2009 Cost Center Setup Cross Reference
Exhibit 3, 4, 11, 19, 20, 30, 31A, and 46
Also available as an Excel Spreadsheet
CMS S-3 Line Code |
ICR Exhibit 3 Line Code |
CMS 2552 Center Code |
HCRIS Code |
2009 Description |
ICR Cost Center Code |
Exh. 19 & 20 Column Code |
Sort Order |
Exhibit 46 Charge Code Assign. |
Exh 4, 30 & 31A Code Assign. |
---|---|---|---|---|---|---|---|---|---|
General Service Cost Center Line Assignments (95) | |||||||||
(38) Standard 001-026, 029-030, 033, 040-047, 095 | |||||||||
(57)Variable 027-028, 031-032, 034-039, 048 - 094 | |||||||||
(Program Capabilities 200) | |||||||||
1 | 0100 | Old Capital Related Costs-- Buildings and Fixtures | 001 | 1100 | 1 | ||||
2 | 0200 | Old Capital Related Costs-- Movable Equipment | 002 | 1101 | 2 | ||||
3 | 0300 | New Capital Related Costs-- Buildings and Fixtures | 042 | 1128 | 3 | ||||
4 | 0400 | New Capital Related Costs-- Movable Equipment | 043 | 1129 | 4 | ||||
5 | 0500 | Employee Benefits | 003 | 1102 | 5 | ||||
5.01 | 1080 | Inservice Education | 044 | 1144 | 6 | ||||
5.02 | 0501 | Day Care | 045 | 1142 | 7 | ||||
7 | 0700 | Maintenance and Repairs | 004 | 1100 | 8 | ||||
8 | 0800 | Operation of Plant | 041 | 1100 | 9 | ||||
9 | 0900 | Laundry and Linen Service | 005 | 1103 | 10 | ||||
10 | 1000 | Housekeeping | 006 | 1104 | 11 | ||||
11.01 | 1101 | Dietary--Raw Food | 007 | 1105 | 12 | ||||
11.02 | 1102 | Dietary--Other | 008 | 1106 | 13 | ||||
12 | 1200 | Cafeteria | 009 | 1107 | 14 | ||||
13 | 1300 | Maintenance of Personnel | 010 | 1108 | 15 | ||||
17 | 1700 | Medical Records & Medical Records Library | 011 | 1109 | 16 | ||||
18 | 1800 | Social Service | 012 | 1110 | 17 | ||||
19 | 1501 | Medical Supplies and Expense | 015 | 1113 | 18 | ||||
19.01 | 1500 | Central Services and Supply | 016 | 1114 | 19 | ||||
19.02 | 1600 | Pharmacy | 017 | 1115 | 20 | ||||
19.03 | 1400 | Nursing Administration | 018 | 1120 | 21 | ||||
19.04 | 1950 | Intensive Nursing Care | 019 | 1117 | 22 | ||||
19.05 | 1951 | General Nursing Service | 021 | 1116 | 23 | ||||
19.06 | 1952 | Supervising Physicians-- Other | 040 | 1139 | 24 | ||||
19.07 | 1953 | Transportation | 046 | 1141 | 25 | ||||
19.08 | 1954 | Activities | 047 | 1143 | 26 | ||||
20 | 2000 | Nonphysician Anesthetists | 029 | 1130 | 27 | ||||
21 | 2100 | Nursing School | 020 | 1118 | 28 | ||||
22 | 2200 | Intern & Res. Service-- Salary & Fringes (Appvd) | 013 | 1111 | 29 | ||||
23 | 2300 | Intern & Res. Other Program Costs (Appvd) | 033 | 1131 | 30 | ||||
23.01 | 2301 | Supervising Physicians - Teaching | 014 | 1112 | 31 | ||||
24 | 2400 | Paramedical Ed. Program (Specify) | 030 | 1127 | 32 | ||||
6.01 | 0610 | Nonpatient Telephones | 022 | 1122 | 33 | ||||
6.02 | 0620 | Data Processing | 023 | 1123 | 34 | ||||
