REVENUE CODES CODE DESCRIPTION STANDARD ABBREVIATION 100 ALL INCLUSIVE RATE, ROOM AND BOARD PLUS ALL INCL R&B/ANC

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1 100 ALL INCLUSIVE RATE, ROOM AND BOARD PLUS ALL INCL R&B/ANC ANCILLARY 101 ALL INCLUSIVE ROOM AND BOARD ALL INCL R&B 110 ROOM AND BOARD, PRIVATE, ROOM-BOARD/PVT 111 MEDICAL/SURGICAL/GYNE MED-SUR-GY/PVT 112 OB OB/PVT 113 PEDIATRIC PEDS/PVT 114 PSYCHIATRIC PSYCH/PVT 115 HOSPICE HOSPICE/PVT 116 DETOXIFICATION DETOX/PVT 117 ONCOLOGY ONCOLOGY/PVT 118 REHABILITATION REHAB/PVT 119 OTHER OTHER/PVT 120 ROOM AND BOARD, SEMI-PRIVATE 2 BED, ROOM-BOARD/SEMI 121 MEDICAL/SURGICAL/GYNE MED-SUR-GY/2BED 122 OB OB/2BED 123 PEDIATRIC PEDS/2BED 124 PSYCHIATRIC PSTAY/2BED 125 HOSPICE HOSPICE/2BED 126 DETOXIFICATION DETOX/2BED 127 ONCOLOGY ONCOLOGY/2BED 128 REHABILITATION REHAB/2BED 129 OTHER OTHER/2BED 130 ROOM AND BOARD, SEMI-PRIVATE ROOM/BOARD/3&4BED 3-4 BEDS, 131 MEDICAL/SURGICAL/GYNE MED-SUR-GY/3&4 132 OB OB/3&4BED 133 PEDIATRIC PEDS/3&4BED 134 PSYCHIATRIC PSYCH/3&4BED 135 HOSPICE HOSPICE/3&4BED 136 DETOXIFICATION DETOX/3&4BED 137 ONCOLOGY ONCOLOGY/3&4BED 138 REHABILITATION REHAB/3&4BED 139 OTHER OTHER/3&4BED 140 ROOM AND BOARD, PRIVATE, DELUXE, ROOM BOARD/PVT/DLX 141 MEDICAL/SURGICAL/GYNE MED-SUR-GY/DLX 142 OB OB/DLX PAGE 1 OF 16

2 143 PEDIATRIC PEDS/DLX 144 PSYCHIATRIC PSYCH/DLX 145 HOSPICE HOSPICE/DLX 146 DETOXIFICATION DETOX/DLX 147 ONCOLOGY ONCOLOGY/DLX 148 REHABILITATION REHAB/DLX 149 OTHER OTHER/DLX 150 ROOM AND BOARD, WARD, ROOM-BOARD/WARD 151 MEDICAL/SURGICAL/GYNE MED-SUR-GY/WARD 152 OB OB/WARD 153 PEDIATRIC PEDS/WARD 154 PSYCHIATRIC PSYCH/WARD 155 HOSPICE HOSPICE/WARD 156 DETOXIFICATION DETOX/WARD 157 ONCOLOGY ONCOLOGY/WARD 158 REHABILITATION REHAB/WARD 159 OTHER OTHER/WARD 160 ROOM AND BOARD, OTHER, R&B 164 STERILE ENVIRONMENT R&B/STERILE 167 SELF CARE R&B/SELF 169 OTHER R&B/OTHER 170 ROOM AND BOARD, NURSERY, NURSERY 171 NEWBORN - LEVEL I NURSERY/LEVEL I 172 PREMATURE - LEVEL II NURSERY/ LEVEL II 173 NEWBORN - LEVEL III NURSERY/LEVEL III 174 NEO-NATAL ICU - LEVEL IV NURSERY/LEVEL IV 179 OTHER NURSERY/OTHER 180 LEAVE OF ABSENCE, LEAVE OF ABSENCE OR LOA 181 RESERVED PATIENT CONVENIENCE LOA/PT CONV 183 THERAPEUTIC LEAVE LOA/THERAPEUTIC 184 RESERVED HOSPITALIZATION LOA/HOSPITALIZATION 189 OTHER LEAVE OF ABSENCE LOA/OTHER 190 SUBACUTE CARE, SUBACUTE 191 SUBACUTE CARE LEVEL I SUBACUTE / LEVEL I PAGE 2 OF 16

