Health Care Claim Status Codes - Full list

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

Medicare PQRS payment update

Medicare Physician Fee Schedule Update 2012:


In 2012, the Centers for Medicare & Medicaid Services (CMS) is implementing payment updates and policy changes to the Medicare Physician Fee Schedule, including:

• Policies and procedures to identify and provide accurate payment for misvalued services; and

• Changes to the factors used to adjust physician fee schedule payment for geographic differences in physicians’ practice costs.

Incentives and Payment Adjustments for Quality Reporting:

We are continuing our efforts to promote improvement in quality of care and patient outcomes through the Electronic Prescribing (eRx) Incentive Program and the Physician Quality Reporting System (PQRS). Eligible professionals or group practices that meet satisfactory reporting requirements under the PQRS in calendar year (CY) 2011 will be eligible for incentive payments equal to 1.0 percent of their total estimated allowed charges for the reporting period. This incentive payment will be made in CY 2012.

In addition, eligible professionals or group practices that meet satisfactory reporting requirements under the PQRS in CY 2012 will be eligible for incentive payments equal to 0.5 percent of their total estimated allowed charges for the reporting period.

Eligible professionals or group practices that meet the requirements of the eRx Incentive Program in CY 2011 will be eligible for incentive payments equal to 1.0 of their total estimated allowed charges for the reporting period. Similar to the PQRS, this incentive payment will be made in CY 2012. In addition, eligible professionals or group practices that meet the requirements of the eRx Incentive Program in CY 2012 will be eligible for incentive payments equal to 1.0 percent of their total estimated allowed charges for the reporting period.

Eligible professionals who did not become successful electronic prescribers by reporting on the electronic prescribing measure for at least 10 unique events from January 1, 2011, through June 30, 2011, or were not granted an exemption due to a significant hardship will be subject to a negative payment adjustment equal to 1.0 percent of their fee schedule amounts for covered professional services furnished during 2012. Feedback reports based on information reported by eligibleprofessionals to CMS during the 2012 eRx payment adjustment reporting period (i.e., January 1, 2011- June 30, 2011) are expected to be made available to eligible professionals in late-2011.

In addition, a negative payment adjustment equal to 1.5 percent of the physician fee schedule amounts for covered professional services furnished during 2013 will apply to eligible professionals unless:

(1) the eligible professional was a successful electronic prescriber for purposes of the 2011 eRx incentive;

(2) the eligible professional becomes a successful electronic prescriber by reporting on the electronic prescribing measure on at least 10 unique events (which need not be associated with the measure’s
denominator) from January 1, 2012, through June 30, 2012; or

(3) the eligible professional was granted an exemption due to a significant hardship.

Service type code full list

Health Care Services Type Codes – All


Health Care Service Type Codes are used to identify the classification of service or benefits.

