|
0001
|
Total Charge
|
|
001X
|
RESERVED
|
|
002X
|
Health Insurance - Prospective Payment
System (HIPPS)
|
|
|
Subcategory
|
|
2
|
Skilled
Nursing Facility (SNF PPS)
|
|
3
|
Home
Health Agency (HHA PPS)
|
|
4
|
Inpatient
Rehab Facility (REHAB PPS) (Effective 10/16/2003)
|
|
003X TO 006X
|
RESERVED for National Assignment
|
|
007X TO 009X
|
RESERVED for National Assignment
|
|
010X
|
All Inclusive Rate
|
|
|
Flat fee charge incurred on either a daily
basis or total stay basis for services rendered. Charge may cover room
and board plus ancillary services or room and board only.
|
|
Subcategory
|
|
0
|
All-Inclusive
Room and Board Plus Ancillary
|
|
1
|
All-Inclusive
Room and Board
|
|
011X
|
Room and Board - Private Medical or
General
|
|
|
Routine service charges for single bed rooms.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Medical/Surgical/Gyn
|
|
2
|
OB
|
|
3
|
Pediatric
|
|
4
|
Psychiatric
|
|
5
|
Hospice
|
|
6
|
Detoxification
|
|
7
|
Oncology
|
|
8
|
Rehabilitation
|
|
9
|
Other
|
|
012X
|
Room and Board - Semi-Private Two Bed
(Medical or General)
|
|
|
Routine service charges incurred for accommodations
with two beds.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Medical/Surgical/Gyn
|
|
2
|
OB
|
|
3
|
Pediatric
|
|
4
|
Psychiatric
|
|
5
|
Hospice
|
|
6
|
Detoxification
|
|
7
|
Oncology
|
|
8
|
Rehabilitation
|
|
9
|
Other
|
|
013X
|
Semi-Private - Three and Four Beds
|
|
|
Routine service charges incurred for accommodations
with three and four beds.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Medical/Surgical/Gyn
|
|
2
|
OB
|
|
3
|
Pediatric
|
|
4
|
Psychiatric
|
|
5
|
Hospice
|
|
6
|
Detoxification
|
|
7
|
Oncology
|
|
8
|
Rehabilitation
|
|
9
|
Other
|
|
014X
|
Private (Deluxe)
|
|
|
Deluxe rooms are accommodations with amenities
substantially in excess of those provided to other patients.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Medical/Surgical/Gyn
|
|
2
|
OB
|
|
3
|
Pediatric
|
|
4
|
Psychiatric
|
|
5
|
Hospice
|
|
6
|
Detoxification
|
|
7
|
Oncology
|
|
8
|
Rehabilitation
|
|
9
|
Other
|
|
015X
|
Room and Board Ward (Medical or General)
|
|
|
Routine service charge for accommodations
with five or more beds.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Medical/Surgical/Gyn
|
|
2
|
OB
|
|
3
|
Pediatric
|
|
4
|
Psychiatric
|
|
5
|
Hospice
|
|
6
|
Detoxification
|
|
7
|
Oncology
|
|
8
|
Rehabilitation
|
|
9
|
Other
|
|
016X
|
Other Room and Board
|
|
|
Any routine service charges for accommodations
that cannot be included in the more specific revenue center codes.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
4
|
Sterile
Environment
|
|
7
|
Self
Care
|
|
9
|
Other
|
|
017X
|
Nursery
|
|
|
Accommodation charges for nursing care to
newborn and premature infants in nurseries.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Newborn
- Level I
|
|
2
|
Premature
- Level II
|
|
3
|
Neonatal
(Intermediate Care) - Level III
|
|
4
|
Neonatal
ICU - Level IV
|
|
9
|
Other
|
|
018X
|
Leave of Absence
|
|
|
Charges for holding a room while the patient
is temporarily away from the provider.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
2
|
Patient
Convenience
|
|
3
|
Therapeutic
Leave
|
|
4
|
RESERVED
(Effective 04/01/2004)
|
|
5
|
Hospitalization
|
|
9
|
Other
Leave of Absence
|
|
019X
|
Subacute Care
|
|
|
Accommodation charges for subacute care to
inpatients in hospitals or skilled nursing facilities.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Subacute
Care - Level I (Skilled Care)
|
|
2
|
Subacute
Care - Level II (Comprehensive Care)
|
|
3
|
Subacute
Care - Level III (Complex Care)
|
|
4
|
Subacute
Care - Level IV (Intensive Care)
|
|
9
|
Other
Subacute Care
|
|
020X
|
Intensive Care
|
|
|
Routine service charge for medical or surgical
care provided to patients who require a more intensive level of
care than is rendered in the general medical or surgical unit.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Surgical
|
|
2
|
Medical
|
|
3
|
Pediatric
|
|
4
|
Psychiatric
|
|
6
|
Intermediate
- ICU
|
|
7
|
Burn
Care
|
|
8
|
Trauma
|
|
9
|
Other
Intensive Care
|
|
021X
|
Coronary Care
|
|
|
Routine service charge for medical care provided
to patients with coronary illness who require a more intensive level
of care than is rendered in the general medical care unit.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Myocardial
Infarction
|
|
2
|
Pulmonary
Care
|
|
3
|
Heart
Transplant
|
|
4
|
Intermediate
- CCU
|
|
9
|
Other
Coronary Care
|
|
022X
|
Special Charges
|
|
|
Charges incurred during an inpatient stay
or on a daily basis for certain services.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Admission
Charge
|
|
2
|
Technical
Support Charge
|
|
3
|
U.R.
