Health Care Claim Status Codes convey the status of an entire claim or a specific service line.

00   Cannot provide further status electronically.  Start: 01/01/1995
01   For more detailed information, see remittance advice.  Start: 01/01/1995
02   More detailed information in letter.  Start: 01/01/1995
03   Claim has been adjudicated and is awaiting payment cycle.  Start: 01/01/1995
04   This is a subsequent request for information from the original request.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
05   This is a final request for information.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
06   Balance due from the subscriber.  Start: 01/01/1995
07   Claim may be reconsidered at a future date.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
08   No payment due to contract/plan provisions.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
09   No payment will be made for this claim.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
10   All originally submitted procedure codes have been combined.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
11   Some originally submitted procedure codes have been combined.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
12   One or more originally submitted procedure codes have been combined.  Start: 01/01/1995 | Last Modified: 06/30/2001
13   All originally submitted procedure codes have been modified.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
14   Some all originally submitted procedure codes have been modified.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
15   One or more originally submitted procedure code have been modified.  Start: 01/01/1995 | Last Modified: 06/30/2001
16   Claim/encounter has been forwarded to entity. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
17   Claim/encounter has been forwarded by third party entity to entity. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
18   Entity received claim/encounter, but returned invalid status. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
19   Entity acknowledges receipt of claim/encounter. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
20   Accepted for processing.  Start: 01/01/1995 | Last Modified: 06/30/2001
21   Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information.  Start: 01/01/1995 | Last Modified: 07/09/2007
22   … before entering the adjudication system.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
23   Returned to Entity. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
24   Entity not approved as an electronic submitter. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
25   Entity not approved. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
26   Entity not found. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
27   Policy canceled.  Start: 01/01/1995 | Last Modified: 06/30/2001
28   Claim submitted to wrong payer.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
29   Subscriber and policy number/contract number mismatched.  Start: 01/01/1995
30   Subscriber and subscriber id mismatched.  Start: 01/01/1995
31   Subscriber and policyholder name mismatched.  Start: 01/01/1995
32   Subscriber and policy number/contract number not found.  Start: 01/01/1995
33   Subscriber and subscriber id not found.  Start: 01/01/1995
34   Subscriber and policyholder name not found.  Start: 01/01/1995
35   Claim/encounter not found.   Start: 01/01/1995
37   Predetermination is on file, awaiting completion of services.  Start: 01/01/1995
38   Awaiting next periodic adjudication cycle.  Start: 01/01/1995
39   Charges for pregnancy deferred until delivery.  Start: 01/01/1995
40   Waiting for final approval.  Start: 01/01/1995
41   Special handling required at payer site.  Start: 01/01/1995
42   Awaiting related charges.  Start: 01/01/1995
44   Charges pending provider audit.  Start: 01/01/1995
45   Awaiting benefit determination.  Start: 01/01/1995
46   Internal review/audit.  Start: 01/01/1995
47   Internal review/audit – partial payment made.  Start: 01/01/1995
48   Referral/authorization.  Start: 01/01/1995 | Last Modified: 02/28/2001 | Stop: 01/01/2012  Notes: Refer to codes 252 and 761.
49   Pending provider accreditation review.  Start: 01/01/1995
50   Claim waiting for internal provider verification.  Start: 01/01/1995
51   Investigating occupational illness/accident.  Start: 01/01/1995
52   Investigating existence of other insurance coverage.  Start: 01/01/1995
53   Claim being researched for Insured ID/Group Policy Number error.  Start: 01/01/1995
54   Duplicate of a previously processed claim/line.  Start: 01/01/1995
55   Claim assigned to an approver/analyst.  Start: 01/01/1995
56   Awaiting eligibility determination.  Start: 01/01/1995
57   Pending COBRA information requested.  Start: 01/01/1995
59   Information was requested by a non-electronic method. Note: At least one other status code is required to identify the requested information.  Start: 01/01/1995 | Last Modified: 10/17/2010
60   Information was requested by an electronic method. Note: At least one other status code is required to identify the requested information.  Start: 01/01/1995 | Last Modified: 10/17/2010
61   Eligibility for extended benefits.  Start: 01/01/1995
64   Re-pricing information.  Start: 01/01/1995
65   Claim/line has been paid.  Start: 01/01/1995
66   Payment reflects usual and customary charges.  Start: 01/01/1995
67   Payment made in full.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
68   Partial payment made for this claim.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
69   Payment reflects plan provisions.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
70   Payment reflects contract provisions.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
71   Periodic installment released.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
72   Claim contains split payment.  Start: 01/01/1995
73   Payment made to entity, assignment of benefits not on file. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
78   Duplicate of an existing claim/line, awaiting processing.  Start: 01/01/1995
81   Contract/plan does not cover pre-existing conditions.  Start: 01/01/1995
83   No coverage for newborns.  Start: 01/01/1995
84   Service not authorized.  Start: 01/01/1995
85   Entity not primary. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
86   Diagnosis and patient gender mismatch.  Start: 01/01/1995 | Last Modified: 02/28/2000
87   Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
88   Entity not eligible for benefits for submitted dates of service. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
89   Entity not eligible for dental benefits for submitted dates of service. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
90   Entity not eligible for medical benefits for submitted dates of service. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
91   Entity not eligible/not approved for dates of service. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
92   Entity does not meet dependent or student qualification. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
93   Entity is not selected primary care provider. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
94   Entity not referred by selected primary care provider. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
95   Requested additional information not received.  Start: 01/01/1995 | Last Modified: 07/09/2007  Notes: If known, the payer must report a second claim status code identifying the requested information.
