US · guidance

CMS Pub. 100-04, ch. 23, § 50.2

Institutional Claim Record Layout for the Durable Medical Equipment,

activein force · 2026-08-25 – presentas-observed

Prosthetic, Orthotic and Supply Fee Schedule

(Rev. 3350, Issued: 09-11-15, Effective: 01-01-16, Implementation: 01-04-16)

This file contains services subject to national Floors and Ceilings under the DMEPOS Fee Schedules

including Surgical Dressings. The CMS will provide the specific file names when the prices are released.

The file name will contain the label DMEPOS.

Record Length - 60

Record Format - FB

Block Size - 6000

Character Code - EBCDIC

Sort Sequence - Label, HCPCS Code, MOD, State

Data Element Name Picture Location Comment

1-HCPCS X(05) 1 - 5

2-MOD X(02) 6 – 7

3-MOD 2 X(02) 8 – 9

4-Fee Schedule Amt 9(05)V99 10 – 16

5-Filler X(01) 17

6-Rural Fee Amt 9(05)v99 18 – 24

7-Filler X(01) 25

8-Rural Fee indicator X(01) 26- R = Rural Fee is present

9-Filler X(04) 27-30

10-State X(02) 31 - 32

11-Filler X(05) 33 - 37

12-*Label* X(3) 38 - 40 DME = Durable Medical Equipment

(other than oxygen)

OXY = Oxygen

P/O = Prosthetic/Orthotic

S/D = Surgical Dressings

13-Filler X(4) 41 - 44

14-*Pricing Change

Indicator

X(1) 45 - 45 0 = No change to Update Fee Schedule

Amount since previous release

1 = A change has occurred to the

Update Fee Schedule Amount since the

previous release.

NOTE: In the initial release of the

annual update, this field is initialized to

>0’

15-Filler X(02) 46 – 47

16-Effective Date X(08) 48 – 55 Update effective date (YYYYMMDD)

17-Filler X(05) 56 – 60

History

(Rev. 3350, Issued: 09-11-15, Effective: 01-01-16, Implementation: 01-04-16)

Provenance

Source: cms.gov
Retrieved: 2026-08-25
Edition: iom-2026-08-25
Content hash: 3cad808a50e50b78227fb45f0114de9361b833ad674ef2786455a12d72b6028e

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