Use the following table to answer questions 1-3.
EXAMPLE OF A CHARGE DESCRIPTION MASTER (CDM) FILE LAYOUT
Charge
Code
Item Description Dept
#
HCPCS Code Charge Revenue
Code
Activity
Medicare Medicaid Date
49683
...
Use the following table to answer questions 1-3.
EXAMPLE OF A CHARGE DESCRIPTION MASTER (CDM) FILE LAYOUT
Charge
Code
Item Description Dept
#
HCPCS Code Charge Revenue
Code
Activity
Medicare Medicaid Date
49683105 CT scan; head; w/o
contrast
3 70450 70450 500.00 0351 1/1/2017
49683106 CT scan; head; with
contract
3 70460 70460 675.00 0351 1/1/2017
1. This information is included on the 837I electronic claim form (or UB-04 printed claim form) to represent the cost
center (e.g., lab, radiology, cardiology, respiratory, etc.) for the department in which the item is provided. It is
used for Medicare billing.
a. HCPCS code
b. Revenue code
c. Charge code
d. Department number
2. This information is used because it provides a uniform system of identifying procedures, services, or supplies.
Multiple columns can be available for various financial classes.
a. HCPCS code
b. Revenue code
c. Department number
d. Charge code
3. This information provides a narrative name of the services provided. This information should be presented in a
clear and concise manner.
a. Department number
b. HCPCS code
c. Item Description
d. Revenue code
Use the following case scenario to answer questions 4-8.
A patient with Medicare is seen in the physician’s office. The total charge for this office visit is $250.00. The patient has
previously paid his deductible under Medicare Part B. The PAR Medicare fee schedule amount for this service is $200.00.
The nonPAR Medicare fee schedule amount for this service is $190.00
4. The patient is financially liable for the coinsurance amount, which is
a. 80%
b. 100%
c. 20%
d. 15%
5. If this physician is a participating physician who accepts assignment for this claim, the total amount the physician
will receive is
a. $200.00
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