Expanded List of Valid Revenue Codes

Transcription

1 681 Not assigned 682 Not assigned 683 Not assigned 684 Not assigned 685 Not assigned 686 Not assigned 687 Not assigned 688 Not assigned 689 Not assigned 691 Not assigned 692 Not assigned 693 Not assigned 694 Not assigned 695 Not assigned 696 Not assigned 697 Not assigned 698 Not assigned 699 Not assigned 0001 Total Charge 001 Total Charge 0022 HIPPS 0023 HIPPS 0024 HIPPS 010 Reserved for national assignment 0100 All Inclusive Rate 0101 All Inclusive Rate 011 Reserved for national assignment 0110 Room & Board (Private) 0111 Medical/Surgical/Gyn 0112 OB 0113 Pediatric 0114 Psychiatric 0115 Hospice 0116 Detoxification 0117 Oncology 0118 Rehab 0119 Other 012 Reserved for national assignment 0120 Room & Board (Semi-Private 2 beds) 0121 Medical/Surgical/Gyn 0122 OB 0123 Pediatric 0124 Psychiatric 0125 Hospice 0126 Detoxification 0127 Oncology

2 0128 Rehab 0129 Other 013 Reserved for national assignment 0130 Room&Board (Semi private 3-4 beds) 0131 Medical/Surgical/Gyn 0132 OB 0133 Pediatric 0134 Psychiatric 0135 Hospice 0136 Detoxification 0137 Oncology 0138 Rehab 0139 Other 014 Reserved for national assignment 0140 Room & Board (Private Deluxe) 0141 Medical/Surgical/Gyn 0142 OB 0143 Pediatric 0144 Psychiatric 0145 Hospice 0146 Detoxification 0147 Oncology 0148 Rehab 0149 Other 015 Reserved for national assignment 0150 Room & Board (Ward) 0151 Medical/Surgical/Gyn 0152 OB 0153 Pediatric 0154 Psychiatric 0155 Hospice 0156 Detoxification 0157 Oncology 0158 Rehab 0159 Other 016 Reserved for national assignment 0160 Room & Board (other) 0164 Sterile Environment 0167 Self care 0169 Other 017 Reserved for national assignment 0170 Nursery 0171 Newborn-Level I 0172 Newborn-Level II 0173 Newborn-Level III 0174 Newborn-Level IV 2

3 0179 Other Nursery 018 Reserved for national assignment 0180 Leave of Absence 0182 Patient Convenience 0183 Therapeutic Leave 0185 Hospitalization 0189 Other leave of absence 019 Reserved for national assignment 0190 Subacute care 0191 Subacute care-level I 0192 Subacute care-level II 0193 Subacute care-level III 0194 Subacute care-level IV 0199 Other subacute care 020 Reserved for national assignment 0200 Intensive care 0201 Surgical 0202 Medical 0203 Pediatric 0204 Psychiatric 0206 Intermediate ICU 0207 Burn care 0208 Trauma 0209 Other intensive care 021 Reserved for national assignment 0210 Coronary care 0211 Myocardial Infarction 0212 Pulmonary Care 0213 Heart Transplant 0214 Intermediate CCU 0219 Other Coronary Care 022 Reserved for national assignment 0220 Special charges 0221 Admission charge 0222 Technical support charge 0223 U.R. service charge 0224 Late discharge, medically necessary 0229 Other special charges 023 Reserved for national assignment 0230 Incremental nursing charge rate 0231 Nursery 0232 OB 0233 ICU 0234 CCU 0235 Hospice 0239 Other 3

4 024 Reserved for national assignment 0240 All inclusive Ancillary 0241 Basic 0242 Comprehensive 0243 Specialty 0249 Other all inclusive ancillary 025 Reserved for national assignment 0250 Pharmacy 0251 Pharmacy: Generic 0252 Pharmacy: Nongeneric 0253 Take home drugs 0254 Pharmacy: Incident to other diagnostic services 0255 Pharmacy: Incident to radiology 0256 Pharmacy: Experimental drugs 0257 Pharmacy: Non-prescription 0258 Pharmacy: IV solutions 0259 Pharmacy: Other 026 Reserved for national assignment 0260 IV Therapy 0261 IV Therapy: Infusion pump 0262 IV Therapy: IV Therapy, pharm services 0263 IV Therapy: IV Therapy/drug/supp/delivery 0264 IV Therapy: supplies 0269 IV Therapy: Other IV therapy 027 Reserved for national assignment 0270 Medical/Surgical Supplies 0271 Medical/Surgical Supplies: Nonsterile supplies 0272 Medical/Surgical Supplies: Sterile supplies 0273 Medical/Surgical Supplies: Take home supplies 0274 Medical/Surgical Supplies: Prosthetic/Orthotic devices 0275 Medical/Surgical Supplies: Pacemaker 0276 Medical/Surgical Supplies: Intraocular lens 0277 Oxygen-Take home 0278 Medical/Surgical Supplies: Other implants 0279 Medical/Surgical Supplies: Other supplies/devices 028 Reserved for national assignment 0280 Oncology 0289 Oncology: Other oncology 029 Reserved for national assignment 0290 Durable Medical Equipment 0291 Rental 0292 Durable Medical Equipment: Purchase - new equipment 0293 Purchase of used DME 0294 Supplies/Drugs for DME effectiveness (HHA only) 0299 Durable Medical Equipment: Other equipment 030 Reserved for national assignment 4

