      118 = Charges reduced for ESRD network support.
      119 = Benefit maximum for this time period has been reached.
      120 = Patient is covered by a managed care plan. INACTIVE
      121 = Indemnification adjustment.
      122 = Psychiatric reduction.
      123 = Payer refund due to overpayment.  INACTIVE
      124 = Payer refund amount - not our patient. INACTIVE
      125 = Claim/service adjusted due to a submission/billing
      error(s).
      126 = Deductible - Major Medical.
      127 = Coinsurance - Major Medical.
      128 = Newborn's services are covered in the mother's
      allowance.
      129 = Claim denied - prior processing information appears
      incorrect.
      130 = Paper claim submission fee.
      131 = Claim specific negotiated discount.
      132 = Prearranged demonstration project adjustment.
      133 = The disposition of this claim/service is pending
      further review.
      134 = Technical fees removed from charges.
      135 = Claim denied.  Interim bills cannot be processed.
      136 = Claim adjusted.  Plan procedures of a prior payer
      were not followed.
      137 = Payment/Reduction for Regulatory Surcharges, Assess-
      ments, Allowances or Health Related Taxes.
      138 = Claim/service denied.  Appeal procedures not
      followed or time limits not met.
      139 = Contracted funding agreement - subscriber is employed
      by the provider of services.
      140 = Patient/Insured health identification number and name
      do not match.
      141 = Claim adjustment because the claim spans eligible
      and ineligible periods of coverage.
      142 = Claim adjusted by the monthly Medicaid patient
      liability amount.
      A0 = Patient refund amount
      A1 = Claim denied charges.
      A2 = Contractual adjustment.
      A3 = Medicare Secondary Payer liability met. INACTIVE
      A4 = Medicare Claim PPS Capital Day Outlier Amount.
      A5 = Medicare Claim PPS Capital Cost Outlier Amount.
      A6 = Prior hospitalization or 30 day transfer requirement
      not met.
      A7 = Presumptive Payment Adjustment.
      A8 = Claim denied; ungroupable DRG.
      B1 = Non-covered visits.
      B2 = Covered visits. INACTIVE
      B3 = Covered charges. INACTIVE
      B4 = Late filing penalty.
      B5 = Claim/service adjusted because coverage/program
      guidelines were not met or were exceeded.
      B6 = This service/procedure is adjusted when performed/
      billed by this type of provider, by this type of
      facility, or by a provider of this specialty.
      B7 = This provider was not certified/eligible to be
      paid for this procedure/service on this date of
      service.
      B8 = Claim/service not covered/reduced because alter-
      native services were available, and should have
      been utilized.
      B9 = Services not covered because the patient is en-
      rolled in a Hospice.
      B10 = Allowed amount has been reduced because a com-
      ponent of the basic procedure/test was paid.  The
      beneficiary is not liable for more than the charge
      limit for the basic procedure/test.
      B11 = The claim/service has been transferred to the
      proper payer/processor for processing.  Claim/
      service not covered by this payer/processor.
      B12 = Services not documented in patients' medical re-
      cords.
      B13 = Previously paid.  Payment for this claim/service
      may have been provided in a previous payment.
      B14 = Claim/service denied because only one visit or
      consultation per physician per day is covered.
      B15 = Claim/service adjusted because this procedure/
      service is not paid separately.
      B16 = Claim/service adjusted because 'New Patient'
      qualifications were not met.
      B17 = Claim/service adjusted because this service was
      not prescribed by a physician, not prescribed
      prior to delivery, the prescription is incomplete,
      or the prescription is not current.
      B18 = Claim/service denied because this procedure code/
      modifier was invalid on the date of service or
      claim submission.
      B19 = Claim/service adjusted because of the finding of a
      Review Organization.  INACTIVE
      B20 = Charges adjusted because procedure/service was
      partially or fully furnished by another provider.
      B21 = The charges were reduced because the service/care
      was partially furnished by another physician.
      INACTIVE
      B22 = This claim/service is adjusted based on the
      diagnosis.
      B23 = Claim/service denied because this provider has
      failed an aspect of a proficiency testing program.
      W1 = Workers Compensation State Fee Schedule Adjustment.



 REV_CNTR_APC_BUFR_TB                    Revenue Center Ambulatory Payment Classification (APC) Buffer Code Table

      00 = No composite group assigned
      01 = First composite group on claim
      02 = Second composite group on claim
      NN = nth composite group on claim
        ---------------------------------
      00    =     N/A in this case
      01-99 =    1st composite - 99th composite
      A1-A9 =  100th composite - 108th composite
      B1-B9 =  109th composite - 117th composite
      C1-C9 =  118th composite - 126th composite
      D1-D9 =  127th composite - 135th composite
      E1-E9 =  136th composite - 144th composite
      F1-F9 =  145th composite - 153rd composite
      G1-G9 =  154th composite - 162nd composite
      H1-H9 =  163rd composite - 171st composite
      I1-I9 =  172nd composite - 180th composite
      J1-J9 =  181st composite - 189th composite
      K1-K9 =  190th composite - 198th composite
      L1-L9 =  199th composite - 207th composite
      M1-M9 =  208th composite - 216th composite
      N1-N9 =  217th composite - 225th composite
      O1-O9 =  226th composite - 234th composite
      P1-P9 =  235th composite - 243rd composite
      Q1-Q9 =  244th composite - 252nd composite
      R1-R9 =  253rd composite - 261st composite
      S1-S9 =  262nd composite - 270th composite
      T1-T9 =  271st composite - 279th composite
      U1-U9 =  280th composite - 288th composite
      V1-V9 =  289th composite - 297th composite
      W1-W9 =  298th composite - 306th composite
      X1-X9 =  307th composite - 315th composite
      Y1-Y9 =  316th composite - 324th composite
      Z1-Z9 =  325th composite - 333rd composite

      AA-AZ =  334th composite - 359th composite
      BA-BZ =  360th composite - 385th composite
      CA-CZ =  386th composite - 411th composite
      DA-DZ =  412th composite - 437th composite
      EA-EZ =  438th composite - 463rd composite
      FA-FZ =  464th composite - 489th composite
      GA-GZ =  490th composite - 515th composite
      HA-HZ =  516th composite - 541st composite
      IA-IZ =  542nd composite - 567th composite
      JA-JZ =  568th composite - 593rd composite
      KA-KZ =  594th composite - 619th composite
      LA-LZ =  620th composite - 645th composite
      MA-MZ =  646th composite - 671st composite
      NA-NZ =  672nd composite - 697th composite
      OA-OZ =  698th composite - 723rd composite
      PA-PZ =  724th composite - 749th composite
      QA-QZ =  750th composite - 775th composite
      RA-RZ =  776th composite - 801st composite
      SA-SZ =  802nd composite - 827th composite
      TA-TZ =  828th composite - 853rd composite
      UA-UZ =  854th composite - 879th composite
      VA-VZ =  880th composite - 905th composite
      WA-WZ =  906th composite - 931st composite
      XA-XZ =  932nd composite - 957th composite
      ZA-ZZ =  958th composite - 983rd composite



 REV_CNTR_APC_TB                         Revenue Center Ambulatory Payment Classification (APC)

