|<< Previous Appendix||AS, ED, IP X12-837 Input / IP Output / OP Output||Next Appendix >>|
Appendix I- Revenue Codes
|Definition: On the paper UB-04 report the total for all revenue codes as indicated in FL47 Total Charges and FL48 Non-covered Charges on Line 23 of the last page of the UB-04.
For electronic transactions, report the total charge in the appropriate data segment/field-Loop 2300 CLM02.
|Health Insurance - Prospective Payment System (HIPPS)
Definition: This revenue code is used to denote that a HIPPS rate code is being reported in FL44.
|SKILLED NURSING FACILITY-PPS||SNFPPS (RUG)||0022|
|HOME HEALTH - PPS||HH PPS (HRG)||0023|
|INPATIENT REHAB FACILITY - PPS||REHAB PPS (CMG)||0024|
|All Inclusive Rate
Definition: Flat fee charge incurred on either a daily basis or total stay basis for services rendered. Charge may cover room and board plus ancillary services or room and board only.
|ALL-INCLUSIVE ROOM AND BOARD/PLUS ANCILLARY||ALL INCL R&B/ANC||0100|
|ALL-INCLUSIVE ROOM AND BOARD||ALL INCL R&B||0101|
|Room & Board - Private (One Bed)
Definition: Routine service charges for accommodations in a private room (1 bed).
Note: Most health plans require that private rooms be separately identified.
|Room & Board - Semi - Private (Two Beds)
Definition: Routine service charges for accommodations in a private room (2 beds).
Note: Most health plans cover semi-private rooms.
|Room & Board - Three and Four Beds
Definition: Routine service charges for rooms containing three and four beds.
Note: Most health plans require private rooms be separately identified.
|Room & Board - Deluxe Private
Definition: Delux accommodations substantially in excess of private room services.
Note: Most health plans require delux private rooms to be separately identified; these are generally not covered.
|GENERAL CLASSIFICATION||ROOM-BOARD/DLX PVT||0140|
|OBSTETRICS (OB)||OB/DLX PVT||0142|
|Room & Board - Ward
Routine service charges for accommodations with five or more beds.
Note: Most health plans require ward rooms to be separately identified.
|Room & Board - Other
Definition: Any routine service charges for accommodations that cannot be included in the more specific revenue center codes. Sterile environment is a room and board charge to be used by hospitals that are currently separating this charge for billing.
Definition: Accommodation charges for nursing care to newborns and premature infants in nurseries.
Notes: The levels of care correlate to the intensity of medical care provided to an infant and not the NICU facility certification level assigned by the state.
The level of care should be clinically evaluated on a daily basis, typically based on the resources provided to the infant. The assigned revenue code corresponds to the level of care determined during the daily evaluation. The levels of care and resulting revenue codes may, and likely will, fluctuate during the infants stay in the facility.
Subcategories 1 - 4 for use by facilities with nursery services designed around distinct areas and/or levels of care. Levels of care defined under state regulations or other statutes that supersede the guidelines below. For example, some states may have fewer than four levels of care or may have multiple levels within a category such as intensive care.
Level I: Routine care of apparently normal full-term or preterm neonates. (Newborn Nursery *)
Level II: Low birth-weight neonates who are not sick, but require frequent feeding, and neonates who require more hours of nursing than do normal neonates. (Continuing Care*)
Level III: Sick neonates who do not require intensive care, but require 6-12 hours of nursing each day. (Intermediate Care*)
Level IV: Constant nursing and continuous cardiopulmonary and other support for severely ill infants. (Intensive Care*)
*As defined in the guidelines adapted from Chapter 2 (Physical Facilities) of GUIDELINES FOR PERINATAL CARE, SECOND EDITION published by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (1988).
|NEWBORN - LEVEL I||NURSERY/LEVEL I||0171|
|NEWBORN - LEVEL II||NURSERY/LEVEL II||0172|
|NEWBORN - LEVEL III||NURSERY/LEVEL III||0173|
|NEWBORN - LEVEL IV||NURSERY/LEVEL IV||0174|
|Leave of Absence
Definition: Charges for holding a room while the patient is temporarily away from the provider.
|GENERAL CLASSIFICATION||LEAVE OF ABSENCE OR LOA||0180|
|PATIENT CONVENIENCE||LOA/PT CONV||0182|
|NURSING HOME (for Hospitalization)||LOA/NURS HOME||0185|
|OTHER LEAVE OF ABSENCE||LOA/OTHER||0189|
Definition: Accommodation charges for subacute care to inpatients in hospitals or skilled nursing facilities.
