Read Me File for the 1999 Durable Medical Equipment, Prosthetics/Orthotics, and Supplies
           (DMEPOS) Fee Schedule Public Use File (PUF)


Disclaimer:         Inclusion or exclusion of a fee schedule for an item or service
                    does not imply any health insurance coverage.  

File Name:          Because of the DMEPOS fee schedule's quarterly update process,
                    the executable you receive will be named for the quarterly release
                    corresponding to that file.  The following naming conventions will
                    be used to identify each DMEPOS fee schedule PUF:  

               DME99_A.EXE:   January 1999 release
               DME99_B.EXE:   Second Quarter 1999 release
               DME99_C.EXE:   Third Quarter 1999 release
               DME99_D.EXE:   Fourth Quarter 1999 release

File           You have received a self-extracting, compressed file.  When
Contents:      decompressed, the executable explodes into four separate files:
               DMEBACK which outlines the policy origins of the DMEPOS fee
               schedule (in WordPerfect 6.1 (.wpd) and ASCII test (.txt) formats);
               DMEREAD which contains general information about the file's
               content, background, organization, update schedule, and record
               layout (in WordPerfect 6.1 (.wpd) and ASCII test (.txt) formats); as
               well as the DMEPOS fee schedule data available in  Excel (.xls)
               and comma delimited (.csv) formats and in an ASCII text (txt) which
               contains the fee schedule data in a non-grid format (i.e, one fee
               schedule per record).   

               Additionally, the quarterly release files will contain DMECHNG (in
               Excel (.xls) and comma delimited (.csv) formats) which identifies
               those prices which have changed during that quarterly update
               cycle. 
 
Decompressing  After copying the executable to your hard drive, use the following
the File:       steps to decompress the file:  
          
               Type CD and the hard drive directory you copied to
               Press Enter
               Type the file name of the executable minus the .exe
               Press Enter

Background:         The DMEPOS fee schedule contains fee schedule amounts,
                    floors, and ceilings for each procedure code subject to the
                    DMEPOS fee schedule payment methodology.  Although
                    these fee schedule amounts are contained in a single file,
                    their calculations have been mandated by three separate
                    payment methodologies:  DME, prosthetic and orthotic, and
                    surgical dressings.  For further information on these
                    payment methodologies and their policy histories, please
                    refer to DMEBACK.WPD.  

File                This file contains a fee schedule amount, floor, ceiling,
Organization:        jurisdiction, and category for each unique combination of
                    procedure code, modifier code (where applicable), and state
                    and is sorted in ascending DMEPOS category/procedure
                    code/modifier order.  

Update Schedule:         The DMEPOS fee schedule will be updated on a quarterly
                         basis, with the January 1 implementation date being the
                         primary update.  In addition to the January file, updated
                         PUFs will be available in early April, July, and October. 
                         Carriers will implement these updates by mid-month.  These
                         PUFs will be complete replacement files for the DMEPOS
                         fee schedule, not only the quarterly changes.  Please refer
                         to the file name section for the names used to identify each
                         release.  

               Record Layout: See Attachment A.  ATTACHMENT A-1


        Record Layout for the 1999 DMEPOS Fee Schedule PUF
                     EXCEL AND CSV FORMATS

COLUMN
NUMBER & NAME           COMMENT

1--HCPCS CODE     All current year active and deleted codes subject to DMEPOS
                  floors and ceilings.  

2--1ST MODIFIER   NU--Purchased, New
    RR--Rented
    UE--Purchased, Used

3--2ND MODIFIER   Reserved for future use.  

4--JURISDICTION   D--DMERC jurisdiction 
    L--Local Part B Carrier jurisdiction
    J--Joint DMERC/Local Carrier jurisdiction

5--CATEGORY       IN--Inexpensive and Other Routinely Purchased Items
    FS--Frequently Serviced Items
    CR--Capped Rental Items
    OX--Oxygen and Oxygen Equipment
    OS--Ostomy, Tracheostomy & Urological Items
    SD--Surgical Dressings
    PO--Prosthetics & Orthotics
    SU--Supplies
    TE--Transcutaneous Electrical Nerve Stimulators

6--CEILING         Maximum fee schedule amount.  
    Please note that since E0607 is priced via national Inherent
    Reasonableness, it is not priced using floors and ceilings.  For
    E0607, this field will be filled with zeros.  
    Since pricing amounts for E1405 and E1406 were developed
    by summing pricing amounts from source codes, they are not
    subject to ceilings and floors. 