      0000 = Code used when Payment Method Indicator
      equals 'N9'
      0001 = Photochemotherapy
      0002 = Fine needle Biopsy/Aspiration
      0003 = Bone Marrow Biopsy/Aspiration
      0004 = Level I Needle Biopsy/ Aspiration Except
      Bone Marrow
      0005 = Level II Needle Biopsy /Aspiration Except
      Bone Marrow
      0006 = Level I Incision & Drainage
      0007 = Level II Incision & Drainage
      0008 = Level III Incision & Drainage
      0009 = Nail Procedures
      0010 = Level I Destruction of Lesion
      0011 = Level II Destruction of Lesion
      0012 = Level I Debridement & Destruction
      0013 = Level II Debridement & Destruction
      0014 = Level III Debridement & Destruction
      0015 = Level IV Debridement & Destruction
      0016 = Level V Debridement & Destruction
      0017 = Level VI Debridement & Destruction
      0018 = Biopsy Skin, Subcutaneous Tissue or Mucous Membrane
      0019 = Level I Excision/ Biopsy
      0020 = Level II Excision/ Biopsy
      0021 = Level III Excision/ Biopsy
      0022 = Level IV Excision/ Biopsy
      0023 = Exploration Penetrating Wound
      0024 = Level I Skin Repair
      0025 = Level II Skin Repair
      0026 = Level III Skin Repair
      0027 = Level IV Skin Repair
      0028 = Level I Incision/Excision Breast
      0029 = Incision/Excision Breast (obsolete 12/00);
      Level II Incision/Excision Breast (effective 1/01)
      0030 = Breast Reconstruction/Mastectomy
      0031 = Hyperbaric Oxygen (obsolete 1/01)
      0032 = Placement Transvenous Catheters/Arterial Cutdown
      0033 = Partial Hospitalization
      0040 = Arthrocentesis & Ligament/Tendon Injection
      0041 = Arthroscopy
      0042 = Arthroscopically-Aided Procedures
      0043 = Closed Treatment Fracture Finger/Toe/Trunk
      0044 = Closed Treatment Fracture/Dislocation Except
      Finger/Toe/Trunk
      0045 = Bone/Joint Manipulation Under Anesthesia
      0046 = Open/Percutaneous Treatment Fracture or Dislocation
      0047 = Arthroplasty without Prosthesis
      0048 = Arthroplasty with Prosthesis
      0049 = Level I Musculoskeletal Procedures Except Hand
      and Foot
      0050 = Level II Musculoskeletal Procedures Except Hand
      and Foot
      0051 = Level III Musculoskeletal Procedures Except Hand
      and Foot
      0052 = Level IV Musculoskeletal Procedures Except Hand
      and Foot
      0053 = Level I Hand Musculoskeletal Procedures
      0054 = Level II Hand Musculoskeletal Procedures
      0055 = Level I Foot Musculoskeletal Procedures
      0056 = Level II Foot Musculoskeletal Procedures
      0057 = Bunion Procedures
      0058 = Level I Strapping and Cast Application
      0059 = Level II Strapping and Cast Application
      0060 = Manipulation Therapy
      0070 = Thoracentesis/Lavage Procedures
      0071 = Level I Endoscopy Upper Airway
      0072 = Level II Endoscopy Upper Airway
      0073 = Level III Endoscopy Upper Airway
      0074 = Level IV Endoscopy Upper Airway
      0075 = Level V Endoscopy Upper Airway
      0076 = Endoscopy Lower Airway
      0077 = Level I Pulmonary Treatment
      0078 = Level II Pulmonary Treatment
      0079 = Ventilation Initiation and Management
      0080 = Diagnostic Cardiac Catheterization
      0081 = Non-Coronary Angioplasty or Atherectomy
      0082 = Coronary Atherectomy
      0083 = Coronary Angiosplasty
      0084 = Level I Electrophysiologic Evaluation
      0085 = Level II Electrophysiologic Evaluation
      0086 = Ablate Heart Dysrhythm Focus
      0087 = Cardiac Electrophysiologic Recording/Mapping
      0088 = Thrombectomy
      0089 = Level I Implantation/Removal/Revision of
      Pacemaker, AICD Vascular Device (obsolete 12/00);
      Insertion/Replacement of Permanent Pacemaker and
      Electrodes (eff. 1/01)
      0090 = Level II Implantation/Removal/Revision of
      Pacemaker AICD Vascular Device (obsolete 12/00);
      Insertion/Replacement of Permanent Pacemaker
      and Pulse Generator
      0091 = Level I Vascular Ligation
      0092 = Level II Vascular Ligation
      0093 = Vascular Repair/Fistula Construction
      0094 = Resuscitation and Cardioversion
      0095 = Cardiac Rehabilitation
      0096 = Non-Invasive Vascular Studies
      0097 = Cardiovascular Stress Test (obsolete 12/00);
      Cardiac Monitoring for 30 days (eff. 1/01)
      0098 = Injection of Sclerosing Solution
      0099 = Continuous Cardiac Monitoring (obsolete 12/00);
      Electrocardiograms (eff. 1/01)
      0100 = Stress test and continuous ECG
      0101 = Tilt Table Evaluation
      0102 = Electronic Analysis of Pacemakers/other Devices
      0103 = Miscellaneous Vascular Procedures (eff. 1/01)
      0104 = Transcatheter Placement of Intracoronary Stents
      (eff. 1/01)
      0105 = Revision/Removal of Pacemakers, AICD or Vascular
      (eff. 1/01)
      0106 = Insertion/Replacement/Repair of Pacemaker
      Electrode (eff. 1/01)
      0107 = Insertion of Cardioverter-Defibrillator
      (eff. 1/01)
      0108 = Insertion/Replacement/Repair of Cardioverter-
      Defibrillator Leads (eff. 1/01)
      0109 = Bone Marrow Harvesting and Bone Marrow/Stem Cell
      Transplant (obsolete 12/00); Removal of Implanted
      Devices (eff. 1/01)
      0110 = Transfusion
      0111 = Blood PRODuct Exchange
      0112 = Extracorporeal Photopheresis
      0113 = Excision Lymphatic System
      0114 = Thyroid/Lymphadenectomy Procedures
      0115 = Cannula/Access Device Procedures
      (eff. 1/01)
      0116 = Chemotherapy Administration by Other Technique
      Except Infusion
      0117 = Chemotherapy Administration by Infusion Only
      0118 = Chemotherapy Administration by Both Infusion and
      Other Technique
      0119 = Implantation of Devices (eff. 1/01)
      0120 = Infusion Therapy Except Chemotherapy
      0121 = Level I Tube changes and Repositioning
      0122 = Level II Tube changes and Repositioning
      0123 = Bone Marrow Harvesting and Bone Marrow/Stem
      Cell Transplant
      0124 = Revision of Implanted Infusion Pump
      (eff. 1/01)
      0130 = Level I Laparoscopy
      0131 = Level II Laparoscopy
      0132 = Level III Laparoscopy
      0140 = Esophageal Dilation without Endoscopy
      0141 = Upper GI Procedures
      0142 = Small Intestine Endoscopy
      0143 = Lower GI Endoscopy
      0144 = Diagnostic Anoscopy
      0145 = Therapeutic Anoscopy
      0146 = Level I Sigmoidoscopy
      0147 = Level II Sigmoidoscopy
      0148 = Level I Anal/Rectal Procedure
      0149 = Level II Anal/Rectal Procedure
      0150 = Level III Anal/Rectal Procedure
      0151 = Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
      0152 = Percutaneous Biliary Endoscopic Procedures
      0153 = Peritoneal and Abdominal Procedures
      0154 = Hernia/Hydrocele Procedures
      0157 = Colorectal Cancer Screening: Barium Enema
      (Not subject to National coinsurance)
      0158 = Colorectal Cancer Screening: Colonoscopy
      Not subject to National coinsurance.  Minimum
      unadjusted coinsurance is 25% of the payment rate.
      Payment rate is lower of the HOPD payment rate or
      the Ambulatory Surgical Center payment.
      0159 = Colorectal Cancer Screening: Flexible Sigmoidoscopy
      Not subject to National coinsurance.  Minimum
      unadjusted coinsurance is 25% of the payment rate.
      Payment rate is lower of the HOPD payment rate or
      the Ambulatory Surgical Center payment.
      0160 = Level I Cystourethroscopy and other Genitourinary
      Procedures
      0161 = Level II Cystourethroscopy and other Genitourinary
      Procedures
      0162 = Level III Cystourethroscopy and other Genitourinary
      Procedures
      0163 = Level IV Cystourethroscopy and other Genitourinary
      Procedures
      0164 = Level I  Urinary and Anal Procedures
      0165 = Level II  Urinary and Anal Procedures
      0166 = Level I Urethral Procedures
      0167 = Level II Urethral Procedures
      0168 = Level III Urethral Procedures
      0169 = Lithotripsy
      0170 = Dialysis for Other Than ESRD Patients
      0180 = Circumcision
      0181 = Penile Procedures
      0182 = Insertion of Penile Prosthesis
      0183 = Testes/Epididymis Procedures
      0184 = Prostate Biopsy
      0190 = Surgical Hysteroscopy
      0191 = Level I Female RePRODuctive Procedures
      0192 = Level II Female RePRODuctive Procedures
      0193 = Level III Female RePRODuctive Procedures
      0194 = Level IV Female RePRODuctive Procedures
      0195 = Level V Female RePRODuctive Procedures
      0196 = Dilatation & Curettage
      0197 = Infertility Procedures
      0198 = Pregnancy and Neonatal Care Procedures
      0199 = Vaginal Delivery
      0200 = Therapeutic Abortion
      0201 = Spontaneous Abortion
      0210 = Spinal Tap
      0211 = Level I Nervous System Injections
      0212 = Level II Nervous System Injections
      0213 = Extended EEG Studies and Sleep Studies
      0214 = Electroencephalogram
      0215 = Level I Nerve and Muscle Tests
      0216 = Level II Nerve and Muscle Tests
      0217 = Level III Nerve and Muscle Tests
      0220 = Level I Nerve Procedures
      0221 = Level II Nerve Procedures
      0222 = Implantation of Neurological Device
      0223 = Level I Revision/Removal Neurological Device
      (obsolete 12/00); Implantation of Pain
      Management Device (eff. 1/01)
      0224 = Level II Revision/Removal Neurological Device
      (obsolete 12/00); Implantation of Reservoir/
      Pump/Shunt (eff. 1/01)
      0225 = Implantation of Neurostimulator Electrodes
      0226 = Implantation of Drug Infusion Reservior
      (eff. 1/01)
      0227 = Implantation of Drug Infusion Device
      (eff. 1/01)
      0228 = Creation of Lumbar Subarachnoid Shunt
      (eff. 1/01)
      0229 = Transcatherter Placement of Intravascular Shunts
      (eff. 1/01)
      0230 = Level I Eye Tests
      0231 = Level II Eye Tests
      0232 = Level I Anterior Segment Eye
      0233 = Level II Anterior Segment Eye
      0234 = Level III Anterior Segment Eye Procedures
      0235 = Level I Posterior Segment Eye Procedures
      0236 = Level II Posterior Segment Eye Procedures
      0237 = Level III Posterior Segment Eye Procedures
      0238 = Level I Repair and Plastic Eye Procedures
      0239 = Level II Repair and Plastic Eye Procedures
      0240 = Level III Repair and Plastic Eye Procedures
      0241 = Level IV Repair and Plastic Eye Procedures
      0242 = Level V Repair and Plastic Eye Procedures
      0243 = Strabismus/Muscle Procedures
      0244 = Corneal Transplant
      0245 = Cataract Procedures without IOL Insert
      0246 = Cataract Procedures with IOL Insert
      0247 = Laser Eye Procedures Except Retinal
      0248 = Laser Retinal Procedures
      0250 = Nasal Cauterization/Packing
      0251 = Level I ENT Procedures
      0252 = Level II ENT Procedures
      0253 = Level III ENT Procedures
      0254 = Level IV ENT Procedures
      0256 = Level V ENT Procedures
      0257 = Implantation of Cochlear Device (obsolete 1/01)
      0258 = Tonsil and Adenoid Procedures
      0260 = Level I Plain Film Except Teeth
      0261 = Level II Plain Film Except Teeth Including Bone
      Density Measurement
      0262 = Plain Film of Teeth
      0263 = Level I Miscellaneous Radiology Procedures
      0264 = Level II Miscellaneous Radiology Procedures
      0265 = Level I Diagnostic Ultrasound Except Vascular
      0266 = Level II Diagnostic Ultrasound Except Vascular
      0267 = Vascular Ultrasound
      0268 = Guidance Under Ultrasound
      0269 = Echocardiogram Except Transesophageal
      0270 = Transesophageal Echocardiogram
      0271 = Mammography
      0272 = Level I Fluoroscopy
      0273 = Level II Fluoroscopy
      0274 = Myelography
      0275 = Arthrography
      0276 = Level I Digestive Radiology
      0277 = Level II Digestive Radiology
      0278 = Diagnostic Urography
      0279 = Level I Diagnostic Angiography and Venography
      Except Extremity
      0280 = Level II Diagnostic Angiography and Venography
      Except Extremity
      0281 = Venography of Extremity
      0282 = Level I Computerized Axial Tomography
      0283 = Level II Computerized Axial Tomography
      0284 = Magnetic Resonance Imaging
      0285 = Positron Emission Tomography (PET)
      0286 = Myocardial Scans
      0290 = Standard Non-Imaging Nuclear Medicine
      0291 = Level I Diagnostic Nuclear Medicine Excluding
      Myocardial Scans
      0292 = Level II Diagnostic Nuclear Medicine Excluding
      Myocardial Scans
      0294 = Level I Therapeutic Nuclear Medicine
      0295 = Level II Therapeutic Nuclear Medicine
      0296 = Level I Therapeutic Radiologic Procedures
      0297 = Level II Therapeutic Radiologic Procedures
      0300 = Level I Radiation Therapy
      0301 = Level II Radiation Therapy
      0302 = Level III Radiation Therapy
      0303 = Treatment Device Construction
      0304 = Level  I Therapeutic Radiation Treatment
      Preparation
      0305 = Level II Therapeutic Radiation Treatment
      Preparation
      0310 = Level III Therapeutic Radiation Treatment
      Preparation
      0311 = Radiation Physics Services
      0312 = Radioelement Applications
      0313 = Brachytherapy
      0314 = Hyperthermic Therapies
      0320 = Electroconvulsive Therapy
      0321 = Biofeedback and Other Training
      0322 = Brief Individual Psychotherapy
      0323 = Extended Individual Psychotherapy
      0324 = Family Psychotherapy
      0325 = Group Psychotherapy
      0330 = Dental Procedures
      0340 = Minor Ancillary Procedures
      0341 = Immunology Tests
      0342 = Level I Pathology
      0343 = Level II Pathology
      0344 = Level III Pathology
      0345 = Transfusion Laboratory Procedures Level I
      (eff. 1/01)
      0346 = Transfusion Laboratory Procedures Level II
      (eff. 1/01)
      0347 = Transfusion Laboratory Procedures Level III
      (eff. 1/01)
      0348 = Fertility Laboratory Procedures
      (eff. 1/01)
      0349 = Miscellaneous Laboratory Procedures
      (eff. 1/01)
      0354 = Administration of Influenza Vaccine (Not
      subject to national coinsurance)
      0355 = Level I Immunizations
      0356 = Level II Immunizations
      0357 = Level III Immunizations (obsolete 1/01)
      0358 = Level IV Immunizations (obsolete 1/01)
      0359 = Injections
      0360 = Level I Alimentary Tests
      0361 = Level II Alimentary Tests
      0362 = Fitting of Vision Aids
      0363 = Otorhinolaryngologic Function Tests
      0364 = Level I Audiometry
      0365 = Level II Audiometry
      0366 = Electrocardiogram (ECG) (obsolete 1/01)
      0367 = Level I Pulmonary Test
      0368 = Level II Pulmonary Test
      0369 = Level III Pulmonary Test
      0370 = Allergy Tests
      0371 = Allergy Injections
      0372 = Therapeutic Phlebotomy
      0373 = Neuropsychological Testing
      0374 = Monitoring Psychiatric Drugs
      0600 = Low Level Clinic Visits
      0601 = Mid Level Clinic Visits
      0602 = High Level Clinic Visits
      0603 = Interdisciplinary Team Conference (obsolete 1/01)
      0610 = Low Level Emergency Visits
      0611 = Mid Level Emergency Visits
      0612 = High Level Emergency Visits
      0620 = Critical Care
      0701 = Strontium (eligible for pass-through payments)
      (obsolete 12/00); SR 89 chloride, per mCi
      (eff. 1/01)
      0702 = Samariam (eligible for pass-through payments)
      (obsolete 12/00); SM 153 lexidronam, 50 mCi
      (eff. 1/01)
      0704 = IN 111 Satumomab Pendetide (eligible for pass-
      through payments)
      0705 = Tc99 Tetrofosmin (eligible for pass-through
      payments)
      0725 = Leucovorin Calcium (eligible for pass-through
      payments)
      0726 = Dexrazoxane Hydrochloride (eligible for pass-
      through payments)
      0727 = Injection, Etidronate Disodium (eligible for
      pass-through payments)
      0728 = Filgrastim (G-CSF) (eligible for pass-through
      payments)
      0730 = Pamidronate Disodium (eligible for pass-through
      payments)
      0731 = Sargramostim (GM-CSF) (eligible for pass-through
      payments)
      0732 = Mesna (eligible for pass-through payments)
      0733 = Non-ESRD Epoetin Alpha (eligible for pass-
      through payments)
      0750 = Dolasetron Mesylate 10 mg (eligible for pass-
      through payments)
      0754 = Metoclopramide HCL (eligible for pass-through
      payments)
      0755 = Thiethylperazine Maleate (eligible for pass-through
      payments)
      0761 = Oral Substitute for IV Antiemtic (eligible for pass-
      through payments)
      0762 = Dronabinol (elibible for pass-through payments)
      0763 = Dolasetron Mesylate 100 mg Oral (eligible for
      pass-through payments)
      0764 = Granisetron HCL, 100 mcg (eligible for pass-
      through payments)
      0765 = Granisetron HCL, 1mg Oral (eligible for pass-
      through payments)
      0768 = Ondansetron Hydrochloride per 1 mg Injection
      (eligible for pass-through payments)
      0769 = Ondansetron Hydrochloride 8 mg oral
      (eligible for pass-through payments)
      0800 = Leuprolide Acetate per 3.75 mg (eligible for
      pass-through payments)
      0801 = Cyclophosphamide (eligible for pass-through
      payments)
      0802 = Etoposide (eligible for pass-through payments)
      0803 = Melphalan (eligible for pass-through payments)
      0807 = Aldesleukin single use vial (eligible for pass-
      through payments)
      0809 = BCG (Intravesical) one vial (eligible for pass-
      through payments)
      0810 = Goserelin Acetate Implant, per 3.6 mg (eligible for
      pass-through payments)
      0811 = Carboplatin 50 mg (eligible for pass-through
      payments)
      0812 = Carmustine 100 mg (eligible for pass-through
      payments)
      0813 = Cisplatin 10 mg (eligible for pass-through
      payments)
      0814 = Asparaginase, 10,000 units (eligible for pass-
      through payments)
      0815 = Cyclophosphamide 100 mg (eligible for pass-
      through payments)
      0816 = Cyclophosphamide, Lyophilized 100 mg (eligible
      for pass-through payments)
      0817 = Cytrabine 100 mg (eligible for pass-through
      payments)
      0818 = Dactinomycin 0.5 mg (eligible for pass-through
      payments)
      0819 = Dacarbazine 100 mg (eligible for pass-through
      payments)
      0820 = Daunorubicin HCI 10 mg (eligible for pass-through
      payments)