Service Charge
|
|
4
|
Late
Discharge, Medically Necessary
|
|
9
|
Other
Special Charges
|
|
023X
|
Incremental Nursing Charge Rate
|
|
|
Charge for nursing service assessed in addition
to room and board.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Nursery
|
|
2
|
OB
|
|
3
|
ICU
|
|
4
|
CCU
|
|
5
|
Hospice
|
|
9
|
Other
|
|
024X
|
All Inclusive Ancillary
|
|
|
A flat rate charge incurred on either a daily
basis or total stay basis for ancillary services only.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Basic
|
|
2
|
Comprehensive
|
|
3
|
Speciality
|
|
9
|
Other
All Inclusive Ancillary
|
|
025X
|
Pharmacy
|
|
|
Charges for medication produced, manufactured,
packaged, controlled, assayed, dispensed and distributed under the
direction of licensed pharmacist.
|
|
Subcategory
|
|
0
|
General
classification
|
|
1
|
Generic
Drugs
|
|
2
|
Non-Generic
Drugs
|
|
3
|
Take
Home Drug
|
|
4
|
Drugs
Incident to Other Diagnostic Services
|
|
5
|
Drugs
Incident to Radiology
|
|
6
|
Experimental
Drugs
|
|
7
|
Non-Prescription
|
|
8
|
IV
Solutions
|
|
9
|
Other
Pharmacy
|
|
026X
|
IV Therapy
|
|
|
Equipment charge or administration of intravenous
solution by specially trained personnel to individuals requiring
such treatment. This code should be used only when a discrete service
unit exists.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Infusion
Pump
|
|
2
|
IV
Therapy/Pharmacy Services
|
|
3
|
IV
Therapy/Drug/Supply Delivery
|
|
4
|
IV
Therapy/Supplies
|
|
9
|
Other
IV Therapy
|
|
027X
|
Medical/Surgical Supplies and Devices
|
|
|
Charges for supply items required for patient
care.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Non-Sterile
Supply
|
|
2
|
Sterile
Supply
|
|
3
|
Take
Home Supplies
|
|
4
|
Prosthetic/Orthotic
Devices
|
|
5
|
Pacemaker
|
|
6
|
Intraocular
Lens
|
|
7
|
Oxygen
- Take Home
|
|
8
|
Other
Implants
|
|
9
|
Other
Supplies/Devices
|
|
028X
|
Oncology
|
|
|
Charges for the treatment of tumors and related
diseases.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Oncology
|
|
029X
|
Durable Medical Equipment (other than
renal)
|
|
|
Charge for medical equipment that can withstand
repeated use (excluding renal equipment).
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Rental
|
|
2
|
Purchase
of New DME
|
|
3
|
Purchase
of Used DME
|
|
4
|
Supplies/Drugs
for DME Effectiveness (Home Health Agency [HHA] Only)
|
|
9
|
Other
Equipment
|
|
030X
|
Laboratory
|
|
|
Charges for the performance of diagnostic
and routine clinical laboratory tests.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Chemistry
|
|
2
|
Immunology
|
|
3
|
Renal
Patient (home)
|
|
4
|
Non-Routine
Dialysis
|
|
5
|
Hematology
|
|
6
|
Bacteriology
& Microbiology
|
|
7
|
Urology
|
|
9
|
Other
Laboratory
|
|
031X
|
Laboratory Pathological
|
|
|
Charges for diagnostic and routine laboratory
tests on tissues and culture.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Cytology
|
|
2
|
Histology
|
|
4
|
Biopsy
|
|
9
|
Other
Laboratory Pathological
|
|
032X
|
Radiology - Diagnostic
|
|
|
Charges for diagnostic radiology services
provided for the examination and care of patients. Includes: taking,
processing, examining and interpreting radiographs and fluorographs.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Angiocardiography
|
|
2
|
Arthrography
|
|
3
|
Arteriography
|
|
4
|
Chest
X-Ray
|
|
9
|
Other
Radiology - Diagnostic
|
|
033X
|
Radiology - Therapeutic
|
|
|
Charges for therapeutic radiology services
and chemotherapy are required for care and treatment of patients.