96   No agreement with entity. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
97   Patient eligibility not found with entity. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
98   Charges applied to deductible.  Start: 01/01/1995
99   Pre-treatment review.  Start: 01/01/1995
100  Pre-certification penalty taken.  Start: 01/01/1995
101  Claim was processed as adjustment to previous claim.  Start: 01/01/1995
102  Newborn’s charges processed on mother’s claim.  Start: 01/01/1995
103  Claim combined with other claim(s).  Start: 01/01/1995
104  Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient)  Start: 01/01/1995 | Last Modified: 06/01/2008
105  Claim/line is capitated.  Start: 01/01/1995
106  This amount is not entity’s responsibility. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010 
107  Processed according to contract provisions (Contract refers to provisions that exist between t  he Health Plan and a Provider of Health Care Services)  Start: 01/01/1995 | Last Modified: 06/01/2008
108  Coverage has been canceled for this entity. (Use code 27)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
109  Entity not eligible. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
110  Claim requires pricing information.  Start: 01/01/1995
111  At the policyholder’s request these claims cannot be submitted electronically.  Start: 01/01/1995
112  Policyholder processes their own claims.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
113  Cannot process individual insurance policy claims.  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
114  Claim/service should be processed by entity. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
115  Cannot process HMO claims  Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008  
116  Claim submitted to incorrect payer.  Start: 01/01/1995  
117  Claim requires signature-on-file indicator.  Start: 01/01/1995
118  TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
119  TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
120  TPO rejected claim/line because claim does not contain enough information. (Use status code 21)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
121  Service line number greater than maximum allowable for payer.  Start: 01/01/1995
122  Missing/invalid data prevents payer from processing claim. (Use CSC Code 21)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
123  Additional information requested from entity. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
124  Entity’s name, address, phone and id number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
125  Entity’s name. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
126  Entity’s address. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
127  Entity’s Communication Number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 06/06/2010
128  Entity’s tax id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
129  Entity’s Blue Cross provider id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
130  Entity’s Blue Shield provider id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
131  Entity’s Medicare provider id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
132  Entity’s Medicaid provider id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
133  Entity’s UPIN. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
134  Entity’s CHAMPUS provider id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
135  Entity’s commercial provider id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
136  Entity’s health industry id number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
137  Entity’s plan network id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
138  Entity’s site id . Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
139  Entity’s health maintenance provider id (HMO). Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
140  Entity’s preferred provider organization id (PPO). Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
141  Entity’s administrative services organization id (ASO). Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
142  Entity’s license/certification number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
143  Entity’s state license number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
144  Entity’s specialty license number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
145  Entity’s specialty/taxonomy code. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
146  Entity’s anesthesia license number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
147  Entity’s qualification degree/designation (e.g. RN,PhD,MD). Note: This code requires use of an Entity Code.  Start: 02/28/1997 | Last Modified: 02/11/2010
148  Entity’s social security number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010  
149  Entity’s employer id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
150  Entity’s drug enforcement agency (DEA) number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
152  Pharmacy processor number.  Start: 01/01/1995
153  Entity’s id number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
154  Relationship of surgeon & assistant surgeon.  Start: 01/01/1995
155  Entity’s relationship to patient. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
156  Patient relationship to subscriber  Start: 01/01/1995
157  Entity’s Gender. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
158  Entity’s date of birth. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
159  Entity’s date of death. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
160  Entity’s marital status. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
161  Entity’s employment status. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
162  Entity’s health insurance claim number (HICN). Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
163  Entity’s policy number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
164  Entity’s contract/member number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
165  Entity’s employer name, address and phone. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
166  Entity’s employer name. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
167  Entity’s employer address. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
168  Entity’s employer phone number. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
169  Entity’s employer id.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
170  Entity’s employee id. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
171  Other insurance coverage information (health, liability, auto, etc.).  Start: 01/01/1995
172  Other employer name, address and telephone number.  Start: 01/01/1995
173  Entity’s name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
174  Entity’s student status. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
175  Entity’s school name. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
176  Entity’s school address. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
177  Transplant recipient’s name, date of birth, gender, relationship to insured.  Start: 01/01/1995 | Last Modified: 02/28/2000
