2010 Cost Center Setup Cross Reference

Exhibit 3, 4, 11, 19, 20, 30, 31A, and 46

Also available as an Excel Spreadsheet

CMS
S-3
Line
Code
ICR
Exhibit 3
Line
Code
CMS
2552
Center
Code
HCRIS
Code
2009
Description
ICR
Cost
Center
Code
Exh. 19
& 20
Column
Code
Sort
Order
Exhibit 46
Charge
Code
Assign.
Exh 4,
30 & 31A
Code
Assign.
General Service Cost Center Line Assignments (95)
(38)  Standard 001-026, 029-030, 033, 040-047, 095
(57)Variable 027-028, 031-032, 034-039, 048 - 094
(Program Capabilities 200)
1 0100 Old Capital Related Costs-- Buildings and Fixtures 001 1100 1
2 0200 Old Capital Related Costs-- Movable Equipment 002 1101 2
3 0300 New Capital Related Costs-- Buildings and Fixtures 042 1128 3
4 0400 New Capital Related Costs-- Movable Equipment 043 1129 4
5 0500 Employee Benefits 003 1102 5
5.01 1080 Inservice Education 044 1144 6
5.02 0501 Day Care 045 1142 7
7 0700 Maintenance and Repairs 004 1100 8
8 0800 Operation of Plant 041 1100 9
9 0900 Laundry and Linen Service 005 1103 10
10 1000 Housekeeping 006 1104 11
11.01 1101 Dietary--Raw Food 007 1105 12
11.02 1102 Dietary--Other 008 1106 13
12 1200 Cafeteria 009 1107 14
13 1300 Maintenance of Personnel 010 1108 15
17 1700 Medical Records & Medical Records Library 011 1109 16
18 1800 Social Service 012 1110 17
19 1501 Medical Supplies and Expense 015 1113 18
19.01 1500 Central Services and Supply 016 1114 19
19.02 1600 Pharmacy 017 1115 20
19.03 1400 Nursing Administration 018 1120 21
19.04 1950 Intensive Nursing Care 019 1117 22
19.05 1951 General Nursing Service 021 1116 23
19.06 1952 Supervising Physicians-- Other 040 1139 24
19.07 1953 Transportation 046 1141 25
19.08 1954 Activities 047 1143 26
20 2000 Nonphysician Anesthetists 029 1130 27
21 2100 Nursing School 020 1118 28
22 2200 Intern & Res. Service-- Salary & Fringes (Appvd) 013 1111 29
23 2300 Intern & Res. Other Program Costs (Appvd) 033 1131 30
23.01 2301 Supervising Physicians - Teaching 014 1112 31
24 2400 Paramedical Ed. Program (Specify) 030 1127 32
6.01 0610 Nonpatient Telephones 022 1122 33
6.02 0620 Data Processing 023 1123 34
6.03 0630 Purchasing Receiving and Stores 024 1124 35
6.04 0640 Admitting 025 1125 36
6.05 0650 Cashiering/Accounts Receivable 026 1126 37
6.06 0660 Other Administrative  and General 095 0000 38
Variable Variable Any Additional General Service Cost Centers 027, 028, 031, 032, 034 to 039, 048 to 094 1119, 1132 to 1138, 1200 to 1248
Ancillary Service Cost Center Line Assignments (99)
(66) Standard 100 - 124, 126 - 128, 132 - 158, 187-197
(33) Variable 125, 129 - 131, 159 - 186
(Program Capabilities 150 lines for Ancillary and Outpatient Cost Centers)
37 3700 Operating Room 100 1150 100
38 3800 Recovery Room 101 1179 101
39 3900 Delivery Room & Labor Room 103 1152 102
40 4000 Anesthesiology 102 1151 103
41 4100 Radiology-Diagnostic 104 1153 104
42 4200 Radiology-Therapeutic 105 1154 105
43 4300 Radioisotope 121 1167 106