3 192 SUBACUTE CARE LEVEL II SUBACUTE / LEVEL II 193 SUBACUTE CARE LEVEL III SUBACUTE / LEVEL III 194 SUBACUTE CARE LEVEL IV SUBACUTE / LEVEL IV 199 OTHER SUBACUTE CARE SUBACUTE / OTHER 200 INTENSIVE CARE, INTENSIVE CARE/ICU 201 SURGICAL ICU/SURGICAL 202 MEDICAL ICU/MEDICAL 203 PEDIATRIC ICU PEDS 204 PSYCHIATRIC ICU/PSTAY 206 INTERMEDIATE ICU ICU/INTERMEDIATE 207 BURN CARE ICU/BURN CARE 208 TRAUMA ICU/TRAMA 209 OTHER INTENSIVE CARE ICU/OTHER 210 CORONARY CARE, CORONARY CARE/CCU 211 MYOCARDIAL INFARCTION CCU/MYO INFARC 212 PULMONARY CCU/PULMONARY 213 HEART TRANSPLANT CCU/TRANSPLANT 214 INTERMEDIATE CCU CCU/INTERMEDIATE 219 OTHER CORONARY CARE CCU/OTHER 220 SPECIAL CHARGES, SPECIAL CHARGES 221 ADMISSION CHARGE ADMIT CHARGE 222 TECHNICAL SUPPORT CHARGE TECH SUPPORT CHG 223 UTILIZATION REVIEW SERVICE CHARGE UR CHARGE 224 LATE DISCHARGE MEDICALLY NECESSARY LATE DISCH/MED NEC 229 OTHER SPECIAL CHARGES OTHER SPEC CHG 230 INCREMENTAL NURSING, NURSING INCREM 231 NURSERY NUR INCR/NURSERY 232 OB NUR INCR/OB 233 ICU NUR INCR/ICU 234 CCU NUR INCR/CCU 235 HOSPICE NUR INCR/HOSPICE 239 OTHER NUR INCR/OTHER 240 ALL INCLUSIVE ANCILLARY, ALL INCL ANCIL 241 ALL INCLUSIVE ANCILLARY - BASIC ALL INCL ANCIL/BASIC 242 AL INCLUSIVE ANCILLARY - COMPREHENSIVE ALL INCL ANCIL/COMP 243 ALL INCLUSIVE ANCILLARY - SPECIALTY ALL INCL ANCIL/SPEC PAGE 3 OF 16

4 249 OTHER INCLUSIVE ANCILLARY ALL INCL ANCIL/OTHER 250 PHARMACY, PHARMACY 251 GENERIC DRUGS DRUGS/GENERIC 252 NON-GENERIC DRUGS/NONGENERIC 253 TAKE HOME DRUGS DRUGS/TAKEHOME 254 DRUGS INCIDENT TO OTHER DIAGNOSTIC SERVICES DRUGS/INCIDNT OTHER DX 255 DRUGS INCIDENT TO RADIOLOGY DRUGS/INCIDENT RAD 256 EXPERIMENTAL DRUGS DRUGS/EXPERIMT 257 NON-PRESCRIPTION DRUGS DRGS/NONSCRPT 258 IV SOLUTIONS IV SOLUTIONS 259 OTHER PHARMACY DRGS/OTHER 260 IV THERAPY, IV THERAPY 261 INFUSION PUMP IV THER/INFSN PUMP 262 IV THERAPY/PHARMACY SERVICES IV THER/PHARM/SVC 263 IV THERAPY/DRUG/SUPPLY DELIVERY IV THER/DRUG/ SUPPLY DELV 264 IV THERAPY/SUPPLIES IV THER/SUPPLIES 269 OTHER IV THERAPY IV THERAPY/OTHER 270 MEDICAL/SURGICAL SUPPLIES DEVICES, MED-SUR SUPPLIES 271 NON-STERILE SUPPLY NON-STER SUPPLY 272 STERILE SUPPLY STERILE SUPPLY 273 TAKE HOME SUPPLIES TAKEHOME SUPPLY 274 PROSTHETIC/ORTHOTIC DEVICES PROSTH/ORTH DEV 275 PACEMAKER PACEMAKER 276 INTRAOCULAR LENS INTRA OC LENS 277 OXYGEN, TAKE HOME 02/TAKEHOME 278 OTHER IMPLANTS SUPPLY/IMPLANTS 279 OTHER SUPPLY/DEVICES SUPPLY/OTHER 280 ONCOLOGY, ONCOLOGY 289 OTHER ONCOLOGY ONCOLOGY/OTHER 290 DME (OTHER THAN RENAL), MED EQUIP/DURAB 291 RENTAL MED EQUIP/RENT 292 PURCHASE OF NEW DME MED EQUIP/NEW 293 PURCHASE OF USED DME MED EQUIP/USED 294 SUPPLIES/DRUGS FOR DME EFFECTIVENESS MED EQUIP/ SUPPLIES/DRUGS (HOME HEALTH AGENCY ONLY) 299 OTHER EQUIPMENT MED EQUIP/OTHER PAGE 4 OF 16

