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Sub-Field: 162.06

Package: Fee Basis

FEE BASIS PAYMENT(#162)-->162.01-->162.02-->162.03-->162.06

Sub-Field: 162.06


Information

Parent File Name Number Package
162.03 CPT MODIFIER 162.06 Fee Basis

Details

Field # Name Loc Type Details
.01 CPT MODIFIER 0;1 POINTER TO CPT MODIFIER FILE (#81.3) CPT MODIFIER(#81.3)

  • LAST EDITED:  JUN 01, 1999
  • DESCRIPTION:  
    This field is used to better describe the service (CPT) rendered. The modifiers (if any) will be combined with the CPT code to determine fee schedule amounts and to check for duplicate payments.
  • CROSS-REFERENCE:  162.06^B
    1)= S ^FBAAC(DA(4),1,DA(3),1,DA(2),1,DA(1),"M","B",$E(X,1,30),DA)=""
    2)= K ^FBAAC(DA(4),1,DA(3),1,DA(2),1,DA(1),"M","B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  162^AE^MUMPS
    1)= D SMOD^FBAAUTL7
    2)= D KMOD^FBAAUTL7
    Cross-reference built to concatenate CPT with Modifier(s) for duplicate payment checks. The cross-reference is set by both the Service Provided field, as well as the CPT Modifier field.
    The cross-reference format is
    ^FBAAC("AE",pat IEN,ven IEN,date,cpt-mod list,serv prov IEN)="" where
    pat IEN is the PATIENT internal entry number in file 162. (dinum)
    ven IEN is the VENDOR multiple internal entry number. (dinum)
    date is the value of the INITIAL TREATMENT DATE (fileman format)
    cpt-mod list is the value of the SERVICE PROVIDED (internal)
    followed by a dash ("-") and a sorted list of values (internal) from
    the CPT MODIFIER multiple. Examples:
    12345 for a service provided without any modifiers
    12345-11,12 for a service provided with two modifiers
    serv prov IEN is the SERVICE PROVIDED multiple internal entry number.
    ***If the need arises to re-index the entire cross-reference, it should be done by re-indexing the Service Provided field and not the CPT Modifier the CPT Modifier field. As a Service Provided (CPT code) is
    mandatory for each payment entry, but a CPT Modifier is not, to assure a complete cross-reference, the re-indexing should be done on the Service Provided field.
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