6.03 | 0630 | Purchasing Receiving and Stores | 024 | 1124 | 35 | ||||
6.04 | 0640 | Admitting | 025 | 1125 | 36 | ||||
6.05 | 0650 | Cashiering/Accounts Receivable | 026 | 1126 | 37 | ||||
6.06 | 0660 | Other Administrative and General | 095 | 0000 | 38 | ||||
Variable | Variable | Any Additional General Service Cost Centers | 027, 028, 031, 032, 034 to 039, 048 to 094 |
1119, 1132 to 1138, 1200 to 1248 |
|||||
Ancillary Service Cost Center Line Assignments (99) | |||||||||
(66) Standard 100 - 124, 126 - 128, 132 - 158, 187-197 | |||||||||
(33) Variable 125, 129 - 131, 159 - 186 | |||||||||
(Program Capabilities 150 lines for Ancillary and Outpatient Cost Centers) | |||||||||
37 | 3700 | Operating Room | 100 | 1150 | 100 | ||||
38 | 3800 | Recovery Room | 101 | 1179 | 101 | ||||
39 | 3900 | Delivery Room & Labor Room | 103 | 1152 | 102 | ||||
40 | 4000 | Anesthesiology | 102 | 1151 | 103 | ||||
41 | 4100 | Radiology-Diagnostic | 104 | 1153 | 104 | ||||
42 | 4200 | Radiology-Therapeutic | 105 | 1154 | 105 | ||||
43 | 4300 | Radioisotope | 121 | 1167 | 106 | ||||
43.01 | 3230 | CAT Scan | 128 | 1177 | 107 | ||||
44 | 4400 | Laboratory | 106 | 1155 | 108 | ||||
44.01 | 4401 | Bio-Medical (Lab) (Engineering) | 139 | 1192 | 109 | ||||
45 | 4500 | PBP Clinical Lab Srvc-Program Only | 132 | 1185 | 110 | ||||
46 | 4600 | Whole Blood and Packed Red Blood Cells | 114 | 1160 | 111 | ||||
46.30 | 4650 | Blood Clotting Factors Admin Costs | 118 | 1164 | 112 | ||||
47 | 4700 | Blood Storing, Processing & Trans. | 115 | 1168 | 113 | ||||
48 | 4800 | Intravenous Therapy | 117 | 1162 | 114 | ||||
49 | 4900 | Respiratory Therapy | 113 | 1159 | 115 | ||||
50 | 5000 | Physical Therapy | 109 | 1158 | 116 | ||||
51 | 5100 | Occupational Therapy | 110 | 1163 | 117 | ||||
52 | 5200 | Speech Pathology | 111 | 1173 | 118 | ||||
53 | 5300 | Electrocardiology | 107 | 1156 | 119 | ||||
54 | 5400 | Electroencephalography | 108 | 1157 | 120 | ||||
55 | 5500 | Med Supplies Charged to Patients | 122 | 1169 | 121 | ||||
55.30 | 5530 | Implantable Devices Charged to Patients | 197 | 1298 | 122 | ||||
56 | 5600 | Drugs Charged to Patients | 123 | 1170 | 123 | ||||
57 | 5700 | Renal Dialysis | 124 | 1172 | 124 | ||||
58 | 5800 | ASC (Non-Distinct) | 126 | 1184 | 125 | ||||
59 | 3996 | Blank Line - Not Used | 198 | 1299 | 126 | ||||
59.01 | 3040 | Audiology | 112 | 1174 | 127 | ||||
59.02 | 3320 | Shock Therapy | 116 | 1161 | 128 | ||||
59.03 | 3160 | Cardiopulmonary | 119 | 1199 | 129 | ||||
59.04 | 3950 | Cystoscopy | 120 | 1166 | 130 | ||||
59.05 | 3630 | Ultrasound Diagnostic | 127 | 1176 | 131 | ||||
59.06 | 3480 | Oncology | 134 | 1187 | 132 | ||||
59.07 | 3430 | Magnetic Resonance Imaging | 135 | 1188 | 133 | ||||
59.08 | 3440 | Mammography | 136 | 1189 | 134 | ||||
