CPT/HCPCS Outpatient Codes

Title
CPT/HCPCS Outpatient Code Edits (OCE)

File
CPTOCE

Description
This file lists CPT/HCPCS codes, their narrative descriptions, appropriate procedures and flags used to validate health care claims.

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Record Layout comma delimited

Field	Position	Description
1	CPT4 or HCPCS Code	CPT/HCPCS Procedure Code

2	Short Description	CPT/HCPCS short description

3	Sex Indicator	Sex procedure applicable to only one of the sexes

4	Non-covered procedures	Non-Covered Service Based on Other Than Statute

5	Questionable Procedures	Medicare may cover some procedures only under certain medical circumstances

6	No additional payment	Additional payment for services not provided by Medicare

7	Site of Service	Site of service not included in Outpatient Prospective Prospective Service system

8	Inpatient Procedures	Not covered by OPPS

9	Not recognized	Code not recognized by Medicare

10	ASC Procedure	Medicare approved Ambulatory Surgical Center procedures

11	Unlisted procedures	Flags procedure codes used when a specific procedure is not listed in the CPT code book

12	Non-Covered Service Based on Statute	Medicare does not provide reimbursement for these procedures

13	Not Recognized by OPPS	Code not recognized by OPPS; alternate code for same service may be available.

14	DME	Service can only be billed to the DMERC

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