REVENUE CODE TABLE. Use for Dates of Services on and after 4/1/2007 HCPCS REQ COV SVC UNITS REQ UNITS REQ COV SVC REQ
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- Erin Grant
- 8 years ago
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1 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0001 TOTAL CHARGE Y NA - - Y Y Y Y Y 001X Reserved for Internal Payer Use Health Insurance-Prospective Payment 002X System (HIPPS) NA NA 0020 Reserved 0021 Reserved 0022 SNF PPS (RUG) NA - - NA - - NA - - NA - - NA - - NA - - NA HH PPS (HRG) NA - - NA REHAB PPS (CMG) NA - - NA - - C Reserved 003X to 009X Reserved 010X All-Inclusive Rate 0100 ALL INCL R&B/ANC NA - NA - - NC - - NA - - NA - - NA - - NA ALL INCL R&B NA - NA - - NC - - NA - - NA - - NA - - C Y Y Reserved 011X Room & Board (R&B) Private(One Bed) 0110 ROOM-BOARD NA - - NA - - C Y Y NA - - NA - - NA - - C Y N 0111 MED-SUR-GY NA - - NA - - C Y Y NA - - NA - - NA - - NA OB NA - - NA - - C Y Y NA - - NA - - NA - - NA PEDS NA - - NA - - C Y Y NA - - NA - - NA - - NA PSYCH NA - - NA - - C Y Y NA - - NA - - NA - - NA HOSPICE NA - - NA - - NA - - NA - - NA - - NA - - NA DETOX NA - - NA - - C Y Y NA - - NA - - NA - - NA ONCOLOGY NA - - NA - - C Y Y NA - - NA - - NA - - NA REHAB NA - - NA - - C Y Y NA - - NA - - NA - - NA Other * NA - - NA - - NC - - NA - - NA - - NA - - C X Room & Board Semi Private(Two beds) 0120 ROOM-BOARD/SEMI NA - - NA - - C Y Y C Y - NA - - NA - - C Y N 0121 MED-SUR-GY/SEMI NA - - NA - - C Y Y NA - - NA - - NA - - NA OB/SEMI-PVT NA - - NA - - C Y Y NA - - NA - - NA - - NA PEDS/SEMI-PVT NA - - NA - - C Y Y NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 1 of 19
2 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0124 PSYCH/SEMI-PVT NA - - NA - - C Y Y NA - - NA - - NA - - NA H0SPICE/SEMI-PVT NA - - NA - - NA - - NA - - NA - - NA - - NA DETOX/SEMI-PVT NA - - NA - - C Y Y NA - - NA - - NA - - NA ONCOLOGY/SEMI NA - - NA - - C Y Y NA - - NA - - NA - - NA REHAB/SEMI-PVT NA - - NA - - C Y Y NA - - NA - - NA - - NA Other/SEMI-PVT * NA - - NA - - NC - - NA NA NA C Y N 013X Room & Board (3 & 4 beds) 0130 ROOM-BOARD/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - C Y N 0131 MED-SUR-GY/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - NA B/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - NA PEDS/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - NA PSYCH/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - NA HOSPICE/3&4BED NA - - NA - - NA - - NA - - NA - - NA - - NA DETOX/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - NA ONCOLOGY/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - NA REHAB/3&4BED NA - - NA - - C Y Y NA - - NA - - NA - - NA Other/3&4BED NA - - NA - - NC - - NA - - NA - - NA - - NA X Room & Board - Deluxe Private 0140 ROOM-BOARD/DLX PVT NA - - NA - - NC - - NA - - NA - - NA - - C Y N 0141 MED-SUR-GY/DLX PVT NA - - NA - - NC - - NA - - NA - - NA - - NA OB/DLXPVT NA - - NA - - NC - - NA - - NA - - NA - - NA PEDS/DLXPVT NA - - NA - - NC - - NA - - NA - - NA - - NA PSYCH/DLXPVT NA - - NA - - NC - - NA - - NA - - NA - - NA HOSPICE/DLXPVT NA - - NA - - NA - - NA - - NA - - NA - - NA DETOX/DLXPVT NA - - NA - - NC - - NA - - NA - - NA - - NA ONCOLOGY/DLXPVT NA - - NA - - NC - - NA - - NA - - NA - - NA REHAB//DLXPVT NA - - NA - - NC - - NA - - NA - - NA - - NA Other/DLXPVT NA - - NA - - NC - - NA - - NA - - NA - - NA X ROOM & BOARD WARD 0150 ROOM-BOARD/WARD NA - - NA - - C Y Y NA - - NA - - NA - - C Y N 0151 MED-SUR-GY/WARD NA - - NA - - C Y Y NA - - NA - - NA - - NA OB/WARD NA - - NA - - C Y Y NA - - NA - - NA - - NA PEDS/WARD NA - - NA - - C Y Y NA - - NA - - NA - - NA PSYCH/WARD NA - - NA - - C Y Y NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 2 of 19
