HCPCS Codes With Coverage Indicators

CODE DATA INDEX

Description

This data file contains the entire listing of HCPCS National Codes with short descriptions (up to 35 characters) and Medicare's coverage indicators. Three types of indicators are provided: General Coverage, Medicare Carrier Manual (MCM) references and Medicare's Coverage Issues Manual (CIM) references. The indicators may be used as a flag to reference specific coverage guidelines in the MCM and/or CIM. Updated annually in January.

Record Layout - Fixed Field

Field	Columns			Description
1	1	-	5	HCPCS Code Number or Modifier
2	6	-	40	Short Description
3		-	41	Coverage Indicator (*1)
4		-	42	Unlisted Indicator
5	43	-	60	Coverage Issues Manual (CIM) Reference(s) (*2)
6	61	-	84	Medicare Carriers Manual (MCM) Reference(s) (*3)
7	85	-	94	Statute Reference (*4)
8	95	-	119	CPT^© Cross-Reference (*5)


Note:
	*1	alpha field containing the following elements:
		D	=	Special Coverage Instructions Apply
		M	=	Non-Covered by Medicare
		S	=	Non-covered by Medicare Statute
		I	=	Not valid for Medicare
		C	=	Carrier Discretion

	*2	field contains two groups of 6 positions; each group represents a
		section of the Coverage Issues Manual (CIM).
	*3	field contains three groups of 8 positions; each group represents a
		section of the Medicare Carriers Manual (MCM).
	*4	field indicating the statute reference for non-covered Medicare items
		or services.
	*5	field contains five groups of 5 positions; each identifies a crosswalk
		to an alphanumeric or CPT code to relate services previously or
		currently coded in HCPCS. If too many CPT codes are crosswalked,
		"CPT" will be shown in this field. Check the CPT book for
		appropriate values.

Formats Available

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

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