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TMSIS Dataguide Medicaid.gov
Version 3.28.0

HCPCS-RATE

Data Element

DE Number

CIP279

System DE Number

CIP.003.279

File Segment Number

CIP00003

File Segment Name

CLAIM-LINE-RECORD-IP

Last updated

No Updates

Definition This data element is expected to capture data from the HIPAA 837I claim loop 2400 SV206 or UB-04 FL 44.
Size X(14)
FLF Start Position 856
FLF Stop Position 869
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 14 characters or less
2. Value must not contain a pipe or asterisk symbols
3. Value must be in HCPCS Rate List (VVL)
4. Conditional
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CLT231 CLT.003.231 HCPCS-RATE CLT00003 CLAIM-LINE-RECORD-LT