0001 | Total Charges |
001X | Reserved for internal payer use |
002X | Health Insurance Prospective Payment System (HIPPS) - 0020-0021 Reserved
- 0022 - Skilled Nursing Facility (SNF) PPS
- 0023 - Home Health PPS
- 0024 - Inpatient Rehabilitation Facility (IRF) PPS
- 0025-0029 - Reserved
|
003X-009X | |
010X | All-inclusive Rate - 0100 - All inclusive room and board plus ancillary
- 0101 - All inclusive room and board
|
011X | Room and Board Private (one bed) - 0110 - General
- 0111 - Medical/Surgical/GYN
- 0112 - OB
- 0113 - Pediatric
- 0114 - Psychiatric
- 0115 - Hospice
- 0116 - Detoxification
- 0117 - Oncology
- 0118 - Rehabilitation
- 0119 - Other
|
012X | Room and Board Semiprivate (two beds) - 0120 - General
- 0121 - Medical/Surgical/GYN
- 0122 - OB
- 0123 - Pediatric
- 0124 - Psychiatric
- 0125 - Hospice
- 0126 - Detoxification
- 0127 - Oncology
- 0128 - Rehabilitation
- 0129 - Other
|
013X | Room and Board (3 and 4 beds) - 0130 - General
- 0131 - Medical/Surgical/GYN
- 0132 - OB
- 0133 - Pediatric
- 0134 - Psychiatric
- 0135 - Hospice
- 0136 - Detoxification
- 0137 - Oncology
- 0138 - Rehabilitation
- 0139 - Other
|
014X | Room and Board Deluxe Private - 0140 - General
- 0141 - Medical/Surgical/GYN
- 0142 - OB
- 0143 - Pediatric
- 0144 - Psychiatric
- 0145 - Hospice
- 0146 - Detoxification
- 0147 - Oncology
- 0148 - Rehabilitation
- 0149 - Other
|
015X | Room and Board Ward - 0150 - General
- 0151 - Medical/Surgical/GYN
- 0152 - OB
- 0153 - Pediatric
- 0154 - Psychiatric
- 0155 - Hospice
- 0156 - Detoxification
- 0157 - Oncology
- 0158 - Rehabilitation
- 0159 - Other
|
016X | Other Room and Board - 0160 - General
- 0164 - Sterile
- 0167 - Self-care
- 0169 - Other
|
017X | Nursery - 0170 - General
- 0171 - Newborn Level I
- 0172 - Newborn Level II
- 0173 - Newborn Level III
- 0174 - Newborn Level IV
- 0179 - Other
|
018X | Leave of Absence - 0180 - General
- 0182 - Patience convenience - charges billable
- 0183 - Therapeutic leave
- 0185 - Nursing home (for hospitalization)
- 0189 - Other
|
019X | Subacute Care - 0190 - General
- 0191 - Level I
- 0192 - Level II
- 0193 - Level III
- 0194 - Level IV
- 0199 - Other
|
020X | Intensive Care Unit - 0200 - General
- 0201 - Surgical
- 0202 - Medical
- 0203 - Pediatric
- 0204 - Psychiatric
- 0206 - Intermediate ICU
- 0207 - Burn Care
- 0208 - Trauma
- 0209 - Other
|
021X | Coronary Care Unit - 0210 - General
- 0211 - Myocardial Infarction
- 0212 - Pulmonary Care
- 0213 - Heart Transplant
- 0214 - Intermediate CCU
- 0219 - Other
|
022X | Special Charges - 0220 - General
- 0221 - Admission Charge
- 0222 - Technical Support Charge
- 0223 - UR Service Charge
- 0224 - Late Discharge - Medically Necessary
- 0229 - Other
|
023X | Incremental Nursing Charge - 0230 - General
- 0231 - Nursery
- 0232 - OB
- 0233 - ICU
- 0234 - CCU
- 0235 - Hospice
- 0239 - Other
|
024X | All-inclusive Ancillary - 0240 - General
- 0241 - Basic
- 0242 - Comprehensive
- 0243 - Specialty
- 0249 - Other
|
025X | Pharmacy - 0250 - General
- 0251 - Generic drugs
- 0252 - Nongeneric drugs
- 0253 - Take-home drugs
- 0254 - Drugs incident to Other diagnostic services
- 0255 - Drugs incident to radiology
- 0256 - experimental drugs
- 0257 - Nonprescription