3 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0155 HOSPICE/WARD NA - - NA - - NA - - NA - - NA - - NA - - NA DETOX/WARD NA - - NA - - C Y Y NA - - NA - - NA - - NA ONCOLOGY/WARD NA - - NA - - C Y Y NA - - NA - - NA - - NA REHAB/WARD NA - - NA - - C Y Y NA - - NA - - NA - - NA Other/WARD NA - - NA - - NC - - NA - - NA - - NA - - NA X ROOM & BOARD OTHER 0160 R&B NA - - NA - - NA - - NA - - NA - - NA - - C Y N RESERVED 0164 R&B/STERILE NA - - NA - - C - - NA - - NA - - NA - - NA RESERVED 0167 R&B/SELF NA - - NA - - NA - - NA - - NA - - NA - - NA RESERVED 0169 R&B/OTHER NA - - NA - - NC - - NA - - NA - - NA - - NA X NURSERY NA NA 0170 NURSERY NA - - NA - - C Y Y NA - - NA - - NA - - NA NURSERY/LEVEL I NA - - NA - - C - - NA - - NA - - NA - - NA NURSERY/LEVEL II NA - - NA - - C Y Y NA - - NA - - NA - - NA NURSERY/LEVEL III NA - - NA - - C - - NA - - NA - - NA - - NA NURSERY/LEVEL IV NA - - NA - - C Y Y NA - - NA - - NA - - NA RESERVED 0179 NURSERY/OTHER NA - - NA - - C - - NA - - NA - - NA - - NA X LEAVE OF ABSENCE NA NA 0180 Leave of Absence or LOA NA - - NA - - C Y N NA - - NA - - NA - - NA RESERVED 0182 LOA/PT CONV NA - - NA - - NA - - NA - - NA - - NA - - NA LOA/THERAPEUTIC NA - - NA - - NA - - C Y N NA - - NA - - C Y N 0184 RESERVED 0185 LOA/NURS HOME NA - - NA - - NA - - C Y N NA - - NA - - C Y N RESERVED 0189 LOA/OTHER * NA - - NA - - NC - - C - - NA - - NA - - C Y N 019X SUBACUTE CARE NA NA 020X INTENSIVE CARE UNIT NA NA 0200 INTENSIVE CARE (ICU) NA - - NA - - C Y Y NA - - NA - - NA - - NA ICU/SURGICAL NA - - NA - - C Y Y NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 3 of 19
4 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0202 ICU/MEDICAL NA - - NA - - C Y Y NA - - NA - - NA - - NA ICU/PEDS NA - - NA - - C Y Y NA - - NA - - NA - - NA ICU/PSYCH NA - - NA - - C Y Y NA - - NA - - NA - - NA RESERVED 0206 ICU/INTERMEDIATE NA - - NA - - C Y Y NA - - NA - - NA - - NA ICU/BURN CARE NA - - NA - - C Y Y NA - - NA - - NA - - NA ICU/TRAUMA NA - - NA - - C Y Y NA - - NA - - NA - - NA ICU/OTHER NA - - NA - - NC - - NA - - NA - - NA - - NA X CORONARY CARE UNIT) NA NA 0210 CORONARY CARE(CCU) NA - - NA - - C Y Y NA - - NA - - NA - - NA CCU/MYO INFARC NA - - NA - - C Y Y NA - - NA - - NA - - NA CCU/PULMONARY NA - - NA - - C Y Y NA - - NA - - NA - - NA CCU/TRANSPLANT NA - - NA - - C Y Y NA - - NA - - NA - - NA CCU/INTERMEDIATE NA - - NA - - C Y Y NA - - NA - - NA - - NA RESERVED 0219 CCU/OTHER NA - - NA - - NC - - NA - - NA - - NA - - NA X SPECIAL CHARGES 0220 SPECIAL CHARGE C - - NA - - NC - - NA - - NA - - NA - - NA ADMIT CHARGE NA - - NA - - NC - - NA - - NA - - NA - - NA TECH SUPPT CHG NA - - NA - - NC - - NA - - NA - - NA - - NA UR CHARGE NA - - NA - - NC - - NA - - NA - - NA - - NA LATE DISCH/MED NEC NA - - NA - - NC - - NA - - NA - - NA - - NA RESERVED 0229 OTHER SPEC CHG C - - NC Y Y NC - - NA - - NA - - NA - - NA X INCREMENTAL NURSING CHARGE NA NA 0230 NURSING INCREM NA - - NA - - C N N NA - - NA - - NA - - NA NUR INCR/NURSERY NA - - NA - - C N N NA - - NA - - NA - - NA NUR INCR/OB NA - - NA - - C N N NA - - NA - - NA - - NA NUR INCR/ICU NA - - NA - - C N N NA - - NA - - NA - - NA NUR INCR/CCU NA - - NA - - C N N NA - - NA - - NA - - NA NUR INCR/HOSPICE NA - - NA - - NA - - NA - - NA - - NA - - NA RESERVED 0239 NUR INCR/OTHER NA - - NA - - C N N NA - - NA - - NA - - NA X ALL INCLUSIVE ANCILLARY NA NA Rev. 12/3/15 Page 4 of 19
