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Line-item charges and payments from CMS-1500 forms submitted to the Texas Division of Workers' Compensation over the last five years. The Texas Department of Insurance maintains this database of professional medical services billed for injured employees. Individual line items must be grouped into bills using the bill selection date and bill ID fields.
Requires joining with a separate header dataset using bill selection date and bill ID to reconstruct complete bills. A detailed data dictionary is provided separately by the DWC.
| # | Column Name |
|---|---|
| 1 | Total Charge Per Line |
| 2 | Service Adjustment Amount 1 |
| 3 | Service Adjustment Units 3 |
| 4 | Third HCPCS Modifier Paid Code |
| 5 | Line Number |
| 6 | Service Adjustment Reason Code 3 |
| 7 | Third HCPCS Modifier Billed Code |
| 8 |
| Provider Agreement Line Code |
| 9 | Service Adjustment Amount 3 |
| 10 | Treatment Line Authorization Number |
| 11 | CRNA Supervision Indicator |
| 12 | Service Adjustment Group Code 4 |
| 13 | Days/Units Billed |
| 14 | Service Line To Date |
| 15 | Number of Service Adjustments |
| 16 | Rendering Line Provider National Provider ID |
| 17 | Service Adjustment Reason Code 5 |
| 18 | Service Adjustment Units 1 |
| 19 | Service Adjustment Group Code 1 |
| 20 | Third Diagnosis Pointer |
| 21 | Fourth Diagnosis Pointer |
| 22 | Service Line From Date |
| 23 | Second HCPCS Modifier Billed Code |
| 24 | Second HCPCS Modifier Paid Code |
| 25 | Service Adjustment Units 2 |
| 26 | First HCPCS Modifier Paid Code |
| 27 | Service Adjustment Group Code 3 |
| 28 | Service Adjustment Amount 4 |
| 29 | Days/Units Code |
| 30 | Contract Line Type Code |
| 31 | First Diagnosis Pointer |
| 32 | Service Adjustment Units 5 |
| 33 | Service Adjustment Units 4 |
| 34 | Service Adjustment Reason Code 4 |
| 35 | Place of Service Line Code |
| 36 | HCPCS Line Procedure Billed Code |
| 37 | Bill Detail ID |
| 38 | Bill ID |
| 39 | Bill Selection Date |
| 40 | Service Adjustment Group Code 2 |
| 41 | Days/Units Paid |
| 42 | Total Amount Paid Per Line |
| 43 | HCPCS Line Procedure Paid Code |
| 44 | Service Adjustment Reason Code 1 |
| 45 | Second Diagnosis Pointer |
| 46 | Service Adjustment Amount 5 |
| 47 | Service Adjustment Amount 2 |
| 48 | Service Adjustment Reason Code 2 |
| 49 | First HCPCS Modifier Billed Code |
| 50 | Procedure Description |
| 51 | Fourth HCPCS Modifier Paid Code |
| 52 | Service Adjustment Group Code 5 |
| 53 | Fourth HCPCS Modifier Billed Code |