Notes: Level I - Skilled Care: Minimal nursing intervention. Comorbidities do not complicate treatment plan. Assessment of vitals and body systems required 1-2 times per day.
Level II - Comprehensive Care: Moderate nursing intervention. Active treatment of comorbidities. Assessment of vitals and body systems required 2-3 times per day.
Level III - Complex Care: Moderate to extensive nursing intervention. Active medical care and treatment of comorbidities. Potential for comorbidities to affect the treatment plan. Assessment of vitals and body systems required 3-4 times per day.
Level IV - Intensive Care: Extensive nursing and technical intervention. Active medical care and treatment of comorbidities. Potential for comorbidities to affect the treatment plan. Assessment of vitals and body systems required 4-6 times per day.
|SUBACUTE CARE - LEVEL I||SUBACUTE/LEVEL I||0191|
|SUBACUTE CARE - LEVEL II||SUBACUTE/LEVEL II||0192|
|SUBACUTE CARE - LEVEL III||SUBACUTE/LEVEL III||0193|
|SUBACUTE CARE - LEVEL IV||SUBACUTE/LEVEL IV||0194|
|OTHER SUBACUTE CARE||SUBACUTE/OTHER||0199|
Definition: Routine service charges for medical or surgical care provided to patients who require a more intensive level of care than is rendered in the general medical or surgical unit.
Note: Most third party payers require that charges for this service are to be identified.
|GENERAL CLASSIFICATION||INTENSIVE CARE (ICU)||0200|
|BURN CARE||ICU/BURN CARE||0207|
|OTHER INTENSIVE CARE||ICU/OTHER||0209|
Definition: Routine service charges for medical care provided to patients with coronary illness who require a more intensive level of
care than is rendered in the general medical or surgical unit.
Note: Report when a discrete coronary care unit exists for rendering such services.
|GENERAL CLASSIFICATION||CORONARY CARE (CCU)||0210|
|MYOCARDIAL INFARCTION||CCU/MYO INFARC||0211|
|OTHER CORONARY CARE||CCU/OTHER||0219|
Definition: Charges incurred during an inpatient stay or on a daily basis for certain services.
Note: Some hospitals may prefer to identify the components of services rendered in greater detail and thus break out charges that normally would be considered part of routine services.
|GENERAL CLASSIFICATION||SPECIAL CHARGE||0220|
|ADMISSION CHARGE||ADMIT CHARGE||0221|
|TECHNICAL SUPPORT CHARGE||TECH SUPPORT CHG||0222|
|U. R. SERVICE CHARGE||UR CHARGE||0223|
|LATE DISCHARGE, MEDICALLY NECESSARY||LATE DISCH/MED NEC||0224|
|OTHER SPECIAL CHARGES||OTHER SPEC CHG||0229|
|Incremental Nursing Charge
Definition: Extraordinary charges for nursing services assessed in addition to the normal nursing charge associated with the typical room and board unit.
Note: Most third-party payers require that charges for this service are to be identified.
|GENERAL CLASSIFICATION||NURSING INCREM||0230|
|All Inclusive Ancillary
Definition: A flat-rate charge that is applied on a daily basis or on a total stay basis for ancillary services only.
Note: Hospitals billing in this manner may wish to segregate these charges.Revenue Codes 0241, 0242, and 0243 are designed for use by Special Residential Facilities only. See FL 4 Type of Bill 086x.
|GENERAL CLASSIFICATION||ALL INCL ANCIL||0240|
|BASIC||ALL INCL BASIC||0241|
|COMPREHENSIVE||ALL INCL COMPL||0242|
|SPECIALTY||ALL INCL SPECIAL||0243|
|OTHER ALL INCLUSIVE ANCILLARY||ALL INCL ANCIL/OTHER||0249|
|Pharmacy (also see 063x, an extension of 25x)
Definition: Charges for medication produced, manufactured, packed, controlled, assayed, dispensed and distributed under the direction of a licensed pharmacist.
|TAKE HOME DRUGS||DRUGS/TAKEHOME||0253|
|DRUGS INCIDENT TO OTHER DIAGNOSTIC SERVICES||DRUGS/INCIDENT OTHER DX||0254|
|DRUGS INCIDENT TO RADIOLOGY||DRUGS/INCIDENT RAD||0255|
|IV SOLUTIONS||IV SOLUTIONS||0258|
Definition: Equipment charge or administration of intravenous solution by specially trained personnel to individuals requiring such treatment.
