California Cancer Reporting System Standards Volume I: Abstracting and Coding Procedures for Hospitals
These data items have been added for hospital-based registrars to collect payment information on their cancer patients at the time of diagnosis. It consists of three fields, one for recording the primary source of payment, one for recording the secondary source of payment, and a 40-character alphanumeric field for collecting the specific name of the payment source, i.e., Foundation Health Plan, Blue Shield, etc.
The primary payment source and text fields are required and may not be left blank. Record the primary payer from the information available at diagnosis. When the primary payer at diagnosis is unknown, record the information available during the initial treatment period.
Enter the secondary payment source if it is available in the medical record.
The CCR has adopted the codes and definitions used by the American College of Surgeons. The codes are the same for both fields and are as follows:
Code |
Label |
Definition |
01 |
NOT INSURED |
Patient has no insurance and is declared a charity write-off. |
02 |
NOT INSURED, SELF PAY |
Patient has no insurance and is declared responsible for charges. |
10 |
INSURANCE, NOS |
Type of insurance unknown or other than the types listed in codes 20, 21, 31, 35, 60–68. |
20 |
PRIVATE INSURANCE: MANAGED CARE, HMO, OR PPO |
An organized system of prepaid care for a group of enrollees usually within a defined geographic area. Generally formed as one of four types: a group model, an independent physician association (IPA), a network, or a staff model. “Gate-keeper model” is another term for describing this type of insurance. |
21 |
PRIVATE INSURANCE: FEE-FOR SERVICE |
An insurance plan that does not have a negotiated fee structure with the participating hospital. Type of insurance plan not coded as 20. |
28 |
HMO |
California specific code |
29 |
PPO |
California specific code |
31 |
MEDICAID |
State government administered insurance for persons who are uninsured, below the poverty level, or covered under entitlement programs. Medicaid other than described in code 35. Medicaid other than described in code 35. |
35 |
MEDICAID ADMINISTERED THROUGH A MANAGED CARE PLAN |
Patient is enrolled in Medicaid through a Managed Care program (for example, HMO or PPO). The Managed Care plan pays for all incurred costs. |
60 |
MEDICARE WITHOUT SUPPLEMENT, MEDICARE, NOS |
Federal government funded insurance for persons who are 62 years of age or older, or are chronically disabled (Social Security insurance eligible). Not described in codes 61, 62, or 63. |
61 |
MEDICARE WITH SUPPLEMENT, NOS |
Patient has Medicare and another type of unspecified insurance to pay costs not covered by Medicare. |
62 |
MEDICARE - ADMINISTERED THROUGH A MANAGED CARE PLAN |
Patient is enrolled in Medicare through a Managed Care plan (for example, HMO or PPO). The Managed Care plan pays for all incurred costs |
63 |
MEDICARE WITH PRIVATE SUPPLEMENT |
Patient has Medicare and private insurance to pay costs not covered by Medicare. |
64 |
MEDICARE WITH MEDICAID ELIGIBILITY |
Federal government Medicare insurance with State Medicaid administered supplement. |
65 |
TRICARE |
Department of Defense program providing supplementary civilian-sector hospital and medical services beyond a military treatment facility to military dependents, retirees, and their dependents. Formally CHAMPUS (Civilian Health and Medical Program of the Uniformed Services). |
66 |
MILITARY |
Military personnel or their dependents who are treated at a military facility. |
67 |
VETERANS AFFAIRS |
Veterans who are treated in Veterans Affairs facilities. |
68 |
INDIAN/PUBLIC HEALTH SERVICES |
Patient who receives care at an Indian Health Service facility or at another facility, and the medical costs are reimbursed by the Indian Health Service. Patient receives care at a Public Health Service facility or at another facility, and medical costs are reimbursed by the Public Health Service. |
89 |
COUNTY FUNDED, NOS |
California specific code |
99 |
INSURANCE STATUS UNKNOWN |
It is unknown from the patient’s medical record whether or not the patient is insured. |
Note: Codes 28-HMO, 29-PPO and 89-County Funded, NOS are California specific codes. Effective with 2004 cases, codes 28-HMO and 29-PPO are converted to code 20-Managed Care, for submission to standard setting agencies. Effective with 2006 cases, code 89-County Funded, NOS, is converted to code 31-Medicaid for submission to standard setting agencies.