COT.003.179

MEDICAID-FFS-EQUIVALENT-AMT

Data Element

DE Number

COT179

System DE Number

COT.003.179

File Name

COT - CLAIM OTHER

File Segment Number

COT00003

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The amount that would have been paid had the services been provided on a Fee for Service basis.
Size	S9(11)V99
FLF Start Position	274
FLF Stop Position	286
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided 4. Conditional

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

RULE ID	RULE Definition
RULE-7122	If a claim is a non-denied claim from an OT file, then the medicaid FFS equivalent amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name
MCR-12-126-125	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 57 (Enabling services)
MCR-12-135-135	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 69 (HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services)
MCR-12-134-134	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 68 (HCBS - Respite care services)
MCR-12-133-133	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 67 (HCBS - Habilitation services)
MCR-12-132-132	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 66 (HCBS - Adult day health services)
MCR-12-131-131	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 65 (HCBS - Personal care services)
MCR-12-130-130	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 64 (HCBS - Home health aide services)
MCR-12-129-129	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 63 (HCBS - Homemaker services)
MCR-12-128-128	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 62 (HCBS - Case management services)
MCR-12-127-127	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 61 (Critical access hospital services - OT)
MCR-12-136-137	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 70 (HCBS - Day Care)
MCR-12-125-124	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 56 (Transportation services)
MCR-12-124-123	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 55 (Care coordination services)
MCR-12-123-122	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 54 (Case Management services other than those that meet the definition of primary care case management services or targeted case management services)
MCR-12-122-121	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 53 (Targeted case management services )
MCR-12-121-120	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 52 (Primary care case management services)
MCR-12-120-119	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 51 (Personal care services)
MCR-12-119-118	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 50 (Inpatient substance abuse treatment services and residential substance abuse treatment services.)
MCR-12-118-116	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 49 (Outpatient mental health services)
MCR-12-117-115	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 43 (Rehabilitative services)
MCR-12-146-148	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 80 (HCBS-65-plus - Personal care services)
MCR-12-155-83	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 127 (Indian Health Service (IHS) - Family Plan)
MCR-12-154-81	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 115 (Residential care)
MCR-12-153-155	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 89 (Disposable medical supplies.)
MCR-12-152-154	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 88 (Any other health care services or items specified by the Secretary and not excluded under regulations.)
MCR-12-151-153	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 87 (Hospice services)
MCR-12-150-152	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 85 (Prenatal care and pre-pregnancy family planning services and supplies.)
MCR-12-149-151	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 83 (HCBS-65-plus - Other medical and social services)
MCR-12-148-150	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 82 (HCBS-65-plus - Respite care services)
MCR-12-147-149	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 81 (HCBS-65-plus - Adult day health services)
MCR-12-116-114	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 42 (Well-baby and well-child care services as defined by the State.)
MCR-12-145-146	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 79 (HCBS-65-plus - Home health aide services)
MCR-12-144-145	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 78 (HCBS-65-plus - Homemaker services)
MCR-12-143-144	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 77 (HCBS-65-plus - Case management services)
MCR-12-142-143	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 76 (HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment)
MCR-12-141-142	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 75 (HCBS - Expanded habilitation services - Educational services)
MCR-12-140-141	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 74 (HCBS - Expanded habilitation services - Prevocational services)
MCR-12-139-140	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 73 (HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization)
MCR-12-138-139	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 72 (HCBS - Minor modification to the home)
MCR-12-137-138	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 71 (HCBS - Training for family members)
MCR-12-086-79	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 10 (Early and periodic screening and diagnosis and treatment (EPSDT) services)
MCR-12-095-90	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 19 (Home health services - Physical therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services)
MCR-12-094-89	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 18 (Home health services - Medical supplies, equipment, and appliances suitable for use in the home)
MCR-12-093-88	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 17 (Home health services - Home health aide services)
MCR-12-092-87	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 16 (Home health services - Nursing services)
MCR-12-091-86	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 15 (Medical or other remedial care or services, other than physicians' services)
MCR-12-090-85	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 14 (Outpatient substance abuse treatment services.)
MCR-12-089-84	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 13 (Medical and surgical services of a dentist)
MCR-12-088-82	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 12 (Physicians' services)
MCR-12-087-80	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 11 (Family planning services and supplies for individuals of child-bearing age)
MCR-12-096-92	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 20 (Home health services - Occupational therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services)
MCR-12-085-147	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 8 (Technical radiological services)
MCR-12-084-136	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 7 (Professional radiological services)
MCR-12-083-126	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 6 (Technical laboratory services)
MCR-12-082-117	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 5 (Professional laboratory services)
MCR-12-081-111	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 4 (Other ambulatory services furnished by a rural health clinic)
MCR-12-080-102	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 3 (Rural health clinic services)
MCR-12-079-91	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 2 (Outpatient hospital services)
MIS-84-014-14	% missing: MEDICAID-FFS-EQUIVALENT-AMT (COT00003)
MIS-26-015-15	% missing: MEDICAID-FFS-EQUIVALENT-AMT (COT00003)
MCR-12-106-103	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 30 (Physical therapy services (when not provided under home health services))
MCR-12-115-113	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 41 (Preventive services)
MCR-12-114-112	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 40 (Screening services)
MCR-12-113-110	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 39 (Diagnostic services)
MCR-12-112-109	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 38 (Hearing Aids)
MCR-12-111-108	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 37 (Eyeglasses)
MCR-12-110-107	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 36 (Medical equipment/prosthetic devices)
MCR-12-109-106	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 35 (Dentures)
MCR-12-108-105	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 32 (Speech, hearing, and language disorders services (when not provided under home health services))
MCR-12-107-104	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 31 (Occupational therapy services (when not provided under home health services))
MIS-7-015-15	% missing: MEDICAID-FFS-EQUIVALENT-AMT (COT00003)
MCR-12-105-101	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 29 (Dental services)
MCR-12-104-100	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 28 (Clinic services)
MCR-12-103-99	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 27 (Respiratory care for ventilator-dependent individuals)
MCR-12-102-98	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 26 (Nurse practitioner services)
MCR-12-101-97	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 25 (Nurse-midwife service)
MCR-12-100-96	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 24 (Pediatric nurse)
MCR-12-099-95	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 23 (Advanced practice nurse services)
MCR-12-098-94	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 22 (Private duty nursing services)
MCR-12-097-93	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 21 (Home health services - Speech pathology and audiology services)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP255	CIP.003.255	MEDICAID-FFS-EQUIVALENT-AMT	CIP00003	CLAIM-LINE-RECORD-IP
CLT209	CLT.003.209	MEDICAID-FFS-EQUIVALENT-AMT	CLT00003	CLAIM-LINE-RECORD-LT
CRX126	CRX.003.126	MEDICAID-FFS-EQUIVALENT-AMT	CRX00003	CLAIM-LINE-RECORD-RX