5 300 LABORATORY, LABORATORY OR (LAB) 301 CHEMISTRY LAB/CHEMISTRY 302 IMMUNOLOGY LAB/IMMUNOLOGY 303 RENAL PATIENT (HOME) LAB/RENAL HOME 304 NON-ROUTINE DIALYSIS LAB/NR DIALYSIS 305 HEMATOLOGY LAB/HEMATOLOGY 306 BACTERIOLOGY & MICROBIOLOGY LAB/BACT-MICRO 307 UROLOGY LAB/UROLOGY 309 OTHER LABORATORY LAB/OTHER 310 LABORATORY PATHOLOGICAL, PATHOLOGY LAB OR (PATH LAB) 311 CYTOLOGY PATHOL/CYTOLOGY 312 HISTOLOGY PATHOL/HYSTOL 314 BIOPSY PATHOL/BIOPSY 319 OTHER PATHOL/OTHER 320 RADIOLOGY DIAGNOSTIC, DX X-RAY 321 ANGIOCARDIOGRAPHY DX X-RAY/ANGIO 322 ARTHROGRAPHY DX X-RAY/ARTH 323 ARTERIOGRAPHY DX X-RAY/ARTER 324 CHEST X-RAY DX X-RAY/CHEST 329 OTHER DX X-RAY/OTHER 330 RADIOLOGY THERAPEUTIC AND/OR RX X-RAY CHEMOTHERAPY ADMINISTRATION, 331 CHEMOTHERAPY ADMINISTRATION-INJECTED CHEMOTHER/INJ 332 CHEMOTHERAPY ADMINISTRATION-ORAL CHEMOTHER/ORAL 333 RADIATION THERAPY RADIATION RX 335 CHEMOTHERAPY ADMINISTRATION-IV CHEMOTHERP-IV 339 OTHER RX X-RAY/OTHER 340 NUCLEAR MEDICINE, NUCLEAR MEDICINE OR (NUCMED) 341 DIAGNOSTIC NUC MED/DX 342 THERAPEUTIC NUC MED/RX 343 DIAGNOSTIC RADIOPHARMACEUTICALS NUC MED/DXRADIOPHARM 344 THERAPEUTIC RADIOPHARMACEUTICALS NUC MED/RXRAIIOPHARM 349 OTHER NUC MED/OTHER 350 CT SCAN, CT SCAN 351 HEAD SCAN CT SCAN/HEAD 352 BODY SCAN CT SCAN/BODY 359 OTHER CT SCANS CT SCAN/OTHER PAGE 5 OF 16

6 360 OPERATING ROOM SERVICES, OR SERVICES 361 MINOR SURGERY OR/MINOR 362 ORGAN TRANSPLANT-OTHER THAN KIDNEY OR/ORGAN TRANS 367 KIDNEY TRANSPLANT OR/KIDNEY TRANS 369 OTHER OPERATING ROOM SERVICES OR/OTHER 370 ANESTHESIA, ANESTHESIA 371 ANESTHESIA INCIDENT TO RADIOLOGY ANESTHE/INCIDENT RAD 372 ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC SERVICES ANESTHE/INCDNT OTHER DX 374 ACUPUNCTURE ANESTHE/ACUPUNC 379 OTHER ANESTHESIA ANESTHE/OTHER 380 BLOOD, BLOOD 381 PACKED RED CELLS BLOOD/PKD RED 382 WHOLE BLOOD BLOOD/WHOLE 383 PLASMA BLOOD/PLASMA 384 PLATELETS BLOOD/PLATELET 385 LEUKOCYTES BLOOD/LEUCOCYTES 386 OTHER COMPONENTS BLOOD/COMPONENTS 387 OTHER DERIVATIVES (CRYOPRECIPITATES) BLOOD/DERIVATIVES 389 OTHER BLOOD BLOOD OTHER 390 BLOOD AND BLOOD COMPONENT BLOOD/STOR-PROC ADMINISTRATION, PROCESSING, AND STORAGE, 391 BLOOD ADMINISTRATION (E.G., TRANSFUSIONS) BLOOD/ADMIN 399 OTHER BLOOD STORAGE & PROCESSING BLOOD/OTHER STOR 400 OTHER IMAGING SERVICES, IMAGE SERVICE 401 DIAGNOSTIC MAMMOGRAPHY DIAG MAMMOGRAPHY 402 ULTRASOUND ULTRASOUND 403 SCREENING MAMMOGRAPHY SCRN MAMMOGRAPHY 404 POSITRON EMISSION TOMOGRAPHY PET SCAN 409 OTHER IMAGING SERVICES OTHER IMAG SVS 410 RESPIRATORY SERVICES, RESPIRATORY SVC 412 INHALATION SERVICES INHALATION SVC 413 HYPERBARIC OXYGEN THERAPY HYPERBARIC OTHER RESPIRATORY SERVICES OTHER RESPIR SVS 420 PHYSICAL THERAPY, PHYSICAL THERP 421 VISIT CHARGE PHYS THERP/VISIT 422 HOURLY CHARGE PHYS THERP/HOUR PAGE 6 OF 16