- 0258 - IV solutions
- 0259 - Other
|
026X | IV Therapy - 0260 - General
- 0261 - Infusion pump
- 0262 - Pharmacy services
- 0263 - Drug/supply delivery
- 0264 - Supplies
- 0269 - Other
|
027X | Medical/Surgical Supplies and Devices - 0270 - General
- 0271 - Nonsterile
- 0272 - Sterile
- 0273 - Take-home supplies
- 0274 - Prosthetic/orthotic devices
- 0275 - Pacemaker
- 0276 - Intracular lens
- 0277 - Take-home oxygen
- 0278 - Other implants
- 0279 - Other
|
028X | Oncology - 0280 - General
- 0289 - Other
|
029X | Durable Medical Equipment (Other than Renal) - 0290 - General
- 0291 - Rental
- 0292 - Purchase of new DME
- 0293 - Purchase of used DME
- 0294 - Supplies/Drugs for DME
- 0299 - Other
|
030X | Laboratory - 0300 - General
- 0301 - Chemistry
- 0302 - Immunology
- 0303 - Renal patient (home)
- 0304 - Nonroutine dialysis
- 0305 - Hematology
- 0306 - Bacteriology and Microbiology
- 0307 - Urology
- 0309 - Other
|
031X | Laboratory Pathology - 0310 - General
- 0311 - Cytology
- 0312 - Histology
- 0314 - Biopsy
- 0319 - Other
|
032X | Radiology Diagnostic - 0320 - General
- 0321 - Angiocardiography
- 0322 - Arthrography
- 0323 - Arteriography
- 0324 - Chest X-ray
- 0329 - Other
|
033X | Radiology Therapeutic and/of Chemotherapy Administration - 0330 - General
- 0331 - Chemotherapy administration - injection
- 0332 - Chemotherapy administration - oral
- 0333 - Radiation therapy
- 0335 - Chemotherapy administration - IV
- 0339 - Other
|
034X | Nuclear Medicine - 0340 - General
- 0341 - Diagnostic
- 0342 - Therapeutic
- 0343 - Diagnostic radiopharmaceuticals
- 0344 - Therapeutic radiopharmaceuticals
- 0349 - Other
|
035X | CT Scan - 0350 - General
- 0351 - Head scan
- 0352 - Body scan
- 0359 - Other
|
036X | Operating Room Services - 0360 - General
- 0361 - Minor surgery
- 0362 - Organ transplant - other than kidney
- 0367 - Kidney transplant
- 0369 - Other
|
037X | Anesthesia - 0370 - General
- 0371 - Incident to radiology
- 0372 - incident to Other Diagnostic services
- 0374 - Acupuncture
- 0379 - Other
|
038X | Blood and Blood Products - 0380 - General
- 0381 - Packed red cells
- 0382 - Whole blood and blood products
- 0383 - Plasma
- 0384 - Platelets
- 0385 - Leukocytes
- 0386 - Other components
- 0387 - Other derivatives (cryoprecipitates)
- 0389 - Other
|
039X | Administration, Processing and Storage for Blood and Blood Components - 0390 - General
- 0391 - Administration (e.g., transfusions)
- 0392 - Processing and storage
- 0399 - Other processing and storage
|
040X | Other Imaging Services - 0400 - General
- 0401 - Diagnostic mammography
- 0402 - Ultrasound
- 0403 - Screening mammography
- 0404 - Positron Emission Tomography
- 0409 - Other
|
041X | Respiratory Services - 0410 - General
- 0412 - Inhalation services
- 0413 - Hyperbaric oxygen therapy
- 0419 - Other
|
042X | Physical Therapy - 0420 - General
- 0421 - Visit charge
- 0422 - Hourly charge
- 0423 - Group rate
- 0424 - Evaluation or reevaluation
- 0429 - Other
|
043X | Occupational Therapy - 0430 - General
- 0431 - Visit charge
- 0432 - Hourly charge
- 0433 - Group rate
- 0434 - Evaluation or reevaluation
- 0439 - Other
|
044X | Speech Therapy Language Pathology - 0440 - General
- 0441 - Visit charge