5 0300 Laboratory - Clinical Diagnostic 0301 Laboratory - Clinical Diagnostic: Chemistry 0302 Laboratory - Clinical Diagnostic: Immunology 0303 Laboratory - Clinical Diagnostic: Renal patient (home) 0304 Laboratory - Clinical Diagnostic: Nonroutine dialysis 0305 Laboratory - Clinical Diagnostic: Hematology 0306 Laboratory - Clinical Diagnostic: Bacteriology/microbiology 0307 Laboratory - Clinical Diagnostic: Urology 0309 Laboratory - Clinical Diagnostic: Other laboratory 031 Reserved for national assignment 0310 Laboratory - Pathology 0311 Laboratory - Pathology: Cytology 0312 Laboratory - Pathology: Histology 0314 Laboratory - Pathology: Biopsy 0319 Laboratory - Pathology: Other 032 Reserved for national assignment 0320 Radiology - Diagnostic 0321 Radiology - Diagnostic: Angiocardiography 0322 Radiology - Diagnostic: Arthrography 0323 Radiology - Diagnostic: Arteriography 0324 Radiology - Diagnostic: Chest X-ray 0329 Radiology - Diagnostic: Other 033 Reserved for national assignment 0330 Radiology - Therapeutic 0331 Radiology - Therapeutic: Chemotherapy - injected 0332 Radiology - Therapeutic: Chemotherapy - oral 0333 Radiology - Therapeutic: Radiation therapy 0335 Radiology - Therapeutic: Chemotherapy - IV 0339 Radiology - Therapeutic: Other 034 Reserved for national assignment 0340 Nuclear Medicine 0341 Nuclear Medicine: Diagnostic 0342 Nuclear Medicine: Therapeutic 0343 Diagnostic Radiopharms 0344 Therapeutic Radiopharms 0349 Nuclear Medicine: Other 035 Reserved for national assignment 0350 CT Scan 0351 CT Scan: Head 0352 CT Scan: Body 0359 CT Scan: Other CT scans 036 Reserved for national assignment 0360 Operating Room Services 0361 Operating Room Services: Minor surgery 0362 Operating Room Services: Organ trnsplnt, not kidney 0367 Operating Room Services: Kidney transplant 5

6 0369 Operating Room Services: Other operating room services 037 Reserved for national assignment 0370 Anesthesia 0371 Anesthesia: Incident to radiology 0372 Anesthesia: Incident to other diag services 0374 Acupuncture 0379 Anesthesia: Other anesthesia 038 Reserved for national assignment 0380 Blood 0381 Blood: Packed red cells 0382 Blood: Whole blood 0383 Blood: Plasma 0384 Blood: Platelets 0385 Blood: Leukocytes 0386 Blood: Other components 0387 Blood: Other derivatives 0389 Blood: Other blood 039 Reserved for national assignment 0390 Blood Storage/Processing 0391 Blood Storage/Processing: Blood administration (eg. Transfusion) 0399 Blood Storage/Processing: Other processing and storage 040 Reserved for national assignment 0400 Other Imaging Services 0401 Other Imaging Services: Diagnostic mammography 0402 Other Imaging Services: Ultrasound 0403 Other Imaging Services: Screening mammography 0404 Other Imaging Services: PET scan 0409 Other Imaging Services: Other imaging services 041 Reserved for national assignment 0410 Respiratory Services 0412 Respiratory Services: Inhalation services 0413 Respiratory Services: Hyberbaric oxygen therapy 0419 Respiratory Services: Other respiratory services 042 Reserved for national assignment 0420 Physical Therapy 0421 Physical Therapy: Visit charge 0422 Physical Therapy: Hourly charge 0423 Physical Therapy: Group rate 0424 Physical Therapy: Evaluation/re-evaluation 0429 Physical Therapy: Other physical therapy 043 Reserved for national assignment 0430 Occupational Therapy 0431 Occupational Therapy: Visit charge 0432 Occupational Therapy: Hourly charge 0433 Occupational Therapy: Group rate 0434 Occupational Therapy: Evaluation/re-evaluation 6