59.09 | 3450 | Nuclear Medicine - Diagnostic | 137 | 1190 | 135 | ||||
59.10 | 3470 | Nuclear Medicine - Therapeutic | 138 | 1191 | 136 | ||||
59.11 | 3240 | Cytology | 140 | 1193 | 137 | ||||
59.12 | 3120 | Cardiac Catherization Laboratory | 141 | 1194 | 138 | ||||
59.13 | 3650 | Vascular Lab | 142 | 1195 | 139 | ||||
59.14 | 3580 | Recreational Therapy | 143 | 1196 | 140 | ||||
59.15 | 3140 | Cardiology | 144 | 1197 | 141 | ||||
59.16 | 3260 | Echocardiography | 145 | 1198 | 142 | ||||
59.17 | 3560 | Pulmonary Function Testing | 146 | 1250 | 143 | ||||
59.18 | 3620 | Stress Test | 147 | 1251 | 144 | ||||
59.19 | 3640 | Urology | 148 | 1252 | 145 | ||||
59.20 | 3330 | Endoscopy | 149 | 1253 | 146 | ||||
59.21 | 3340 | Gastro Intestinal Services | 150 | 1254 | 147 | ||||
59.22 | 3520 | Ophthalmology | 151 | 1255 | 148 | ||||
59.23 | 3550 | Psychiatric/Psychological Services | 152 | 1256 | 149 | ||||
59.24 | 3250 | Dental Services | 153 | 1257 | 150 | ||||
59.25 | 3070 | Birthing Center | 154 | 1258 | 151 | ||||
59.26 | 3951 | Fee For Service - Cardiology | 155 | 1259 | 152 | ||||
59.27 | 3952 | Fee For Service - Emergency Service | 156 | 1260 | 153 | ||||
59.28 | 3953 | Fee For Service - Laboratory | 157 | 1261 | 154 | ||||
59.29 | 3954 | Fee For Service - Radiology | 158 | 1262 | 155 | ||||
59.30 | 3190 | Chemotherapy | 133 | 1186 | 156 | ||||
59.31 | 3955 | Asthma | 196 | 1297 | 157 | ||||
59.97 | 3997 | Cardiac Rehabilitation | 195 | 1296 | 158 | ||||
59.32 | 3956 | Diabetes | 194 | 1295 | 159 | ||||
59.99 | 3999 | Lithotripsy | 193 | 1294 | 160 | ||||
59.33 | 3957 | Nutritional Counseling | 192 | 1293 | 161 | ||||
59.34 | 3958 | Pain Management | 191 | 1292 | 162 | ||||
59.35 | 3959 | PET Scans | 190 | 1291 | 163 | ||||
59.36 | 3960 | Sleep Lab | 189 | 1290 | 164 | ||||
59.37 | 3961 | Wound Care | 188 | 1289 | 165 | ||||
59.98 | 3998 | Hyperbaric Oxygen Therapy | 187 | 1288 | 166 | ||||
Variable | Variable | Any Additional Ancillary Cost Centers | 125, 129 to 131, 159 to 186 |
1165, 1175, 1178, 1180 to 1183, 1263 to 1287 |
|||||
Inpatient Service Cost Center Line Assignments (99) | |||||||||
(40) Standard 201, 204 -209, 214 - 215, 217 - 221, 224 - 229, | |||||||||
268, 301 - 317, 377-378 | |||||||||
(59) Variable 318 - 376 | |||||||||
(Program Capabilities 50) | |||||||||
25 | Adults and Pediatrics (CMS line comb. lines 25) | ||||||||
1.06 | 050 | 25.01 | 2501 | Medical Surgical Inpatients | 201 | 200 | 0195 | 001 | |
1.07 | 054 | 25.02 | 2502 | Pediatric Unit | 214 | 201 | 0094 | 020 | |
1.08 | 055 | 25.03 | 2503 | Maternity Unit | 215 | 202 | 0095 | 030 | |
1.09 | 25.04 | 2504 | Alternate Level of Care | 219 | 203 | 0370 | 043 | ||
1.10 | 053 | 25.05 | 2505 | Epilepsy Unit | 205 | 204 | 0182 | 042 | |
