<< Previous Data Element Outpatient Output Table of Contents Next Data Element >>

Data Element Name:   Outpatient Ancillary Services Information Group Definition
SPARCS Data Element Number:  41 - 46
Record Positions:  662 - 1321 Format-Length:  A/N - 660
Effective Date:  1/1/2003 Revision Date:  January 2003

Definition:

The following block of data represents ancillary information reported on the bill in one to twenty occurrences. The codes were entered in ascending numerical order with common ancillary codes grouped where possible.

If more than fifteen Ancillary Service Codes were reported for a patient stay, overflow records were used to record this data. See Record Sequence Number (Data Element 7) and Record Sequence Count (Data elements 8).

It is necessary to report at least one Outpatient Ancillary with each claim. There must have been at least one total and non-covered charge for all ancillary codes reported except for the 036x, 049x, or 045x categories. For these exceptions the total and non-covered charges may have been rolled up to the first occurrence of the revenue code category with zero reported for subsequent occurrences on each claim.

Data Element
Number
Data Element
Name

Occurrence

Record Positions
41 Ancillary Revenue Code 1 662 - 665
2 695 - 698
3 728 - 731
4 761 - 764
5 794 - 797
6 827 - 830
7 860 - 863
8 893 - 896
9 926 - 929
10 959 - 962
11 992 - 995
12 1,025 - 1,028
13 1,058 - 1,061
14 1,091 - 1,094
15 1,124 - 1,127
16 1,157 - 1,160
17 1,190 - 1,193
18 1,223 - 1,226
19 1,256 - 1,259
20 1,289 - 1,292

42 Procedure Code-CPT4/HCPCS 1 666 - 670
2 699 - 703
3 732 - 736
4 765 - 769
5 798 - 802
6 831 - 835
7 864 - 868
8 897 - 901
9 930 - 934
10 963 - 967
11 996 - 1,000
12 1,029 - 1,033
13 1,062 - 1,066
14 1,095 - 1,099
15 1,128 - 1,132
16 1,161 - 1,165
17 1,194 - 1,198
18 1,227 - 1,231
19 1,260 - 1,264
20 1,293 - 1,297

43 Modifier 1 1 671 - 672
2 704 - 705
3 737 - 738
4 770 - 771
5 803 - 804
6 836 - 837
7 869 - 870
8 902 - 903
9 935 - 936
10 968 - 969
11 1,001 - 1,002
12 1,034 - 1,035
13 1,067 - 1,068
14 1,100 - 1,101
15 1,133 - 1,134
16 1,166 - 1,167
17 1,199 - 1,200
18 1,232 - 1,233
19 1,265 - 1,266
20 1,298 - 1,299

44 Modifier 2 1 673 - 674
2 706 - 707
3 739 - 740
4 772 - 773
5 805 - 806
6 838 - 839
7 871 - 872
8 904 - 905
9 937 - 938
10 970 - 971
11 1,003 - 1,004
12 1,036 - 1,037
13 1,069 - 1,070
14 1,102 - 1,103
15 1,135 - 1,136
16 1,168 - 1,169
17 1,201 - 1,202
18 1,234 - 1,235
19 1,267 - 1,268
20 1,300 - 1,301

45 Ancillary Total Charge 1 675 - 684
2 708 - 717
3 741 - 750
4 774 - 783
5 807 - 816
6 840 - 849
7 873 - 882
8 906 - 915
9 939 - 948
10 972 - 981
11 1,005 - 1,014
12 1,038 - 1,047
13 1,071 - 1,080
14 1,104 - 1,113
15 1,137 - 1,146
16 1,170 - 1,179
17 1,203 - 1,212
18 1,236 - 1,245
19 1,269 - 1,278
20 1,302 - 1,311

46 Ancillary Total Non-Covered Charge 1 685 - 694
2 718 - 727
3 751 - 760
4 784 - 793
5 817 - 826
6 850 - 859
7 883 - 892
8 916 - 925
9 949 - 958
10 982 - 991
11 1,015 - 1,024
12 1,048 - 1,057
13 1,081 - 1,090
14 1,114 - 1,123
15 1,147 - 1,156
16 1,180 - 1,189
17 1,213 - 1,222
18 1,246 - 1,255
19 1,279 - 1,288
20 1,312 - 1,321