(Medicare Claims Processing Manual)

Bid Business Rule 2  X(1)  39 - 39 When field contains S, permits non-contract physicians to bill selected CB items or H, permits Hospitals to bill selected CB items.  Bid Business Rule 3   X(1)   40 - 40  For  future use   Bid Business Rule 4   X(1)   41- 41  For future use   Bid Business Rule 5   X(1)   42 - 42  For future use  Filler  X(8)  43 - 50   100.2 - Record Layout for Competitive Bidding Pricing File  (Rev. 2088, Issued: 11- 05-10, Effective: 01 -01-11, Implementation: 01- 03-11)  Field Name  Pic Position  Comment  CBA Bid Round Effective Date  X(8)  1-8  Bid Round Effective Date -  CC 9(2) 1 -2  Bid Round Effective Date - Year  9(2) 3-4  Bid Round Effective Date -  Month  9(2) 5 - 6  Bid Round Effective Date -  Day  9(2) 7 - 8  Field Name  Pic Position  Comment  Bid Round Expiration  X(8)  9-16  Bid Round Expiration Date - CC 9(2) 9 - 10  Bid Round Expiration Date -  Year  9(2) 11 - 12  Bid Round Expiration Date-  Month  9(2) 13 - 14  Bid Round Expiration Date -  Day  9(2) 15 - 16  HCPCS Procedure Code  X(5)  17 - 21  Modifier 1  X(2)  22 - 23  Modifier 2  X(2)  24 - 25  Modifier 3  X(2)  26 - 27  Modifier 4  X(2)  28 - 29  DMEPOS Category  X(2)  30 - 31 IN = Inexpensive/Routinely Purchased  FS = Frequently Serviced CR = Capped Rental  OX = Oxygen & Oxygen Equipment  OS = Ostomy, Tracheostomy & Urologicals  SD = Surgical Dressings  PO = Prosthetics & Orthotics  SU = Supplies  TE = TENS  Field Name  Pic Position  Comment  CBA Area  X(5)  32 - 36 16740 = Charlotte NC -SC 16741 = Charlotte NC -SC Mail Order  17140 = Cincinnati OH  17141 = Cincinnati OH Mail Order  17460 = Cleveland OH  17461 = Cleveland OH Mail Order  19100 = Dallas TX  19101 = Dallas TX Mail Order  28140 = Kansas MO -KS 28141 = Kansas MO - KS Mail Order  33100 = Miami FL  33101 = Miami FL Mail Order  36740 = Orlando FL  36741 = Orlando FL Mail Order  38300 = Pittsburgh PA  38301 = Pittsburgh PA Mail Order  40140 = Riverside CA  40141 = Riverside CA Mail Order  Bid Price  9(6)V99.  37 - 44 Competitive Bidding Single Payment Amount for HCPCS code  Bid Price Effective Date  X(8)  45 - 52  Bid Price Effective Date -  CC 9(2) 45 - 46  Bid Price Effective Date - Year  9(2) 47 - 48  Bid Price Effective Date -  Month  9(2) 49 - 50  Bid Price Effective Date -  Day  9(2) 51 - 52  Field Name  Pic Position  Comment  Bid Price Expiration Date  X(8)  53 - 60  Bid Price Expiration Date - CC 9(2) 53 - 54  Bid Price Expiration Date -  Year  9(2) 55 - 56  Bid Price Expiration Date-  Month  9(2) 57 - 58  Bid Price Expiration Date -  Day  9(2) 59 - 60  Price Change Indicator  X(1)  61 - 61  Bid Product Category X(3)  62 - 64 001 = Oxygen Supplies & Equipment  002 = Standard Power Wheelchairs  003 = Complex Rehab Power Wheelchairs  004 = Mail Order Diabetic Supplies  005 = Enteral Nutrients, Equipment  006 = CPAPs, RADs and Related Supplies  007 = Hospital Beds & Related Supplies  009 = Walkers & Related Supplies  010 = Support Surfaces  Filler  X(12)  65 - 76   100.3 - Record Layout for Competitive Bidding ZIP Code File  (Rev. 2088, Issued: 11- 05-10, Effective: 01 -01-11, Implementation: 01- 03-11)  Field Name  Pic Position  Comment  CBA ZIP Code Effective Date  X(8)  1- 8   Field Name  Pic Position  Comment  Bid ZIP  Code Effective Date - CC 9(2) 1 - 2  Bid ZIP  Code Effective Date -Year  9(2) 3-4  Bid ZIP  Code Effective Date - Month 9(2) 5 - 6  Bid ZIP  Code Effective Date -  Day  9(2) 7- 8  Bid ZIP Code Expiration Date  X(8)  9-16  Bid ZIP Code Expiration Date - CC 9(2) 9 - 10  Bid ZIP  Code Expiration Date -  Year  9(2) 11 - 12  Bid ZIP  Code Expiration Date - Month 9(2) 13 - 14  Bid ZIP  Code Expiration Date -  Day  9(2) 15 - 16  CBA ZIP  Code  X(5)  17 - 21 ZIP Code for the CBA  CBA State  X(2)  22 - 23  Field Name  Pic Position  Comment  CBA Area  X(5)  24- 28 16740 = Charlotte NC -SC 16741 = Charlotte NC -SC Mail Order  17140 = Cincinnati OH  17141 = Cincinnati OH Mail Order  17460 = Cleveland OH  17461 = Cleveland OH Mail Order  19100 = Dallas TX  19101 = Dallas TX Mail Order  28140 = Kansas MO -KS 28141 = Kansas MO - KS Mail Order  33100 = Miami FL  33101 = Miami FL Mail Order  36740 = Orlando FL  36741 = Orlando FL Mail Order  38300 = Pittsburgh PA  38301 = Pittsburgh PA Mail Order  40140 = Riverside CA  40141 = Riverside CA Mail Order  Filler  X(12)  29 - 40   100.4 - Record Layout for Competitive Bidding Contract Supplier File  (Rev. 2088, Issued: 11- 05-10, Effective: 01 -01-11, Implementation: 01- 03-11)  Field Name  Pic Position  Comment  Supplier NSC Number  X(10)  1 - 10  Supplier NPI Number  X(10)  11 - 20  Field Name  Pic Position  Comment  CBA Area  X(5)  21 - 25 16740 = Charlotte NC -SC 16741 = Charlotte NC -SC Mail Order  17140 = Cincinnati OH  17141 = Cincinnati OH