VSABs: HCPCS2023, HCDT2023, HCPT2023
Three SABs are assigned to HCPCS data, based on the code value.
The standard HCPCS data files do not include a hierarchy. The NLM uses the printed book and other resources to generate a hierarchy during Metathesaurus source processing. This hierarchy has not been reviewed by CMS and is attributed to SAB = HCPCS, TTY = MTH_HT.
HCPCS includes many attributes. When possible, NLM source processing has attempted to include an expanded value in the ATV field of MRSAT to enable the data to be self-documenting.
The expanded values have been extracted from HCPCS2023_recordlayout.txt and proc_notes_JAN2023.txt as appropriate.
For example, for the HCPCS Multiple Pricing Indicator Code is assigned an ATN of "HMP" in MRSAT.RRF.
A value that appears as "A"in the data file is given an expanded ATV of "A=Not applicable as HCPCS priced under one methodology" in MRSAT.RRF.
The complete HCPCS Contractor distribution includes the following:
| File Name | Description |
|---|---|
| HCPC<YYYY>_<MON>_TRANS_ALL.xlsx | A series of reports containing information on the types of transactions (updates and changes) which were made to the HCPCS database. This file is not processed directly. |
| HCPC<YYYY>_recordlayout.txt | Documentation for the contractor record layout, including field names, lengths, beginning and ending character positions, and detailed descriptions of the values. |
| proc_notes_<YYYY>.txt | Explanations of values for HCPCS Processing Notes. |
| File Name | Description |
|---|---|
| HCPC<YYYY>_<MON>_CONTR.txt | Fixed-length field data file, including Level I and Level II codes and all associated data. |
Details on format of input files and representation of source data. Consult the HCPCS documentation for additional details.
| # | Field | Length | Begin | End | Description | Representation |
|---|---|---|---|---|---|---|
| 1 | Code | 5 | 1 | 5 | HCPCS Level I or Level II Code; for modifiers, characters 1-3 are filler | MRCONSO.CODE, MRCONSO.SCUI |
| 2 | Sequence Number | 5 | 6 | 10 | Sequence number by 100s. Used to group procedure or modifier codes together | Not represented in the Metathesaurus |
| 3 | Record Identification Code | 1 | 11 | 11 | Code to identify record type | Used to determine TTY: 3 = Modifier (TTY = "MP", "AM", "OM", "OAM"); 7 = procedure record (TTY = "PT", "AB", "OP", "OA") |
| 4 | Long Description | 80 | 12 | 91 | Contains all text of procedure or modifier long description | MRCONSO.STR, TTY = "PT", "OP", "OM" or "OP" depending on values of the "Record Identification Code" and the "Termination Date." The "MP" atom is generally created by extracting the text before the first ":". Material appearing after the first ":" is included in MRSAT.ATN = "CPF". |
| 5 | Short Description | 28 | 92 | 119 | Short descriptive text of procedure or modifier code. | MRCONSO.STR; TTY = "AM", "OAM", "AB", or "OA" depending on values of the "Record Identification Code" and the "Termination Date." |
| 6 | Pricing Indicator | 2 | 120 | 121 | Code used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have multiple pricing codes. | MRSAT.ATN = "HPI" (value expanded per documentation). |
| 7 | Multiple Pricing Code | 1 | 128 | 128 | Code used to identify instances where a procedure could be priced under multiple methodologies. | MRSAT.ATN = "HMP" (value expanded per documentation). |
| 8 | Coverage Issues Manual Reference Section Number | 6 | 129 | 134 | Number identifying the reference section of the coverage issues manual. A procedure may have multiple references. | MRSAT.ATN = "HIR" |
| 9 | Medicare Carriers Manual Reference Section Number | 8 | 147 | 154 | Number identifying a section of the Medicare carriers manual. A procedure may have multiple references. | MRSAT.ATN = "HMR" |