1 Medical Care Start: 09/20/2009

2 Surgical Start: 09/20/2009

3 Consultation Start: 09/20/2009

4 Diagnostic X-Ray Start: 09/20/2009

5 Diagnostic Lab Start: 09/20/2009

6 Radiation Therapy Start: 09/20/2009

7 Anesthesia Start: 09/20/2009

8 Surgical Assistance Start: 09/20/2009

10 Blood Start: 09/20/2009

11 Durable Medical Equipment Used Start: 09/20/2009

12 Durable Medical Equipment Purchased Start: 09/20/2009

14 Renal Supplies Start: 09/20/2009

17 Pre-Admission Testing Start: 09/20/2009

18 Durable Medical Equipment Rental Start:09/20/2009

19 Pneumonia Vaccine Start: 09/20/2009

20 Second Surgical Opinion Start: 09/20/2009

21 Third Surgical Opinion Start: 09/20/2009

22 Social Work Start: 09/20/2009

23 Diagnostic Dental Start: 09/20/2009

24 Periodontics Start: 09/20/2009

25 Restorative Start: 09/20/2009

26 Endodontics Start: 09/20/2009

27 Maxillofacial Prosthetics Start: 09/20/2009

28 Adjunctive Dental Services Start: 09/20/2009

30 Health Benefit Plan Coverage Start: 09/20/2009

32 Plan Waiting Period Start: 09/20/2009

33 Chiropractic Start: 09/20/2009

34 Chiropractic Modality Start: 09/20/2009

35 Dental Care Start: 09/20/2009

36 Dental Crowns Start: 09/20/2009

37 Dental Accident Start: 09/20/2009

38 Orthodontics Start: 09/20/2009

39 Prosthodontics Start: 09/20/2009

40 Oral Surgery Start: 09/20/2009

41 Preventive Dental Start: 09/20/2009
Last Modified: 01/24/2010

42 Home Health Care Start: 09/20/2009

43 Home Health Prescriptions Start: 09/20/2009

45 Hospice Start: 09/20/2009

46 Respite Care Start: 09/20/2009

47 Hospitalization Start: 09/20/2009

49 Hospital - Room and Board Start: 09/20/2009

54 Long Term Care Start: 09/20/2009

55 Major Medical Start: 09/20/2009

56 Medically Related Transportation Start: 09/20/2009

60 General Benefits Start: 09/20/2009

61 In-vitro Fertilization Start: 09/20/2009

62 MRI Scan Start: 09/20/2009

63 Donor Procedures Start: 09/20/2009

64 Acupuncture Start: 09/20/2009

65 Newborn Care Start: 09/20/2009

66 Pathology Start: 09/20/2009

67 Smoking Cessation Start: 09/20/2009

68 Well Baby Care Start: 09/20/2009

69 Maternity Start: 09/20/2009

70 Transplants Start: 09/20/2009

71 Audiology Start: 09/20/2009

72 Inhalation Therapy Start: 09/20/2009

73 Diagnostic Medical Start: 09/20/2009

74 Private Duty Nursing Start: 09/20/2009

75 Prosthetic Device Start: 09/20/2009

76 Dialysis Start: 09/20/2009

77 Otology Start: 09/20/2009

78 Chemotherapy Start: 09/20/2009

79 Allergy Testing Start: 09/20/2009

80 Immunizations Start: 09/20/2009

81 Routine Physical Start: 09/20/2009

82 Family Planning Start: 09/20/2009

83 Infertility Start: 09/20/2009

84 Abortion Start: 09/20/2009

85 HIV - AIDS Treatment Start: 09/20/2009

86 Emergency Services Start: 09/20/2009

87 Cancer Treatment Start: 09/20/2009

88 Pharmacy Start: 09/20/2009

89 Free Standing Prescription Drug Start: 09/20/2009

90 Mail Order Prescription Drug Start: 09/20/2009

91 Brand Name Prescription Drug Start: 09/20/2009

92 Generic Prescription Drug Start: 09/20/2009

93 Podiatry Start: 09/20/2009

A4 Psychiatric Start: 09/20/2009

A6 Psychotherapy Start: 09/20/2009

A7 Psychiatric - Inpatient Start: 09/20/2009

A8 Psychiatric - Outpatient Start: 09/20/2009

A9 Rehabilitation Start: 09/20/2009

AB Rehabilitation - Inpatient Start: 09/20/2009

AC Rehabilitation - Outpatient Start: 09/20/2009

AD Occupational Therapy Start: 09/20/2009

AE Physical Medicine Start: 09/20/2009

AF Speech Therapy Start: 09/20/2009

AG Skilled Nursing Care Start: 09/20/2009

AI Substance Abuse Start: 09/20/2009

AJ Alcoholism Treatmen Start: 09/20/2009

AK Drug Addiction Start: 09/20/2009

AL Optometry Start: 09/20/2009

AM Frames Start: 09/20/2009

AO Lenses Start: 09/20/2009

AP Routine Eye Exam Start: 09/20/2009

AQ Nonmedically Necessary Physical (These physicals are required by other entities e.g., insurance application, pilot license, employment or school) Start: 09/20/2009