- 0442 - Hourly charge
- 0443 - group rate
- 0444 - Evaluation or reevaluation
- 0449 - Other
|
045X | Emergency Room - 0450 - General
- 0451 - EMTALA emergency medical screening services
- 0452 - ER beyond EMTALA screening
- 0456 - Urgent care
- 0459 - Other
|
046X | Pulmonary Function - 0460 - General
- 0469 - Other
|
047X | Audiology - 0470 - General
- 0471 - Diagnostic
- 0472 - Treatment
- 0479 - Other
|
048X | Cardiology - 0480 - General
- 0481 - Cardiac cath lab
- 0482 - Stress test
- 0483 - Echocardiology
- 0489 - Other
|
049X | Ambulatory Surgical Care - 0490 - General
- 0499 - Other
|
050X | Outpatient Services - 0500 - General
- 0509 - Other
|
051X | Clinic - 0510 - General
- 0511 - Chronic pain center
- 0512 - Dental clinic
- 0513 - Psychiatric clinic
- 0514 - OB/GYN clinic
- 0515 - Pediatric clinic
- 0516 - Urgent care clinic
- 0517 - Family practice clinic
- 0519 - Other
|
052X | Freestanding Clinic - 0520 - General
- 0521 - Clinic visit by member to RHC/FQHC
- 0522 - Home visit by RHC/FQHC practitioner
- 0523 - Family practice clinic
- 0524 - Visit by RHC/FQHC practitioner to member in a Part A covered stay in SNF
- 0525 - Visit by RHC/FQHC practitioner to member in a stay not covered by Part A in a
- SNF, NF or ICF MR or other residential facility
- 0526 - Urgent care clinic
- 0527 - Visiting nurse services to member's home in a home health shortage area
- 0528 - Visit by RHC/FQHC practitioner to other non-RHC/FQHC site (e.g., scene of accident)
- 0529 - Other
|
053X | Osteopathic Services - 0530 - General
- 0531 - Osteopathic therapy
- 0539 - Other
|
054X | Ambulance - 0540 - General
- 0541 - Supplies
- 0542 - Medical transport
- 0543 - Heart mobile
- 0544 - Oxygen
- 0545 - Air ambulance
- 0546 - Neonatal ambulance
- 0547 - Pharmacy
- 0548 - EKG transmission
- 0549 - Other
|
055X | Skilled Nursing - 0550 - General
- 0551 - Visit charge
- 0552 - Hourly charge
- 0559 - Other
|
056X | Home Health Medical Social Services - 0560 - General
- 0561 - Visit charge
- 0562 - Hourly charge
- 0569 - Other
|
057X | Home Health Aide - 0570 - General
- 0571 - Visit charge
- 0572 - Hourly charge
- 0579 - Other
|
058X | Home Health Other Visits - 0580 - General
- 0581 - Visit charge
- 0582 - Hourly charge
- 0583 - Assessment
- 0589 - Other
|
059X | Home Health Units of Service |
060X | Home Health Oxygen - 0600 - General
- 0601 - Stat/Equip/Supply or contents
- 0602 - Stat/Equip/Supply Under 1 LPM
- 0603 - Stat/Equip Over 4 LPM
- 0604 - Portable Add-on
- 0609 - Other
|
061X | Magnetic Resonance Technology (MRT) - 0610 - General
- 0611 - Brain/brain stem
- 0612 - Spinal cord/spine
- 0614 - Other MRI
- 0615 - Head and neck
- 0616 - Lower extremities
- 0618 - Other MRA
- 0619 - Other MRT
|
062X | Medical/Surgical Supplies - Extension of 027X - 0621 - Incident to Radiology
- 0622 - Incident to Other Diagnostic services
- 0623 - Surgical Dressings
- 0624 - FDA investigational devices
|
063X | Pharmacy - Extension of 025X - 0631 - Single source drug
- 0632 - Multiple source drug
- 0633 - Restrictive prescription
- 0634 - Erythropoietin (EPO) less than 10,000 units
- 0635- Erythropoietin (EPO) 10,000 or more units
- 0636 - Drugs requiring detailed coding