1.17 | 301 | 25.12 | 2506 | Psychiatric | 301 | 205 | 3001 | 301 | |
1.12 | 057 | 25.07 | 2508 | Rehabilitation Medicine | 218 | 206 | 0093 | 41 | |
1.18 | 302 | 25.13 | 2509 | Traumatic Brain Injury/Coma | 302 | 207 | 3002 | 302 | |
1.13 | 060 | 25.08 | 2510 | Tuberculosis | 217 | 208 | 0198 | 45 | |
1.14 | 061 | 25.09 | 2511 | H. I. V. Care | 224 | 209 | 0193 | 47 | |
1.15 | 062 | 25.10 | 2512 | Chemical Dependency - Drug Rehab | 204 | 210 | 0181 | 46 | |
1.19 | 303 | 25.14 | 2513 | Chemical Dependency - Drug Detox | 303 | 211 | 3003 | 303 | |
1.16 | 064 | 25.11 | 2514 | Chemical Dependency - Alcohol Rehab | 220 | 212 | 0190 | 013 | |
1.20 | 059 | 25.15 | 2515 | Chemical Dependency - Alcohol Detox | 221 | 213 | 0371 | 044 | |
1.21 | 304 | 25.16 | 2516 | Bone Marrow Unit | 304 | 214 | 3004 | 304 | |
6 | 002 | 26 | 2600 | Intensive Care Unit | 206 | 215 | 0196 | 002 | |
6.01 | 305 | 26.01 | 2601 | Pediatric ICU | 305 | 216 | 3005 | 305 | |
377 | 26.02 | 2602 | Cardiac ICU | 377 | 217 | 3080 | 377 | ||
7 | 003 | 27 | 2700 | Coronary Care Unit | 207 | 218 | 0197 | 003 | |
8 | 040 | 28 | 2800 | Burn Intensive Care Unit | 208 | 219 | 0183 | 004 | |
9 | 041 | 29 | 2900 | Surgical Intensive Care Unit | 209 | 220 | 0184 | 005 | |
10 | 063 | 30 | 2060 | Neonatal Intensive Care Unit | 229 | 221 | 0194 | 054 | |
10.98 | 310 | Neonatal Intermediate Care | 222 | 310 | |||||
10.99 | 311 | Neonatal Continuing Care | 223 | 311 | |||||
See Below | 30.01 | See HCRIS List | Other Special Care Units (specify) | See Below | See Below | See Below | |||
14 | 009 | 31 | 3100 | Subprovider 1 - Psychiatric | 225 | 224 | 0188 | 055 | |
14.03 | 378 | 31.03 | 3103 | Long Term Psychiatric Unit | 378 | 225 | 3081 | 378 | |
14.01 | 010 | 31.01 | 3101 | Subprovider 2 Rehabilitation | 226 | 226 | 0189 | 056 | |
14.02 | 306 | 31.02 | 3102 | Traumatic Brain Injury/Coma | 306 | 227 | 3006 | 306 | |
11 | 33 | Nursery CMS Only (Comb. Prem. & Newborn) | |||||||
11.01 | 039 | 33.01 | 3301 | Nursery - Premature | 227 | 228 | 0024 | 051 | |
11.02 | 007 | 33.02 | 3302 | Nursery - Newborn | 228 | 229 | 0025 | 052 | |
15 | 34 | Skilled Nursing Facility (Comb. for CMS 2552-96) | |||||||
15.01 | 011 | 34.01 | 3400 | Skilled Nursing Facility 1 (RHCF) | 268 | 230 | 0032 | 053 | |
15.02 | 307 | 34.02 | 3401 | Skilled Nursing Facility 2 (RHCF) | 307 | 231 | 3007 | 307 | |
15.03 | 312 | 34.03 | 3402 | SNF Head Injury | 312 | 232 | 3012 | 312 | |
15.04 | 313 | 34.04 | 3403 | Long Term Ventilator Dependent | 313 | 233 | 3015 | 313 | |
15.05 | 314 | 34.05 | 3404 | Behavioral Intervention | 314 | 234 | 3016 | 314 | |
15.06 | 315 | 34.06 | 3405 | Specialty Pediatric SNF | 315 | 235 | 3017 | 315 | |
15.07 | 316 | 34.07 | 3406 | Aids SNF | 316 | 236 | 3018 | 316 | |
15.08 | 317 | 34.08 | 3407 | Transitional Care Unit | 317 | 237 | 3019 | 317 | |
