|
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 |
|