7 423 GROUP RATE PHYS THERP/GROUP 424 EVALUATION OR RE-EVALUATION PHYS THERP/EVAL 429 OTHER PHYSICAL THERAPY OTHER PHYS THERP 430 OCCUPATIONAL THERAPY, OCCUPATION THER 431 VISIT CHARGE OCCUP THERP/VISIT 432 HOURLY RATE OCCUP THERP/HOUR 433 GROUP RATE OCCUP THERP/GROUP 434 EVALUATION OR RE-EVALUATION OCCUP THERP/EVAL 439 OTHER OCCUPATIONAL THERAPY OTHER OCCUP THER 440 SPEECH LANGUAGE PATHOLOGY, SPEECH PATHOL 441 VISIT CHARGE SPEECH PATH/VISIT 442 HOURLY RATE SPEECH PATH/HOUR 443 GROUP RATE SPEECH PATH/GROUP 444 EVALUATION OR RE-EVALUATION SPEECH PATH/EVAL 449 OTHER SPEECH-LANGUAGE PATHOLOGY OTHER SPEECH PAT 450 EMERGENCY ROOM, EMERG ROOM 451 EMTALA EMERGENCY MEDICAL SCREENING SERVICES ER/EMTALA 452 ER BEYOND EMTALA SCREENING SERVICES ER/BEYOND EMTALA 456 URGENT CARE URGENT CARE 459 OTHER EMERGENCY ROOM OTHER EMER ROOM 460 PULMONARY FUNCTION, PULMONARY FUNC 469 OTHER PULMONARY FUNCTION OTHER PULMON FUNC 470 AUDIOLOGY, AUDIOLOGY 471 DIAGNOSTIC AUDIOLOGY/DX 472 TREATMENT AUDIOLOGY/RX 479 OTHER AUDIOLOGY OTHER AUDIOL 480 CARDIOLOGY, (I.E., CORONARY ANGIOGRAPHY, SWAN-GANZ CATHETERIZATION) CARDIOLOGY 481 CARDIAC CATHETERIZATION LAB CARDIAC CATH LAB 482 STRESS TEST STRESS TEST 483 ECHOCARDIOLOGY ECHOCARDIOLOGY 489 OTHER CARDIOLOGY OTHER CARDIOL 490 AMBULATORY SURGICAL CARE, AMBUL SURG 499 OTHER AMBULATORY SURGICAL CARE OTHER AMBL SURG 500 OUTPATIENT SERVICES, OUTPATIENT SVS PAGE 7 OF 16

8 509 OTHER OUTPATIENT SERVICES OUTPATIENT/OTHER 510 CLINIC, CLINIC 511 CHRONIC PAIN CENTER CHRONIC PAIN CL 512 DENTAL CLINIC DENTAL CLINIC 513 PSYCHIATRIC CLINIC PSYCH CLINIC 514 OB-GYN CLINIC OB-GYN CLINIC 515 PEDIATRIC CLINIC PEDS CLINIC 516 URGENT CARE CLINIC URGENT CLINIC 517 FAMILY PRACTICE CLINIC FAMILY CLINIC 519 OTHER CLINIC OTHER CLINIC 520 FREE-STANDING CLINIC, FREESTAND CLINIC 521 RURAL HEALTH CLINIC RURAL/CLINIC 522 RURAL HEALTH HOME RURAL/HOME 523 FAMILY PRACTICE CLINIC FAMILY PRACTICE 526 URGENT CARE CLINIC URGENT CLINIC 529 OTHER FREESTANDING CLINIC OTHER FR/STD CLINIC 530 OSTEOPATHIC SERVICES, OSTEOPATH SVS 531 OSTEOPATHIC THERAPY OSTEOPATH RX 539 OTHER OSTEOPATHIC SERVICES OTHER OSTEOPATH 540 AMBULANCE, AMBULANCE 541 SUPPLIES AMBUL/SUPPLY 542 MEDICAL TRANSPORT AMBUL/MED TRANS 543 HEART MOBILE AMBUL/HEARTMOBL 544 OXYGEN AMBUL/OXY 545 AIR AMBULANCE AIR AMBULANCE 546 NEO-NATAL AMBULANCE SERVICES AMBUL/NEONAT 547 PHARMACY (AMBULANCE) AMBUL/PHARMACY 548 TELEPHONE TRANSMISSION EKG AMBUL/TELEPHONIC EKG 549 OTHER AMBULANCE OTHER AMBULANCE 550 SKILLED NURSING, SKILLED NURSING 551 VISIT CHARGE SKILLED NURS/VISIT 552 HOURLY CHARGE SKILLED NURS/HOUR 559 OTHER SKILLED NURSING SKILLED NURS/OTHER 560 MEDICAL SOCIAL SERVICES, MED SOCIAL SVS 561 VISIT CHARGE MED SOC SERVS/VISIT 562 HOURLY CHARGE MED SOC SERV/HOUR 569 OTHER MEDICAL SOCIAL SERVICES MED SOC SERV/OTHER PAGE 8 OF 16

