(Medicare Claims Processing Manual)

NOTE:  This is not the date the HCPCS code was created.  It is the date the code was updated or added to the MPFSDB file for the current file year.  This field is set to January 1 for all codes during the annual update process. 8 Pic x(8)  31  Filler  28 Pic x(28)  31EE  Reduced therapy fee schedule amount  9Pic(7)v99 31DD  Filler  1Pic x(2)  FIELD # & ITEM  LENGTH & PIC  31CC  Imaging Cap Indicator  A value of 1 means subject to OPPS payment cap determination.  A value of 9 means not subject to OPPS payment cap determination.  1Pic x(1)  31BB  Non-Facility Imaging Payment Amount  9Pic(7)v99 31AA  Facility Imaging Payment Amount  9Pic(7)v99 31A Physician Supervision of Diagnostic Procedures  This field is for use in post payment review.  01 = Procedure must be performed under the general supervision of a physician.  02 = Procedure must be performed under the direct supervision of a physician. 03 = Procedure must be performed under the personal supervision of a physician.   (Diagnostic imaging procedures performed by a Registered Radiologist Assistant (RRA) who is certified and registered by The American Registry of Radiologic Technologists (ARRT) or a Radiology Practitioner Assistant (RPA) who is certified by the Certification Board for Radiology Practitioner Assistants (CBRPA), and is authorized to furnish the procedure under state law, may be performed under direct supervision.)   04 = Physician supervision policy does not apply when procedure is furnished by a qualified, independent psychologist or a clinical psychologist; otherwise must be performed under the general supervision of a physician. 05 = Not subject to supervision when furnished personally by a qualified audiologist, physician or non physician practitioner.  Direct supervision by a physician is required for those parts of the test that may be furnished by a qualified technician when a ppropriate to the circumstances of the test.  06 = Procedure must be personally performed by a physician or a physical therapist (PT) who is certified by the American Board of Physical Therapy Specialties (ABPTS) as a qualified electrophysiological clinical specialist and is permitted to provide 2 Pic x(2)  FIELD # & ITEM  LENGTH & PIC  the procedure under State law.  Procedure may also be performed by a PT with ABPTS certification without physician supervision. 21 = Procedure may be performed by a technician with certification under general supervision of a physician; otherwise must be performed under direct supervision of a physician.  Procedure may also be performed by a PT with ABPTS certification without phys ician supervision. 22 = May be performed by a technician with on- line real -time contact with physician.  66 = May be personally performed by a physician or by a physical therapist with ABPTS certification and certification in this specific procedure.  6A = Supervision standards for level 66 apply; in addition, the PT with ABPTS certification may personally supervise another PT, but only the PT with ABPTS certification may bill.  77 = Procedure must be performed by a PT with ABPTS certification (TC & PC) or by a PT without certification under direct supervision of a physician (TC & PC), or by a technician with certification under general supervision of a physician (TC only; PC always physician).  7A = Supervision standards for level 77 apply; in addition, the PT with ABPTS certification may personally supervise another PT, but only the PT with ABPTS certification may bill.  09 = Concept does not apply. 31B This field has been deleted to allow for the expansion of field 31A.   31C Facility Setting Practice Expense Relative Value Units  9 Pic(7)v99 31D Non-Facility Setting Practice Expense Relative Value Units  9 Pic(7)v99 31E Filler  9 Pic(7)v99 31F Filler  Reserved for future use.  1 Pic x(1)  31G Endoscopic Base Codes  This field identifies an endoscopic base code for each code with a multiple surgery indicator of 3.  5 Pic x(5)  FIELD # & ITEM  LENGTH & PIC  32A 1996 Transition/Fee Schedule Amount  This field is no longer applicable since transitioning ended in 1996.  This field will contain a zero.  9 Pic 9(7)v99 32B 1996 Transition/Fee Schedule  This field is no longer applicable since transitioning ended in 1996.  This field will contain spaces.  1 Pic x(1)  32C 1996 Transition/Fee Schedule Amount When Site or Service Differential Applies  This field is no longer applicable since transitioning ended in 1996.  This field will contain a zero.  9 Pic 9(7)v99 33A Units Payment Rule Indicator  Reserved for future use.  9 = Concept does not apply. 