LINE CODES The following worksheets are cost center coded worksheets: A, B series, C series, D series and L series. CMS Line Label Codes Std. 1 Capital Related Cost - Buildings & Fixtures 00100-00149 Std. 2 Capital Related Cost - Movable Equipment 00200-00249 Std. 3 Other Capital Related Cost 00300 Std. 4 Employee Benefits 00400-00419 Std. 5 Administrative & General 00500-00539 5 Communications 01160-01179 5 Other Administrative & General 00590-00599 5 Data Processing 00550-00559 5 Management Services 01140-01159 5 Admitting 00570-00579 5 Purchasing, Receiving, and Stores 00560-00569 5 Cashiering and Accounts Receivable 00580-00589 5 NonPatient Telephones 00540-00549 Std. 6 Maintenance and Repairs 00600-00619 Std. 7 Operation of Plant 00700-00719 Std. 8 Laundry & Linen Service 00800-00819 Std. 9 Housekeeping 00900-00919 Std. 10 Dietary 01000-01019 Std. 11 Cafeteria 01100-01119 Std. 12 Maintenance of Personnel 01200-01219 Std. 13 Nursing Administration 01300-01319 Std. 14 Central Services and Supply 01400-01419 Std. 15 Pharmacy 01500-01519 Std. 16 Medical Records & Library 01600-01619 Std. 17 Social Service 01700-01719 18 Other General Service Cost Centers 01850-01899 18 Inservice Education 01080-01099 Std. 19 Nonphysician Anesthetists 01900-01919 Std. 20 Nursing School 02000-02019 Std. 21 Interns & Residents (Approved) - Salary & Fringe 02100-02119 Std. 22 Interns & Residents (Approved) - Other Costs 02200-02219 Std. 23 Paramedical Education Program 02300-02399 Std. 30 Adults & Pediatrics (General Routine Care) 03000 Std. 31 Intensive Care Unit 03100-03119 Std. 32 Coronary Care Unit 03200-03219 Std. 33 Burn Intensive Care Unit 03300-03319 Std. 34 Surgical Intensive Care Unit 03400-03419 35 Psychiatric ICU 02140-02159 35 Pediatric ICU 02080-02099 35 Neonatal ICU 02060-02079 35 Trauma ICU 02180-02199 35 Detoxification ICU 02040-02059 35 Premature ICU 02120-02139 Std. 40 Subprovider IPF 04000 Std. 41 Subprovider IRF 04100
Std. 42 Other Subprovider 04200-04209 Std. 43 Nursery 04300 Std. 44 Skilled Nursing Facility 04400 Std. 45 Nursing Facility 04500 Std. 45.10 ICF/MR 04510 Std. 46 Other Long Term Care 04600 Std. 50 Operating Room 05000-05029 50 Prosthetic Devices 03540-03549 50 Circumcision 03220-03229 50 Endoscopy 03330-03339 Std. 51 Recovery Room 05100-05129 Std. 52 Delivery Room & Labor Room 05200-05229 52 Birthing Center 03070-03079 Std. 53 Anesthesiology 05300-05329 53 Acupuncture 03020-03029 Std. 54 Radiology - Diagnostic 05400-05429 54 Nuclear Medicine - Diagnostic 03450-03459 54 Ultra Sound 03630-03639 54 Mammography 03440-03449 54 Angiocardiography 03030-03039 54 Echocardiography 03260-03269 Std. 55 Radiology - Therapeutic 05500-05529 55 Nuclear Medicine - Therapeutic 03470-03479 55 Electroshock Therapy 03320-03329 55 Chemotherapy 03190-03199 Std. 56 Radioisotope 05600-05629 Std. 57 CT Scan 05700-05729 Std. 58 MRI 05800-05829 Std. 59 Cardiac Catheterization 05900-05929 Std. 60 Laboratory 06000-06029 60 Oncology 03480-03489 60 Biopsy 03060-03069 60 Hematology 03350-03359 60 Cytology 03240-03249 60 Immunology 03380-03389 60 Bacteriology & Microbiology 03050-03059 60 Chemistry 03180-03189 60 Vascular Lab 03650-03659 60 Laboratory - Pathological 03420-03429 60 Laboratory - Clinical 03390-03399 60 Histology 03360-03369 60 Urology 03640-03649 60 Gastro Intestinal Service 03340-03349 Std. 61 PBP Clinical Lab Service Program Only 06100 Std. 62 Whole Blood & Packed Red Blood Cells 06200-06229 Std. 62.50 Blood Clotting for Hemophiliacs 06250-06259 Std. 63 Blood Storing, Processing, & Transfusing 06300-06329 Std. 64 Intravenous Therapy 06400-06429