43.01 3230 CAT Scan 128 1177 107
44 4400 Laboratory 106 1155 108
44.01 4401 Bio-Medical (Lab) (Engineering) 139 1192 109
45 4500 PBP Clinical Lab Srvc-Program Only 132 1185 110
46 4600 Whole Blood and Packed Red Blood Cells 114 1160 111
46.30 4650 Blood Clotting Factors Admin Costs 118 1164 112
47 4700 Blood Storing, Processing & Trans. 115 1168 113
48 4800 Intravenous Therapy 117 1162 114
49 4900 Respiratory Therapy 113 1159 115
50 5000 Physical Therapy 109 1158 116
51 5100 Occupational Therapy 110 1163 117
52 5200 Speech Pathology 111 1173 118
53 5300 Electrocardiology 107 1156 119
54 5400 Electroencephalography 108 1157 120
55 5500 Med Supplies Charged to Patients 122 1169 121
55.30 5530 Implantable Devices Charged to Patients 197 1298 122
56 5600 Drugs Charged to Patients 123 1170 123
57 5700 Renal Dialysis 124 1172 124
58 5800 ASC (Non-Distinct) 126 1184 125
59 3996 Blank Line - Not Used 198 1299 126
59.01 3040 Audiology 112 1174 127
59.02 3320 Shock Therapy 116 1161 128
59.03 3160 Cardiopulmonary 119 1199 129
59.04 3950 Cystoscopy 120 1166 130
59.05 3630 Ultrasound Diagnostic 127 1176 131
59.06 3480 Oncology 134 1187 132
59.07 3430 Magnetic Resonance Imaging 135 1188 133
59.08 3440 Mammography 136 1189 134
59.09 3450 Nuclear Medicine - Diagnostic 137 1190 135
59.10 3470 Nuclear Medicine - Therapeutic 138 1191 136
59.11 3240 Cytology 140 1193 137
59.12 3120 Cardiac Catherization Laboratory 141 1194 138
59.13 3650 Vascular Lab 142 1195 139
59.14 3580 Recreational Therapy 143 1196 140
59.15 3140 Cardiology 144 1197 141
59.16 3260 Echocardiography 145 1198 142
59.17 3560 Pulmonary Function Testing 146 1250 143
59.18 3620 Stress Test 147 1251 144
59.19 3640 Urology 148 1252 145
59.20 3330 Endoscopy 149 1253 146
59.21 3340 Gastro Intestinal Services 150 1254 147
59.22 3520 Ophthalmology 151 1255 148
59.23 3550 Psychiatric/Psychological Services 152 1256 149
59.24 3250 Dental Services 153 1257 150
59.25 3070 Birthing Center 154 1258 151
59.26 3951 Fee For Service - Cardiology 155 1259 152
59.27 3952 Fee For Service - Emergency Service 156 1260 153
59.28 3953 Fee For Service - Laboratory 157 1261 154
59.29 3954 Fee For Service - Radiology 158 1262 155
59.30 3190 Chemotherapy 133 1186 156
59.31 3955 Asthma 196 1297 157
59.97 3997 Cardiac Rehabilitation 195 1296 158
59.32 3956 Diabetes 194 1295 159
59.99 3999 Lithotripsy 193 1294 160
59.33 3957 Nutritional Counseling 192 1293 161
59.34 3958 Pain Management 191 1292 162
59.35 3959 PET Scans 190 1291 163
59.36 3960 Sleep Lab 189 1290 164
59.37 3961 Wound Care 188 1289 165
59.98 3998 Hyperbaric Oxygen Therapy 187 1288 166
Variable Variable Any Additional Ancillary Cost Centers 125, 129 to 131, 159 to 186 1165, 1175, 1178, 1180 to 1183, 1263 to 1287
Inpatient Service Cost Center Line Assignments (99)
(40) Standard 201, 204 -209, 214 - 215, 217 - 221, 224 - 229,
268, 301 - 317, 377-378
(59) Variable 318 - 376
(Program Capabilities 50)