Includes therapy by injection or ingestion of radioactive substances.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Chemotherapy
- Injected
|
|
2
|
Chemotherapy
- Oral
|
|
3
|
Radiation
Therapy
|
|
5
|
Chemotherapy
- IV
|
|
9
|
Other
Radiology - Therapeutic
|
|
034X
|
Nuclear Medicine
|
|
|
Charges for procedures, tests, and radiopharmaceuticals
provided by a department handling radioactive materials as required
for diagnosis and treatment of patients.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Diagnostic
Procedures
|
|
2
|
Therapeutic
Procedures
|
|
3
|
Diagnostic
Radiopharmaceuticals (Effective 10/01/2004)
|
|
4
|
Therapeutic
Radiopharmaceuticals (Effective 10/01/2004)
|
|
9
|
Other
Nuclear Medicine
|
|
035X
|
CT Scan
|
|
|
Charges for computed tomographic scans of
the head and other parts of the body.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Head
Scan
|
|
2
|
Body
Scan
|
|
9
|
Other
CT Scan
|
|
036X
|
Operating Room Services
|
|
|
Charges for services provided to patients
by specially trained nursing personnel who provide assistance to
physicians in the performance of surgical and related procedures
during and immediately following surgery.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Minor
Surgery
|
|
2
|
Organ
Transplant - Other than Kidney
|
|
7
|
Kidney
Transplant
|
|
9
|
Other
Operating Room Services
|
|
037X
|
Anesthesia
|
|
|
Charges for anesthesia services in the hospital.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Anesthesia
Incident to Radiology
|
|
2
|
Anesthesia
Incident to Other Diagnostic Services
|
|
4
|
Acupuncture
|
|
9
|
Other
Anesthesia
|
|
038X
|
Blood
|
|
|
Charges for blood must be separately identified
for private payer purposes.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Packed
Red Cells
|
|
2
|
Whole
Blood
|
|
3
|
Plasma
|
|
4
|
Platelets
|
|
5
|
Leukocytes
|
|
6
|
Other
Components
|
|
7
|
Other
Derivatives (Cryoprecipitates)
|
|
9
|
Other
Blood
|
|
039X
|
Blood and Blood Component Administration,
Storage and Processing
|
|
|
Charges for the storage and processing of
whole blood.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Blood
Administration (e.g., Transfusions)
|
|
2
|
Blood
Storage
|
|
9
|
Other
Blood Storage and Processing
|
|
040X
|
Other Imaging Services
|
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Diagnostic
Mammography
|
|
2
|
Ultrasound
|
|
3
|
Screening
Mammography
|
|
4
|
Positron
Emission Tomography
|
|
9
|
Other
Imaging Services
|
|
041X
|
Respiratory Services
|
|
|
Charges for administration of oxygen and
certain potent drugs through inhalation or positive pressure and
other forms of rehabilitative therapy through measurement of inhaled
and exhaled gases and analysis of blood and evaluation of the patient’s
ability to exchange oxygen and other gases.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
2
|
Inhalation
Services
|
|
3
|
Hyperbaric
Oxygen Therapy
|
|
9
|
Other
Respiratory Services
|
|
042X
|
Physical Therapy
|
|
|
Charges for therapeutic exercises, massage
and utilization of effective properties of light, heat, cold, water,
electricity, and assistive devices for diagnosis and rehabilitation
of patients who have neuromuscular, orthopedic and other disabilities.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
3
|
Group
Rate
|
|
4
|
Evaluation
or Re-Evaluation
|
|
9
|
Other
Physical Therapy
|
|
043X
|
Occupational Therapy
|
|
|
Services provided by a qualified occupational
therapy practitioner for therapeutic interventions to improve, sustain
or restore an individual’s level of function in performance of activities
of daily living and work, including: therapeutic activities; therapeutic
exercises; sensorimotor processing; psychosocial skills training;
cognitive retraining; fabrication and application of orthotic devices;
and training in the use of orthotic and prosthetic devices; adaptation
of environments; and application of physical agent modalities.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
3
|
Group
Rate
|
|
4
|
Evaluation
or Re-Evaluation
|
|
9
|
Other
Occupational Therapy
|
|
044X
|
Speech - Language Pathology
|
|
|
Charges for services provided to persons
with impaired functional communication skills.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
3
|
Group
Rate
|
|
4
|
Evaluation
or Re-Evaluation
|
|
9
|
Other
Speech - Language Pathology
|
|
045X
|
Emergency Room
|
|
|
Charges for emergency treatment to those
ill and injured persons who require immediate unscheduled medical
or surgical care.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Emergency
Medical Treatment & Active Labor Act (EMTALA) Emergency Medical
Screening Services
|
|
2
|
ER
Beyond EMTALA Screening
|
|
6
|
Urgent
Care
|
|
9
|
Other
Emergency Room
|
|
046X
|
Pulmonary Function
|
|
|
