CRX.003.186

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TMSIS Dataguide

Medicaid.gov

Version:

PROCEDURE-CODE-MOD-4

Data Element

DE Number

CRX186

System DE Number

CRX.003.186

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The fourth modifier associated with the procedure code (or if procedure code is missing, then the modifier may be associated with an NDC or Unique Device Identifier).
Size	X(2)
FLF Start Position	641
FLF Stop Position	642
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-9031	If a claim is a non-denied claim from a RX file, then the procedure code modifier 4 value reported must be compatible with the specified T-MSIS picture format: X(2).
RULE-9144	If the procedure code modifier-4 is populated on a non-denied claim line from a RX file, then the procedure code modifier-4 value reported must be in the list of valid values.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
COT219	COT.003.219	PROCEDURE-CODE-MOD-4	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/10/2025	4.0.13	CRX.003.186	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.186	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	CRX.003.186	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.186	ADD	N/A		Created