7 0439 Occupational Therapy: Other occupational therapy 044 Reserved for national assignment 0440 Speech-Language Pathology 0441 Speech-Language Pathology: Visit charge 0442 Speech-Language Pathology: Hourly charge 0443 Speech-Language Pathology: Group rate 0444 Speech-Language Pathology: Evaluation/ re-evaluation 0449 Speech-Language Pathology: Other speech language pathology 045 Reserved for national assignment 0450 Emergency Room 0451 Emergency Room: EM/EMTALA 0452 Emergency Room: ER/ Beyond EMTALA 0456 Emergency Room: Urgent care 0459 Emergency Room: Other emergency room 046 Reserved for national assignment 0460 Pulmonary Function 0469 Pulmonary Function: Other 047 Reserved for national assignment 0470 Audiology 0471 Audiology: Diagnostic 0472 Audiology: Treatment 0479 Audiology: Other audiology 048 Reserved for national assignment 0480 Cardiology 0481 Cardiology: Cardiac catheter lab 0482 Cardiology: Stress test 0483 Cardiology: Echocardiology 0489 Cardiology: Other cardiology 049 Reserved for national assignment 0490 Ambulatory Surgery 0499 Ambulatory Surgery: Other ambulatory surgical care 050 Reserved for national assignment 051 Reserved for national assignment 0510 Clinic 0511 Clinic: Chronic pain center 0512 Clinic: Dental clinic 0513 Clinic: Psychiatric clinic 0514 Clinic: OB/GYN clinic 0515 Clinic: Pediatric clinic 0516 Clinic: Urgent care clinic 0517 Clinic: Family clinic 0519 Clinic: Other clinic 052 Reserved for national assignment 0520 Free-Standing Clinic 0521 Rural health-clinic 0522 Rural health-home 7

8 0523 Free-Standing Clinic: Family Practice Clinic 0526 Free-Standing Clinic: Urgent Care Clinic 0529 Free-Standing Clinic: Other 053 Reserved for national assignment 0530 Osteopathic Services 0531 Osteopathic Services: Osteopathic therapy 0539 Osteopathic Services: Other osteopathic services 054 Reserved for national assignment 0540 Ambulance 0541 Supplies 0542 Medical Transport 0543 Heart Mobile 0544 Oxygen 0545 Air ambulance 0546 Neonatal ambulance services 0547 Pharmacy 0548 Telephone Transmission EKG 0549 Other ambulance 055 Reserved for national assignment 0550 Skilled nursing 0551 Visit charge 0552 Hourly charge 0559 Other skilled nursing 056 Reserved for national assignment 0560 Medical Social Services 0561 Medical Social Services: Visit charge 0562 Medical Social Services: Hourly charge 0569 Medical Social Services: Other medical social services 057 Reserved for national assignment 0570 Home health-home health aide 0571 Visit charge 0572 Hourly charge 0579 Other home health aide 058 Reserved for national assignment 0580 Home health-other visits 0581 Visit charge 0582 Hourly charge 0583 Assessment 0589 Other home health visit 059 Reserved for national assignment 0590 Home health-units of service 0599 Home health other units 060 Reserved for national assignment 0600 Home health-oxygen 0601 Oxygen-state/equip/suppl/ or cont 0602 Oxygen-state/equip/suppl/ or under 1 LPM 8

9 0603 Oxygen-state/equip/over 4 LPM 0604 Oxygen-Portable Add-on 0609 Other oxygen 061 Reserved for national assignment 0610 Magnetic Resonance Tech. (MRT) 0611 Magnetic Resonance Tech. (MRT): Brain (incl. Brainstem) 0612 Magnetic Resonance Tech. (MRT): Spinal cord (incl. spine) 0614 Magnetic Resonance Tech. (MRT): MRI - Other 0615 Magnetic Resonance Tech. (MRT): MRA - Head and Neck 0616 Magnetic Resonance Tech. (MRT): MRA - Lower Ext 0618 Magnetic Resonance Tech. (MRT): MRA - Other 0619 Magnetic Resonance Tech. (MRT): Other MRI 062 Reserved for national assignment 0621 Med - Surg Supplies Ext. of 270: Incident to radiology 0622 Med - Surg Supplies Ext. of 270: Incident to other diag Surgical dressings 0624 Med - Surg Supplies Ext. of 270: Investigational Device (IDE) 063 Reserved for national assignment 0631 Drugs Require Specific ID: Single source drug 0632 Drugs Require Specific ID: Multiple source drug 0633 Drugs Require Specific ID: Restrictive prescription 0634 Drugs Require Specific ID: EPO under 10,000 units 0635 Drugs Require Specific ID: EPO over 10,000 units 0636 Drugs Require Specific ID: Drugs requiring detail coding 0637 Drugs Require Specific ID: Self admin drugs (insulin admin in emergency-diabetes coma) 064 Reserved for national assignment 0640 Home IV Therapy Services 0641 Nonroutine nursing, central line 0642 IV site care, Central line 0643 IV start/change, 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 IV therapy services 065 Reserved for national assignment 0650 Hospice service 0651 routine home care 0652 continuous home care 0655 inpatient respite care 0656 general inpatient care (non-respite) 0657 physician services 0658 Hospice Room & Board-Nursing facility 0659 Other hospice service 066 Reserved for national assignment 9