Std. 65 Respiratory Therapy 06500-06529 65 Pulmonary Function Testing 03560-03569 Std. 66 Physical Therapy 06600-06629 66 Osteopathic Therapy 03530-03539 Std. 67 Occupational Therapy 06700-06729 Std. 68 Speech Pathology 06800-06829 Std. 69 Electrocardiology 06900-06929 69 EKG and EEG 03280-03289 69 Electromyography 03290-03299 69 Cardiopulmonary 03160-03179 69 Stress Test 03620-03629 69 Cardiology 03140-03159 69 Holter Monitor 03370-03379 Std. 70 Electroencephalograpy 07000-07029 Std. 71 Medical Supplies Charged to Patients 07100-07129 Std. 72 Implant Devices Charged to Patients 07200-07229 Std. 73 Drugs Charged to Patients 07300-07329 Std. 74 Renal Dialysis 07400 Std. 75 ASC (Non-Distinct Part) 07500-07529 76 Audiology 03040-03049 76 Dental Services 03250-03259 76 Recreational Therapy 03580-03589 76 Psychiatric / Psychological Services 03550-03559 76 Ophthalmology 03520-03529 76 Other Ancillary Cost Centers 03950-03996 76 Cardiac Rehabilitation 07697 76 Hyperbaric oxygen therapy 07698 76 Lithotripsy 07699 Std. 88 Rural Health Clinic 08800-08824 Std. 89 Federally Qualified Health Center 08900-08924 Std. 90 Clinic 09000-09099 Std. 91 Emergency 09100-09119 Std. 92 Observation Beds (Distinct Part) 09201-09209 Std. 92 Observation Beds (Non-Distinct Part) 09200 93 Family Practice 04040-04049 93 Telemedicine 04050-04059 93 All Other Outpatient Cost Centers 04950-04999 Std. 94 Home Program Dialysis 09400 Std. 95 Ambulance Services 09500 Std. 96 Durable Medical Equipment -- Rented 09600-09619 96 Support Surfaces -- Rented 06630-06634 Std. 97 Durable Medical Equipment -- Sold 09700-09719 97 Support Surfaces -- Sold 06730-06734 98 Other Reimbursable Cost Centers (excl. HHA & CORF) 05950-05999 99 CMHC 09900-09909 99.10 CORF 09910-09919 99.20 OPT 09920-09929 99.30 OOT 09930-09939 99.40 OSP 09940-09949
Std. 100 Intern - Resident Svc. (not in Approved Program) 10000 Std. 101 Home Health Agency 10100-10109 Std. 105 Kidney Acquisition 10500 Std. 106 Heart Acquisition 10600 Std. 107 Liver Acquisition 10700 Std. 108 Lung Acquisition 10800 Std. 109 Pancreas Acquisition 10900 Std. 110 Intestine Acquisition 11000 Std. 111 Islet Cell Acquisition 11100 112 Other Organ Acquisition 08600-08619 Std. 113 Interest Expense 11300 Std. 114 Utilization Review -- SNF 11400 Std. 115 ASC (Distinct Part) 11500-11519 Std. 116 Hospice 11600-11604 117 All Other Special Purpose Cost Centers 06950-06999 Std. 190 Gift, Flower, Coffee Shop, & Canteen 19000-19019 Std. 191 Research 19100-19119 Std. 192 Physicians' Private Offices 19200-19219 Std. 193 Nonpaid Workers 19300-19319 194 Other Nonreimbursable Cost Centers 07950-07999
COLUMN CODES The following column codes are for the following worksheets: B, Part I, Columns 1 through 23 B, Part II, Columns 1 through 23 B-1, Columns 1 through 23 CMS Column Label Std. 1 1 Capital Related Cost - Buildings & Fixtures 00100-00149 Std. 2 2 Capital Related Cost - Movable Equipmen 00200-00249 Std. 3 3 Other Capital Related Cost 00300 Std. 4 4 Employee Benefits 00400-00419 Std. 5 Administrat 00500-00539 5 Communications 01160-01179 5 Other Administrative & General 00590-00599 5 Data Processing 00550-00559 5 Management Services 01140-01159 5 Admitting 00570-00579 5 Purchasing, Receiving, and Stores 00560-00569 5 Cashiering and Accounts Receivable 00580-00589 5 NonPatient Telephones 00540-00549 Std. 6 Maintenance and Repairs 00600-00619 Std. 7 Operation of Plant 00700-00719 Std. 8 Laundry & Linen Service 00800-00819 Std. 9 Housekeeping 00900-00919 Std. 10 Dietary 01000-01019 Std. 11 Cafeteria 01100-01119 Std. 12 Maintenance of Personnel 01200-01219 Std. 13 Nursing Administration 01300-01319 Std. 14 Central Services and Supply 01400-01419 Std. 15 Pharmacy 01500-01519 Std. 16 Medical Records & Library 01600-01619 Std. 17 Social Service 01700-01719 18 Other General Service Cost Centers 01850-01899 18 Inservice Education 01080-01099 Std. 19 Nonphysician Anesthetists 01900-01919 Std. 20 Nursing School 02000-02019 Std. 21 Interns & Residents (Approved) - Salary & Fringe 02100-02119 Std. 22 Interns & Residents (Approved) - Other Costs 02200-02219 Std. 23 Paramedical Education Program 02300-02399 Page 5