External External Other Source 8 - Other ICD Diagnosis Code - 9. If not Code ICD Other MC 51 Diagnosis 11/8/12 International varchar[7] applicable do not report any value All 1% C Source 8 Diagnosis Code - 9 Classification of here. - Text Diseases External Codes External Other Source 8 - Other ICD Diagnosis Code - 10. If Code ICD MC 52 Diagnosis 11/8/12 International varchar[7] not applicable do not report any All 1% C Source 8 Diagnosis Code - 10 Classification of value here. - Text Diseases External Codes External Other Source 8 - Other ICD Diagnosis Code - 11. If Code ICD Other MC 53 Diagnosis 11/8/12 International varchar[7] not applicable do not report any All 1% C Source 8 Diagnosis Code - 11 Classification of value here. - Text Diseases External Codes External Other Source 8 - Other ICD Diagnosis Code - 12. If Code ICD Other MC 54 Diagnosis 11/8/12 International varchar[7] not applicable do not report any All 1% C Source 8 Diagnosis Code - 12 Classification of value here. - Text Diseases External Report the National Uniform Required Code External Code Revenue Billing Committee Revenue Code when MC 55 11/8/12 Source Source 14 - char[4] Revenue Code 98% A0 Code here. Code using leading zeroes, MC094 = 14 - Revenue Code and four digits. 002 Numeric External External Code Procedure Code HCPCS / CPT Report a Procedure code for the MC 56 11/8/12 Source 9 - All 98% A1 Code Source 9 Code claim line as defined by MC130. CPTs & HCPCS - Text External Report a valid Procedure modifier Procedure External Code Code HCPCS / CPT when a modifier clarifies / improves MC 57 Modifier - 11/8/12 Source 9 - char[2] All 20% B Source 9 Code Modifier the reporting accuracy of the 1 Modifiers - Text associated procedure code (MC055).
MC 51 Other Diagnosis - 9 11/8/12 External Code Source 8 - Text External Source 8 - International Classification of Diseases varchar[7] ICD Other Diagnosis Code Other ICD Diagnosis Code - 9. If not applicable do not report any value here. All 1% C MC 52 Other Diagnosis - 10 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Diagnosis Code Other ICD Diagnosis Code - 10. If not applicable do not report any value here. All 1% C MC 53 Other Diagnosis - 11 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Other Diagnosis Code Other ICD Diagnosis Code - 11. If not applicable do not report any value here. All 1% C MC 54 Other Diagnosis - 12 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Other Diagnosis Code Other ICD Diagnosis Code - 12. If not applicable do not report any value here. All 1% C MC 55 Revenue Code 11/8/12 External Code Source 14 - Numeric External Code Source 14 - Revenue Code char[4] Revenue Code Report the National Uniform Billing Committee Revenue Code here. Code using leading zeroes, and four digits. Required when MC094 = 002 98% A0 MC 56 Procedure Code 11/8/12 External Code Source 9 - Text External Code Source 9 - CPTs & HCPCS HCPCS / CPT Code Report a Procedure code for the claim line as defined by MC130. All 98% A1 MC 57 Procedure 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 (MC055). All 20% B
apcd-medical-claim-file-submission-guide.docx