COT.003.219

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TMSIS Dataguide

Medicaid.gov

Version:

PROCEDURE-CODE-MOD-4

Data Element

DE Number

COT219

System DE Number

COT.003.219

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	744
FLF Stop Position	745
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. 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-1706	If the procedure mod 4 is populated on a non-denied claim line from an OT file, then the procedure mod 4 value reported must be in the list of valid values for procedure mod 4.
RULE-6375	If a claim line is a non-denied claim line from an OT file, then the procedure mod 4 value reported must be compatible with specified T-MSIS picture format: X(2).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CRX186	CRX.003.186	PROCEDURE-CODE-MOD-4	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	COT.003.219	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.219	ADD	N/A		Created