7--FLOOR          Minimum fee schedule amount.  
    Please note that since E0607 is priced via national Inherent
    Reasonableness, it is not priced using floors and ceilings.  For
    E0607, this field will be filled with zeros.  
    Since pricing amounts for E1405 and E1406 were developed
    by summing pricing amounts from source codes, they are not
    subject to ceilings and floors.  

8--ALABAMA FEE SCHEDULE AMOUNT

9--ARKANSAS FEE SCHEDULE AMOUNT 

10--ARIZONA FEE SCHEDULE AMOUNT

11--CALIFORNIA FEE SCHEDULE AMOUNT

12--COLORADO FEE SCHEDULE AMOUNT

13--CONNECTICUT FEE SCHEDULE AMOUNT    

14--DISTRICT OF COLUMBIA FEE SCHEDULE AMOUNT

15--DELAWARE FEE SCHEDULE AMOUNT

16--FLORIDA FEE SCHEDULE AMOUNT

17--GEORGIA FEE SCHEDULE AMOUNT

18--IOWA FEE SCHEDULE AMOUNT

19--IDAHO FEE SCHEDULE AMOUNT

20--ILLINOIS FEE SCHEDULE AMOUNT

21--INDIANA FEE SCHEDULE AMOUNT

22--KANSAS FEE SCHEDULE AMOUNT

23--KENTUCKY FEE SCHEDULE AMOUNT

24--LOUISIANA FEE SCHEDULE AMOUNT

25--MASSACHUSETTS FEE SCHEDULE AMOUNT

26--MARYLAND FEE SCHEDULE AMOUNT

27--MAINE FEE SCHEDULE AMOUNT

28--MICHIGAN FEE SCHEDULE AMOUNT

29--MINNESOTA FEE SCHEDULE AMOUNT

30--MISSOURI FEE SCHEDULE AMOUNT

31--MISSISSIPPI FEE SCHEDULE AMOUNT

32--MONTANA FEE SCHEDULE AMOUNT

33--NORTH CAROLINA FEE SCHEDULE AMOUNT

34--NORTH DAKOTA FEE SCHEDULE AMOUNT

35--NEBRASKA FEE SCHEDULE AMOUNT

36--NEW HAMPSHIRE FEE SCHEDULE AMOUNT

37--NEW JERSEY FEE SCHEDULE AMOUNT 

38--NEW MEXICO FEE SCHEDULE AMOUNT

39--NEVADA FEE SCHEDULE AMOUNT

40--NEW YORK FEE SCHEDULE AMOUNT

41--OHIO FEE SCHEDULE AMOUNT

42--OKLAHOMA FEE SCHEDULE AMOUNT

43--OREGON FEE SCHEDULE AMOUNT

44--PENNSYLVANIA FEE SCHEDULE AMOUNT

45--RHODE ISLAND FEE SCHEDULE AMOUNT

46--SOUTH CAROLINA FEE SCHEDULE AMOUNT

47--SOUTH DAKOTA FEE SCHEDULE AMOUNT

48--TENNESSEE FEE SCHEDULE AMOUNT

49--TEXAS FEE SCHEDULE AMOUNT

50--UTAH FEE SCHEDULE AMOUNT

51--VIRGINIA FEE SCHEDULE AMOUNT

52--VERMONT FEE SCHEDULE AMOUNT

53--WASHINGTON FEE SCHEDULE AMOUNT

54--WISCONSIN FEE SCHEDULE AMOUNT

55--WEST VIRGINIA FEE SCHEDULE AMOUNT

56--WYOMING FEE SCHEDULE AMOUNT

57 --ALASKA FEE SCHEDULE AMOUNT   Fee schedule amounts for non-continental areas are not subject to the
                                  ceilings and floors. 

58--HAWAII FEE SCHEDULE AMOUNT    Fee schedule amounts for non-continental areas are not subject to the
                                  ceilings and floors. 

59--PUERTO RICO FEE SCHEDULE AMT  Fee schedule amounts for non-continental areas are not subject to the
                                  ceilings and floors. 

60--VIRGIN ISLANDS FEE SCHED AMT  Fee schedule amounts for non-continental areas are not subject to the
                                  ceilings and floors.

61--SHORT DESCRIPTION  

ATTACHMENT A-2

        Record Layout for the 1999 DMEPOS Fee Schedule PUF
                           TEXT FORMAT
         
       START/
       END
FIELD NAME         POSITION PIC        COMMENT

 
DATA RECORD
1--YEAR           1-4   X(04)          Value  1999 '

2--FILLER          5-5  X(01)     Value  ,'

3--HCPCS CODE     6-10  X(05)               All current year active and deleted
                                            codes subject to DMEPOS floors and
                                            ceilings

4--FILLER          11-11    X(01)           Value  ,' 

5--MODIFIER       12-13 X(02)     NU--Purchased, New
                   RR--Rented
                   UE--Purchased, Used

6--FILLER          14-14    X(01)      Value  ,' 

7--SECOND MODIFIER 15-16    X(02) Reserved for future use.  

