You should use the Claim Pricing Code table when you adjudicate the entire claim based on a characteristic, regardless of individual charges.

• A. True
• B. It depends
• C. False
• D. Not sure

Answer: (A)

When a claim is being priced based on a single characteristic that applies to the whole submission, you rely on a centralized pricing source that standardizes payment for that characteristic. The Claim Pricing Code table is designed for this purpose. It assigns a pricing code to that characteristic and provides the allowed amount or pricing rule that should be applied to the entire claim. By adjudicating the whole claim through this lens, you apply the same price to all eligible portions that share that characteristic, regardless of the individual line-item charges. This ensures consistency with payer contracts and prevents variability caused by pricing each line item separately. Therefore, this statement is true.