9 570 HOME HEALTH AIDE, AID/HOME HEALTH 571 VISIT CHARGE AIDE/HOME HLTH/VISIT 572 HOURLY CHARGE AIDE/HOME HLTH/HOUR 579 OTHER HOME HEALTH AIDE AIDE/HOME HLTH/OTHER 580 OTHER VISITS (HOME HEALTH), VISIT/HOME HEALTH 581 VISIT CHARGE VISIT/HOME HLTH/VISIT 582 HOURLY CHARGE VISIT/HOME HLTH/HOUR 583 ASSESSMENT VISIT/HOME HLTH/ASSESS 589 OTHER HOME HEALTH VISITS VISIT/HOME HLTH/OTHER 590 UNITS OF SERVICE (HOME HEALTH), UNIT/HOME HEALTH 599 OTHER HOME HEALTH UNITS UNIT/HOME HLTH/OTHER 600 OXYGEN (HOME HEALTH), 02/HOME HEALTH 601 OXYGEN - STATE/EQUIP/SUPPL/OR CONT 02/STAT EQUIP/SUPPL/CONT 602 OXYGEN - STATE/EQUIP/SUPPL/UNDER 1 LPM (LITERS PER 02/STAT EQUIP/UNDER 1 LPM MINUTE) 603 OXYGEN - STATE/EQUIP/OVER 4 LPM (LITERS PER MINUTE) 02/STAT EQUIP/OVER 4 LPM 604 OXYGEN - PORTABLE ADD-ON 02/PORTABLE ADD-ON 609 OXYGEN - OTHER 02/OTHER 610 MAGNETIC RESONANCE TECHNOLOGY (MRT), MRT 611 MRI BRAIN (INCLUDING BRAINSTEM) MRI - BRAIN 612 MRI SPINAL CORD (INCLUDING SPINE) MRI - SPINE 613 RESERVED MRI OTHER MRI OTHER 615 MRA - HEAD AND NECK MRA - HEAD AND NECK 616 MRA - LOWER EXTREMITIES MRA - LOWER EXT 617 RESERVED MRA - OTHER MRA - OTHER 619 MRT OTHER MRT - OTHER 621 MEDICAL/SURGICAL SUPPLIES, MED-SUR SUPP/INCDNT RAD SUPPLIES INCIDENT TO RADIOLOGY 622 SUPPLIES INCIDENT TO OTHER DIAGNOSTIC SERVICES MED-SUR SUP/INCDNTODX 623 SURGICAL DRESSINGS SURG DRESSING 624 FDA INVESTIGATIONAL DEVICES FDA INVEST DEVICE 630 DRUGS REQUIRING SPECIFIC IDENTIFICATION (PHARMACY), DRUGS PAGE 9 OF 16

10 631 SINGLE SOURCE DRUG DRUG/SNGLE 632 MULTIPLE SOURCE DRUG DRUG/MULT 633 RESTRICTIVE PRESCRIPTION DRUG/RSTR 634 ERYTHROPOIETIN (EPO) LESS THAN 10,000 UNITS DRUG/EPO<10,000 UNITS 635 ERYTHROPOIETIN (EPO) 10,000 OR MORE UNITS DRUG/EPO>10,000 UNITS 636 DRUGS REQUIRING DETAILED CODING DRUGS/DETAIL CODE 637 SELF-ADMINISTERED DRUGS SELF ADMIN/DRUG 640 HOME IV THERAPY SERVICES, IV THERAPY SVC 641 NON-ROUTINE NURSING, CENTRAL LINE NON RT NURSING/CENTRAL 642 IV SITE CARE, CENTRAL LINE IV SITE CARE/CENTRAL 643 IV START/CHANGE, PERIPHERAL LINE IV STRT/CHNG/ PERIPHAL 644 NON-ROUTINE NURSING, PERIPHERAL LINE NONRT NURSING/PERIPHRL 645 TRAINING PATIENT/CAREGIVER, CENTRAL LINE TRNG PT/ CAREGVR/CENTRL 646 TRAINING DISABLED PATIENT, CENTRAL LINE TRNG DSBLPT/CENTRAL 647 TRAINING PATIENT/CAREGIVER, PERIPHERAL LINE TRNG/PT/ CAREGVR/PERIPHRL 648 TRAINING, DISABLED PATIENT, PERIPHERAL LINE TRNG/DSBLPAT/ PERIPHRL 649 OTHER IV THERAPY SERVICES OTHER IV THERAPY SVC 650 HOSPICE SERVICES, HOSPICE 651 ROUTINE HOME CARE HOSPICE/RTN HOME 652 CONTINUOUS HOME CARE HOSPICE/CTNS HOME 653 RESERVED RESERVED INPATIENT RESPITE CARE HOSPICE/IP RESPITE 656 INPATIENT CARE (NON-RESPITE) NON-RESPITE 657 PHYSICIAN SERVICES HOSPICE/PHYSICIAN 658 HOSPICE ROOM & BOARD NURSING FACILITY HOSPICE/R&B/NURS FAC 659 OTHER HOSPICE HOSPICE/OTHER 660 RESPITE CARE, RESPITE CARE 661 HOURLY CHARGE/NURSING RESPITE/NURSE 662 HOURLY CHARGE/AIDE/HOMEMAKER/COMPANION RESPITE/AIDE/ HMEMKR/COMP 663 DAILY RESPITE CHARGE RESPITE DAILY 669 OTHER RESPITE CARE RESPITE/OTHER 670 OUTPATIENT SPECIAL RESIDENCE CHARGES, OP SPEC RES 671 HOSPITAL BASED OP SPEC RES/HOSP BASED 672 CONTRACTED OP SPEC RES/CONTRACTED 679 OTHER SPECIAL RESIDENCE CHARGES OP SPEC RES/OTHER 680 TRAUMA RESPONSE, (THIS CODE IS NOT USED) -- PAGE 10 OF 16

