CSTM Codes Discussion

Summary

Summary

For plans that submit Machine Readable Files (MRFs) or the HSQ data spec files, HealthSparq accepts ‘CSTM’ codes as per the CMS allowance of these codes for plans. For more information about these codes see, https://github.com/CMSgov/price-transparency-guide/tree/master/schemas/in-network-rates#additional-notes-concerning-bill ing_code

  • The billing_code_type of “CSTM-ALL” and billing_code “CSTM-00” indicates that the rate applies to all billing_codes for all billing_code_types.

Examples:

  • A rate/allowed amount having a billing_code_type of “CSTM-ALL” and a
    • billing_code of “12345” would apply to all billing_code_types having a billing code of “12345”
  • A rate/allowed amount having a billing_code_type of “CSTM-ALL” and a billing_code of “CSTM-00” would apply to all billing_code_types and billing code combinations
    • The UI will display the highest rate (which may be only that rate) for that billing code-billing code type for that CSTM-All & CSTM-00 code