10 067 Reserved for national assignment 0670 Outpatient Special Residence Charges 0671 Hospital based 342 Nuclear medicine therapeutic 349 Nuclear medicine other 350 CT scan general classification 351 CT scan head scan 352 CT scan body scan 359 CT scan other 360 Operating room services general classification 361 Operating room services minor surgery 362 Operating room services organ transplant (other than kidney) 367 Operating room services kidney transplant 369 Operating room other 370 Anesthesia general classification 371 Anesthesia incident RAD 372 Anesthesia incident to other diagnostic services 374 Anesthesia acupuncture 379 Anesthesia other 380 Blood general classification 381 Blood packed red cells 382 Blood whole blood 383 Blood plasma 384 Blood platelets 385 Blood Leucocytes 386 Blood other components 387 Blood other derivatives (cyoprecipitates) 389 Blood other 400 Other imaging services general classification 401 Other imaging services diagnostic mammography 402 Other imaging services ultrasound 403 Other imaging services screening mammography 404 Other imaging services positron emission tomography 409 Other imaging services other 410 Respiratory services general classification 412 Respiratory services inhalation services 413 Respiratory services hyperbaric oxygen therapy 419 Respiratory service other 420 Physical therapy general classification 421 Physical therapy visit charge 422 Physical therapy hour charge 423 Physical therapy group rate 424 Physical therapy evaluation or re-evaluation 429 Physical therapy other 430 Occupational therapy general classification 431 Occupational therapy visit charge 10

11 432 Occupational therapy hourly charge 433 Occupational therapy group rate 434 Occupational therapy evaluation or re-evaluation 439 Occupational therapy other 440 Speech language pathology general classification 441 Speech language pathology visit charge 442 Speech language pathology hourly charge 443 Speech language pathology group rate 444 Speech language pathology evaluation or re-evaluation 449 Speech language pathology other 450 Emergency room general classification 451 Emergency room EMTALA emergency medical screening services 452 Emergency room ER beyond EMTALA screening 456 Emergency room urgent care 459 Emergency room other 460 Pulmonary function general classification 469 Pulmonary function other 470 Audiology general classification 471 Audiology diagnostic 472 Audiology treatment 479 Audiology other 480 Cardiology general classification 481 Cardiology cardiac cath lab 482 Cardiology stress test 483 Cardiology echocardiology 489 Cardiology other 490 Ambulatory surgical care general classification 499 Ambulatory other 500 Outpatient services general classification 509 Outpatient services other 510 Clinic general classification 511 Clinic chronic pain center 512 Clinic dental 513 Clinic psychiatric 514 Clinic OB/GYN 515 Clinic pediatric 516 Clinic urgent care 517 Clinic family practice 519 Clinic other 520 Free standing clinic general clinic 521 Free standing clinic rural health 522 Free standing clinic rural health home 523 Free standing clinic family practice 526 Free standing clinic urgent care 529 Free standing clinic other 530 Osteopathic services general classification 11

12 531 Osteopathic services therapy 539 Osteopathic services other 540 Ambulance general classification 541 Ambulance supplies 542 Ambulance medical transport 543 Ambulance heart mobile 544 Ambulance oxygen 545 Ambulance air 546 Ambulance neo-natal 547 Ambulance pharmacy 548 Ambulance telephone transmission EKG 549 Ambulance other 550 Skilled nursing general classification 551 Skilled nursing visit charge 552 Skilled nursing hourly charge 559 Skilled nursing other 560 Medical social services general classification 561 Medical social services visit charge 562 Medical social services hourly charge 569 Medical social services other 570 Home health aide general classification 571 Home health aide visit charge 572 Home health aide hourly charge 579 Home health aide other 580 Other visits general classification (home health) 581 Other visits visit charge (home health) 582 Other visits hourly charge (home health) 589 Other visits other 590 Units of services general classification (home health) 599 Units of services other 600 Oxygen general classification (home health) 601 Oxygen state/equip/supply/or cont (home health) 602 Oxygen state/equip/supply under 1LPM (home health) 603 Oxygen state/equip/supply over 4 LPM (home health) 604 Oxygen portable add-on (home health) 610 MRI general classification 611 MRI brain (including brain stem) 612 MRI spinal cord (including spine) 619 MRI other 621 Medical/surgical supplies incident to radiology (ext of 270 codes) 622 Medical/surgical supplies incident to other diag svcs(ext 270 code) 623 Medical/surgical supplies surgical dressings (ext 270 codes) 624 Medical/surgical supplies investigational device (ext 270 codes) 630 Drugs requiring specific identification general classification 631 Drugs requiring specific identification single source drug 632 Drugs requiring specific identification multiple source drug 12

13 633 Drugs requiring specific identification restrictive prescription 634 Drugs requiring specific identification erythropoeitin < 10,000 units 635 Drugs requiring specific identification erythropoeitin > 10,000 units 636 Drugs requiring specific identification drugs detailed coding 637 Drugs requiring specific identification self-administrable drugs 640 Home IV therapy services general classification 641 Home IV therapy services non-routine nursing 642 Home IV therapy services IV site care, central line 643 Home IV therapy services IV start/chg, peripheral line 644 Home IV therapy services non-routine nursing, peripheral line 645 Home IV therapy services training patient caregiver, central line 646 Home IV therapy services training disabled patient, central line 647 Home IV therapy services training patient/caregiver, peripheral line 648 Home IV therapy services training disabled patient, peripheral line 649 Home IV therapy services other 650 Hospice services general classifications 651 Hospice services routine home care 652 Hospice services continuous home care2 653 Reserved 654 Reserved 655 Hospice inpatient care 656 Hospice general inpatient care (non-respite) 657 Hospice physician services 659 Hospice other 660 Respite care general classification 661 Respite care hourly charge/skilled nursing 662 Respite care hourly charge/home health aide/homemaker 670 Outpatient special residence charges general classification 671 Outpatient special residence charges hospital based 672 Outpatient special residence charges contracted 679 Outpatient special residence charges other 680 Not assigned 690 Not assigned 700 Cast room general classification 709 Cast room other 710 Recovery room general classification 719 recovery room other 720 Labor room/delivery general classification 721 Labor room/delivery labor 722 Labor room/delivery delivery 723 Labor room/ delivery circumcision 724 Labor room/delivery birthing center 729 Labor room/delivery other 730 EKG/ECG general classification 731 EKG/ECG holter monitor 732 EKG/ECG telemetry 13