5 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy Pharmacy (also see 063X, an extension of 025X 025X) 0250 PHARMACY C - - Pkg - - C N N NA - - NA - - NA - - NA DRUGS/GENERIC C - - Pkg - - C N N NA - - NA - - NA - - NA DRUGS/NONGENERIC C - - Pkg - - C N N NA - - NA - - NA - - NA DRUGS/TAKEHOME NA - - NC - - NA - - NA - - NA - - NA - - NA DRUGS/ICIDENT ODX C - - Pkg - - NA - - NA - - NA - - NA - - NA DRUGS/ICIDENT RAD C - - Pkg - - NA - - NA - - NA - - NA - - NA DRUGS/EXPERIMT NC - - NC - - NC - - NA - - NA - - NA - - NA DRUGS/NONPSCRPT C N Pkg - - C N N NA - - NA - - NA - - NA IV SOLUTIONS C N Pkg - - C N N NA - - NA - - NA - - NA DRUGS/OTHER C N Pkg - - NC - - NA - - NA - - NA - - NA X IV THERAPY 0260 IV THERAPY C - - Pkg - - C N N NA - - NA - - NA - - NA IV THER/INFSN PUMP NC - C Y Y C N N NA - - NA - - NA - - NA IV THER/PHARM SVC C - - Pkg - - NA - - NA - - NA - - NA - - NA IV THER/DRUG/SUPPLY/DEL C - - Pkg - - NA - - NA - - NA - - NA - - NA IV THER/SUPPLIES C - - Pkg - - NA - - NA - - NA - - NA - - NA RESERVED 0269 IV THERAPY/OTHER C N Pkg - - NA - - NA - - NA - - NA - - NA X MED/SURG Supplies & Devices (also see 062X, an extension of 027X) 0270 MED-SUR SUPPLIES C - - Pkg - - C N N NA - - C Y Y NA - - NA NON-STER SUPPLY C - - Pkg - - C N N NA C Y Y NA - - NA 0272 STERILE SUPPLY C - - Pkg - - C N N NA - - C Y Y NA - - NA TAKEHOME SUPPLY NC - Pkg - - NC - - NA - - NC - - NA - - NA PROSTH/ORTH DEV C - - C Y Y C N N NA - - NC - - NA - - NA PACE MAKER C - - Pkg - - C N N NA - - NC - - NA - - NA INTRA OC LENS C - - Pkg - - C N N NA - - NC - - NA - - NA /TAKEHOME NC - NC - - NA - - NA - - NC - - NA - - NA SUPPLY/IMPLANTS C - - Pkg - - C N N NA - - NC - - NA - - NA SUPPLY/OTHER C - - Pkg - - C N N NA - - NC - - NA - - NA X ONCOLOGY 0280 ONCOLOGY C Y Pkg - - C N N NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 5 of 19
6 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy RESERVED 0289 ONCOLOGY/OTHER C Y Pkg - - NC - - NA - - NA - - NA - - NA - - Durable Medical Equipment (DME) (other 029X than renal) NA NC 030X LABORATORY 0300 LAB C Y C Y Y C N N NA - - NA - - NA - - NA CHEMISTRY TESTS C Y C Y Y C N N NA - - NA - - NA - - NA IMMUNOLOGY TESTS C Y C Y Y C N N NA - - NA - - NA - - NA RENAL-HOME C Y C Y Y C N N NA - - NA - - NA - - NA NON-RTNE DIALYSIS C Y C Y Y C N N NA - - NA - - NA - - NA HEMATOLOGY TESTS C Y C Y Y C N N NA - - NA - - NA - - NA BACT & MICRO TESTS C Y C Y Y C N N NA - - NA - - NA - - NA UROLOGY TESTS C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0309 OTHER LAB TESTS C Y C Y Y NC - - NA - - NA - - NA - - NA X LABORATORY PATHOLOGY 0310 PATHOLOGY LAB C Y C Y Y C N N NA - - NA - - NA - - NA CYTOLOGY TESTS C Y C Y Y C N N NA - - NA - - NA - - NA HYSTOLOGY TESTS C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED NA - NA - - NA - - NA - - NA - - NA BIOPSY TESTS C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED NA - NA - - NA - - NA - - NA - - NA PATH LAB OTHER C Y C Y Y C N N NA - - NA - - NA - - NA X RADIOLOGY - DIAGNOSTIC 0320 DX X-RAY C Y C Y Y C N N NA - - NA - - NA - - NA DX X-RAY/ANGlO C Y C Y Y C N N NA - - NA - - NA - - NA DX X-RAY/ARTHO C Y C Y Y C N N NA - - NA - - NA - - NA DX X-RAY/ARTER C Y C Y Y C N N NA - - NA - - NA - - NA DX X-RAY/CHEST C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED NA - NA - - NA - - NA - - NA - - NA DX X-RAY/OTHER C Y C Y Y C N N NA - - NA - - NA - - NA X Radiology -Therapeutic and/or Chemotherapy Administration 0330 RADIOLOGY THERAPY C Y C Y Y C N N NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 6 of 19