Note: Billing for Home IV providers require the HCPCS code which describes the pump to be entered in FL 44.
|GENERAL CLASSIFICATION||IV THERAPY||0260|
|INFUSION PUMP||IV THER/INFSN PUMP||0261|
|IV THERAPY/PHARMACY SVCS||IV THER/PHARM/SVC||0262|
|IV THERAPY/DRUG/SUPPLY/DELIVERY||IV THER/DRUG/SUPPLY/DEL||0263|
|IV THERAPY/SUPPLIES||IV THER/SUPPLIES||0264|
|OTHER IV THERAPY||IV THERAPY/OTHER||0269|
|Medical/Surgical Supplies and Devices (also see 062X, an extension of 027X)
Definition: (a) Implantables: That which is implanted, such as a piece of tissue, a tooth, a pellet of medicine, or a tube or needle containing a radioactive substance, a graft, or an insert. Also included are liquid and solid plastic materials used to augment tissues or to fill in areas traumatically or surgically removed. An object or material partially or totally inserted or grafted into the body for prosthetic, therapeutic, diagnostic purposes.
Examples of Other Implants (not all-inclusive): Stents, artifical joints, shunts, grafts, pins, plates, screws, anchors, radioactive seeds.
Note: Experimental devices that are implantable and have been granted an FDA Investigational Device Exemption (IDE) number should be billed with revenue code 0624.
|GENERAL CLASSIFICATION||MED-SUR SUPPLIES||0270|
|NON STERILE SUPPLY||NON-STER SUPPLY||0271|
|STERILE SUPPLY||STERILE SUPPLY||0272|
|TAKE HOME SUPPLIES||TAKEHOME SUPPLY||0273|
|PROSTHETIC/ORTHOTIC DEVICES||PROSTH/ORTH DEV||0274|
|INTRAOCULAR LENS||INTRA OC LENS||0276|
|OXYGEN - TAKE HOMES||02/TAKEHOME||0277|
|OTHER IMPLANT (A)||SUPPLY/IMPLANTS||0278|
Definition: Charges for the treatment of tumors and related diseases.
|Durable Medical Equipment (OTHER THAN RENAL)
Definition: Charges for medical equipment that can withstand repeated use (excludes renal equipment).
|PURCHASE OF NEW DME||DME-NEW||0292|
|PURCHASE OF USED DME||DME-USED||0293|
|SUPPLIES/DRUGS FOR DME||DME-SUPPLIES/DRUGS||0294|
Definition: Charges for the performance of diagnostic and routine clinical laboratory tests.
|RENAL PATIENT (HOME)||RENAL-HOME||0303|
|NON-ROUTINE DIALYSIS||NON-RTNE DIALYSIS||0304|
|BACTERIOLOGY AND MICROBIOLOGY||BACT & MICRO TESTS||0306|
|OTHER LABORATORY||OTHER LAB TESTS||0309|
|Laboratory - Pathology
Definition: Charges for diagnostic and routine laboratory tests on tissues and culture.
|GENERAL CLASSIFICATION||PATHOLOGY LAB||0310|
|OTHER LABORATORY PATHOLOGY||PATH LAB OTHER||0319|
|Radiology - Diagnostic
Definition: Charges for diagnostic radiology services including interpretation of radiographs and fluorographs.
|GENERAL CLASSIFICATION||DX X-RAY||0320|
|CHEST X-RAY||DX X-RAY/CHEST||0324|
|OTHER RADIOLOGY - DIAGNOSTIC||DX X - RAY/OTHER||0329|
|Radiology - Therapeutic and/or Chemotherapy Administration
Definition: Charges for therapeutic radiology services and chemotherapy administration to care and treat patients. Therapies also include injection and/or ingestion of radioactive substances. Excludes charges for chemotherapy drugs; report these under the appropriate revenue code (025x or 063x).