11 681 LEVEL I TRAUMA/LEVEL I 682 LEVEL II TRAUMA/LEVEL II 683 LEVEL III TRAUMA/LEVEL III 684 LEVEL IV TRAUMA/LEVEL IV 689 OTHER TRAUMA RESPONSE TRAUMA/OTHER 700 CAST ROOM, CAST ROOM 709 OTHER CAST ROOM OTHER CAST ROOM 710 RECOVERY ROOM, RECOVERY ROOM 719 OTHER RECOVERY OTHER RECOV RM 720 LABOR ROOM/DELIVERY ROOM, DELIVEROOM/LABOR 721 LABOR LABOR 722 DELIVERY DELIVERY ROOM 723 CIRCUMCISION CIRCUMCISION 724 BIRTHING CENTER BIRTHING CENTER 729 OTHER LABOR ROOM/DELIVERY OTHER/DELIV-LABOR 730 EKG/ECG (ELECTROCARDIOGRAM), EKG/ECG 731 HOLTER MONITOR HOLTER MONT 732 TELEMETRY TELEMETRY 739 OTHER EKG/ECG OTHER EKG-ECG 740 EEG (ELECTROENCEPHALOGRAM), EEG ENG (ELECTRONYSTAGMOGRAM) DIAGNOSTIC SLEEP DISORDER STUDY 749 OTHER EEG OTHER EEG 750 GASTRO INTESTINAL SERVICES, GASTR-INST SVS 759 OTHER GASTRO-INTESTINAL OTHER GASTRO-INTS 760 TREATMENT OR OBSERVATION ROOM, TREATMENT/ OBSERVATION RM 761 TREATMENT ROOM TREATMENT RM 762 OBSERVATION ROOM OBSERVATION RM 769 OTHER TREATMENT/OBSERVATION ROOM OTHER TREAT/ OBSERV RM 770 PREVENTIVE CARE SERVICES, PREVENT CARE SVS 771 VACCINE ADMINISTRATION VACCINE ADMIN 779 OTHER OTHER PREVENT PAGE 11 OF 16

12 780 TELEMEDICINE, TELEMEDICINE 789 OTHER TELEMEDICINE TLELMEDICENE / OTHER 790 EXTRA CORPOREAL SHOCK WAVE THERAPY ESWT (FORMERLY LITHOTRIPSY), 799 OTHER ESWT ESWT/OTHER 800 INPATIENT RENAL DIALYSIS, RENAL DIALYSIS 801 INPATIENT HEMODIALYSIS DIALY/INPT/ 802 INPATIENT PERITONEAL (NON-CAPD) DIALY/INPT/PER 803 INPATIENT CONTINUOUS AMBULATORY DIALY/INPT/CAPD PERITONEAL DIALYSIS (CAPD) 804 INPATIENT CONTINUOUS CYCLING PERITONEAL DIALYSIS (CCPD) DIALY/INPT/CCPD 809 OTHER INPATIENT DIALYSIS DIALY/INPT/OTHER 810 ACQUISITION OF BODY COMPONENTS, ORGAN ACQUISIT 811 LIVING DONOR LIVING DONOR 812 CADAVER DONOR CADAVER/DONOR 813 UNKNOWN DONOR UNKNOWN DONOR 814 UNSUCCESSFUL ORGAN SEARCH DONER BANK CHARGES UNSUCCESSFUL SEARCH 819 OTHER DONOR OTHER DONOR 820 HEMODIALYSIS OUTPATIENT OR HOME, HEMO/OP OR HOME 821 HEMODIALYSIS/COMPOSITE OR OTHER RATE HEMO/COMPOSITE 822 HOME SUPPLIES HEMO/HOME/SUPPL 823 HOME EQUIPMENT HEMO/HOME/EQUIP 824 MAINTENANCE/100% (HOME) HEMO/HOME/100% 825 SUPPORT SERVICES (HOME) HEMO/HOME/ SUPSERV 829 OTHER OUTPATIENT HEMODIALYSIS (HOME) HEMO/HOME/OTHER 830 PERITONEAL DIALYSIS OUTPATIENT OR HOME, PERITONEAL/OP OR HOME 831 PERITONEAL/COMPOSITE OR OTHER RATE PERTNL/COMPOSITE 832 HOME SUPPLIES PERTNL/HOME/SUPPL 833 HOME EQUIPMENT PERTNL/HOME/EQUIP 834 MAINTENANCE/100% (HOME) PERTNL/HOME/100% 835 SUPPORT SERVICE (HOME) PERTNL/HOME/ SUPSERV 839 OTHER OUTPATIENT PERITONEAL DIALYSIS (HOME) PERTNL/HOME/OTHER PAGE 12 OF 16

