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Line Item APC / HIPPS Code

CLM_REV_APC_HIPPS_CD

THE AMBULATORY PAYMENT CLASSIFICATION (APC) CODE AND THE HIPPS CODE. THE APC IS USED TO IDENTIFY GROUPINGS OF OUTPATIENT SERVICES. APC CODES ARE USED TO CALCULATE PAYMENT FOR SERVICES UNDER OPPS. THE APC IS A FOUR BYTE FIELD. THE HIPPS CODES ARE USED

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.item.productOrService.coding.where(
  system = 'https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes'
).code
Coverage / Claim Type
  • HHA
  • Hospice
  • Inpatient
  • Outpatient
  • SNF
Source View
V2_MDCR_CLM_LINE_INSTNL
Source Column
CLM_REV_APC_HIPPS_CD
Sources
  • FISS
  • NCH
Profiles
  • Basis
  • Regular
  • CMS

Example 

NHNC1

Mappings

CCLF
  • CCLF2.CLM_REV_APC_HIPPS_CD
CCW
  • REV_CNTR_APC_HIPPS_CD

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