|
Code
|
Description
|
Version
|
| ...
|
See
NUBC
codes
|
added
v2.5.1,
removed
after
v2.6
|
|
01
|
Most
common
semi-private
rate
|
added
v2.3.1,
removed
after
v2.4
|
|
02
|
Hospital
has
no
semi-private
rooms
|
added
v2.3.1,
removed
after
v2.4
|
|
04
|
Inpatient
professional
component
charges
which
are
combined
billed
|
added
v2.3.1,
removed
after
v2.4
|
|
05
|
Professional
component
included
in
charges
and
also
billed
separate
to
carrier
|
added
v2.3.1,
removed
after
v2.4
|
|
06
|
Medicare
blood
deductible
|
added
v2.3.1,
removed
after
v2.4
|
|
08
|
Medicare
life
time
reserve
amount
in
the
first
calendar
year
|
added
v2.3.1,
removed
after
v2.4
|
|
09
|
Medicare
co-insurance
amount
in
the
first
calendar
year
|
added
v2.3.1,
removed
after
v2.4
|
|
10
|
Lifetime
reserve
amount
in
the
second
calendar
year
|
added
v2.3.1,
removed
after
v2.4
|
|
11
|
Co-insurance
amount
in
the
second
calendar
year
|
added
v2.3.1,
removed
after
v2.4
|
|
12
|
Working
aged
beneficiary/spouse
with
employer
group
health
plan
|
added
v2.3.1,
removed
after
v2.4
|
|
13
|
ESRD
beneficiary
in
a
Medicare
coordination
period
with
an
employer
group
health
plan
|
added
v2.3.1,
removed
after
v2.4
|
|
14
|
No
Fault
including
auto/other
|
added
v2.3.1,
removed
after
v2.4
|
|
15
|
Worker's
Compensation
|
added
v2.3.1,
removed
after
v2.4
|
|
16
|
PHS,
or
other
federal
agency
|
added
v2.3.1,
removed
after
v2.4
|
|
17
|
Payer
code
|
added
v2.3.1,
removed
after
v2.4
|
|
21
|
Catastrophic
|
added
v2.3.1,
removed
after
v2.4
|
|
22
|
Surplus
|
added
v2.3.1,
removed
after
v2.4
|
|
23
|
Recurring
monthly
incode
|
added
v2.3.1,
removed
after
v2.4
|
|
24
|
Medicaid
rate
code
|
added
v2.3.1,
removed
after
v2.4
|
|
30
|
Pre-admission
testing
|
added
v2.3.1,
removed
after
v2.4
|
|
31
|
Patient
liability
amount
|
added
v2.3.1,
removed
after
v2.4
|
|
37
|
Pints
of
blood
furnished
|
added
v2.3.1,
removed
after
v2.4
|
|
38
|
Blood
deductible
pints
|
added
v2.3.1,
removed
after
v2.4
|
|
39
|
Pints
of
blood
replaced
|
added
v2.3.1,
removed
after
v2.4
|
|
40
|
New
coverage
not
implemented
by
HMO
(for
inpatient
service
only)
|
added
v2.3.1,
removed
after
v2.4
|
|
41
|
Black
lung
|
added
v2.3.1,
removed
after
v2.4
|
|
42
|
VA
|
added
v2.3.1,
removed
after
v2.4
|
|
43
|
Disabled
beneficiary
under
age
64
with
LGHP
|
added
v2.3.1,
removed
after
v2.4
|
|
44
|
Amount
provider
agreed
to
accept
from
primary
payer
when
this
amount
is
less
than
charges
but
higher
than
payment
received,,
then
a
Medicare
secondary
payment
is
due
|
added
v2.3.1,
removed
after
v2.4
|
|
45
|
Accident
hour
|
added
v2.3.1,
removed
after
v2.4
|
|
46
|
Number
of
grace
days
|
added
v2.3.1,
removed
after
v2.4
|
|
47
|
Any
liability
insurance
|
added
v2.3.1,
removed
after
v2.4
|
|
48
|
Hemoglobin
reading
|
added
v2.3.1,
removed
after
v2.4
|
|
49
|
Hematocrit
reading
|
added
v2.3.1,
removed
after
v2.4
|
|
50
|
Physical
therapy
visits
|
added
v2.3.1,
removed
after
v2.4
|
|
51
|
Occupational
therapy
visits
|
added
v2.3.1,
removed
after
v2.4
|
|
52
|
Speech
therapy
visits
|
added
v2.3.1,
removed
after
v2.4
|
|
53
|
Cardiac
rehab
visits
|
added
v2.3.1,
removed
after
v2.4
|
|
56
|
Skilled
nurse
-
home
visit
hours
|
added
v2.3.1,
removed
after
v2.4
|
|
57
|
Home
health
aide
-
home
visit
hours
|
added
v2.3.1,
removed
after
v2.4
|
|
58
|
Arterial
blood
gas
|
added
v2.3.1,
removed
after
v2.4
|
|
59
|
Oxygen
saturation
|
added
v2.3.1,
removed
after
v2.4
|
|
60
|
HHA
branch
MSA
|
added
v2.3.1,
removed
after
v2.4
|
|
67
|
Peritoneal
dialysis
|
added
v2.3.1,
removed
after
v2.4
|
|
68
|
EPO-drug
|
added
v2.3.1,
removed
after
v2.4
|
|
70
...
72
|
Payer
codes
|
added
v2.3.1,
removed
after
v2.4
|
|
75
...
79
|
Payer
codes
|
added
v2.3.1,
removed
after
v2.4
|
|
80
|
Psychiatric
visits
|
added
v2.3.1,
removed
after
v2.4
|
|
81
|
Visits
subject
to
co-payment
|
added
v2.3.1,
removed
after
v2.4
|
|
A1
|
Deductible
payer
A
|
added
v2.3.1,
removed
after
v2.4
|
|
A2
|
Coinsurance
payer
A
|
added
v2.3.1,
removed
after
v2.4
|
|
A3
|
Estimated
responsibility
payer
A
|
added
v2.3.1,
removed
after
v2.4
|
|
X0
|
Service
excluded
on
primary
policy
|
added
v2.3.1,
removed
after
v2.4
|
|
X4
|
Supplemental
coverage
|
added
v2.3.1,
removed
after
v2.4
|
|
…
|
See
NUBC
codes
|
added
v2.7
|