|
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
|
|
1
|
Room & Board/Hospital
at Home
|
|
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
|