evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
Field Name  Pic Position  Comment  CBA Bid Category Effective Date  X(8)  1 - 8  Bid Product Category Effective Date - CC 9(2) 1 - 2  Bid Product Category Effective Date -Year  9(2) 3 - 4  Bid Product Category Effective Date - Month 9(2) 5 - 6  Bid Product Category Effective -Day 9(2) 7 - 8  Bid Category Expiration Date  X(8)  9 - 16  Bid Product Category Expiration Date - CC 9(2) 9 - 10  Bid Product Category Expiration Date -  Year  9(2) 11 - 12  Field Name  Pic Position  Comment  Bid Product Category Expiration Date - Month 9(2) 13 - 14  Bid Product Category Expiration Date -  Day  9(2) 15 - 16  HCPCS Procedure Codes  X(13)_  17 - 29  HCPCS Procedure Code  X(5)  17 - 21 All Competitive Bidding Active Codes.  Modifier 1  X(2)  22 - 23  Modifier 2  X(2)  24 - 25  Modifier 3  X(2)  26 - 27  Modifier 4  X(2)  28 - 29  Field Name  Pic Position  Comment  CBA Area  X(5)  30 - 34 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 Product Category Number  X(3)  35 - 37 001 = 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  Field Name  Pic Position  Comment  Bid Business Rule 1  X(1)  38 - 38 When field contains S, permits non-contract physicians to bill selected CB items or H, permits Hospitals to bill selected CB items
(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)
(Medicare Claims Processing Manual)
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 -
(Medicare Claims Processing Manual)
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
(Medicare Claims Processing Manual)
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)
(Medicare Claims Processing Manual)
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)
(Medicare Claims Processing Manual)
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.
(Medicare Claims Processing Manual)
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)   The CMS MPFSDB includes the total fee schedule amount, related component parts, and payment policy indicators.  The record layout is provided below.  Beginning with the 2019 MPFSDB, and thereafter, the MPFSDB File Record Layout will no longer be revised annually in this section for the sole purpose of changing the calendar year, but will only be revised when there is a change to a field.  Previous MPFSD B file layouts (for 2018 and prior) can be found on the CMS web site on the Physician Fee Schedule web page at:  https://www.cms.gov/Medicare/Medicare -Fee-for-Service-Payment/PhysicianFeeSched/index.html.  MPFSDB File Layout  HEADER RECORD
(Medicare Claims Processing Manual)
FIELD #  DATA ELEMENT NAME  LOCATION  PIC 1 Header ID  1-4 x(4) Value Head"  2 Header Number  5 x(1) 3 Data Set Name  6-50 x(45)  4 Record Length  51-53 x(3) 5 Filler  54-54 x(1) 6 Block size  55-58 x(4) 7 Filler  59-59 x(1) 8 Number of Records  Number does not include this header record.  60-69 9(10)  9 Date Created  70-77 x(8) YYYYMMDD  10 Blanks  78-345 x(268)
(Medicare Claims Processing Manual)
DATA RECORD  FIELD # & ITEM  LENGTH & PIC  1 File Year  This field displays the effective year of the file.  4 Pic x(4)  2 A/B MAC (B) Number  This field represents the 5 -digit number assigned to the A/B MAC (B). 5 Pic x(5)  3 Locality  This 2 -digit code identifies the pricing locality used. 2 Pic x(2)  4 HCPCS Code  This field represents the procedure code.  Each A/B MAC (B) Current Procedural Terminology (CPT) code (other than codes for Multianalyte Assays with Algorithmic Analyses (MAAA) and Proprietary Laboratory Analyses (PLA)) and alpha -numeric HCPCS codes other than B, C, E, K, L and U codes will be included.  The standard sort for this field is blanks, alpha, and numeric in ascending order.  Note:  MAAA and PLA are alpha- numeric CPT codes. 5 Pic x(5)  5 Modifier  2 Pic x(2)  FIELD # & ITEM  LENGTH & PIC  For diagnostic tests, a blank in this field denotes the global service and the following modifiers identify the components:  26 = Professional component  TC = Technical component  For services other than those with a professional and/or technical component, a blank will appear in this field with one exception: the presence of CPT modifier - 53 which indicates that separate Relative Value Units (RVUs) and a fee schedule amount have be en established for procedures which the physician terminated before completion.  This modifier is used only with colonoscopy through stoma code 44388, colonoscopy code 45378 and screening colonoscopy codes G0105 and G0121.  Any other codes billed with modi fier - 53 are subject to medical review and priced by individual consideration.  Modifier -53 = Discontinued Procedure -  Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure.  Due to extenuating circumstances, or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. 6 Descriptor  This field will include a brief description of each procedure code.  50 Pic x(50)  7 Code Status  This 1 position field provides the status of each code under the full fee schedule.  Each status code is explained in 30.2.2. 1 Pic x(1)  8 Conversion Factor
(Medicare Claims Processing Manual)
procedure code.  50 Pic x(50)  7 Code Status  This 1 position field provides the status of each code under the full fee schedule.  Each status code is explained in 30.2.2. 1 Pic x(1)  8 Conversion Factor  This field displays the multiplier which transforms relative values into payment amounts.  The file will contain the conversion factor for the File Year which will reflect all adjustments.  8 Pic 9(4)v9999 9 Update Factor  This update factor has been included in the conversion factor in Field 8.  6 Pic 9(2)v9999 10 Work Relative Value Unit  This field displays the unit value for the physician work RVU.  9 Pic 9(7)v99 FIELD # & ITEM  LENGTH & PIC  11 Filler  9 Pic 9(7)v99 12 Malpractice Relative Value Unit  This field displays the unit value for the malpractice expense RVU.  9 Pic 9(7)v99 13 Work Geographic Practice Cost Indices (GPCIs)  This field displays a work geographic adjustment factor used in computing the fee schedule amount. 5 Pic 99v999 14 Practice Expense GPCI  This field displays a practice expense geographic adjustment factor used in computing the fee schedule amount. 5 Pic 99v999 15 Malpractice GPCI  This field displays a malpractice expense geographic adjustment factor used in computing the fee schedule amount. 5 Pic 99v999 16 Global Surgery  This field provides the postoperative time frames that apply to payment for each surgical procedure or another indicator that describes the applicability of the global concept to the service.  000 = Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payab le. 010 = Minor procedure with preoperative relative values on the day of the procedure and postoperative relative values during a 10- day postoperative period included in the fee schedule amount; evaluation and management services on the day of the procedure a nd during this 10- day postoperative period generally not payable.  090 = Major surgery with a 1- day preoperative period and 90- day postoperative period included in the fee schedule payment amount. MMM = Maternity codes; usual global period does not apply. XXX = Global concept does not apply.