7 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0331 RAD-CHEMO-INJECT C N C Y Y C N N NA - - NA - - NA - - NA RAD-CHEMO-ORAL NA - C Y Y C N N NA - - NA - - NA - - NA RAD-RADIATION C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED NA - NA - - NA - - NA - - NA - - NA RAD-CHEMO-IV C N C Y Y C N N NA - - NA - - NA - - NA RESERVED 0339 RADIOLOGY/OTHER C Y C Y Y NC - - NA - - NA - - NA - - NA X NUCLEAR MEDICINE (NUC MED) 0340 NUCLEAR MEDICINE C Y C Y Y C N N NA - - NA - - NA - - NA NUC MED/DX C Y C Y Y C N N NA - - NA - - NA - - NA NUC MED/RX C Y C Y Y C N N NA - - NA - - NA - - NA NUC MED/DX RADIOPHARM C Y Pkg - - C N N NA - - NA - - NA - - NA NUC MED/RX RADIOPHARM C Y Pkg - - C N N NA - - NA - - NA - - NA RESERVED 0349 NUC MED/OTHER C Y C Y Y NC - - NA - - NA - - NA - - NA X COMPUTED TOMOGRAPH (CT) SCAN 0350 CT SCAN C Y C Y Y C N N NA - - NA - - NA - - NA CT SCAN/HEAD C Y C Y Y C N N NA - - NA - - NA - - NA CT SCAN/BODY C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0359 CT SCAN/OTHER C Y C Y Y NC - - NA - - NA - - NA - - NA X OPERATING ROOM SERVICES 0360 OR SERYICES C Y C Y Y C N N NA - - NA - - NA - - NA OR/MINOR C Y C Y Y C N N NA NA NA NA 0362 OR/ORGAN TRANS NA - C - Y C N N NA - - NA - - NA - - NA RESERVED 0367 OR/KIDNEY TRANS NA - NC - - C N N NA - - NA - - NA - - NA RESERVED 0369 OR/OTHER C Y C Y Y NC - NA - - NA - - NA - - NA X ANESTHESIA 0370 ANESTHESIA C N Pkg - - C N N NA - - NA - - NA - - NA ANESTH/INCIDENT RAD C N Pkg - - C N N NA - - NA - - NA - - NA ANESTH/INCDNT OTHR DX C N Pkg - - C N N NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 7 of 19
8 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0373 RESERVED 0374 ANESTH/ACUPUNC NC - NC - - NC - - NA - - NA - - NA - - NA RESERVED 0379 ANESTH/OTHER C N Pkg - - NC - NA - - NA - - NA - - NA X BLOOD & BLOOD COMPONENTS 0380 BLOOD & BLOOD COMP C Y C Y Y C Y N NA - - NA - - NA - - NA BLOOD/PKD RED C Y C Y Y C Y N NA - - NA - - NA - - NA BLOOD/WHOLE C Y C Y Y C Y N NA - - NA - - NA - - NA BLOOD/PLASMA C Y C Y Y C N N NA - - NA - - NA - - NA BLOOD/PLATELETS C Y C Y Y C N N NA - - NA - - NA - - NA BLOOD/LEUKOCYTES C Y C Y Y C N N NA - - NA - - NA - - NA BLOOD/COMPONENTS C Y C Y Y C N N NA - - NA - - NA - - NA BLOOD/DERIVATIVES C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0389 BLOOD/OTHER C Y C Y Y NC - - NA - - NA - - NA - - NA X BLOOD STORAGE & PROCESSING 0390 BLOOD/ADMIN/STOR C Y Pkg - - C N N NA - - NA - - NA - - NA BLOOD/ADMIN C Y C Y Y C N N NA - - NA - - NA - - NA BLOOD/STORAGE C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0399 BLOOD/ADMIN/STOR/OTHER C Y Pkg - - NC - - NA - - NA - - NA - - NA X OTHER IMAGING SERVICES 0400 IMAGING SERVICE C Y C Y Y C N N NA - - NA - - NA - - NA DIAG MAMMOGRAPHY C Y C Y Y C N N NA - - NA - - NA - - NA ULTRASOUND C Y C Y Y C N N NA - - NA - - NA - - NA SCRN MAMMOGRAPHY C Y C Y Y C N N NA - - NA - - NA - - NA PET SCAN C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0409 OTHER IMAG SVS C Y C Y Y NC - - NA - - NA - - NA - - NA X RESPIRATORY SERVICES 0410 RESPIRATORY SVC C Y C Y Y C N N NA - - NA - - NA - - C Y N 0411 RESERVED 0412 INHALATION SVC C Y C Y Y C N N NA - - NA - - NA - - NA HYPERBARIC O2 C Y C Y Y C N N NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 8 of 19
9 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy RESERVED 0419 OTHER RESPIR SVCS C Y C Y Y NC - - NA - - NA - - NA - - NA X PHYSICAL THERAPY 0420 PHYSICAL THERP C Y C Y Y C N N NA - - C Y Y NA - - C Y Y 0421 PHYS THERP/VISIT C Y C Y Y C N N NA - - C Y Y NA - - NA PHYS THERP/HOUR C Y C Y Y C N N NA - - C Y Y NA - - NA PHYS THERP/GROUP C Y C Y Y C N N NA - - NC - - NA - - NA PHYS THERP/EVAL C Y C Y Y C N N NA - - C Y Y NA - - C Y Y RESERVED 0429 OTHER PHYS THERP C Y C Y Y NC - - NA - - NC - - NA - - C Y Y 043X OCCUPATIONAL THERAPY 0430 OCCUPATIONAL THER C Y C Y Y C N N NA - - C Y Y NA - - C Y Y 0431 OCCUP THERP/VISIT C Y C Y Y C N N NA - - C Y Y NA - - NA OCCUP THERP/HOUR C Y C Y Y C N N NA - - C Y Y NA - - NA OCCUP THERP/GROUP C Y C Y Y C N N NA - - NC - - NA - - NA OCCUP THERP/EVAL C Y C Y Y C N N NA - - C Y Y NA - - C Y Y RESERVED 0439 OCCUP THER/OTHER C Y C Y Y NC - - NA - - NC - - NA - - C Y Y 044X SPEECH-LANGUAGE PATHOLOGY 0440 SPEECH THERAPY C Y C Y Y C N N NA - - NC - - NA - - C Y Y 0440 T5 SPEECH THERAPY C Y Y 0441 SPEECH THERP/VISIT C Y C Y Y C N N NA - - NC - - NA - - NA T5 SPEECH THERP/VISIT C Y Y 0442 SPEECH THERP/HOUR C Y C Y Y C N N NA - - NC - - NA - - NA T5 SPEECH THERP/HOUR C Y Y 0443 SPEECH THERP/GROUP C Y C Y Y C N N NA - - NC - - NA - - C Y Y 0444 SPEECH THERP/EVAL C Y C Y Y C N N NA - - NC - - NA - - C Y Y 0444 T5 SPEECH THERP/EVAL C Y Y RESERVED 0449 OTHER SPEECH THERP C Y C Y Y NC - - NA - - NC - - NA - - C Y Y 045X EMERGENCY ROOM 0450 EMERG ROOM C N C Y Y C N N NA - - NA - - NA - - NA ER/EMATALA C N C Y Y NA - - NA - - NA - - NA - - NA ER/BEYOND EMTALA C N C Y Y NA - - NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 9 of 19
10 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy RESERVED 0456 ER/URGENT C N C Y Y NA - - NA NA NA NA RESERVED 0459 OTHER EMERG ROOM NC - NC - - NC - - NA - - NA - - NA - - NA X PULMONARY FUNCTION 0460 PULMONARY FUNC C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0469 OTHER PULMONARY FUNC C Y C Y Y NC - - NA - - NA - - NA - - NA X AUDIOLOGY 0470 AUDIOLOGY C Y C Y Y C N N NA - - NA - - NA - - NA AUDIOLOGY/DX C Y C Y Y C N N NA - - NA - - NA - - NA AUDIOLOGY/RX C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0479 OTHER AUDIOL C Y C Y Y NC - - NA - - NA - - NA - - NA X CARDIOLOGY 0480 CARDIOLOGY C Y C Y Y C N N NA - - NA - - NA - - NA CARDIAC CATH LAB C Y C Y Y C N N NA - - NA - - NA - - NA STRESS TEST C Y C Y Y C N N NA - - NA - - NA - - NA ECHOCARDIOLOGY C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0489 OTHER CARDIOL C Y C Y Y NC - - NA - - NA - - NA - - NA X AMBULATORY SURGICAL CARE NC NC 050X OUTPATIENT SERVICES NC NC 051X CLINIC 0510 CLINIC C N C Y Y NA - - NA - - NA - - NA - - NA CHRONIC PAIN CLINIC C N C Y Y NA - - NA - - NA - - NA - - NA DENTAL CLINIC NC - NC - - NA - - NA - - NA - - NA - - NA PSYCHIATRIC CLINIC (PT 21 ONLY) C Y Y NC - - NA - - NA - - NA - - NA - - NA OB-GYN CLINIC C Y Y C Y Y NA - - NA - - NA - - NA - - NA PEDIATRIC CLINIC C Y Y C Y Y NA - - NA - - NA - - NA - - NA URGENT CARE CLINIC C Y Y C Y Y NA - - NA - - NA - - NA - - NA FAMILY CLINIC C Y Y C Y Y NA - - NA - - NA - - NA - - NA RESERVED 0519 OTHER CLINIC C Y Y C Y Y NA - - NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 10 of 19
11 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 052X FREE-STANDING CLINIC NC 053X OSTEOPATHIC SERVICES NC 054X AMBULANCE 0540 AMBULANCE NA - C Y Y NA - - NA - - NA - - NA - - NA AMBUL/SUPPLY NA - NC - - NA - - NA - - NA - - NA - - NA AMBUL/MED TRANS NA - NC - - NA - - NA - - NA - - NA - - NA AMBUL/HEART MOB NA - NC - - NA - - NA - - NA - - NA - - NA AMBUL/OXYGEN NA - NC - - NA - - NA - - NA - - NA - - NA AIR AMBULANCE NA - C Y Y NA - - NA - - NA - - NA - - NA AMBUL/NEONAT NA - C Y Y NA - - NA - - NA - - NA - - NA AMBUL/PHARMAS NA - NC - - NA - - NA - - NA - - NA - - NA AMBUL/EKG TRANS NA - ` NC - - NA - - NA - - NA - - NA - - NA AMBUL/OTHER C N NC - - NA - - NA - - NA - - NA - - NA X SKILLED NURSING NA NC 0550 SKILLED NURSING NA - NC - - NA - - NA - - C Y Y NA - - NA SKILLED NURS/VISIT NA - NC - - NA - - NA - - C Y Y NA - - NA SKILLED NURS/HOUR NA - NC - - NA - - NA - - C Y Y NA - - NA RESERVED 0559 SKILLED NURS/OTHER NA - NC - - NA - - NA - - NC - - NA - - NA - - HOME HEALTH (HH) - MEDICAL 056X SOCIAL SERVICES NA NC 057X HOME HEALTH (HH) AIDE NA NC 0570 HH AIDE NA - NC - - NA - - NA - - C Y Y NA - - NA HH AIDE-VISIT NA - NC - - NA - - NA - - C Y Y NA - - NA HH AIDE-HOUR NA - NC - - NA - - NA - - C Y Y NA - - NA RESERVED 0579 HH AIDE-OTHER NA - NC - - NA - - NA - - NC - - NA - - NA X HOME HEALTH (HH) - OTHER VISITS NA NC 0580 HH-OTH VIS NA - NC - - NA - - NA - - NC - - NA - - NA HH-OTH VIS/VISIT NA - NC - - NA - - NA - - NC - - NA - - NA HH-OTH VIS/HOUR NA - NC - - NA - - NA - - NC - - C Y Y NA HH-OTH VIS/ASSESS NA - NC - - NA - - NA - - NC - - NA - - NA RESERVED 0589 HH-OTH VIS/OTHER NA - NC - - NA - - NA - - NC - - NA - - NA - - Rev. 12/3/15 Page 11 of 19
