150 North Wacker Drive
Suite 2360
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax

User Information

Create New Account

Lost Password


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule


Physician Fee Schedule


OPPS Fee Schedule


ASC Fee Schedule


APC Codes


DRG Codes


ASP Drug Pricing Files

April 2024
January 2024

CMS Transmittals

CodeMap® Medical Necessity Data Files for Hospitals

CodeMap® Medical Necessity Data Files

CodeMap® provides Medical Necessity Data Files to over 1,000 Hospitals, Medical Centers, Laboratories and Imaging Facilities. 

Each CodeMap® Medical Necessity Data File contains the exact National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs) and Local Coverage Articles (LCAs) that apply to your Medicare contractor, primarily the procedure code to diagnosis code-pairs you need to ensure clean claims and compliance with Medicare's medical necessity requirements.  These files are imported into your existing system and are used to know when an order requires an ABN.  

Files can be ordered for monthly or quarterly delivery by email or ftp.

Laboratory and Radiology data subsets are also available.

Covered Medicare Contractors

CodeMap® Partners

Technical FAQ

Pre-Sales FAQ

Pricing and Ordering Information

Customer Quotes

"CodeMap was more accurate and we are saving over $7,000 a year in license fees. We are extremely satisfied with the product, the service, and the cost-savings we realized as a result of this change." Barbara K.

"I have been very pleased with the level of service offered by Codemap.  I feel that the ease of importing the updates, and the quick response to my many questions regarding specific CPT® codes and limited coverage tests have been very timely and helpful." Brenda L.

"We delayed implementing our (HIS) medical necessity tools for years. Pricing from other vendors made it difficult to justify our ROI. CodeMap made the project feasible again." Curtis N.

"Speedy and efficient with every order.  They have always been accommodating and customer friendly."  -Jeanne K.

"CodeMap has supplied data files for our customers for many years.  The files are accurate and provided on time each quarter.  Customer support and communication has always been excellent especially when handling special needs or requirements.  And of course - the price is the best out there for this "must have" service in the world of medical billing." Susan B.

"Other vendors wanted to know how many beds we had or number of patient encounters just to give us a price. CodeMap was the only vendor we found with pricing online and references that were happy to talk to us."  Tom M.

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.