AR Experimental Drug Therapy Start: 09/20/2009

B1 Burn Care Start: 09/20/2009

B2 Brand Name Prescription Drug - Formulary Start: 09/20/2009

B3 Brand Name Prescription Drug - Non-Formulary Start: 09/20/2009

BA Independent Medical Evaluation Start: 09/20/2009

BB Psychiatric Treatment Partial Hospitalization Start: 09/20/2009

BC Day Care (Psychiatric) Start: 09/20/2009

BD Cognitive Therapy Start: 09/20/2009

BE Massage Therapy Start: 09/20/2009

BF Pulmonary Rehabilitation Start: 09/20/2009

BG Cardiac Rehabilitation Start: 09/20/2009

BH Pediatric Start: 09/20/2009

BI Nursery Room and Board Start: 09/20/2009

BK Orthopedic Start: 09/20/2009

BL Cardiac Start: 09/20/2009

BM Lymphatic Start: 09/20/2009

BN Gastrointestinal Start: 09/20/2009

BP Endocrine Start: 09/20/2009

BQ Neurology Start: 09/20/2009

BT Gynecological Start: 09/20/2009

BU Obstetrical Start: 09/20/2009

BV Obstetrical/Gynecological Start: 09/20/2009

BW Mail Order Prescription Drug: Brand Name Start: 09/20/2009

BX Mail Order Prescription Drug: Generic Start: 09/20/2009

BY Physician Visit - Sick Start: 09/20/2009

BZ Physician Visit - Well Start: 09/20/2009

C1 Coronary Care Start: 09/20/2009

CK Screening X-ray Start: 09/20/2009

CL Screening laboratory Start: 09/20/2009

CM Mammogram, High Risk Patient Start: 09/20/2009

CN Mammogram, Low Risk Patient Start: 09/20/2009

CO Flu Vaccination Start: 09/20/2009

CP Eyewear Accessories Start: 09/20/2009

CQ Case Management Start: 09/20/2009

DG Dermatology Start: 09/20/2009

DM Durable Medical Equipment Start: 09/20/2009

DS Diabetic Supplies Start: 09/20/2009

E0 Allied Behavioral Analysis Therapy Start: 09/20/2009

E1 Non-Medical Equipment (non DME) Start: 09/20/2009

E2 Psychiatric Emergency Start: 09/20/2009

E3 Step Down Unit Start: 09/20/2009

E4 Skilled Nursing Facility Head Level of Care Start: 09/20/2009

E5 Skilled Nursing Facility Ventilator Level of Care Start: 09/20/2009

E6 Level of Care 1 Start: 09/20/2009 E7 Level of Care 2 Start: 09/20/2009

E8 Level of Care 3 Start: 09/20/2009

E9 Level of Care 4 Start: 09/20/2009

E10 Radiographs Start: 01/24/2010

E11 Diagnostic Imaging Start: 01/24/2010

E12 Basic Restorative - Dental Start: 01/24/2010

E13 Major Restorative - Dental Start: 01/24/2010

E14 Fixed Prosthodontics Start: 01/24/2010

E15 Removable Prosthodontics Start: 01/24/2010

E16 Intraoral Images - Complete Series Start: 01/24/2010

E17 Oral Evaluation Start: 01/24/2010

E18 Dental Prophylaxis Start: 01/24/2010

E19 Panoramic Images Start: 01/24/2010

E20 Sealants Start: 01/24/2010

E21 Flouride Treatments Start: 01/24/2010

E22 Dental Implants Start: 01/24/2010

E23 Temporomandibular Joint Dysfunction Start: 01/24/2010

E24 Retail Pharmacy Prescription Drug Start: 06/06/2010

E25 Long Term Care Pharmacy Start: 06/06/2010

E26 Comprehensive Medication Therapy Management Review Start: 06/05/2011

E27 Targeted Medication Therapy Management Review Start: 06/05/2011

EA Preventive Services Start: 09/20/2009

EB Specialty Pharmacy Start: 09/20/2009

EC Durable Medical Equipment New Start: 09/20/2009

ED CAT Scan Start: 09/20/2009

EE Ophthalmology Start: 09/20/2009

EF Contact Lenses Start: 09/20/2009

GF Generic Prescription Drug - Formulary Start: 09/20/2009

GN Generic Prescription Drug - Non-Formulary Start: 09/20/2009

GY Allergy Start: 09/20/2009

IC Intensive Care Start: 09/20/2009

MH Mental Health Start: 09/20/2009

NI Neonatal Intensive Care Start: 09/20/2009

ON Oncology Start: 09/20/2009

PE Positron Emission Tomography (PET) Scan Start: 09/20/2009

PT Physical Therapy Start: 09/20/2009

PU Pulmonary Start: 09/20/2009

RN Renal Start: 09/20/2009

RT Residential Psychiatric Treatment Start: 09/20/2009

SMH Serious Mental Health Start : 01/30/2011

TC Transitional Care Start: 09/20/2009

TN Transitional Nursery Care Start: 09/20/2009

UC Urgent Care Start: 09/20/2009

Health Care Services Decision Reason Codes - All

Health Care Services Decision Reason Codes are used to indicate the primary reason for the certification action code assigned as part of a health care services review.


