Institutional

50.7 - Institutional Claim Record Layout for the Mammography Fee Schedule (Rev. 2643, Issued: 01-31-13, Effective: 07-01-13, Implementation: 07-01-13) This is a physician fee schedule abstract file for mammography services payment. The CMS will provide the specific file names when the prices are released. The file name will contain the label MAMMO. Record Length - 60 FIELD NAME & DESCRIPTION LENGTH & PIC Position This field provides an indicator for services for which team surgeons may be paid. 0 = Team surgeons not permitted for this procedure. 1 = Team surgeons could be paid; supporting documentation required to establish medical necessity of a team; pay by report. 2 = Team surgeons permitted; pay by report. 9 = Concept does not apply. Endoscopic Base Codes This field identifies an endoscopic base code for each code with a multiple surgery indicator of 3. 5 Pic (x) 5 40-44 Performance Payment Indicator (For future use) 1 Pic x (1) 45 Diagnostic Imaging Family Indicator 88 = Subject to the reduction for diagnostic imaging (effective for services January 1, 2011, and after). 99 = Concept Does Not Apply 2 Pic x (2) 46-47 Effective Date This field displays the effective date of the file in YYYYMMDD format. 8 Pic x(8) 48 - 55 Filler 30 Pic x(30) 56 -75 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 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 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 15-Filler X(01) 60 - 60