









| Field | Description | Required | Notes |
|---|---|---|---|
| A | Database | If not specified, the Database the User is logged in to when Uploading the file will be inserted. Records for multiple Databases can be included in a single file. | |
| B | User Code | If not specified, inserts the User Code for the current User performing the Upload. | |
| C | Patient Account # | Y | Must be a registered Patient Account Number within CGM webPRACTICE. |
| D | Accounting Date | Reserved field — leave blank. The current date will be inserted. | |
| E | Service Date | Y | MM-DD-YYYY or MMDDYYYY or MM/DD/YYYY. If the date provided is more than 90 days old, a warning will be provided after the file integrity has been checked. |
| F | Location | See note (a). | |
| G | Procedure Code | Y | See note (a). |
| H | Modifiers 1 & 2 | #### (two to four numeric characters only). | |
| I | Modifiers 3 & 4 | #### (two to four numeric characters only). | |
| J | Multiplier | # (one numeric character only). | |
| K | Charge Amount | See note (b). | |
| L | Procedure Description | If not specified, inserts the Short Description from the Procedure Code Table. | |
| M | Performing Doctor | Y | See note (a). |
| N | Referring Doctor | See note (a). | |
| O | Insurance Doctor | See note (a). | |
| P | ICD-10 Code 1 | Y | See note (a). |
| Q | ICD-10 Code 2 | ||
| R | ICD-10 Code 3 | ||
| S | ICD-10 Code 4 | ||
| T | ICD-10 Code 5 | ||
| U | ICD-10 Code 6 | ||
| V | ICD-10 Code 7 | ||
| W | ICD-10 Code 8 | ||
| X | Date of Onset | MM-DD-YYYY or MMDDYYYY or MM/DD/YYYY. | |
| Y | Superbill Number | If included and it is not a defined superbill number in CGM webPRACTICE, a warning will be provided after the file integrity has been checked. | |
| Z | Accept Assignment | Y, N, or leave blank. If left blank, the value will be set based on the current Accept Assignment Protocols in CGM webPRACTICE. | |
| AA | Department Code |