Record Layout for Competitive Bidding Pricing File

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