Report the amount that defines a preset, fixed amount for this claim line service that the patient is responsible to pay. Report 0 if no Amount of Copay Copay applies. Do not code decimal MC 66 6/24/10 Integer Currency member/patient is All 99% A1 Amount or round up / down to whole dollars, responsible to pay code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the amount that defines a calculated percentage amount for this line service that the patient is Amount of responsible to pay. Report 0 if no coinsurance Coinsurance applies. Do not code MC 67 6/24/10 Integer Currency All 99% A1 Amount member/patient is decimal or round up / down to whole responsible to pay dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the amount that defines a preset, fixed amount for this claim line service that the patient is Amount of responsible to pay. Report 0 if no deductible Deductible Deductible applies to service. Do not MC 68 6/24/10 Integer Currency member/patient is All 99% A1 Amount code decimal or round up / down to responsible to pay whole dollars, code zero cents (00) on the claim line when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070
MC 66 Copay Amount 6/24/10 Integer Currency Amount of member/patient is responsible to pay Report the amount that defines a preset, fixed amount for this claim line service that the patient is responsible to pay. Report 0 if no Copay applies. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 99% A1 MC 67 Amount 6/24/10 Integer Currency Amount of coinsurance member/patient is responsible to pay Report the amount that defines a calculated percentage amount for this line service that the patient is responsible to pay. Report 0 if no Coinsurance applies. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 99% A1 MC 68 Deductible Amount 6/24/10 Integer Currency Amount of deductible member/patient is responsible to pay on the claim line Report the amount that defines a preset, fixed amount for this claim line service that the patient is responsible to pay. Report 0 if no Deductible applies to service. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 99% A1