12 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy HOME HEALTH (HH) UNITS OF 059X SERVICE NA NC 060X HOME HEALTH (HH) - OXYGEN NA NC MAGNETIC RESONANCE 061X TECHNOLOGY (MRT) 0610 MRT C Y C Y Y C N N NA - - NA - - NA - - NA MRI/BRAIN C Y C Y Y C N N NA - - NA - - NA - - NA MRI/SPINE C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0614 MRI/OTHER C Y C Y Y NA - - NA - - NA - - NA - - NA MRA/HEAD & NECK C Y C Y Y C N N NA - - NA - - NA - - NA MRA/LOWER EXTRM C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 0618 MRA/OTHER C Y C Y Y NA - - NA - - NA - - NA - - NA MRT/OTHER C Y C Y Y NA - - NA - - NA - - NA - - NA X Medical/Surgical Supplies (Extension of 027X) 0620 RESERVED (use 0270 for General Classification) 0621 MED SURG SUPL-INCDT RAD C - Pkg - - NA - - NA - - NA - - NA - - NA MED SURG SUPL-INCDT ODX NC - Pkg - - NA - - NA - - NA - - NA - - NA SURG DRESSINGS C - C Y Y NA - - NA - - NA - - NA - - NA FDA INVEST DEVICE NA - NC - - NA NA - - NA - - NA - - NA RESERVED 063X PHARMACY - Extension of 025X 0630 RESERVED (Use 0250 for General Classification) 0631 DRUG/SINGLE C N Pkg - - NA - - NA - - NA - - NA - - NA DRUG/MULTIPLE C N Pkg - - NA - - NA - - NA - - NA - - NA DRUG/RESTRICT NC - NC - - NA - - NA - - NA - - NA - - NA DRUG/EPO<10,000 Units C Y C Y Y NA - - NA - - NA - - NA - - NA DRUG/EPO>=10,000 Units C Y C Y Y NA - - NA - - NA - - NA - - NA DRUG/DETAIL CODE C Y C Y Y NA - - NA - - NA - - NA - - NA DRUG/SELF ADMIN NC - - NC - - NA - - NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 12 of 19
13 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy RESERVED 064X HOME IV THERAPY SERVICES NA NC 065X HOSPICE SERVICES NA NC 0650 HOSPICE NA - NC - - NA - - NC - - NA - - NA - - NA HOSPICE/RTN HOME NA - NC - - NA - - C Y N NA - - NA - - NA HOSPICE/CTNS HOME NA - NC - - NA - - C Y N NA - - NA - - NA RESERVED 0655 HOSPICE/IP RESPITE NA - NC - - NA - - C Y N NA - - NA - - NA HOSPICE/IP NON RESPITE NA - NC - - NA - - C Y N NA - - NA - - NA HOSPICE/PHYSICIAN NA - NC - - NA - - C Y Y NA NA NA 0658 HOSPICE/R&B NURSE FAC NA - NC - - C N N 0659 HOSPICE/OTHER * NA - NC - - NA - - C NA - - NA - - NA X RESPITE CARE (HHA ONLY) NA NC 067X OUTPATIENT SPECIAL RESIDENCE CHARGES NA NC 068X TRAUMA RESPONSE NC 0680 NOT USED NA - NA NA NA - - NA - - NA - - NA TRAUMA LEVEL I NA - C A - C A - NA - - NA - - NA - - NA TRAUMA LEVEL II NA - C A - C A - NA - - NA - - NA - - NA TRAUMA LEVEL III NA - C A - C A - NA - - NA - - NA - - NA TRAUMA LEVEL IV NA - C A - C A - NA - - NA - - NA - - NA RESERVED NA NA - - NA - - NA - - NA TRAUMA OTHER NA - - NA - - NA - - NA - - NA - - NA - - NA X NOT ASSIGNED 0700X CAST ROOM 0700 CAST ROOM C N Pkg - - C N N NA - - NA - - NA - - NA RESERVED 071X RECOVERY ROOM 0710 RECOVERY ROOM C Y Pkg - - C N N NA - - NA - - NA - - NA RESERVED 072X LABOR ROOM/DELIVERY 0720 DELIVERY ROOM/LABOR C N Pkg - - C N N NA - - NA - - NA - - NA LABOR C N Pkg - - C N N NA - - NA - - NA - - NA DELIVERY ROOM C N C Y Y C N N NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 13 of 19