01 Price Authorization Expired Start: 01/10/2001

02 Price authorization no longer required Start: 01/10/2001

03 Product not on the price authorization Start: 01/10/2001

04 Authorized Quantity Exceeded Start: 01/10/2001

05 Special Cost Incorrect Start: 01/10/2001

06 No Credit Allowed Start: 01/10/2001

07 Administrative Cancellation Start: 01/10/2001

08 Unit resale higher than authorized Start: 01/10/2001

09 Out of Network Start: 01/10/2001

0A Testing not Included Start: 01/10/2001

0B Request Forwarded To and Decision Response Forthcoming From an External Review Organization Start: 01/10/2001

0C Authorization/Access Restrictions Start: 01/10/2001

0D Requires PCP authorization Start: 01/10/2001

0E Provider is Not Primary Care Physician Start: 01/10/2001

0F Not Medically Necessary Start: 01/10/2001

0G Level of Care Not Appropriate Start: 01/10/2001

0H Certification Not Required for this Service Start: 01/10/2001

0J Certification Responsibility of External Review Organization Start: 01/10/2001

0K Primary Care Service Start: 01/10/2001

0L Exceeds Plan Maximums Start: 01/10/2001

0M Non-covered Service Start: 01/10/2001

0N No Prior Approval Start: 01/10/2001

0P Requested Information Not Received Start: 01/10/2001

0Q Duplicate Request Start: 01/10/2001

0R Service Inconsistent with Diagnosis Start: 01/10/2001

0S Pre-existing Condition Start: 01/10/2001

0T Experimental Service or Procedure Start: 01/10/2001

0U Additional Patient Information required Start: 01/10/2001

0V Requires Medical Review Start: 01/10/2001

0W Disposition pending review Start: 01/10/2001

0X Service Inconsistent with Provider Type Start: 01/10/2001

0Y Service inconsistent with Patient's Age Start: 01/10/2001

0Z Service inconsistent with Patient's Gender Start: 01/10/2001

10 Product/service/procedure delivery pattern (e.g., units, days, visits, weeks, hours, months) Start: 01/10/2001

11 Pricing Start: 01/10/2001

12 Patient is restricted to specific provider Start: 01/10/2001

13 Service authorized for another provider Start: 01/10/2001

14 Plan/contractual guidelines not followed Start: 01/10/2001

15 Plan/contractual geographic restriction Start: 01/10/2001

16 Inappropriate facility type Start: 01/10/2001

17 Time limits not met Start: 02/01/2002

18 Notification received Start: 06/01/2002

19 Cosmetic Start: 06/01/2002

20 Once in a lifetime restriction applies Start: 02/01/2004

21 Transport Request Denied Start: 06/01/2004

22 Ambulance Certification Segment information doesn't correspond to Transport Address Segment Start: 06/01/2004

23 Mileage cannot be computed based on data submitted Start: 06/01/2004

24 Computed mileage is inconsistent with transport information or service units submitted Start: 06/01/2004

25 Services were not considered due to other errors in the request. Start: 06/06/2010

26 Missing Provider Role Start: 06/05/2011

Medicaid EHR PAYMENT - How to get and how much provider get.

Medicaid “Incentive Payments for Eligible Professional


Florida will be ready to begin making the Florida Medicaid EHR incentive payments in September 2011, but you can start preparing now.

The incentive program does not provide additional incentive payments beyond the limits established by legislation, regardless of your EHR system’s cost. The purpose of the incentive payments is to encourage the adoption and meaningful use of certified EHR technology, not to act as a direct reimbursement. The CMS final rule does not dictate how Medicaid providers must use their EHR incentive payment.

Eligible professionals (EPs) can receive $63,750 over six years. Pediatricians who qualify with a 20-29% Medicaid patient volume receive two-thirds of the maximum incentive payment, totaling $42,500. Pediatricians who qualify with a 30% Medicaid patient volume can receive the full incentive payment.

EPs may receive an incentive payment from either Medicaid or Medicare, but not both. A Medicaid eligible professional may receive an incentive payment from only one state in a payment year.

An EP can participate in the Medicaid EHR Incentive Program and CMS eRx Incentive Program simultaneously.