(Medicare Claims Processing Manual)
= Major surgery with a 1- day preoperative period and 90- day postoperative period included in the fee schedule payment amount. MMM = Maternity codes; usual global period does not apply. XXX = Global concept does not apply. YYY = A/B MAC (B)  determines whether global concept applies and establishes postoperative period, if appropriate, at time of pricing. 3 Pic x(3)  FIELD # & ITEM  LENGTH & PIC  ZZZ = Code related to another service and is always included in the global period of the other service.  (Note: Physician work is associated with intra -service time and in some instances the post service time.)  17 Preoperative Percentage (Modifier 56)  This field contains the percentage (shown in decimal format) for the preoperative portion of the global package.  For example, 10 percent will be shown as 010000.  The total of fields 17, 18, and 19 will usually equal one.  Any variance is slight and resul ts from rounding. 6 Pic 9v9(5)  18 Intraoperative Percentage (Modifier 54)  This field contains the percentage (shown in decimal format) for the intraoperative portion of the global package including postoperative work in the hospital.  For example, 63 percent will be shown as 063000.  The total of fields 17, 18, and 19 will usually equal one.  Any variance is slight and res ults from rounding.  6 Pic 9v9(5)  19 Postoperative Percentage (Modifier 55)  This field contains the percentage (shown in decimal format) for the postoperative portion of the global package that is provided in the office after discharge from the hospital.  For example, 17 percent will be shown as 017000.  The total of fields 17, 18, and 19 will usually equal one.  Any variance is slight and results from rounding. 6 Pic 9v9(5)  20 Professional Component (PC)/Technical Component (TC) Indicator  0 = Physician service codes: This indicator identifies codes that describe physician services.  Examples include visits, consultations, and surgical procedures.  The concept of PC/TC does not apply since physician services cannot be split into professional  and technical components.  Modifiers 26 & TC cannot be used with these codes.  The total Relative Value Units (RVUs) include values for physician work, practice expense and malpractice expense.  There are some codes with no work RVUs. 1 = Diagnostic tests
(Medicare Claims Processing Manual)
Modifiers 26 & TC cannot be used with these codes.  The total Relative Value Units (RVUs) include values for physician work, practice expense and malpractice expense.  There are some codes with no work RVUs. 1 = Diagnostic tests or radiology services: This indicator identifies codes that describe diagnostic tests, e.g., pulmonary function tests, or therapeutic radiology procedures, e.g., radiation therapy.  These codes generally have both a professional and te chnical component.  Modifiers 26 and TC can be used with these codes. The total RVUs for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense.  1 Pic x(1)  FIELD # & ITEM  LENGTH & PIC  The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only.  The total RVUs for codes reported without a modifier equals the sum of RVUs for both the professional and technical component. 2 = Professional component only codes: This indicator identifies stand alone codes that describe the physician work portion of selected diagnostic tests for which there is an associated code that describes the technical component of the diagnostic test onl y and another associated code that describes the global test.  An example of a professional component only code is 93010, Electrocardiogram; interpretation and report.  Modifiers 26 and TC cannot be used with these codes.  The total RVUs for professional component only codes include values for physician work, practice expense, and ma lpractice expense.  3 = Technical component only codes: This indicator identifies stand alone codes that describe the technical component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the professional compo nent of the diagnostic tests only. An example of a technical component code is 93005, Electrocardiogram, tracing only, without interpretation and report.  It also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code.  Modifiers 26 and TC cannot be used with these codes.  The total RVUs for technical component only codes include values for practice expense and malpractice expense only.  4 = Global test only codes: This indicator identifies stand alone codes for which there are associated codes that describe: a) the professional component of the test only and b) the technical component of the test only.  Modifiers 26 and TC cannot be used with these