How can MAOs or other entities determine which diagnosis codes are accepted on the Phase III MAO-004 Report?


The MAO-002 report indicates whether an encounter data record has been “Accepted” or “Rejected.” The Phase III version 3 MAO-004 report includes diagnoses from almost all of the Encounter Data System (EDS) accepted records. The MAO-004 indicates whether the diagnoses are “Allowed” or “Disallowed” depending on whether they pass the CMS filtering logic. To pass the filtering logic, the diagnosis must be submitted on an encounter data record with an acceptable type of bill and/or Current Procedural Terminology (CPT)/ Healthcare Common Procedure Coding System (HCPCS) code, depending on the type of submission.

Source: CMS HPMS Memo with subject “Phase III Version 3 MAO-004 Report Release Date and Announcement Regarding Final Encounter Data Deadlines for Payment Years 2016-17” (December 20, 2017)

Last Updated: 12/20/2017