178  Submitted charges.  Start: 01/01/1995
179  Outside lab charges.  Start: 01/01/1995
180  Hospital s semi-private room rate.  Start: 01/01/1995
181  Hospital s room rate.  Start: 01/01/1995
182  Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code.  Start: 01/01/1995 | Last Modified: 01/24/2010
183  Amount entity has paid. Note: This code requires use of an Entity Code.  Start: 01/01/1995 | Last Modified: 02/11/2010
184  Purchase price for the rented durable medical equipment.  Start: 01/01/1995
185  Rental price for durable medical equipment.  Start: 01/01/1995
186  Purchase and rental price of durable medical equipment.  Start: 01/01/1995
187  Date(s) of service.  Start: 01/01/1995
188  Statement from-through dates.  Start: 01/01/1995
189  Facility admission date  Start: 01/01/1995 | Last Modified: 10/31/2006
190  Facility discharge date  Start: 01/01/1995 | Last Modified: 10/31/2006
191  Date of Last Menstrual Period (LMP)  Start: 02/28/1997
192  Date of first service for current series/symptom/illness.  Start: 01/01/1995
193  First consultation/evaluation date.  Start: 02/28/1997
194  Confinement dates.  Start: 01/01/1995
195  Unable to work dates/Disability Dates.  Start: 01/01/1995 | Last Modified: 09/20/2009
196  Return to work dates.  Start: 01/01/1995
197  Effective coverage date(s).  Start: 01/01/1995
198  Medicare effective date.  Start: 01/01/1995
199  Date of conception and expected date of delivery.  Start: 01/01/1995
200  Date of equipment return.  Start: 01/01/1995
201  Date of dental appliance prior placement.  Start: 01/01/1995
202  Date of dental prior replacement/reason for replacement.  Start: 01/01/1995
203  Date of dental appliance placed.  Start: 01/01/1995
204  Date dental canal(s) opened and date service completed.  Start: 01/01/1995
205  Date(s) dental root canal therapy previously performed.  Start: 01/01/1995
206  Most recent date of curettage, root planing, or periodontal surgery.  Start: 01/01/1995
207  Dental impression and seating date.  Start: 01/01/1995
208  Most recent date pacemaker was implanted.  Start: 01/01/1995
209  Most recent pacemaker battery change date.  Start: 01/01/1995
210  Date of the last x-ray.  Start: 01/01/1995
211  Date(s) of dialysis training provided to patient.  Start: 01/01/1995
212  Date of last routine dialysis.  Start: 01/01/1995
213  Date of first routine dialysis.  Start: 01/01/1995
214  Original date of prescription/orders/referral.  Start: 02/28/1997
215  Date of tooth extraction/evolution.  Start: 01/01/1995
216  Drug information.  Start: 01/01/1995
217  Drug name, strength and dosage form.  Start: 01/01/1995
218  NDC number.  Start: 01/01/1995
219  Prescription number.  Start: 01/01/1995
220  Drug product id number. (Use code 218)  Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
221  Drug days supply and dosage.  Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
222  Drug dispensing units and average wholesale price (AWP).  Start: 01/01/1995
223  Route of drug/myelogram administration.  Start: 01/01/1995
224  Anatomical location for joint injection.  Start: 01/01/1995
225  Anatomical location.  Start: 01/01/1995
226  Joint injection site.  Start: 01/01/1995
227  Hospital information.  Start: 01/01/1995
228  Type of bill for UB claim  Start: 01/01/1995 | Last Modified: 10/31/2006
229  Hospital admission source.  Start: 01/01/1995
230  Hospital admission hour.  Start: 01/01/1995
231  Hospital admission type.  Start: 01/01/1995
232  Admitting diagnosis.  Start: 01/01/1995
233  Hospital discharge hour  Start: 01/01/1995
234  Patient discharge status.  Start: 01/01/1995
235  Units of blood furnished.  Start: 01/01/1995
236  Units of blood replaced.  Start: 01/01/1995
237  Units of deductible blood.  Start: 01/01/1995
238  Separate claim for mother/baby charges.  Start: 01/01/1995
239  Dental information.  Start: 01/01/1995
240  Tooth surface(s) involved.  Start: 01/01/1995
241  List of all missing teeth (upper and lower).  Start: 01/01/1995
242  Tooth numbers, surfaces, and/or quadrants involved.  Start: 01/01/1995
243  Months of dental treatment remaining.  Start: 01/01/1995
244  Tooth number or letter.  Start: 01/01/1995
245  Dental quadrant/arch.  Start: 01/01/1995
246  Total orthodontic service fee, initial appliance fee, monthly fee, length of service.  Start: 01/01/1995
247  Line information.  Start: 01/01/1995
248  Accident date, state, description and cause.  Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
249  Place of service.  Start: 01/01/1995
250  Type of service.  Start: 01/01/1995
251  Total anesthesia minutes.  Start: 01/01/1995
252  Authorization/certification number. This change effective 11/1/2011: Entity’s authorization/certification number. Note: This code requires the use of an Entity Code.  Start: 01/01/1995 | Last Modified: 01/30/2011
253  Procedure/revenue code for service(s) rendered. Use codes 454 or 455.  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
254  Primary diagnosis code. This change effective 11/1/2011: Principal doagnosis code.  Start: 01/01/1995 | Last Modified: 01/30/2011
255  Diagnosis code.  Start: 01/01/1995
256  DRG code(s).  Start: 01/01/1995
257  ADSM-III-R code for services rendered.  Start: 01/01/1995
258  Days/units for procedure/revenue code.  Start: 01/01/1995
259  Frequency of service.  Start: 01/01/1995
260  Length of medical necessity, including begin date.  Start: 02/28/1997
261  Obesity measurements.  Start: 01/01/1995
262  Type of surgery/service for which anesthesia was administered.  Start: 01/01/1995
263  Length of time for services rendered.  Start: 01/01/1995
264  Number of liters/minute & total hours/day for respiratory support.  Start: 01/01/1995
265  Number of lesions excised.  Start: 01/01/1995
266  Facility point of origin and destination – ambulance.  Start: 01/01/1995
267  Number of miles patient was transported.  Start: 01/01/1995
268  Location of durable medical equipment use.  Start: 01/01/1995
269  Length/size of laceration/tumor.  Start: 01/01/1995
270  Subluxation location.  Start: 01/01/1995
271  Number of spine segments.  Start: 01/01/1995
272  Oxygen contents for oxygen system rental.  Start: 01/01/1995
273  Weight.  Start: 01/01/1995
274  Height.  Start: 01/01/1995
275  Claim.  Start: 01/01/1995
276  UB04/HCFA-1450/1500 claim form  Start: 01/01/1995 | Last Modified: 10/31/2006
277  Paper claim.  Start: 01/01/1995
278  Signed claim form.  Start: 01/01/1995 | Stop: 11/01/2011
279  Claim/service must be itemized  Start: 01/01/1995 | Last Modified: 10/17/2010
280  Itemized claim by provider.  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 279
281  Related confinement claim.  Start: 01/01/1995
282  Copy of prescription.  Start: 01/01/1995
283  Medicare entitlement information is required to determine primary coverage  Start: 01/01/1995 | Last Modified: 01/27/2008
284  Copy of Medicare ID card.  Start: 01/01/1995
285  Vouchers/explanation of benefits (EOB).  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 286
286  Other payer’s Explanation of Benefits/payment information.  Start: 01/01/1995
