CMS RIF REPORT

 AS OF: 10/28/2010

 NAME LENGTH BEG END CONTENTS

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 *** HCPCS Contractor Record - 2011

 320 1 320 REC

 2011 Healthcare Common Procedure Coding System (HCPCS)

 Contractor record description.

 STANDARD ALIAS : HCPCS_CNTRCTR_11_REC

SYSTEM ALIAS : HCPCS11C

 1. Healthcare Common Procedure Coding System Code

 5 1 5 CHAR

 The 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 two

 levels, or groups, as described Below:

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 non-physician services.

   NOTE: ** **

 CPT-4 codes including both long and short descriptions

 shall be used in accordance with the CMS/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,

 eighth edition (CDT-2011/12). 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 CMS, 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 non-physician services that are not

represented in the level I codes.

 DB2 ALIAS : UNDEFINED

 SAS ALIAS : HCPCS_CD

STANDARD ALIAS : HCPCS_CD

 TITLE ALIAS : HCPCS_CD

 LENGTH : 5

 2. HCPCS Code Redefinition Group

 5 1 5 GRP

 REDEFINE : HCPCS_CD

 3. FILLER CHAR

 3 1 3

 DB2 ALIAS : FILLER

 LENGTH : 3

 4. HCPCS Modifier Code

 2 4 5 CHAR

 A modifier provides the means by which the reporting

 physician or provider can indicate that a service or

 procedure that has been performed has been altered by some

specific circumstance but not changed in its definition or

code. The judicious application of modifiers obviates the

necessity for separate procedure listings that may describe

the modifying circumstance. Modifiers may be used to

indicate to the recipient of a report that:

 > A service or procedure has both a professional

 and technical component.

> A service or procedure was performed by more

 than one physician and/or in more than one

 location.

> A service or procedure has been increased or

 reduced.

 > Only part of a service was performed.

> An adjunctive service was performed.
 > A bilateral procedure was performed.

> A service or procedure was provided more than

once.

 > Unusual events occurred.

 HCPCS modifier codes are divided into two levels, or

groups, as described below:

 Level I

Codes and descriptors copyrighted by the American Medical

 Association's current procedural terminology, fourth

 edition (CPT-4). These are 2 position numeric codes.

   NOTE: ** **

 CPT-4 codes including both long and short descriptions

 shall be used in accordance with the CMS/AMA agreement.

Any other use violates the AMA copyright.

Level II

Codes and descriptors approved and maintained jointly by

the alpha-numeric editorial panel (consisting of CMS, the

 Health Insurance Association of America, and the Blue

Cross and Blue Shield Association). These are 2 position

 alpha-numeric codes.

 DB2 ALIAS : UNDEFINED

SAS ALIAS : MDFR

 STANDARD ALIAS : HCPCS_MDFR_CD

 LENGTH : 2

SOURCE : CMS

 5. HCPCS Sequence Number

 5 6 10 NUM

 Sequence number by 100s. Used to group procedure

or modifier codes together.

 DB2 ALIAS : UNDEFINED

 STANDARD ALIAS : HCPCS_SQNC_NUM

LENGTH : 5 SIGNED : N

 6. HCPCS Record Identification Code
 1 11 11 CHAR

 Code to identify record type

DB2 ALIAS : UNDEFINED

 SAS ALIAS : RIC

 STANDARD ALIAS : HCPCS_REC_IDENT_CD

LENGTH : 1

 CODES :

 3 = First line of procedure record

 also contains detail information

 in positions 92-275

 4 = Second, third, fourth, etc., Description

 of procedure record. No detail information

in positions 92-275

 7 = First line of modifier record

 also contains detail information

in positions 92-275

 8 = Second, third, fourth, etc., Description

 of modifier record. No detail information

 in positions 92-275

 7. HCPCS Long Description

 80 12 91 CHAR

 Contains all text of procedure or modifier long

 descriptions.

The AMA owns the copyright on the CPT codes and

 descriptions; CPT codes and descriptions are not

 public property and must always be used in compliance

with copyright law.

