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Line Item Allowed Charge Amount

CLM_LINE_ALOWD_CHRG_AMT

THE MAXIMUM AMOUNT ALLOWED BY THE PLAN FOR PAYMENT. THE AMOUNT ELIGIBLE FOR PAYMENT AFTER APPLYING PRICING GUIDELINES/DISCOUNTS. USUALLY INCLUDES COPAYMENT, COINSURANCE, DEDUCTIBLE, PENALTY, AND 3RD PARTY SAVINGS AMTS. FOR ENCTRS, MAY BE FFS EQUIVALENTS.

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.item.adjudication.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication'
  ) and
    category.coding.where(
      code = 'CLM_LINE_ALOWD_CHRG_AMT'
    )
).amount.value
Coverage / Claim Type
  • Carrier
  • DME
Source View
V2_MDCR_CLM_LINE
Source Column
CLM_LINE_ALOWD_CHRG_AMT
Sources
  • MCS
  • NCH
  • VMS
Profiles
  • Regular
  • CMS

Example 

9194.22

Notes

Technically this variable is available in partially-adjudicated claims, but is consolidated (and represented) in CLM_ALOWD_CHRG_AMT in both adjudicated + partially-adjudicated claims. Financial fields on 1XXX claim type codes should be expected to change.

Mappings

CCLF
  • CCLF5.CLM_LINE_ALOWD_CHRG_AMT
  • CCLF6.CLM_LINE_ALOWD_CHRG_AMT
CCW
  • LINE_ALOWD_CHRG_AMT

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