Provider Type Codes. Institutional: Code Description

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1 Institutional: Code Description 0A 0B 0C 0D 0E 0F 0G 0H 0I 0J 0K 0L 0M 0N 0O 0P 0Q 0R 0S 0T 0U 0V 0W 0X 0Y 0Z FE FR IH LT OF PF Intern/Residency Hospital Plan Intern/Residency Uniform Pre-Payment (U.P.P.) Freestanding Dialysis Coordinated Home Care Plan Hospital Uniform Pre-Payment (U.P.P.) Hospital Freestanding Surgicenter State Hospital Foreign Hospital (outside of U.S.A) Christian Science Sanitarium Freestanding Physical Therapy Center Freestanding Alcohol & Substance Abuse Treatment Center Alcohol & Substance Abuse - Outpatient Only Non-Plan Provider Extended Care Facility Out-of-State Plan Hospital Medicare Approved Extended Care Facility (ECF) Ambulance Hospice (Plan) Medicare Approved Home Heath Service (Coordinated Home Care) Medicare Approved Freestanding Dialysis Center State Licensed Ambulatory Surgicenter JCAH Approved Extended Care Facility (ECF) JCAH Approved Alcohol Rehabilitation (Inpatient & Outpatient) Nursing Home Contracted Provider Affiliation Free Standing ER Free Standing Rehab Inpatient Hospital Psych Long Term Acute Care Occupational Therapy Facility Physical Therapy Facility Page 1 of 5

2 RH SF ST TH TI TJ T1 T2 T5 Rural Health Provider Skilled Nursing Facility Speech Therapy Facility Birthing Center Psychiatric/Partial Day Hospital Rehabilitation Hospital Non-Member Hospital Government Hospital Renal Dialysis Non-Contracting Professional: A0 Chiropractor D.C. A1 Regular Medical Doctor, Medical Genetics (Ind) M.D. A2 Podiatrist D.P.M., D.S.C. A3 Dentist D.D.S., D.M.D. A4 Radiology Technician, Laboratory Technician, Bacteriologist/Microbiologist -- A5 Group Medical Practice, Clinic or Mixed Therapy Group, Medical Genetics (Grp) -- A6 Osteopath, Medical Genetics (Ind) D.O. A7 Physical Therapist R.P.T A8 Clinical Psychologist or Neuropsychologist Ph.D. A9 Registered Nurse R.N. AB Hospital Based Physician, Medical Genetics (Ind) -- AC Ambulance Service -- AD Prosthetic-Orthotic Devices -- AE Durable Medical Equipment -- AF Optometrist O.D. AG Optician -- AH Hearing Aid Supplier -- AI Audiologist -- AJ Christian Science Healer -- AK Paramedic -- AL Clinical Social Worker or Licensed Clinical Social Worker C.S.W, L.C.S.W AM Pharmacist -- AN Home Health Agency H.H.A. AP Pastoral Counselor -- AQ Registered Dietician -- AR Licensed Physician Assistant L.P.A. AS Occupational Therapist O.T, O.T.R. AT Speech Therapist S.T., R.S.T., S.L.P., S.P.T. AU Dental Group D.D.S., D.M.D. Page 2 of 5

