Extensions defined for the Blue Button Implementation Guide

This page lists the - Extensions defined as part of the Blue Button implementation Guide. A - registry of standard extensions can be found in the FHIR specification and additional extensions may be registered on the HL7 FHIR registry at https://bluebutton.cms.gov/assets/ig/registry.

Carrier Claim extensions

Extensions belonging to the Carrier Claim Profile:

• NCH Primary Payer (if not Medicare) Claim Paid Amount
• Carrier Claim Provider Assignment Indicator Switch
• Carrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)
• Carrier Claim Payment Denial Code
• NCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)
• NCH Carrier Claim Submitted Charge Amount (sum of all line-level submitted charges)
• NCH Claim Payment Amount to Beneficiary
• NCH Claim Provider Payment Amount
• Clinical Trial Number
• Carrier Line Provider Type Code
• Line Provider Participating Indicator Code
• Organization (or group) NPI Number
• Carrier Line Miles/Time/Units/Services (MTUS) Indicator Code
• Carrier Line Miles/Time/Units/Services (MTUS) Count
• Line Berenson-Eggers Type of Service (BETOS) Code
• Line Beneficiary Primary Payer Code
• Line Service Deductible Indicator Switch
• Hematocrit / Hemoglobin Test Results
• Line National Drug Code
• Carrier Line Anesthesia Unit Count
• Carrier NCH Provider SSA State Code
• Carrier Line Performing Provider ZIP Code
• Carrier Line Pricing Locality Code
• Clinical Laboratory Improvement Amendments (CLIA) monitored laboratory number
• Carrier Line Payment 80% / 100% Code

Coverage Profile extensions

Extensions belonging to the Coverage Profile:

• Part A Termination Code
• Part B Termination Code
• Current Reason for Entitlement Code
• End-stage Renal Disease (ESRD) Indicator
• Medicare Status Codes
• Reason for Entitlement Code

DME Claim extensions

Extensions belonging to the DME Claim Profile:

• NCH Primary Payer (if not Medicare) Claim Paid Amount
• Carrier or MAC Number
• DME Claim Provider Assignment Indicator Switch
• Carrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)
• DME Claim Payment Denial Code
• NCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)
• NCH Carrier Claim Submitted Charge Amount (sum of all line-level submitted charges)
• NCH Claim Payment Amount to Beneficiary
• NCH Claim Provider Payment Amount
• Clinical Trial Number
• Line Provider Participating Indicator Code
• Carrier Line Miles/Time/Units/Services (MTUS) Count
• Line Berenson-Eggers Type of Service (BETOS) Code
• Line Beneficiary Primary Payer Code
• Line Service Deductible Indicator Switch
• Hematocrit / Hemoglobin Test Results
• Line National Drug Code
• DMERC Line Supplier Provider Number
• DMERC Line Screen Savings Amount
• Carrier Line Anesthesia Unit Count
• DME NCH Provider SSA State Code
• DME Line Pricing Locality Code
• DMERC Line Pricing State Code (SSA)
• DME Line Payment 80% / 100% Code

HHA Claim extensions

Extensions belonging to the HHA Claim Profile:

• Claim Medicare Non Payment Reason Code
• NCH Primary Payer (if not Medicare) Claim Paid Amount
• FI or MAC Number
• Claim Facility Type Code
• Revenue Center National Drug Code (NDC) Quantity
• Revenue Center Status Indicator Code
• Revenue Center Deductible Coinsurance Code

Hospice Claim extensions

Extensions belonging to the Hospice Claim Profile:

• Claim Medicare Non Payment Reason Code
• NCH Primary Payer (if not Medicare) Claim Paid Amount
• FI or MAC Number
• Claim Facility Type Code
• Beneficiary’s Hospice Period Count
• Revenue Center National Drug Code (NDC) Quantity
• Revenue Center Deductible Coinsurance Code

Inpatient Claim extensions

Extensions belonging to the Inpatient Claim Profile:

• Operating Indirect Medical Education (IME) Amount
• Operating Disproportionate Share (DSH) Amount
• Claim Pass Thru Per Diem Amount
• Professional Component Charge Amount
• Claim Total PPS Capital Amount
• NCH Beneficiary Inpatient (or other Part A) Deductible Amount
• NCH Beneficiary Part A Coinsurance Liability Amount
• NCH Inpatient(or other Part A) Non-covered Charge Amount
• NCH Inpatient (or other Part A) Total Deductible/Coinsurance Amount
• Claim PPS Capital Disproportionate Share Amount
• Claim PPS Capital Exception Amount
• Claim PPS Capital Federal Specific Portion (FSP) Amount
• Claim PPS Capital Indirect Medical Education (IME) Amount
• Claim PPS Capital Outlier Amount
• Claim PPS Old Capital Hold Harmless Amount
• NCH DRG Outlier Approved Payment Amount
• NCH Beneficiary Blood Deductible Liability Amount
• Claim Medicare Non Payment Reason Code
• NCH Primary Payer (if not Medicare) Claim Paid Amount
• FI or MAC Number
• Claim Query Code
• Claim Facility Type Code
• Claim Diagnosis Code I Diagnosis Present on Admission (POA) Indicator Code
• Revenue Center National Drug Code (NDC) Quantity
• Revenue Center Deductible Coinsurance Code

Outpatient Claim extensions

Extensions belonging to the Outpatient Claim Profile:

• Professional Component Charge Amount
• NCH Beneficiary Part B Deductible Amount
• NCH Beneficiary Part B Coinsurance Amount
• Claim Outpatient Provider Payment Amount
• Claim Outpatient Payment Amount to Beneficiary
• NCH Beneficiary Blood Deductible Liability Amount
• Claim Medicare Non Payment Reason Code
• NCH Primary Payer (if not Medicare) Claim Paid Amount
• FI or MAC Number
• Claim Query Code
• Claim Facility Type Code
• Revenue Center National Drug Code (NDC) Quantity
• Revenue Center Status Indicator Code
• Revenue Center IDE, NDC, or UPC Number

Patient Profile extensions

Extensions belonging to the Patient Profile:

• Blue Button Race Codes

PDE Claim extensions

Extensions belonging to the PDE Claim Profile:

• Additional Content defined by implementations
• Plan Contract ID
• Benefit Package ID
• Fill Number
• Days Supply Number

SNF Claim extensions

Extensions belonging to the SNF Claim Profile:

• NCH Beneficiary Inpatient (or other Part A) Deductible Amount
• NCH Beneficiary Part A Coinsurance Liability Amount
• NCH Inpatient(or other Part A) Non-covered Charge Amount
• NCH Inpatient (or other Part A) Total Deductible/Coinsurance Amount
• Claim PPS Capital Disproportionate Share Amount
• Claim PPS Capital Exception Amount
• Claim PPS Capital Federal Specific Portion (FSP) Amount
• Claim PPS Capital Indirect Medical Education (IME) Amount
• Claim PPS Capital Outlier Amount
• Claim PPS Old Capital Hold Harmless Amount
• NCH Beneficiary Blood Deductible Liability Amount
• Claim Medicare Non Payment Reason Code
• NCH Primary Payer (if not Medicare) Claim Paid Amount
• FI or MAC Number
• Claim Query Code
• Claim Facility Type Code
• Revenue Center Deductible Coinsurance Code