287  Medical necessity for service.  Start: 01/01/1995
288  Hospital late charges  Start: 01/01/1995 | Last Modified: 10/17/2010
289  Reason for late discharge.  Start: 01/01/1995 | Stop: 11/01/2011
290  Pre-existing information.  Start: 01/01/1995
291  Reason for termination of pregnancy.  Start: 01/01/1995
292  Purpose of family conference/therapy.  Start: 01/01/1995
293  Reason for physical therapy.  Start: 01/01/1995
294  Supporting documentation. Note: At least one other status code is required to identify the supporting documentation.  Start: 01/01/1995 | Last Modified: 10/17/2010
295  Attending physician report.  Start: 01/01/1995
296  Nurse’s notes.  Start: 01/01/1995
297  Medical notes/report.  Start: 02/28/1997
298  Operative report.  Start: 01/01/1995
299  Emergency room notes/report.  Start: 01/01/1995
300  Lab/test report/notes/results.  Start: 02/28/1997
301  MRI report.  Start: 01/01/1995
302  Refer to codes 300 for lab notes and 311 for pathology notes  Start: 01/01/1995 | Stop: 01/31/1997
303  Physical therapy notes. Use code 297:6O (6 ‘OH’ – not zero)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
304  Reports for service.  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 297, 298, 299, 300
305  Radiology/x-ray reports and/or interpretation  Start: 01/01/1995 | Last Modified: 01/30/2011
306  Detailed description of service.  Start: 01/01/1995
307  Narrative with pocket depth chart.  Start: 01/01/1995
308  Discharge summary.  Start: 01/01/1995
309  Code was duplicate of code 299  Start: 01/01/1995 | Stop: 01/31/1997
310  Progress notes for the six months prior to statement date.  Start: 01/01/1995
311  Pathology notes/report.  Start: 01/01/1995
312  Dental charting.  Start: 01/01/1995
313  Bridgework information.  Start: 01/01/1995
314  Dental records for this service.  Start: 01/01/1995
315  Past perio treatment history.  Start: 01/01/1995
316  Complete medical history.  Start: 01/01/1995
317  Patient’s medical records.  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 297 or other specific report type codes
318  X-rays/radiology films  Start: 01/01/1995 | Last Modified: 10/17/2010
319  Pre/post-operative x-rays/photographs.  Start: 02/28/1997
320  Study models.  Start: 01/01/1995
321  Radiographs or models. (Use codes 318 and/or 320)  Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
322  Recent Full Mouth X-rays  Start: 01/01/1995 | Last Modified: 10/17/2010
323  Study models, x-rays, and/or narrative.  Start: 01/01/1995
324  Recent x-ray of treatment area and/or narrative.  Start: 01/01/1995
325  Recent fm x-rays and/or narrative.  Start: 01/01/1995
326  Copy of transplant acquisition invoice.  Start: 01/01/1995
327  Periodontal case type diagnosis and recent pocket depth chart with narrative.  Start: 01/01/1995
328  Speech therapy notes. Use code 297:6R  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
329  Exercise notes.  Start: 01/01/1995
330  Occupational notes.  Start: 01/01/1995
331  History and physical.  Start: 01/01/1995 | Last Modified: 08/01/2007
332  Authorization/certification (include period covered). (Use code 252)  Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
333  Patient release of information authorization.  Start: 01/01/1995
334  Oxygen certification.  Start: 01/01/1995
335  Durable medical equipment certification.  Start: 01/01/1995
336  Chiropractic certification.  Start: 01/01/1995
337  Ambulance certification/documentation.  Start: 01/01/1995
338  Home health certification. Use code 332:4Y  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
339  Enteral/parenteral certification.  Start: 01/01/1995
340  Pacemaker certification.  Start: 01/01/1995
341  Private duty nursing certification.  Start: 01/01/1995
342  Podiatric certification.  Start: 01/01/1995
343  Documentation that facility is state licensed and Medicare approved as a surgical facility.  Start: 01/01/1995
344  Documentation that provider of physical therapy is Medicare Part B approved.  Start: 01/01/1995
345  Treatment plan for service/diagnosis  Start: 01/01/1995
346  Proposed treatment plan for next 6 months.  Start: 01/01/1995
347  Refer to code 345 for treatment plan and code 282 for prescription  Start: 01/01/1995 | Stop: 01/31/1997
348  Chiropractic treatment plan. (Use 345:QL)  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
349  Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 ‘OH’ – not zero), 5P  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
350  Speech pathology treatment plan. Use code 345:6R  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
351  Physical/occupational therapy treatment plan. Use codes 345:6O (6 ‘OH’ – not zero), 6N  Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
352  Duration of treatment plan.  Start: 01/01/1995
353  Orthodontics treatment plan.  Start: 01/01/1995
354  Treatment plan for replacement of remaining missing teeth.  Start: 01/01/1995
355  Has claim been paid?  Start: 01/01/1995 | Stop: 11/01/2011
356  Was blood furnished?  Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 235
357  Has or will blood be replaced?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 236
358  Does provider accept assignment of benefits? (Use code 589)  Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
359  Is there a release of information signature on file? (Use code 333)  Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
360  Benefits Assignment Certification Indicator  Start: 01/01/1995 | Last Modified: 10/17/2010
361  Is there other insurance?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 171 and 550
362  Is the dental patient covered by medical insurance?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 171
363  Possible Workers’ Compensation  Start: 01/01/1995 | Last Modified: 10/17/2010
364  Is accident/illness/condition employment related?  Start: 01/01/1995
365  Is service the result of an accident?   Start: 01/01/1995
366  Is injury due to auto accident?  Start: 01/01/1995   367 Is service performed for a recurring condition or new condition?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 397
368  Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 676
369  Does patient condition preclude use of ordinary bed?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 287, 335
370  Can patient operate controls of bed?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 287, 335
371  Is patient confined to room?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 287, 335, 527
372  Is patient confined to bed?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 287, 335, 527
373  Is patient an insulin diabetic?  Start: 01/01/1995 | Stop: 11/01/2011
374  Is prescribed lenses a result of cataract surgery?  Start: 01/01/1995
375  Was refraction performed?  Start: 01/01/1995
376  Was charge for ambulance for a round-trip?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 453
377  Was durable medical equipment purchased new or used?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 184, 185, 186, 335
378  Is pacemaker temporary or permanent?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 340
