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Line Item HCPCS Code

CLM_LINE_HCPCS_CD

A CODE IDENTIFYING A HEALTHCARE COMMON PROCEDURE CODING SYSTEM (HCPCS) PROCEDURE, SUPPLY, PRODUCT, OR SERVICE PROVIDED TO A MEDICARE BENEFICIARY OR AN INDIVIDUAL ENROLLED IN PRIVATE HEALTH INSURANCE PROGRAMS. REFERENCE TABLE: HCPCS_CD

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.item.productOrService.where(
  coding.system = 'http://www.ama-assn.org/go/cpt' or
    coding.system = 'https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets' or
    coding.system = 'http://terminology.hl7.org/CodeSystem/data-absent-reason'
).coding.code
Coverage / Claim Type
  • Carrier
  • DME
  • HHA
  • Hospice
  • Inpatient
  • Outpatient
  • SNF
Source View
V2_MDCR_CLM_LINE
Source Column
CLM_LINE_HCPCS_CD
Sources
  • FISS
  • MCS
  • NCH
  • VMS
Profiles
  • Basis
  • Regular
  • CMS

Example 

99213

Mappings

CCLF
  • CCLF2.CLM_LINE_HCPCS_CD
  • CCLF5.CLM_LINE_HCPCS_CD
  • CCLF6.CLM_LINE_HCPCS_CD
CCW
  • HCPCS_CD

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