1 Pic x(1)  33B Mapping Indicator  This field is no longer applicable since transitioning ended in 1996.  This field will contain spaces.  1 Pic x(1)  33C Anti-markup Locality Informational Use Locality used for reporting utilization of anti -markup services. NOT FOR A/B MAC (B) USE: These Medicare Advantage encounter pricing localities are for Shared System Maintainer purposes only.  The locality values were developed to facilitate centralized processing of encounter data by the Medicare Advantage organizations.  2 Pic x(2)  33D Calculation Flag  This field is informational only; the SSMs do not need to add this  field.  The intent is to assist A/B MACs (B) to understand how the fee schedule amount in fields 28 and 29 are calculated. The MMA mandates an additional adjustment to selected HCPCS codes.  A value of 1 indicates an additional fee schedule adjustment of 1.32 in 2004 and 1.03 in 2005.  A value of 0 indicates no additional adjustment needed.  A value of 2 indicates an additional fee schedule adjustment of 1.05 effective 7/1/2008. 1 Pic x(1)  FIELD # & ITEM  LENGTH & PIC  33 E Diagnostic Imaging Family Indicator  For services effective January 1, 2011, and after, family indicators 01 - 11 will not be populated.  01 = Family 1 Ultrasound (Chest/Abdomen/Pelvis  Non Obstetrical  02 = Family 2 CT and CTA (Chest/Thorax/Abd/Pelvis)  03 = Family 3 CT and CTA (Head/Brain/Orbit/Maxillofacial/Neck)  04  = Family 4 MRI and MRA (Chest/Abd/Pelvis)  05 = Family 5 MRI and MRA (Head/Brain/Neck)  06 = Family 6 MRI and MRA (spine)  07 = Family 7 CT (spine)  08 = Family 8 MRI and MRA (lower extremities)  09 = Family 9 CT and CTA (lower extremities)  10 = Family 10 Mr and MRI (upper extremities and joints)  11 = Family 11 CT and CTA (upper extremities)  88 = Subject to the reduction of the TC diagnostic imaging (effective for services January 1, 2011, and after). Subject to the reduction of the PC diagnostic imaging (effective for services January 1, 2012 and after).  99 = Concept Does Not Apply 2Pic x(2)  33F Performance Payment Indicator  (For future use)  1 Pic x (1)  33G National Level Future Expansion 3 Pic x (3)  34 Non-Facility Fee Schedule Amount  This field replicates field 28.  9 Pic 9(7)v99 35 Facility Fee Schedule Amount  This field replicates field 29.  9 Pic 9(7)v99 36 Filler  1 Pic x(1)  37 7 Pic x(7)  FIELD # & ITEM  LENGTH & PIC  Future Local Level Expansion**  The Updated 1992 Transition Amount was previously stored in this field.  A/B MACs (B) can continue to maintain the updated transition amount in this field.  38A Future Local Level Expansion** The adjusted historical payment basis (AHPB) was previously stored in this field.  A/B MACs (B) can continue to maintain the AHPB in this field.  7 Pic x(7)   38 B  Filler  This field was originally established for 15 spaces.  Since AHPB data will only use 7 of the 15 spaces, A/B MACs (B) have 8 remaining spaces for their purposes.  ** These fields will be appended by each A/B MAC (B) at the local level.  8 Pix x(8)       Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12326CP  10/26/2023  Internet -Only Manual Update, Pub. 100-04, Chapter 23 (Fee Schedule Administration and Coding Requirements), Section 50.6 01/29/2024 13410 R12068CP  06/02/2023  July Quarterly Update for 2023 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule  07/03/2023 13235 R11630CP  10/06/2022  Instructions to the Fiscal Intermediary Shared System [FISS] to Add Additional Multiple Procedure Indicators 6 and 7 Into the Physician Fee Schedule Payment Policy Indicator File Record Layout  04/03/2023 12871 R11137CP  12/02/2021  Calendar Year 2022 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule  01/03/2022 12521 R10878CP  07/15/2021  Update to the Internet -only Manual (IOM) Publication (Pub.) 100- 04, Medicare Claims Processing Manual, Chapter 23 -  Fee Schedule Administration and Coding Requirements, Section 20.9 -  Fee Schedule Administration and Coding Requirements  08/16/2021 12311 R10504CP  12/04/2020  CY 2021 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule  01/04/2021 12063 R10320CP  08/28/2020  Updates to Chapter 23 -  Fee Schedule Administration and Coding Requirements  12/01/2020 11941 R10356CP  09/18/2020  Update to the Medicare Claims Processing Manual    10/19/2020 11958 Rev #  Issue Date  Subject  Impl Date  CR#  R10233CP  07/24/2020  Update to the (IOM) Publication 100- 04, Medicare Claims Processing Manual, Chapter 23 -  Fee Schedule Administration and Coding Requirements, Section 20.9 -  Fee Schedule Administration and Coding Requirements  06/16/2020 11782 R10211CP  07/10/2020  Manual Update to Section 20.7 in Chapter 23 of Publication (Pub) 100- 04 08/10/2020 11833 R10136CP