External External Code Code CDT Source 10 - HCPCS / CDT DC 33 11/8/12 Source char[5] Report the Dental Terminology code here All 99% A2 Code Current Dental Code 10 - Terminology Text External Report a valid Procedure modifier when a External Code Code HCPCS / CPT modifier clarifies / improves the reporting DC 34 11/8/12 Source 9 - char[2] All 0% C Modifier - Source Code Modifier accuracy of the associated procedure code Modifiers 1 9 - Text (DC032). External Report a Procedure modifier when a External Code Code HCPCS / CPT modifier clarifies / improves the reporting DC 35 11/8/12 Source 9 - char[2] All 0% C Modifier - Source Code Modifier accuracy of the associated procedure code Modifiers 2 9 - Text (DC032). Date of Full Century Year Date of Report the date of service for this claim line DC 36 Service - 6/24/10 Date - Month Day - int[8] All 99% A0 Service in CCYYMMDD Format. From Integer CCYYMMDD Report the end service date for the claim Date of Full Century Year Last date of line in CCYYMMDD Format; it can equal DC 37 Service - 6/24/10 Date - Month Day - int[8] service for this All 0% B DC035 when a single date of service is Thru Integer CCYYMMDD service line. being reported. Report the amount the provider billed the insurance carrier for this claim line service. Amount of Report 0 for services rendered in Charge provider conjunction with other services on the claim. DC 38 6/24/10 Integer Currency All 99% A0 Amount charges for the Do not code decimal or round up / down to claim line whole dollars code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the amount paid for the claim line. Report 0 if line is paid as part of another Amount paid procedure / claim line. Do not report any Paid by the carrier value if the line is denied. Do not code DC 39 10/3/10 Integer Currency All 99% A0 Amount for the claim decimal or round up / down to whole dollars line code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070
DC 33 CDT Code 11/8/12 External Code Source 10 - Text External Code Source 10 - Current Dental Terminology char[5] HCPCS / CDT Code Report the Dental Terminology code here All 99% A2 DC 34 Modifier - 1 11/8/12 External Code Source 9 - Text External Code Source 9 - Modifiers char[2] HCPCS / CPT Code Modifier Report a valid Procedure modifier when a modifier clarifies / improves the reporting accuracy of the associated procedure code (DC032). All 0% C DC 35 Modifier - 2 11/8/12 External Code Source 9 - Text External Code Source 9 - Modifiers char[2] HCPCS / CPT Code Modifier Report a Procedure modifier when a modifier clarifies / improves the reporting accuracy of the associated procedure code (DC032). All 0% C DC 36 Date of Service - From 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Date of Service Report the date of service for this claim line in CCYYMMDD Format. All 99% A0 DC 37 Date of Service - Thru 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Last date of service for this service line. Report the end service date for the claim line in CCYYMMDD Format; it can equal DC035 when a single date of service is being reported. All 0% B DC 38 Charge Amount 6/24/10 Integer Currency Amount of provider charges for the claim line Report the amount the provider billed the insurance carrier for this claim line service. Report 0 for services rendered in conjunction with other services on the claim. 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% A0 DC 39 Paid Amount 10/3/10 Integer Currency Amount paid by the carrier for the claim line Report the amount paid for the claim line. Report 0 if line is paid as part of another procedure / claim line. Do not report any value if the line is denied. 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% A0
v6-apcd-dental-claim-file-submission-guide-Redline-.docx