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Record Layout Summary for Medicare Non-Institutional Data
(Version H, Variable Block Data)

How to use this page

Carrier [old name: Physician/Supplier] [Carrier], Durable Medical Equipment [DME]

SAS Name Short Description Type Length Carrier
text		 DME
text
        SAS SAS
REC_LEN Record Length Count PACK 3 1 1
REC_LVL NCH Near-Line Record Version Code CHAR 1 2 2
RIC_CD NCH Near Line Record Identification Code CHAR 1 3 3
MQA_RIC NCH MQA RIC Code CHAR 1 4 4
CLM_TYPE NCH Claim Type Code CHAR 2 6 6
ENTRY_CD Carrier Claim Entry Code CHAR 1 8 8
DISP_CD Claim Disposition Code CHAR 2 10 10
EDITDISP NCH Edit Disposition Code CHAR 2 11 11
HIC Health Insurance Claim Number CHAR 11 0 0
CAN Beneficiary Claim Account Number CHAR 9 12 12
EQ_BIC NCH Category Equatable Beneficiary Identification CHAR 2 13 13
BIC Beneficiary Identification Code CHAR 2 14 14
BIC_MDFY NCH Claim BIC Modify H Code CHAR 1 15 15
ST_SGMT NCH State Segment Code CHAR 1 16 16
STATE_CD Beneficiary Residence SSA Standard State Code CHAR 2 17 17
CNTY_CD Beneficiary Residence SSA Standard County Code CHAR 3 18 18
FROM_DT Claim From Date NUM 8 19 19
THRU_DT Claim Through Date NUM 8 20 20
RCPT_DT Carrier Claim Receipt Date NUM 8 21 21
ACRTN_DT CWF Claim Accretion Date NUM 8 22 22
ACRTN_NM CWF Claim Accretion Number PACK 2 23 23
SCHLD_DT Carrier Claim Scheduled Payment Date NUM 8 24 24
FRWRD_DT CWF Forwarded Date NUM 8 25 25
DAILY_DT NCH Daily Process Date NUM 8 26 26
WKLY_DT NCH Weekly Claim Processing Date NUM 8 27 27
CARR_NUM Carrier Number CHAR 5 29 29
FIBATCH CWF Transmission Batch Number CHAR 4 31 31
BENE_ZIP Beneficiary Mailing Contact ZIP Code CHAR 9 32 32
SEX Beneficiary Sex Identification Code CHAR 1 33 33
RACE Beneficiary Race Code CHAR 1 34 34
BENE_DOB Beneficiary Birth Date NUM 8 35 35
MS_CD CWF Beneficiary Medicare Status Code CHAR 2 36 36
SURNAME Claim Patient 6 Position Surname CHAR 6 37 37
FRSTINIT Claim Patient 1st Initial Given Name CHAR 1 38 38
MDL_INIT Claim Patient First Initial Middle Name CHAR 1 39 39
CWFLOCCD Beneficiary CWF Location Code CHAR 1 40 40
PDGNS_CD Claim Principal Diagnosis Code CHAR 5 41 41
PMT_AMT Claim Payment Amount PACK 6 43 43
PRPAYAMT Carrier Claim Primary Payer Paid Amount PACK 6 44 44
CARRCNTL Carrier Claim Control Number CHAR 15 46 46
PMTDNLCD Carrier Claim Payment Denial Code CHAR 1 47 47
RFR_UPIN Carrier Claim Refer/Order UPIN Number CHAR 6 48 48
RFR_NPI Carrier Claim Refer/Order Physician NPI Number CHAR 8 49 49
RFR_LOC Carrier Claim Refer/Order Physician Location Code CHAR 2 50 50
ASGMNTCD Carrier Claim Provider Assignment Indicator Switch CHAR 1 51 51
PROV_PMT NCH Claim Provider Payment Amount PACK 6 52 52
BENE_PMT NCH Claim Beneficiary Payment Amount PACK 6 53 53
BENEPAID Carrier Claim Beneficiary Paid Amount PACK 6 54 54
SBMTCHRG NCH Carrier Claim Submitted Charge Amount PACK 6 55 55
ALOWCHRG NCH Carrier Claim Allowed Charge Amount PACK 6 56 56
DEDAPPLY Carrier Claim Cash Deductible Applied Amount PACK 6 57 57
