Grouping Revenue Code Description

Transcription

1 Pharmacy 250 General Classification Pharmacy 251 Generic Drugs Pharmacy 252 Non-Generic Drugs Pharmacy 254 Drugs incident to other Diagnostic Services Pharmacy 255 Drugs incident to Radiology Pharmacy 257 Non-prescription Pharmacy 258 IV Solutions Pharmacy 259 Other Pharmacy IV Therapy 260 General Classification IV Therapy 261 Infusion Pump IV Therapy 262 IV Therapy/Pharmacy Services IV Therapy 263 IV Therapy/Drug/Supply Delivery IV Therapy 264 IV Therapy/Supplies IV Therapy 269 Other IV Therapy Oncology 280 General Classification Oncology 289 Other Oncology Laboratory 300 General Classification Laboratory 301 Chemistry Laboratory 302 Immunology Laboratory 304 Non-Routine Dialysis Laboratory 305 Hematology Laboratory 306 Bacteriology & Microbiology Laboratory 307 Urology Laboratory 309 Other Laboratory Laboratory Pathology 310 General Classification Laboratory Pathology 311 Cytology Laboratory Pathology 312 Histology Laboratory Pathology 314 Biopsy Laboratory Pathology 319 Other: Laboratory Pathology Diagnostic 320 General Classification Diagnostic 321 Angiocardiography Diagnostic 322 Arthrography Diagnostic 323 Arteriography Diagnostic 324 Chest X-ray 1

2 Diagnostic 329 Other Diagnostic Therapeutic 330 General Classification Therapeutic 331 Chemotherapy - Injected Therapeutic 332 Chemotherapy - Oral Therapeutic 333 Radiation Therapy Therapeutic 335 Chemotherapy - IV Therapeutic 339 Other: Therapeutic Nuclear Medicine 340 General Classification Nuclear Medicine 341 Diagnostic Nuclear Medicine 342 Therapeutic Nuclear Medicine 349 Other CT Scan 350 General Classification CT Scan 351 Head Scan CT Scan 352 Body Scan CT Scan 359 Other CT Scan Operating Room Services 360 General Classification Operating Room Services 361 Minor Surgery Anesthesia 370 General Classification Anesthesia 371 Anesthesia Incident to Radiology Anesthesia 372 Anesthesia Incident to Services Anesthesia 379 Other Anesthesia Blood 380 General Classification Blood 381 Packed Red Cells Blood 382 Whole Blood Blood 383 Plasma Blood 384 Platelets Blood 385 Leucocytes Blood 386 Other components Blood 387 Other Derivatives (Cryopricipitates) Blood 389 Other Blood 2

3 Services 400 General Classification Services 401 Diagnostic Mammography Services 402 Ultrasound Services 403 Screening Mammography Services 404 Postron Emission Tomography Services 409 Services Respiratory Services 410 General Classification Respiratory Services 412 Inhalation Services Respiratory Services 413 Hyperbaric Oxygen Therapy Respiratory Services 419 Other Respiratory Services Physical Therapy 420 General Classification Physical Therapy 421 Visit Charge Physical Therapy 423 Group Rate Physical Therapy 424 Evaluation or Re-evaluation Physical Therapy 429 Other Physical Therapy Occupational Therapy 430 General Classification Occupational Therapy 431 Visit Charge Occupational Therapy 433 Group Rate Occupational Therapy 434 Evaluation or Re-evaluation Occupational Therapy 439 Other Physical Therapy Pathology 440 General Classification Pathology 441 Visit Charge Pathology 443 Group Rate Pathology 444 Evaluation or Re-evaluation Pathology 449 Other Physical Therapy Emergency Room 450 General Classification Emergency Room 456 Urgent Care Emergency Room 459 Other Emergency Room Pulmonary Function 460 General Classification Pulmonary Function 469 Other Pulmonary Function 3

4 Audiology 470 General Classification Audiology 471 Diagnostic Audiology 472 Treatment Audiology 479 Other Audiology Cardiology 480 General Classification Cardiology 481 Cardiac Cath Lab Cardiology 482 Stress Test Cardiology 483 Echocardiology Cardiology 489 Other Cardiology Ambulatory Surgical Care 490 General Classification Ambulatory Surgical Care 499 Other Ambulatory Surgical Care Outpatient Services 500 General Classification Outpatient Services 509 Other Outpatient Services Clinic 510 General Classification Clinic 511 Chronic Pain Center Clinic 512 Dental Clinic Clinic 513 Psychiatric Clinic Clinic 514 OB-GYN Clinic Clinic 515 Pediatric Clinic Clinic 516 Urgent Care Clinic Clinic 517 Family Practice Clinic Clinic 519 Other Clinic MRI 610 General Classification MRI 611 Brain (including brainstem) MRI 612 Spinal Cord (including Spine) MRI 614 MRI - other MRI 615 MRI - head & neck MRI 616 MRI - lower extremities MRI 618 MRI - other MRI 619 Other MRI Cast Room 700 General Classification Cast Room 709 Other Cast Room (Electrocardiogram) 730 General Classification (Electrocardiogram) 731 Holter monitor 4

5 (Electrocardiogram) 732 Telemetry (Electrocardiogram) 739 Other EEG (Electroencephalogra m) 740 General Classification EEG (Electroencephalogra m) 749 Other EEG Gastro-Intestinal Services 750 General Classification Gastro-Intestinal Services 759 Other Gastro-Intestinal Treatment/Observatio n Room 761 Treatment Room Preventive Care Services 770 General Classification Preventive Care Services 771 Vaccine Administration Preventive Care Services 779 Other Preventive Care Services Lithotripsy 790 General Classification Lithotripsy 799 Other Lithotripsy Organ Acquisition 810 General Classification Organ Acquisition 811 Living Donor ical Treatments 900 General Classification ical Treatments 901 Electroshock Treatment ical Treatments 902 Milieu Therapy ical Treatments 903 Play Therapy ical Treatments 904 Activity Therapy ical Treatments 909 Other ical Services 910 General Classification 5

6 ical Services 911 Rehabilitation ical Services 914 Individual Therapy ical Services 915 Group Therapy ical Services 916 Family Therapy ical Services 917 Bio Feedback ical Services 918 Testing ical Services 919 Other Services 920 General Classification Services 921 Peripheral Vascular Lab Services 922 Electromyelogram Services 923 Pap Smear Services 924 Allergy Test Services 925 Pregnancy Test Services 929 Services Services 940 General Classification Services 941 Recreational Therapy Services 942 Education/Training Services 943 Cardiac Rehabilitation Services 944 Drug Rehabilitation Services 945 Alcohol Rehabilitation Services 949 Services Services: extension of 094X 952 Kinesiotherapy Emergency Room Pro-Fee 981 ER Pro-fee Alternative Therapy Services 2100 General Classification 6

7 Alternative Therapy Services 2109 Other Alternative Therapy Services 7