14 739 EKG/ECG other 740 EEG general classification 749 EEG other 750 Gastro-intestinal services general classification 759 Gastro-intestinal services other 760 Treatment or observation room general classification 761 Treatment or observation room treatment 762 Treatment or observation room observation 769 Treatment or observation other 770 Preventative care services general classification 771 Preventative care services vaccine administration 779 Preventative care services other 780 Telemedicine general classification 789 Telemedicine other 790 Lithotripsy general classification 799 Lithotriptsy other 800 Inpatient renal dialysis general classification 801 Inpatient renal dialysis hemodialysis 802 Inpatient renal dialysis peritoneal (non-capd) 803 Inpatient renal dialysis continuous ambulatory peritoneal (CAPD) 804 Inpatient renal dialysis continuous cycling peritoneal (CCPD) 809 Inpatient renal dialysis other 810 Organ acquisition general classification 811 Organ acquisition living donor 812 Organ acquisition cadaver donor 813 Organ acquisition unknown donor 814 Organ acquisition unsuccessful organ search donor bank chg 819 Organ acquisition other 820 Hemodialysis general classification 821 Hemodialysis composite or other rate 822 Hemodialysis home supplies 823 Hemodialysis home equipment 824 Hemodialysis maintenance 100% 825 Hemodialysis support services 829 Hemodialysis other 830 Peritoneal dialysis general classification 831 Peritoneal composite or other rate 832 Peritoneal home supplies 833 Peritoneal home equipment 834 Peritoneal maintenance 100% 835 Peritoneal support services 839 Peritoneal other 840 CAPD outpatient general classification 841 CAPD composite or other rate 842 CAPD home supplies 843 CAPD home equipment 14

15 844 CAPD maintenance 100% 845 CAPD support services 849 CAPD other 850 CCPD Outpatient general classification 851 CCPD composite or other rate 852 CCPD home supplies 853 CCPD home equipment 854 CCPD maintenance 100% 855 CCPD support services 859 CCPD other 860 Reserved for dialysis (national assignment) 861 Reserved for dialysis (national assignment) 862 Reserved for dialysis (national assignment) 863 Reserved for dialysis (national assignment) 864 Reserved for dialysis (national assignment) 865 Reserved for dialysis (national assignment) 866 Reserved for dialysis (national assignment) 867 Reserved for dialysis (national assignment) 868 Reserved for dialysis (national assignment) 869 Reserved for dialysis (national assignment) 870 Reserved for dialysis (state assignment) 871 Reserved for dialysis (state assignment) 872 Reserved for dialysis (state assignment) 873 Reserved for dialysis (state assignment) 874 Reserved for dialysis (state assignment) 875 Reserved for dialysis (state assignment) 876 Reserved for dialysis (state assignment) 877 Reserved for dialysis (state assignment) 878 Reserved for dialysis (state assignment) 879 Reserved for dialysis (state assignment) 890 Reserved for national assignment 891 Reserved for national assignment 892 Reserved for national assignment 893 Reserved for national assignment 894 Reserved for national assignment 895 Reserved for national assignment 896 Reserved for national assignment 897 Reserved for national assignment 898 Reserved for national assignment 899 Reserved for national assignment 900 Psychiatric/psychological treatments general classification 901 Psychiatric/psychological treatments electroshock treatment 902 Psychiatric/psychological treatments milieu therapy 903 Psychiatric/psychological treatments play therapy 904 Psychiatric/psychological treatments activity therapy 909 Psychiatric/psychological treatments other 15

16 910 Psychiatric/psychological services general classification 911 Psychiatric/psychological services rehabilitation 912 Psychiatric/psychological svc partial hospitalization < intensive 913 Psychiatric/psychological svc partial hospitalization intensive 914 Psychiatric/psychological services individual therapy 915 Psychiatric/psychological services group therapy 916 Psychiatric/psychological services family therapy 917 Psychiatric/psychological services bio feedback 918 Psychiatric/psychological services testing 919 Psychiatric/psychological other 920 Other diagnostic services general classification 921 Other diagnostic services peripheral vascular lab 922 Other diagnostic services electromyelogram 923 Other diagnostic services pap smear 924 Other diagnostic services allergy test 925 Other diagnostic services pregnancy test 929 Other diagnostic services other 930 Not assigned 931 Not assigned 932 Not assigned 933 Not assigned 934 Not assigned 935 Not assigned 936 Not assigned 937 Not assigned 938 Not assigned 939 Not assigned 940 Other therapeutic services general classification 941 Other therapeutic services recreational therapy 942 Other therapeutic services education/training 943 Other therapeutic services cardiac rehabilitation 944 Other therapeutic services drug rehabilitation 945 Other therapeutic services alcohol rehabilitation 946 Other therapeutic services complex medical equipment routine 947 Other therapeutic services complex medical equipment ancillary 949 Other therapeutic services 950 Not assigned 951 Not assigned 952 Not assigned 953 Not assigned 954 Not assigned 955 Not assigned 956 Not assigned 957 Not assigned 958 Not assigned 959 Not assigned 16

