COT.003.172

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TMSIS Dataguide

Medicaid.gov

Version:

PROCEDURE-CODE-MOD-1

Data Element

DE Number

COT172

System DE Number

COT.003.172

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The procedure code modifier used with an associated procedure code. For example, some states use modifiers to indicate assistance in surgery or anesthesia services.
Size	X(2)
FLF Start Position	205
FLF Stop Position	206
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 2 characters 2. Value must be in Procedure Code Mod List (VVL) 3. Must be associated with a Procedure Code 4. Situational

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

RULE ID	RULE Definition
RULE-1642	If the procedure code modifier is populated on a non-denied, non-void claim line from an OT file, then the procedure code modifier must be a valid value from the list of procedure code modifier values.
RULE-6386	If a claim line is a non-denied claim line from an OT file, then the procedure code MOD 1 value reported must be compatible with specified T-MSIS picture format: X(2).

Measure ID	Measure Name
MIS-7-023-23	% missing: PROCEDURE-CODE-MOD-1 (COT00003)
MIS-26-023-23	% missing: PROCEDURE-CODE-MOD-1 (COT00003)
MIS-84-022-22	% missing: PROCEDURE-CODE-MOD-1 (COT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CRX183	CRX.003.183	PROCEDURE-CODE-MOD-1	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/17/2025	4.0.14	COT.003.172	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	COT.003.172	UPDATE	Coding requirement	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional	1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational
09/16/2024	4.0.0	COT.003.172	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.172	ADD	N/A		Created