Charges for tests that measure inhaled and
exhaled gases and analysis of blood and for tests that evaluate
the patient’s ability to exchange oxygen and other gases.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Pulmonary Function
|
|
047X
|
Audiology
|
|
|
Charges for the detection and management
of communication handicaps centering in whole or in part on the
hearing function.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Diagnostic
|
|
2
|
Treatment
|
|
9
|
Other
Audiology
|
|
048X
|
Cardiology
|
|
|
Charges for cardiac procedures rendered in
a separate unit within the hospital. Such procedures include, but
are not limited to: heart catheterization, coronary angiography,
Swan-Ganz catheterization, and exercise stress test.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Cardiac
Cath Lab
|
|
2
|
Stress
Test
|
|
3
|
Echocardiology
|
|
9
|
Other
Cardiology
|
|
049X
|
Ambulatory Surgical Care
|
|
|
Charges for ambulatory surgery which are
not covered by other categories.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Ambulatory Surgical Care
|
|
050X
|
Outpatient Services
|
|
|
Outpatient charges for services rendered
to an outpatient who is admitted as an inpatient before midnight
of the day following the date of service.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Outpatient Services
|
|
051X
|
Clinic (to be submitted on Non-Institutional
TED)
|
|
|
Clinic (non-emergency/scheduled outpatient
visit) charges for providing diagnostic, preventive, curative, rehabilitative,
and education services on a scheduled basis to ambulatory patients.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Chronic
Pain Center
|
|
2
|
Dental
Clinic
|
|
3
|
Psychiatric
Clinic
|
|
4
|
OB-GYN
Clinic
|
|
5
|
Pediatric
Clinic
|
|
6
|
Urgent
Care Clinic
|
|
7
|
Family
Practice Clinic
|
|
9
|
Other
Clinic
|
|
052X
|
Free-Standing Clinic (to be submitted
on Non-Institutional TED)
|
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Rural
Health Clinic (RHC)/Federally Qualified Health Center (FQHC)
|
|
2
|
RHC/FQHC
- Home
|
|
3
|
Family
Practice Clinic
|
|
4
|
RHC/FQHC
(SNF Stay Covered in Part A)
|
|
5
|
RHC/FQHC
(SNF Stay Not Covered in Part A)
|
|
6
|
Urgent
Care Clinic
|
|
7
|
RHC/FQHC
Visiting Nurse Service - Home
|
|
8
|
RHC/FQHC
Visit To Other Site
|
|
9
|
Other
Free-Standing Clinic
|
|
053X
|
Osteopathic Services (to be submitted
on Non-Institutional TED)
|
|
|
Charges for a structural evaluation of the
cranium, entire cervical, dorsal and lumbar spine by a doctor of osteopathy.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Osteopathic
Therapy
|
|
9
|
Other
Osteopathic Services
|
|
054X
|
Ambulance (to be submitted on Non-Institutional
TED)
|
|
|
Charges for ambulance service, usually on
an unscheduled basis to the ill and injured who require immediate
medical attention.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Supplies
|
|
2
|
Medical
Transport
|
|
3
|
Heart
Mobile
|
|
4
|
Oxygen
|
|
5
|
Air
Ambulance
|
|
6
|
Neonatal
Ambulance Service
|
|
7
|
Pharmacy
|
|
8
|
Telephone
Transmission EKG
|
|
9
|
Other
Ambulance
|
|
055X
|
Skilled Nursing
|
|
|
Charges for nursing services that must be
provided under the direct supervision of a licensed nurse to assure
the safety of the patient and to achieve the medically desired result.
This code may be used for nursing home services, Comprehensive Outpatient
Rehabilitation Facilities (CORFs), or a service charge for home
health billing.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
9
|
Other
Skilled Nursing
|
|
056X
|
Medical Social Services
|
|
|
Charges for services such as counseling patients,
interviewing patients, and interpreting problems of social situation
rendered to patients on any basis.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
9
|
Other
Medical Social Services
|
|
057X
|
Home Health Aide (Home Health)
|
|
|
Charges made by a home health agency for
personnel that are primarily responsible for the personal care of
the patient.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
9
|
Other
Home Health Aide
|
|
058X
|
Other Visits (Home Health)
|
|
|
Charges by a home health agency for visits
other than physical therapy, occupational therapy or speech therapy,
which must be specifically identified.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
3
|
Assessment
|
|
9
|
Other
Home Health Visit
|
|
059X
|
Units of Service (Home Health)
|
|
|
Revenue code used by a home health agency
that bills on the basis of units of service.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Home
Health Other Units (Terminated 10/01/2007)
|
|
060X
|
Oxygen (Home Health)
|
|
|
Charges by a home health agency for oxygen
equipment supplies or contents, excluding purchased equipment.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Oxygen
- Stat. Equip/Supply or Cont.