- 0637 - Self-administerable drugs
|
064X | Home IV Therapy Services - 0640 - General
- 0641 - Nonroutine nursing, central line
- 0642 - IV site care, central line
- 0643 - IV start/care, peripheral line
- 0644 - Nonroutine nursing, peripheral line
- 0645 - Training patient/caregiver, central line
- 0646 - Training disabled patient, central line
- 0647 - Training patient/caregiver, peripheral line
- 0648 - Training disabled patient, peripheral line
- 0649 - Other
|
065X | Hospice Service - 0650 - General
- 0651 - Routine home care
- 0652 - Continuous home care
- 0655 - Inpatient respite care
- 0656 - General inpatient care (nonrespite)
- 0657 - Physician services
- 0658 - Hospice room and board - nursing facility
- 0659 - Other
|
066X | Respite Care - 0660 - General
- 0661 - Hourly charge/nursing
- 0662 - Hourly charge/aide/homemaker/companion
- 0663 - daily respite charge
- 0669 - Other
|
067X | Outpatient Special Residence Charges - 0670 - General
- 0671 - Hospital owned
- 0672 - Contracted
- 0679 - Other
|
068X | Trauma Response - 0681 - Level I
- 0682 - Level II
- 0683 - Level III
- 0684 - Level IV
- 0689 - Other
|
069X | |
070X | Cast Room |
071X | Recovery Room |
072X | Labor Room/Delivery - 0720 - General
- 0721 - Labor
- 0722 - Delivery
- 0723 - Circumcision
- 0724 - Birthing center
- 0729 - Other
|
073X | EKG/ECG Electrocardiogram - 0730 - General
- 0731 - Holter monitor
- 0732 - Telemetry
- 0739 - Other
|
074X | EEG Electroencephalogram |
075X | Gastrointestinal Services |
076X | Specialty Services - 0760 - General
- 0761 - Treatment room
- 0762 - Observation hours
- 0769 - Other
|
077X | Preventive Services - 0770 - General
- 0771 - Vaccine administration
|
078X | Telemedicine |
079X | Extra-Corporeal Shock Wave Therapy (formerly Lithotripsy) |
080X | Inpatient Renal Dialysis - 0800 - General
- 0801 - Inpatient hemodialysis
- 0802 - Inpatient peritoneal (non-CAPD)
- 0803 - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD)
- 0804 - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)
- 0809 - Other
|
081X | Acquisition of Body Components - 0810 - General
- 0811 - Living donor
- 0812 - Cadaver donor
- 0813 - Unknown donor
- 0814 - Unsuccessful organ search - donor bank charges
- 0819 - Other
|
082X | Hemodialysis - Outpatient or Home - 0820 - General
- 0821 - Composite or other rate
- 0822 - Home supplies
- 0823 - Home equipment
- 0824 - Maintenance/100%
- 0825 - Support Services
- 0829 - Other
|
083X | Peritoneal Dialysis - Outpatient or Home - 0830 - General
- 0831 - Composite or other rate
- 0832 - Home supplies
- 0833 - Home equipment
- 0834 - Maintenance/100%
- 0835 - Support Services
- 0839 - Other
|
084X | Continuous Ambulatory Peritoneal Dialysis (CAPD)- Outpatient or Home - 0840 - General
- 0841 - Composite or other rate
- 0842 - Home supplies
- 0843 - Home equipment
- 0844 - Maintenance/100%
- 0845 - Support Services
- 0849 - Other
|
085X | Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - 0850 - General
- 0851 - Composite or other rate
- 0852 - Home supplies
- 0853 - Home equipment
- 0854 - Maintenance/100%
- 0855 - Support Services
- 0859 - Other
|
086X | Magnetoencephalography - 0860 - General
- 0861 - MEG
|
087X | |
088X | Miscellaneous Dialysis - 0880 - General