Note: When using 0331, 0332, or 0335 there must be use of RC 0636.
|GENERAL CLASSIFICATION||RADIOLOGY THERAPY||0330|
|CHEMOTHERAPY ADMIN - INJECTED||RAD-CHEMO-INJECT||0331|
|CHEMOTHERAPY ADMIN - ORAL||RAD-CHEMO-ORAL||0332|
|CHEMOTHERAPY ADMIN - IV||RAD-CHEMO-IV||0335|
|OTHER RADIOLOGY - THERAPEUTIC||RADIOLOGY OTHER||0339|
Definition: Charges for procedures, tests, and radiopharmaceuticals performed by a department handling radioactive materials as required for diagnosis and treatment of patients.
Note: Subcategories provide a breakdown to identify specific types of services billed under Nuclear Medicine.
|GENERAL CLASSIFICATION||NUCLEAR MEDICINE||0340|
|DIAGNOSTIC RADIOPHARMACEUTICALS||NUC MED/DX-RADIOPHARM||0343|
|THERAPEUTIC RADIOPHARMACEUTICALS||NUC MED/RX-RADIOPHARM||0344|
|OTHER NUCLEAR MED||NUC MED/OTHER||0349|
Definition: Charges for computed tomographic scans of the head and other parts of the body.
|GENERAL CLASSIFICATION||CT SCAN||0350|
|CT - HEAD SCAN||CT SCAN/HEAD||0351|
|CT - BODY SCAN||CT SCAN/BODY||0352|
|CT - OTHER||CT SCAN/OTHER||0359|
|Operating Room Services
Definition: Charges for services provided to patients by specifically trained nursing personnel who assist physicians in the performance of surgical and related procedures during and immediately following surgery.
|GENERAL CLASSIFICATION||OR SERVICES||0360|
|ORGAN TRANSPLANT - OTHER THAN KIDNEY||OR/ORGAN TRANS||0362|
|KIDNEY TRANSPLANT||OR/KIDNEY TRANS||0367|
|OTHER OR SERVICES||OR/OTHER||0369|
Definition: Charges for anesthesia services.
|ANESTHESIA INCIDENT TO RADIOLOGY||ANESTH/INCIDENT RAD||0371|
|ANESTHESIA INCIDENT TO OTHER DX SERVICES||ANESTH/INCIDNT OTHER DX||0372|
|Blood and Blood Components
Definition: Charges for blood and blood components.
|GENERAL CLASSIFICATION||BLOOD & BLOOD COMP||0380|
|PACKED RED CELLS||BLOOD/PKD RED||0381|
|OTHER BLOOD COMPONENTS||BLOOD/COMPONENTS||0386|
|OTHER DERIVATIVES (CRYOPRECIPITATE)||BLOOD/DERIVATIVES||0387|
|OTHER BLOOD AND BLOOD COMPONENTS||BLOOD/OTHER||0389|
|Administration, Processing, and Storage for Blood and Blood
Definition: Charges for administration, processing and storage of whole blood, red blood cells, platelets, and other blood components.
|ADMINISTRATION (E.G., TRANSFUSION)||BLOOD/ADMIN||0391|
|PROCESSING AND STORAGE||BLOOD/STORAGE||0392|
|OTHER BLOOD HANDLING||BLOOD/ADMIN/STOR/OTHER||0399|
|Other Imaging Services
Definition: Charges for specialty imaging services for body structures.
|GENERAL CLASSIFICATION||IMAGING SERVICE||0400|
|DIAGNOSTIC MAMMOGRAPHY||DIAG MAMMOGRAPHY||0401|
|SCREENING MAMMOGRAPHY||SCRN MAMMOGRAPHY||0403|
|POSITRON EMISSION TOMOGRAPHY||PET SCAN||0404|
|OTHER IMAGING SERVICES||OTHER IMAG SVCS||0409|
Definition: Charges for respiratory services including administration of oxygen and certain potent drugs through inhalation or positive pressure and other forms of rehabilitative therapy.
|GENERAL CLASSIFICATION||RESPIRATORY SVC||0410|
|INHALATION SERVICES||INHALATION SVC||0412|
|HYPERBARIC OXYGEN THERAPY||HYPERBARIC O2||0413|
|OTHER RESPIRATORY SERVICES||OTHER RESPIR SVCS||0419|
Definition: Charges for therapeutic exercises, massage and utilization of Effective Date properties of light, heat, cold, water, electricity, and assist devices for diagnosis and rehabilitation of patients who have neuromuscular, orthopedic and other disabilities.
|GENERAL CLASSIFICATION||PHYSICAL THERP||0420|
|EVALUATION OR RE-EVALUATION||PHYS THERP/EVAL||0424|
|OTHER PHYSICAL THERAPY||OTHER PHYS THERP||0429|
Definition: Charges for therapeutic interventions to improve, sustain, or restore an individual's level of function in performance of activities of daily living and work, including therapeutic activities, therapeutic exercises; sensorimotor processing; psychosocial skills training; cognitive retraining, fabrication and application of orthotic devices; and training in the use of orthotic and prosthetic devices; adaptation of environments; and application of physical agent modalities.