|
|
2
|
Oxygen
- Stat. Equip/Supply Under 1 LPM
|
|
3
|
Oxygen
- Stat. Equip/Over 4 LPM
|
|
4
|
Oxygen
- Portable Add-On
|
|
9
|
Other
Oxygen
|
|
061X
|
Magnetic Resonance Technology (MRT)
|
|
|
Charges for Magnetic Resonance Imaging (MRI)
and Magnetic Resonance Angiography (MRA) of the Brain and other
parts of the body
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
MRI
- Brain (including brainstem)
|
|
2
|
MRI
- Spinal Cord (including spine)
|
|
4
|
MRI
- Other
|
|
5
|
MRA
- Head and Neck
|
|
6
|
MRA
- Lower Extremities
|
|
8
|
MRA
- Other
|
|
9
|
Other
MRT
|
|
062X
|
Medical/Surgical Supplies and Devices
- Other
|
|
|
Charges for supply items required for patient
care. The category is an extension of 027X for reporting additional
breakdown where needed. Subcode 1 is for providers that cannot bill
supplies used for radiology procedures under radiology. Subcode
2 is for providers that cannot bill supplies used for other diagnostic
procedures.
|
|
Subcategory
|
|
1
|
Supplies
Incident to Radiology
|
|
2
|
Supplies
Incident to Other Diagnostic Service
|
|
3
|
Surgical
Dressings
|
|
4
|
FDA
Investigational Devices
|
|
063X
|
Pharmacy
|
|
|
Charges for medication produced, manufactured,
package, controlled, assayed, dispensed and distributed under the
direction of a licensed pharmacist. The category is an extension
of 025X for reporting addition breakdown where needed.
|
|
Subcategory
|
|
1
|
Single
Source Drug
|
|
2
|
Multiple
Source Drug
|
|
3
|
Restrictive
Prescription
|
|
4
|
Erythropoietin
(EPO) Less than 10,000 Units
|
|
5
|
Erythropoietin
(EPO) 10,000 or More Units
|
|
6
|
Drugs
Requiring Detailed Coding (Blood Clotting Factor Only)
(Note: Detail is not required for TRICARE.)
|
|
7
|
Self-Administrable
Drugs
|
|
064X
|
Home IV Therapy Services
|
|
|
Charge for intravenous drug therapy services
which are performed in the patient’s residence. For Home IV providers
the HCPCS code must be entered for all equipment, and all types
of covered therapy.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Non-Routine
Nursing, Central Line
|
|
2
|
IV
Site Care, Central Line
|
|
3
|
IV
Site/Change, Peripheral Line
|
|
4
|
Non-Routine
Nursing, Peripheral Line
|
|
5
|
Training
Patient/Caregiver, Central Line
|
|
6
|
Training,
Disabled Patient, Central Line
|
|
7
|
Training,
Patient/Caregiver Peripheral Line
|
|
8
|
Training,
Disabled Patient, Peripheral Line
|
|
9
|
Other
IV Therapy Services
|
|
065X
|
Hospice Service
|
|
|
Charges for hospice care services for a terminally
ill patient if he elects these services in lieu of other services
for the terminal condition.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Routine
Home Care
|
|
2
|
Continuous
Home Care
|
|
5
|
Inpatient
Respite Care
|
|
6
|
General
Inpatient Care (non-respite)
|
|
7
|
Physician
Services
|
|
8
|
Hospice
Room & Board Nursing Facility
|
|
9
|
Other
Hospice Services
|
|
066X
|
Respite Care
|
|
|
Charges for hours of care under the Respite
Care Benefit for services of a homemaker or home health aide, personal
care services, and nursing care provided by a licensed professional
nurse.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Hourly
Charge/Nursing
|
|
2
|
Hourly
Charge/Home Health Aide/Home Maker/Companion
|
|
3
|
Daily
Respite Charge
|
|
9
|
Other
Respite Care
|
|
067X
|
Outpatient Special Residence Charges
|
|
|
Residence arrangements for patients requiring
continuous outpatient care.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Hospital-Based
|
|
2
|
Contracted
|
|
9
|
Other
Special Residence Charges
|
|
068X
|
Trauma Response
|
|
|
Charge for a trauma team activation.
|
|
Subcategory
|
|
1
|
Level
I
|
|
2
|
Level
II
|
|
3
|
Level
III
|
|
4
|
Level
IV
|
|
9
|
Other
Trauma Response
|
|
069X
|
Pre-Hospice
|
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Visit
Charge
|
|
2
|
Hourly
Charge
|
|
3
|
Evaluation
|
|
4
|
Consultation
and Education
|
|
5
|
Inpatient
Care
|
|
6
|
Physician
Services
|
|
7
|
RESERVED
|
|
8
|
RESERVED
|
|
9
|
Other
Pre-Hospice/Palliative
|
|
070X
|
Cast Room
|
|
|
Charges for services related to the application,
maintenance and removal of casts.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Cast Room (Terminated 10/01/2007)
|
|
071X
|
Recovery Room
|
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Recovery Room (Terminated 10/01/2007)
|
|
072X
|
Labor Room/Delivery
|
|
|
Charges for labor and delivery room services
provided by specially trained nursing personnel to patients including
prenatal care during labor, assistance during delivery, postnatal
care in the recovery room, and minor gynecologic procedures if they
are performed in the delivery suite.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Labor
|
|
2
|
Delivery
|
|
3
|
Circumcision
|
|
4
|
Birthing
Center
|
|
9
|
Other
Labor Room/Delivery
|
|
073X
|
EKG/ECG (Electrocardiogram)
|
|
|
Charges for operation of specialized equipment
to record electromotive variations in actions of the heart muscle
on an electrocardiography for diagnosis of heart ailments.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Holter
Monitor
|
|
2
|
Telemetry
|
|
9
|
Other
EKG/ECG
|
|
074X
|
EEG (Electroencephalogram)
|
|
|
Charges for operation of specialized equipment
to measure impulse frequencies and differences in electrical potential
in various areas of the brain to obtain data for use in diagnosing
brain disorders.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
EEG (Terminated 10/01/2007)
|
|
075X
|
Gastro-intestinal Services
|
|
|
Procedure room charges for endoscopic procedures
not performed in the operating room.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Gastro-intestinal (Terminated 10/01/2007)
|
|
076X
|
Treatment or Observation Room
|
|
|
Charges for the use of a treatment room;
or for the room charge associated with outpatient observation services.
