Institutional Claim Record Layout for Clinical Laboratory Fee Schedule

40.3 - Institutional Claim Record Layout for Clinical Laboratory Fee Schedule (Rev. 2643, Issued: 01-31-13, Effective: 07-01-13, Implementation: 07-01-13) The CMS will provide the specific file names when the prices are released. The file name will contain the label CLAB. Record Length = 60 Record Format = FB Block Size = 6000 Character Code = EBCDIC Sort Sequence = A/B MAC (B), Locality, HCPCS Code Header Record Data Element Name Picture Location Comment 1-Label X(03) 1 - 3 Value = Lab 2-Filler X(07) 4 - 10 3-Filler X(08) 11 - 15 4-Filler X(04) 16 - 22 5-Date Fee Update X(08) 23 - 30 YYYYMMDD 6-Filler X(22) 31 - 52 7-Date File Created X(08) 53 - 60 YYYYMMDD Data Record Data Element Name Picture Location Comment 1-HCPCS X(05) 1 - 5 2-Filler X(04) 6 - 9 3-60% Fee 9(05)V99 10 - 16 4-62% Fee 9(05)V99 17 - 23 5-Filler X(07) 24 - 30 6- A/B MAC (B) Number X(05) 31 - 35 7- A/B MAC (B) Locality X(02) 36 - 37 00 = Single State A/B MAC (B) 01 = North Dakota 02 = South Dakota 20 = Puerto Rico Data Element Name Picture Location Comment 8-State Locality X(02) 38 - 39 Separate instructions will be used for the use of this field at a later date. 9-Filler X(02) 40 - 41 10-Effective Date X(08) 42 - 49 Update effective date (YYYYMMDD) 11-Filler X(11) 50 - 60