      0821 = Daunorubicin Citrate, Liposomal Formulation, 10 mg
      (eligible for pass-through payments)
      0822 = Diethylstibestrol Diphosphate 250 mg
      (eligible for pass-through payments)
      0823 = Docetaxel 20 mg (eligible for pass-through
      payments)
      0824 = Etoposide 10 mg (eligible for pass-through
      payments)
      0826 = Methotrexate Oral 2.5 mg (eligible for pass-through
      payments)
      0827 = Floxuridine injection 500mg
      0828 = Gemcitabine HCL 200 mg (eligibile for pass-
      through payments)
      0830 = Irinotecan 20 mg (eligible for pass-through
      payments)
      0831 = Ifosfamide injection 1 gm (eligible for pass-through
      payments)
      0832 = Idarubicin HCL injection 5 mg (eligible for pass-
      through payments)
      0833 = Interferon Alfacon-1, 1 mcg
      (eligible for pass-through payments)
      0834 = Interferon,  Alfa-2A, Recombinant 3 million units
      (eligible for pass-through payments)
      0836 = Interferon,  Alfa-2B, Recombinant, 1 million units
      (eligible for pass-through payments)
      0838 = Interferon, Gamma 1-B injection, 3 million units
      (eligible for pass-through payments)
      0839 = Mechlorethamine HCL injection 10 mg
      (eligible for pass-through payments)
      0840 = Melphalan HCL 50 mg (eligible for pass-
      through payments)
      0841 = Methotrexate sodium injection 5 mg (eligible for
      pass-through payments)
      0842 = Fludarabine Phosphate injection 50 mg (eligible for
      pass-through payments)
      0843 = Pegaspargase, single dose vial (eligible for
      pass-through payments)
      0844 = Pentostatin injection, 10 mg (eligible for pass-
      through payments)
      0847 = Doxorubicin HCL 10 mg (eligible for pass-through
      payments)
      0849 = Rituximab, 100 mg (eligible for pass-through
      payments)
      0850 = Streptozocin injection, 1 gm (eligible for pass-
      through payments)
      0851 = Thiotepa injection, 15 mg (eligible for pass-through
      payments)
      0852 = Topotecan 4 mg (eligible for pass-through payments)
      0853 = Vinblastine Sulfate injection, 1 mg (eligible for
      pass-through payments)
      0854 = Vincristine Sulfate 1 mg (eligible for pass-through
      payments)
      0855 = Vinorelbine Tartrate per 10 mg (eligible for pass-
      through payments)
      0856 = Porfimer Sodium 75 mg (eligible for pass-through
      payments)
      0857 = Bleomycin Sulfate injection 15 units (eligible for
      pass-through payments)
      0858 = Cladribine, 1mg (eligible for pass-through payments)
      0859 = Fluorouracil injection 500 mg
      0860 = Plicamycin (mithramycin) injection, 2.5 mg
      0861 = Leuprolide Acetate 1 mg (eligible for pass-through
      payments)
      0862 = Mitomycin, 5mg (eligible for pass-through payments)
      0863 = Paclitaxel, 30mg (eligible for pass-through payments)
      0864 = Mitoxantrone HCl,  per 5mg (eligible for pass-through
      payments)
      0865 = Interferon alfa-N3, 250,000 IU (eligible for pass-
      through payments)
      0884 = Rho (D) Immune Globulin, Human one dose pack
      (eligible for pass-through payments)
      0886 = Azathioprine,  50 mg oral
      (Not subject to national coinsurance)
      0887 = Azathioprine, Parenteral 100 mg, 20 ml each injection
      (Not subject to national coinsurance)
      0888 = Cyclosporine, Oral 100 mg
      (Not subject to national coinsurance)
      0889 = Cyclosporine, Parenteral
      (Not subject to national coinsurance)
      0890 = Lymphocyte Immune Globulin 250 mg
      (Not subject to national coinsurance)
      0891 = Tacrolimus per 1 mg oral
      (Not subject to national coinsurance)
      0892 = Daclizumab, Parenteral, 25 mg (obsolete 1/01)
      (eligible for pass-through payments)
      0900 = Injection, Alglucerase per 10 units
      (eligible for pass-through payments)
      0901 = Alpha I, Proteinase Inhibitor, Human per 10mg
      (eligible for pass-through payments)
      0902 = Botulinum Toxin, Type A per unit
      (eligible for pass-through payments)
      0903 = CMV Immune Globulin (obsolete 12/00);
      Cytomegalovirus imm IV, vial
      (eligible for pass-through payments) (eff. 1/01)
      0905 = Immune Globulin per 500 mg
      (eligible for pass-through payments)
      0906 = RSV-ivig 50 mg
      (eligible for pass-through payments)
      0907 = Ganciclovir Sodium 500 mg injection
      (Not subject to national coinsurance)
      0908 = Tetanus Immune Globulin, injection up to 250 units
      (Not subject to national coinsurance)
      0909 = Interferon Beta - 1a   33 mcg (eligible for pass-
      through payments)
      0910 = Interferon Beta - 1b   0.25 mg (eligible for pass-
      through payments)
      0911 = Streptokinase per 250,000 iu
      (Not subject to national coinsurance)
      0913 = Ganciclovir long act implant 4.5  mg (eligible for
      pass-through payments)
      0914 = Reteplase, 37.6 mg
      (Not subject to national coinsurance)
      0915 = Alteplase injection,recombinant, 10mg
      (Not subject to national coinsurance)
      0916 = Imiglucerase per unit (eligible for pass-through
      payments)
      0917 = Dipyridamole, 10mg / Adenosine 6MG
      (Not subject to national coinsurance) (obsolete 1/01)
      Pharmalogic stresses (eff. 1/01)
      0918 = Brachytherapy Seeds, Any type, Each (eligible
      for pass-through payments) (obsolete 4/01)
      0925 = Factor VIII (Antihemophilic Factor, Human) per iu
      (eligible for pass-through payments)
      0926 = Factor VIII (Antihemophilic Factor, Porcine) per  iu
      (eligible for pass-through payments)
      0927 = Factor VIII (Antihemophilic Factor, Recombinant)
      per iu (eligible for pass-through payments)
      0928 = Factor IX,  Complex (eligible for pass-through
      payments)
      0929 = Other Hemophilia Clotting Factors per iu (eligible
      for pass-through payments) (obsolete 1/01)
      Anti-inhibitor per iu (eff. 1/01)
      0930 = Antithrombin III (Human) per iu (eligible for pass-
      through payments)
      0931 = Factor IX (Antihemophilic Factor, Purified, Non-
      Recombinant) (eligible for pass-through payments)
      0932 = Factor IX (Antihemophilic Factor, Recombinant)
      (eligible for pass-through payments)
      0949 = Plasma, Pooled Multiple Donor, Solvent/Detergent
      Treated, Frozen (not subject to national coinsurance)
      0950 = Blood (Whole) For Transfusion (not subject to
      national coinsurance)
      0952 = Cryoprecipitate (not subject to national coinsurance)
      0953 = Fibrinogen Unit (not subject to national coinsurance)
      0954 = Leukocyte Poor Blood (not subject to national
      coinsurance)
      0955 = Plasma, Fresh Frozen (not subject to national
      coinsurance)
      0956 = Plasma Protein Fraction (not subject to national
      coinsurance)
      0957 = Platelet Concentrate (not subject to national
      coinsurance)
      0958 = Platelet Rich Plasma (not subject to national
      coinsurance)
      0959 = Red Blood Cells (not subject to national coinsurance)
      0960 = Washed Red Blood Cells (not subject to national
      coinsurance)
      0961 = Infusion, Albumin (Human) 5%, 500 ml
      (not subject to national coinsurance)
      0962 = Infusion, Albumin (Human) 25%, 50 ml
      (not subject to national coinsurance)
      0970 = New Technology - Level I     ($0 - $50)
      (not subject to national coinsurance)
      0971 = New Technology - Level II    ($50 - $100)
      (not subject to national coinsurance)
      0972 = New Technology - Level III    ($100 - $200)
      (not subject to national coinsurance)
      0973 = New Technology - Level IV   ($200 - $300)
      (not subject to national coinsurance)
      0974 = New Technology - Level V    ($300 - $500)
      (not subject to national coinsurance)
      0975 = New Technology - Level VI   ($500 - $750)
      (not subject to national coinsurance)
      0976 = New Technology - Level VII   ($750 - $1000)
      (not subject to national coinsurance)
      0977 = New Technology - Level VIII  ($1000 - $1250)
      (not subject to national coinsurance)
      0978 = New Technology - Level IX    ($1250 - $1500)
      (not subject to national coinsurance)
      0979 = New Technology - Level X     ($1500 - $1750)
      (not subject to national coinsurance)
      0980 = New Technology - Level XI    ($1750 - $2000)
      (not subject to national coinsurance)
      0981 = New Technology - Level XII   ($2000 - $2500)
      (not subject to national coinsurance)
      0982 = New Technology - Level XIII   ($2500 - $3500)
      (not subject to national coinsurance)
      0983 = New Technology - Level XIV  ($3500 - $5000)
      (not subject to national coinsurance)
      0984 = New Technology - Level XV   ($5000 - $6000)
      (not subject to national coinsurance)
      0987 = New Device Technology - Level I ($0 - $250)
      (eff. 1/01)
      0988 = New Device Technology - Level II ($250 - $500)
      (eff. 1/01)
      0989 = New Device Technology - Level III ($500 - $750)
      (eff. 1/01)
      0990 = New Device Technology - Level IV ($750 - $1000)
      (eff. 1/01)
      0991 = New Device Technology - Level V ($1000 - $1500)
      (eff. 1/01)
      0992 = New Device Technology - Level VI ($1500 - $2000)
      (eff. 1/01)
      0993 = New Device Technology - Level VII ($2000 - $3000)
      (eff. 1/01)
      0994 = New Device Technology - Level VIII ($3000 - $4000)
      (eff. 1/01)
      0995 = New Device Technology - Level IX ($4000 - $5000)
      (eff. 1/01)
      0996 = New Device Technology - Level X ($5000 - $7000)
      (eff. 1/01)
      0997 = New Device Technology - Level XI ($7000 - $9000)
      (eff. 1/01)
      1000 = Perclose Closer Prostar Arterial Vascular
      Closure (eff. 1/01)
      1001 = AcuNav-diagnostic ultrasound ca (eff. 1/01)
      1002 = Cochlear Implant System (eff. 1/01)
      1003 = Cath, ablation, livewire TC (eff. 1/01)
      1004 = Fast-Cath, Swartz, SAFL, CSTA (eff. 1/01)
      1006 = ARRAY post chamb IOL (eff. 1/01)
      1007 = Ams 700 penile prosthesis (eff. 1/01)
      1008 = Urolume-implant urethral stent (eff. 1/01)
      1009 = Plasma, cryoprecipitate-reduced, unit
      (eff. 1/01)
      1010 = Blood, L/R CMV-neg (eff. 1/01)
      1011 = Platelets, L/R, CMV-neg (eff. 1/01)
      1012 = Platelet concentrate, L/R, irradiated, unit
      (eff. 1/01)
      1013 = Platelet concentrate, L/R, unit (eff. 1/01)
      1014 = Platelets, aph/pher, L/R, unit (eff. 1/01)
      1016 = Blood, L/R, froz/deglycerol/washed (eff. 1/01)
      1017 = Platelets, aph/pher, L/R CMV-neg, unit
      (eff. 1/01)
      1018 = Blood, L/R, irradiated (eff. 1/01)
      1019 = Platelets, aph/pher, L/R, irradiated, unit
      (eff. 1/01)
      1024 = Quinupristin 150 mg/dalfopriston 350 mg
      (eff. 1/01)
      1025 = Marinr CS catheter (eff. 1/01)
      1026 = RF Perfrmr cath 5F RF Marinr (eff. 1/01)
      1027 = Magic x/short, radius 14m (eff. 1/01)
      1028 = Prcis Twst trnsvg anch sys (eff. 1/01)
      1029 = CRE guided balloon dil cath (eff. 1/01)
      1030 = Cthtr:Mrshal, Blu Max Utr Dmnd (eff. 1/01)
      1033 = Sonicath mdl 37-410 (eff. 1/01)
      1034 = SURPASS, Long30 SURPASS-cath (eff. 1/01)
      1035 = Cath, Ultra ICE (eff. 1/01)
      1036 = R port/reservior impl dev (eff. 1/01)
      1037 = Vaxcelchronic dialysis cath (eff. 1/01)
      1038 = UltraCross Imaging Cath (eff. 1/01)
      1039 = Wallstent/RP:Trach (eff. 1/01)
      1040 = Wallstent/RP TIPS -- 20/40/60 (eff. 1/01)
      1042 = Wallstent, UltraFlex: Bil (eff. 1/01)
      1045 = I-131 MIBG (ioben-sulfate) 0.5mCi
      (eff. 1/01)
      1047 = Navi-Star, Noga-Star cath (eff. 1/01)
      1048 = NeuroCyberneticPros: gen (eff. 1/01)
      1051 = Oasis Thrombectomy Cath (eff. 1/01)
      1053 = EnSite 3000 catheter (eff. 1/01)
      1054 = Hydrolyser Thromb Cath 6/7F (eff. 1/01)
      1055 = Transesoph 210, 210-S Cath (eff. 1/01)
      1056 = Thermachoice II Cath (eff. 1/01)
      1057 = Micromark Tissue Marker (eff. 1/01)
      1059 = Carticel, auto cult-chndr cyte (eff. 1/01)
      1060 = ACS multi-link tristor stent (eff. 1/01)
      1061 = ACS Viking Guiding cath (eff. 1/01)
      1063 = EndoTak Endurance EZ,RX leads (eff. 1/01)
      1067 = Megalink biliary stent (eff. 1/01)
      1068 = Pulsar DDD pmkr (eff. 1/01)
      1069 = Discovery DR, pmaker
      1071 = Pulsar Max, Pulsar SR pmkr (eff. 1/01)
      1072 = Guidant: blln dil cath (eff. 1/01)
      1073 = Gynecare Morcellator (eff. 1/01)
      1074 = RX/OTW Viatrac-peri dil cath (eff. 1/01)
      1075 = Guidant: lead (eff. 1/01)
      1076 = Ventak minisc defib (eff. 1/01)
      1077 = Ventak VR Prizm VR, sc defib (eff. 1/01)
      1078 = Ventak: Prizm, AVIIIDR defib
      1079 = CO 57/58 0.5 mCi (eff. 1/01)
      1084 = Denileukin diftitox, 300 mcg (eff. 1/01)
      1086 = Temozolomide, 5 mg (eff. 1/01)
      1087 = I-123 per uCi capsule (eff. 1/01)
      1089 = CO 57, 0.5 mCi (eff. 1/01)
      1090 = IN 111 Chloride, per mCi (eff. 1/01)
      1091 = IN 111 Oxyquinoline, per 5 mCi (eff. 1/01)
      1092 = IN 111 Pentetate, per 1.5 mCi (eff. 1/01)
      1094 = TC 99M Albumin aggr, per vial
      1095 = TC 99M Depreotide, per vial (eff. 1/01)
      1096 = TC 99M Exametazime, per dose (eff. 1/01)
      1097 = TC 99M Mebrofenin, per vial (eff. 1/01)
      1098 = TC 99M Pentetate, per vial (eff. 1/01)
      1099 = TC 99M Pyrophosphate, per vial (eff. 1/01)
      1100 = Medtronic AVE GT1 guidewire (eff. 1/01)
      1101 = Medtronic AVE, AVE Z2 cath (eff. 1/01)
      1102 = Synergy Neurostim Genrtr (eff. 1/01)
      1103 = Micro Jewell Defibrillator (eff. 1/01)
      1104 = RF ConductorAblative Cath (eff. 1/01)
      1105 = Sigman 300VDD pacmkr (eff. 1/01)
      1106 = SynergyEZ Pt Progmr (eff. 1/01)
      1107 = Torqr, Solist cath (eff. 1/01)
      1108 = Reveal Cardiac Recorder (eff. 1/01)
      1109 = Implantable anchor: Ethicon (eff. 1/01)
      1110 = Stable Mapper, cath electrd (eff. 1/01)
      1111 = AneuRxAort-Uni-llicstnt & cath (eff. 1/01)
      1112 = AneuRx Stent graft/del cath (eff. 1/01)
      1113 = Tlnt Endo Sprng Stnt Grft Sys (eff. 1/01)
      1114 = TalntSprgStnt + Graf endo pros (eff. 1/01)
      1115 = 5038S, 5038, 5038L pace lead (eff. 1/01)
      1116 = CapSureSP pacing lead (eff. 1/01)
      1117 = Ancure Endograft Del Sys (eff. 1/01)
      1118 = Sigma300DR LegIIDR, pacemkr (eff. 1/01)
      1119 = Sprint6932, 6943 defib lead (eff. 1/01)
      1120 = Sprint6942, 6945 defi lead (eff. 1/01)
      1121 = Gem defibrillator (eff. 1/01)
      1122 = TC 99M arcitumomab per dose (eff. 1/01)
      1123 = Gem II VR defibrillator (eff. 1/01)
      1124 = InterStim Test Stim Kit (eff. 1/01)
      1125 = Kappa 400SR, Ttopaz II SR pmkr (eff. 1/01)
      1126 = Kappa 700 DR pacemkr (eff. 1/01)
      1127 = Kappa 700SR, pmkr sgl chamber (eff. 1/01)
      1128 = Kappa 700D, Ruby IID pmkr (eff. 1/01)
      1129 = Kappa 700VDD, pacmkr (eff. 1/01)
      1130 = Sigma 200D, LGCY IID sc pmkr (eff. 1/01)
      1131 = Sigma 200DR pmker (eff. 1/01)
      1132 = Sigma 200SR Leg II:sc pac (eff. 1/01)
      1133 = Sigma SR, Vita SR, pmaker (eff. 1/01)
      1134 = Sigma 300D pmker (eff. 1/01)
      1135 = Entity DR 5326L/R, DC, pmkr (eff. 1/01)
      1136 = Affinity DR 5330L/R, DC, pmkr (eff. 1/01)
      1137 = CardioSEAL implant syst (eff. 1/01)
      1143 = AddVent mod 2060BL, VDD (eff. 1/01)
      1144 = Afnty SP 5130, Integrity SR, pmkr (eff. 1/01)
      1145 = Angio-Seal 6fr, 8fr (eff. 1/01)
      1147 = AV Plus DX 1368: lead (eff. 1/01)
      1148 = Contour MD sc defib (eff. 1/01)
      1149 = Entity DC 5226R-pmker (eff. 1/01)
      1151 = Passiveplus DXlead, 10mdls (eff. 1/01)
      1152 = LifeSite Access System (eff. 1/01)
      1153 = Regency SC+ 2402L pmkr (eff. 1/01)
      1154 = SPL:SPOI, 0204- defib lead (eff. 1/01)
      1155 = Repliform 8 sq cm (eff. 1/01)
      1156 = Tr 1102TrSR+ 2260L, 2264L, 5131 (eff. 1/01)
      1157 = Trilogy DCT 23/8L pmkr (eff. 1/01)
      1158 = TVL lead SV01, SV02, SV04 (eff. 1/01)
      1159 = TVL RV02, RV06, RV07: lead (eff. 1/01)
      1160 = TVL-ADX 1559: lead (eff. 1/01)
      1161 = Tendril DX, 1338 pacing lead (eff. 1/01)
      1162 = TempoDr, TrilogyDR+ DC pmkr (eff. 1/01)
      1163 = Tendril SDX, 1488T pacing lead (eff. 1/01)
      1164 = Iodine-125 brachytx seed (eff. 1/01)
      1166 = Cytarabine liposomal, 10 mg (eff. 1/01)
      1167 = Epirubicin hcl, 2 mg (eff. 1/01)
      1171 = Autosuture site marker stple (eff. 1/01)
      1172 = Spacemaker dissect ballon (eff. 1/01)
      1173 = Cor stntS540, S670, o-wire stn (eff. 1/01)
      1174 = Bard brachytx needle (eff. 1/01)
      1178 = Busulfan IV, 6 mg (eff. 1/01)
      1180 = Vigor SR, SC, pmkr (eff. 1/01)
      1181 = Meridian SSI, SC pmkr (eff. 1/01)
      1182 = Pulsar SSI, SC, pmkr (eff. 1/01)
      1183 = Jade IIS, Sigma 300S, SC, pmkr (eff. 1/01)
      1184 = Sigma 200S, SC, pmkr (eff. 1/01)
      1188 = I 131, per mCi (eff. 1/01)
      1200 = TC 99M Sodium Clucoheptonate, per vial
      (eff. 1/01)
      1201 = TC 99M succimer, per vial (eff. 1/01)
      1202 = TC 99M Sulfur Colloid, per dose (eff. 1/01)
      1203 = Verteporfin for Injection (eff. 1/01)
      1205 = TC 99M Disofenin, per vial (eff. 1/01)
      1207 = Octreotide acetate depot 1 mg (eff. 1/01)
      1302 = SQ01:lead (eff. 1/01)
      1303 = CapSure Fix 6940/4068-110, lead (eff. 1/01)
      1304 = Sonicath mdl 37-416,-418 (eff. 1/01)
      1305 = Apligraf (eff. 1/01)
      1306 = NeuroCyberneticsPros: lead (eff. 1/01)
      1311 = Trilogy DR + DAO pmkr (eff. 1/01)
      1312 = Magic WALLSTENT stent-mini (eff. 1/01)
      1313 = Magic medium, radius 31mm (eff. 1/01)
      1314 = Magic WALLSTENT stent-Long (eff. 1/01)
      1315 = Vigor DR, Meridian DR pmkr (eff. 1/01)
      1316 = Meridian DDD pmkr (eff. 1/01)
      1317 = Discovery SR, pmkr (eff. 1/01)
      1318 = Meridian SR pmkr (eff. 1/01)
      1319 = Wallstent/RP Enteral--60mm (eff. 1/01)
      1320 = Wallstent/RP lliac Del Sys (eff. 1/01)
      1325 = Pallidium - 103 seed (eff. 1/01)
      1326 = Angio-jet rheolytic thromb cath (eff. 1/01)
      1328 = ANS Renew NS trnsmtr (eff. 1/01)
      1333 = PALMZA Corinthian bill stent (eff. 1/01)
      1334 = Crown, Mini-crown,CrossLC (eff. 1/01)
      1335 = Mesh, Prolene (eff. 1/01)
      1336 = Constant Flow Imp Pump (eff. 1/01)
      1337 = IsoMed 8472-20/35/60 (eff. 1/01)