DB2 ALIAS : UNDEFINED

SAS ALIAS : DESC_TXT

STANDARD ALIAS : HCPCS_LONG_DESC_TXT

 LENGTH : 80

 8. HCPCS Short Description

 28 92 119 CHAR

 Short descriptive text of procedure or modifier code
 (28 characters or less).

The AMA owns the copyright on the CPT codes and

descriptions; CPT codes and descriptions are not

 public property and must always be used in compliance

with copyright law.

 DB2 ALIAS : UNDEFINED

 SAS ALIAS : SHRTDESC

STANDARD ALIAS : HCPCS_SHRT_DESC_TXT

 TITLE ALIAS : HCPCS_SHORT_DESC_TEXT

 LENGTH : 28

 9. HCPCS Pricing Indicator Code

 2 120 121 CHAR

 Code used to identify the appropriate methodology for

 developing unique pricing amounts under part B. A 

procedure

may have one to four pricing codes.

DB2 ALIAS : UNDEFINED

SAS ALIAS : PRCNGCD

STANDARD ALIAS : HCPCS_PRCNG_IND_CD

LENGTH : 2

CODES :

 00 = Service not separately priced by part B

 (e.g., services not covered, bundled, used

 by part a only, etc.)

 Physician Fee Schedule And Non-Physician Practitioners

 ------------------------------------------------------

 Linked To The Physician Fee Schedule

 ------------------------------------

 11 = Price established using national RVU's

 12 = Price established using national anesthesia

 base units

 13 = Price established by carriers (e.g., not

 otherwise classified, individual determination,

 carrier discretion)

 Clinical Lab Fee Schedule

 -------------------------

21 = Price subject to national limitation amount
 22 = Price established by carriers (e.g.,

 gap-fills, carrier established panels)

 Durable Medical Equipment, Prosthetics, Orthotics,

 --------------------------------------------------

 Supplies And Surgical Dressings

-------------------------------

31 = Frequently serviced DME (price

 subject to floors and ceilings)

 32 = Inexpensive & routinely purchased

 DME (price subject to floors and

 ceilings)

 33 = Oxygen and oxygen equipment (price

 subject to floors and ceilings)

 34 = DME supplies (price subject to floors

 and ceilings)

 35 = Surgical dressings (price subject to

 floors and ceilings)

 36 = Capped rental DME (price subject to

 floors and ceilings)

 37 = Ostomy, tracheostomy and urological

 supplies (price subject to floors and

 ceilings)

 38 = Orthotics, prosthetics, prosthetic

 devices & vision services (price subject

 to floors and ceilings)

 39 = Parenteral and Enteral Nutrition

 45 = Customized DME items

 46 = Carrier priced (e.g., not otherwise classified,

 individual determination, carrier discretion,

gap-filled amounts)

 Other

 -----

 51 = Drugs

 52 = Reasonable charge

 53 = Statute

 54 = Vaccinations

 55 = Priced by carriers under clinical psychologist

 fee schedule (not applicable as of January 1, 1998)

 56 = Priced by carriers under clinical

 social worker fee schedule (not applicable as of

 January 1, 1998)

 57 = Other carrier priced

99 = Value not established

 OCCURS MIN: 4 OCCURS MAX: 0
 10. HCPCS Multiple Pricing Indicator Code

 1 128 128 CHAR

 Code used to identify instances where a procedure

 could be priced under multiple methodologies.

