Institutional Claim Record Layout for Hospice, Radiology and Other Diagnostic

50.1 - Institutional Claim Record Layout for Hospice, Radiology and Other Diagnostic Prices and Local HCPCS Codes (Rev. 2643, Issued: 01-31-13, Effective: 07-01-13, Implementation: 07-01-13) This file contains hospice fee schedule prices extracted from the Physician Fee schedule. This file contains pricing data for A/B MAC (B)-priced and local HCPCS codes for radiology, other diagnostic services, and hospice services paid under the physician fee schedule. This file contains some high volume services such as portable x-rays. The file is also used to pay claims for Critical Access Hospitals that have elected the optional method. The CMS will provide the specific file names when the prices are released. The file name will contain the label HHH. Record Length - 60 Record Format - FB Block Size - 6000 Character Code - EBCDIC Sort Sequence - A/B MAC (B), Locality, HCPCS Code, Modifier Data Element Name Picture Location Comment 1-HCPCS X(05) 1 - 5 2-Modifier X(02) 6 - 7 3-Non-Facility Fee 9(05)V99 8 - 14 Data Element Name Picture Location Comment 4-PCTC Indicator X(01) 15 - 15 This field is only applicable when pricing Critical Access Hospitals (CAHs) that have elected the optional method (Method 2) of payment. 5-Facility Fee 9(05)V99 16 - 22 6-Effective Date 7- A/B MAC (B) Number X(08) X(05) 23 - 30 31 - 35 8-Locality X(02) 36 - 37 9-**Label** X(03) 38 - 40 HPH = Hospice Physician Services ODX = Other Diagnostic Services PRF = Portable Radiology RAD = Radiology 10-Filler X(2) 41 - 42 11-Status Code X(1) 43 - 43 Separate instructions will be used for the use of this field at a later date. This field indicates whether the code is in the physician fee schedule and whether it is separately payable if the service is covered. 12-Multiple Surgery X(01) 44 - 44 Indicator indicates which payment adjustment rule for multiple procedures apply to the service. 13-Non Facility PE 9(05)V99 45 - 51 Non-facility practice expense RVU 14-Filler X(01) 52 - 52 15- A/B MAC (A) or (HHH) Therapy Reduction 9(05)V99 53 - 59 Reduces payment amount for multiple surgery 16-Filler X(01) 60 - 60