13 840 CONTINUOUS AMBULATORY PERITONEAL CAPD/OP OR HOME DIALYSIS (CAPD) OUTPATIENT OR HOME, 841 CAPD/COMPOSITE OR OTHER RATE CAPD/COMPOSITE 842 HOME SUPPLIES CAPD/HOME/SUPPL 843 HOME EQUIPMENT CAPD/HOME/EQUIP 844 MAINTENANCE/100% (HOME) CAPD/HOME/100% 845 SUPPORT SERVICES (HOME) CAPD/HOME/SUPSERV 849 OTHER OUTPATIENT CAPD (HOME) CAPD/HOME/OTHER 850 CONTINUOUS CYCLING PERITONEAL CCPD/OP OR HOME DIALYSIS (CCPD) OUTPATIENT OR HOME, 851 CCPD/COMPOSITE OR OTHER RATE CCPD/COMPOSITE 852 HOME SUPPLIES CCPD/HOME/SUPPL 853 HOME EQUIPMENT CCPD/HOME/EQUIP 854 MAINTENANCE/100% (HOME) CCPD/HOME/100% 855 SUPPORT SERVICES (HOME) CCPD/HOME/SUPSERV 859 OTHER OUTPATIENT CCPD (HOME) CCPD/HOME/OTHER 880 MISCELLANEOUS DIALYSIS, DIALY/MISC 881 ULTRAFILTRATION DIALY/ULTRAFILT 882 HOME DIALYSIS AID VISIT HOME DIALYSISAID VISIT 889 MISC. DIALYSIS OTHER DIALY/MISC/OTHER 890 OTHER DONOR BANK, NOW RESERVED FOR NATIONAL ASSIGNMENT 891 BONE NOW RESERVED FOR NATIONAL ASSIGNMENT 892 ORGAN (OTHER THAN KIDNEY) NOW RESERVED FOR NATIONAL ASSIGNMENT 893 SKIN NOW RESERVED FOR NATIONAL ASSIGNMENT 899 OTHER DONOR BANK NOW RESERVED FOR NATIONAL ASSIGNMENT 900 BEHAVIORAL HEALTH BH TREATMENTS/SERVICES, 901 ELECTROSHOCK TREATMENT ELECTRO SHOCK 902 MILIEU THERAPY MILIEU THERAPY 903 PLAY THERAPY PLAY THERAPY 904 ACTIVITY THERAPY ACTIVITY THERAPY PAGE 13 OF 16

14 905 INTENSIVE OUTPATIENT SERVICES, CHEMICAL BH/INTENS OP/PSYCH DEPENDENCY 906 INTENSIVE OUTPATIENT SERVICES, CHEMICAL DEPENDENCY 907 COMMUNITY BEHAVIORAL HEALTH PROGRAM, DAY TREATMENT BH/INTENS OP/CHEM DEP BH/COMMUNITY 908 RESERVED OTHER BH/OTHER PSYCH RX 910 BEHAVIORAL HEALTH PSYCH SERVICES TREATMENTS/SERVICES, 911 REHABILITATION BH/PSYCH/REHAB 912 PARTIAL HOSPITALIZATION, LESS INTENSIVE BH/PSYCH/PARTIAL /LESS INTENSIVE 913 PARTIAL HOSPITALIZATION, INTENSIVE BH/PSYCH/PARTIAL/INTENSIVE 914 INDIVIDUAL THERAPY BH/PSYCH/INDIV RX 915 GROUP THERAPY BH/PSYCH/GROUP RX 916 FAMILY THERAPY BH/PSYCH/FAMILY RX 917 BIOFEEDBACK BH/PSYCH/BIOFEED 918 TESTING BH/PSYCH/TESTING 919 OTHER BH/PSYCH/OTHER 920 OTHER DIAGNOSTIC SERVICES, OTHER DX SVS 921 PERIPHERAL VASCULAR LAB PERI VASCUL LAB 922 ELECTROMYOGRAM EMG 923 PAP SMEAR PAP SMEAR 924 ALLERGY TEST ALLERGY TEST 925 PREGNANCY TEST PREG TEST 929 OTHER DIAGNOSTIC SERVICES ADDITIONAL DX SVS 931 MEDICAL REHABILITATION DAY PROGRAM, HALF DAY HALF DAY 932 FULL DAY FULL DAY 940 OTHER THERAPEUTIC SERVICES, OTHER RX SVS 941 RECREATIONAL THERAPY RECREATION RX 942 EDUCATION/TRAINING EDUC/TRAINING 943 CARDIAC REHABILITATION CARDIAC REHAB 944 DRUG REHABILITATION DRUG REHAB 945 ALCOHOL REHABILITATION ALCOHOL REHAB 946 COMPLEX MEDICAL EQUIPMENT-ROUTINE CMPLX MED EQUIP-ROUT 947 COMPLEX MEDICAL EQUIPMENT-ANCILLARY CMPLX MED EQUIP-ANC 949 OTHER THERAPEUTIC SERVICES ADDITIONAL RX SVS PAGE 14 OF 16

