|
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
|