CMS Pub. 100-04, ch. 23, § 40.3

The CMS will provide the specific file names when the prices are released. The file name will contain the

label CLAB.

Record Length = 60

Record Format = FB

Block Size = 6000

Character Code = EBCDIC

Sort Sequence = A/B MAC (B), Locality, HCPCS Code

Header Record

Data Element Name Picture Location Comment

1-Label X(03) 1 - 3 Value = Lab

2-Filler X(07) 4 - 10

3-Filler X(08) 11 - 15

4-Filler X(04) 16 - 22

5-Date Fee Update X(08) 23 - 30 YYYYMMDD

6-Filler X(22) 31 - 52

7-Date File Created X(08) 53 - 60 YYYYMMDD

Data Record

Data Element Name Picture Location Comment

1-HCPCS X(05) 1 - 5

2-Filler X(04) 6 - 9

3-60% Fee 9(05)V99 10 - 16

4-62% Fee 9(05)V99 17 - 23

5-Filler X(07) 24 - 30

6- A/B MAC (B)

Number

X(05) 31 - 35

7- A/B MAC (B)

Locality

X(02) 36 - 37 00 = Single State A/B MAC (B)

01 = North Dakota

02 = South Dakota

20 = Puerto Rico

Data Element Name Picture Location Comment

8-State Locality X(02) 38 - 39 Separate instructions will be used

for the use of this field at a later

date.

9-Filler X(02) 40 - 41

10-Effective Date X(08) 42 - 49 Update effective date

(YYYYMMDD)