8--FILLER          17-17    X(01)      Value  ,' 

9--JURISDICTION   18-18 X(01)     D--DMERC jurisdiction 
                   L--Local Part B Carrier jurisdiction
                   J--Joint DMERC/Local Carrier
                   jurisdiction

10--FILLER         19-19    X(01)      Value  ,' 

11--CATEGORY      20-21 X(02)     IN--Inexpensive and Other Routinely
                                  Purchased Items
                   FS--Frequently Serviced Items
                   CR--Capped Rental Items
                   OX--Oxygen and Oxygen Equipment
                   OS--Ostomy, Tracheostomy &
                   Urological Items
                   SD--Surgical Dressings
                   PO--Prosthetics & Orthotics
                   SU--Supplies
                   TE--Transcutaneous Electrical Nerve
                   Stimulators

12--FILLER         22-22    X(01)      Value  ,' 

13--STATUS        23-23 X(01)     Indicates active/delete status in HCPCS
                                  file
                   A--Active Code
                   D--Deleted Code, price provided for                              grace period processing only
14--FILLER           24-24 X(01)     Value  ,' 

15--REGION  25-26    X(02) This amount is not used for pricing                              claims.  It is on file for informational
                                                                                            purposes.
                               00--For all non Prosthetic and Orthotic
                               Services 
                               01-10--For Prosthetic and Orthotic
                               Services Only.  This field denotes the
                               applicable regional fee schedule 

16--FILLER           27-27 X(01)        Value  ,' 
  
17--STATE            28-32 X(05)     

18--FILLER           33-33 X(01)      Value  ,' 

19--ORIGINAL BASE    34-42 999999.99      This amount is not used for pricing
      YEAR FEE                       claims.  It is on file for informational
                                     purposes. 
                               For capped rental services this
                               amount represents the base fee after
                               adjustments for rebasing and
                               statewide conversions.
                               The base year for E0607 and L8603 is
                               1995. 
                               Since pricing amounts for E1405 and
                               E1406 are developed by summing
                               pricing amounts from source codes,
                               they do not have a true base fee.  For
                               these codes, this field will be filled with
                               zeros. 

20--FILLER           43-43 X(01)     Value  ,' 

21--CEILING 44-52    999999.99 This amount is not used for pricing
                               claims.  It is on file for informational
                               purposes, and could be integrated into
                               other processes (i.e., IR review,
                               validation, inquiries).
                               Please note that since E0607 is priced
                               via national Inherent Reasonableness,
                               it is not priced using floors and
                               ceilings.  For E0607, this field will be
                               filled with zeros.
                               Since pricing amounts for E1405 and
                               E1406 are developed by summing
                               pricing amounts from source codes,
                               they are not subject to ceilings and
                               floors.  For these codes, this field will
                               be filled with zeros.

22--FILLER           53-53 X(01)     Value  ,' 


23--FLOOR            54-62 999999.99 This amount is not used for pricing
                                     claims.  It is on file for informational
                                     purposes, and could be integrated into
                                     other processes (i.e., IR review,
                                     validation, inquiries).
                               Please note that since E0607 is priced
                               via national Inherent Reasonableness,
                               it is not priced using floors and
                               ceilings.  For E0607, this field will be
                               filled with zeros.
                               Since pricing amounts for E1405 and
                               E1406 are developed by summing
                               pricing amounts from source codes,
                               they are not subject to ceilings and
                               floors.  For these codes, this field will
                               be filled with zeros.

24--FILLER           63-63 X(01)     Value  ,' 

25--UPDATED FEE      64-72 999999.99 Amount used for pricing
SCHEDULE AMOUNT

26--FILLER           73-73 X(01)     Value  ,'

27--GAP FILL         74-74 X(01)     0--No Gap-filling Required
INDICATOR                            1--Carrier Needs to Gap-fill Original
                                     Base Year Amount 

28--FILLER           75-75 X(01)     Value  ,'
  
29--PRICING CHANGE   76-76 X(01)     0--No change to Updated Fee
INDICATOR                            Schedule Amount since previous
                                     release
                               1--A change has occurred to the        
                                Updated Fee Schedule Amount
                               since the previous release 
                               NOTE: In the initial release of the
                               annual update, this field is initialized
                               to  0'

30--FILLER           77-77 X(01)     Value  ,'

31--SHORT            78-105    X(28)
DESCRIPTION