Variable: CLM_VAL_CD

Claim Value Code

Description

The code indicating a monetary condition which was used by the intermediary to process an institutional claim. The associated monetary value is in the claim value amount field (CLM_VAL_AMT).

Comment

n/a

Values

This variable is coded, and will contain one of the following values.

Values for
Value	Description
01	Most Common Semi-Private Rate - to provide for the recording of hospital's most common semi-private rate.
02	Hospital Has No Semi-Private Rooms - Entering this code requires $0.00 amount.
03	Reserved for national assignment.
04	Inpatient professional component charges which are combined billed - For use only by some all-inclusive rate hospitals.
05	Professional component included in charges and also billed separately to carrier - For use on Medicare and Medicaid bills if the state requests this information.
06	Medicare blood deductible - Total cash blood deductible (Part A blood deductible).
07	Medicare cash deductible reserved for national assignment.
08	Medicare Part A lifetime reserve amount in first calendar year -Lifetime reserve amount charged in the year of admission.
09	Medicare Part A coinsurance amount in the first calendar year -Coinsurance amount charged in the year of admission.
10	Medicare Part A lifetime reserve amount in the second calendar year - Lifetime reserve amount charged in the year of discharge where the bill spans two calendar years.
11	Medicare Part A coinsurance amount in the second calendar year -Coinsurance amount charged in the year of discharge where the bill spans two calendar years
12	Amount is that portion of higher priority EGHP insurance payment made on behalf of aged bene provider applied to Medicare covered services on this bill. Six zeroes indicate provider claimed conditional Medicare payment.
13	Amount is that portion of higher priority EGHP insurance payment made on behalf of ESRD bene provider applied to Medicare covered services on this bill. Six zeroes indicate the provider claimed conditional Medicare payment.
14	That portion of payment from higher priority no fault auto/other liability insurance made on behalf of bene provider applied to Medicare covered services on this bill. Six zeroes indicate provider claimed conditional payment
15	That portion of a payment from a higher priority WC plan made on behalf of a bene that the provider applied to Medicare covered services on this bill. Six zeroes indicate the provider claimed conditional Medicare payment.
16	That portion of a payment from higher priority PHS or other federal agency made on behalf of a bene the provider applied to Medicare covered services on this bill. Six zeroes indicate provider claimed conditional Medicare payment.
17	Operating Outlier amount - Providers do not report this. For payer internal use only. Indicates the amount of day or cost outlier payment to be made. (Do not include any PPS capital outlier payment in this entry).
18	Operating Disproportionate share amount - Providers do not report this. For payer internal use only. Indicates the disproportionate share amount applicable to the bill. Use the amount provided by the disproportionate share field in PRICER. (Do not include any PPS capital DSH adjustment in this entry).
19	Operating Indirect medical education amount - Providers do not report this. For payer internal use only. Indicates the indirect medical education amount applicable to the bill. (Do not include PPS capital IME adjustment in this entry).
20	Total payment sent provider for capital under PPS, including HSP, FSP, outlier, old capital, DSH adjustment, IME adjustment, and any exception amount.
21	Catastrophic - Medicaid - Eligibility requirements to be determined at state level.
22	Surplus - Medicaid - Eligibility requirements to be determined at state level.
23	Recurring monthly income - Medicaid - Eligibility requirements to be determined at state level.
24	Medicaid rate code - Medicaid - Eligibility requirements to be determined at state level.
25	Offset to the Patient Payment Amount (Prescription Drugs) -Prescription drugs paid for out of a long-term care facility resident/patient's fund in the billing period submitted (Statement Covers Period).
26	Prescription Drugs Offset to Patient (Payment Amount - Hearing and Ear Services) Hearing and ear services paid for out of a long term care facility resident/patient's funds in the billing period submitted (Statement covers period).
27	Offset to the Patient (Payment Amount - Vision and Eye Services) -Vision and eye services paid for out of a long term care facility resident/patient's funds in the billing period submitted (Statement Covers Period).
28	Offset to the Patient (Payment Amount - Dental Services) - Dental services paid for out of a long term care facility resident/ patient's funds in the billing period submitted (Statement Covers Period).
29	Offset to the Patient (Payment Amount - Chiropractic Services) -Chiropractic services paid for out of a long term care facility resident/patient's funds in the billing period submitted (Statement Covers Period).