Observation services are those services
furnished by a hospital on the hospital’s premises, including use of
a bed and periodic monitoring by a hospital’s nursing or other staff,
which are reasonable and necessary to evaluate an outpatient’s condition
or determine the need for a possible admission to the hospital as
an inpatient. Such services are covered only when provided by the
order of a physician or another individual authorized by State licensure
law and hospital staff bylaws to admit patients to the hospital
or order outpatient tests. The reason for observation must be stated
in the orders for observation. Payers should establish written guidelines
which identify coverage of observation.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Treatment
Room
|
|
2
|
Observation
Room
|
|
9
|
Other
Treatment/Observation Room
|
|
077X
|
Preventive Care Services
|
|
|
Revenue Code used to capture preventive services
established by payers.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Vaccine
Administration
|
|
9
|
Other
(Terminated 10/01/2007)
|
|
078X
|
Telemedicine
|
|
|
Facility telemedicine charges related to
a three year Medicare demonstration project commencing
10/01/1996.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Telemedicine (Terminated 10/01/2007)
|
|
079X
|
Lithotripsy
|
|
|
Extra-corporeal Shockwave Therapy (formerly
Lithotripsy).
|
|
Subcategory
|
|
0
|
General
Classification
|
|
9
|
Other
Lithotripsy (Terminated 10/01/2007)
|
|
080X
|
Inpatient Renal Dialysis
|
|
|
A waste removal process performed in an inpatient
setting, that uses an artificial kidney when the body’s own kidneys
have failed. The waste may be removed directly from the blood (hemodialysis)
or indirectly from the blood by flushing a special solution between
the abdominal covering and the tissue (peritoneal dialysis).
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Inpatient
Hemodialysis
|
|
2
|
Inpatient
Peritoneal (non-CAPD)
|
|
3
|
Inpatient
Continuous Ambulatory Peritoneal Dialysis (CAPD)
|
|
4
|
Inpatient
Continuous Cycling Peritoneal Dialysis (CCPD)
|
|
9
|
Other
Inpatient Dialysis
|
|
081X
|
Acquisition of Stem Cell and Body Components
|
|
|
The acquisition and storage costs of body
tissue, bone marrow, organs and other components not otherwise identified
used for transplantation.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Living
Donor
|
|
2
|
Cadaver
Donor
|
|
3
|
Unknown
Donor
|
|
4
|
Unsuccessful
Organ Search - Donor Bank Charges
|
|
5
|
Cadaver
Donor - Heart (Terminated 10/01/2000)
|
|
5
|
Allogeneic
Stem Cell Acquisition Services (Effective 01/01/2017)
|
|
6
|
Other
Heart Acquisition (Terminated 10/01/2000)
|
|
7
|
Donor
- Liver (Terminated 10/01/2000)
|
|
9
|
Other
Donor
|
|
082X
|
Hemodialysis - Outpatient or Home (To
be submitted on Non-Institutional TED)
|
|
|
A waste removal process, performed in an
outpatient or home setting, necessary when the body’s own kidneys
have failed. Waste is removed directly from the blood.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Hemodialysis/Composite
or Other Rate
|
|
2
|
Home
Supplies
|
|
3
|
Home
Equipment
|
|
4
|
Maintenance/100%
|
|
5
|
Support
Services
|
|
9
|
Other
Outpatient Hemodialysis
|
|
083X
|
Peritoneal Dialysis - Outpatient or
Home (to be submitted on Non-Institutional TED)
|
|
|
A waste removal process, performed in an
outpatient or home setting, necessary when the body’s own kidneys
have failed. Waste is removed indirectly by flushing a special solution
between the abdominal covering and the tissue.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Peritoneal/Composite
or Other Rate
|
|
2
|
Home
Supplies
|
|
3
|
Home
Equipment
|
|
4
|
Maintenance/100%
|
|
5
|
Support
Services
|
|
9
|
Other
Outpatient Peritoneal Dialysis
|
|
084X
|
Cont. Ambulatory Peritoneal Dialysis
(CAPD) - Outpatient or Home (To be submitted on Non-Institutional
TED)
|
|
|
A continuous dialysis process performed in
