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Record Layout / Sample Data

File Description / Details:

Description: DMEPOS Codes, Descriptions and Fees (all localities)

Record Layout:
Field Type Size  Description
HCPCS Char 5 All current year active and deleted codes subject to DMEPOS floors and ceilings.  
DESC Char 29 Short Description 
MOD / 

MOD2

 

Char 2 NU-Purchased New,  RR-Rented  UE-Purchased, Used,  KM-Replacement of Facial Prosthesis including new impression/moulage,   KN-Replacement of Facial Prosthesis using previous master mold,  AU-Urological, ostomy or trach item,   AV-Item with prosthetic/orthotic device,  AW-Item with a surgical dressing,  KE-Bid Under Round I of the DMEPOS Competitive Bid Program For Use With Non-Competitive Bid Base Equipment KF-Class III device,  KL-DMEPOS Item Delivered Via Mail,  KCóReplacement of Special Power Wheelchair Interface
JURIS Char 2 D-DMERC jurisdiction,  L--Local Part B Carrier jurisdiction, J-Joint DMERC/Local Carrier jurisdiction
CATG Char 2 IN-Inexpensive and Other Routinely Purchased Items, FS-Frequently Serviced Items,  CR-Capped Rental Items,  OX-Oxygen and Oxygen Equipment,  OS-Ostomy, Tracheostomy & Urological Items,  SD-Surgical Dressings,  PO-Prosthetics & Orthotics,  SU-Supplies,  TE-Transcutaneous Electrical Nerve Stimulators, TS-Therapeutic Shoes
CEILING Num 10.2 Maximum fee schedule amount
FLOOR Num 9.2 Minimum fee schedule amount
STATE  Num 10.2 State fee schedules for all localities

Sample Data  
 
HCPCS Description Mod Mod2 JURIS CATG Ceiling Floor AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AK HI PR VI
A4216 Sterile water/saline, 10 ml

D OS $0.47 $0.40 $0.45 $0.47 $0.46 $0.47 $0.47 $0.47 $0.47 $0.47 $0.45 $0.47 $0.47 $0.40 $0.40 $0.47 $0.40 $0.42 $0.47 $0.47 $0.46 $0.47 $0.47 $0.47 $0.47 $0.47 $0.47 $0.42 $0.45 $0.46 $0.47 $0.47 $0.47 $0.47 $0.43 $0.40 $0.40 $0.40 $0.47 $0.42 $0.47 $0.41 $0.41 $0.41 $0.47 $0.45 $0.47 $0.40 $0.47 $0.45 $0.47 $0.72 $0.70 $0.41 $0.43
A4217 Sterile water/saline, 500 ml

D SU $3.29 $2.80 $2.80 $3.29 $3.29 $2.80 $3.29 $3.29 $2.92 $3.29 $3.29 $3.29 $3.29 $2.80 $3.29 $3.29 $2.80 $2.80 $3.29 $2.80 $3.29 $2.80 $3.29 $3.29 $2.80 $2.97 $2.80 $2.80 $3.16 $2.86 $2.80 $3.29 $3.29 $2.80 $2.80 $3.29 $2.84 $3.29 $3.29 $2.80 $2.80 $3.29 $2.80 $3.29 $2.80 $2.98 $3.20 $3.29 $3.29 $3.29 $3.29 $1.61 $2.84 $3.61 $2.80
A4217 Sterile water/saline, 500 ml AU
D OS $3.29 $2.80 $2.80 $3.29 $3.29 $2.80 $3.29 $3.29 $2.92 $3.29 $3.29 $3.29 $3.29 $2.80 $3.29 $3.29 $2.80 $2.80 $3.29 $2.80 $3.29 $2.80 $3.29 $3.29 $2.80 $2.97 $2.80 $2.80 $3.16 $2.86 $2.80 $3.29 $3.29 $2.80 $2.80 $3.29 $2.84 $3.29 $3.29 $2.80 $2.80 $3.29 $2.80 $3.29 $2.80 $2.98 $3.20 $3.29 $3.29 $3.29 $3.29 $1.61 $2.84 $3.61 $2.80
A4221 Maint drug infus cath per wk