17 960 Professional fees general classification 961 Professional fees psychiatric 962 Professional fees ophthalmology 963 Professional fees anesthesiologist (MD) 964 Professional fees anesthetist (CRNA) 969 Professional fees other 971 Professional fees laboratory 972 Professional fees radiology diagnostic 973 Professional fees radiology therapeutic 974 Professional fees radiology nuclear medicine 975 Professional fees operating room 976 Professional fees respiratory therapy 977 Professional fees physical therapy 0672 Contracted 0679 Other special residence charge 068 Reserved for national assignment 0681 Trauma Response: Level I 0682 Trauma Response: Level II 0683 Trauma Response: Level III 0684 Trauma Response: Level IV 0689 Trauma Response: Other 069 Reserved for national assignment 070 Reserved for State Use 0700 Cast Room 0709 Cast Room: Other cast room 071 Reserved for State Use 0710 Recovery Room 0719 Recovery Room: Other recovery room 072 Reserved for State Use 0720 Labor Room 0721 Labor Room: Labor 0722 Labor Room: Delivery 0723 Labor Room: Circumcision 0724 Labor Room: Birthing center 0729 Labor Room: Other labor room/delivery 073 Reserved for State Use 0730 EKG/ECG 0731 EKG/ECG: Holter monitor 0732 EKG/ECG: Telemetry 0739 EKG/ECG: Other EKG/ECG 074 Reserved for State Use 0740 EEG 0749 EEG: Other EEG 075 Reserved for State Use 0750 Gastrointestinal 0759 Gastrointestinal: Other gastrointestinal 17

18 076 Reserved for State Use 0760 Treatment/Observation Room 0761 Treatment/Observation Room: Treatment room 0762 Treatment/Observation Room: Observation room 0769 Treatment/Observation Room: Other treatment room 077 Reserved for State Use 0770 Preventive Care Services 0771 Preventive Care Services: Admin. of vaccine 0779 Preventive Care Services: Other 078 Reserved for State Use 0780 Telemedicine 0789 Other telemedicine 079 Reserved for State Use 0790 Extra-Corp Shock Wage Therapy 0799 Extra-Corp Shock Wage Therapy: Other ESWT 0800 Inpatient Dialysis 0801 Inpatient Demodialysis 0802 Inpatient peritoneal dialysis 0803 inpatient dialysis CAPD 0804 Inpatient dialysis CCPD 0809 Other inp dialysis 0810 Organ Acquisition 0811 Organ Acquisition: Living donor 0812 Organ Acquisition: Cadaver donor 0813 Organ Acquisition: Unknown donor 0814 Organ Acquisition: Unsuccessful Organ Search Donor Bank Charges 0819 Organ Acquisition: Other donor 0820 Hemo OPD/Home 0821 Hemo OPD/Home: Hemodialysis comp or other rate 0822 Hemo OPD/Home supplies 0823 Hemo OPD/home equipment 0824 Hemo OPD/Home Maintenance 100% 0825 Hemo OPD/Home Support Services 0829 Hemo OPD/Home: Other HEMO outpatient 0830 Peritoneal OPD/Home 0831 Peritoneal OPD/Home: Peritoneal comp or other rate 0832 Home supplies 0833 Home equipment 0834 Maintenance/100% 0835 Support services 0839 Peritoneal OPD/Home: Other peritoneal dialysis 0840 CAPD OPD/Home 0841 CAPD OPD/Home: CAPD comp or other rate 0842 Home supplies 0843 Home equipment 0844 Maintenance/100% 18