Note: Services are provided by a qualified occupational therapist.
|GENERAL CLASSIFICATION||OCCUPATIONAL THER||0430|
|EVALUATION OR RE-EVALUATION||OCCUP THERP/EVAL||0434|
|OTHER PHYSICAL THERAPY||OCCUP THER/OTHER||0439|
|Speech Therapy - Language Pathology
Definition: Charges for services related to impaired functional communications skills.
Note: Services are provided by a qualified speech therapist.
|GENERAL CLASSIFICATION||SPEECH THERAPY||0440|
|EVALUATION OR RE-EVALUATION||SPEECH THERP/EVAL||0444|
|OTHER SPEECH THERAPY||OTHER SPEECH THERP||0449|
Definition: Charges for emergency treatment to those ill and injured persons who require immediate unscheduled medical or surgical care.
Notes: Report Patient's Reason for Visit code in FL 70 in conjunction with this revenue code.
An "X" in the matrix below indicates acceptable coding.
(a) General classification code 0450 should not be used in conjunction with any subcategory. The sum of 0451 and 0452 is the equivalent to 0450.
(b) Stand-alone usage of 0451 is acceptable when no services beyond an initial screening/assessment are rendered.
(c) Stand-alone usage of 0452 is not acceptable.
|GENERAL CLASSIFICATION||EMERG ROOM||0450|
|EMTALA EMERGENCY MEDICAL SCREENING||ER/EMTALA||0451|
|ER BEYOND EMTALA||ER/BEYOND EMTALA||0452|
|OTHER EMERGENCY ROOM||OTHER EMERG ROOM||0459|
Definition: Charges for tests that measure inhaled and exhaled gases and analysis of blood and for tests that evaluate the patient's ability to exchange oxygen and other exhaled gases.
|GENERAL CLASSIFICATION||PULMONARY FUNC||0460|
|OTHER PULMONARY||OTHER PULMONARY FUNC||0469|
Definition: Charges for the detection and management of communication handicaps centering in whole or in part on the hearing function.
Note: Services are provided by or through the supervision of a qualified audiologist.
|OTHER AUDIOLOGY||OTHER AUDIOL||0479|
Definition: Charges for cardiac procedures.
Note: Services provided are by staff from the cardiology department of the hospital or under arrangement. Services include procedures such as: heart catheterization coronary angiography, Swan-Ganz catheterization, and exercise stress test.
|CARDIAC CATH LAB||CARDIAC CATH LAB||0481|
|STRESS TEST||STRESS TEST||0482|
|OTHER CARDIOLOGY||OTHER CARDIOL||0489|
|Ambulatory Surgical Care
Definition: Charges for ambulatory surgery not covered by other categories.
|GENERAL CLASSIFICATION||AMBULTRY SURG||0490|
|OTHER AMBULATORY SURGICAL||OTHER AMBL SURG||0499|
Definition: Charges for services rendered to an outpatient who is then admitted as an inpatient before midnight of the day following the date of services.
Note: Medicare no longer requires this revenue code.
|GENERAL CLASSIFICATION||OUTPATIENT SVCS||0500|
|OTHER OUTPATIENT||OTHER - O/P SERVICES||0509|
Definition: Clinic visit charges for providing diagnostic, preventative, curative, rehabilitative, and education services to ambulatory patients.
Note: *Report the Patients Reason for Visit diagnosis codes for all Urgent Care Clinic visits.
|CHRONIC PAIN CENTER||CHRONIC PAIN CLINIC||0511|
|DENTAL CLINIC||DENTAL CLINIC||0512|
|PSYCHIATRIC CLINIC||PSYCHIATRIC CLINIC||0513|
|OB-GYN CLINIC||OB-GYN CLINIC||0514|
|PEDIATRIC CLINIC||PEDIATRIC CLINIC||0515|
|URGENT CARE CLINIC*||URGENT CARE CLINIC||0516|
|FAMILY PRACTICE CLINIC||FAMILY CLINIC||0517|
|OTHER CLINIC||OTHER CLINIC||0519|
Definition: Charges for the outpatient visit at a freestanding clinic.