17 | 36 | Other Long Term Care (Combined for CMS 2552-96) | |||||||
17.01 | 308 | 36.01 | 3601 | Other Long Term Care 1 | 308 | 238 | 3008 | 308 | |
17.02 | 309 | 36.02 | 3602 | Other Long Term Care 2 | 309 | 239 | 3009 | 309 | |
Variable | 318-377 | Variable | Variable | Any Additional Inpatient Component | 318-376 | 3021-3079 | 318-376 | ||
Outpatient Service Cost Center Line Assignment (98) | |||||||||
(51) Standard 216, 235 - 237, 239, 240, 246 - 249, 253, 254, | |||||||||
260, 261, 263, 288 - 291, 401 - 426, 474-480 | |||||||||
(47) Variable 427 - 473 | |||||||||
(Program Capabilities for all Ancillary and Outpatient Cost Centers is 150 possible lines) | |||||||||
60 | 6000 | Clinic | 235 | 300 | 0026 | ||||
60.04 | 6001 | Alcohol Clinic | 291 | 301 | 0387 | ||||
60.15 | 6002 | Alcohol Day Rehab Clinic | 401 | 302 | 4830 | ||||
60.16 | 6003 | Chemotherapy Clinic | 402 | 303 | 4831 | ||||
60.17 | 6004 | Day Hospital | 403 | 304 | 4832 | ||||
60.18 | 6005 | Early Intervention | 404 | 305 | 4833 | ||||
60.19 | 6006 | Family Clinic | 405 | 306 | 4834 | ||||
60.20 | 6007 | Family Planning | 406 | 307 | 4835 | ||||
60.21 | 6008 | Head Injury Clinic | 407 | 308 | 4836 | ||||
60.05 | 6009 | H. I. V. Clinics | 263 | 309 | 0388 | ||||
60.22 | 6010 | Hyperbaric Clinic | 408 | 310 | 4837 | ||||
60.23 | 6011 | Intravenous Gamma Gobulin Pediatric Clinic - Discontinue beg 1/1/2009 | 409 | 311 | 4838 | ||||
60.24 | 6012 | Oncology Clinic | 410 | 312 | 4839 | ||||
60.25 | 6013 | Pediatric Clinic | 411 | 313 | 4840 | ||||
60.26 | 6014 | Rehabilitation Clinic | 412 | 314 | 4841 | ||||
60.27 | 6015 | Spina Bifada Clinic-Discontinue for reports beginning 1/1/09 and after | 413 | 315 | 4842 | ||||
60.39 | 6039 | Cardiac Rehabilitation Clinic | 480 | 345 | 4909 | ||||
60.40 | 6040 | Dental Clinic | 479 | 346 | 4908 | ||||
60.41 | 6041 | Diabetes Clinic | 478 | 347 | 4907 | ||||
60.42 | 6042 | PCAP Clinic | 477 | 348 | 4906 | ||||
60.43 | 6043 | Sleep Clinic | 476 | 349 | 4905 | ||||
60.44 | 6044 | Wound Care Clinic | 475 | 350 | 4904 | ||||
60.07 | 6016 | Mental Health Clinic | 289 | 316 | 0386 | ||||
60.08 | 6017 | Blank Line - Not Used | 290 | 317 | 380 | ||||
60.09 | 6018 | Mental Health Continuing Day Treatment | 249 | 318 | 0108 | ||||
60.06 | 6019 | Mental Health Day Treatment | 246 | 319 | 0033 | ||||
60.10 | 6020 | Mental Health Intensive Psychiatric Rehab. Outpatient | 253 | 320 | 0111 | ||||
60.11 | 6021 | Mental Health Partial Hosp. | 254 | 321 | 0112 | ||||
60.12 | 6022 | All Other OMH Programs O/P | 247 | 322 | 0106 | ||||
60.13 | 6023 | All Other OASAS Programs O/P | 248 | 323 | 0107 | ||||
60.32 | 6032 | Mental Health Outpatient ACT Programs | 420 | 324 | 4849 | ||||
