P.O. Box 510949 Milwaukee, WI 53203 800 669-3337 414 272-6666 Fax info@medicaldatafiles.com
Record Layout / Sample Data
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MedicalDataFiles.Com
P.O. Box 510949 Milwaukee, WI 53203 800 669-3337 414 272-6666 Fax info@medicaldatafiles.com Record Layout / Sample Data |
|
File Description / Details: |
| Description: | DMEPOS Codes, Descriptions and Fees (all localities) |
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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, KC—Replacement 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 |
| 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 |