Calendar Year    Payment

Year 1         $21,250
Year 2         $8,500
Year 3         $8,500
Year 4         $8,500
Year 5         $8,500
Year 6         $8,500
Total          $63,750


Eligible Professionals for Medicaid


Eligible professionals (EPs) are non-hospital-based physicians, dentists, nurse practitioners, and certified nurse midwives. Additionally, physician assistants practicing predominantly in a Federally Qualified Health Center (FQHC)

EPs can receive $63,750 over six years for adopting, implementing or upgrading and demonstrating meaningful use of certified EHR technology. Medicaid providers may opt out of the incentive program without their Medicaid reimbursements being affected. EPs can switch between the Medicare and Medicaid incentive programs one time. The last year for making an incentive program switch is 2014.

Eligible professionals must meet the following patient volume requirements.


Non-Hospital-Based Eligible Professionals            Patient Volume Over 90-Day Period

Physician (MD, DO)                                                 30% Medicaid
Dentist                                                                      30% Medicaid
Certified Nurse Midwife                                            30% Medicaid
Nurse Practitioner                                                      30% Medicaid
Physician Assistant (PA) in a RHC or FQHC led by PA*    30% Medicaid
Pediatrician**                                                             20% Medicaid

* Eligible professionals that practice in a RHC or FQHC at least 50% of the time can count “needy individuals”1 to meet their patient volume threshold.

**Pediatricians, like other physicians, can be eligible for the full incentive payment ($63,750) if they meet the minimum 30% Medicaid patient volume requirements. However, Pediatricians only are also eligible if their Medicaid patient volume is between 20-29%. Pediatricians who qualify with a 20-29% Medicaid patient volume receive two-thirds of the maximum incentive payment, totaling $42,500.

*** Non-Hospital-Based is defined as not having 90% or more necounters in a hospital or emergency room setting.

Medicare speciality code full list

Medicare provider/supplier specialty codes




Here is the list of Medicare provider/supplier specialty codes you can use as a reference during the enrollment process.

Code Description

01 General practice

02 General surgery

03 Allergy/immunology

04 Otolaryngology

05 Anesthesiology

06 Cardiology

07 Dermatology

08 Family practice

09 Interventional pain management

10 Gastroenterology

11 Internal medicine

12 Osteopathic manipulative medicine

13 Neurology

14 Neurosurgery

15 Speech language pathology

16 Obstetrics/gynecology

17 Hospice and palliative Care

18 Ophthalmology

19 Oral surgery (dentist only)

20 Orthopedic surgery

21 Cardiac electrophysiology

22 Pathology

23 Sports medicine

24 Plastic and reconstructive surgery

25 Physical medicine and rehabilitation

26 Psychiatry

27 Geriatric psychiatry

28 Colorectal surgery

29 Pulmonary disease

30 Diagnostic radiology

32 Anesthesiologist assistant

33 Thoracic surgery

34 Urology

35 Chiropractic

36 Nuclear medicine

37 Pediatric medicine

38 Geriatric medicine

39 Nephrology

40 Hand surgery

41 Optometry

42 Certified nurse midwife

43 Certified registered nurse anesthetist (CRNA)

44 Infectious disease

45 Mammography screening center

46 Endocrinology

47 Independent diagnostic testing facility

48 Podiatry

49 Ambulatory surgical center

50 Nurse practitioner

51 Medical supply company with certified orthotist

52 Medical supply company with certified prosthetist

53 Medical supply company with certified prosthetist-orthotist

54 Medical supply company not included in specialties 51-53

59 Ambulance service (private)

63 Portable x-ray supplier

64 Audiologist (billing independently)

65 Physical therapist (private practice)

66 Rheumatology

67 Occupational therapist (private practice)

68 Clinical psychologist

69 Clinical laboratory (billing independently)

70 Multi-specialty clinic or group practice

71 Dietitian/nutritionist (effective 1/1/2002)

72 Pain management (effective 1/1/2002)

73 Mass immunization roster biller

74 Radiation therapy center

75 Slide preparation facility

76 Peripheral vascular disease

77 Vascular surgery

78 Cardiac surgery

79 Addiction medicine

80 Licensed clinical social worker

81 Critical care (intensivists)

82 Hematology

83 Hematology/oncology

84 Preventative medicine

85 Maxillofacial surgery

86 Neuropsychiatry

87 All other (drug and department store, etc.)

88 Unknown supplier/provider

89 Certified clinical nurse specialist

90 Medical oncology

91 Surgical oncology

92 Radiation oncology

93 Emergency medicine

94 Interventional radiology

95 Open

96 Optician

97 Physician assistant

98 Gynecological/oncology

99 Unknown physician specialty