an outpatient or home setting which uses the patient peritoneal
membrane as a dialyzer.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
CAPD/Composite
or Other Rate
|
|
2
|
Home
Supplies
|
|
3
|
Home
Equipment
|
|
4
|
Maintenance/100%
|
|
5
|
Support
Services
|
|
9
|
Other
Outpatient CAPD
|
|
085X
|
Cont. Cycling Peritoneal Dialysis (CCPD)
- Outpatient or Home (to be submitted on Non-Institutional TED)
|
|
|
A continuous dialysis process performed in
an outpatient or home setting which uses a machine to make automatic
exchanges at night.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
CCPD/Composite
or Other Rate
|
|
2
|
Home
Supplies
|
|
3
|
Home
Equipment
|
|
4
|
Maintenance/100%
|
|
5
|
Support
Services
|
|
9
|
Other
Outpatient CCPD
|
|
086X
|
Magnetoencephalography (MEG)
|
|
|
An imaging technique that identifies brain
activity to pinpoint the source of seizures.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Magnetoencephalography
(MEG)
|
|
087X
|
Cell/Gene Therapy (Effective
01/01/2018)
|
|
|
Charges for procedures performed
by staff for the acquisition and infusion/injection of genetically modified
cells.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Cell
Collection
|
|
2
|
Specialized
Biologic Processing and Storage - Prior to Transport
|
|
3
|
Storage
and Processing after Receipt of Cells from Manufacturer
|
|
4
|
Infusion
of Modified Cells
|
|
5
|
Injection
of Modified Cells
|
|
6
|
RESERVED
|
|
7
|
RESERVED
|
|
8
|
RESERVED
|
|
9
|
RESERVED
|
|
088X
|
Miscellaneous Dialysis
|
|
|
Charges for dialysis services not identified
elsewhere.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Ultrafiltration
|
|
2
|
Home
Dialysis Aid Visit
|
|
9
|
Other
Miscellaneous Dialysis
|
|
089X
|
Pharmacy - Extension
of 025X and 063X (Effective 01/01/2018)
|
|
|
The category is an extension
of 025X and 063X for reporting additional breakdown where needed.
|
|
Subcategory
|
|
0
|
RESERVED (Use
0250 for General Classification)
|
|
1
|
Special
Processed Drugs - FDA Approved Cell (Charges for drugs and biologics
for modified cell therapy requiring specific identification as required
by the payer. If using a HCPCS to describe the drug, enter the HCPCS
code in the appropriate HCPCS column.)
|
|
2
|
RESERVED
|
|
3
|
RESERVED
|
|
4
|
RESERVED
|
|
5
|
RESERVED
|
|
6
|
RESERVED
|
|
7
|
RESERVED
|
|
8
|
RESERVED
|
|
9
|
RESERVED
|
|
090X
|
Behavioral Health Treatments/Services
|
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Electroshock
Treatment
|
|
2
|
Milieu
Therapy
|
|
3
|
Play
Therapy
|
|
4
|
Activity
Therapy
|
|
5
|
Intensive
Outpatient Services - Psychiatric (Effective 10/16/2003)
|
|
6
|
Intensive
Outpatient Services - Chemical Dependency (Effective 10/16/2003)
|
|
7
|
Community
Behavioral Health Program (Day Treatment) (Effective 10/16/2003)
|
|
8
|
RESERVED
for National Use (Effective 10/16/2003)
|
|
9
|
RESERVED
for National Use
|
|
091X
|
Behavioral
Health Treatments/Services
|
|
|
Subcategories 0912 and 0913 are designed
as zero-billed revenue codes (i.e., no dollars in the amount field)
to be used as vehicle to supply program information as defined in
the provider/payer contract.
|
|
Subcategory
|
|
0
|
RESERVED
for National Use
|
|
1
|
Rehabilitation
|
|
2
|
Partial
Hospitalization - Less Intensive
|
|
3
|
Partial
Hospitalization - Intensive
|
|
4
|
Individual
Therapy
|
|
5
|
Group
Therapy
|
|
6
|
Family
Therapy
|
|
7
|
Biofeedback
|
|
8
|
Testing
|
|
9
|
Other
Behavioral Health Treatments/Services
|
|
092X
|
Other Diagnostic Services
|
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Peripheral
Vascular Lab
|
|
2
|
Electromyogram
|
|
3
|
Pap
Smear
|
|
4
|
Allergy
Test
|
|
5
|
Pregnancy
Test
|
|
9
|
Other
Diagnostic Services
|
|
093X
|
Medical Rehabilitation Day Program
|
|
|
Medical rehabilitation services as contracted
with a payer and/or certified by the state. Services may include
physical therapy, occupational therapy and speech therapy.