379  Were services performed supervised by a physician?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to codes 453, 454, 666 & procedure code
380  CRNA supervision/medical direction.  Start: 01/01/1995 | Last Modified: 10/17/2010
381  Is drug generic?  Start: 01/01/1995 | Stop: 11/01/2011  Notes: Refer to code 216
382  Did provider authorize generic or brand name dispensing?  Start: 01/01/1995
383  Nerve block use (surgery vs. pain management)  Start: 01/01/1995 | Last Modified: 10/17/2010
384  Is prosthesis/crown/inlay placement an initial placement or a replacement?  Start: 01/01/1995
385  Is appliance upper or lower arch & is appliance fixed or removable?  Start: 01/01/1995
386  Orthodontic Treatment/Purpose Indicator  Start: 01/01/1995 | Last Modified: 10/17/2010
387  Date patient last examined by entity. Note: This code requires use of an Entity Code.  Start: 02/28/1997 | Last Modified: 02/11/2010
388  Date post-operative care assumed  Start: 02/28/1997
389  Date post-operative care relinquished  Start: 02/28/1997
390  Date of most recent medical event necessitating service(s)  Start: 02/28/1997
391  Date(s) dialysis conducted  Start: 02/28/1997
392  Date(s) of blood transfusion(s)  Start: 02/28/1997 | Stop: 11/01/2011
393  Date of previous pacemaker check  Start: 02/28/1997 | Stop: 11/01/2011
394  Date(s) of most recent hospitalization related to service  Start: 02/28/1997
395  Date entity signed certification/recertification Note: This code requires use of an Entity Code.  Start: 02/28/1997 | Last Modified: 02/11/2010
396  Date home dialysis began  Start: 02/28/1997
397  Date of onset/exacerbation of illness/condition  Start: 02/28/1997
398  Visual field test results  Start: 02/28/1997
399  Report of prior testing related to this service, including dates  Start: 02/28/1997 | Stop: 11/01/2011  Notes: Refer to code 417
400  Claim is out of balance  Start: 02/28/1997
401  Source of payment is not valid  Start: 02/28/1997
402  Amount must be greater than zero. Note: At least one other status code is required to identify which amount element is in error.  Start: 02/28/1997 | Last Modified: 09/20/2009
403  Entity referral notes/orders/prescription  Start: 02/28/1997
404  Specific findings, complaints, or symptoms necessitating service  Start: 02/28/1997 | Stop: 11/01/2011  Notes: Refer to codes 287, 488
405  Summary of services  Start: 02/28/1997 | Stop: 11/01/2011  Notes: Refer to code 306
406  Brief medical history as related to service(s)  Start: 02/28/1997
407  Complications/mitigating circumstances  Start: 02/28/1997
408  Initial certification  Start: 02/28/1997
409  Medication logs/records (including medication therapy)  Start: 02/28/1997
410  Explain differences between treatment plan and patient’s condition  Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
411  Medical necessity for non-routine service(s)  Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 287
412  Medical records to substantiate decision of non-coverage  Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
413  Explain/justify differences between treatment plan and services rendered.  Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
414  Necessity for concurrent care (more than one physician treating the patient)  Start: 02/28/1997 | Last Modified: 10/17/2010
415  Justify services outside composite rate  Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 287
416  Verification of patient’s ability to retain and use information  Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
417  Prior testing, including result(s) and date(s) as related to service(s)  Start: 02/28/1997
418  Indicating why medications cannot be taken orally  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
419  Individual test(s) comprising the panel and the charges for each test  Start: 02/28/1997
420  Name, dosage and medical justification of contrast material used for radiology procedure  Start: 02/28/1997
421  Medical review attachment/information for service(s)  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
422  Homebound status  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 575
423  Prognosis  Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
424  Statement of non-coverage including itemized bill  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
425  Itemize non-covered services  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
426  All current diagnoses  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 255, 232 & 488
427  Emergency care provided during transport  Start: 02/28/1997 | Stop: 11/01/2011
428  Reason for transport by ambulance  Start: 02/28/1997
429  Loaded miles and charges for transport to nearest facility with appropriate services  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to codes 267, 178, 430
430  Nearest appropriate facility  Start: 02/28/1997
431  Patient’s condition/functional status at time of service.  Start: 02/28/1997 | Last Modified: 10/17/2010
432  Date benefits exhausted  Start: 02/28/1997
433  Copy of patient revocation of hospice benefits  Start: 02/28/1997
434  Reasons for more than one transfer per entitlement period  Start: 02/28/1997
435  Notice of Admission  Start: 02/28/1997
436  Short term goals  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
437  Long term goals  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
438  Number of patients attending session  Start: 02/28/1997 | Stop: 11/01/2011
439  Size, depth, amount, and type of drainage wounds  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
440  why non-skilled caregiver has not been taught procedure  Start: 02/28/1997 | Stop: 11/01/2011
441  Entity professional qualification for service(s)  Start: 02/28/1997
442  Modalities of service  Start: 02/28/1997
443  Initial evaluation report  Start: 02/28/1997
444  Method used to obtain test sample  Start: 02/28/1997 | Stop: 11/01/2011
445  Explain why hearing loss not correctable by hearing aid  Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 287
446  Documentation from prior claim(s) related to service(s)  Start: 02/28/1997 | Stop: 11/01/2011
447  Plan of teaching  Start: 02/28/1997 | Stop: 11/01/2011
448  Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used.  Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
449  Projected date to discontinue service(s)  Start: 02/28/1997
450  Awaiting spend down determination  Start: 02/28/1997
451  Preoperative and post-operative diagnosis  Start: 02/28/1997
452  Total visits in total number of hours/day and total number of hours/week  Start: 02/28/1997
453  Procedure Code Modifier(s) for Service(s) Rendered  Start: 02/28/1997
454  Procedure code for services rendered.  Start: 02/28/1997
455  Revenue code for services rendered.  Start: 02/28/1997
456  Covered Day(s)  Start: 02/28/1997
457  Non-Covered Day(s)  Start: 02/28/1997
458  Coinsurance Day(s)  Start: 02/28/1997
459  Lifetime Reserve Day(s)  Start: 02/28/1997
460  NUBC Condition Code(s)  Start: 02/28/1997
461  NUBC Occurrence Code(s) and Date(s)  Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