31	Patient liability amount - Amount shown is that which you or the PRO approved to charge the bene for non-covered accommodations, diagnostic procedures or treatments.
32	Multiple patient ambulance transport - The number of patients transported during one ambulance ride to the same destination. (eff. 4/1/2003)
33	Offset to the Patient Payment Amount (Podiatric Services) --Podiatric services paid out of a long-term care facility resident/ patient's funds in the billing period submitted.
34	Offset to the Patient Payment Amount (Medical Services) -- Other medical services paid out of a long-term care facility resident/ patient's funds in the billing period submitted.
35	Offset to the Patient Payment Amount (Health Insurance Premiums) --Other medical services paid out of a long-term care facility resident/ patient's funds in the billing period submitted.
37	Pints of blood furnished - Total number of pints of whole blood or units of packed red cells furnished to the patient.
38	Blood deductible pints - The number of unreplaced pints of whole blood or units of packed red cells furnished for which the patient is responsible.
39	Pints of blood replaced - The total number of pints of whole blood or units of packed red cells furnished to the patient that have been replaced by or on behalf of the patient.
40	New coverage not implemented by HMO - amount shown is for inpatient charges covered by HMO. (use this code when the bill includes inpatient charges for newly covered services which are not paid by HMO.)
41	Amount is that portion of a payment from higher priority BL program made on behalf of bene the provider applied to Medicare covered services on this bill. Six zeroes indicate the provider claimed conditional Medicare payment.
42	Amount is that portion of a payment from higher priority VA made on behalf of bene the provider applied to Medicare covered services on this bill. Six zeroes indicate the provider claimed conditional Medicare payment.
43	Disabled bene under age 65 with LGHP - Amount is that portion of a payment from a higher priority LGHP made on behalf of a disabled Medicare bene the provider applied to Medicare covered services on this bill.
44	Amount provider agreed to accept from primary payer when amount less than charges but more than payment received - When a lesser amount is received and the received amount is less than charges, a Medicare secondary payment is due.
45	Accident Hour - The hour the accident occurred that necessitated medical treatment.
46	Number of grace days - Following the date of the PRO/UR determination, this is the number of days determined by the PRO/UR to be necessary to arrange for the patient's post-discharge care.
47	Any liability insurance - Amount is that portion from a higher priority liability insurance made on behalf of Medicare bene the provider is applying to Medicare covered services on this bill.
48	Hemoglobin reading - The patient's most recent hemoglobin reading taken before the start of the billing period (eff. 1/3/2006). Prior to 1/3/2006 defined as the latest hemoglobin reading taken during the billing cycle.
49	Hematocrit reading - The patient's most recent hematocrit reading taken before the start of the billing period (eff. 1/3/2006). Prior to 1/3/2006 defined as hematocrit reading taken during the billing cycle.
50	Physical therapy visits - Indicates the number of physical therapy visits from onset (at billing provider) through this billing period.
51	Occupational therapy visits - Indicates the number of occupational therapy visits from onset (at the billing provider) through this billing period.
52	Speech therapy visits - Indicates the number of speech therapy visits from onset (at billing provider) through this billing period.
53	Cardiac rehabilitation - Indicates the number of cardiac rehabilitation visits from onset (at billing provider) through this billing period.
54	New birth weight in grams - Actual birth weight or weight at time of admission for an extramural birth. Required on all claims with type of admission of '4' and on other claims as required by law.
55	Eligibility Threshold for Charity Care - code identifies the corresponding value amount at which a health care facility determines the eligibility threshold of charity care.
56	Hours skilled nursing provided - The number of hours skilled nursing provided during the billing period. Count only hours spent in the home.
57	Home health visit hours - The number of home health aide services provided during the billing period. Count only the hours spent in the home.
58	Arterial blood gas - Arterial blood gas value at beginning of each reporting period for oxygen therapy. This value or value 59 will be required on the initial bill for oxygen therapy and on the fourth month's bill.
59	Oxygen saturation - Oxygen saturation at the beginning of each reporting period for oxygen therapy. This value or value 58 will be required on the initial bill for oxygen therapy and on the fourth month's bill.
60	HHA branch MSA - MSA in which HHA branch is located.