      1348 = I 131 per mCi solution (eff. 1/01)
      1350 = Prosta/OncoSeed, RAPID strand, I-125 (eff. 1/01)
      1351 = CapSure (Fix) pacing lead (eff. 1/01)
      1352 = Gem II defib (eff. 1/01)
      1353 = Itrel Interstm neurostim + ext (eff. 1/01)
      1354 = Kappa 400DR, Diamond II 820 DR (eff. 1/01)
      1355 = Kappa 600 DR, Vita DR (eff. 1/01)
      1356 = Profile MD V-186HV3 sc defib (eff. 1/01)
      1357 = Angstrom MD V-190HV3 sc defib (eff. 1/01)
      1358 = Affinity DC 5230R-Pacemaker (eff. 1/01)
      1359 = Pulsar, Pulsar Max DR, pmkr  (eff. 1/01)
      1363 = Gem DR, DC, defib (eff. 1/01)
      1364 = Photon DR V-230HV3 DC defib (eff. 1/01)
      1365 = Guidewire, Hi-Torque 14/18/35 (eff. 1/01)
      1366 = Guidewire, PTCA, Hi-Torque (eff. 1/01)
      1367 = Guidewire, Hi-Torque Crosslt (eff. 1/01)
      1369 = ANS Renew Stim Sys recvr (eff. 1/01)
      1370 = Tension-Free Vaginal Tape (eff. 1/01)
      1371 = Symp Nitinol Transhep Bil Sys (eff. 1/01)
      1372 = Cordis Nitinol bil Stent (eff. 1/01)
      1375 = Stent, corornary, NIR (eff. 1/01)
      1376 = ANS Renew Stim Sys lead (eff. 1/01)
      1377 = Specify 3988 neuro lead (eff. 1/01)
      1378 = InterStim Tx 3080/3886 lead (eff. 1/01)
      1379 = Pisces-Quad 3887 lead (eff. 1/01)
      1400 = Diphenhydramine hcl 50 mg (eff. 1/01)
      1401 = Prochlorperazine maleate 5 mg (eff. 1/01)
      1402 = Promethazine hcl 12.5 mg oral (eff. 1/01)
      1403 = Chlorpromazine hcl 10mg oral (eff. 1/01)
      1404 = Trimethobenzamide hcl 250mg (eff. 1/01)
      1405 = Thiethylperazine maleate 10 mg (eff. 1/01)
      1406 = Perphenazine 4 mg oral (eff. 1/01)
      1407 = Hydroxyzine pamoate 25 mg (eff. 1/01)
      1409 = Factor via recombinant, per 1.2 mg (eff. 1/01)
      1410 = Prosorba column (eff. 1/01)
      1411 = Herculink, OTW SDS bil stent (eff. 1/01)
      1420 = StapleTac2 Bone w/Dermis (eff. 1/01)
      1421 = StapleTac2 Bone w/o Dermis (eff. 1/01)
      1450 = Orthosphere Arthroplasty (eff. 1/01)
      1451 = Orthosphere Arthroplasty Kity (eff. 1/01)
      1500 = Atherectomy sys, peripheral (eff. 1/01)
      1600 = TC 99M sestamibi, per syringe (eff. 1/01)
      1601 = TC 99M medronate, per dose (eff. 1/01)
      1602 = TC 99M apcitide, per vial (eff. 1/01)
      1603 = TL 201, mCi (eff. 1/01)
      1604 = IN 111 capromab pendetide, per dose (eff. 1/01)
      1605 = Abciximab injection, 10 mg (eff. 1/01)
      1606 = Anistreplase, 30 u (eff. 1/01)
      1607 = Eptifibatide injection, 5 mg (eff. 1/01)
      1608 = Etanercept injection, 25 mg (eff. 1/01)
      1609 = Rho(D) Immune globulin h, sd 100 iu (eff. 1/01)
      1611 = Hylan G-F 20 injection, 16 mg (eff. 1/01)
      1612 = Daclizumab, parenteral, 25 mg (eff. 1/01)
      1613 = Trastuzumab, 10 mg (eff. 1/01)
      1614 = Valrubicin, 200 mg (eff. 1/01)
      1615 = Basiliximab, 20 mg (eff. 1/01)
      1616 = Histrelin Acetate, 0.5 mg (eff. 1/01)
      1617 = Lepirdin, 50 mg (eff. 1/01)
      1618 = Von Willebrand factor, per iu (eff. 1/01)
      1619 = Ga 67, per mCi (eff. 1/01)
      1620 = TC 99M Bicisate, per vial (eff. 1/01)
      1621 = Xe 133, per mCi (eff. 1/01)
      1622 = TC 99M Mertiatide, per vial (eff. 1/01)
      1623 = TC 99M Gluceptate (eff. 1/01)
      1624 = P32 sodium, per mCi (eff. 1/01)
      1625 = IN 111 Pentetreotide, per mCi (eff. 1/01)
      1626 = TC 99M Oxidronate, per vial (eff. 1/01)
      1627 = TC-99 labeled red blood cell, per test (eff. 1/01)
      1628 = P32 phosphate chromic,per mCi (eff. 1/01)
      1700 = Authen Mick TP brachy needle (eff. 1/01)
      (obsolete 4/01)
      1701 = Medtec MT-BT-5201-25 ndl (eff. 1/01)
      (obsolete 4/01)
      1702 = WWMT brachytx needle (eff. 1/01)
      (obsolete 4/01)
      1703 = Mentor Prostate Brachy (eff. 1/01)
      (obsolete 4/01)
      1704 = MT-BT-5001-25/5051-25 (eff. 1/01)
      (obsolete 4/01)
      1705 = Best Flexi Brachy Needle (eff. 1/01)
      (obsolete 4/01)
      1706 = Indigo Prostate Seeding Ndl (eff. 1/01)
      (obsolete 4/01)
      1707 = Varisource Implt Ndl (eff. 1/01)
      (obsolete 4/01)
      1708 = UroMed Prostate Seed Ndl (eff. 1/01)
      (obsolete 4/01)
      1709 = Remington Brachytx Needle (eff. 1/01)
      (obsolete 4/01)
      1710 = US Biopsy Prostate Needle (eff. 1/01)
      (obsolete 4/01)
      1711 = MD Tech brachytx needle (eff. 1/01)
      (obsolete 4/01)
      1712 = Imagyn brachytx needle (eff. 1/01)
      (obsolete 4/01)
      1713 = Anchor/screw bn/bn,tis/bn (eff. 4/01)
      1714 = Cath, trans atherectomy, dir (eff. 4/01)
      1715 = Brachytherapy needle (eff. 4/01)
      1716 = Brachytx seed, Gold 198 (eff. 4/01)
      1717 = Brachytx seed, HDR Ir-192 (eff. 4/01)
      1718 = Brachytx seed, Iodine 125 (eff. 4/01)
      1719 = Brachytx seed, Non-HDR Ir-192 (eff. 4/01)
      1720 = Brachytx, Palladium 103 (eff. 4/01)
      1721 = AICD, dual chamber (eff. 4/01)
      1722 = AICD, single chamber (eff. 4/01)
      1723 = Cath, ablation, non-cardiac (eff. 4/01)
      1724 = Cath, trans atherec, rotation (eff. 4/01)
      1725 = Cath, translumin non-laser (eff. 4/01)
      1726 = Cath, bal dil, non-vascular (eff. 4/01)
      1727 = Cath, bal tis, dis, nonvas (eff. 4/01)
      1728 = Cath, brachytx seed adm (eff. 4/01)
      1729 = Cath, drainage, biliary (eff. 4/01)
      1730 = Cath, EP, 19 or fewer elect (eff. 4/01)
      1731 = Cath, EP, 20 or more elect (eff. 4/01)
      1732 = Cath, EP, diag/abl, 3D/vect (eff. 4/01)
      1733 = Cath, EP, other than temp (eff. 4/01)
      1750 = Cath, hemodialysis, long-term (eff. 4/01)
      1751 = Cath, inf pr/cent/midline (eff. 4/01)
      1752 = Cath, hemodialysis, short-term (eff. 4/01)
      1753 = Cath, intravas ultrasound (eff. 4/01)
      1754 = Catheter, intradiscal (eff. 4/01)
      1755 = Catheter, intraspinal (eff. 4/01)
      1756 = Cath, pacing, transesoph (eff. 4/01)
      1757 = Cath, thrombectomy/embolect (eff. 4/01)
      1758 = Cath, ureteral (eff. 4/01)
      1759 = Cath, intra echocardiography (eff. 4/01)
      1760 = Closure dev, vasc, imp/insert (eff. 4/01)
      1762 = Conn tiss, human (inc fascia) (eff. 4/01)
      1763 = Conn tiss, non-human (eff. 4/01)
      1764 = Event recorder, cardiac (eff. 4/01)
      1767 = Generator, neurostim, imp (eff. 4/01)
      1768 = Graft, vascular (eff. 4/01)
      1769 = Guide wire (eff. 4/01)
      1770 = Imaging coil, MR insertable (eff. 4/01)
      1771 = Rep dev, urinary , w/sling (eff. 4/01)
      1772 = Infusion pump, programmable (eff. 4/01)
      1773 = Retrieval dev, insert (eff. 4/01)
      1776 = Joint device (implantable) (eff. 4/01)
      1777 = Lead, AICD, endo single coil (eff. 4/01)
      1778 = Lead, neurostimulator (eff. 4/01)
      1779 = Lead, pmkr, transvenous VDD (eff. 4/01)
      1780 = Lens, intraocular (eff. 4/01)
      1781 = Mesh (implantable) (eff. 4/01)
      1782 = Morcellator (eff. 4/01)
      1784 = Ocular dev, intraop, det ret (eff. 4/01)
      1785 = Pmkr, dual, rate-resp (eff. 4/01)
      1786 = Pmkr, single, rate-resp (eff. 4/01)
      1787 = Patient progr, neurostim (eff. 4/01)
      1788 = Port, indwelling, imp (eff. 4/01)
      1789 = Prosthesis, breast, imp. (eff. 4/01)
      1790 = Iridium 192 HDR (eff. 1/01)
      (obsolete 4/01)
      1791 = OncoSeed, Rapid Strand I-125 (eff. 1/01)
      (obsolete 4/01)
      1792 = UroMed I-125 Brachy seed (eff. 1/01)
      (obsolete 4/01)
      1793 = Bard InterSource P-103 seed (eff. 1/01)
      (obsolete 4/01)
      1794 = Bard IsoSeed P-103 seed (eff. 1/01)
      (obsolete 4/01)
      1795 = Bard BrachySource I-125 (eff. 1/01)
      (obsolete 4/01)
      1796 = Source Tech Med I-125 (eff. 1/01)
      (obsolete 4/01)
      1797 = Draximage I-125 seed (eff. 1/01)
      (obsolete 4/01)
      1798 = Syncor I-125 PharmaSeed (eff. 1/01)
      (obsolete 4/01)
      1799 = I-Plant I-125 Brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1800 = Pd-103 brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1801 = IoGold I-125 brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1802 = Iridium 192 brachytx seed (eff. 1/01)
      (obsolete 4/01)
      1803 = Best Iodine 125 brachytx seeds (eff. 1/01)
      (obsolete 4/01)
      1804 = Best Palladium 103 seeds (eff. 1/01)
      (obsolete 4/01)
      1805 = IsoStar Iodine-125 seeds (eff. 1/01)
      (obsolete 4/01)
      1806 = Gold 198 (eff. 1/01)
      (obsolete 4/01)
      1810 = D114S Dilatation Cath (eff. 1/01)
      (obsolete 4/01)
      1811 = Surgical Dynamics Anchors (eff. 1/01)
      (obsolete 4/01)
      1812 = OBL Anchors (eff. 1/01)
      (obsolete 4/01)
      1813 = Prosthesis, penile, inflatab (eff. 4/01)
      1815 = Pros, urinary sph, imp (eff. 4/01)
      1816 = Receiver/transmitter, neuro (eff. 4/01)
      1817 = Septal defect imp sys (eff. 4/01)
      1850 = Repliform 14/21 sq cm (eff. 1/01)
      (obsolete 4/01)
      1851 = Repliform 24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      1852 = TransCyte, per 247 sq cm (eff. 1/01)
      (obsolete 4/01)
      1853 = Suspend, per 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      1854 = Suspend, per 24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      1855 = Suspend, per 36 sq cm (eff. 1/01)
      (obsolete 4/01)
      1856 = Suspend, per 48 sq cm (eff. 1/01)
      (obsolete 4/01)
      1857 = Suspend, per 84 sq cm (eff. 1/01)
      (obsolete 4/01)
      1858 = DuraDerm, per 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      1859 = DuraDerm, per 21/24 sq cm (eff. 1/01)
      (obsolete 4/01)
      1860 = DuraDerm, per 48 sq cm (eff. 1/01)
      (obsolete 4/01)
      1861 = DuraDerm, per 36 sq cm (eff. 1/01)
      (obsolete 4/01)
      1862 = DuraDerm, per 72 sq cm (eff. 1/01)
      (obsolete 4/01)
      1863 = DuraDerm, per 84 sq cm (eff. 1/01)
      (obsolete 4/01)
      1864 = SpermaTex, per 13/44 sq cm (eff. 1/01)
      (obsolete 4/01)
      1865 = FasLata, per 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      1866 = FasLata, per 24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      1867 = FasLata, per 36/48 sq cm (eff. 1/01)
      (obsolete 4/01)
      1868 = FasLata, per 96 sq cm (eff. 1/01)
      (obsolete 4/01)
      1869 = Gore Thyroplasty Dev (eff. 1/01)
      (obsolete 4/01)
      1870 = DermMatrix, per 16 sq cm (eff. 1/01)
      (obsolete 4/01)
      1871 = DermMatrix, 32 or 64 sq cm (eff. 1/01)
      (obsolete 4/01)
      1872 = Dermagraft, per 37.5 sq cm (eff. 1/01)
      (obsolete 4/01)
      1873 = Bard 3DMax Mesh (eff. 1/01)
      (obsolete 4/01)
      1874 = Stent, coated/cov w/del sys (eff. 4/01)
      1875 = Stent, coated/cov w/o del sys (eff. 4/01)
      1876 = Stent, non-coated/no-cov w/del (eff. 4/01)
      1877 = Stent, non-coated/cov w/o del (eff. 4/01)
      1878 = Martl for vocal cord (eff. 4/01)
      1879 = Tissue marker, imp (eff. 4/01)
      1880 = Vena cava filter (eff. 4/01)
      1881 = Dialysis access system (eff. 4/01)
      1882 = AICD, other than sing/dual (eff. 4/01)
      1883 = Adapt/ext, pacing/neuro lead (eff. 4/01)
      1885 = Cath, translumin angio laser (eff. 4/01)
      1887 = Catheter, guiding (eff. 4/01)
      1891 = Infusion pump, non-prog, perm (eff. 4/01)
      1892 = Intro/sheath , fixed, peel-away (eff. 4/01)
      1893 = Intro/sheath, fixed, non-peel (eff. 4/01)
      1894 = Intro/sheath, non-laser (eff. 4/01)
      1895 = Lead, AICD, endo dual coil (eff. 4/01)
      1896 = Lead, AICD, non sing/dual (eff. 4/01)
      1897 = Lead, neurostim test kit (eff. 4/01)
      1898 = Lead, pmkr, other than trans (eff. 4/01)
      1899 = Lead, pmkr/AICD combination (eff. 4/01)
      1929 = Maverick PTCA Cath (eff. 1/01) (obsolete 4/01)
      1930 = Coyote Dil Cath, 20/30/40mm (eff. 1/01)
      (obsolete 4/01)
      1931 = Talon Dil Cath (eff. 1/01) (obsolete 4/01)
      1932 = Scimed remedy Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1933 = Opti-Plast XL/Centurion Cath (eff. 1/01)
      (obsolete 4/01)
      1934 = Ultraverse 3.5F Bal Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1935 = Workhorse PTA Bal Cath (eff. 1/01)
      (obsolete 4/01)
      1936 = Uromax Ultra Bal Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1937 = Synergy Balloon Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1938 = Uroforce Bal Dil Cath (eff. 1/01) (obsolete 4/01)
      1939 = Raptur, Ninja PTCA Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1940 = PowerFlex, OPTA 5/LP Bal Cath (eff. 1/01)
      (obsolete 4/01)
      1941 = Jupiter PTA Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1942 = Cordis Maxi LD PTA Bal Cath (eff. 1/01)
      (obsolete 4/01)
      1943 = RXCrossSail OTW OpenSail (eff. 1/01)
      (obsolete 4/01)
      1944 = Rapid Exchange Bil Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1945 = Savvy PTA Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1946 = R1s Rapid Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1947 = Gazelle Bal Dil Cath (eff. 1/01)
      (obsolete 4/01)
      1948 = Pursuit Balloon Cath (eff. 1/01)
      (obsolete 4/01)
      1949 = Oracle Megasonics Cath (eff. 1/01)
      (obsolete 4/01)
      1979 = Visions PV/Avanar US Cath (eff. 1/01)
      (obsolete 4/01)
      1980 = Atlantis SR Coronary Cath (eff. 1/01)
      (obsolete 4/01)
      1981 = PTCA Catheters (eff. 1/01)
      (obsolete 4/01)
      2000 = Orbiter ST Steerable Cath (eff. 1/01)
      (obsolete 4/01)
      2001 = Constellation Diag Cath (eff. 1/01)
      (obsolete 4/01)
      2002 = Irvine 5F Inquiry Diag EP Cath (eff. 1/01)
      (obsolete 4/01)
      2003 = Irvine 6F Inquiry Diag EP Cath (eff. 1/01)
      (obsolete 4/01)
      2004 = Biosense EP Cath -- Octapolar (eff. 1/01)
      (obsolete 4/01)
      2005 = Biosense EP Cath -- Hexapolar (eff. 1/01)
      (obsolete 4/01)
      2006 = Biosense EP Cath -- Decapolar (eff. 1/01)
      (obsolete 4/01)
      2007 = Irvine 6F Luma-Cath EP Cath (eff. 1/01)
      (obsolete 4/01)
      2008 = 7F Luma-Cath EP Cath 81910-15 (eff. 1/01)
      (obsolete 4/01)
      2009 = Irvine 7F Luma-Cath EP Cath (eff. 1/01)
      (obsolete 4/01)
      2010 = Fixed Curve EP Cath (eff. 1/01)
      (obsolete 4/01)
      2011 = Deflectable Tip Cath--Quad (eff. 1/01)
      (obsolete 4/01)
      2012 = Celsius Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2013 = Celsius Large Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2014 = Celsius II Asym Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2015 = Celsius II Sym Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2016 = Navi-Star DS, Navi-Star Ther (eff. 1/01)
      (obsolete 4/01)
      2017 = Navi-Star Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2018 = Polaris T Ablation Cath (eff. 1/01)
      (obsolete 4/01)
      2019 = EP Deflectable Cath (eff. 1/01)
      (obsolete 4/01)
      2020 = Blazer II XP Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2021 = SilverFlex EP Cath (eff. 1/01)
      (obsolete 4/01)
      2022 = CP Chilli Cooled Abln Cath (eff. 1/01)
      (obsolete 4/01)
      2023 = Chilli Cld AblnCath-std, lg (eff. 1/01)
      (obsolete 4/01)
      2100 = CP CS Reference Cath (eff. 1/01)
      (obsolete 4/01)
      2102 = CP Radii 7F EP Cath (eff. 1/01)
      (obsolete 4/01)
      2103 = CP Radii 7F EP Cath w/Track (eff. 1/01)
      (obsolete 4/01)
      2104 = Lasso Deflectable Cath (eff. 1/01)
      (obsolete 4/01)
      2151 = Veripath Guiding Cath (eff. 1/01)
      (obsolete 4/01)
      2152 = Cordis Vista Brite Tip Cath (eff. 1/01)
      (obsolete 4/01)
      2153 = Bard Viking Cath (eff. 1/01)
      (obsolete 4/01)
      2200 = Arrow-Trerotola PTD Cath (eff. 1/01)
      (obsolete 4/01)
      2300 = Varisource Stnd Catheters (eff. 1/01)
      (obsolete 4/01)
      2597 = Clinicath/kit 16/18 sgl/dbl (eff. 1/01)
      (obsolete 4/01)
      2598 = Clinicath 18/20/24-G single (eff. 1/01)
      (obsolete 4/01)
      2599 = Clinicath 16/18-G-double (eff. 1/01)
      (obsolete 4/01)
      2601 = Bard DL Ureteral Cath (eff. 1/01)
      (obsolete 4/01)
      2602 = Vitesse Laser Cath 1.4/1.7mm (eff. 1/01)
      (obsolete 4/01)
      2603 = Vitesse Laser Cath 2.0mm (eff. 1/01)
      (obsolete 4/01)
      2604 = Vitesse E Laser Cath 2.0mm (eff. 1/01)
      (obsolete 4/01)
      2605 = Extreme Laser Catheter (eff. 1/01)
      (obsolete 4/01)
      2606 = SpineCath XL Catheter (eff. 1/01)
      (obsolete 4/01)
      2607 = SpineCath Intradiscal Cath (eff. 1/01)
      (obsolete 4/01)
      2608 = Scimed 6F Wiseguide Cath (eff. 1/01)
      (obsolete 4/01)
      2609 = Flexima Bil Draingage Cath (eff. 1/01)
      (obsolete 4/01)
      2610 = FlexTipPlus Intraspinal Cath (eff. 1/01)
      (obsolete 4/01)
      2611 = AlgoLine Intraspinal Cath (eff. 1/01)
      (obsolete 4/01)
      2612 = InDura Catheter (eff. 1/01)
      (obsolete 4/01)
      2615 = Sealant, pulmonary, liquid (eff. 4/01)
      2616 = Brachytx seed, Yttrium-90 (eff. 4/01)
      2617 = Stent, non-cor, tem w/o del (eff. 4/01)
      2618 = Probe, cryoablation (eff. 4/01)
      2619 = Pmkr, dual, non rate-resp (eff. 4/01)
      2620 = Pmkr, single, non rate-resp (eff. 4/01)
      2621 = Pmkr, other than single/dual (eff. 4/01)
      2622 = Prosthesis, penile, non-inf (eff. 4/01)
      2625 = Stent, non-cor , tem w/del sys (eff. 4/01)
      2626 = Infusion pump, non-prog, temp (eff. 4/01)
      2627 = Cath, suprapubic/cystoscopic (eff. 4/01)
      2628 = Catheter, occlusion (eff. 4/01)
      2629 = Intro/sheath, laser (eff. 4/01)
      2630 = Cath, EP, temp-controlled (eff. 4/01)
      2631 = Rep dev, urinary, w/o sling (eff. 4/01)
      2700 = MycroPhylax Plus CS defib (eff. 1/01)
      (obsolete 4/01)
      2701 = Phylax XM SC defib (eff. 1/01)
      (obsolete 4/01)
      2702 = Ventak Prizm 2VR Defib (eff. 1/01)
      (obsolete 4/01)
      2703 = Ventak Prizm VR HE Defib (eff. 1/01)
      (obsolete 4/01)
      2704 = Ventak Mini IV + Defib (eff. 1/01)
      (obsolete 4/01)
      2801 = Defender IV DR 612 DC defib (eff. 1/01)
      (obsolete 4/01)
      2802 = Phylax AV DC defib (eff. 1/01)
      (obsolete 4/01)
      2803 = Ventak Prizm DR HE Defib (eff. 1/01)
      (obsolete 4/01)
      2804 = Ventak Prizm 2 DR Defib (eff. 1/01)
      (obsolete 4/01)
      2805 = Jewel AF 7250 Defib (eff. 1/01)
      (obsolete 4/01)
      2806 = GEM VR 7227 Defib (eff. 1/01)
      (obsolete 4/01)
      2807 = Contak CD 1823 (eff. 1/01)
      (obsolete 4/01)
      2808 = Contak TR 1241 (eff. 1/01)
      (obsolete 4/01)