25 Adults and Pediatrics (CMS line comb. lines 25)
1.06 050 25.01 2501 Medical Surgical Inpatients 201 200 0195 001
1.07 054 25.02 2502 Pediatric Unit 214 201 0094 020
1.08 055 25.03 2503 Maternity Unit 215 202 0095 030
1.09 25.04 2504 Alternate Level of Care 219 203 0370 043
1.10 053 25.05 2505 Epilepsy Unit 205 204 0182 042
1.17 301 25.12 2506 Psychiatric 301 205 3001 301
1.12 057 25.07 2508 Rehabilitation Medicine 218 206 0093 41
1.18 302 25.13 2509 Traumatic Brain Injury/Coma 302 207 3002 302
1.13 060 25.08 2510 Tuberculosis 217 208 0198 45
1.14 061 25.09 2511 H. I. V. Care 224 209 0193 47
1.15 52 25.10 2512 Chemical Dependency Detoxification 203 210 0018 203
1.16 42 25.11 2514 Chemical Dependency Rehabiliatation 210 211 0019 210
1.21 304 25.16 2516 Bone Marrow Unit 304 214 3004 304
6 002 26 2600 Intensive Care Unit 206 213 0196 002
6.01 305 26.01 2601 Pediatric ICU 305 214 3005 305
377 26.02 2602 Cardiac ICU 377 215 3080 377
7 003 27 2700 Coronary Care Unit 207 216 0197 003
8 040 28 2800 Burn Intensive Care Unit 208 217 0183 004
9 041 29 2900 Surgical Intensive Care Unit 209 218 0184 005
10 063 30 2060 Neonatal Intensive Care Unit 229 219 0194 054
10.98 310 Neonatal Intermediate Care 220 310
10.99 311 Neonatal Continuing Care 221 311
See Below 30.01 See HCRIS List Other Special Care Units (specify) See Below See Below See Below
14 009 31 3100 Subprovider 1 - Psychiatric  225 222 0188 055
14.03 378 31.03 3103 Long Term Psychiatric Unit 378 223 3081 378
14.01 010 31.01 3101 Subprovider 2 Rehabilitation 226 224 0189 056
14.02 306 31.02 3102 Traumatic Brain Injury/Coma 306 225 3006 306
11 33 Nursery CMS Only (Comb. Prem. & Newborn)
11.01 039 33.01 3301 Nursery - Premature 227 226 0024 051
11.02 007 33.02 3302 Nursery - Newborn 228 227 0025 052
Variable 318-371 Variable Variable Any Add'l Inpatient Component Other than SNF/Other Long Term Care 318-371   3021-3074 318-371
15 34 Skilled Nursing Facility (Comb. for CMS 2552-96)
15.01 011 34.01 3400 Skilled Nursing Facility 1 (RHCF) 268 228 0032 053
15.02 307 34.02 3401 Skilled Nursing Facility 2 (RHCF) 307 229 3007 307
15.03 312 34.03 3402 SNF Head Injury 312 230 3012 312
15.04 313 34.04 3403 Long Term Ventilator Dependent 313 231 3015 313
15.05 314 34.05 3404 Behavioral Intervention 314 232 3016 314
15.06 315 34.06 3405 Specialty Pediatric SNF 315 233 3017 315
15.07 316 34.07 3406 Aids SNF 316 234 3018 316
15.08 317 34.08 3407 Transitional Care Unit 317 235 3019 317
Variable 372-373 Variable Variable Any Additional Skilled Nursing Facility Component 372-373 3075-3076 372-373
17 36 Other Long Term Care (Combined for CMS 2552-96)
17.01 308 36.01 3601 Other Long Term Care 1 308 236 3008 308
17.02 309 36.02 3602 Other Long Term Care 2 309 237 3009 309
Variable 374-376 Variable Variable Any Additional Other Long Term Care Component 374-376   3077-3079 374-376
Outpatient Service Cost Center Line Assignment (98)
(51) Standard 216, 235 - 237, 239, 240,  246 - 249, 253, 254,
