Institutional Claim Record Layout for the Skilled Nursing Facility Fee Schedule

50.4 - Institutional Claim Record Layout for the Skilled Nursing Facility Fee Schedule (Rev. 2643, Issued: 01-31-13, Effective: 07-01-13, Implementation: 07-01-13) This section contains the record layout for the SNF extract for radiology Services, other diagnostic services, and other SNF services priced on the MPFS. The CMS will provide the specific file names when the prices are released. The file name will contain the label SNF. Record Length - 60 Record Format - FB Block Size - 6000 Character Code - EBCDIC 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 The SNF fee schedule amount is based on the “non-facility rate” which is the fee that physicians may receive if performing the service in the physician’s office. 4-PCTC Indicator X(01) 15 - 15 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 Update effective date 8-Locality X(02) 36 - 37 9-Filler X(05) 38 - 42 10-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. 11-Multiple Surgery X(01) 44 - 44 Indicator indicates which payment adjustment rule for multiple procedures apply to the service. 12-Non Facility PE 9(05)V99 45 - 51 Non-facility practice expense RVU 13-Filler X(01) 52 - 52 14- A/B MAC (A) or (HHH) Therapy Reduction 9(05)V99 53 - 59 Reduces payment amount for multiple surgery Data Element Name Picture Location Comment 15-Filler X(01) 60 - 60