462  NUBC Occurrence Span Code(s) and Date(s)  Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
463  NUBC Value Code(s) and/or Amount(s)  Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
464  Payer Assigned Claim Control Number  Start: 02/28/1997 | Last Modified: 10/31/2004
465  Principal Procedure Code for Service(s) Rendered  Start: 02/28/1997
466  Entities Original Signature. Note: This code requires use of an Entity Code. This change effective 11/1/2011: Entity’s Original Signature. Note: This code requires use of an Entity Code.  Start: 02/28/1997 | Last Modified: 01/30/2011
467  Entity Signature Date. Note: This code requires use of an Entity Code.  Start: 02/28/1997 | Last Modified: 02/11/2010
468  Patient Signature Source  Start: 02/28/1997
469  Purchase Service Charge  Start: 02/28/1997
470  Was service purchased from another entity? Note: This code requires use of an Entity Code.  Start: 02/28/1997 | Last Modified: 02/11/2010
471  Were services related to an emergency?  Start: 02/28/1997
472  Ambulance Run Sheet  Start: 02/28/1997
473  Missing or invalid lab indicator  Start: 06/30/1998
474  Procedure code and patient gender mismatch  Start: 06/30/1998 | Last Modified: 02/29/2000
475  Procedure code not valid for patient age  Start: 06/30/1998 | Last Modified: 02/29/2000
476  Missing or invalid units of service  Start: 06/30/1998
477  Diagnosis code pointer is missing or invalid  Start: 06/30/1998
478  Claim submitter’s identifier  Start: 06/30/1998 | Last Modified: 01/24/2010
479  Other Carrier payer ID is missing or invalid  Start: 06/30/1998
480  Entity’s claim filing indicator. Note: This code requires use of an Entity Code.  Start: 06/30/1998 | Last Modified: 06/06/2010
481  Claim/submission format is invalid.  Start: 10/31/1998
482  Date Error, Century Missing  Start: 02/28/1999 | Last Modified: 09/20/2009 | Stop: 10/01/2010
483  Maximum coverage amount met or exceeded for benefit period.  Start: 06/30/1999
484  Business Application Currently Not Available  Start: 02/29/2000
485  More information available than can be returned in real time mode. Narrow your current search criteria.  Start: 02/28/2001
486  Principal Procedure Date  Start: 10/31/2001 | Last Modified: 07/01/2009
487  Claim not found, claim should have been submitted to/through ‘entity’. Note: This code requires use of an Entity Code.  Start: 02/28/2002 | Last Modified: 02/11/2010
488  Diagnosis code(s) for the services rendered.  Start: 06/30/2002
489  Attachment Control Number  Start: 10/31/2002
490  Other Procedure Code for Service(s) Rendered  Start: 02/28/2003
491  Entity not eligible for encounter submission. Note: This code requires use of an Entity Code.  Start: 02/28/2003 | Last Modified: 02/11/2010
492  Other Procedure Date   Start: 02/28/2003
493  Version/Release/Industry ID code not currently supported by information holder  Start: 02/28/2003
494  Real-Time requests not supported by the information holder, resubmit as batch request  Start: 02/28/2003
495  Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit.  Start: 10/31/2003
496  Submitter not approved for electronic claim submissions on behalf of this entity. Note: This code requires use of an Entity Code.  Start: 02/29/2004 | Last Modified: 02/11/2010
497  Sales tax not paid  Start: 06/30/2004
498  Maximum leave days exhausted  Start: 06/30/2004
499  No rate on file with the payer for this service for this entity Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
500  Entity’s Postal/Zip Code. Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
501  Entity’s State/Province. Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
502  Entity’s City. Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
503  Entity’s Street Address. Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
504  Entity’s Last Name. Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
505  Entity’s First Name. Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
506  Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Note: This code requires use of an Entity Code.  Start: 06/30/2004 | Last Modified: 02/11/2010
507  HCPCS  Start: 10/31/2004
508  ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code.  Start: 10/31/2004 | Last Modified: 07/01/2009
509  E-Code. This change effective 11/1/2011: External Cause of Injury Code (E-code).  Start: 10/31/2004 | Last Modified: 01/30/2011
510  Future date. Note: At least one other status code is required to identify the data element in error.  Start: 10/31/2004 | Last Modified: 09/20/2009
511  Invalid character. Note: At least one other status code is required to identify the data element in error.  Start: 10/31/2004 | Last Modified: 09/20/2009
512  Length invalid for receiver’s application system. Note: At least one other status code is required to identify the data element in error.  Start: 10/31/2004 | Last Modified: 09/20/2009
513  HIPPS Rate Code for services Rendered  Start: 10/31/2004
514  Entities Middle Name Note: This code requires use of an Entity Code. This change effective 11/1/2011: Entity’s Middle Name Note: This code requires use of an Entity Code.  Start: 10/31/2004 | Last Modified: 01/30/2011
515  Managed Care review  Start: 10/31/2004
516  Other Entity’s Adjudication or Payment/Remittance Date. Note: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary.  Start: 10/31/2004 | Last Modified: 11/29/2009
517  Adjusted Repriced Claim Reference Number  Start: 10/31/2004
518  Adjusted Repriced Line item Reference Number  Start: 10/31/2004
519  Adjustment Amount  Start: 10/31/2004
520  Adjustment Quantity  Start: 10/31/2004
521  Adjustment Reason Code  Start: 10/31/2004
522  Anesthesia Modifying Units  Start: 10/31/2004
523  Anesthesia Unit Count  Start: 10/31/2004
524  Arterial Blood Gas Quantity  Start: 10/31/2004
525  Begin Therapy Date  Start: 10/31/2004
526  Bundled or Unbundled Line Number  Start: 10/31/2004
527  Certification Condition Indicator  Start: 10/31/2004
528  Certification Period Projected Visit Count  Start: 10/31/2004
529  Certification Revision Date  Start: 10/31/2004
530  Claim Adjustment Indicator  Start: 10/31/2004
531  Claim Disproportinate Share Amount  Start: 10/31/2004
532  Claim DRG Amount  Start: 10/31/2004
533  Claim DRG Outlier Amount  Start: 10/31/2004
534  Claim ESRD Payment Amount  Start: 10/31/2004
535  Claim Frequency Code  Start: 10/31/2004
536  Claim Indirect Teaching Amount  Start: 10/31/2004
537  Claim MSP Pass-through Amount  Start: 10/31/2004
538  Claim or Encounter Identifier  Start: 10/31/2004
539  Claim PPS Capital Amount  Start: 10/31/2004
540  Claim PPS Capital Outlier Amount  Start: 10/31/2004
541  Claim Submission Reason Code  Start: 10/31/2004
542  Claim Total Denied Charge Amount  Start: 10/31/2004
543  Clearinghouse or Value Added Network Trace  Start: 10/31/2004
544  Clinical Laboratory Improvement Amendment  Start: 10/31/2004
545  Contract Amount  Start: 10/31/2004
546  Contract Code  Start: 10/31/2004
547  Contract Percentage  Start: 10/31/2004
548  Contract Type Code  Start: 10/31/2004
549  Contract Version Identifier  Start: 10/31/2004
550  Coordination of Benefits Code  Start: 10/31/2004