14 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0723 CIRCUMCISION NA - NC - - C N N NA - - NA - - NA - - NA BIRTHING CNTR (LICENSED) C N C Y Y C N N NA - - NA - - NA - - NA RESERVED 0729 OTHER/DELIV-LABOR C N C Y Y C N N NA - - NA - - NA - - NA X ELECTROCARDIOGRAM (EKG/ECG) 0730 EKG/ECG C Y C Y Y C N N NA - - NA - - NA - - NA HOLTER MONT C Y C Y Y C N N NA - - NA - - NA - - NA TELEMETRY C Y Pkg - - C N N NA - - NA - - NA - - NA RESERVED 0739 OTHER EKG/ECG C Y C Y Y C N N NA - - NA - - NA - - NA X ELECTROENCEPHALOGRAM (EEG) 0740 EEG C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 075X GASTRO-INTESTINAL (GI) SERVICES 0750 GASTRO-INTSTL SVCS C Y C Y Y C N N NA - - NA - - NA - - NA RESERVED 076X SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM 0760 SPECIALTY ROOM C Y C Y Y C N N NA - - NA - - NA - - NA TREATMENT RM C Y C Y Y C N N NA - - NA - - NA - - NA OBSERVATION RM C Y Pkg - - C N N NA - - NA - - NA - - NA RESERVED 0769 OTHER TREAT/OBSERV RM C Y C Y Y NA - - NA - - NA - - NA - - NA X PREVENTIVE CARE SERVICES 0770 PREVENT CARE SVCS C N C Y Y C N N NA - - NA - - NA - - NA VACCINE ADMIN C N C Y Y C N N NA - - NA - - NA - - NA RESERVED 078X TELEMEDICINE 0780 TELEMEDICINE C - Y C Y Y NA - - NA - - NA - - NA - - NA RESERVED EXTRA-CORPOREAL SHOCK WAVE 079X THERAPY (FORMERLY LITHOTRIPSY) 0790 ESWT C N C Y Y C N N NA - - NA - - NA - - NA RESERVED Rev. 12/3/15 Page 14 of 19
15 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 080X INPATIENT RENAL DIALYSIS NA NC 0800 RENAL DIALYSIS NA - NA - - NA - - NA - - NA - - NA - - NA DIALY/INPATIENT NA - NA - - C Y N NA - - NA - - NA - - NA DIALY/IP/PER NA - NA - - C Y N NA - - NA - - NA - - NA DIALY/IPCAPD NA - NA - - C Y N NA - - NA - - NA - - NA DlALY/lP/CCPD NA - NA - - C Y N NA - - NA - - NA - - NA RESERVED 0809 DIALY/IP/OTHER NA - NA - - NA - - NA - - NA - - NA - - NA X ACQUISITION OF BODY COMPONENTS 0810 ORGAN ACQUISIT NA - NA - - NA - - NA - - NA - - NA - - NA LIVING DONOR NA - NA - - C N N NA - - NA - - NA - - NA CADAVER DONOR NA - NA - - C N N NA - - NA - - NA - - NA UNKNOWN DONOR NA - NA - - NA - - NA - - NA - - NA - - NA UNSUCCESSFUL SEARCH C N C Y Y NA - - NA - - NA - - NA - - NA RESERVED 0819 OTHER DONOR NA - C - Y C - Y NA - - NA - - NA - - NA X HEMODIALYSIS - OUTPATIENT or HOME 0820 HEMO/OP OR HOME C Y C Y Y NA - - NA NA NA NA 0821 HEMO/COMPOSITE C Y C Y Y NA - - NA - - NA - - NA - - NA HEMO/HOME/SUPPL NA - NC - - NA - - NA - - NA - - NA - - NA HEMO/HOME/EQUIP NA - NC - - NA - - NA - - NA - - NA - - NA HEMO/HOME/100% NA - NC - - NA - - NA - - NA - - NA - - NA HEMO/HOME/SUPSERV C N C Y Y NA - - NA - - NA - - NA - - NA RESERVED 0829 HEMO-OTHER op C N C Y Y NA - - NA - - NA - - NA - - NA X PERITONEAL DIALYSIS - OUTPATIENT or HOME 0830 PERlTONEAL/OP OR HOME C Y C Y Y NA - - NA - - NA - - NA - - NA PERTNL/COMPOSITE C Y C Y Y NA - - NA - - NA - - NA - - NA PERTNL/HOME/SUPPL NA - NC - - NA - - NA - - NA - - NA - - NA PERTINL/HOME/EQUIP NA - NC - - NA - - NA - - NA - - NA - - NA PERTINL/HOME/100% NA - NC - - NA - - NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 15 of 19
16 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0835 PERTNL/HOME/SUPSERV C N C Y Y NA - - NA - - NA - - NA - - NA RESERVED 0839 PERTNL/HOME/OTHER C N C Y Y NA - - NA - - NA - - NA - - NA - - Continuous Ambulatory Peritoneal 084X Dialysis (CAPD) - Outpatient or Home 0840 CAPD/OP OR HOME C Y C Y Y NA - - NA - - NA - - NA - - NA CAPD/COMPOSITE C Y C Y Y NA - - NA - - NA - - NA - - NA CAPD/HOME/SUPPL NA - NC - - NA - - NA - - NA - - NA - - NA CAPD/HOME/EQUIP NA - NC - - NA - NA - - NA - - NA - - NA CAPD/HOME/100% NA - NC - - NA - - NA - - NA - - NA - - NA CAPD/HOME/SUPSERV C N C Y Y NA - - NA - - NA - - NA - - NA - - RESERVED 0849 CAPD/HOME/OTHER C N C Y Y NA - - NA - - NA - - NA - - NA X Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home 0850 CCPD/OP OR HOME C Y C Y Y NA - - NA - - NA - - NA - - NA CCPD/COMPOSITE C Y C Y Y NA - - NA - - NA - - NA - - NA CCPD/HOME/SUPPL NA - NC - - NA - - NA - - NA - - NA - - NA CCPD/HOME/EQUIP NA - NC - - NA - - NA - - NA - - NA - - NA CCPD/HOME/100% NA - NC - - NA - NA - - NA - - NA - - NA CCPD/HOME/SUPSERV C Y C Y Y NA - - NA - - NA - - NA - - NA CCPD/HOME/OTHER C N C Y Y NA - - NA - - NA - - NA - - NA X Magnetoencephalography (MEG) 0860 General Classification NA - C Y Y C N N NA - - NA - - NA - - NA MEG NA - C Y Y C N N NA - - NA - - NA - - NA RESERVED 087X RESERVED 088X MISCELLANEOUS DIALYSIS NA NC 089X RESERVED 090X BEHAVIORAL HEALTH TREATMENT/SERVICES (also see 091x, an extension of 090x) 0900 BH/TREATMENTS C Y C Y Y C N N NA - - NA - - NA - - NA BH/ELECTRO SHOCK C Y C Y Y C N N NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 16 of 19
