CMS Pub. 100-04, ch. 23, § 50.1

Prices and Local HCPCS Codes

(Rev. 2643, Issued: 01-31-13, Effective: 07-01-13, Implementation: 07-01-13)

This file contains hospice fee schedule prices extracted from the Physician Fee schedule. This file contains

pricing data for A/B MAC (B)-priced and local HCPCS codes for radiology, other diagnostic services, and

hospice services paid under the physician fee schedule. This file contains some high volume services such

as portable x-rays. The file is also used to pay claims for Critical Access Hospitals that have elected the

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

will contain the label HHH.

Record Length - 60

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

Data Element Name Picture Location Comment

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

8-Locality X(02) 36 - 37

9-**Label** X(03) 38 - 40 HPH = Hospice Physician Services

ODX = Other Diagnostic Services

PRF = Portable Radiology

RAD = Radiology

10-Filler X(2) 41 - 42

11-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.

12-Multiple Surgery X(01) 44 - 44 Indicator indicates which payment

adjustment rule for multiple procedures

apply to the service.

13-Non Facility PE 9(05)V99 45 - 51 Non-facility practice expense RVU

14-Filler X(01) 52 - 52

15- A/B MAC (A) or

(HHH) Therapy

Reduction

9(05)V99 53 - 59 Reduces payment amount for multiple

surgery

16-Filler X(01) 60 - 60