      3001 = Kainox SL/RV defib lead (eff. 1/01)
      (obsolete 4/01)
      3002 = EasyTrak Defib Lead (eff. 1/01)
      (obsolete 4/01)
      3003 = Endotak SQ Array XP lead (eff. 1/01)
      (obsolete 4/01)
      3004 = Intervene Defib lead (eff. 1/01)
      (obsolete 4/01)
      3400 = Siltex Spectrum, Contour Prof (eff. 1/01)
      (obsolete 4/01)
      3401 = Saline-Filled Spectrum (eff. 1/01)
      (obsolete 4/01)
      3500 = Mentor alpha I Inf Penile Pros (eff. 1/01)
      (obsolete 4/01)
      3510 = AMS 800 Urinary Pros (eff. 1/01)
      (obsolete 4/01)
      3551 = Choice/PT Graphix/Luge/Trooper (eff. 1/01)
      (obsolete 4/01)
      3552 = Hi-Torque Whisper (eff. 1/01)
      (obsolete 4/01)
      3553 = Cordis guidewires (eff. 1/01)
      (obsolete 4/01)
      3554 = Jindo guidewire (eff. 1/01)
      (obsolete 4/01)
      3555 = Wholey Hi-Torque Plus GW (eff. 1/01)
      (obsolete 4/01)
      3556 = Wave/FlowWire Guidewire (eff. 1/01)
      (obsolete 4/01)
      3557 = HyTek guidewire (eff. 1/01)
      (obsolete 4/01)
      3800 = SynchroMed EL infusion pump (eff. 1/01)
      (obsolete 4/01)
      3801 = Arrow/Microject PCAQ Sys (eff. 1/01)
      (obsolete 4/01)
      3851 = Elastic UV IOL AA-4203T/TF/TL (eff. 1/01)
      (obsolete 4/01)
      4000 = Opus G 4621, 4624 SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4001 = Opus S 4121/4124 SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4002 = Talent 113 SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4003 = Kairos SR SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4004 = Actros SR, Actros SLR SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4005 = Philos SR/SR-B SC pmkr (eff. 1/01)
      (obsolete 4/01)
      4006 = Pulsar Max II SR pmkr (eff. 1/01)
      (obsolete 4/01)
      4007 = Marathon SR pmkr (eff. 1/01)
      (obsolete 4/01)
      4008 = Discovery II SSI pmkr (eff. 1/01)
      (obsolete 4/01)
      4009 = Discovery II SR pmkr (eff. 1/01)
      (obsolete 4/01)
      4300 = Integrity AFx DR 5342 pmkr (eff. 1/01)
      (obsolete 4/01)
      4301 = Integrity AFx DR 5346 pmkr (eff. 1/01)
      (obsolete 4/01)
      4302 = Affinity VDR 5430 DR (eff. 1/01)
      (obsolete 4/01)
      4303 = Brio 112 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4304 = Brio 212, Talent 213/223 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4305 = Brio 222 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4306 = Brio 220 DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4307 = Kairos DR DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4308 = Inos2, Inos2+ DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4309 = Actros DR,D,DR-A, SLR DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4310 = Actros DR-B DC pmkr (eff. 1/01)
      (obsolete 4/01)
      4311 = Philos DR/DR-B/SLR DC (eff. 1/01)
      (obsolete 4/01)
      4312 = Pulsar Max II DR pmkr (eff. 1/01)
      (obsolete 4/01)
      4313 = Marathon DR pmkr (eff. 1/01)
      (obsolete 4/01)
      4314 = Momentum DR pmkr (eff. 1/01)
      (obsolete 4/01)
      4315 = Selection AFm pmkr (eff. 1/01)
      (obsolete 4/01)
      4316 = Discovery II DR (eff. 1/01)
      (obsolete 4/01)
      4317 = Discovery II DDD (eff. 1/01)
      (obsolete 4/01)
      4600 = Snynox, Polyrox, Elox, Retrox (eff. 1/01)
      (obsolete 4/01)
      4602 = Tendril SDX, 1488K pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4603 = Oscor/Flexion pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4604 = CrystallineActFix, CapsureFix (eff. 1/01)
      (obsolete 4/01)
      4605 = CapSure Epi pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4606 = Flextend pmkr lead (eff. 1/01)
      (obsolete 4/01)
      4607 = FinelineII/EZ, ThinlineII/EZ (eff. 1/01)
      (obsolete 4/01)
      5000 = BX Velocity w/Hepacoat (eff. 1/01)
      (obsolete 4/01)
      5001 = Memotherm Bil Stent, sm, med (eff. 1/01)
      (obsolete 4/01)
      5002 = Memotherm Bil Stent, large (eff. 1/01)
      (obsolete 4/01)
      5003 = Memotherm Bil Stent, x-large (eff. 1/01)
      (obsolete 4/01)
      5004 = PalmazCorinthian IQ Bil Stent (eff. 1/01)
      (obsolete 4/01)
      5005 = PalmazCorinthian IQ Trans/Bil (eff. 1/01)
      (obsolete 4/01)
      5006 = PalmazTran Bil Stent Sys-Med (eff. 1/01)
      (obsolete 4/01)
      5007 = PalmazTran XL Bil Stent--40mm (eff. 1/01)
      (obsolete 4/01)
      5008 = PalmazTran XL Bil Stent--50mm (eff. 1/01)
      (obsolete 4/01)
      5009 = VistaFlex Biliary Stent (eff. 1/01)
      (obsolete 4/01)
      5010 = Rapid Exchange Bil Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5011 = IntraStent, IntraStent LP (eff. 1/01)
      (obsolete 4/01)
      5012 = IntraStent DoubleStrut LD (eff. 1/01)
      (obsolete 4/01)
      5013 = IntraStent DoubleStrut XS (eff. 1/01)
      (obsolete 4/01)
      5014 = AVE Bridge Stent Sys-10/17/28 (eff. 1/01)
      (obsolete 4/01)
      5015 = AVE/X3 Bridge Sys, 40-100 (eff. 1/010
      (obsolete 4/01)
      5016 = Biliary stent single use cov (eff. 1/01)
      (obsolete 4/01)
      5017 = WallstentRP Bil--20/40/60/68mm (eff. 1/01)
      (obsolete 4/01)
      5018 = WallstentRP Bil--80/94mm (eff. 1/01)
      (obsolete 4/01)
      5019 = Flexima Bil Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5020 = Smart Nitinol Stent--20mm (eff. 1/01)
      (obsolete 4/01)
      5021 = Smart Nitinol Stent--40/60mm (eff. 1/01)
      (obsolete 4/01)
      5022 = Smart Nitinol Stent--80mm (eff. 1/01)
      (obsolete 4/01)
      5023 = BX Velocity Stent--8/13mm (eff. 1/01)
      (obsolete 4/01)
      5024 = BX Velocity Stent 18mm (eff. 1/01)
      (obsolete 4/01)
      5025 = BX Velocity Stent 23 mm (eff. 1/01)
      (obsolete 4/01)
      5026 = BX Velocity Stent 28/33mm (eff. 1/01)
      (obsolete 4/01)
      5027 = BX Velocity Stent w/Hep--8/13mm (eff. 1/01)
      (obsolete 4/01)
      5028 = BX Velocity Stent w/Hep--18mm (eff. 1/01)
      (obsolete 4/01)
      5029 = BX Velocity Stent w/Hep--23mm (eff. 1/01)
      (obsolete 4/01)
      5030 = Stent, coronary, S660 9/12mm (eff. 1/01)
      (obsolete 4/01)
      5031 = Stent, coronary, S660 15/18mm (eff. 1/01)
      (obsolete 4/01)
      5032 = Stent, coronary, S660 24/30mm (eff. 1/01)
      (obsolete 4/01)
      5033 = Niroyal Stent Sys, 9mm (eff. 1/01)
      (obsolete 4/01)
      5034 = Niroyal Stent Sys, 12/15mm (eff. 1/01)
      (obsolete 4/01)
      5035 = Niroyal Stent Sys, 18mm (eff. 1/01)
      (obsolete 4/01)
      5036 = Niroyal Stent Sys, 25mm (eff. 1/01)
      (obsolete 4/01)
      5037 = Niroyal Stent Sys, 31mm (eff. 1/01)
      (obsolete 4/01)
      5038 = BX Velocity Stent w/Raptor (eff. 1/01)
      (obsolete 4/01)
      5039 = IntraCoil Periph Stent--40mm (eff. 1/01)
      (obsolete 4/01)
      5040 = IntraCoil Periph Stent--60mm (eff. 1/01)
      (obsolete 4/01)
      5041 = BeStent Over-the-Wire 24/30mm (eff. 1/01)
      (obsolete 4/01)
      5042 = BeStent Over-the-Wire 18mm (eff. 1/01)
      (obsolete 4/01)
      5043 = BeStent Over-the-Wire 15mm (eff. 1/01)
      (obsolete 4/01)
      5044 = BeStent Over-the-Wire 9/12mm (eff. 1/01)
      (obsolete 4/01)
      5045 = Multilink Tetra Cor Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5046 = Radius 20mm cor stent (eff. 1/01)
      (obsolete 4/01)
      5047 = Niroyal Elite Cor Stent Sys (eff. 1/01)
      (obsolete 4/01)
      5048 = GR II Coronary Stent (eff. 1/01)
      (obsolete 4/01)
      5130 = Wilson-Cook Colonic Z-Stent (eff. 1/01)
      (obsolete 4/01)
      5131 = Bard Colorectal Stent-60mm (eff. 1/01)
      (obsolete 4/01)
      5132 = Bard Colorectal Stent-80mm (eff. 1/01)
      (obsolete 4/01)
      5133 = Bard Colorectal Stent-100mm (eff. 1/01)
      (obsolete 4/01)
      5134 = Enteral Wallstent-90mm (eff. 1/01)
      (obsolete 4/01)
      5279 = Contour/Percuflex Stent (eff. 1/01)
      (obsolete 4/01)
      5280 = Inlay Dbl Ureteral Stent (eff. 1/01)
      (obsolete 4/01)
      5281 = Wallgraft Trach Sys 70mm (eff. 1/01)
      (obsolete 4/01)
      5282 = Wallgraft Trach Sys 20/30/50 (eff. 1/01)
      (obsolete 4/01)
      5283 = Wallstent/RP TIPS--80mm (eff. 1/01)
      (obsolete 4/01)
      5284 = Wallstent TrachUltraFlex (eff. 1/01)
      (obsolete 4/01)
      5600 = Closure dev, VasoSeal ES (eff. 1/01)
      (obsolete 4/01)
      5601 = VasoSeal Model 1000 (eff. 1/01)
      (obsolete 4/01)
      6001 = Composix Mesh 8/21 in (eff. 1/01)
      (obsolete 4/01)
      6002 = Composix Mesh 32 in (eff. 1/01)
      (obsolete 4/01)
      6003 = Composix Mesh 48 in (eff. 1/01)
      (obsolete 4/01)
      6004 = Composix Mesh 80 in (eff. 1/01)
      (obsolete 4/01)
      6005 = Composix Mesh 140 in (eff. 1/01)
      (obsolete 4/01)
      6006 = Composix Mesh 144 in (eff. 1/01)
      (obsolete 4/01)
      6012 = Pelvicol Collagen 8/14 sq cm (eff. 1/01)
      (obsolete 4/01)
      6013 = Pelvicol Collagen 21/24/28 sq cm (eff. 1/01)
      (obsolete 4/01)
      6014 = Pelvicol Collagen 36 sq cm (eff. 1/01)
      (obsolete 4/01)
      6015 = Pelvicol Collagen 48 sq cm (eff. 1/01)
      (obsolete 4/01)
      6016 = Pelvicol Collagen 96 sq cm (eff. 1/01)
      (obsolete 4/01)
      6017 = Gore-Tex DualMesh 75/96 sq cm (eff. 1/01)
      (obsolete 4/01)
      6018 = Gore-Tex DualMesh 150 sq cm (eff. 1/01)
      (obsolete 4/01)
      6019 = Gore-Tex DualMesh 285 sq cm (eff. 1/01)
      (obsolete 4/01)
      6020 = Gore-Tex DualMesh 432 sq cm (eff. 1/01)
      (obsolete 4/01)
      6021 = Gore-Tex DualMesh 600 sq cm (eff. 1/01)
      (obsolete 4/01)
      6022 = Gore-Tex DualMesh 884 sq cm (eff. 1/01)
      (obsolete 4/01)
      6023 = Gore-TexPlus 1mm, 75/96 sq cm (eff. 1/01)
      (obsolete 4/01)
      6024 = Gore-TexPlus 1mm, 150 sq cm (eff. 1/01)
      (obsolete 4/01)
      6025 = Gore-TexPlus 1mm, 285 sq cm (eff. 1/01)
      (obsolete 4/01)
      6026 = Gore-TexPlus 1mm, 432 sq cm (eff. 1/01)
      (obsolete 4/01)
      6027 = Gore-TexPlus 1mm, 600 sq cm (eff. 1/01)
      (obsolete 4/01)
      6028 = Gore-TexPlus 1mm, 884 sq cm (eff. 1/01)
      (obsolete 4/01)
      6029 = Gore-TexPlus 2mm, 150 sq cm (eff. 1/01)
      (obsolete 4/01)
      6030 = Gore-TexPlus 2mm, 285 sq cm (eff. 1/01)
      (obsolete 4/01)
      6031 = Gore-TexPlus 2mm, 432 sq cm (eff. 1/01)
      (obsolete 4/01)
      6032 = Gore-TexPlus 2mm, 600 sq cm (eff. 1/01)
      (obsolete 4/01)
      6033 = Gore-TexPlus 2mm, 884 sq cm (eff. 1/01)
      (obsolete 4/01)
      6034 = Bard ePTFE: 150 sq cm-2mm
      (obsolete 4/01)
      6035 = Bard ePTFE: 150sqcm-1mm,75-2mm (eff. 1/01)
      (obsolete 4/01)
      6036 = Bard ePTFE: 50/75sqcm-1,2mm (eff. 1/01)
      (obsolete 4/01)
      6037 = Bard ePTFE: 300 sq cm-1,2mm (eff. 1/01)
      (obsolete 4/01)
      6038 = Bard ePTFE: 600 sq cm-1mm (eff. 1/01)
      (obsolete 4/01)
      6039 = Bard ePTFE: 884sq cm-1mm (eff. 1/01)
      (obsolete 4/01)
      6040 = Bard ePTFE: 600sq cm-2mm (eff. 1/01)
      (obsolete 4/01)
      6041 = Bard ePTFE: 884sq cm -2mm (eff. 1/01)
      (obsolete 4/01)
      6050 = Female Sling Sys w/wo Matrl (eff. 1/01)
      (obsolete 4/01)
      6051 = Stratasis Sling, 20/40 cm (eff. 1/01)
      (obsolete 4/01)
      6052 = Stratasis Sling, 60 cm (eff. 1/01)
      (obsolete 4/01)
      6053 = Surgisis Soft Graft (eff. 1/01)
      (obsolete 4/01)
      6054 = Surgisis Enhanced Graft (eff. 1/01)
      (obsolete 4/01)
      6055 = Surgisis Enhanced Tissue (eff. 1/01)
      (obsolete 4/01)
      6056 = Surgisis Soft Tissue Graft (eff. 1/01)
      (obsolete 4/01)
      6057 = Surgisis Hernia Graft (eff. 1/01)
      (obsolete 4/01)
      6058 = SurgiPro Hernia Plug, med/lg (eff. 1/01)
      (obsolete 4/01)
      6080 = Male Sling Sys w/wo Matrial (eff. 1/01)
      (obsolete 4/01)
      6200 = Exxcel Soft ePTFE vas graft (ef. 1/01)
      (obsolete 4/01)
      6201 = Impra Venaflo--10/20cm (eff. 1/01)
      (obsolete 4/01)
      6202 = Impra Venaflo--30/40 cm (eff. 1/01)
      (obsolete 4/01)
      6203 = Impra Venaflo--50 cm, vt45 (eff. 1/01)
      (obsolete 4/01)
      6204 = Impra Venaflo--stepped (eff. 1/01)
      (obsolete 4/01)
      6205 = Impra Carboflo--10cm (eff. 1/01)
      (obsolete 4/01)
      6206 = Impra Carboflo--20 cm (eff. 1/01)
      (obsolete 4/01)
      6207 = Impra Carboflo--30/35/40cm (eff. 1/01)
      (obsolete 4/01)
      6208 = Impra Carboflo--40/50cm (eff. 1/01)
      (obsolete 4/01)
      6209 = Impra Carboflo--ctrflex (eff. 1/01)
      (obsolete 4/01)
      6210 = Exxcel ePTFE vas graft (eff. 1/01)
      (obsolete 4/01)
      6300 = Vanguard III Endovas Graft (eff. 1/01)
      (obsolete 4/01)
      6500 = Preface Guiding Sheath (eff. 1/01)
      (obsolete 4/01)
      6501 = Soft Tip Sheaths (eff. 1/01)
      (obsolete 4/01)
      6502 = Perry Exchange Dilator (eff. 1/01)
      (obsolete 4/01)
      6525 = Spectranetics Laser Sheath (eff. 1/01)
      (obsolete 4/01)
      6600 = Micro Litho Flex Probes (eff. 1/01)
      (obsolete 4/01)
      6650 = Fast-Cath Guiding Introducer (eff. 1/01)
      (obsolete 4/01)
      6651 = Seal-Away Guding Introducer (eff. 1/01)
      (obsolete 4/01)
      6652 = Bard Excalibur Introducer (eff. 1/01)
      (obsolete 4/01)
      6700 = Focal Seal-L (eff. 1/01)
      (obsolete 4/01)
      7000 = Amifostine, 500 mg (eligible for pass-through
      payments)
      7001 = Amphotericin B lipid complex, 50 mg, Inj
      (eligible for pass-through payments)
      7002 = Clonidine, HCl, 1 MG (eligible for pass-
      through payments) (obsolete 1/01)
      7003 = Epoprostenol, 0.5 MG, inj (eligible for pass-
      through payments)
      7004 = Immune globulin intravenous human 5g, inj
      (eligible for pass-through payments)
      7005 = Gonadorelin hcI, 100 mcg (eligible for pass-
      through payments)
      7007 = Milrinone lacetate, per 5 ml, inj (not subject
      to national coinsurance)
      7010 = Morphine sulfate concentrate (preservative free)
      per 10 mg (eligible for pass-through payments)
      7011 = Oprelevekin, inj, 5 mg (eligible for pass-through
      payments)
      7012 = Pentamidine isethionate, 300 mg (eligible for
      pass-through payments) (obsolete 1/01)
      7014 = Fentanyl citrate, inj, up to 2 ml (eligible for
      pass-through payments)
      7015 = Busulfan, oral 2 mg (eligible for pass-through
      payments)
      7019 = Aprotinin, 10,000 kiu (eligible for pass-through
      payments)
      7021 = Baclofen, intrathecal, 50 mcg (eligible for pass-
      through payments) (obsolete 1/01)
      7022 = Elliotts B Solution, per ml (eligible for pass-
      through payments)
      7023 = Treatment for bladder calculi, I.e. Renacidin
      per 500 ml (eligible for pass-through payments)
      7024 = Corticorelin ovine triflutate, 0.1 mg
      (eligible for pass-through payments)
      7025 = Digoxin immune FAB (Ovine), 10 mg
      (eligible for pass-through payments)
      7026 = Ethanolamine oleate, 1000 ml
      (eligible for pass-through payments)
      7027 = Fomepizole, 1.5 G
      (eligible for pass-through payments)
      7028 = Fosphenytoin, 50 mg
      (eligible for pass-through payments)
      7029 = Glatiramer acetate, 25 mg
      (eligible for pass-through payments)
      7030 = Hemin, 1 mg
      (eligible for pass-through payments)
      7031 = Octreotide Acetate, 500 mcg
      (eligible for pass-through payments)
      7032 = Sermorelin acetate, 0.5 mg
      (eligible for pass-through payments)
      7033 = Somatrem, 5 mg
      (eligible for pass-through payments)
      7034 = Somatropin, 1 mg
      (eligible for pass-through payments)
      7035 = Teniposide, 50 mg
      (eligible for pass-through payments)
      7036 = Urokinase, inj, IV, 250,000 I.U.
      (not subject to national coinsurance)
      7037 = Urofollitropin, 75 I.U.
      (eligible for pass-through payments)
      7038 = Muromonab-CD3, 5 mg
      (eligible for pass-through payments)
      7039 = Pegademase bovine inj 25 I.U.
      (eligible for pass-through payments)
      7040 = Pentastarch 10% inj, 100 ml
      (eligible for pass-through payments)
      7041 = Tirofiban HCL, 0.5 mg
      (not subject to national coinsurance)
      7042 = Capecitabine, oral 150 mg
      (eligible for pass-through payments)
      7043 = Infliximab, 10 MG (eligible for pass-through
      payments)
      7045 = Trimetrexate Glucoronate (eligible for pass-
      through payments)
      7046 = Doxorubicin Hcl Liposome (eligible for pass-
      through payments)
      7047 = Droperidol/fentanyl inj (eff. 1/01)
      7048 = Alteplase, 1 mg (eff. 1/01)
      7049 = Filgrastim 480 mcg injection (eff. 1/01)
      7315 = Sodium hyaluronate, 20 mg (eff. 1/01)
      8099 = Spectranetics Lead Lock Dev (eff. 1/01)
      (obsolete 4/01)
      8100 = Adhesion barrier, ADCON-L (eff. 1/01)
      (obsolete 4/01)
      8102 = SurgiVision Esoph Coil (eff. 1/01)
      (obsolete 4/01)
      9000 = Na chromate Cr51, per 0.25mCi (eff. 1/01)
      9001 = Linezolid inj, 200mg (eff. 1/01)
      9002 = Tenecteplase, 50mg/vial (eff. 1/01)
      9003 = Palivizumab, per 50 mg (eff. 1/01)
      9004 = Gemtuzumab ozogamicin inj, 5mg (eff. 1/01)
      9005 = Reteplase inj, half-kit, 18.8 mg/vial (eff. 1/01)
      9006 = Tacrolimus inj, per 5 mg (1 amp) (eff. 1/01)
      9007 = Baclofen Intrathecal kit-1amp (eff. 1/01)
      9008 = Baclofen Refill Kit--500mcg (eff. 1/01)
      9009 = Baclofen Refill Kit--2000mcg (eff. 1/01)
      9010 = Baclofen Refill Kit--4000mcg (eff. 1/01)
      9011 = Caffeine Citrate, inj, 1ml (eff. 1/01)
      9012 = Arsenic Trioxide, 1mg/kg (eff. 4/01)
      9013 = Co 57 Cobaltous Cl, 1 ml (eff. 4/01)
      9100 = Iodinated I-131 Albumin (eff. 1/01)
      9102 = 51 Na chromate, 50mCi (eff. 1/01)
      9103 = Na lothalamate I-125, 10uCi (eff. 1/01)
      9104 = Anti-thymocyte globin, 25 mg (eff. 1/01)
      9105 = Hep B immun glob, per 1 ml (eff. 1/01)
      9106 = Sirolimus 1 mg/ml (eff. 1/01)
      9107 = Tinzaparin sodium, 2ml vial (eff. 1/01)
      9108 = Thyrotropin Alfa, 1.1 mg (eff. 1/01)
      9109 = Tirofiban hydrachloride 6.25 mg (eff. 1/01)
      9217 = Leuprolide acetate for depot suspension,
      7.5 mg (eff. 1/01)
      9500 = Platelets, irrad, ea unit (eff. 1/01)
      9501 = Platelets, pheresis, ea unit (eff. 1/01)
      9502 = Platelets, pher/irrad, ea unit (eff. 1/01)
      9503 = Fresh frozen plasma, ea unit (eff. 1/01)
      9504 = RBC, deglycerolized, ea unit (eff. 1/01)
      9505 = RBC, irradiated, ea unit (eff. 1/01)
      9998 = Enoxaparin (eff. 1/01)



