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Data Element Name:  Procedure Code - CPT-4/HCPCS & Modifier 1 and 2
Format-Length:  A/N - 9 Required For:  AS, ED
Effective Date:  1/1/94 Revision Date:  May 2008

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2400 SV202-1 235 HC HCPCS Qualifier
SV202-2 234 HCPCS Procedure Code
SV202-3 1339 Procedure Modifier 1
SV202-4 1339 Procedure Modifier 2

Paper Form Locator Code Qualifier
Institutional - UB-04 44 N/A

Definition:

The American Medical Association's Current Procedural Terminology 4th Edition (CPT-4) Code or the Healthcare Common Procedure Coding System (HCPCS) code and modifiers, which applies to the outpatient procedure performed and associated with each line of service.

Codes and Values:

  1. Entered exactly as shown in the American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code for ambulatory surgery and emergency department procedures performed.

  2. If CPT-4/HCPCS & Modifier 1 and 2 are entered the associated Outpatient Ancillary Revenue Code, Outpatient Ancillary Total Charges and Outpatient Total Non-Covered Charges must also be reported.

Edit Applications:

  1. Edits pertaining to CPT4 and HCPCS codes are validated on the basis of the Statement-Covers-Thru Date.

  2. SPARCS allows a maximum of 200 CPT4 and HCPCS codes.
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