15 950 OTHER THERAPEUTIC SERVICES 951 ATHLETIC TRAINING ATHLETIC TRAINING 952 KINESIOTHERAPY KINESIOTHERAPY 960 PROFESSIONAL FEES, PRO FEE 961 PSYCHIATRIC PRO FEE/PSYCH 962 OPTHALMOLOGY PRO FEE/EYE 963 ANESTHESIOLOGIST (MD) PRO FEE/ANES MD 964 ANESTHETIST (CRNA) PRO FEE/ANES CRNA 969 OTHER PROFESSIONAL FEES OTHER PRO FEE 971 PROFESSIONAL FEES, LAB PRO FEE/LAB 972 RADIOLOGY-DIAGNOSTIC PRO FEE/RAD/DX 973 RADIOLOGY-THERAPEUTIC PRO FEE/RAD/RX 974 RADIOLOGY-NUCLEAR MEDICINE PRO FEE/NUC/MED 975 OPERATING ROOM PRO FEE/OR 976 RESPIRATORY THERAPY PRO FEE/RESPIR 977 PHYSICAL THERAPY PRO FEE/PHYSI 978 OCCUPATIONAL THERAPY PRO FEE/OCCUPA 979 SPEECH PATHOLOGY PRO FEE/SPEECH 981 PROFESSIONAL FEES, EMERGENCY ROOM PRO FEE/ER 982 OUTPATIENT SERVICES PRO FEE/OUTPT 983 CLINIC PRO FEE/CLINIC 984 MEDICAL SOCIAL SERVICES PRO FEE/SOC SVC 985 EKG PRO FEE/EKG 986 EEG PRO FEE/EEG 987 HOSPITAL VISIT PRO FEE/HOS VIS 988 CONSULTATION PRO FEE/CONSULT 989 PRIVATE DUTY NURSE FEE/PVT NURSE 990 PATIENT CONVENIENCE ITEMS, PT CONVENIENCE 991 CAFETERIA / GUEST TRAY CAFETERIA 992 PRIVATE LINEN SERVICE LINEN 993 TELEPHONE/TELEGRAPH TELEPHONE 994 TV/RADIO TV/RADIO 995 NON-PATIENT ROOM RENTALS NONPT ROOM RENT 996 LATE DISCHARGE CHARGE LATE DISCHARGE 997 ADMISSION KITS ADMIT KITS 998 BEAUTY SHOP/BARBER BARBER/BEAUTY 999 OTHER PATIENT CONVENIENCE ITEMS PT CONVENCE/OTH PAGE 15 OF 16

16 1000 BEHAVIORAL HEALTH ACCOMMODATIONS BH R&B 1001 RESIDENTIAL TREATMENT-PSYCHIATRIC BH R&B/PSYCH 1002 RESIDENTIAL TREATMENT-CHEMICAL DEPENDENCY BH R&B/CHEM DEP 1003 SUPERVISED LIVING BH R&B/SUP LIVING 1004 HALFWAY HOUSE BH R&B/HALFWAY HOUSE 1005 GROUP HOME BH R&B/GROUP HOME 2100 ALTERNATIVE THERAPY SERVICES, ALTTHERAPY 2101 ACUPUNCTURE ACUPUNCTURE 2102 ACUPRESSURE ACUPRESSURE 2103 MASSAGE MASSAGE 2104 REFLEXOLOGY REFLEXOLOGY 2105 BIOFEEDBACK BIOFEEDBACK 2106 HYPNOSIS HYPNOSIS 2109 OTHER ALTERNATIVE THERAPY SERVICES OTHER ALTTHERAPY 3100 ADULT CARE, NOT IN USE 3101 ADULT DAY CARE/MEDICAL AND SOCIAL/HOURLY ADULT MED/SOC HR 3102 ADULT DAY CARE/SOCIAL/HOURLY ADULT SOC HR 3103 ADULT DAY CARE/MEDICAL AND SOCIAL/DAILY ADULT MED/SOC DAY 3104 ADULT DAY CARE/SOCIAL/DAILY ADULT SOC DAY 3105 ADULT FOSTER CARE/DAILY ADULT FOSTER DAY 3109 OTHER ADULT CARE OTHER ADULT PAGE 16 OF 16

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