| 10 | Statute Number | 10 | 171 | 180 | Number identifying statute reference for coverage or non-coverage of procedure or service. | MRSAT.ATN = "HSN". |
| 11 | Lab Certification Code | 3 | 181 | 183 | Code used to classify laboratory procedures according to the specialty certification categories listed by CMS. Any generally certifiable laboratory (e.g., 100) may perform any of the tests in its subgroups (e.g., 110, 120, etc.) A procedure may have multiple certification codes. | MRSAT.ATN = "HLC" |
| 12 | Cross Reference Code | 5 | 205 | 209 | Explicit reference cross-walking a deleted code or a code that is not valid for Medicare to a valid current code (or range of codes). | MRSAT.ATN = "HXR"; when codes are valid, cross-references are also represented in MRREL, with REL = "RQ" and RELA = "mapped_to"/"mapped_from". |
| 13 | Coverage Code | 1 | 230 | 230 | Code denoting Medicare coverage status. | MRSAT.ATN = "HCC" |
| 14 | ASC Payment Group Code | 2 | 231 | 232 | A value of "YY" indicates that this procedure is approved to be performed in an ambulatory surgical center. | MRSAT.ATN = "HPG" |
| 15 | ASC Payment Group Date | 8 | 233 | 240 | Date the procedure is assigned to the ASC payment group. | MRSAT.ATN = "HPD" |
| 16 | MOG Payment Group Code | 3 | 241 | 243 | Medicare outpatient groups (MOG) payment group code. | Not applicable (in the current HCPCS version, this field is always empty.) |
| 17 | MOG Payment Policy | 1 | 244 | 244 | Indicator identifying whether a HCPCS code is subject to payment of an ASC facility fee, to a separate fee under another provision of Medicare, or to no fee at all. | Not applicable (in the current HCPCS version, this field is always empty.) |
| 18 | MOG Effective Date | 8 | 245 | 252 | The date the procedure is assigned to the Medicare outpatient group (MOG) payment group. | Not applicable (in the current HCPCS version, this field is always empty.) |
| 19 | Processing Note Number | 4 | 253 | 256 | Number identifying the processing note contained in Appendix A of the HCPCS manual. | MRSAT.ATN="HPN" (value expanded per documentation). |
| 20 | Berenson-Eggers Type of Service Code | 3 | 257 | 259 | The BETOS for the procedure code based on generally agreed-upon clinically meaningful groupings of procedures and services (values expanded per documentation). | MRSAT.ATN = "HBT" |
| 21 | filler | 1 | 260 | 260 | Not applicable | Not applicable |
| 22 | Type of Service Code | 1 | 261 | 261 | The carrier-assigned CMS type of service which describes the particular kind(s) of service represented by the procedure code . A procedure may have multiple type of service codes. | MRSAT.ATN = "HTS" |
| 23 | Anesthesia Base Unit Quality | 3 | 266 | 268 | Represents the level of intensity for anesthesia procedure services that reflects all activities except time. These activities include usual pre-operative and post-operative visits, the administration of fluids and/or blood incident to anesthesia care, and monitoring procedures. | MRSAT.ATN = "HAQ" |
| 24 | Code Added Date | 8 | 269 | 276 | Year the code was added to HCPCS. | MRSAT.ATN = "HCD" |
| 25 | Action Effective Date | 8 | 277 | 284 | Effective date of action to a procedure or modifier code. | MRSAT.ATN = "HAD" |
| 26 | Termination Date | 8 | 285 | 292 | Last date for which a procedure or modifier code may be used by Medicare providers. | MRSAT.ATN = "HTD"; a non-blank termination date is also used to assign obsolete term types (TTY = "OP", "OA", "OM", "OAM"). |
| 27 | Action Code | 1 | 293 | 293 | A code denoting the change made to a procedure or modifier code within the HCPCS system (value expanded per documentation). | MRSAT.ATN = "HAC" |
| 28 | filler | 27 | 294 | 320 | Not applicable | Not applicable |