19 0845 Support services 0849 CAPD OPD/Home: Other CAPD dialysis 0850 CCPD OPD/Home 0851 CCPD OPD/Home: CCPD comp or other rate 0852 Home supplies 0853 Home equipment 0854 Maintenance/100% 0855 Support services 0859 CCPD OPD/Home: Other CCPD dialysis 0880 Miscellaneous Dialysis 0881 Miscellaneous Dialysis: Ultrafiltration 0882 Home dialysis aid visit 0889 Miscellaneous Dialysis: Other misc dialysis 0900 Psychiatric/Psychological Trt 0901 Psychiatric/Psychological Trt: Electroshock treatment 0902 Psychiatric/Psychological Trt: Milieu therapy 0903 Psychiatric/Psychological Trt: Play therapy 0904 Psychiatric/Psychological Trt: Activity therapy 0905 Psychiatric/Psychological Trt: Intensive Outpatient serv-sych 0906 Psychiatric/Psychological Trt: Intensive out serv - chem dep 0907 Psychiatric/Psychological Trt: Comm behavioral program 0910 Psychiatric/Psychological Svcs 0911 Psychiatric/Psychological Svcs: Rehabilitation 0912 Psychiatric/Psychological Svcs: Partial Hosp - less intensive 0913 Psychiatric/Psychological Svcs: Partial Hosp - Intensive 0914 Psychiatric/Psychological Svcs: Individual therapy 0915 Psychiatric/Psychological Svcs: Group therapy 0916 Psychiatric/Psychological Svcs: Family therapy 0917 Psychiatric/Psychological Svcs: Biofeedback 0918 Psychiatric/Psychological Svcs: Testing 0919 Psychiatric/Psychological Svcs: Other behavioral treat/serv 0920 Other Diagnostic Services 0921 Other Diagnostic Services: Peripheral vascular lab 0922 Other Diagnostic Services: Electromyelogram 0923 Other Diagnostic Services: Pap smear 0924 Other Diagnostic Services: Allergy test 0925 Other Diagnostic Services: Pregnancy test 0929 Other Diagnostic Services: Other diagnostic services 0940 Other Therapeutic Serv 0941 Other Therapeutic Serv: Recreation Rx 0942 Other Therapeutic Serv: Educ/training 0943 Other Therapeutic Serv: Cardiac rehab 0944 Other Therapeutic Serv: Drug rehab 0945 Other Therapeutic Serv: Alcohol rehab 0946 Complex medical equipment-routine 0947 Complex medical equipment-ancillary 19

20 0949 Other Therapeutic Serv: Additional RX SVS 0951 Other therapeutic services-(940x) Athletic training 0952 Other therapeutic services-(940x) Kinesiotherapy 0960 Professional fees 0961 Psychiatric 0962 Ophthalmology 0963 Anesthesiologist (MD) 0964 Anesthetist (CRNA) 0969 Other professional fee 0971 Professional fees (096x) Laboratory 0972 Professional fees (096x) Radiology-Diagnostic 0973 Professional fees (096x) Radiology-Therapeutic 0974 Professional fees (096x) Radiology-nuclear medicine 0975 Professional fees (096x) Operating room 0976 Professional fees (096x) Respiratory Therapy 0977 Professional fees (096x) Physical therapy 0978 Professional fees (096x) Occupational therapy 0979 Professional fees (096x) Speech pathology 0981 Professional fees (096x) Emergency room 0982 Professional fees (096x) Outpatient services 0983 Professional fees (096x) clinic 0984 Professional fees (096x) medical social services 0985 Professional fees (096x) EKG 0986 Professional fees (096x) EEK 0987 Professional fees (096x) Hospital visit 0988 Professional fees (096x) Consultation 0989 Private duty nurse 0990 Patient convenience items 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 patient convenience item 100 All inclusive rate and board plus ancillary 1000 Behavioral health accomodations 1001 Residential treatment-psychiatric 1002 residential treatment-chemical dependency 1003 Supervised living 1004 halfway house 1005 group home 101 All inclusive rate and board 110 Private room and board general classification 20

21 111 Private room and board medical/surgical/gyn 112 Private room and board OB 113 Private room and board pediatric 114 Private room and board psychiatric 115 Private room and board hospice 116 Private room and board detoxification 117 Private room and board oncology 118 Private room and board rehabilitation 119 Private room and board other 120 Two bed semi-private room & board general classification 121 Two bed semi-private room & board medical/surgical/gyn 122 Two bed semi-private room & board OB 123 Two bed semi-private room & board pediatric 124 Two bed semi-private room & board psychiatric 125 Two bed semi-private room & board hospice 126 Two bed semi-private room & board detoxification 127 Two bed semi-private room & board oncology 128 Two bed semi-private room & board rehabilitation 129 Two bed semi-private room & board other & 4 bed semi-private room & board general classification & 4 bed semi-private room & board medical/surgical/gyn & 4 bed semi-private room & board OB & 4 bed semi-private room & board pediatric & 4 bed semi-private room & board psychiatric & 4 bed semi-private room & board hospice & 4 bed semi-private room & board detoxification & 4 bed semi-private room & board oncology & 4 bed semi-private room & board rehabilitation & 4 bed semi-private room & board other 140 Deluxe private general classification 141 Deluxe private medical/surgical/gyn 142 Deluxe private OB 143 Deluxe private pediatric 144 Deluxe private psychiatric 145 Deluxe private hospice 146 Deluxe private detoxification 147 Deluxe private oncology 148 Deluxe private rehabilitation 149 Deluxe private other 150 Room & board ward general classification 151 Room & board ward medical/surgical/gyn 152 Room & board ward OB 153 Room & board ward pediatric 154 Room & board ward psychiatric 155 Room & board ward hospice 156 Room & board ward detoxification 21