HCPCS_YR Carrier Claim HCPCS Year Code NUM 1 59 59
MCOOVRRD Carrier Claim MCO Override Indicator Code CHAR 1 60 60
HOSPOVRD Carrier Claim Hospice Override Indicator Code CHAR 1 61 61
RFR_PRFL Carrier Claim Referring PIN Number CHAR 14 63 -
CPO_PROV Care Plan Oversight (CPO) Provider Number CHAR 6 64 -
CPO_NPI CPO Organization NPI Number CHAR 8 65 -
CPO_LOC CPO Organization Provider Location Code CHAR 2 66 -
BLDFRNSH Claim Blood Pints Furnished Quantity PACK 2 67 -
BLD_DED Claim Blood Deductible Pints Quantity PACK 2 68 -
CEDCNT NCH Edit Code Count NUM 2 69 63
CPATCNT NCH Patch Code Count NUM 2 70 64
CMCOCNT MCO Period Count NUM 1 71 65
CPAYCNT Claim PAYERID Count NUM 1 72 66
CDEMCNT Claim Demonstration ID Count NUM 1 73 67
CDGNCNT Claim Diagnosis Code Count NUM 1 74 68
CLINECNT Claim Line Count NUM 2 75 69
EDITIND NCH Edit Trailer Indicator Code CHAR 1 77 71
EDIT_CD NCH Edit Code CHAR 4 78 72
PATCHIND NCH Patch Trailer Indicator Code CHAR 1 79 73
PATCHCD NCH Patch Code CHAR 2 80 74
PATCHDT NCH Patch Applied Date NUM 8 81 75
MCOIND NCH MCO Trailer Indicator Code CHAR 1 82 76
MCONUM MCO Contract Number CHAR 5 83 77
MCOOPTN MCO Option Code CHAR 1 84 78
MCOEFFDT MCO Period Effective Date NUM 8 85 79
MCOTRMDT MCO Period Termination Date NUM 8 86 80
MCOPAYID MCO PAYERID Number CHAR 9 87 81
PAYERIND NCH PAYERID Trailer Indicator Code CHAR 1 88 82
PAYIDCD Claim PAYERID Code CHAR 1 89 83
PAYIDNUM Claim PAYERID Number CHAR 9 90 84
DEMOIND NCH Demonstration Trailer Indicator Code CHAR 1 91 85
DEMONUM Claim Demonstration Identification Number CHAR 2 92 86
DEMOTXT Claim Demonstration Information Text CHAR 15 93 87
DGNSIND NCH Diagnosis Trailer Indicator Code CHAR 1 94 88
DGNS_CD Claim Diagnosis Code CHAR 5 95 89
LINEIND NCH Line Item Trailer Indicator Code CHAR 1 97 91
PRF_PRFL Carrier Line Performing PIN Number CHAR 10 98 -
PRF_UPIN Carrier Line Performing UPIN Number CHAR 6 99 -
PRFNPI Carrier Line Performing NPI Number CHAR 8 100 -
PRFLOC Carrier Line Performing Provider Location Code CHAR 2 101 -
PRGRPNPI Carrier Line Performing Group NPI Number CHAR 8 102 -
PRGRPLOC Carrier Line Performing Group Location Code CHAR 2 103 -
PRV_TYPE Carrier Line Provider Type Code CHAR 1 104 -
TAX_NUM Line Provider Tax Number CHAR 10 105 98
PRVSTATE Line NCH Provider State Code CHAR 2 106 -
PROVZIP Carrier Line Performing Provider ZIP Code CHAR 9 107 -
HCFASPCL Line CMS Provider Specialty Code CHAR 2 108 99
CARRSPCL Carrier Line Provider Specialty Code CHAR 2 109 -
PRTCPTG Line Provider Participating Indicator Code CHAR 1 110 100
ASTNT_CD Carrier Line Reduced Payment Physician Assistant CHAR 1 111 -
SRVC_CNT Line Service Count PACK 2 112 101
TYPSRVCB Line CMS Type Service Code CHAR 1 113 102
PTYPESRV Carrier Line Type Service Code CHAR 2 114 -
PLCSRVC Line Place Of Service Code CHAR 2 115 103
LCLTY_CD Carrier Line Pricing Locality Code CHAR 2 116 -
EXPNSDT1 Line First Expense Date NUM 8 117 104
EXPNSDT2 Line Last Expense Date NUM 8 118 105
HCPCS_CD Line HCPCS Code CHAR 5 120 107
MDFR_CD1 Line HCPCS Initial Modifier Code CHAR 2 121 108