Note: *Report the Patients Reason for Visit diagnosis codes for all Urgent Care Clinic visits.
|GENERAL CLASSIFICATION||FREESTAND CLINIC||0520|
|CLINIC VISIT BY MEMBER TO RHC/FQHC||FS-RURAL/CLINIC||0521|
|HOME VISIT BY RHC/FQHC PRACTICIONER||FS-RURAL/HOME||0522|
|FAMILY PRACTICE CLINIC||FS-FAMILY PRACT||0523|
|VISIT BY RHC/FQHC PRACTICIONER TO A MEMBER IN A COVERED PART A STAY AT SNF||FR/STD FAMILY CLINIC||0524|
|VISIT BY RHC/FQHC PRACTICIONER TO A MEMBER IN A SNF (NOT IN A COVERED PART A STAY) OR NF OR ICF MR OR OTHER RESIDENTIAL FACILITY||RHC/FQHC/SNF/NONCOVERED||0525|
|URGENT CARE CLINIC*||FR/STD URGENT CLINIC||0526|
|VISITING NURSE SERVICE(S) TO A MEMBER'S HOME WHEN IN A HOME HEALTH SHORTAGE AREA||RHC/FQHC/HOME/VIS NURSE||0527|
|VISIT BY RHC/FQHC PRACTICIONER TO OTHER NON-RHC/FQHC SITE (E.G., SCENE OF ACCIDENT)||RHC/FQHC/OTHER SITE||0528|
|OTHER FREESTANDING CLINIC||OTHER FS-CLINIC||0529|
Definition: Charges for a structural evaluation of the cranium, entire cervical, dorsal and lumbar spine by a doctor of osteopathy.
Note: Generally, these services are unique to osteopathic hospitals and cannot be accommodated in any of the existing revenue codes.
|GENERAL CLASSIFICATION||OSTEOPATH SVCS||0530|
|OSTEOPATHIC THERAPY||OSTEOPATH RX||0531|
|OTHER OSTEOPATHIC SERVICES||OTHER OSTEOPATH||0539|
Definition: Charges for ambulance services necessary for the transport of the ill or injured who require medical attention at a health care facility.
|MEDICAL TRANSPORT||AMBUL/MED TRANS||0542|
|HEART MOBILE||AMBUL/HEART MOB||0543|
|AIR AMBULANCE||AIR AMBULANCE||0545|
|NEONATAL AMBULANCE SERVICES||AMBUL/NEONAT||0546|
|EKG TRANSMISSION||AMBUL/EKG TRANS||0548|
Definition: Charges for nursing services that must be provided under the direct supervision of a licensed nurse to assure the safety of the patient and to achieve the medically desired result. This code may be used for nursing home services, CORFS, or a service charge for home health billing.
|GENERAL CLASSIFICATION||SKILLED NURSING-HH||0550|
|VISIT CHARGE||SKILLED NURS-VISIT||0551|
|HOURLY CHARGE||SKILLED NURS-HOUR||0552|
|OTHER SKILLED NURSING||SKILLED NURS/OTHER||0559|
|Home Health (HH) - Medical Social Services
Definition: Home Health (HH) charges for services such as counseling patients, interviewing patients, and interpreting problems of social situation rendered to patients on any basis.
|GENERAL CLASSIFICATION||MED SOCIAL-HH||0560|
|VISIT CHARGE||MED SOC SVCS-VISIT||0561|
|HOURLY CHARGE||MED SOC SVCS-HOUR||0562|
|OTHER MED SOCIAL SERVICE||MED SOC SVCS-OTHER||0569|
|Home Health (HH) Aide
Definition: Home Health (HH) charges for personnel (aides) that are primarily responsible for the personal care of the patient.
|GENERAL CLASSIFICATION||HH AIDE||0570|
|VISIT CHARGE||HH AIDE-VISIT||0571|
|HOURLY CHARGE||HH AIDE-HOUR||0572|
|OTHER HH - AIDE||HH AIDE-OTHER||0579|
|Home Health (HH) - Other Visits
Definition: Home Health (HH) agency charges for visits other than physical therapy, occupational therapy or speech therapy, requiring specific identification.
|GENERAL CLASSIFICATION||HH-OTH VIS||0580|
|VISIT CHARGE||HH-OTH VIS/VISIT||0581|
|HOURLY CHARGE||HH-OTH VIS/HOUR||0582|
|OTHER HOME HEALTH VISIT||HH-OTH VIS/OTHER||0589|
|Home Health (HH) Units of Service
Definition: Home Health (HH) charges for services billed according to the units of service provided.
|GENERAL CLASSIFICATION||HH - SVCS/UNIT||0590|
|Home Health (HH) - Oxygen
Definition: Home Health (HH) agency charges for oxygen equipment, supplies or contents, excluding purchased equipment.