22 157 Room & board ward oncology 158 Room & board ward rehabilitation 159 Room & board ward other 160 Other room & board general classification 164 Other room & board sterile environment 167 Other room & board self care 169 Other room & board other 170 Nursery general classification 171 Nursery newborn level Nursery newborn level Nursery newborn level Nursery newborn level Nursery newborn other 180 Leave of absence general classification 181 Reserved 182 Leave of absence patient convenience charges billable 183 Leave of absence therapeutic leave 184 Leave of absence ICF mentally retarded any reason 185 Leave of absence nursing home (hospitalization) 189 Leave of absence other 190 Sub acute care general classification 191 Sub acute care level Sub acute care level Sub acute care level Sub acute care level Sub acute care other 200 Intensive care general classification 201 Intensive care surgical 202 Intensive care medical 203 Intensive care pediatric 204 Intensive care psychiatric 206 Intensive care intermediate ICU 207 Intensive care burn care 208 Intensive care trauma 209 Intensive care other 210 Coronary care general classification 2100 Alternative therapy services 2101 acupuncture 2102 acupressure 2103 massage 2104 reflexology 2105 biofeedback 2106 hypnosis 2109 aother alternative therapy services 211 Coronary care myocardial infarction 212 Coronary care pulmonary care 22

23 213 Coronary care heart transplant 214 Coronary care intermediate CCU 219 Coronary care other 220 Special charges general classification 221 Special charges admission 222 Special charges technical support 223 Special charges UR service charge 224 Special charges late discharge medically necessary 229 Special charges other 230 Incremental nursing charge general classification 231 Incremental nursing charge nursery 232 Incremental nursing charge OB 233 Incremental nursing charge ICU (includes transitional care) 234 Incremental nursing charge CCU (includes transitional care) 235 Incremental nursing charge hospice 239 Incremental nursing other 240 All inclusive ancillary general classification 249 All inclusive ancillary other 250 Pharmacy general classification 251 Pharmacy generic drugs 252 Pharmacy non-generic drugs 253 Pharmacy take home drugs 254 Pharmacy drugs incident to other diagnostic services 255 Pharmacy drugs incident to radiology 256 Pharmacy experimental drugs 257 Pharmacy non-prescription 258 Pharmacy IV solutions 259 Pharmacy other 260 Therapy general classification 261 Therapy infusion pump 262 Therapy IV therapy/pharmacy services 263 Therapy IV therapy/drug/supply/delivery 264 Therapy IV Therapy/supplies 269 Therapy IV other 270 Medical/surgical supplies general classification 271 Medical/surgical supplies non-sterile supply 272 Medical/surgical supplies sterile supply 273 Medical/surgical supplies take home supplies 274 Medical/surgical supplies prosthetic/orthotic devices 275 Medical/surgical supplies pace maker 276 Medical/surgical supplies intraocular lens 277 Medical/surgical supplies oxygen take home 278 Medical/surgical supplies other implants 279 Medical/surgical supplies other 280 Oncology general classification 289 Oncology other 23

24 290 Durable medical equipment (DME) general classification 291 Durable medical equipment (DME) rental 292 Durable medical equipment (DME) purchase of new DME 293 Durable medical equipment (DME) purchase of old DME 294 Durable medical equipment (DME) supplies/drugs (HHAs only) 299 Durable medical equipment (DME) other 300 Laboratory general classification 301 Laboratory chemistry 302 Laboratory immunology 303 Laboratory renal patient (home) 304 Laboratory non-routine dialysis 305 Laboratory hematology 306 Laboratory bacteriology and microbiology 307 Laboratory urology 309 Laboratory other 310 Laboratory pathological general classification 3101 Adult day care, Medical and social, hourly 3102 Adult day care, social, hourly 3103 Adult day care, medical and social, daily 3104 Adult day care, social, daily 3105 Adult foster care, daily 3109 Other adult care 311 Laboratory pathological cytology 312 Laboratory pathological histology 314 Laboratory pathological biopsy 319 Laboratory pathological other 320 Radiology diagnostic general classification 321 Radiology diagnostic angiocardiography 322 Radiology diagnostic arthrography 323 Radiology diagnostic arteriography 324 Radiology diagnostic chest x-ray 329 Radiology diagnostic other 330 Radiology therapeutic general classification 331 Radiology therapeutic chemotherapy injected 332 Radiology therapeutic chemotherapy oral 333 Radiology therapeutic radiation therapy 335 Radiology therapeutic chemotherapy IV 339 Radiology therapeutic other 340 Nuclear medicine general classification 341 Nuclear medicine diagnostic 978 Professional fees occupational therapy 979 Professional fees speech pathology 981 Professional fees emergency room 982 Professional fees outpatient services 983 Professional fees clinic 984 Professional fees medical social services 24

25 985 Professional fees EKG 986 Professional fees EEG 987 Professional fees hospital visit 988 Professional fees consultation 989 Professional fees private duty nurse 990 Patient convenience items general classification 991 Patient convenience items cafeteria/guest tray 992 Patient convenience items private linen service 993 Patient convenience items telephone/telegram 994 Patient convenience items TV/radio 995 Patient convenience items non-patient room rentals 996 Patient convenience items late discharge fee 997 Patient convenience items admission kits 998 Patient convenience items beauty shop/barber 999 Patient convenience items other 25