Record Layout for Competitive Bidding HCPCS Category File

100.1 - Record Layout for Competitive Bidding HCPCS Category File (Rev. 2088, Issued: 11-05-10, Effective: 01-01-11, Implementation: 01-03-11) Field Name Pic Position Comment CBA Bid Category Effective Date X(8) 1 - 8 Bid Product Category Effective Date- CC 9(2) 1 - 2 Field Name Pic Position Comment 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 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 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