260, 261, 263, 288 - 291, 401 - 426, 474-480
(47) Variable 427 - 473
(Program Capabilities for all Ancillary and Outpatient Cost Centers is 150 possible lines)
60 6000 Clinic 235 300 0026
60.04 6001 Alcohol Clinic 291 301 0387
60.15 6002 Alcohol Day Rehab Clinic 401 302 4830
60.16 6003 Chemotherapy Clinic 402 303 4831
60.17 6004 Day Hospital 403 304 4832
60.18 6005 Early Intervention 404 305 4833
60.19 6006 Family Clinic 405 306 4834
60.20 6007 Family Planning 406 307 4835
60.21 6008 Head Injury Clinic 407 308 4836
60.05 6009 H. I. V. Clinics 263 309 0388
60.22 6010 Hyperbaric Clinic 408 310 4837
60.23 6011 Intravenous Gamma Gobulin Pediatric Clinic - Discontinue beg 1/1/2009 409 311 4838
60.24 6012 Oncology Clinic 410 312 4839
60.25 6013 Pediatric Clinic 411 313 4840
60.26 6014 Rehabilitation Clinic 412 314 4841
60.27 6015 Spina Bifada Clinic-Discontinue for reports beginning 1/1/09 and after 413 315 4842
60.39 6039 Cardiac Rehabilitation Clinic 480 345 4909
60.40 6040 Dental Clinic 479 346 4908
60.41 6041 Diabetes Clinic 478 347 4907
60.42 6042 PCAP Clinic 477 348 4906
60.43 6043 Sleep Clinic 476 349 4905
60.44 6044 Wound Care Clinic 475 350 4904
60.07 6016 Mental Health Clinic 289 316 0386
60.08 6017 Blank Line - Not Used 290 317 380
60.09 6018 Mental Health Continuing Day Treatment  249 318 0108
60.06 6019 Mental Health Day Treatment 246 319 0033
60.10 6020 Mental Health Intensive Psychiatric Rehab. Outpatient 253 320 0111
60.11 6021 Mental Health Partial Hosp. 254 321 0112
60.12 6022 All Other OMH Programs O/P 247 322 0106
60.13 6023 All Other OASAS Programs O/P 248 323 0107
60.32 6032 Mental Health Outpatient ACT Programs 420 324 4849
60.33 6033 Mental Health Outpatient ICM Programs 421 325 4850
60.34 6034 Mental Health Outpatient SCM Programs 422 326 4851
60.35 6035 Comprehensive PROS with Clinic 423 327 4852
60.36 6036 Comprehensive PROS  424 328 4853
60.37 6037 Limited License PROS 425 329 4854
60.38 6038 PROS Rehabilitation and Support 426 330 4855
60.28 6024 Adult Day Care 1 414 331 4843
60.31 6031 Adult Day Care 2 419 332 4848
60.02 6025 Ambulatory Surgical Service 239 333 0034
60.14 6026 Referred Ambulatory Service 237 334 0028
60.01 6027 Renal Dialysis 240 335 0383
60.29 6028 Methadone Maintenance Treatment Program 262 336 0119
60.30 6029 Birthing Center-Discontinue for reports beginning 1/1/09 and after 415 337 4844
60.03 6030 Women and Infant Children Program (WIC) 418 338 4847
61 6100 Emergency Service 236 339 0027
61.01 6101 CPEP 288 340 0385
61.02 6102 Poison Control 416 341 4845
26 024 62 6200 Observation Beds  (Non-Distinct Part) 260 342 0030
62.01 6201 Observation Beds  (Distinct Part) 417 343 4846
62.02 6202 CPEP Observation Beds (Psychiatric) 216 344 0096
63 See HCRIS List Other Outpatient Cost Centers 427-473 4856-4902
63.60 6320 Federally Qualified Health Center (FQHC) 474 351 4903
13 482 Not Applic. Not Applic. RPCH Not Applic. Not Applic.