- 0881 - Ultrafiltration
- 0882 - Home dialysis aid visit
- 0889 - Other
|
089X | |
090X | Behavioral Health Treatments/Services (also see 091X, and extension of 090X) - 0900 - General
- 0901 - Electroshock
- 0902 - Milieu therapy
- 0903 - Play therapy
- 0904 - Activity therapy
- 0905 - Intensive outpatient services - psychiatric
- 0906 - Chemical dependency
- 0907 - Community behavioral health program - day treatment
|
091X | Behavioral Health Treatments/Services - Extension of 090X - 0911 - Rehabilitation
- 0912 - Partial hospitalization - less intensive
- 0913 - Partial hospitalization - intensive
- 0914 - Individual therapy
- 0915 - Group therapy
- 0916 - Family therapy
- 0917 - Biofeedback
- 0918 - Testing
- 0919 - Behavioral health treatments
|
092X | Other Diagnostic Services - 0920 - General
- 0921 - Peripheral vascular lab
- 0922 - Electromyelogram
- 0923 - Pap smear
- 0924 - Allergy test
- 0925 - Pregnancy test
- 0929 - Other
|
093X | Medical Rehabilitation Day Program - 0931 - Half day
- 0932 - Full day
|
094X | Other Therapeutic Services - See alos 095X - 0940 - General
- 0941 - Recreational
- 0942 - Education/training
- 0943 - Cardiac rehabilitation
- 0944 - Drug rehabilitation
- 0945 - Alcohol rehabilitation
- 0946 - Complex medical equipment - routine
- 0947 - Complex medical equipment - ancillary
- 0948 - Pulmonary rehabilitation
- 0949 - Other
|
095X | Other Therapeutic Services (Extension of 094X) - 0951 - Athletic training
- 0952 - Kinesiotherapy
|
096X | Professional Fees - 0960 - General
- 0961 - Psychiatric
- 0962 - Ophthalmology
- 0963 - Anesthesiologist (MD)
- 0964 - Anesthesiologist (CRNA)
- 0969 - Other
|
097x | Professional Fees (Extension of 096X) - 0971 - Laboratory
- 0972 - Radiology - diagnostic
- 0973 - Radiology - therapeutic
- 0974 - Nuclear medicine
- 0975 - Operating room
- 0976 - Respiratory therapy
- 0977 - Physical therapy
- 0978 - Occupational therapy
- 0979 - Speech pathology
|
098X | Professional Fees (Extension of 096X and 097X) - 0981 - Emergency room
- 0982 - Outpatient services
- 0983 - Clinic
- 0984 - Medical social services
- 0985 - EKG
- 0986 - EEG
- 0987 - Hospital visit
- 0988 - Consultation
- 0989 - Private-duty nurse
|
099X | Patient Convenience Items - 0990 - General
- 0991 - Cafeteria/guest tray
- 0992 - Private linen service
- 0993 - Telephone/telegraph
- 0994 - TV/radio
- 0995 - Nonpatient room rentals
- 0996 - Late discharge charge
- 0997 - Admission kits
- 0998 - Beauty shop/barber
- 0999 - Other
|
100X | Behavioral Health Accommodations - 1000 - General
- 1001 - Residential treatment - psychiatric
- 1002 - Residential treatment - chemical dependency
- 1003 - Supervised living
- 1004 - Halfway House
- 1005 - Group Home
|
101X-209X | |
210X | Alternative Therapy Services - 2100 - General
- 2101 - Acupuncture
- 2102 - Acupressure
- 2103 - Massage
- 2104 - Reflexology
- 2105 - Biofeedback
- 2106 - Hypnosis
- 2109 - Other
|
211x - 300X | |
310X | Adult Care - 3101 - adult daycare, medical and social - hourly
- 3102 - Adult daycare, social - hourly
- 3103 - Adult daycare, medical and social - daily
- 3104 - Adult daycare, social - daily
- 3105 - Adult foster care - daily
- 3109 - Other
|
311X-999X | |