|
|
Subcategory
|
|
1
|
Half
Day
|
|
2
|
Full
Day
|
|
094X
|
Other Therapeutic Services
|
|
|
Charges for other therapeutic services not
otherwise categorized.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Recreational
Therapy
|
|
2
|
Education/Training
|
|
3
|
Cardiac
Rehabilitation
|
|
4
|
Drug
Rehabilitation
|
|
5
|
Alcohol
Rehabilitation
|
|
6
|
Complex
Medical Equipment - Routine
|
|
7
|
Complex
Medical Equipment - Ancillary
|
|
8
|
Pulmonary
Rehabilitation
|
|
9
|
Other
Therapeutic Service
|
|
095X
|
Other
Therapeutic Services Extension of 094X
|
|
|
Subcategory
|
|
0
|
RESERVED for National Use
|
|
1
|
Athletic
Training
|
|
2
|
Kinesiotherapy
|
|
096X
|
Professional Fees
|
|
|
Charges
for medical professionals that the hospitals or third party payers
required to be separately identified on the billing form.
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Psychiatric
|
|
2
|
Ophthalmology
|
|
3
|
Anesthesiologist
(MD)
|
|
4
|
Anesthetist
(CRNA)
|
|
9
|
Other
Professional Fees
|
|
097X
|
Professional Fees (cont)
|
|
|
Subcategory
|
|
1
|
Laboratory
|
|
2
|
Radiology
- Diagnostic
|
|
3
|
Radiology
- Therapeutic
|
|
4
|
Radiology
- Nuclear Medicine
|
|
5
|
Operating
Room
|
|
6
|
Respiratory
Therapy
|
|
7
|
Physical
Therapy
|
|
8
|
Occupational
Therapy
|
|
9
|
Speech
Pathology
|
|
098X
|
Professional Fees (cont)
|
|
|
Subcategory
|
|
1
|
Emergency Room
|
|
2
|
Outpatient
Services
|
|
3
|
Clinic
|
|
4
|
Medical
Social Services
|
|
5
|
EKG
|
|
6
|
EEG
|
|
7
|
Hospital
Visit
|
|
8
|
Consultation
|
|
9
|
Private
Duty Nursing
|
|
099X
|
Patient
Convenience Items
|
|
|
Charges
for items that are generally considered by the third party payers
to be strictly convenience items and, as such, are not covered.
|
|
Subcategory
|
|
0
|
General Classification
|
|
1
|
Cafeteria/Guest
Tray
|
|
2
|
Private
Linen Service
|
|
3
|
Telephone/Telegraph
|
|
4
|
TV/Radio
|
|
5
|
Non-Patient
Room Rentals
|
|
6
|
Late
Discharge Charge
|
|
7
|
Admission
Kits
|
|
8
|
Beauty
Shop/Barber
|
|
9
|
Other
Patient Convenience Items
|
|
100X
|
Behavioral Health Accommodations
|
|
|
Routine
service charges incurred for accommodations at specified behavior
health facilities.
|
|
Subcategory
|
|
0
|
General
Classification (Effective 10/16/2003)
|
|
1
|
Residential
Treatment - Psychiatric (Effective 10/16/2003)
|
|
2
|
Residential
Treatment - Chemical Dependency (Effective 10/16/2003)
|
|
3
|
Supervised
Living (Effective 10/16/2003)
|
|
4
|
Halfway
House (Effective 10/16/2003)
|
|
5
|
Group
Home (Effective 10/16/2003)
|
|
6
|
Outdoor/Wilderness
Behavioral Health (Effective 07/01/2017)
|
|
101X TO 209X
|
RESERVED for National Assignment
|
|
210X
|
Alternative Therapy Services
|
|
|
Charges for therapies not elsewhere categorized
under other therapeutic service revenue codes (042X, 043X, 044X,
091X, 094X, 095X) or services such as anesthesia or clinic (0374,
0511).
|
|
Subcategory
|
|
0
|
General
Classification
|
|
1
|
Acupuncture
|
|
2
|
Acupressure
|
|
3
|
Massage
|
|
4
|
Reflexology
|
|
5
|
Biofeedback
|
|
6
|
Hypnosis
|
|
9
|
Other
Alternative Therapy Services
|
|
211X TO 309X
|
RESERVED for National Assignment
|
|
310X
|
Adult
Care
|
|
|
Charges for personal, medical, psycho-social,
and/or therapeutic services in a special community setting for adults
needing supervision and/or assistance with Activities of Daily Living
(ADLs).
|
|
Subcategory
|
|
0
|
Not
Used
|
|
1
|
Adult
Day Care, Medical and Social - Hourly
|
|
2
|
Adult
Day Care, Social - Hourly
|
|
3
|
Adult
Day Care, Medical and Social - Daily
|
|
4
|
Adult
Day Care, Social - Daily
|
|
5
|
Adult
Foster Care - Daily
|
|
9
|
Other
Adult Care
|
|
311X TO 999X
|
RESERVED for National Assignment
|