17 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0902 BH/MILIEU THERAPY C Y C Y Y NC - - NA - - NA - - NA - - NA BH/PLAY THERAPY C Y C Y Y NC - - NA - - NA - - NA - - NA BH/ACTIVITY THERAPY NC - NC - - NA - - NA - - NA - - NA - - NA BH/INTENS OP/PSYCH NC BH/INTENS OP/CHEM DEP NC BH/COMMUNITY NC RESERVED BEHAVIORAL HEALTH TREATMENTS/SERVICES - EXTENSION 091X OF 090X 0910 RESERVED 0911 BH/REHAB C Y C Y Y C N N NA - - NA - - NA - - NA BH/PARTIAL HOSP NA - NC - - NA - - NA - - NA - - NA - - NA BH/PARTIAL INTENSV NA - NC - - NA - - NA - - NA - - NA - - NA BH/INDIV RX C Y C Y Y C N N NA - - NA - - NA - - NA BH/GROUP RX C Y C Y Y C N N NA - - NA - - NA - - NA BH/FAMILY RX C Y C Y Y C N N NA - - NA - - NA - - NA BH/BIOFEED NC - NC - - NC - - NA - - NA - - NA - - NA BH/TESTING C Y C Y Y C N N NA - - NA - - NA - - NA BH/OTHER C Y C Y Y NA - - NA - - NA - - NA - - NA X OTHER DIAGNOSTIC SERVICES 0920 OTHER DX SVCS C Y C Y Y C N N NA - - NA - - NA - - NA PERI VASCUL LAB C Y C Y Y C N N NA - - NA - - NA - - NA EMG C Y C Y Y C N N NA - - NA - - NA - - NA PAP SMEAR C N C Y Y C N N NA - - NA - - NA - - NA ALLERGY TEST C N C Y Y C N N NA NA NA NA 0925 PREG TEST C N C Y Y C N N NA - - NA - - NA - - NA RESERVED 0929 OTHER DX SVCS C N C Y Y NA - - NA - - NA - - NA - - NA X MEDICAL REHAB DAY PROGRAM NC 094X Other Therapeutic Services (also see 095X, ext of 094X) 0940 OTHER RX SVCS C N C Y Y C N N NA - - NA - - NA - - NA RECREATION RX NC - NC - - C N N NA - - NA - - NA - - NA - - Rev. 12/3/15 Page 17 of 19
18 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 0942 EDUC/TRAINING C N Pkg - - NA - - NA - - NA - - NA - - NA CARDIAC REHAB NC - - C Y Y C N N NA - - NA - - NA - - NA DRUG REHAB NA - NC - - NA - - NA - - NA - - NA - - NA ALCOHOL REHAB NA - NC - - NA - - NA - - NA - - NA - - NA CMPLX MED EQUIP-ROUT NA - NC - - NA - - NA - - NA - - NA - - NA CMPLX MED EQUIP-ANC NA - NC - - NC - - NA - - NA - - NA - - NA PULMONARY REHAB NA - C Y Y NA - - NA - - NA - - NA - - NA OTHER C - C Y Y NA - - NA - - NA - - NA - - NA X Other Therapeutic Services (extension of 094X) NA NA 096x PROFESSIONAL FEES (also see 097x and 098x) NA NA 097X PROFESSIONAL FEES (extension of 096X) NA NA 098X PROFESSIONAL FEES (extension of 096X & 097X) 0980 RESERVED (use 0960 for General Classification) 0981 PRO FEE/ER NA - NA - - NA - - NA - - NA - - NA - - NA PRO FEE/OUTPT NA - NA - - NA - - NA - - NA - - NA - - NA PRO FEE/CLINIC NA - NA - - NA - - NA - - NA - - NA - - NA PRO FEE/SOC SVC NA - NA - - NA - - NA - - NA - - NA - - NA PRO FEE/EKG NA - NA - - NA - - NA - - NA - - NA - - NA PRO FEE/EEG NA - NA - - NA - - NA - - NA - - NA - - NA PRO FEE/HOS VIS NC - NC - - NA - - NA - - NA - - NA - - NA PRO FEE/CONSULT NC - NC - - NA - - NA - - NA - - NA - - NA PRO FEE/PVT NURSE NC - NC - - NC - - NA - - NA - - NA - - NA X PATIENT CONVENIENCE ITEMS NC NC 100x BEHAVIORAL HEALTH ACCOMMODATIONS NC NC 101X to 209X RESERVED 210x ALTERNATIVE THERAPY SERVICES NA NA Rev. 12/3/15 Page 18 of 19
19 The descriptions and code ranges are subject to change by National Uniform Billing s (NUBC) direction and does not supersede MDHHS published policy 211X to 309x RESERVED 310x ADULT CARE NC NC x to 999x RESERVED NC NC Rev. 12/3/15 Page 19 of 19
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