60.33 | 6033 | Mental Health Outpatient ICM Programs | 421 | 325 | 4850 | ||||
60.34 | 6034 | Mental Health Outpatient SCM Programs | 422 | 326 | 4851 | ||||
60.35 | 6035 | Comprehensive PROS with Clinic | 423 | 327 | 4852 | ||||
60.36 | 6036 | Comprehensive PROS | 424 | 328 | 4853 | ||||
60.37 | 6037 | Limited License PROS | 425 | 329 | 4854 | ||||
60.38 | 6038 | PROS Rehabilitation and Support | 426 | 330 | 4855 | ||||
60.28 | 6024 | Adult Day Care 1 | 414 | 331 | 4843 | ||||
60.31 | 6031 | Adult Day Care 2 | 419 | 332 | 4848 | ||||
60.02 | 6025 | Ambulatory Surgical Service | 239 | 333 | 0034 | ||||
60.14 | 6026 | Referred Ambulatory Service | 237 | 334 | 0028 | ||||
60.01 | 6027 | Renal Dialysis | 240 | 335 | 0383 | ||||
60.29 | 6028 | Methadone Maintenance Treatment Program | 262 | 336 | 0119 | ||||
60.30 | 6029 | Birthing Center-Discontinue for reports beginning 1/1/09 and after | 415 | 337 | 4844 | ||||
60.03 | 6030 | Women and Infant Children Program (WIC) | 418 | 338 | 4847 | ||||
61 | 6100 | Emergency Service | 236 | 339 | 0027 | ||||
61.01 | 6101 | CPEP | 288 | 340 | 0385 | ||||
61.02 | 6102 | Poison Control | 416 | 341 | 4845 | ||||
26 | 024 | 62 | 6200 | Observation Beds (Non-Distinct Part) | 260 | 342 | 0030 | ||
62.01 | 6201 | Observation Beds (Distinct Part) | 417 | 343 | 4846 | ||||
62.02 | 6202 | CPEP Observation Beds (Psychiatric) | 216 | 344 | 0096 | ||||
63 | See HCRIS List | Other Outpatient Cost Centers | 427-473 | 4856-4902 | |||||
63.60 | 6320 | Federally Qualified Health Center (FQHC) | 474 | 351 | 4903 | ||||
13 | 482 | Not Applic. | Not Applic. | RPCH | Not Applic. | Not Applic. | |||
Other Reimbursable Cost Center Line Assignments (50) | |||||||||
(18) Standard 230 - 232, 234, 238, 243, 250, 255, 257, 259, 280 - 283, 501 - 504 | |||||||||
(32) Variable 505 - 536 | |||||||||
(Program Capabilities of 98 total lines for Other, Special Purpose and Non-reimbursable) | |||||||||
64 | 6400 | Home Program Dialysis | 250 | 400 | 0020 | ||||
65 | 6500 | Ambulance Services | 234 | 401 | 0031 | ||||
66 | 6600 | Durable Medical Equip-Rented | 280 | 402 | 0133 | ||||
67 | 6700 | Durable Medical Equip-Sold | 257 | 403 | 0115 | ||||
68 | See HCRIS List | Other Reimbursable (specify) | See Below | See Below | |||||
19 | 015 | 69 | 6900 | CORF | 259 | 404 | 0117 | ||
22 | 501 | 69.10 | 6910 | CMHC | 501 | 405 | 4912 | ||
23 | 502 | 69.20 | 6920 | OPT | 502 | 406 | 4913 | ||
23.01 | 503 | 69.30 | 6930 | OOT | 503 | 407 | 4914 | ||
23.02 | 504 | 69.40 | 6940 | OSP | 504 | 408 | 4915 | ||
70 | 7000 | I&R Services -Non Apprvd Prgm | 243 | 409 | 0103 | ||||
18 | 014 | 71 | 7100 | Home Health Agency (CMS 2552 Only) | |||||
72 | 7200 | HHA - Administrative & General | 255 | 410 | 0113 | ||||
73 | 7300 | HHA - Skilled Nursing Care | 230 | 411 | 0381 | ||||