 DB2 ALIAS : UNDEFINED

SAS ALIAS : MULTCD

 STANDARD ALIAS : HCPCS_MLTPL_PRCNG_IND_CD

 LENGTH : 1

CODES :

 9 = Not applicable as HCPCS not priced separately

 by part B (pricing indicator is 00) or value

is not established (pricing indicator is '99')

 A = Not applicable as HCPCS priced under one

 methodology

 B = Professional component of HCPCS priced using

 RVU's, while technical component and global

service priced by Medicare part B carriers

 C = Physician interpretation of clinical lab service

 is priced under physician fee schedule using

 RVU's, while pricing of lab service is paid

 under clinical lab fee schedule

 D = Service performed by physician is priced under

 physician fee schedule using RVU's, while service

 performed by clinical psychologist is priced

 under clinical psychologist fee schedule

 (not applicable as of January 1, 1998)

 E = Service performed by physician is priced under

 physician fee schedule using RVU's, service

performed by clinical psychologist is priced

 under clinical psychologist's fee schedule and

 service performed by clinical social worker

is priced under clinical social worker fee

 schedule (not applicable as of January 1, 1998)

 F = Service performed by physician is priced under

 physician fee schedule by carriers, service

 performed by clinical psychologist is priced

under clinical psychologist's fee schedule and

service performed by clinical social worker

is priced under clinical social worker fee

 schedule (not applicable as of January 1, 1998)
 G = Clinical lab service priced under reasonable

 charge when service is submitted on claim with

blood products, while service is priced under

clinical lab fee schedule when there are no

 blood products on claim.

 11. HCPCS Coverage Issues Manual Reference Section Number

 6 129 134 CHAR

 Number identifying the reference section of the

 coverage issues manual.

DB2 ALIAS : UNDEFINED

 SAS ALIAS : CIM

 STANDARD ALIAS : HCPCS_CIM_RFRNC_SECT_NUM

LENGTH : 6

OCCURS MIN: 3 OCCURS MAX: 0

 12. HCPCS Medicare Carriers Manual Reference Section Number

 8 147 154 CHAR

 Number identifying a section of the Medicare carriers

 manual.

 DB2 ALIAS : UNDEFINED

SAS ALIAS : MCM

 STANDARD ALIAS : HCPCS_MCM_RFRNC_SECT_NUM

 LENGTH : 8

OCCURS MIN: 3 OCCURS MAX: 0

 13. HCPCS Statute Number

 10 171 180 CHAR

 Number identifying statute reference for coverage or

non-coverage of procedure or service.

 DB2 ALIAS : UNDEFINED

 SAS ALIAS : STATUTE

STANDARD ALIAS : HCPCS_STATUTE_NUM

 LENGTH : 10
 14. HCPCS Lab Certification Code

 3 181 183 CHAR

 Code used to classify laboratory procedures according

to the specialty certification categories listed by

CMS. Any generally certified laboratory (e.g., 100)

 may perform any of the tests in its subgroups (e.g.,

 110, 120, etc.).

DB2 ALIAS : UNDEFINED

 SAS ALIAS : LABCERT

 STANDARD ALIAS : HCPCS_LAB_CRTFCTN_CD

LENGTH : 3

 CODES :

 010 = Histocompatibility testing

100 = Microbiology

 110 = Bacteriology

 115 = Mycobacteriology

120 = Mycology

130 = Parasitology

140 = Virology

150 = Other microbiology

 200 = Diagnostic immunology

 210 = Syphilis serology

 220 = General immunology

 300 = Chemistry

 310 = Routine chemistry

 320 = Urinalysis

330 = Endocrinology

 340 = Toxicology

 350 = Other chemistry

 400 = Hematology

 500 = Immunohematology

 510 = Abo group & RH type

520 = Antibody detection (transfusion)

 530 = Antibody detection (nontransfusion)

 540 = Antibody identification

550 = Compatibility testing

 560 = Other immunohematology

 600 = Pathology

 610 = Histopathology

 620 = Oral pathology
 630 = Cytology

 800 = Radiobioassay

 900 = Clinical cytogenetics

OCCURS MIN: 8 OCCURS MAX: 0

 15. HCPCS Cross Reference Code

 5 205 209 CHAR

 An explicit reference crosswalking a deleted code

 or a code that is not valid for Medicare to a

valid current code (or range of codes).

DB2 ALIAS : UNDEFINED

SAS ALIAS : XREF

STANDARD ALIAS : HCPCS_XREF_CD

LENGTH : 5

OCCURS MIN: 5 OCCURS MAX: 0

 16. HCPCS Coverage Code

 1 230 230 CHAR

 A code denoting Medicare coverage status.

 DB2 ALIAS : UNDEFINED

SAS ALIAS : CVRG_CD

 STANDARD ALIAS : HCPCS_CVRG_CD

 LENGTH : 1

CODES :

 D = Special coverage instructions apply

 I = Not payable by Medicare

 M = Non-covered by Medicare

 S = Non-covered by Medicare statute

 C = Carrier judgment

 17. HCPCS ASC Payment Group Code

 2 231 232 GRP

 CHAR

 The 'YY' indicator represents that this procedure is approved

to be performed in an ambulatory surgical center. You must
access the ASC tables on the mainframe or CMS website to get 

the dollar amounts. Payment group rates, which are updated

annually, (most recently on April 1, 2004), are as follows:

 Group 1 - $333; Group 2 - $446; Group 3 - $510; Group 4 –

$630; Group 5 - $717; Group 6 - $826 ($676 for intraocular

lenses IOLS); Group 7 - $995; Group 8 - $973 ($823+$150 for

IOLS); Group 9 - $1339. The $150 payment allowance in groups

6 and 8 is for intraocular lenses.

 DB2 ALIAS : UNDEFINED

 SAS ALIAS : ASCIND

STANDARD ALIAS : HCPCS_ASC_PMT_GRP_CD

LENGTH : 2

EDIT RULES :

 CODE: YY

BLANK = Not Approved For ASC

 18. HCPCS ASC Payment Group Effective Date

 8 233 240 GRP

 NUM

 The date the procedure is assigned to the ASC

 payment group.

DB2 ALIAS : UNDEFINED

 SAS ALIAS : ASCGRP

 STANDARD ALIAS : HCPCS_ASC_PMT_GRP_EFCTV_DT

TITLE ALIAS : HCPCS_ASC_PMT_GROUP_EFCTV_DT

 LENGTH : 8 SIGNED : N

 EDIT RULES :

 YYYYMMDD

 19. HCPCS MOG Payment Group Code

 3 241 243 GRP

 CHAR

Medicare outpatient groups (MOG) payment group code

 DB2 ALIAS : UNDEFINED

 SAS ALIAS : MOGGRP

STANDARD ALIAS : HCPCS_MOG_PMT_GRP_CD
 LENGTH : 3

COMMENTS :

1St digit indicates the body system

 2nd digit is sequential numbering within the body system

 3rd digit is the level of intensity where:

'1', '2', '3' or '4' represents levels

for a given group type

'0' and '9' represent single level

for a given group type

 CODES :

 No MOG applies

000 = No MOG applies

 Integumentary

 102 = Level II needle biopsy/aspiration

112 = Level II incision and drainage

 132 = Level II debridement/destruction

 142 = Level II excision/biopsy

143 = Level III excision/biopsy

 151 = Level I skin repair

 152 = Level II skin repair

153 = Level III skin repair

 160 = Incision/excision breast

 169 = Breast reconstruction/mastectomy

 Musculoskeletal

 201 = Level I skull and facial bone procedures

202 = Level II skull and facial bone procedures

 211 = Level I hand musculoskeletal procedures

 212 = Level II hand musculoskeletal procedures

 221 = Level I foot musculoskeletal procedures

 222 = Level II foot musculoskeletal procedures

 231 = Level I musculoskeletal procedures

232 = Level II musculoskeletal procedures

 233 = Level III musculoskeletal procedures

241 = Level I arthroscopy

 242 = Level II arthroscopy

 260 = Closed treatment fracture finger/toe/trunk

 269 = Closed treatment fracture/dislocation/except
 finger/toe/trunk

 270 = Open/percutaneous treatment fracture or dislocation

279 = Bone/joint manipulation under anesthesia

 280 = Bunion procedures

289 = Arthroplasty

290 = Arthroplasty with prosthesis

 ENT/Respiratory/Cardiovascular/Lymphatic/Endocrine

 302 = Level II ENT procedures

 303 = Level III ENT procedures

 304 = Level IV ENT procedures

 309 = Implantation of cochlear device (ASC rate does

 not include cost of implant)