551  Coordination of Benefits Total Submitted Charge  Start: 10/31/2004
552  Cost Report Day Count  Start: 10/31/2004
553  Covered Amount  Start: 10/31/2004
554  Date Claim Paid  Start: 10/31/2004
555  Delay Reason Code  Start: 10/31/2004
556  Demonstration Project Identifier  Start: 10/31/2004
557  Diagnosis Date  Start: 10/31/2004
558  Discount Amount  Start: 10/31/2004
559  Document Control Identifier  Start: 10/31/2004
560  Entity’s Additional/Secondary Identifier. Note: This code requires use of an Entity Code.  Start: 10/31/2004 | Last Modified: 02/11/2010
561  Entity’s Contact Name. Note: This code requires use of an Entity Code.  Start: 10/31/2004 | Last Modified: 02/11/2010
562  Entity’s National Provider Identifier (NPI). Note: This code requires use of an Entity Code.  Start: 10/31/2004 | Last Modified: 02/11/2010
563  Entity’s Tax Amount. Note: This code requires use of an Entity Code.  Start: 10/31/2004 | Last Modified: 02/11/2010
564  EPSDT Indicator  Start: 10/31/2004
565  Estimated Claim Due Amount  Start: 10/31/2004
566  Exception Code  Start: 10/31/2004
567  Facility Code Qualifier  Start: 10/31/2004
568  Family Planning Indicator  Start: 10/31/2004
569  Fixed Format Information  Start: 10/31/2004
570  Free Form Message Text  Start: 10/31/2004
571  Frequency Count  Start: 10/31/2004
572  Frequency Period  Start: 10/31/2004
573  Functional Limitation Code  Start: 10/31/2004
574  HCPCS Payable Amount Home Health  Start: 10/31/2004
575  Homebound Indicator  Start: 10/31/2004
576  Immunization Batch Number  Start: 10/31/2004
577  Industry Code  Start: 10/31/2004
578  Insurance Type Code  Start: 10/31/2004
579  Investigational Device Exemption Identifier  Start: 10/31/2004
580  Last Certification Date  Start: 10/31/2004
581  Last Worked Date  Start: 10/31/2004
582  Lifetime Psychiatric Days Count  Start: 10/31/2004
583  Line Item Charge Amount  Start: 10/31/2004
584  Line Item Control Number  Start: 10/31/2004
585  Denied Charge or Non-covered Charge  Start: 10/31/2004 | Last Modified: 07/09/2007
586  Line Note Text  Start: 10/31/2004
587  Measurement Reference Identification Code  Start: 10/31/2004
588  Medical Record Number  Start: 10/31/2004
589  Provider Accept Assignment Code  Start: 10/31/2004 | Last Modified: 10/17/2010
590  Medicare Coverage Indicator  Start: 10/31/2004
591  Medicare Paid at 100% Amount  Start: 10/31/2004
592  Medicare Paid at 80% Amount  Start: 10/31/2004
593  Medicare Section 4081 Indicator  Start: 10/31/2004
594  Mental Status Code  Start: 10/31/2004
595  Monthly Treatment Count  Start: 10/31/2004
596  Non-covered Charge Amount  Start: 10/31/2004
597  Non-payable Professional Component Amount  Start: 10/31/2004
598  Non-payable Professional Component Billed Amount  Start: 10/31/2004
599  Note Reference Code  Start: 10/31/2004
600  Oxygen Saturation Qty  Start: 10/31/2004
601  Oxygen Test Condition Code  Start: 10/31/2004
602  Oxygen Test Date  Start: 10/31/2004
603  Old Capital Amount  Start: 10/31/2004
604  Originator Application Transaction Identifier  Start: 10/31/2004
605  Orthodontic Treatment Months Count  Start: 10/31/2004
606  Paid From Part A Medicare Trust Fund Amount  Start: 10/31/2004
607  Paid From Part B Medicare Trust Fund Amount  Start: 10/31/2004
608  Paid Service Unit Count  Start: 10/31/2004
609  Participation Agreement  Start: 10/31/2004
610  Patient Discharge Facility Type Code  Start: 10/31/2004
611  Peer Review Authorization Number  Start: 10/31/2004
612  Per Day Limit Amount  Start: 10/31/2004
613  Physician Contact Date  Start: 10/31/2004
614  Physician Order Date  Start: 10/31/2004
615  Policy Compliance Code  Start: 10/31/2004
616  Policy Name  Start: 10/31/2004
617  Postage Claimed Amount  Start: 10/31/2004
618  PPS-Capital DSH DRG Amount  Start: 10/31/2004
619  PPS-Capital Exception Amount  Start: 10/31/2004
620  PPS-Capital FSP DRG Amount  Start: 10/31/2004
621  PPS-Capital HSP DRG Amount  Start: 10/31/2004
622  PPS-Capital IME Amount  Start: 10/31/2004
623  PPS-Operating Federal Specific DRG Amount  Start: 10/31/2004
624  PPS-Operating Hospital Specific DRG Amount  Start: 10/31/2004
625  Predetermination of Benefits Identifier  Start: 10/31/2004
626  Pregnancy Indicator  Start: 10/31/2004
627  Pre-Tax Claim Amount  Start: 10/31/2004
628  Pricing Methodology  Start: 10/31/2004
629  Property Casualty Claim Number  Start: 10/31/2004
630  Referring CLIA Number  Start: 10/31/2004
631  Reimbursement Rate  Start: 10/31/2004
632  Reject Reason Code  Start: 10/31/2004
633  Related Causes Code (Accident, auto accident, employment)  Start: 10/31/2004 | Last Modified: 10/17/2010
634  Remark Code  Start: 10/31/2004
635  Repriced Ambulatory Patient Group Code  Start: 10/31/2004
636  Repriced Line Item Reference Number  Start: 10/31/2004
637  Repriced Saving Amount  Start: 10/31/2004
638  Repricing Per Diem or Flat Rate Amount  Start: 10/31/2004
639  Responsibility Amount  Start: 10/31/2004
640  Sales Tax Amount  Start: 10/31/2004
641  Service Adjudication or Payment Date. Note: Use code 516.  Start: 10/31/2004 | Last Modified: 09/20/2009 | Stop: 10/01/2010
642  Service Authorization Exception Code  Start: 10/31/2004
643  Service Line Paid Amount  Start: 10/31/2004
644  Service Line Rate  Start: 10/31/2004
645  Service Tax Amount  Start: 10/31/2004
646  Ship, Delivery or Calendar Pattern Code  Start: 10/31/2004
647  Shipped Date  Start: 10/31/2004
648  Similar Illness or Symptom Date  Start: 10/31/2004
649  Skilled Nursing Facility Indicator  Start: 10/31/2004
650  Special Program Indicator  Start: 10/31/2004
651  State Industrial Accident Provider Number  Start: 10/31/2004
652  Terms Discount Percentage  Start: 10/31/2004
653  Test Performed Date  Start: 10/31/2004
654  Total Denied Charge Amount  Start: 10/31/2004
655  Total Medicare Paid Amount  Start: 10/31/2004
656  Total Visits Projected This Certification Count  Start: 10/31/2004
657  Total Visits Rendered Count  Start: 10/31/2004
658  Treatment Code  Start: 10/31/2004
659  Unit or Basis for Measurement Code  Start: 10/31/2004
660  Universal Product Number  Start: 10/31/2004
661  Visits Prior to Recertification Date Count CR702  Start: 10/31/2004
662  X-ray Availability Indicator  Start: 10/31/2004
663  Entity’s Group Name. Note: This code requires use of an Entity Code.  Start: 10/31/2004 | Last Modified: 02/11/2010
664  Orthodontic Banding Date  Start: 10/31/2004
665  Surgery Date  Start: 10/31/2004
666  Surgical Procedure Code  Start: 10/31/2004
667  Real-Time requests not supported by the information holder, do not resubmit   Start: 02/28/2005
668  Missing Endodontics treatment history and prognosis  Start: 06/30/2005
669  Dental service narrative needed.  Start: 10/31/2005
670  Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts  Start: 06/30/2006 | Last Modified: 02/28/2007
671  Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts  Start: 06/30/2006 | Last Modified: 02/28/2007
672  Other Payer’s payment information is out of balance  Start: 10/31/2006
673  Patient Reason for Visit  Start: 10/31/2006
674  Authorization exceeded  Start: 10/31/2006