Mail Order  17460 = Cleveland OH  17461 = Cleveland OH Mail Order  19100 = Dallas TX  19101 = Dallas TX Mail Order  28140 = Kansas MO -KS 28141 = Kansas MO - KS Mail Order  33100 = Miami FL  33101 = Miami FL Mail Order  36740 = Orlando FL  36741 = Orlando FL Mail Order  38300 = Pittsburgh PA  38301 = Pittsburgh PA Mail Order  40140 = Riverside CA  40141 = Riverside CA Mail Order  Bid Effective Date  X(8)  26 - 33   Bid Effective Date-  CC 9(2) 26 - 27  Bid Effective Date-Year  9(2) 28 - 29  Bid Effective Date -Month 9(2) 30 - 31  Bid Effective Date-Day 9(2) 32 - 33  Bid Expiration Date  X(8)  34 - 41  Bid Expiration Date -CC 9(2) 34 - 35  Field Name  Pic Position  Comment  Bid Expiration Date -  Year  9(2) 36 - 37  Bid Expiration Date - Month 9(2) 38 - 39  Bid Expiration Date -  Day 9(2) 40 - 41  Bid Switches Occurs 500 Times  X(500)  42-541 The switch occurrence equates to the 500 Times Bid category; i.e., Bid Switch (1) denotes the supplier contract for category 001  Bid Switch (1)  X(1)  42 - 42  Bid Switch (2)  X(1)  43 - 43  Filler  X(59)  542 -  600   100.5 - Adjustments to the Single Payment Amounts to Reflect Changes in HCPCS Codes  (Rev. 1535, Issued: 06- 13-08, Effective: 07 -01-08, Implementation: 07- 07-08)  If new HCPCS codes are established following the start of a competitive bidding contract period that describe new technology items that did not previously fall under HCPCS codes for competitive bidding items, they will not be added to the competitive biddi ng HCPCS, CBA pricing and public use files.  If a HCPCS code descriptor for a competitive bidding item is revised to clarify the item described by that code after the competitive bidding contract period begins, a corresponding code descriptor change will be made in the competitive bidding HCPCS, CBA pricing and public use files.  Should a HCPCS code be deleted from the HCPCS after the competitive bidding contract period begins, the deleted code will be considered invalid for claims submission under the competitive bidding program and will be removed from the competitive bidding HCP CS, CBA pricing and public use files.  Although the code is discontinued, as explained below, the items that previously fell under the code may continue to be subject to the competitive bidding program.  If a HCPCS code for a competitive bidding item is revised after the contract period for a competitive bidding program begins, CMS will adjust the single payment amount(s) for the item(s) on the CBA pricing file for that Round using one of the following met hods:   a. If a single HCPCS code for an item is divided into two or more HCPCS codes for the components of that item, the sum of the single payment amounts for the new HCPCS codes will equal the single payment amount for the original item.  In accordance with ins tructions provided in future recurring update notifications, the payment amounts for the HCPCS codes for the components will be established based on the corresponding fee schedule amounts for these codes that are established in accordance with section 60.3 of chapter 23 of the Claims Processing Manual.  These amounts for the components of the item will then be adjusted by the same percentage to the level where the sum of the payment amounts for the HCPCS codes for the components equals the single payment am ount for the item.  b. If a single HCPCS code is divided into two or more separate HCPCS codes for different but similar items, the single payment amount for each of the new separate HCPCS codes is equal to the single payment amount applied to the original, single HCPCS code.   c. If the HCPCS codes for components of an item are merged into a single HCPCS code for the item, the single payment amount for the new HCPCS code is equal to the total of the separate single payment amounts for the components.   d. If multiple HCPCS codes for different but similar items are merged into a single HCPCS code, the items to which the new HCPCS codes apply may be furnished by any supplier that has a valid Medicare billing number.  Payment for the new code will be based on the fee schedule methodology, even if single payment amounts were established for the discontinued multiple HCPCS codes.  The old codes will be considered invalid and no longer included in the competitive bidding program for the remainder of the contrac t term.   Contract suppliers must furnish the item(s) described by the new HCPCS code(s) in scenarios (a) through (c) above and submit claims using the new codes.  Notification of a competitive bidding HCPCS code change will occur through program instruction.  Addendum - MPFSDB File Record Layout and Field Descriptions         (Rev. 10356, Issued: 09- 18-2020, Effective Date: 10- 19-2020, Implementation Date: 10-19-2020)