61	Location of HHA service or hospice service - the balanced budget act (BBA) requires that the geographic location of where the service was provided be furnished instead of the geographic location of the provider. NOTE: HHA claims with a thru date on or before 12/31/05, the value code amount field reflects the MSA code (followed by zeroes to fill the field). HHA claims with a thru date after 12/31/05, the value code amount field reflects the CBSA code.
62	Number of Part A home health visits accrued during a period of continuous care - necessitated by the change in payment basis under HH PPS (eff. 10/00)
63	Number of Part B home health visits accrued during a period of continuous care - necessitated by the change in payment basis under HH PPS (eff. 10/00)
64	Amount of home health payments attributed to the Part A trust fund in a period of continuous care - necessitated by the change in payment basis under HH PPS (eff. 10/00)
65	Amount of home health payments attributed to the Part B trust fund in a period of continuous care - necessitated by the change in payment basis under HH PPS (eff. 10/00)
66	Medicare Spend-down Amount -- The dollar amount that was used to meet the recipient's spend-down liability for this claim.
67	Peritoneal dialysis - The number of hours of peritoneal dialysis provided during the billing period (only the hours spent in the home).
68	EPO drug - Number of units of EPO administered relating to the billing period.
69	State charity Care Percent
70	Interest amount - (Providers do not report this.) Report the amount applied to this bill.
71	Funding of ESRD networks - (Providers do not report this.) Report the amount the Medicare payment was reduced to help fund the ESRD networks.
72	Flat rate surgery charge - Code indicates the amount of the charge for outpatient surgery where the hospital has such a charging structure.
73	Drug deductible - (For internal use by third party payers only). Report the amount of the drug deductible to be applied to the claim.
74	Drug coinsurance - (For internal use by third party payers only). Report the amount of drug coinsurance to be applied to the claim.
75	Gramm/Rudman/Hollings - (Providers do not report this.) Report the amount of the sequestration applied to this bill.
76	Report provider's percentage of billed charges interim rate during billing period. Applies to OP hospital, SNF and HHA claims where interim rate is applicable. Report to left of dollar/cents delimiter. (TP payers internal use only)
77	New Technology Add-on Payment Amount - Amount of payments made for discharges involving approved new technologies. If the total covered costs of the discharge exceed the DRG payment for the case (including adjustments for IME and disproportionate share hospitals (DSH) but excluding outlier payments) an add-on amount is made indicating a new technology was used in the treatment of the beneficiary. (eff. 4/1/03, under Inpatient PPS)
78	Payer code - This codes is set aside for payer use only. Providers do not report these codes.
79	Payer code - This code is set aside for payer use only. Providers do not report these codes.
80	Covered Days
81	Non-Covered Days
82	Coinsurance Days
83	Lifetime Reserve Days
84-99	Reserved for state assignment.
A0	Special Zip Code Reporting - five digit zip code of the location from which the beneficiary is initially placed on board the ambulance. (eff. 9/01)
A1	Deductible Payer A - The amount assumed by the provider to be applied to the patient's deductible amount to the involving the indicated payer. (eff. 10/93) - Prior value 07
A2	Coinsurance Payer A - The amount assumed by the provider to be applied to the patient's Part B coinsurance amount involving the indicated payer.
A3	Estimated Responsibility Payer A - The amount estimated by the provider to be paid by the indicated payer.
A4	Self-administered drugs administered in an emergency situation -Ordinarily the only non-covered self-administered drug paid for under Medicare in an emergency situation is insulin administered to a patient in a diabetic coma.
A5	Covered self-administered drugs -- The amount included in covered charges for self-administrable drugs administered to the patient because the drug was not self-administered in the form and situation in which it was furnished to the patient.
A6	Covered self-administered drugs -Diagnostic study and Other --- the amount included in covered charges for self-administrable drugs administered to the patient because the drug was necessary for diagnostic study or other reasons. For use with Revenue Center 0637.
A7	Copayment A -- The amount assumed by the provider to be applied toward the patient's copayment amount involving the indicated payer.
A8	Patient Weight -- Weight of patient in kilograms. Report this data only when the health plan has a predefined change in reimbursement that is affected by weight.
A9	Patient Height - Height of patient in centimeters. Report this data only when the health plan has a predefined change in reimbursement that is affected by height.
AA	Regulatory Surcharges, Assessments, Allowances or Health Care Related Taxes (Payer A) -- The amount of regulatory surcharges, assessments, allowances or health care related taxes pertaining to the indicated payer (eff. 10/2003).
