CARRIER (PHYSICIAN/SUPPLIER) ACRONYMS
| CARRIER NUMBER: | The identification number assigned by CMS (previously HCFA) to a carrier authorized to process claims from a physician or supplier. |
| HCPCS CODE: | The Centers for Medicare &
Medicaid Services (CMS--previously HCFA) Common Procedure Coding System (HCPCS) is a Collection of codes that represent procedures, supplies, Products and services that may be provided to Medicare Beneficiaries and to individuals enrolled in private Health Insurance programs. The codes are divided into three Levels, or groups. Level I - CPT-4 codes and descriptors copyrighted By the American Medical Association's Current Procedural Terminology Level II - Includes codes and descriptors copyrighted by the American Dental Association and codes and descriptors approved and maintained jointly by the Alphanumeric editorial panel (consisting of CMS, The Health Insurance Association of America, and the Blue Cross and Blue Shield Association. Level II codes are non-numeric codes representing primarily items and non-physician services that are not represented in the Level I Codes. Level III - Codes and descriptors developed by |
| SPECIALTY CODE: | CMS (previously HCFA) Provider Specialty Code used for pricing the line item service on the non-institutional claim. |
| TYPE OF SERVICE CODE | Code indicating the type of service, as defined in the CMS (previously HCFA) Medicare Carrier Manual for line items on the Non-Institutional claim. |
| PLACE OF SERVICE CODE | The code indicating the place of service, as defined in the Medicare Carrier Manual for line items on the non-Institutional claim. |
| HCPCS MODIFIER CODE INITIAL | A first modifier to the HCPCS procedure code to enable a more specific procedure identification for the line item service on the non-institutional claim. |
| BETOS CODE | The BETOS code was developed
primarily for analyzing the growth in Medicare expenditures. The codes
cover all the HCPCS codes; only one HCPCS code is assigned to one
BETOS code; they consist of readily understood clinical categories
(as opposed to statistical or financial categories); and is relatively immune to minor changes in technology or practice patterns. |
| MTUS INDICATOR | Code indicating the units associated
with services needing units definition reporting on the carrier claim. 0 = Values reported as zero (no allowed activities) 1 = Transportation (ambulance) miles 2 = Anesthesia time units 3 = Services 4 = Oxygen Units 5 = Units of Blood |
| SUMMARIZED SERVICES AND AMOUNTS | |
| TOTAL SERVICES | The total unduplicated count of submitted services |
| ALLOWED SERVICES | Services derived from (Total Services - Denied Services). |
| DENIED SERVICES | Number of times the service counted in Total Services has been denied because of coverage or medical necessity. |
| MILES, TIMES,
UNITS, SERVICES (MTUS) |
Count of services or anesthesia time units or oxygen units or blood units. The MTUS Indicator identifies the content of this element. |
| SUBMITTED CHARGES | The amount submitted on the non-institutional claim. (Usually the Fee Schedule) |
| ALLOWED CHARGE | Total charges of all the allowed services including the deductible amounts. This amount is used to compute payment to providers or reimbursement to beneficiaries. Determined by the payment screen used, i.e. Actual Charge, Fee Schedules. |
| PAYMENT AMOUNT | Total payments from the trust funds (after deductible and coinsurance amounts have been paid) |
| DENIED AMOUNT | The total submitted charge for the services shown in denied Services. |
| ASSIGNED SERVICES | The number of times the services shown in Total Services were provided on assignment. |