 REV_CNTR_CNSLDTD_BLG_TB                 Revenue Center Consolidated Billing Table

      1 = Home Health Consolidated Billing Override Code
      2 = SNF Consolidated Billing Override Code



 REV_CNTR_DDCTBL_COINSRNC_TB             Revenue Center Deductible Coinsurance Code

       0 = Charges are subject to deductible
           and coinsurance
       1 = Charges are not subject to deductible
       2 = Charges are not subject to coinsurance
       3 = Charges are not subject to deductible
           or coinsurance
       4 = No charge or units associated with this
           revenue center code.  (For multiple
           HCPCS per single revenue center code)

       For revenue center code 0001, the following
       MSP override values may be present:

       M = Override code; EGHP services involved
           (eff 12/90 for non-institutional claims;
           10/93 for institutional claims)
       N = Override code; non-EGHP services involved
           (eff 12/90 for non-institutional claims;
           10/93 for institutional claims)
       X = Override code: MSP cost avoided
           (eff 12/90 for non-institutional claims;
           10/93 for institutional claims)



 REV_CNTR_DSCNT_IND_TB                   Revenue Center Discount Indicator Table

      *DISCOUNTING FORMULAS*
      1 = 1.0
      2 = (1.0+D(U-1))/U
      3 = T/U
      4 = (1+D)/U
      5 = D
      6 = TD/U
      7 = D(1+D)/U
      8 = 2.0/U

      NOTE:  VALUES D, U & T REPRESENT THE FOLLOWING:
      D = Discounting fraction (currently 0.5)
      U = Number of units
      T = Terminated procedure discount (currently 0.5)



 REV_CNTR_DUP_CLM_CHK_IND_TB             Revenue Center Duplicate Claim Check Indcator Table

       1 = Suspect duplicate review performed



 REV_CNTR_NDC_QTY_QLFR_TB                Revenue Center NDC Qualifier Code Table

      Valid Values:
      F2 = International Unit
      GR = Gram
      ML = Milliliter
      UN = Unit



 REV_CNTR_PACKG_IND_TB                   Revenue Center Packaging Indicator Table

      0 = Not packaged
      1 = Packaged service (service indicator N)
      2 = Packaged as part of partial hospitalization
          per diem or daily mental health service
          per diem
      3 = Artificial charges for surgical procedure
          (eff. 7/2004)



 REV_CNTR_PMT_MTHD_IND_TB                Revenue Center Payment Method Indicator Table

      NOTE: Prior to 10/2005, this table contained the
      valid values for both the payment indicator and
      status indicator.  Effective 10/2005, the payment
      indicator codes will remain in this table and the
      status indicator code values will be reflected in
      the new table: REV_CNTR_STUS_IND_TB. Both the
      payment indicator and status indicator values have
      been expanded to 2-btyes.

      1 =  Paid standard hospital OPPS amount
           (status indicators K, S,T,V,X)
      2 =  Services not paid under OPPS (status
           indicator A, or no HCPCS code and not
           certain revenue center codes)
      3 =  Not paid (status indicator M,W,Y,E) or not
           paid under OPPS (status indicator B,C & Z)
      4 =  Paid at reasonable cost (status  indica-
           tor F,L)
      5 =  Additional payment for drug or biological
           (status indicator G)
      6 =  Additional payment for device (status
           indicator H)
      7 =  Additional payment for new drug or new
           biological (status indicator J)
      8 =  Paid partial hospitalization per diem
           (status indicator P)
      9 =  No additional payment, payment included
           in line items with APCs (status indicator
           N, or no HCPCS code and certain revenue
           center codes, or HCPCS codes G0176
           (activity therapy), G0129 (occupational
           therapy) or G0177 (partial hospitalization
           program services)
      A2 = Surgical procedure on ASC list in CY 2007;
           payment based on OPPS payment relative weight
      B5 = Alternative code may be available; no payment
           made
      D5 = Deleted/discontinued code; no payment made
      F4 = Corneal tissue acquisition, hepatitis B vaccine;
           paid at reasonable cost
      G2 = Non-office based surgical procedure added in CY 2008
           or later; payment based on OPPS relative payment
           weight
      H2 = Brachytherapy source paid separately when provided
           intregal to a surgical procedure on an ASC lists;
           payment based on OPPS rates
      J7 = OPPS pass-through device paid when separately provided
           intregal to a surgical procedure on ASC list; pay-
           ment contractor priced
      J8 = Device-intensive procedure; paid at adjusted rate
      K2 = Drugs and biologicals paid separately when provided
           intregal to a surgical procedure on ASC list; pay-
           ment based on OPPS rate
      K7 = Unclassified drugs and biologicals; payment contractor
           priced
      L1 = Influenza vaccine; pneumoccocal vaccine.  Packaged
           item/service, no separate payment made
      L6 = New Technology Intarocular Lens (NTIOL); special
           payment
      N1 = Package service/item; no separate payment made
      P2 = Office-based surgical procedure added to ASC list
           in CY 2008 or later with MPFS non-facility PE RUVs
           payment based on OPPS relative payment weight.
      P3 = Office-based surgical procedure added to ASC list
           in CY 2008 or later with MPFS non-facility PE RUVs
           payment based on MPFS nonfacility PE RUVs.
      R2 = Office-based surgical procedure added to ASC list
           in CY 2008 or later without MPFS non-facility PE
           RVUs payment based on OPPS relative payment weight.
      Z2 = Radioloty or diagnostic service paid separately
           when provided intregal to a surgical procedure on
           an ASC list; payment based on OPPS relative payment
           weight.
      Z3 = Radioloty or diagnostic service paid separately
           when provided intregal to a surgical procedure on
           an ASC list; payment based on MFPS nonfacility PE
           RVUs.

      *********VALUES PRIOR TO 10/3/2005**************
      ****************Service Indicator**************
      **************** 1st position *****************

      A = Services not paid under OPPS
      C = Inpatient procedurel pass-through
      E = Noncovered items or services
      F = Corneal tissue acquistion
      G = Current drug or biological pass-through
      H = Device pass-through
      J = New drug or new biological pass-through
      N = Packaged incidental service
      P = Partial hospitalization services
      S = Significant procedure not subject to
          multiple procedure discounting
      T = Significant procedure subject to multiple
          procedure discounting
      V = Medical visit to clinic or emergency
          department
      X = Ancillary service

      **********Payment Indicator**************
      ********** 2nd position *****************
      1 = Paid standard hospital OPPS amount
          (service indicators S,T,V,X)
      2 = Services not paid under OPPS (service
          indicator A, or no HCPCS code and not
          certain revenue center codes)
      3 = Not paid (service indicators C & E)
      4 = Acquisition cost paid (service indica-
          tor F)
      5 = Additional payment for current drug or
          biological (service indicator G)
      6 = Additional payment for device (service
          indicator H)
      7 = Additional payment for new drug or new
          biological (service indicator J)
      8 = Paid partial hospitalization per diem
          (service indicator P)
      9 = No additional payment, payment included
          in line items with APCs (service
          indicator N, or no HCPCS code and certain
          revenue center codes, or HCPCS codes Q0082
          (activity therapy), G0129 (occupational
          therapy) or G0172 (partial hospitalization
          training)



 REV_CNTR_PRICNG_IND_TB                  Revenue Center Pricing Indicator Table

      A = A valid HCPCS code not subject to a fee schedule payment.
      Reimbursement is calculated on provider submitted
      charges.

      B = A valid HCPCS code subject to the fee schedule payment.
      for the provider billed charges. NOTE: There is an excep-
      tion for Critical Access Hospitals (provider numbers
      XX1300-XX1399) with reimbursement method 'J' (all-
      inclusive method) and dates of service on or after
      7/1/01.  In these situations, reimbursement for pro-
      fessional services (revenue codes 96X, 97X, 98X) is
      always at the fee schedule amount of logic is not
      applicable.

      C = Unlisted Rehabilitation Carrier Priced HCPCS

      D = a valid radiology HCPCS code subject to the Radiology
      Pricer and the rate is reflected as zeroes on the HCPCS
      file and cost report.  The Radiology Pricer treates this
      HCPCS as a non-covered service.  Reimbursement is cal-
      culated on provider submitted charges.

      E = A valid ASC HCPCS code subject to the ASC Pricer. The
      rate is reflected as zeroes on the HCPCS file.  The
      ASC Pricer determines the ASC payment rate and is re-
      ported on the cost report.

      F = A valid ESRD HCPCS code subject to the parameter rate.
      Reimbursement is the lesser of provider submitted
      charges or the fee schedule amount for non-dialysis
      HCPCS.  Reimbursement is calculated on the provider
      file rates for dialysis HCPCS.

      NOTE: The ESRD Pricing Indicator is used when process-
      ing the ESRD claim. The non-ESRD pricing indicator
      is used only for Inpatient claims as follows: valid
      Hemophilia HCPCS for inpatient claim only and code is
      summed to parameter rate.

      G = A valid HCPCS, code is subject to a fee schedule, but
      the rate is no longer present on the HCPCS file.
      Reimbursement is calculated on provider submitted
      charges.

      H = A valid DME HCPCS, code is subject to a fee schedule.
      The rates are reflected under the DME segment.  Reim-
      bursement is calculated either on a fee schedule, pro-
      vider submitted charges or the lesser of provider
      submitted, or the fee schedule depending on the cate-
      gory of DME.

      I = A valid DME category 5 HCPCS, HCPCS is not found on
      the DME history record, but a match was found on HIC,
      category and generic code.  Claim must be reviewed by
      Medical Review before payment can be calculated.

      J = A valid DME HCPCS, no DME history is present, and a
      prescription is required before delivery.  Claim must
      be reviewed by Medical Review.

      K = A valid DME HCPCS, prescribed has been reviewed, and
      fee schedule payment is approved as prescription was
      present before delivery.

      L = A valid TENS HCPCS, rental period is six months or
      greater and must be reviewed by Medical Review. This
      code will be automatically set by the system.

      M = A valid TENS HCPCS, Medical Review has approved the
      rental charge in excess of five months. This must be
      set by Medical Review.  This must be set by Medical
      Review when approved for payment.

      N = Paid based on the fee amount for non ESRD TOB's.
          NOTE: Fee amount is paid regardless of charges.

      Q = Manual pricing

      R = A valid radiology HCPCS code and is subject to
      APC.  The rate is reported on the cost report.
      Reimbursement is calculated on provider submitted
      charges.

      S = Valid influenza/PPV HCPCS.  A fee amount is not
      applicable.  The amount payable is present in the
      covered charge field.  This amount is not subject
      to the coinsurance and deductible.  This charge is
      subject to the provider's reimbursement rate.

      T = Valid HCPCS.  A fee amount is present.  The amount
      payable should be the lower of the billed charge or
      fee amount.  The system should compute the fee amount
      by multiplying the covered units times the rate.
      The fee amount is not subject to coinsurance and
      deductible or provider's reimbursement rate.

      U = Valid ambulance HCPCS. A fee amount is present.
      The amount payable is a blended amount based on  a
      percentage of the fee schedule and a percentage of
      the reasonable cost.  The fee amount is subject to
      coinsurance and deductible.

      X = Unclassified drug as subject to manual pricing.



 REV_CNTR_PRIOR_AUTHRZTN_TB              Revenue Center Prior Authorization Indicator Table

      A = Part A
      B = Part B
      D = DME
      H = Home Health and Hospice
      + 3 digit number



 REV_CNTR_PWK_TB                         Revenue Center Paperwork Table


      P1 = one iteration is present
      P2 = two iterations are present
      P3 = three iterations are present
      P4 = four iterations are present
      P5 = five iterations are present
      P6 = six iterations are present
      P7 = seven iterations are present
      P8 = eight iterations are present
      P9 = nine iterations are present
      P0 = ten iterations are present



 REV_CNTR_STUS_IND_TB                    Revenue Center Status Indicator Table

      A =  Services not paid under OPPS; paid by MACs under a fee
           schedule or payment system other than OPPS
      B =  Non-allowed item or service for OPPS
      C =  Inpatient procedure; not paid under OPPS
      D =  Discontinued Codes - not paid under OPPS or any other
           Medicare payment system
      E1 = Non-allowed item or service - not paid by Medicare when
           submitted on outpatient claims (any outpatient bill
           type)
      E2 = Non-allowed item or service for which pricing information
           and claims data is not available - not paid by Medicare
           when submitted on outpatient claims (any outpatient
           bill type)
      F =  Corneal tissue acquisition and certain CRNA
           services and Hepatitis B vaccines
      G =  Drug/bilogical pass-through
      H =  Device pass-through
      J1 = Hospital Part B services paid through a comprehensive
           APC -- Paid under OPPS; all covered Part B services on
           on the claim are packaged with the primary "J1" service
           service for the claim, except services with OPPS status
           indicator of "F","G", "H", "L" and "U"; ambulance
           services; diagnostic and screening mammography; rehab-
           ilitation therapy services; new technology services;
           self-administered drugs; all preventive services; and
           certain Part B inpatient services.
      J2 = Hospital Part B services that may be paid through a
           comprehensize APC - Paid under OPPS; Addendum B displays
           APC assignments when services are separately payable
      K =  Non pass-through drug/biological, radio-
           pharmaceutical agent, certain brachytherapy
           sources.  Paid under OPPS; separate APC payment
      L =  Flu/PPV vaccines - Not paid under OPPS. Paid at
           reasonable cost; not subject to deductible or
           coinsurance
      M =  Service not billable to MAC; Not paid under OPPS
      N =  Items and services packaged into APC rates
           Paid under OPPS; payment is packaged into payment
           for other services.  Therefore, there is no separate
           APC payment
      P =  Partial Hospitalization; Paid under OPPS; per diem
           APC payment
      Q1 = STV - Packaged Codes - Paid under OPPS; Addendum B
           displays APC assignments when services are
           separately paybable
      Q2 = T - Packaged Codes - Paid under OPPS; Addendum B
           displays APC assignments when services are
           separately paybable
      Q3 = Codes that may be paid through a composite APC
      Q4 = Conditionally packaged laboratory tests
           Paid under OPPS or CLFS
      R =  Blood and blood products; Paid under OPPS; separate
           APC payment
      S =  Significant procedure not subject to multiple
           procedure discounting - Paid under OPPS; separate
           APC payment
      T =  Significant procedure subject to multiple
           procedure discounting; Paid under OPPS; separate
           APC payment
      U =  Brachytherapy Sources - Paid under OPPS; separate
           APC payment
      V =  Medical visit to clinic or emergency department -
           Paid under OPPS; separate APC payment
      W =  Invalid HCPCS or invalid revenue code with blank
           HCPCS (terminated)
      X =  Ancillary service (terminated)
      Y =  Non-implantable DME, Therapeutic shoes
      Z =  Valid revenue with blank HCPCS and no other SI
           assigned (terminated)