D SU $23.77 $20.20 $23.77 $23.77 $23.37 $23.37 $23.77 $23.77 $23.77 $23.77 $23.77 $23.77 $23.37 $23.37 $23.77 $23.77 $23.37 $23.77 $23.77 $23.77 $23.77 $23.77 $23.77 $23.77 $23.37 $23.77 $23.37 $23.77 $23.37 $23.37 $23.77 $23.77 $23.77 $23.37 $23.77 $23.77 $23.77 $23.37 $23.77 $23.77 $23.77 $23.37 $23.77 $23.77 $23.37 $23.77 $23.77 $23.37 $23.77 $23.77 $23.37 $23.60 $25.24 $28.54 $23.77
A4222 Infusion supplies with pump

D SU $49.07 $41.71 $49.07 $49.07 $46.38 $46.38 $49.07 $49.07 $47.19 $49.07 $47.19 $49.07 $46.38 $46.38 $47.19 $49.07 $46.38 $49.07 $49.07 $49.07 $47.19 $49.07 $49.07 $49.07 $46.38 $49.07 $46.38 $48.60 $46.38 $46.38 $49.07 $49.07 $49.07 $46.38 $49.07 $47.19 $49.07 $46.38 $49.07 $49.07 $49.07 $46.38 $49.07 $47.19 $46.38 $47.19 $49.07 $46.38 $49.07 $47.19 $46.38 $46.85 $50.10 $56.61 $49.07
A4233 Alkalin batt for glucose mon NU
D IN $0.84 $0.71 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $0.84 $1.00 $0.84
A4233 Alkalin batt for glucose mon NU KL D IN $0.72 $0.61 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.72 $0.86 $0.72
A4234 J-cell batt for glucose mon NU
D IN $3.81 $3.24 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $3.81 $4.58 $3.81
A4234 J-cell batt for glucose mon NU KL D IN $3.29 $2.80 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.29 $3.95 $3.29
A4235 Lithium batt for glucose mon NU KL D IN $2.12 $1.80 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.12 $2.53 $2.12
A4235 Lithium batt for glucose mon NU
D IN $2.46 $2.09 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.46 $2.94 $2.46
A4236 Silvr oxide batt glucose mon NU
D IN $1.76 $1.50 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $1.76 $2.10 $1.76
A4236 Silvr oxide batt glucose mon NU KL D IN $1.52 $1.29 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.52 $1.81 $1.52
A4253 Blood glucose/reagent strips NU
D IN $0.00 $0.00 $38.79 $38.79 $37.98 $38.79 $34.38 $38.79 $38.79 $37.65 $38.79 $37.28 $38.79 $36.44 $38.79 $35.75 $34.55 $38.78 $38.79 $38.79 $38.79 $38.79 $38.79 $37.81 $34.38 $38.79 $37.66 $34.88 $36.42 $34.71 $38.79 $38.79 $34.80 $35.44 $38.79 $38.78 $34.38 $38.79 $38.79 $37.66 $38.79 $37.17 $38.79 $36.28 $38.79 $38.79 $38.79 $36.53 $37.35 $38.79 $38.80 $37.91 $38.78 $37.30 $38.79
A4253 Blood glucose/reagent strips NU KL D IN $0.00 $0.00 $33.43 $33.43 $32.73 $33.43 $29.63 $33.43 $33.43 $32.45 $33.43 $32.13 $33.43 $31.40 $33.43 $30.82 $29.77 $33.42 $33.43 $33.43 $33.43 $33.43 $33.43 $32.59 $29.63 $33.43 $32.46 $30.06 $31.39 $29.92 $33.43 $33.43 $29.99 $30.54 $33.43 $33.42 $29.63 $33.43 $33.43 $32.46 $33.43 $32.04 $33.43 $31.27 $33.43 $33.43 $33.43 $31.48 $32.19 $33.43 $33.44 $32.67 $33.42 $32.15 $33.43
A4255 Glucose monitor platforms

