Value |
Description |
German Interpretation |
Comment |
Chapter |
01 |
Most common semi-private rate |
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|
|
02 |
Hospital has no semi-private rooms |
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|
|
04 |
Inpatient professional component charges which are combined billed |
|
|
|
05 |
Professional component included in charges and also billed separate to carrier |
|
|
|
06 |
Medicare blood deductible |
|
|
|
08 |
Medicare life time reserve amount in the first calendar year |
|
|
|
09 |
Medicare co-insurance amount in the first calendar year |
|
|
|
10 |
Lifetime reserve amount in the second calendar year |
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|
|
11 |
Co-insurance amount in the second calendar year |
|
|
|
12 |
Working aged beneficiary/spouse with employer group health plan |
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|
|
13 |
ESRD beneficiary in a Medicare coordination period with an employer group health plan |
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|
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14 |
No Fault including auto/other |
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|
|
15 |
Worker’s Compensation |
|
|
|
16 |
PHS, or other federal agency |
|
|
|
17 |
Payer code |
|
|
|
21 |
Catastrophic |
|
|
|
22 |
Surplus |
|
|
|
23 |
Recurring monthly incode |
|
|
|
24 |
Medicaid rate code |
|
|
|
30 |
Pre-admission testing |
|
|
|
31 |
Patient liability amount |
|
|
|
37 |
Pints of blood furnished |
|
|
|
38 |
Blood deductible pints |
|
|
|
39 |
Pints of blood replaced |
|
|
|
40 |
New coverage not implemented by HMO (for inpatient service only) |
|
|
|
41 |
Black lung |
|
|
|
42 |
VA |
|
|
|
43 |
Disabled beneficiary under age 64 with LGHP |
|
|
|
44 |
Amount provider agreed to accept from primary payer when this amount is less than charges but higher than payment received,, then a Medicare secondary payment is due |
|
|
|
45 |
Accident hour |
|
|
|
46 |
Number of grace days |
|
|
|
47 |
Any liability insurance |
|
|
|
48 |
Hemoglobin reading |
|
|
|
49 |
Hematocrit reading |
|
|
|
50 |
Physical therapy visits |
|
|
|
51 |
Occupational therapy visits |
|
|
|
52 |
Speech therapy visits |
|
|
|
53 |
Cardiac rehab visits |
|
|
|
56 |
Skilled nurse - home visit hours |
|
|
|
57 |
Home health aide - home visit hours |
|
|
|
58 |
Arterial blood gas |
|
|
|
59 |
Oxygen saturation |
|
|
|
60 |
HHA branch MSA |
|
|
|
67 |
Peritoneal dialysis |
|
|
|
68 |
EPO-drug |
|
|
|
70 |
Payer codes |
|
|
|
72 |
Payer codes |
|
|
|
70 ... 72 |
Payer codes |
|
|
|
71 |
Payer codes |
|
|
|
75 |
Payer codes |
|
|
|
75 ... 79 |
Payer codes |
|
|
|
76 |
Payer codes |
|
|
|
77 |
Payer codes |
|
|
|
78 |
Payer codes |
|
|
|
79 |
Payer codes |
|
|
|
80 |
Psychiatric visits |
|
|
|
81 |
Visits subject to co-payment |
|
|
|
A1 |
Deductible payer A |
|
|
|
A2 |
Coinsurance payer A |
|
|
|
A3 |
Estimated responsibility payer A |
|
|
|
X0 |
Service excluded on primary policy |
|
|
|
X4 |
Supplemental coverage |
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|