 310 = Nasal cauterization/packing

319 = Tonsil/adenoid procedures

322 = Level II endoscopy upper airway

323 = Level III endoscopy upper airway

 329 = Endoscopy lower airway

 330 = Thoracentesis/lavage procedures

350 = Placement transvenous caths/cutdown

 359 = Removal/revision, pacemaker/vascular device

 360 = Vascular ligation

369 = Vascular repair/fistula construction

 370 = Lymph node excisions

 379 = Thyroid/lymphadenectomy procedures

 Digestive

 400 = Esophageal dilation without endoscopy

 410 = Esophagoscopy

421 = Level I upper GI endoscopy/intubation

 422 = Level II upper GI endoscopy/intubation

 429 = Lower GI endoscopy

 430 = Anoscopy and diagnostic sigmoidoscopy

 439 = Therapeutic proctosigmoidoscopy

440 = Small intestine endoscopy

449 = Percutaneous biliary endoscopic procedures

 450 = Endoscopic retrograde cholangio-pancreatography

 (ERCP)

 460 = Hernia/hydrocele procedures

 472 = Level II anal/rectal procedures

473 = Level III anal/rectal procedures

480 = Peritoneal and abdominal procedures

490 = Tube procedures
 Urinary/Genital

 501 = Level I laparoscopy

 502 = Level II laparoscopy

 509 = Lithotripsy

 511 = Level I cystourethroscopy and other

 genitourinary procedures

 512 = Level II cystourethroscopy and other

 genitourinary procedures

 513 = Level III cystourethroscopy and other

 genitourinary procedures

 521 = Level I urethral procedures

522 = Level II urethral procedures

530 = Circumcision

539 = Penile procedures

540 = Insertion of penile prosthesis (ASC rate does

 include cost of implant)

 549 = Testes/epididymis procedures

550 = Prostrate biopsy

 562 = Level II female reproductive procedures

 563 = Level III female reproductive procedures

570 = Surgical hysteroscopy

 579 = D & C

 580 = Spontaneous abortion

589 = Therapeutic abortion

Nervous/Eye

602 = Level II nervous system injections

 609 = Revision/removal neurological device

 610 = Implantation of neurostimulator electrodes (ASC

 rate does not include cost of implant)

 619 = Implantation of neurological devices (ASC rate

 does not include cost of implant)

 621 = Level I nerve procedures

622 = Level II nerve procedures

629 = Spinal tap

639 = Laser eye procedures except retinal

 640 = Cataract procedures

649 = Cataract procedures with IOL insert (includes

 $150 insert)

 651 = Level I anterior segment eye procedures

652 = Level II anterior segment eye procedures

 659 = Corneal transplant (ASC rate includes price
 of transplant)

 660 = Posterior segment eye procedures

 669 = Strabismus/muscle procedures

 673 = Level III eye procedure

674 = Level IV eye procedure

 680 = Vitrectomy

 689 = Implantation/replacement of intraitreal drug

 20. HCPCS MOG Payment Policy Indicator

 1 244 244 CHAR

 Indicator identifying whether a HCPCS code is subject

to payment of an ASC facility fee, to a separate

 fee under another provision of Medicare, or to no

 fee at all.

DB2 ALIAS : UNDEFINED

SAS ALIAS : MOGIND

STANDARD ALIAS : HCPCS_MOG_PMT_PLCY_IND_CD

LENGTH : 1

CODES :

 1 = ASC covered procedure

 2 = Bundled service/no separate payment

 3 = Excluded from ASC list

 4 = Invalid code/90 day grace period

 6 = Separate payment when furnished in an ASC

 7 = ASC restricted coverage procedure

 9 = ASC payment not applicable

 21. HCPCS MOG Effective Date

 8 245 252 GRP

 NUM

The date the procedure is assigned to the Medicare

outpatient group (MOG) payment group.

