Institutional Claim Record Layout for the Durable Medical Equipment,

50.2 - Institutional Claim Record Layout for the Durable Medical Equipment, Prosthetic, Orthotic and Supply Fee Schedule (Rev. 3350, Issued: 09-11-15, Effective: 01-01-16, Implementation: 01-04-16) This file contains services subject to national Floors and Ceilings under the DMEPOS Fee Schedules including Surgical Dressings. The CMS will provide the specific file names when the prices are released. The file name will contain the label DMEPOS. Record Length - 60 Record Format - FB Block Size - 6000 Character Code - EBCDIC Sort Sequence - Label, HCPCS Code, MOD, State Data Element Name Picture Location Comment 1-HCPCS X(05) 1 - 5 2-MOD X(02) 6 – 7 3-MOD 2 X(02) 8 – 9 4-Fee Schedule Amt 9(05)V99 10 – 16 5-Filler X(01) 17 6-Rural Fee Amt 9(05)v99 18 – 24 7-Filler X(01) 25 8-Rural Fee indicator X(01) 26- R = Rural Fee is present 9-Filler X(04) 27-30 10-State X(02) 31 - 32 11-Filler X(05) 33 - 37 12-*Label* X(3) 38 - 40 DME = Durable Medical Equipment (other than oxygen) OXY = Oxygen P/O = Prosthetic/Orthotic S/D = Surgical Dressings 13-Filler X(4) 41 - 44 14-*Pricing Change Indicator X(1) 45 - 45 0 = No change to Update Fee Schedule Amount since previous release 1 = A change has occurred to the Update Fee Schedule Amount since the previous release. NOTE: In the initial release of the annual update, this field is initialized to >0’ 15-Filler X(02) 46 – 47 16-Effective Date X(08) 48 – 55 Update effective date (YYYYMMDD) 17-Filler X(05) 56 – 60