CLT.003.224

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

XIX-MBESCBES-CATEGORY-OF-SERVICE

Data Element

DE Number

CLT224

System DE Number

CLT.003.224

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code indicating the category of service for the paid claim. The category of service is the line item from the CMS-64 form that states use to report their expenditures and request federal financial participation.
Size	X(5)
FLF Start Position	351
FLF Stop Position	355
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in XIX MBESCBES Category of Service List (VVL) 2. Value must be 5 characters or less 3. Conditional 4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported 5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M' 6. If XXI MBESCBES Category of Service is populated then must not be populated

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1259	If the XIX MBESCBES category of service is populated on a non-denied claim line LT file, then the value reported must be in the list of valid values for XIX MBESCBES category of service.
RULE-1260	If a non-denied LT claim line has XIX MBESCBES category of service equal to pregnancy-related services, then primary demographics eligibility segment must not be populated with the value 'M' for sex.
RULE-6152	If a claim line is a non-denied claim line from an LT file, then the XIX MBESCBES category of service value reported must be compatible with specified T-MSIS picture format: X(5).
RULE-7373	If a claim is a non-denied, non-void Medicaid fee for service or Medicaid CHIP supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to '0.00' and cms 64 category for federal reimbursement is equal to '01', then the XIX-MBESCBES category of service must be populated.
RULE-7386	If a claim is a non-denied, non-void Medicaid or Medicaid expansion CHIP service tracking claim line from an LT file and the service tracking payment amount is a non-null value and cms 64 category for federal reimbursement is equal to '01', then the claim line must have a value populated for XIX MBESCBES category of service.
RULE-7962	If a claim is a non-denied, Medicaid or M-CHIP supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to '0.00' and CMS 64 category for federal reimbursement is equal to '01', then the XIX-MBESCBES category of service must be populated.
RULE-7946	If a claim is a non-denied, Medicaid or M-CHIP fee for service claim from an LT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to zero and CMS 64 category for federal reimbursement is equal to '01', then the XIX-MBESCBES category of service must be populated.

Measure ID	Measure Name
ALL-20-002-2	% of claim lines with both XIX and XXI MBESCBES Category of Service
MIS-42-001-1	% missing: XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
MIS-66-001-1	% missing: XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
RULE-7373	% of claim lines on non-zero paid claims with Title XIX funding with missing XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
RULE-7534	% of claim lines with both XIX and XXI MBESCBES Category of Service
RULE-7386	% missing: XIX-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
ALL-16-013-13	% of claim lines with XIX-MBESCBES-CATEGORY-OF-SERVICE = “14”, “35”, “42” or “44” (LT) linked to an MSIS ID where SEX = “M”

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP270	CIP.003.270	XIX-MBESCBES-CATEGORY-OF-SERVICE	CIP00003	CLAIM-LINE-RECORD-IP
COT211	COT.003.211	XIX-MBESCBES-CATEGORY-OF-SERVICE	COT00003	CLAIM-LINE-RECORD-OT
CRX150	CRX.003.150	XIX-MBESCBES-CATEGORY-OF-SERVICE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	CLT.003.224	UPDATE	Coding requirement	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '1', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated	1. Value must be in XIX MBESCBES Category of Service List (VVL)2. Value must be 5 characters or less3. Conditional4. (Medicaid Claim) if the associated CMS-64 Category for Federal Reimbursement value is '01', then a valid value is mandatory and must be reported5. If value is in ['14', '35', '42' or '44'], then Sex (ELG.002.023) must not equals 'M'6. If XXI MBESCBES Category of Service is populated then must not be populated
06/24/2022	3.0.0	CLT224/ XIX-MBESCBES-CATEGORY-OF-SERVICE	Modify DE Width	Data Dictionary - Record Layout	SIZE X(4)	SIZE X(5)
02/26/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|Valid Value ID\|Effective Date\|End Date\|Value\|Description\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46\|OUD Medicaid Assisted Treatment – Drugs\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A1\| OUD MAT DRUG REBATE/National Agreement\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A2\|OUD MAT DRUG REBATE/State Sidebar\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A3\| OUD MAT DRUG REBATE MCO /National Agreement\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A4\| OUD MAT DRUG REBATE MCO /State Sidebar\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A5\| OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46A6\| OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20201001\|99991231\|46B\| OUD Medicaid Assisted Treatment Services\|
03/19/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	UPDATE	Data Dictionary - Valid Values	\|Data Element\|Effective Date\|End Date\|Value\|Name\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|50\|Total\|	N/A
04/30/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|Valid Value\|Effective Date\|End Date\|Name\| \|2C\|00010101\|99991231\|Certified Community Behavior Health Clinic Payments\| \|18A5\|00010101\|99991231\|Medicaid MCO - Certified Community Behavior Health Clinic Payments\| \|18B1e\|00010101\|99991231\|Medicaid PAHP - Certified Community Behavior Health Clinic Payments\| \|18B2e\|00010101\|99991231\|Medicaid PIHP - Certified Community Behavior Health Clinic Payments\| \|46\|00010101\|99991231\|OUD Medicaid Assisted Treatment – Drugs\| \|46A1\|00010101\|99991231\|OUD MAT DRUG REBATE/National Agreement\| \|46A2\|00010101\|99991231\|OUD MAT DRUG REBATE/State Sidebar\| \|46A3\|00010101\|99991231\|OUD MAT DRUG REBATE MCO /National Agreement\| \|46A4\|00010101\|99991231\|OUD MAT DRUG REBATE MCO /State Sidebar\| \|46A5\|00010101\|99991231\|OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%\| \|46A6\|00010101\|99991231\|OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%\| \|46B\|00010101\|99991231\|OUD Medicaid Assisted Treatment Services\|
12/03/2021	3.0.0	XIX-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|XIX-MBESCBES-CATEGORY-OF-SERVICE\|20210311\|99991231\|47\|ARP Section 9811 COVID Vaccine/Vaccine Administration\|