CPT Codes With Medicare Relational Edits

CODE DATA INDEX

Product Number: CMR04

Description

This data file provides basic Medicare edit information for CPT^© and HCPCS codes. Edits listed range from surgical follow-up days to incidental services. The edits contained in this data can be used to develop software that identifies Medicare billing violations in advance of claims submission. Updated annually in January.

Record Layout - Comma-Delimited/Fixed Field

HIghlighted fields can be clicked to obtain additional information.

Fields	Columns			Description
1	1	-	5	CPT^© (or HCPCS) Code Number
2	6	-	7	Modifier
3			8	Status
4			9	Surgical Indicator
5			10	Site-of-Service
6			11	PC/TC
7	12	-	14	Surgical Follow-up Days
8	15	-	16	Pre-Operative Percentage
9	17	-	18	Intra-Operative Percentage
10	19	-	20	Post-Operative Percentage
11			21	Multiple Surgery
12			22	Bilateral Surgery
13			23	Assistant Surgeon
14			24	Two Surgeons
15			25	Team Surgeons
16			26	Supply Charges
17	27	-	31	Related Procedure
18	32	-	36	Endoscopic Base Code

Formats Available

* ASCII Diskette: 3.5" (Fixed Field or Comma-Delimited)
* CD-ROM (Fixed Field or Comma-Delimited)

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Last modified: April 11, 2007