Other Reimbursable Cost Center Line Assignments (50)
(18) Standard 230 - 232, 234, 238, 243, 250, 255, 257, 259, 280 - 283, 501 - 504
(32) Variable 505 - 536
(Program Capabilities of  98 total lines for Other, Special Purpose and Non-reimbursable)
64 6400 Home Program Dialysis 250 400 0020
65 6500 Ambulance Services 234 401 0031
66 6600 Durable Medical Equip-Rented 280 402 0133
67 6700 Durable Medical Equip-Sold 257 403 0115
68 See HCRIS List Other Reimbursable (specify) See Below See Below
19 015 69 6900 CORF 259 404 0117
22 501 69.10 6910 CMHC 501 405 4912
23 502 69.20 6920 OPT 502 406 4913
23.01 503 69.30 6930 OOT 503 407 4914
23.02 504 69.40 6940 OSP 504 408 4915
70 7000 I&R Services -Non Apprvd Prgm 243 409 0103
18 014 71 7100 Home Health Agency (CMS 2552 Only)
72 7200 HHA - Administrative & General 255 410 0113
73 7300 HHA - Skilled Nursing Care 230 411 0381
74 7400 HHA - Physical Therapy 281 412 0134
75 7500 HHA - Occupational Therapy 282 413 0135
76 7600 HHA - Speech Pathology 283 414 0136
77 7700 HHA - Medical Social Services 231 415 0382
78 7800 Home Health Aide 238 416 0029
79 7900 Other HHA Services 232 417 0021
Variable Variable Additional Other Reimbursable Cost Centers 505-536 3212-3236,4916-4922
Special Purpose Cost Center Line Assignments  (50)
(14) Standard 241, 244, 245, 275, 
285 - 287, 292, 293, 601 - 605
(36) Variable 606 to 641
(Program Capabilities - See Other Reimbursable)
82 8200 Lung Acquisition 602 500 3302
83 8300 Kidney Acquisition 241 501 0101
84 8400 Liver Acquisition 285 502 0138
85 8500 Heart Acquisition 292 503 0392
85.01 8510 Pancreas Acquisition 603 504 3303
85.02 8520 Intestinal Acquisition 604 505 3304
85.03 8530 Islet Cell Acquisition 605 506 3305
86 8600 Other Organ Acquisition (specify) 286 507 0390
Variable Variable Additional Special Purpose Cost Center - Organ Acquisition 606 3306
88 8800 Interest Expense 244 508
89 8900 Utilization Review -RHCF 245 509
90 9000 Other Capital Related Costs 293 510
20 92 9200 Ambulatory Surgical Center (Distinct Part) 275 511 0128
21 017 93 9300 Hospice Inpatient 287 512 0391
21.05 601 94 6950 Hospice -Home Care 601 513 3301
Additional Special Purpose Cost Centers Other than Organ Acquisition 607-641 3307-3341
Non Reimbursable Cost Center Line Assignments (25)
(6) Standard 269 - 271, 273, 274, 651
(19) Variable 652 - 670
(Program Capabilities - See Outpatient)
96 9600 Gift, Flower, Coffee Shop, Canteen 269 600
97 9700 Research 270 601
98 9800 Physicians Private Offices 273 602 0126
99 9900 Non - Paid Workers 274 603
100 7950 Appeal For Funds 271 604
100.01 7951 All Other Non- Reimbursable Expenses 651 605 3351
Variable Additional Non Reimbursable Cost Centers 652-670 3352-3370
101 TOTAL Expenses Worksheet A-All Services 960
101 TOTAL Expenses Worksheet A-All Services N/a 36
Totals TOTAL Charges All Other Services N/a 124
Totals TOTAL Charges Inpatient Service (Exh.1 Part 2) N/a 23
Totals TOTAL Charges Outpatient Clinic N/a 123
Totals TOTAL Charges Amb. Surg., Renal Dial., Emergency N/a 122
Totals TOTAL Charges All Home Health Services  N/a 125