675  Facility admission through discharge dates  Start: 10/31/2006
676  Entity possibly compensated by facility. Note: This code requires use of an Entity Code.  Start: 10/31/2006 | Last Modified: 02/11/2010
677  Entity not affiliated. Note: This code requires use of an Entity Code.  Start: 10/31/2006 | Last Modified: 02/11/2010
678  Revenue code and patient gender mismatch  Start: 10/31/2006
679  Submit newborn services on mother’s claim  Start: 10/31/2006
680  Entity’s Country. Note: This code requires use of an Entity Code.  Start: 10/31/2006 | Last Modified: 02/11/2010
681  Claim currency not supported  Start: 10/31/2006
682  Cosmetic procedure  Start: 02/28/2007
683  Awaiting Associated Hospital Claims  Start: 02/28/2007
684  Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Note: Only for use to reject claims or status requests in transactions that were ‘accepted with errors’ on a 997 or 999 Acknowledgement.)  Start: 11/05/2007
685  Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit.  Start: 01/27/2008
686  The claim/ encounter has completed the adjudication cycle and the entire claim has been voided  Start: 01/27/2008
687  Claim estimation can not be completed in real time. Do not resubmit.  Start: 01/27/2008
688  Present on Admission Indicator for reported diagnosis code(s).  Start: 01/27/2008
689  Entity was unable to respond within the expected time frame. Note: This code requires use of an Entity Code.  Start: 06/01/2008 | Last Modified: 02/11/2010
690  Multiple claims or estimate requests cannot be processed in real time.  Start: 06/01/2008
691  Multiple claim status requests cannot be processed in real time.  Start: 06/01/2008
692  Contracted funding agreement-Subscriber is employed by the provider of services  Start: 09/21/2008
693  Amount must be greater than or equal to zero. Note: At least one other status code is required to identify which amount element is in error.  Start: 01/25/2009
694  Amount must not be equal to zero. Note: At least one other status code is required to identify which amount element is in error.  Start: 01/25/2009
695  Entity’s Country Subdivision Code. Note: This code requires use of an Entity Code.  Start: 01/25/2009 | Last Modified: 02/11/2010
696  Claim Adjustment Group Code.  Start: 01/25/2009
697  Invalid Decimal Precision. Note: At least one other status code is required to identify the data element in error.  Start: 07/01/2009
698  Form Type Identification  Start: 07/01/2009
699  Question/Response from Supporting Documentation Form  Start: 07/01/2009
700  ICD10. Note: At least one other status code is required to identify the related procedure code or diagnosis code.  Start: 07/01/2009
701  Initial Treatment Date  Start: 07/01/2009
702  Repriced Claim Reference Number  Start: 11/01/2009
703  Advanced Billing Concepts (ABC) code   Start: 01/24/2010
704  Claim Note Text  Start: 01/24/2010
705  Repriced Allowed Amount  Start: 01/24/2010
706  Repriced Approved Amount  Start: 01/24/2010
707  Repriced Approved Ambulatory Patient Group Amount  Start: 01/24/2010
708  Repriced Approved Revenue Code  Start: 01/24/2010
709  Repriced Approved Service Unit Count  Start: 01/24/2010
710  Line Adjudication Information. Note: At least one other status code is required to identify the data element in error.  Start: 01/24/2010
711  Stretcher purpose  Start: 01/24/2010
712  Obstetric Additional Units  Start: 01/24/2010
713  Patient Condition Description  Start: 01/24/2010
714  Care Plan Oversight Number  Start: 01/24/2010
715  Acute Manifestation Date  Start: 01/24/2010
716  Repriced Approved DRG Code  Start: 01/24/2010
717  This claim has been split for processing.  Start: 01/24/2010
718  Claim/service not submitted within the required timeframe (timely filing).   Start: 01/24/2010
719  NUBC Occurrence Code(s)  Start: 01/24/2010
720  NUBC Occurrence Code Date(s)  Start: 01/24/2010
721  NUBC Occurrence Span Code(s)  Start: 01/24/2010
722  NUBC Occurrence Span Code Date(s)  Start: 01/24/2010
723  Drug days supply  Start: 01/24/2010
724  Drug dosage  Start: 01/24/2010
725  NUBC Value Code(s)  Start: 01/24/2010
726  NUBC Value Code Amount(s)  Start: 01/24/2010
727  Accident date  Start: 01/24/2010
728  Accident state  Start: 01/24/2010
729  Accident description  Start: 01/24/2010
730  Accident cause  Start: 01/24/2010
731  Measurement value/test result  Start: 01/24/2010
732  Information submitted inconsistent with billing guidelines. Note: At least one other status code is required to identify the inconsistent information.  Start: 01/24/2010
733  Prefix for entity’s contract/member number.  Start: 01/24/2010
734  Verifying premium payment  Start: 06/06/2010
735  This service/claim is included in the allowance for another service or claim.  Start: 06/06/2010
736  A related or qualifying service/claim has not been received/adjudicated.  Start: 06/06/2010
737  Current Dental Terminology (CDT) Code  Start: 06/06/2010
738  Home Infusion EDI Coalition (HEIC) Product/Service Code  Start: 06/06/2010
739  Jurisdiction Specific Procedure or Supply Code  Start: 06/06/2010
740  Drop-Off Location  Start: 06/06/2010
741  Entity must be a person. Note: This code requires use of an Entity Code.  Start: 06/06/2010
742  Payer Responsibility Sequence Number Code  Start: 06/06/2010
743  Entity’s credential/enrollment information. Note: This code requires use of an Entity Code.  Start: 10/17/2010
744  Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.  Start: 10/17/2010
745  Identifier Qualifier Note: At least one other status code is required to identify the specific identifier qualifier in error.  Start: 10/17/2010
746  Duplicate Submission Note: use only at the information receiver level in the Health Care Claim Acknowledgement transaction.  Start: 10/17/2010
747  Hospice Employee Indicator  Start: 10/17/2010
748  Corrected Data Note: Requires a second status code to identify the corrected data.  Start: 10/17/2010
749  Date of Injury/Illness  Start: 10/17/2010
750  Invalid Auto Accident State or Province Code. This change effective 11/1/2011: Auto Accident State or Province Code  Start: 10/17/2010 | Last Modified: 01/30/2011
751  Invalid Ambulance Pick-up State or Province Code. This change effective 11/1/2011: Ambulance Pick-up State or Province Code  Start: 10/17/2010 | Last Modified: 01/30/2011
752  Invalid Ambulance Drop-off State or Province Code. This change effective 11/1/2011: Ambulance Drop-off State or Province Code  Start: 10/17/2010 | Last Modified: 01/30/2011
753  Co-pay status code.  Start: 01/30/2011
754  Entity Name Suffix. Note: This code requires the use of an Entity Code.  Start: 01/30/2011
755  Entity’s primary identifier. Note: This code requires the use of an Entity Code.  Start: 01/30/2011
756  Entity’s Received Date. Note: This code requires the use of an Entity Code.  Start: 01/30/2011
757  Last seen date.  Start: 01/30/2011
758  Repriced approved HCPCS code.  Start: 01/30/2011
759  Round trip purpose description.  Start: 01/30/2011
760  Tooth status code.  Start: 01/30/2011
761  Entity’s referral number. Note: This code requires the use of an Entity Code.  Start: 01/30/2011