3 AV Podiatry Group -- AW Clinical Psychiatry Group or Neuropsychologist Group -- AX Registered Nurse Group R.N. AY Chiropractic Group D.C. AZ Osteopath Group D.O. B0 Naprapath Individual D.N. B1 License Clinical Professional Counselor L.C.P.C. B2 Acupuncturist (Individual) L.Ac. B3 Home Infusion Therapist Group -- B4 Massage Therapist -- B5 License Clinical Professional Counselor Group L.C.P.C. B6 Licensed Clinical Social Worker Group L.C.S.W. B7 Physical Therapy Group P.T., R.P.T., L.P.T. B8 Rural Health Clinic -- B9 Advanced/Registered Nurse Practitioner R.N.P. BA Licensed Marriage & Family Therapist L.M.F.T. BB Hospital Based Physician Group, Medical Genetics (Grp) -- BC Registered Nurse First Assistant -- BD Prosthetic Orthotic Group -- BE Surgical Assistant -- BF Optometrist Group O.D. BG Optician Group -- BI Audiologist Group -- BL Certified Registered Nurse Anesthetist C.R.N.A. BM Skilled Nurse/Home Health Aide/Durable Medical Equipment (DME) Therapy Group -- BN Skilled Nurse Therapist Group -- BP Specialty Pharmacy -- BQ Nutritionist/Dietician Group -- BR Licensed Physician Assistant Group L.P.A. BS Occupational Therapist Group O.T., R.O.T., O.T.R. BT Speech Therapist Group S.T., R.S.T., S.L.P. BU Mixed Therapy Occupational Physical Speech BV Certified Diabetes Educator -- BW Licensed Midwife -- BX Certified Nurse Specialist/Individual C.N.S. BY Naprapath Group D.N. CA Licensed Marriage & Family Therapist Group L.M.F.T. CB Imaging Center CC Registered Nurse First Assistant Group -- CD Certified Nurse Practitioner/Individual C.N.P. CE Surgical Assistant Group -- CH Doctor of Oriental Medicine Group -- CI Early Intervention Specialist Individual CG Early Intervention Specialist Group CP Certified Nurse Practitioner C.N.P. CV Certified Diabetes Educator Group -- Page 3 of 5

4 CW Licensed Midwife Group -- CX Certified Nurse Specialist/Group C.N.S. C0 Licensed Clinical Social Worker Group, Licensed Clinical Professional Counselor Group L.C.S.W., L.C.P.C. C2 Acupuncture Group -- C4 Massage Therapist Group -- C9 Advance/Registered Nurse Practitioner Group R.N.P. DA License Genetic Counselor (Individual) DD Certified Nurse Practitioner Group C.N.P. DP Certified Nurse Practitioner Group C.N.P. DW Certified Nurse Midwife Individual C.N.M D4 License Genetic Counselor Group D6 Behavioral Health Mixed Specialty Group D7 Telemedicine Group D8 Licensed Social Worker Individual D9 Dietitian Individual E1 Lactation Consultant Individual E2 Lactation Consultation Group E3 Physical Therapy Assistant - Individual PTA E4 Occupational Therapy Assistant - Individual OTA E5 Speech Therapy Assistant - Individual SLPA EW Certified Nurse Midwife Group C.N.M F1 Federally Qualified Health Center (FQHC) F2 Family Planning F4 Immunization Clinic Pharmacy FW Licensed Practical Nurse L.P.N IC Immunization Clinic ID Independent Diagnostic Testing Facility IR Immediate Care Centers IS Ambulatory Infusion Suites HA Board Certified Behavioral Analyst Individual HB Assistant Behavioral Analyst Group HC Doctorial Behavioral Analyst Group HD Doctorial Behavioral Analyst Individual HG Board Certified Behavioral Analyst Group HP Hospitalist Individual HS Assistant Behavioral Analyst Individual PD Cardio Pulmonary Diagnostic Testing PH Pharmacist RT Respiratory Therapist Individual SI Free Standing Imaging Center SL Sleep Lab SS Home Sleep Study TA Advanced Nurse Practitioner R.N.P. TB Licensed Practical Nurse Group L.P.N TC Licensed Professional Counselor L.P.C. TD Residential Treatment/Crisis Stabilization Center -- Page 4 of 5

5 TE Home Infusion Therapist -- TF Licensed Chemical & Dependency Counselor -- TG Athletic Trainers Group TK Athletic Trainer (Individual) T4 Licensed Marriage & Family Therapist L.M.F.T. T6 Disease Management/Education -- T7 Licensed Psychological Associates -- T8 Certified Registered Nurse Anesthetist C.R.N.A. T9 Certified Registered Nurse Anesthetist Group C.R.N.A. WS Wellness Screening YZ Foreign Provider (Outside U.S.A.) -- ZZ Technologist Technician -- Page 5 of 5

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