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These fields are used in grouping and reimbursement for CMS APCs. Please refer to the "Outpatient Prospective Payment System Final Rule" ("OPPS Final Rule") issued by CMS.

The GP1 segment is specific to the US and may not be implemented in non-US systems.

HL7 Attribute Table - GP1 - Grouping/Reimbursement - Visit Segment

Seq#	DataElement	Description	Must Implement	Flags	Cardinality	Length	C.LEN	Vocabulary	DataType
GP1
1	01599	Type of Bill Code	SHALL		[1..1]			0455 Type of Bill Code	CWE
2	01600	Revenue Code			[0..*]			0456 Revenue code	CWE
3	01601	Overall Claim Disposition Code			[0..1]			0457 Overall Claim Disposition Code	CWE
4	01602	OCE Edits per Visit Code			[0..*]			0458	CWE
5	00387	Outlier Cost			[0..1]				CP

Definition: This field is the same as UB92 Form Locator 4 "Type of Bill". Refer to User-defined Table 0455 - Type of Bill Code in Chapter 2C, Code Tables, for suggested values. Refer to a UB specification for additional information. This field is defined by CMS or other regulatory agencies. It is a code indicating the specific type of bill with digit 1 showing type of facility, digit 2 showing bill classification, and digit 3 showing frequency.

(Definition from FT1.41 in Ch. 6)

Definition: This field contains the Revenue Code for the charge. If valued, this field will override the value in the Service Catalog. Refer to User-defined Table 0456 – Revenue Code in Chapter 2C, Code Tables, for suggested values.

(Definition from GP1.2 in Ch. 6)

Definition: This field is the same as UB92 Form Locator 42 "Revenue Code". Refer to User-defined Table 0456 - Revenue Code in Chapter 2C, Code Tables, for suggested values. This field identifies revenue codes that are not linked to a HCPCS/CPT code. It is used for claiming for non-medical services such as telephone, TV or cafeteria charges, etc. There can be many per visit or claim. This field is defined by CMS or other regulatory agencies.

There can also be a revenue code linked to a HCPCS/CPT code. These are found in GP2-1 - Revenue Code. Refer to UB92 specifications.

(Definition from GP2.1 in Ch. 6)

Definition: This field identifies a specific ancillary service for each HCPC/CPT This field is the same as UB92 Form Locator 42 "Revenue Code". Refer to User-defined Table 0456 - Revenue Code in Chapter 2C, Code Tables, for suggested values. This field is defined by CMS or other regulatory agencies.

Definition: This field identifies the final status of the claim. The codes listed as examples are not an exhaustive or current list, refer to OPPS Final Rule. Refer to User-defined Table 0457 - Overall Claim Disposition Code in Chapter 2C, Code Tables, for suggested values. This field is defined by CMS or other regulatory agencies.

Definition: This field contains the edits that result from processing the HCPCS/CPT procedures for a record after evaluating all the codes, revenue codes, and modifiers. The codes listed as examples are not an exhaustive or current list, refer to OPPS Final Rule. OCE (Outpatient Code Editor) edits also exist at the pre-procedure level. Refer to User-defined Table 0458 - OCE Edit Code in Chapter 2C, Code Tables, for suggested values. This field is defined by CMS or other regulatory agencies.

(Definition from DG1.13 in Ch. 6)

Attention: DG1-13 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6

(Definition from DRG.7 in Ch. 6)

Definition: This field contains the amount of money that has been approved for an outlier payment.

(Definition from GP1.5 in Ch. 6)

Definition: This field contains the amount that exceeds the outlier limitation as defined by APC regulations. This field is analogous to DRG-7 - Outlier Cost; however, the definition in this field note supersedes the DRG-7 definition.