MDFR_CD2 Line HCPCS Second Modifier Code CHAR 2 122 109
BETOS Line NCH BETOS Code CHAR 3 123 112
LINE_IDE Line IDE Number CHAR 7 124 113
NDC_CD Line National Drug Code CHAR 11 125 115
LINEPMT Line NCH Payment Amount PACK 6 126 116
LBENPMT Line Beneficiary Payment Amount PACK 6 127 117
LPRVPMT Line Provider Payment Amount PACK 6 128 118
LDEDAMT Line Beneficiary Part B Deductible Amount PACK 6 129 119
LPRPAYCD Line Beneficiary Primary Payer Code CHAR 1 130 120
LPRPDAMT Line Beneficiary Primary Payer Paid Amount PACK 6 131 121
COINAMT Line Coinsurance Amount PACK 6 132 122
LLMTAMT Carrier Line Psychiatric, Occupational Therapy, PACK 6 133 -
LINT_AMT Line Interest Amount PACK 6 134 123
PRPYALOW Line Primary Payer Allowed Charge Amount PACK 6 135 124
PNLTYAMT Line 10% Penalty Reduction Amount PACK 6 136 125
LBLD_DED Carrier Line Blood Deductible Pints Quantity PACK 2 137 -
LSBMTCHG Line Submitted Charge Amount PACK 6 138 126
LALOWCHG Line Allowed Charge Amount PACK 6 139 127
LAB_NUM Carrier Line Clinical Lab Number CHAR 10 140 -
LAB_AMT Carrier Line Clinical Lab Charge Amount PACK 6 141 -
PRCNGIND Line Processing Indicator Code CHAR 1 143 131
PMTINDSW Line Payment 80%/100% Code CHAR 1 144 132
DED_SW Line Service Deductible Indicator Switch CHAR 1 145 133
PMTINDCD Line Payment Indicator Code CHAR 1 146 134
MTUS_CNT Carrier Line Miles/Time/Units/Services PACK 2 147 -
MTUS_IND Carrier Line Mile/Time/Units/Services CHAR 1 148 -
LINEDGNS Line Diagnosis Code CHAR 5 149 137
ANSTHUNT Carrier Line Anesthesia Base Unit Count PACK 2 151 -
CLIAALRT Carrier Line CLIA Alert Indicator Code CHAR 1 152 -
DCMTN_CD Line Additional Claim Documentation Indicator CHAR 1 153 139
DMEST_DT Carrier Line DME Coverage Period Start Date NUM 8 154 -
DME_PURC Line DME Purchase Price Amount PACK 6 155 129
NCSTY_MO Carrier Line DME Medical Necessity Month Count PACK 2 156 -
EOR End of Record Constant CHAR 3 158 145
SUPLRNUM DMERC Line Supplier Provider Number CHAR 10 - 92
SUP_NPI DMERC Line Item Supplier NPI Number CHAR 8 - 93
SUP_LOC DMERC Line Supplier Location Code CHAR 2 - 94
PRCNG_ST DMERC Line Pricing State Code CHAR 2 - 95
PRVSTATE DMERC Line Provider State Code CHAR 2 - 96
SUP_TYPE DMERC Line Supplier Type Code CHAR 1 - 97
MDFR_CD3 DMERC Line HCPCS Third Modifier Code CHAR 2 - 110
MDFR_CD4 DMERC Line HCPCS Fourth Modifier Code CHAR 2 - 111
NOC_TXT DMERC Line Not Otherwise Classified HCPCS Code Text CHAR 14 - 114
SCRNSVGS DMERC Line Screen Savings Amount PACK 6 - 128
DME_UNIT DMERC Line Miles/Time/Units/Services PACK 4 - 135
UNIT_IND DMERC Line Mile/Time/Units/Services CHAR 1 - 136
SUSP_IND DMERC Line Screen Suspension Indicator Code CHAR 4 - 140
RSLT_IND DMERC Line Screen Result Indicator Code CHAR 1 - 141
WAIVERSW DMERC Line Waiver Of Provider Liability Switch CHAR 1 - 142
DCSN_IND DMERC Line Decision Indicator Switch CHAR 1 - 143


Number shown on the matrix for each claim type indicates the variable sequence printed in CMS data dictionary

"-" means not available for this claim type.

Last Modified August 5, 2008