74 | 7400 | HHA - Physical Therapy | 281 | 412 | 0134 | ||||
75 | 7500 | HHA - Occupational Therapy | 282 | 413 | 0135 | ||||
76 | 7600 | HHA - Speech Pathology | 283 | 414 | 0136 | ||||
77 | 7700 | HHA - Medical Social Services | 231 | 415 | 0382 | ||||
78 | 7800 | Home Health Aide | 238 | 416 | 0029 | ||||
79 | 7900 | Other HHA Services | 232 | 417 | 0021 | ||||
Variable | Variable | Additional Other Reimbursable Cost Centers | 505-536 | 3212-3236, 4916-4922 |
|||||
Special Purpose Cost Center Line Assignments (50) | |||||||||
(14) Standard 241, 244, 245, 275, | |||||||||
285 - 287, 292, 293, 601 - 605 | |||||||||
(36) Variable 606 to 641 | |||||||||
(Program Capabilities - See Other Reimbursable) | |||||||||
82 | 8200 | Lung Acquisition | 602 | 500 | 3302 | ||||
83 | 8300 | Kidney Acquisition | 241 | 501 | 0101 | ||||
84 | 8400 | Liver Acquisition | 285 | 502 | 0138 | ||||
85 | 8500 | Heart Acquisition | 292 | 503 | 0392 | ||||
85.01 | 8510 | Pancreas Acquisition | 603 | 504 | 3303 | ||||
85.02 | 8520 | Intestinal Acquisition | 604 | 505 | 3304 | ||||
85.03 | 8530 | Islet Cell Acquisition | 605 | 506 | 3305 | ||||
86 | 8600 | Other Organ Acquisition (specify) | 286 | 507 | 0390 | ||||
88 | 8800 | Interest Expense | 244 | 508 | |||||
89 | 8900 | Utilization Review -RHCF | 245 | 509 | |||||
90 | 9000 | Other Capital Related Costs | 293 | 510 | |||||
20 | 92 | 9200 | Ambulatory Surgical Center (Distinct Part) | 275 | 511 | 0128 | |||
21 | 017 | 93 | 9300 | Hospice Inpatient | 287 | 512 | 0391 | ||
21.05 | 601 | 94 | 6950 | Hospice -Home Care | 601 | 513 | 3301 | ||
94.01 | Variable | Additional Special Purpose Cost Centers | 606-641 | 3306-3341 | |||||
Non Reimbursable Cost Center Line Assignments (25) | |||||||||
(6) Standard 269 - 271, 273, 274, 651 | |||||||||
(19) Variable 652 - 670 | |||||||||
(Program Capabilities - See Outpatient) | |||||||||
96 | 9600 | Gift, Flower, Coffee Shop, Canteen | 269 | 600 | |||||
97 | 9700 | Research | 270 | 601 | |||||
98 | 9800 | Physicians Private Offices | 273 | 602 | 0126 | ||||
99 | 9900 | Non - Paid Workers | 274 | 603 | |||||
100 | 7950 | Appeal For Funds | 271 | 604 | |||||
100.01 | 7951 | All Other Non- Reimbursable Expenses | 651 | 605 | 3351 | ||||
Variable | Additional Non Reimbursable Cost Centers | 652-670 | 3352-3370 | ||||||
101 | TOTAL Expenses Worksheet A-All Services | 960 | |||||||
101 | TOTAL Expenses Worksheet A-All Services | n/a | 36 | ||||||
Totals | TOTAL Charges All Other Services | n/a | 124 | ||||||
Totals | TOTAL Charges Inpatient Service (Exh.1 Part 2) | n/a | 23 | ||||||
Totals | TOTAL Charges Outpatient Clinic | n/a | 123 | ||||||
Totals | TOTAL Charges Amb. Surg., Renal Dial., Emergency | n/a | 122 | ||||||
Totals | TOTAL Charges All Home Health Services | n/a | 125 |