AB	Other Assessments or Allowances (Payer A) -- The amount of other assessments or allowances pertaining to the indicated payer. (eff. 10/2003).
B1	Deductible Payer B - The amount assumed by the provider to be applied to the patient's deductible amount involving the indicated payer. (eff 10/93) - Prior value 07
B2	Coinsurance Payer B - the amount assumed by the provider to be applied to the patient's Part B coinsurance amount involving the indicated payer.
B3	Estimated Responsibility Payer B - The amount estimated by the provider to be paid by the indicated payer.
B7	Copayment B -- The amount assumed by the provider to be applied toward the patient's copayment amount involving the indicated payer.
BA	Regulatory Surcharges, Assessments, Allowances or Health Care Related Taxes (Payer B) -- The amount of regulatory surcharges, assessments, allowances or health care related taxes pertaining to the indicated payer (eff. 10/2003).
BB	Other Assessments or Allowances (Payer B) -- The amount of other assessments or allowances pertaining to the indicated payer. (eff. 10/2003).
C1	Deductible Payer C - The amount assumed by the provider to be applied to the patient's deductible amount involving the indicated payer. (eff 10/93) - Prior value 07
C2	Coinsurance Payer C - The amount assumed by the provider to be applied to the patient's Part B coinsurance amount involving the indicated payer.
C3	Estimated Responsibility Payer C - The stop/
C7	Copayment C -- The amount assumed by the provider to be applied toward the patient's copayment amount involving the indicated payer.
CA	Regulatory Surcharges, Assessments, Allowances or Health Care Related Taxes (Payer C) -- The amount of regulatory surcharges, assessments, allowances or health care related taxes pertaining to the indicated payer (eff. 10/2003).
CB	Other Assessments or Allowances (Payer C) -- The amount of other assessments or allowances pertaining to the indicated payer. (eff. 10/2003).
D3	Estimated Responsibility Patient - The amount estimated by the provider to be paid by the indicated patient.
D4	Clinical Trial Number Assigned by NLM/NIH - Eight digit numeric National Library of Medicine/National Institute of Health clinical trial registry number or a default number of '99999999' if the trial does not have an 8-digit registry number. (Eff. 10/1/07)
D5	Result of last Kt/V
FC	Patient Prior Payments
FD	Reserved for national assignment
G8	Facility Where Inpatient Hospice Service Is Delivered - MSA or Core Based Statistical Area (CBSA) number (or rural state code) of the facility where inpatient hospice is delivered. (Eff. 1/1/08)
XX	Total Charge Amount for all Part A visits on RIC 'U' claims - for Home Health claims containing both Part A and Part B services this code identifies the total charge amount for the Part A visits (based on revenue center codes 042X, 043X, 044X, 055X, 056X, & 057X). Code created internally in the NCHMQA system (eff. 10/31/01 with HHPPS).
XY	Total Charge Amount for all Part B visits on RIC 'U' claims - for Home Health claims containing both Part A and Part B services this code identifies the total charge amount for the Part B visits (based on revenue center codes 042X, 043X, 044X, 055X, 056X, & 057X). Code created internally in the NCHMQA system (eff. 10/31/01 with HHPPS).
XZ	Total Charge Amount for all Part B non-visit charges on the RIC 'U' claims - for Home Health claims containing both Part A & Part B services, this code identifies the total charge amount for the Part B non-visit charges. Code created internally in the NCHMQA system (eff. 10/31/01 with HHPPS).
Y1	Part A demo payment - Portion of the payment designated as reimbursement for Part A services under the demonstration. This amount is instead of the traditional prospective DRG payment (operating and capital) as well as any outlier payments that might have been applicable in the absence of the demonstration. No deductible or coinsurance has been applied. Payments for operating IME and DSH which are processed in the traditional manner are also not included in this amount.
Y2	Part B demo payment - Portion of the payment designated as reimbursement for Part B services under the demonstration. No deductible or coinsurance has been applied.
Y3	Part B coinsurance - Amount of Part B coinsurance applied by the intermediary to this demo claim. For demonstration claims this will be a fixed copayment unique to each hospital and DRG (or DRG/ procedure group).
Y4	Conventional Provider Payment Amount for Non-Demonstration Claims -This the amount Medicare would have reimbursed the provider for Part A services if there had been no demonstration. This should include the prospective DRG payment (both capital as well as operational) as well as any outlier payment, which would be applicable. It does not include any pass through amounts such as that for direct medical education nor interim payments for operating IME and DSH.

Other Info

Some additional information on this variable:

Short Name: VAL_CD
Long Name: CLM_VAL_CD
Type: CHAR
Length: 2
Source: NCH
Value Format: