Medical Necessity Data Files
What is the source of your Medical Necessity data?
CodeMap® is a leading source of Medicare compliance and reimbursement solutions. Our main products are the CodeMap® line of publications, data-files, services and training that enable health care professionals to manage the complex rules and regulations governing the federal Medicare program. CodeMap’s clients include more than 30 diagnostic test manufacturers and over 1500 providers who rely on CodeMap publications, compliance training, data products and advisory services.
CodeMap maintains a comprehensive database of Medical Necessity coding information including frequency edits, effective and ending dates, indications, limitations and contractor notes for every NCD and LCD. All of our NCD information comes directly from CMS program memorandum, transmittals and updates. LCD information contained in our database is derived directly from a combination of the Central Management Services Medicare Coverage Database, Medicare Carrier and Fiscal Intermediary bulletins, LCD advisory meetings, and other contractor directives.
What Medicare Contractors are available?
CodeMap can provide Medical Necessity Data Files for all Medicare Contractors in all states including Fiscal Intermediaries, Medicare Carriers and newly created Medicare Admistrative Contractors (MAC) A and B. Our full list of all covered medicare contactors and their policies is available at
Covered Medicare Contractors
What specialties are available?
In addition to our full policy data sets, CodeMap has defined data subsets applicable to the following specialties:
Radiology, Laboratory, Pathology, Cardiology
What is the standard format and delivery?
Our files are sent to the systems administrator by email. They are simple text files which can be read by any text reader including TextPad, WordPad, and NotePad. They are saved with DOS linefeeds in UTF-8 Unicode text encoding. We can deliver the files on CD or by FTP site if necessary.
Most HIS, EMR, LIS, and CPOE software can work with a comma delimited format:
We pull our data from a SQL database and can create any format necessary for your system. We currently provide over 30 different formats.
What are the standard fields?
Standard fields are CPT and ICD-10 code pairs in the example above. Depending on the system format ordered, additional fields including LCD ID, effective date, modified dates and additional fields are included.
Extended data fields?
More advanced systems can handle active, expired and draft policies, effective date, revision date, ending date, LCD ID, and frequency limitations. CodeMap can provide all of these fields.
One of our newest features is the ability to include a URL to the full policy hosted on our web servers. For example, if an order is entered that does not meet medical necessity requirements, typically a warning pops up to obtain an ABN. Our new field allows the application to call out to an HTTP page request to retrieve the actual full text of the policy.
Having immediate access to the policy is a time-saving and effective method of increasing coder knowledge of medical necessity issues. CodeMap can provide secure hosted web access to every Medicare Policy.
How frequently do you update your data?
CodeMap updates all policies in our database on a continuous basis. In addition to our data file customers who receive updated files on monthly or quarterly schedules, CodeMap hosts web sites for over 15 major diagnostics test manufacturers that rely on CodeMap’s continuously updated database to provide customers with the most up to date Medicare coverage information. Our business depends on accurate and timely updating of all Medicare policies.
What is the professional background of your team that develops the content?
The three principals that manage our Medical Necessity data are:
Charles B. Root, Ph. D.
Dr. Charles Root is Founder and President of CodeMap. He has provided laboratory coding and reimbursement information to healthcare providers and manufacturers for over 18 years regarding compliance, coding and economic issues.
Publications by Dr. Root include: CodeMap Medicare Reimbursement Manual for Laboratory and Pathology, CodeMap Medicare Reimbursement Manual for Radiology and Nuclear Medicine, and the Hospital Laboratory Compliance Kit. Dr. Root is a member of CLMA, and the American Association of Clinical Chemists and has served on their Government Relations Committee. He provides frequent input and comments to CMS on laboratory issues and provides input to the AMA’s Pathology Coding Caucus regarding CPT coding for lab services.
Dr. Root received his Ph.D. in physical chemistry and nuclear physics from the Catholic University of America, Washington, D.C., and has taken postgraduate courses in business management and economics from Harvard and Northwestern Universities. His experience includes market research, product development, and studies on the economic impact of government regulations on healthcare delivery costs. Prior to founding CodeMap LLC, Dr. Root worked as a rocket scientist with the U.S. Navy on missile systems and high-energy materials.
Gregory B. Root, Esq.
Gregory Root has worked as a Healthcare Consultant/Attorney for fourteen years. In that time, he has served as a research analyst, coding auditor, and contributing author. Presently, he concentrates on regulatory and legislative consulting and designing and implementing compliance programs for hospitals and independent laboratories.
In 1999, Gregory Root cofounded CodeMap, LLC, formerly known as Venture Resources. He now serves as Chief Operating Officer. CodeMap, LLC offers a variety of services to hospitals, clinical laboratories, radiologists, and the diagnostic manufacturing industry. CodeMap, LLC provides online compliance training for hospital and laboratory employees, performs consulting services including chargemaster reviews and compliance program audits, and publishes the highly successful CodeMap™ series of coding and compliance manuals.
Gregory Root has extensive experience in CPT coding, laboratory economics, and regulatory and legal compliance. He speaks frequently for many professional organizations including COLA, AACC, POL News, and the CLMA. Mr. Root is also the author of The CodeMap™ Medicare Medical Necessity Guide for Laboratory Procedures and contributing author and editor of the CodeMap Compliance Briefing, a weekly email newsletter distributed to more than 6,000 Laboratory subscribers and more than 6,000 Radiology subscribers.
Gregory Root is a member of the Health Law section of the American Bar
Association, the Chicago Bar Association, and the American Association of Clinical Chemists. He graduated with honors from Southern Methodist University in Dallas, TX, with a bachelor’s degree in chemistry and earned his Juris Doctorate from the School of Law at Loyola University, Chicago. He is licensed to practice law in the state of Illinois.
Jerry Tavolino serves CodeMap as our Chief Information Officer. His 15 + years of technology and management experience serve as the foundation for his leadership of our technology initiatives.
Mr. Tavolino previously served as Manager of Systems Engineering for Vignette, an enterprise software applications vendor, based in Austin, Texas. He joined Vignette in 1997 as one of the company's first systems engineers and helped develop Vignette's Systems Engineering sales force.
Prior to Vignette, Mr. Tavolino served as Database Administrator for the Chicago Public Relations firm of Jasculca Terman & Associates, an independent strategic communications firm specializing in public affairs, event management and creative services.
Mr. Tavolino graduated Magna Cum Laude with a degree in Finance from Loyola University of Chicago.
How long have you been providing Medical Necessity Data Files?
CodeMap began delivering data files in 2001.
How many customers have installed your data?
As of January 2017, CodeMap data files are in use at over 1,000 facilities.
Number of Vendor Interfaces?
CodeMap has developed formatting for and/or has customers using the following systems:
4Medica, CompuGroup, Eclypsis, Fletcher-Flora Systems, Health Computer Systems (HCS), HexLabs, Iatric Systems, IDX-Radiology, ImPac, LabSoft, Inc, McKesson STAR, MedCom, Medicity, MEDITECH, Medisolution, NetLims, Novo Innovations, Orchard, Park City, Psyche Systems, Schuyler House, SeaCoast, Specialty Labs, Sunquest, Sysmex.
Additional Vendors have requested not to be listed.
Absolutely, available upon request.
Absolutely, available upon request.
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