 REV_CNTR_TB                             Revenue Center Table

       0001 = Total charge
       0022 = SNF claim paid under PPS submitted as TOB 21X,
              effective for cost reporting periods begin-
              ning on or after 7/1/98 (dates of service after
              6/30/98).  NOTE:  This code may appear multiple
              times on a claim to identify different HIPPS
              Rate Code/assessment periods.
       0023 = Home Health services paid under PPS submitted as
              TOB 32X and 33X, effective 10/00.  This code may
              appear multiple times on a claim to identify
              different HIPPS/Home Health Resource Groups (HRG).
       0024 = Inpatient Rehabilitation Facility services paid
              under PPS submitted as TOB 11X, effective for
              cost reporting periods beginning on or after
              1/1/2002 (dates of service after 12/31/01).
              This code may appear only once on a claim.
       0100 = All inclusive rate-room and board plus ancillary
       0101 = All inclusive rate-room and board
       0110 = Private medical or general-general classification
       0111 = Private medical or general-medical/surgical/GYN
       0112 = Private medical or general-OB
       0113 = Private medical or general-pediatric
       0114 = Private medical or general-psychiatric
       0115 = Private medical or general-hospice
       0116 = Private medical or general-detoxification
       0117 = Private medical or general-oncology
       0118 = Private medical or general-rehabilitation
       0119 = Private medical or general-other
       0120 = Semi-private 2 bed (medical or general)
              general classification
       0121 = Semi-private 2 bed (medical or general)
              medical/surgical/GYN
       0122 = Semi-private 2 bed (medical or general)-OB
       0123 = Semi-private 2 bed (medical or general)-pediatric
       0124 = Semi-private 2 bed (medical or general)-psychiatric
       0125 = Semi-private 2 bed (medical or general)-hospice
       0126 = Semi-private 2 bed (medical or general)
              detoxification
       0127 = Semi-private 2 bed (medical or general)-oncology
       0128 = Semi-private 2 bed (medical or general)
              rehabilitation
       0129 = Semi-private 2 bed (medical or general)-other
       0130 = Semi-private 3 and 4 beds-general classification
       0131 = Semi-private 3 and 4 beds-medical/surgical/GYN
       0132 = Semi-private 3 and 4 beds-OB
       0133 = Semi-private 3 and 4 beds-pediatric
       0134 = Semi-private 3 and 4 beds-psychiatric
       0135 = Semi-private 3 and 4 beds-hospice
       0136 = Semi-private 3 and 4 beds-detoxification
       0137 = Semi-private 3 and 4 beds-oncology
       0138 = Semi_private 3 and 4 beds-rehabilitation
       0139 = Semi-private 3 and 4 beds-other
       0140 = Private (deluxe)-general classification
       0141 = Private (deluxe)-medical/surgical/GYN
       0142 = Private (deluxe)-OB
       0143 = Private (deluxe)-pediatric
       0144 = Private (deluxe)-psychiatric
       0145 = Private (deluxe)-hospice
       0146 = Private (deluxe)-detoxification
       0147 = Private (deluxe)-oncology
       0148 = Private (deluxe)-rehabilitation
       0149 = Private (deluxe)-other
       0150 = Room&Board ward (medical or general)
              general classification
       0151 = Room&Board ward (medical or general)
              medical/surgical/GYN
       0152 = Room&Board ward (medical or general)-OB
       0153 = Room&Board ward (medical or general)-pediatric
       0154 = Room&Board ward (medical or general)-psychiatric
       0155 = Room&Board ward (medical or general)-hospice
       0156 = Room&Board ward (medical or general)-detoxification
       0157 = Room&Board ward (medical or general)-oncology
       0158 = Room&Board ward (medical or general)-rehabilitation
       0159 = Room&Board ward (medical or general)-other
       0160 = Other Room&Board-general classification
       0164 = Other Room&Board-sterile environment
       0167 = Other Room&Board-self care
       0169 = Other Room&Board-other
       0170 = Nursery-general classification
       0171 = Nursery-newborn
              level I (routine)
       0172 = Nursery-premature
              newborn-level II (continuing care)
       0173 = Nursery-newborn-level III (intermediate care)
              (eff 10/96)
       0174 = Nursery-newborn-level IV (intensive care)
              (eff 10/96)
       0175 = Nursery-neonatal ICU (obsolete eff 10/96)
       0179 = Nursery-other
       0180 = Leave of absence-general classification
       0182 = Leave of absence-patient convenience charges
              billable
       0183 = Leave of absence-therapeutic leave
       0184 = Leave of absence-ICF mentally retarded-any reason
              (obsolete)
       0185 = Leave of absence-nursing home (hospitalization)
       0189 = Leave of absence-other leave of absence
       0190 = Subacute care - general classification
              (eff. 10/97)
       0191 = Subacute care - level I (eff. 10/97)
       0192 = Subacute care - level II (eff. 10/97)
       0193 = Subacute care - level III (eff. 10/97)
       0194 = Subacute care - level IV (eff. 10/97)
       0199 = Subacute care - other (eff 10/97)
       0200 = Intensive care-general classification
       0201 = Intensive care-surgical
       0202 = Intensive care-medical
       0203 = Intensive care-pediatric
       0204 = Intensive care-psychiatric
       0206 = Intensive care-post ICU; redefined as
              intermediate ICU (eff 10/96)
       0207 = Intensive care-burn care
       0208 = Intensive care-trauma
       0209 = Intensive care-other intensive care
       0210 = Coronary care-general classification
       0211 = Coronary care-myocardial infraction
       0212 = Coronary care-pulmonary care
       0213 = Coronary care-heart transplant
       0214 = Coronary care-post CCU; redefined as
              intermediate CCU (eff 10/96)
       0219 = Coronary care-other coronary care
       0220 = Special charges-general classification
       0221 = Special charges-admission charge
       0222 = Special charges-technical support charge
       0223 = Special charges-UR service charge
       0224 = Special charges-late discharge, medically
              necessary
       0229 = Special charges-other special charges
       0230 = Incremental nursing charge rate-general
              classification
       0231 = Incremental nursing charge rate-nursery
       0232 = Incremental nursing charge rate-OB
       0233 = Incremental nursing charge rate-ICU (include
              transitional care)
       0234 = Incremental nursing charge rate-CCU (include
              transitional care)
       0235 = Incremental nursing charge rate-hospice
       0239 = Incremental nursing charge rate-other
       0240 = All inclusive ancillary-general classification
       0241 = All inclusive ancillary-basic
       0242 = All inclusive ancillary-comprehensive
       0243 = All inclusive ancillary-specialty
       0249 = All inclusive ancillary-other inclusive ancillary
       0250 = Pharmacy-general classification
       0251 = Pharmacy-generic drugs
       0252 = Pharmacy-nongeneric drugs
       0253 = Pharmacy-take home drugs
       0254 = Pharmacy-drugs incident to other diagnostic service-
              subject to payment limit
       0255 = Pharmacy-drugs incident to radiology-
              subject to payment limit
       0256 = Pharmacy-experimental drugs
       0257 = Pharmacy-non-prescription
       0258 = Pharmacy-IV solutions
       0259 = Pharmacy-other pharmacy
       0260 = IV therapy-general classification
       0261 = IV therapy-infusion pump
       0262 = IV therapy-pharmacy services (eff 10/94)
       0263 = IV therapy-drug supply/delivery (eff 10/94)
       0264 = IV therapy-supplies (eff 10/94)
       0269 = IV therapy-other IV therapy
       0270 = Medical/surgical supplies-general classification
              (also see 062X)
       0271 = Medical/surgical supplies-nonsterile supply
       0272 = Medical/surgical supplies-sterile supply
       0273 = Medical/surgical supplies-take home supplies
       0274 = Medical/surgical supplies-prosthetic/orthotic
              devices
       0275 = Medical/surgical supplies-pace maker
       0276 = Medical/surgical supplies-intraocular lens
       0277 = Medical/surgical supplies-oxygen-take home
       0278 = Medical/surgical supplies-other implants
       0279 = Medical/surgical supplies-other devices
       0280 = Oncology-general classification
       0289 = Oncology-other oncology
       0290 = DME (other than renal)-general classification
       0291 = DME (other than renal)-rental
       0292 = DME (other than renal)-purchase of new DME
       0293 = DME (other than renal)-purchase of used DME
       0294 = DME (other than renal)-related to and listed as DME
       0299 = DME (other than renal)-other
       0300 = Laboratory-general classification
       0301 = Laboratory-chemistry
       0302 = Laboratory-immunology
       0303 = Laboratory-renal patient (home)
       0304 = Laboratory-non-routine dialysis
       0305 = Laboratory-hematology
       0306 = Laboratory-bacteriology & microbiology
       0307 = Laboratory-urology
       0309 = Laboratory-other laboratory
       0310 = Laboratory pathological-general classification
       0311 = Laboratory pathological-cytology
       0312 = Laboratory pathological-histology
       0314 = Laboratory pathological-biopsy
       0319 = Laboratory pathological-other
       0320 = Radiology diagnostic-general classification
       0321 = Radiology diagnostic-angiocardiography
       0322 = Radiology diagnostic-arthrography
       0323 = Radiology diagnostic-arteriography
       0324 = Radiology diagnostic-chest X-ray
       0329 = Radiology diagnostic-other
       0330 = Radiology therapeutic-general classification
       0331 = Radiology therapeutic-chemotherapy injected
       0332 = Radiology therapeutic-chemotherapy oral
       0333 = Radiology therapeutic-radiation therapy
       0335 = Radiology therapeutic-chemotherapy IV
       0339 = Radiology therapeutic-other
       0340 = Nuclear medicine-general classification
       0341 = Nuclear medicine-diagnostic
       0342 = Nuclear medicine-therapeutic
       0343 = Nuclear medicine-diagnostic radiopharmaceuticals
       0344 = Nuclear medicine-therapeutic radiopharmaceuticals
       0349 = Nuclear medicine-other
       0350 = Computed tomographic (CT) scan-general
              classification
       0351 = CT scan-head scan
       0352 = CT scan-body scan
       0359 = CT scan-other CT scans
       0360 = Operating room services-general classification
       0361 = Operating room services-minor surgery
       0362 = Operating room services-organ transplant,
              other than kidney
       0367 = Operating room services-kidney transplant
       0369 = Operating room services-other operating room
              services
       0370 = Anesthesia-general classification
       0371 = Anesthesia-incident to RAD and
              subject to the payment limit
       0372 = Anesthesia-incident to other diagnostic service
              and subject to the payment limit
       0374 = Anesthesia-acupuncture
       0379 = Anesthesia-other anesthesia
       0380 = Blood-general classification
       0381 = Blood-packed red cells
       0382 = Blood-whole blood
       0383 = Blood-plasma
       0384 = Blood-platelets
       0385 = Blood-leukocytes
       0386 = Blood-other components
       0387 = Blood-other derivatives (cryopricipatates)
       0389 = Blood-other blood
       0390 = Blood storage and processing-general
              classification
       0391 = Blood storage and processing-blood
              administration
       0392 = Blood storage and processing - storage
              and processing
       0399 = Blood storage and processing-other
       0400 = Other imaging services-general classification
       0401 = Other imaging services-diagnostic mammography
       0402 = Other imaging services-ultrasound
       0403 = Other imaging services-screening mammography
              (eff 1/1/91)
       0404 = Other imaging services-positron emission
              tomography (eff 10/94)
       0409 = Other imaging services-other
       0410 = Respiratory services-general classification
       0412 = Respiratory services-inhalation services
       0413 = Respiratory services-hyperbaric oxygen therapy
       0419 = Respiratory services-other
       0420 = Physical therapy-general classification
       0421 = Physical therapy-visit charge
       0422 = Physical therapy-hourly charge
       0423 = Physical therapy-group rate
       0424 = Physical therapy-evaluation or re-evaluation
       0429 = Physical therapy-other
       0430 = Occupational therapy-general classification
       0431 = Occupational therapy-visit charge
       0432 = Occupational therapy-hourly charge
       0433 = Occupational therapy-group rate
       0434 = Occupational therapy-evaluation or re-evaluation
       0439 = Occupational therapy-other (may include
              restorative therapy)
       0440 = Speech language pathology-general classification
       0441 = Speech language pathology-visit charge
       0442 = Speech language pathology-hourly charge
       0443 = Speech language pathology-group rate
       0444 = Speech language pathology-evaluation or
              re-evaluation
       0449 = Speech language pathology-other
       0450 = Emergency room-general classification
       0451 = Emergency room-emtala emergency medical screening
              services (eff 10/96)
       0452 = Emergency room-ER beyond emtala screening
              (eff 10/96)
       0456 = Emergency room-urgent care (eff 10/96)
       0459 = Emergency room-other
       0460 = Pulmonary function-general classification
       0469 = Pulmonary function-other
       0470 = Audiology-general classification
       0471 = Audiology-diagnostic
       0472 = Audiology-treatment
       0479 = Audiology-other
       0480 = Cardiology-general classification
       0481 = Cardiology-cardiac cath lab
       0482 = Cardiology-stress test
       0483 = Cardiology-Echocardiology
       0489 = Cardiology-other
       0490 = Ambulatory surgical care-general classification
       0499 = Ambulatory surgical care-other
       0500 = Outpatient services-general classification
       0509 = Outpatient services-other
       0510 = Clinic-general classification
       0511 = Clinic-chronic pain center
       0512 = Clinic-dental center
       0513 = Clinic-psychiatric
       0514 = Clinic-OB-GYN
       0515 = Clinic-pediatric
       0516 = Clinic-urgent care clinic (eff 10/96)
       0517 = Clinic-family practice clinic (eff 10/96)
       0519 = Clinic-other
       0520 = Free-standing clinic-general classification
       0521 = Free-standing clinic-Clinic visit by a
              member to RHC/FQHC (eff. 7/1/06). Prior to
              7/1/06 - Rural Health-Clinic
       0522 = Free-standing clinic-Home visit by RHC/FQHC
              practitioner (eff. 7/1/06).  Prior to
              7/1/06 - Rural Health-Home
       0523 = Free-standing clinic-family practice
       0524 = Free-standing clinic - visit by RHC/FQHC
              practitioner to a member in a covered Part
              A stay at the SNF. (eff. 7/1/06)
       0525 = Free-standing clinic - visit by RHC/FQHC
              practitioner to a member in a SNF (not in
              a covered Part A stay) or NF or ICF MR or
              other residential facility. (eff. 7/1/06)
       0526 = Free-standing clinic-urgent care (eff 10/96)
       0527 = Free-standing clinic-RHC/FQHC visiting nurse
              service(s) to a member's home when in a home
              health shortage area. (eff. 7/1/06)
       0528 = Free-standing clinic-visit by RHC/FQHC
              practitioner to other non RHC/FQHC site
              (e.g. scene of accident).  (eff. 7/1/06)
       0529 = Free-standing clinic-other
       0530 = Osteopathic services-general classification
       0531 = Osteopathic services-osteopathic therapy
       0539 = Osteopathic services-other
       0540 = Ambulance-general classification
       0541 = Ambulance-supplies
       0542 = Ambulance-medical transport
       0543 = Ambulance-heart mobile
       0544 = Ambulance-oxygen
       0545 = Ambulance-air ambulance
       0546 = Ambulance-neo-natal ambulance
       0547 = Ambulance-pharmacy
       0548 = Ambulance-telephone transmission EKG
       0549 = Ambulance-other
       0550 = Skilled nursing-general classification
       0551 = Skilled nursing-visit charge
       0552 = Skilled nursing-hourly charge
       0559 = Skilled nursing-other
       0560 = Medical social services-general classification
       0561 = Medical social services-visit charge
       0562 = Medical social services-hourly charges
       0569 = Medical social services-other
       0570 = Home health aid (home health)-general
              classification
       0571 = Home health aid (home health)-visit charge
       0572 = Home health aid (home health)-hourly charge
       0579 = Home health aid (home health)-other
       0580 = Other visits (home health)-general
              classification (under HHPPS, not allowed
              as covered charges)
       0581 = Other visits (home health)-visit charge
              (under HHPPS, not allowed as covered charges)
       0582 = Other visits (home health)-hourly charge
              (under HHPPS, not allowed as covered charges)
       0583 = Other visits (home health) - assessments
              (under HHPPS, not allow as covered charges)
       0589 = Other visits (home health)-other
              (under HHPPS, not allowed as covered charges)
       0590 = Units of service (home health)-general
              classification (under HHPPS, not allowed
              as covered charges)
       0599 = Units of service (home health)-other
              (under HHPPS, not allowed as covered charges)
              (obsolete)
       0600 = Oxygen/Home Health-general classification
       0601 = Oxygen/Home Health-stat or port equip/supply
              or count
       0602 = Oxygen/Home Health-stat/equip/under 1 LPM
       0603 = Oxygen/Home Health-stat/equip/over 4 LPM
       0604 = Oxygen/Home Health-stat/equip/portable add-on
       0609 = Oxygen/Home Health - Other (Obsolete)
       0610 = Magnetic resonance technology (MRT)-general
              classification
       0611 = MRT/MRI-brain (including brainstem)
       0612 = MRT/MRI-spinal cord (including spine)
       0614 = MRT/MRI-other
       0615 = MRT/MRA-Head and Neck
       0616 = MRT/MRA-Lower Extremities
       0618 = MRT/MRA-other
       0619 = MRT/Other MRT
       0620 = Reserved (Use 0270 for general classification)
       0621 = Medical/surgical supplies-incident to radiology-
              subject to the payment limit - extension of 027X
       0622 = Medical/surgical supplies-incident to other
              diagnostic service-subject to the payment limit -
              extension of 027X
       0623 = Medical/surgical supplies-surgical dressings
              (eff 1/95) - extension of 027X
       0624 = Medical/surgical supplies-medical investigational
              devices and procedures with FDA approved IDE's
              (eff 10/96) - extension of 027X
       0630 = Reserved (eff. 1/98)
       0631 = Drugs requiring specific identification-single drug
              source (eff 9/93)
       0632 = Drugs requiring specific identification-multiple drug
              source (eff 9/93)
       0633 = Drugs requiring specific identification-restrictive
              prescription (eff 9/93)
       0634 = Drugs requiring specific identification-EPO under
              10,000 units
       0635 = Drugs requiring specific identification-EPO 10,000
              units or more
       0636 = Drugs requiring specific identification-detailed
              coding (eff 3/92)
       0637 = Self-administered drugs administered in an
              emergency situation - not requiring detailed
              coding
       0640 = Home IV therapy-general classification
              (eff 10/94)
       0641 = Home IV therapy-nonroutine nursing
              (eff 10/94)
       0642 = Home IV therapy-IV site care, central line
              (eff 10/94)
       0643 = Home IV therapy-IV start/change peripheral line
              (eff 10/94)
       0644 = Home IV therapy-nonroutine nursing, peripheral line
              (eff 10/94)
       0645 = Home IV therapy-train patient/caregiver, central
              line (eff 10/94)
       0646 = Home IV therapy-train disabled patient, central
              line (eff 10/94)
       0647 = Home IV therapy-train patient/caregiver, peripheral
              line (eff 10/94)
       0648 = Home IV therapy-train disabled patient, peripheral
              line (eff 10/94)
       0649 = Home IV therapy-other IV therapy services
              (eff 10/94)
       0650 = Hospice services-general classification
       0651 = Hospice services-routine home care
       0652 = Hospice services-continuous home care-1/2