DB2 ALIAS : UNDEFINED

SAS ALIAS : MOGDTE

STANDARD ALIAS : HCPCS_MOG_PMT_GRP_EFCTV_DT

LENGTH : 8 SIGNED : N

EDIT RULES :
 YYYYMMDD

 22. HCPCS Processing Note Number

 4 253 256 CHAR

 Number identifying the processing note contained

in Appendix A of the HCPCS manual.

DB2 ALIAS : UNDEFINED

SAS ALIAS : PROCNOTE

STANDARD ALIAS : HCPCS_PRCSG_NOTE_NUM

 LENGTH : 4

 23. HCPCS Berenson-Eggers Type Of Service Code

 3 257 259 CHAR

 This field is valid beginning with 2003 data.

The Berenson-Eggers Type of Service (BETOS) for the

procedure code based on generally agreed upon clinically

 meaningful groupings of procedures and services.

 DB2 ALIAS : UNDEFINED

SAS ALIAS : BETOS

STANDARD ALIAS : HCPCS_BETOS_CD

TITLE ALIAS : BETOS_CD

LENGTH : 3

 CODE TABLE : BETOS_TB

 24. FILLER CHAR

 1 260 260

 DB2 ALIAS : FILLER

 LENGTH : 1

 25. HCPCS Type Of Service Code

 1 261 261 CHAR

 The carrier assigned CMS type of service which

 describes the particular kind(s) of service

 represented by the procedure code.

DB2 ALIAS : UNDEFINED
 SAS ALIAS : TYPESRVC

 STANDARD ALIAS : HCPCS_TYPE_SRVC_CD

LENGTH : 1

 CODE TABLE : CMS_TYPE_SRVC_TB

 OCCURS MIN: 5 OCCURS MAX: 0

 26. HCPCS Anesthesia Base Unit Quantity

 3 266 268 NUM

 The base unit represents the level of intensity for

anesthesia procedure services that reflects all

activities except time. These activities include

usual preoperative and post-operative visits, the

administration of fluids and/or blood incident to

anesthesia care, and monitoring procedures.

 (Note: the payment amount for anesthesia services

is based on a calculation using base unit, time

units, and the conversion factor.)

DB2 ALIAS : UNDEFINED

 SAS ALIAS : BASEUNIT

 STANDARD ALIAS : HCPCS_ANSTHSA_BASE_UNIT_QTY

TITLE ALIAS : HCPCS_ANESTHESIA_BASE_UNIT_QTY

 LENGTH : 3 SIGNED : N

 27. HCPCS Code Added Date

 8 269 276 NUM

 The year the HCPCS code was added to the Healthcare

 common procedure coding system.

 DB2 ALIAS : HCPCS_CD_ADD_DT

SAS ALIAS : ADD_DT

STANDARD ALIAS : HCPCS_CD_ADD_DT

LENGTH : 8 SIGNED : N

EDIT RULES :

 YYYYMMDD

 28. HCPCS Action Effective Date
 8 277 284 NUM

 Effective date of action to a procedure or

 modifier code

 DB2 ALIAS : UNDEFINED

SAS ALIAS : EFCTV_DT

 STANDARD ALIAS : HCPCS_ACTN_EFCTV_DT

 LENGTH : 8 SIGNED : N

EDIT RULES :

 YYYYMMDD

 29. HCPCS Termination Date

 8 285 292 NUM

 Last date for which a procedure or modifier

code may be used by Medicare providers.

 DB2 ALIAS : UNDEFINED

SAS ALIAS : TERM_DT

STANDARD ALIAS : HCPCS_TRMNTN_DT

TITLE ALIAS : HCPCS_TERMINATION_DT

LENGTH : 8 SIGNED : N

EDIT RULES :

 YYYYMMDD

 30. HCPCS Action Code

 1 293 293 CHAR

 A code denoting the change made to a procedure

or modifier code within the HCPCS system.

