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TMSIS Dataguide Medicaid.gov

Version:

MBESCBES-CATEGORY-OF-SERVICE

Data Element

DE Number

FTX219

System DE Number

FTX.006.219

File Segment Number

FTX00006

File Segment Name

VALUE-BASED-PAYMENT

Last updated

Definition A code indicating the category of service for the paid claim. The category of service is the line item from the MBES/CBES expenditure form (e.g., CMS-64 Base, CMS-64.21U, CMS-21, etc.) that states use to report their expenditures and request federal financial participation.
Size X(5)
FLF Start Position 854
FLF Stop Position 858
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 5 characters or less
2. When MBESCBES Form Group equals "1", value must be in 64.9COS Form List (VVL)
3. When MBESCBES Form equals "2", value must be in 64.21COS Form List (VVL)
4. When MBESCBES Form equals "3", value must be in 21COS Form List (VVL)
5. Mandatory
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP315 CIP.003.315 MBESCBES-CATEGORY-OF-SERVICE CIP00003 CLAIM-LINE-RECORD-IP
CLT261 CLT.003.261 MBESCBES-CATEGORY-OF-SERVICE CLT00003 CLAIM-LINE-RECORD-LT
COT256 COT.003.256 MBESCBES-CATEGORY-OF-SERVICE COT00003 CLAIM-LINE-RECORD-OT
CRX180 CRX.003.180 MBESCBES-CATEGORY-OF-SERVICE CRX00003 CLAIM-LINE-RECORD-RX
FTX046 FTX.002.046 MBESCBES-CATEGORY-OF-SERVICE FTX00002 INDIVIDUAL-CAPITATION-PMPM
FTX091 FTX.003.091 MBESCBES-CATEGORY-OF-SERVICE FTX00003 INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX135 FTX.004.135 MBESCBES-CATEGORY-OF-SERVICE FTX00004 GROUP-INSURANCE-PREMIUM-PAYMENT
FTX177 FTX.005.177 MBESCBES-CATEGORY-OF-SERVICE FTX00005 COST-SHARING-OFFSET
FTX264 FTX.007.264 MBESCBES-CATEGORY-OF-SERVICE FTX00007 STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX304 FTX.008.304 MBESCBES-CATEGORY-OF-SERVICE FTX00008 COST-SETTLEMENT-PAYMENT
FTX343 FTX.009.343 MBESCBES-CATEGORY-OF-SERVICE FTX00009 FQHC-WRAP-PAYMENT
FTX391 FTX.095.391 MBESCBES-CATEGORY-OF-SERVICE FTX00095 MISCELLANEOUS-PAYMENT