       0655 = Hospice services-inpatient care
       0656 = Hospice services-general inpatient care
              (non-respite)
       0657 = Hospice services-physician services
       0658 = Hospice services-Hospice Room & Board -
              Nursing Facility
       0659 = Hospice services-other
       0660 = Respite care (HHA)-general classification
              (eff 9/93)
       0661 = Respite care (HHA)-hourly charge/skilled nursing
              (eff 9/93)
       0662 = Respite care (HHA)-hourly charge/home health aide/
              homemaker (eff 9/93)
       0663 = Respite care-daily respite care
       0669 = Respite care-other respite care
       0670 = OP special residence charges - general
              classification
       0671 = OP special residence charges - hospital based
       0672 = OP special residence charges - contracted
       0679 = OP special residence charges - other special
              residence charges
       0680 = Trauma Response-not used
       0681 = Trauma response-Level I Trauma
       0682 = Trauma response-Level II Trauma
       0683 = Trauma response-Level III Trauma
       0684 = Trauma response-Level IV Trauma
       0689 = Trauma response-Other trauma response
       0690 = Pre-hospice/Palliative Care Services - general
              (eff. 7/1/17)
       0691 = Pre-hospice/Palliative Care Services - visit
              (eff. 7/1/17)
       0692 = Pre-hospice/Palliative Care Services - hourly
              (eff. 7/1/17)
       0693 = Pre-hospice/Palliative Care Services - evaluation
              (eff. 7/1/17)
       0694 = Pre-hospice/Palliative Care Services - consultation &
              education (eff. 7/1/17)
       0695 = Pre-hospice/Palliative Care Services - Inpatient
              (eff. 7/1/17)
       0696 = Pre-hospice/Palliative Care Services - Physician
              (eff. 7/1/17)
       0699 = Pre-hospice/Palliative Care Services - Other
              (eff. 7/1/17)
       0700 = Cast room-general classification
       0709 = Cast room-other (obsolete)
       0710 = Recovery room-general classification
       0719 = Recovery room-other (obsolete)
       0720 = Labor room/delivery-general classification
       0721 = Labor room/delivery-labor
       0722 = Labor room/delivery-delivery
       0723 = Labor room/delivery-circumcision
       0724 = Labor room/delivery-birthing center
       0729 = Labor room/delivery-other
       0730 = EKG/ECG-general classification
       0731 = EKG/ECG-Holter moniter
       0732 = EKG/ECG-telemetry (include fetal monitering until
              9/93)
       0739 = EKG/ECG-other
       0740 = EEG-general classification
       0749 = EEG (electroencephalogram)-other (Obsolete)
       0750 = Gastro-intestinal services-general classification
       0759 = Gastro-intestinal services-other (Obsolete)
       0760 = Treatment or observation room-general
              classification
       0761 = Treatment or observation room-treatment room
              (eff 9/93)
       0762 = Treatment or observation room-observation room
              (eff 9/93)
       0769 = Treatment or observation room-other
       0770 = Preventative care services-general classification
              (eff 10/94)
       0771 = Preventative care services-vaccine administration
              (eff 10/94)
       0779 = Preventative care services-other (eff 10/94) (Obsolete)
       0780 = Telemedicine - general classification
              (eff 10/97)
       0789 = Telemedicine - telemedicine (eff 10/97) (Obsolete)
       0790 = Extra-Corporeal Shock Wave Therapy (ESWT) - general
              classification - formerly Lithotripsy
       0799 = Lithotripsy-other (Obsolete)
       0800 = Inpatient renal dialysis-general classification
       0801 = Inpatient renal dialysis-inpatient hemodialysis
       0802 = Inpatient renal dialysis-inpatient peritoneal
              (non-CAPD)
       0803 = Inpatient renal dialysis-inpatient CAPD
       0804 = Inpatient renal dialysis-inpatient CCPD
       0809 = Inpatient renal dialysis-other inpatient dialysis
       0810 = Organ acquisition-general classification
       0811 = Organ acquisition-living donor (eff 10/94);
              prior to 10/94, defined as living donor kidney
       0812 = Organ acquisition-cadaver donor (eff 10/94);
              prior to 10/94, defined as cadaver donor kidney
       0813 = Organ acquisition-unknown donor (eff 10/94)
              prior to 10/94, defined as unknown donor kidney
       0814 = Organ acquisition - unsuccessful organ search-
              donor bank charges (eff 10/94); prior to 10/94,
              defined as other kidney acquisition
       0815 = Allogeneic Stem Cell Acquisition/Donor Services
       0816 = Organ acquisition-other heart acquisition
              (obsolete, eff 10/94)
       0817 = Organ acquisition-donor-liver
              (obsolete, eff 10/94)
       0819 = Organ acquisition-other donor (eff 10/94);
              prior to 10/94, defined as other
       0820 = Hemodialysis OP or home dialysis-general
              classification
       0821 = Hemodialysis OP or home dialysis-hemodialysis-
              composite or other rate
       0822 = Hemodialysis OP or home dialysis-home supplies
       0823 = Hemodialysis OP or home dialysis-home equipment
       0824 = Hemodialysis OP or home dialysis-maintenance/100%
       0825 = Hemodialysis OP or home dialysis-support services
       0826 = Hemodialysis OP or home dialysis- Hemo short
              (eff. 7/1/17)
       0829 = Hemodialysis OP or home dialysis-other
       0830 = Peritoneal dialysis OP or home-general
              classification
       0831 = Peritoneal dialysis OP or home-peritoneal-
              composite or other rate
       0832 = Peritoneal dialysis OP or home-home supplies
       0833 = Peritoneal dialysis OP or home-home equipment
       0834 = Peritoneal dialysis OP or home-maintenance/100%
       0835 = Peritoneal dialysis OP or home-support services
       0839 = Peritoneal dialysis OP or home-other
       0840 = CAPD outpatient-general classification
       0841 = CAPD outpatient-CAPD/composite or other rate
       0842 = CAPD outpatient-home supplies
       0843 = CAPD outpatient-home equipment
       0844 = CAPD outpatient-maintenance/100%
       0845 = CAPD outpatient-support services
       0849 = CAPD outpatient-other
       0850 = CCPD outpatient-general classification
       0851 = CCPD outpatient-CCPD/composite or other rate
       0852 = CCPD outpatient-home supplies
       0853 = CCPD outpatient-home equipment
       0854 = CCPD outpatient-maintenance/100%
       0855 = CCPD outpatient-support services
       0859 = CCPD outpatient-other
       0860 = Magnetoencephalography (MEG) - general
              classification
       0861 = Magnetoencephalography (MEG) - MEG
       0880 = Miscellaneous dialysis-general classification
       0881 = Miscellaneous dialysis-ultrafiltration
       0882 = Miscellaneous dialysis-home dialysis aide visit
              (eff 9/93)
       0889 = Miscellaneous dialysis-other
       0890 = Other donor bank-general classification; changed to
              reserved for national assignment (eff 4/94)
       0891 = Other donor bank-bone; changed to
              reserved for national assignment (eff 4/94)
       0892 = Other donor bank-organ (other than kidney); changed
              to reserved for national assignment (eff 4/94)
              (term. 3/2020)
       0892 = Special Processed Drugs  - FDA Approved Gene
              Therapy (eff. 4/2020)
       0893 = Other donor bank-skin; changed to
              reserved for national assignment (eff 4/94)
       0899 = Other donor bank-other; changed to
              reserved for national assignment (eff 4/94)
       0900 = Behavior Health Treatment/Services - general
              classification (eff. 10/2004); prior to
              10/2004 defined as Psychiatric/psychological
              treatments-general classification
       0901 = Behavior Health Treatment/Services - electroshock
              treatment (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-electroshock treatment
       0902 = Behavior Health Treatment/Services - milieu
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-milieu therapy
       0903 = Behavior Health Treatment/Services - play
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-play therapy
       0904 = Behavior Health Treatment/Services - activity
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological
              treatments-activity therapy
       0905 = Behavior Health Treatment/Services - intensive
              outpatient services-psychiatric (eff. 10/2004)
       0906 = Behavior Health Treatment/Services - intensive
              outpatient services-chemical dependency
              (eff. 10/2004)
       0907 = Behavior Health Treatment/Services - community
              behavioral health program-day treatment
              (eff. 10/2004)
       0909 = Reserved for National Use (eff. 10/2004); prior
              to 10/2004 defined as Psychiatric/psychological
              treatments-other
       0910 = Behavioral Health Treatment/Services-Reserved for
              National Assignment (eff. 10/2004); prior to
              10/2004 defined as Psychiatric/psychological
              services-general classification
       0911 = Behavioral Health Treatment/Services-rehabilitation
              (eff. 10/2004); prior to 10/2004 defined as
              Psychiatric/psychological services-rehabilitation
       0912 = Behavioral Health Treatment/Services-partial
              hospitalization-less intensive (eff. 10/2004);
              prior to 10/2004 defined as Psychiatric/
              psychological services-less intensive
       0913 = Behavioral Health Treatment/Services-partial
              hospitalization-intensive (eff. 10/2004);
              prior to 10/2004 defined as Psychiatric/
              psychological services-intensive
       0914 = Behavioral Health Treatment/Services-indivi-
              dual therapy (eff. 10/2004); prior to
              10/2004 defined as Psychiatric/psychological
              services-individual therapy
       0915 = Behavioral Health Treatment/Services-group
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological services-
              group therapy
       0916 = Behavioral Health Treatment/Services-family
              therapy (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological services-
              family therapy
       0917 = Behavioral Health Treatment/Services-bio
              feedback (eff. 10/2004); prior to 10/2004
              defined as Psychiatric/psychological services-
              bio feedback
       0918 = Behavioral Health Treatment/Services-testing
              (eff. 10/2004); prior to 10/2004 defined as
              Psychiatric/psychological services-testing
       0919 = Behavioral Health Treatment/Services-other
              (eff. 10/2004); prior to 10/2004 defined as
              Psychiatric/psychological services-other
       0920 = Other diagnostic services-general classification
       0921 = Other diagnostic services-peripheral vascular lab
       0922 = Other diagnostic services-electromyelogram
       0923 = Other diagnostic services-pap smear
       0924 = Other diagnostic services-allergy test
       0925 = Other diagnostic services-pregnancy test
       0929 = Other diagnostic services-other
       0931 = Medical Rehabilitation Day Program - Half Day
       0932 = Medical Rehabilitation Day Program - Full Day
       0940 = Other therapeutic services-general classification
       0941 = Other therapeutic services-recreational therapy
       0942 = Other therapeutic services-education/training
              (include diabetes diet training)
       0943 = Other therapeutic services-cardiac rehabilitation
       0944 = Other therapeutic services-drug rehabilitation
       0945 = Other therapeutic services-alcohol
              rehabilitation
       0946 = Other therapeutic services-routine complex
              medical equipment
       0947 = Other therapeutic services-ancillary complex
              medical equipment (eff 3/92)
       0948 = Other therapeutic services- pulmonary rehab
       0949 = Other therapeutic services-other
       0951 = Professional Fees-athletic training (extension
              of 094X)
       0952 = Professional Fees-kinesiotherapy (extension
              of 094X)
       0953 = Chemical Dependency (eff. 4/2013)
       0960 = Professional fees-general classification
       0961 = Professional fees-psychiatric
       0962 = Professional fees-ophthalmology
       0963 = Professional fees-anesthesiologist (MD)
       0964 = Professional fees-anesthetist (CRNA)
       0969 = Professional fees-other
              NOTE:  097X is an extension of 096X
       0971 = Professional fees-laboratory
       0972 = Professional fees-radiology diagnostic
       0973 = Professional fees-radiology therapeutic
       0974 = Professional fees-nuclear medicine
       0975 = Professional fees-operating room
       0976 = Professional fees-respiratory therapy
       0977 = Professional fees-physical therapy
       0978 = Professional fees-occupational therapy
       0979 = Professional fees-speech pathology
              NOTE:  098X is an extension of 096X & 097X
       0981 = Professional fees-emergency room
       0982 = Professional fees-outpatient services
       0983 = Professional fees-clinic
       0984 = Professional fees-medical social services
       0985 = Professional fees-EKG
       0986 = Professional fees-EEG
       0987 = Professional fees-hospital visit
       0988 = Professional fees-consultation
       0989 = Professional fees-private duty nurse
       0990 = Patient convenience items-general classification
       0991 = Patient convenience items-cafeteria/guest tray
       0992 = Patient convenience items-private linen service
       0993 = Patient convenience items-telephone/telecom
       0994 = Patient convenience items-tv/radio
       0995 = Patient convenience items-nonpatient room rentals
       0996 = Patient convenience items-late discharge charge
       0997 = Patient convenience items-admission kits
       0998 = Patient convenience items-beauty shop/barber
       0999 = Patient convenience items-other
       1000 = Behavioral Health Accommodations -
              general classification
       1001 = Behavioral Health Accommodations -
              residential treatment -Psychiatric
       1002 = Behavioral Health Accommodations -
              residential treatment - chemical
              dependency
       1003 = Behavioral Health Accommodations -
              supervised living
       1004 = Behavioral Health Accommodations -
              halfway house
       1005 = Behavioral Health Accommodations -
              group home
       2100 = Alternative Therapy Services - general
              classification
       2101 = Alternative Therapy Services -
              Acupuncture
       2102 = Alternative Therapy Services -
              Acupressure
       2103 = Alternative Therapy Services -
              massage
       2104 = Alternative Therapy Services -
              reflexology
       2105 = Alternative Therapy Services -
              biofeedback
       2106 = Alternative Therapy Services -
              hypnosis
       2109 = Alternative Therapy Services -
              other alternative therapy service
       3100 = Adult Care - Reserved
       3101 = Adult Care - adult day care, medical
              and social hourly
       3102 = Adult Care - adult day care, social-
              hourly
       3103 = Adult Care - adult day care, medical
              and social - daily
       3104 = Adult Care - adult day care, social -
              daily
       3105 = Adult Care - adult foster care daily
       3109 = Adult Care - other adult care

       NOTE: Following Revenue Codes reported
       for NHCMQ (RUGS) demo claims effective
       2/96.

       9000 = RUGS-no MDS assessment available
       9001 = Reduced physical functions-
              RUGS PA1/ADL index of 4-5
       9002 = Reduced physical functions-
              RUGS PA2/ADL index of 4-5
       9003 = Reduced physical functions-
              RUGS PB1/ADL index of 6-8
       9004 = Reduced physical functions-
              RUGS PB2/ADL index of 6-8
       9005 = Reduced physical functions-
              RUGS PC1/ADL index of 9-10
       9006 = Reduced physical functions-
              RUGS PC2/ADL index of 9-10
       9007 = Reduced physical functions-
              RUGS PD1/ADL index of 11-15
       9008 = Reduced physical functions-
              RUGS PD2/ADL index of 11-15
       9009 = Reduced physical functions-
              RUGS PE1/ADL index of 16-18
       9010 = Reduced physical functions-
              RUGS PE2/ADL index of 16-18
       9011 = Behavior only problems-
              RUGS BA1/ADL index of 4-5
       9012 = Behavior only problems-
              RUGS BA2/ADL index of 4-5
       9013 = Behavior only problems-
              RUGS BB1/ADL index of 6-10
       9014 = Behavior only problems-
              RUGS BB2/ADL index of 6-10
       9015 = Impaired cognition-
              RUGS IA1/ADL index of 4-5
       9016 = Impaired cognition-
              RUGS IA2/ADL index of 4-5
       9017 = Impaired cognition-
              RUGS IB1/ADL index of 6-10
       9018 = Impaired cognition-
              RUGS IB2/ADL index of 6-10
       9019 = Clinically complex-
              RUGS CA1/ADL index of 4-5
       9020 = Clinically complex-
              RUGS CA2/ADL index of 4-5d
       9021 = Clinically complex-
              RUGS CB1/ADL index of 6-10
       9022 = Clinically complex-
              RUGS CB2/ADL index of 6-10d
       9023 = Clinically complex-
              RUGS CC1/ADL index of 11-16
       9024 = Clinically complex-
              RUGS CC2/ADL index of 11-16d
       9025 = Clinically complex-
              RUGS CD1/ADL index of 17-18
       9026 = Clinically complex-
              RUGS CD2/ADL index of 17-18d
       9027 = Special care-
              RUGS SSA/ADL index of 7-13
       9028 = Special care-
              RUGS SSB/ADL index of 14-16
       9029 = Special care-
              RUGS SSC/ADL index of 17-18
       9030 = Extensive services-
              RUGS SE1/1 procedure
       9031 = Extensive services-
              RUGS SE2/2 procedures
       9032 = Extensive services-
              RUGS SE3/3 procedures
       9033 = Low rehabilitation-
              RUGS RLA/ADL index of 4-11
       9034 = Low rehabilitation-
              RUGS RLB/ADL index of 12-18
       9035 = Medium rehabilitation-
              RUGS RMA/ADL index of 4-7
       9036 = Medium rehabilitation-
              RUGS RMB/ADL index of 8-15
       9037 = Medium rehabilitation-
              RUGS RMC/ADL index of 16-18
       9038 = High rehabilitation-
              RUGS RHA/ADL index of 4-7
       9039 = High rehabilitation-
              RUGS RHB/ADL index of 8-11
       9040 = High rehabilitation-
              RUGS RHC/ADL index of 12-14
       9041 = High rehabilitation-
              RUGS RHD/ADL index of 15-18
       9042 = Very high rehabilitation-
              RUGS RVA/ADL index of 4-7
       9043 = Very high rehabilitation-
              RUGS RVB/ADL index of 8-13
       9044 = Very high rehabilitation-
              RUGS RVC/ADL index of 14-18

       ***Changes effective for providers entering***
       **RUGS Demo Phase III as of 1/1/97 or later**

       9019 = Clinically complex-
              RUGS CA1/ADL index of 11
       9020 = Clinically complex-
              RUGS CA2/ADL index of 11D
       9021 = Clinically complex-
              RUGS CB1/ADL index of 12-16
       9022 = Clinically complex-
              RUGS CB2/ADL index of 12-16D
       9023 = Clinically complex-
              RUGS CC1/ADL index of 17-18
       9024 = Clinically complex-
              RUGS CC2/ADL index of 17-18D
       9025 = Special care-
              RUGS SSA/ADL index of 14
       9026 = Special care-
              RUGS SSB/ADL index of 15-16
       9027 = Special care-
              RUGS SSC/ADL index of 17-18
       9028 = Extensive services-
              RUGS SE1/ADL index 7-18/1 procedure
       9029 = Extensive services-
              RUGS SE2/ADL index 7-18/2 procedures
       9030 = Extensive services-
              RUGS SE3/ADL index 7-18/3 procedures
       9031 = Low rehabilitation-
              RUGS RLA/ADL index of 4-13
       9032 = Low rehabilitation-
              RUGS RLB/ADL index of 14-18
       9033 = Medium rehabilitation-
              RUGS RMA/ADL index of 4-7
       9034 = Medium rehabilitation-
              RUGS RMB/ADL index of 8-14
       9035 = Medium rehabilitation-
              RUGS RMC/ADL index of 15-18
       9036 = High rehabilitation-
              RUGS RHA/ADL index of 4-7
       9037 = High rehabilitation-
              RUGS RHB/ADL index of 8-12
       9038 = High rehabilitation-
              RUGS RHC/ADL index of 13-18
       9039 = Very High rehabilitation-
              RUGS RVA/ADL index of 4-8
       9040 = Very high rehabilitation-
              RUGS RVB/ADL index of 9-15
       9041 = Very high rehabilitation-
              RUGS RVC/ADL index of 16
       9042 = Very high rehabilitation-
              RUGS RUA/ADL index of 4-8
       9043 = Very high rehabilitation-
              RUGS RUB/ADL index of 9-15
       9044 = Ultra high rehabilitation-
              RUGS RUC/ADL index of 16-18



 REV_CNTR_THRPY_CAP_IND_CD_TB            Revenue Center Therapy CAP Indicator Code Table

      A = Hospital outpatient claims are subject to the
          therapy cap for this date of service (this indicator
          will be used on institutional claims only).

      B = Critical Access Hospital outpatient claims are
          subject to the therapy cap for this date of service
          (this indicator will be used on institutional claims
          only).  Note:  Currently, Critical Access Hospital
          claims are not subject to any therapy cap policies.
          Indicator B is created here to prepare for possible
          future legislation to include these claims.

      C = The therapy cap exceptions process, as indicated
          by the submission of the KX modifier, no longer
          applies for this date of service (this indicator
          will be used on both institutional and professional
          claims).

      D = The $3700 threshold for review therapy services
          no longer applies for this date of service (this
          indicator will be used on both institutional and
          professional claims).



 RP_IND_TB                               Claim Representative Payee (RP) Indicator Code Table

      R = bypass representative payee
      Space



 RSDL_PMT_IND_TB                         Claim Residual Payment Indicator Code Table

      X = Residual Payment
      Space



                                                           QUERY: RIFQQ11, RIFQQ21 ON DB2T
                                   *******END OF TOC APPENDIX FOR RECORD: FI_OP_CLM_REC********