DB2 ALIAS : UNDEFINED

SAS ALIAS : ACTN_CD

 STANDARD ALIAS : HCPCS_ACTN_CD

 LENGTH : 1

CODES :

 A = Add procedure or modifier code

B = Change in both administrative data field
 and long description of procedure or

modifier code

 C = Change in long description of procedure or

 modifier code

 D = Discontinue procedure or modifier code

 F = Change in administrative data field of

 procedure or modifier code

 N = No maintenance for this code

P = Payment change (MOG, pricing indicator codes,

 anesthesia base units, Ambulatory Surgical Centers)

 R = Re-activate discontinued/deleted procedure

 or modifier code

 S = Change in short description of procedure code

 T = Miscellaneous change (BETOS, type of service)

 31. FILLER CHAR

 27 294 320

 DB2 ALIAS : FILLER

LENGTH : 27

 *******************************************************

H3PM.R_RIF_MAIN_Q,Q1,F

1

 TABLE OF CODES APPENDIX HCPCS_CNTRCTR_10_REC

 FROM CA REPOSITORY RIF REPORT

BETOS_TB BETOS Table

 M1A = Office visits - new

 M1B = Office visits - established

 M2A = Hospital visit - initial

 M2B = Hospital visit - subsequent

 M2C = Hospital visit - critical care

 M3 = Emergency room visit

 M4A = Home visit

 M4B = Nursing home visit

 M5A = Specialist - pathology
 M5B = Specialist - psychiatry

 M5C = Specialist - opthamology

 M5D = Specialist - other

 M6 = Consultations

 P0 = Anesthesia

 P1A = Major procedure - breast

 P1B = Major procedure - colectomy

 P1C = Major procedure - cholecystectomy

 P1D = Major procedure - turp

 P1E = Major procedure - hysterectomy

 P1F = Major procedure - explor/decompr/excisdisc

 P1G = Major procedure - Other

 P2A = Major procedure, cardiovascular-CABG

 P2B = Major procedure, cardiovascular-Aneurysm repair

 P2C = Major Procedure, cardiovascular-Thromboendarterectomy

 P2D = Major procedure, cardiovascualr-Coronary angioplasty (PTCA)

 P2E = Major procedure, cardiovascular-Pacemaker insertion

 P2F = Major procedure, cardiovascular-Other

 P3A = Major procedure, orthopedic - Hip fracture repair

 P3B = Major procedure, orthopedic - Hip replacement

 P3C = Major procedure, orthopedic - Knee replacement

 P3D = Major procedure, orthopedic - other

 P4A = Eye procedure - corneal transplant

 P4B = Eye procedure - cataract removal/lens insertion

 P4C = Eye procedure - retinal detachment

 P4D = Eye procedure - treatment of retinal lesions

 P4E = Eye procedure - other

 P5A = Ambulatory procedures - skin

 P5B = Ambulatory procedures - musculoskeletal

 P5C = Ambulatory procedures - inguinal hernia repair

 P5D = Ambulatory procedures - lithotripsy

 P5E = Ambulatory procedures - other

 P6A = Minor procedures - skin

 P6B = Minor procedures - musculoskeletal

 P6C = Minor procedures - other (Medicare fee schedule)

 P6D = Minor procedures - other (non-Medicare fee schedule)

 P7A = Oncology - radiation therapy

 P7B = Oncology - other

 P8A = Endoscopy - arthroscopy

 P8B = Endoscopy - upper gastrointestinal

 P8C = Endoscopy - sigmoidoscopy

 P8D = Endoscopy - colonoscopy

 P8E = Endoscopy - cystoscopy

 P8F = Endoscopy - bronchoscopy

 P8G = Endoscopy - laparoscopic cholecystectomy
 P8H = Endoscopy - laryngoscopy

 P8I = Endoscopy - other

 P9A = Dialysis services (medicare fee schedule)

 P9B = Dialysis services (non-medicare fee schedule)