D SU $4.32 $3.67 $4.32 $4.32 $4.32 $4.32 $4.32 $4.11 $4.11 $4.11 $4.11 $4.25 $4.32 $4.32 $4.11 $4.32 $4.32 $4.32 $4.32 $4.11 $4.11 $4.11 $4.25 $4.32 $4.32 $4.32 $4.32 $4.20 $4.32 $4.32 $4.11 $4.11 $4.32 $4.32 $4.11 $4.11 $4.32 $4.32 $4.11 $4.11 $4.32 $4.32 $4.32 $4.11 $4.32 $4.11 $4.11 $4.32 $4.32 $4.11 $4.32 $4.42 $4.75 $4.50 $4.32
A4256 Calibrator solution/chips

D SU $12.01 $10.21 $12.01 $10.21 $10.21 $10.21 $12.01 $12.01 $10.21 $12.01 $11.08 $10.21 $12.01 $12.01 $12.01 $12.01 $11.62 $11.55 $10.21 $12.01 $10.94 $12.01 $11.69 $10.38 $11.19 $12.01 $12.01 $12.01 $12.01 $11.74 $12.01 $10.21 $12.01 $10.21 $10.21 $12.01 $11.34 $12.01 $10.21 $12.01 $12.01 $10.21 $12.01 $12.01 $10.21 $10.21 $12.01 $12.01 $12.01 $12.01 $12.01 $5.38 $5.74 $10.61 $10.21
A4256 Calibrator solution/chips KL
D SU $10.35 $8.80 $10.35 $8.80 $8.80 $8.80 $10.35 $10.35 $8.80 $10.35 $9.55 $8.80 $10.35 $10.35 $10.35 $10.35 $10.02 $9.96 $8.80 $10.35 $9.43 $10.35 $10.07 $8.95 $9.65 $10.35 $10.35 $10.35 $10.35 $10.12 $10.35 $8.80 $10.35 $8.80 $8.80 $10.35 $9.77 $10.35 $8.80 $10.35 $10.35 $8.80 $10.35 $10.35 $8.80 $8.80 $10.35 $10.35 $10.35 $10.35 $10.35 $4.63 $4.95 $9.14 $8.80
A4257 Replace Lensshield Cartridge

D SU $13.39 $11.38 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $16.07 $13.39
A4258 Lancet device each

D SU $18.95 $16.11 $18.95 $18.95 $18.64 $18.64 $18.95 $18.95 $18.95 $18.95 $18.95 $18.95 $18.64 $18.64 $18.95 $18.95 $18.64 $18.95 $18.95 $18.95 $18.95 $18.95 $18.95 $18.95 $18.64 $18.95 $18.64 $18.95 $18.64 $18.64 $18.95 $18.95 $18.95 $18.64 $18.95 $18.95 $18.95 $18.64 $18.95 $18.95 $18.95 $18.64 $18.95 $18.95 $18.64 $18.95 $18.95 $18.95 $18.95 $18.95 $18.64 $18.83 $20.15 $22.75 $18.95
A4258 Lancet device each KL
D SU $16.34 $13.89 $16.34 $16.34 $16.06 $16.06 $16.34 $16.34 $16.34 $16.34 $16.34 $16.34 $16.06 $16.06 $16.34 $16.34 $16.06 $16.34 $16.34 $16.34 $16.34 $16.34 $16.34 $16.34 $16.06 $16.34 $16.06 $16.34 $16.06 $16.06 $16.34 $16.34 $16.34 $16.06 $16.34 $16.34 $16.34 $16.06 $16.34 $16.34 $16.34 $16.06 $16.34 $16.34 $16.06 $16.34 $16.34 $16.34 $16.34 $16.34 $16.06 $16.23 $17.37 $19.61 $16.34
A4259 Lancets per box KL
D SU $0.00 $0.00 $9.80 $10.91 $10.91 $10.91 $10.91 $10.91 $9.80 $9.80 $10.91 $10.91 $10.91 $9.85 $10.91 $10.00 $10.83 $10.91 $10.91 $9.80 $9.80 $9.80 $10.91 $10.91 $10.91 $9.80 $10.91 $10.91 $10.91 $10.91 $9.80 $10.91 $10.91 $10.91 $10.91 $9.80 $9.91 $10.91 $9.80 $9.80 $10.91 $10.45 $10.59 $10.91 $10.91 $10.91 $9.80 $10.91 $9.91 $10.39 $10.91 $10.92 $10.91 $10.81 $10.91

02/04/09