 I1A = Standard imaging - chest

 I1B = Standard imaging - musculoskeletal

 I1C = Standard imaging - breast

 I1D = Standard imaging - contrast gastrointestinal

 I1E = Standard imaging - nuclear medicine

 I1F = Standard imaging - other

 I2A = Advanced imaging - CAT/CT/CTA: brain/head/neck

 I2B = Advanced imaging - CAT/CT/CTA: other

 I2C = Advanced imaging - MRI/MRA: brain/head/neck

 I2D = Advanced imaging - MRI/MRA: other

 I3A = Echography/ultrasonography - eye

 I3B = Echography/ultrasonography - abdomen/pelvis

 I3C = Echography/ultrasonography - heart

 I3D = Echography/ultrasonography - carotid arteries

 I3E = Echography/ultrasonography - prostate, transrectal

 I3F = Echography/ultrasonography - other

 I4A = Imaging/procedure - heart including cardiac

 catheterization

 I4B = Imaging/procedure - other

 T1A = Lab tests - routine venipuncture (non Medicare

 fee schedule)

 T1B = Lab tests - automated general profiles

 T1C = Lab tests - urinalysis

 T1D = Lab tests - blood counts

 T1E = Lab tests - glucose

 T1F = Lab tests - bacterial cultures

 T1G = Lab tests - other (Medicare fee schedule)

 T1H = Lab tests - other (non-Medicare fee schedule)

 T2A = Other tests - electrocardiograms

 T2B = Other tests - cardiovascular stress tests

 T2C = Other tests - EKG monitoring

 T2D = Other tests - other

 D1A = Medical/surgical supplies

 D1B = Hospital beds

 D1C = Oxygen and supplies

 D1D = Wheelchairs

 D1E = Other DME

 D1F = Prosthetic/Orthotic devices

 D1G = Drugs Administered through DME

 O1A = Ambulance

 O1B = Chiropractic
 O1C = Enteral and parenteral

 O1D = Chemotherapy

 O1E = Other drugs

 O1F = Hearing and speech services

 O1G = Immunizations/Vaccinations

 Y1 = Other - Medicare fee schedule

 Y2 = Other - non-Medicare fee schedule

 Z1 = Local codes

 Z2 = Undefined codes

CMS_TYPE_SRVC_TB CMS Type of Service Table

 1 = Medical care

 2 = Surgery

 3 = Consultation

 4 = Diagnostic radiology

 5 = Diagnostic laboratory

 6 = Therapeutic radiology

 7 = Anesthesia

 8 = Assistant at surgery

 9 = Other medical items or services

 0 = Whole blood only eff 01/96,

 whole blood or packed red cells before 01/96

 A = Used durable medical equipment (DME)

 B = High risk screening mammography

 (obsolete 1/1/98)

 C = Low risk screening mammography

 (obsolete 1/1/98)

 D = Ambulance (eff 04/95)

 E = Enteral/parenteral nutrients/supplies

 (eff 04/95)

 F = Ambulatory surgical center (facility

 usage for surgical services)

 G = Immunosuppressive drugs

 H = Hospice services (discontinued 01/95)

 I = Purchase of DME (installment basis)

 (discontinued 04/95)

 J = Diabetic shoes (eff 04/95)

 K = Hearing items and services (eff 04/95)

 L = ESRD supplies (eff 04/95)

 (renal supplier in the home before 04/95)

 M = Monthly capitation payment for dialysis

 N = Kidney donor
 P = Lump sum purchase of DME, prosthetics,

 orthotics

 Q = Vision items or services

 R = Rental of DME

 S = Surgical dressings or other medical supplies

 (eff 04/95)

 T = Psychological therapy (term. 12/31/97)

 outpatient mental health limitation (eff. 1/1/98)

 U = Occupational therapy

 V = Pneumococcal/flu vaccine (eff 01/96),

 Pneumococcal/flu/hepatitis B vaccine (eff 04/95-12/95),

 Pneumococcal only before 04/95

 W = Physical therapy

 Y = Second opinion on elective surgery

 (obsolete 1/97)

 Z = Third opinion on elective surgery

 (obsolete 1/97)

10/28/2010

 H3PM.R_RIF_TOC_RPT_Q,F

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