If patient purchases a stationary oxygen system, an oxygen concentrator, or portable equipment, current revenue codes 0292 or 0293 apply. DME (other than oxygen systems) is billed under revenue codes 0291, 0292, or 0293.
|GENERAL CLASSIFICATION||O2/HOME HEALTH||0600|
|OXYGEN - STAT EQUIP/SUPPLY/CONTENT||O2/STAT EQUIP/SUPLY/CONT||0601|
|OXYGEN - STAT EQUIP/SUPPLY<1 LPM||O2/STAT EQP/SUPPL<1 LPM||0602|
|OXYGEN - STAT EQUIP/SUPPLY>4 LPM||O2/STAT EQP/SUPPL>4 LPM||0603|
|OXYGEN - PORT ADD-ON||O2/PORTBLE ADD-ON||0604|
|OXYGEN - OTHER||O2/OTHER||0609|
|Magnetic Resonance Technology (MRT)
Definition: Charges for Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography.
|MRI - BRAIN/BRAINSTEM||MRI/BRAIN||0611|
|MRI - SPINAL CORD/SPINE||MRI/SPINE||0612|
|MRI - OTHER||MRI/OTHER||0614|
|MRA - HEAD AND NECK||MRA/HEAD & NECK||0615|
|MRA - LOWER EXTREMITIES||MRA/LOWER EXTRM||0616|
|MRA - OTHER||MRA/OTHER||0618|
|Medical Surgical Supplies - Extension of 027x
Definition: Charges for supply items required for patient care. The category is an extension of 027x for reporting additional breakdown where needed. Subcategory code 1 is for providers that cannot bill supplies used for radiology procedures under radiology. Subcategory code 2 is for providers that cannot bill supplies used for other diagnostic procedures.
|SUPPLIES INCIDENT TO RADIOLOGY||MED SURG SUPL-INCDT RAD||0621|
|SUPPLIES INCIDENT TO OTHER DX SERVICES||MED SURG SUPL-INCDT ODX||0622|
|SURGICAL DRESSINGS||SURG DRESSINGS||0623|
|FDA INVESTIGATIONAL DEVICES||FDA INVEST DEVICE||0624|
|Pharmacy - Extension of 025x
Definition: Charges for medication produced, manufactured, packaged, controlled, assayed, dispensed and distributed under the direction of a licensed pharmacist. The category is an extension of 025x for reporting additional breakdown where needed.
Note: (a) Charges for drugs and biologics (with the exception of radiopharmaceuticals, which are reported under Revenue Codes 0343 and 0344) requiring specific identification as required by the payer. If using a HCPCS to describe the drug, enter the HCPCS code in the appropriate HCPCS column. The specific service units reported should be in hundreds (100s); rounded to the nearest hundred; do not use a decimal.
(b) Charges for self-administrable drugs not requiring detailed coding. Use Value Codes A4, A5, and A6 to indicate the dollar amount included in covered charges for self-administrable drugs. Amounts for non-covered self-administrable drugs should be charged using Revenue Code 0637 in the non-covered column.
|(USE 0250 FOR GENERAL CLASSIFICATION)|
|SINGLE SOURCE DRUG||DRUG/SINGLE||0631|
|MULTIPLE SOURCE DRUG||DRUG/MULTIPLE||0632|
|ERYTHROPOIETIN (EPO) <10,000 UNITS||DRUG/EPO<10,000 UNITS||0634|
|ERYTHROPOIETIN (EPO)>=10,000 UNITS||DRUG/EPO>=10,000 UNITS||0635|
|DRUGS REQUIRING DETAILED CODING (a)||DRUG/DETAIL CODE||0636|
|SELF-ADMINISTRABLE DRUGS (b)||DRUG/SELF ADMIN||0637|
|Home IV Therapy Services
Definition: Charge for intravenous therapy services performed in the patient's residence. For Home IV providers enter the HCPCS code for all equipment, and all types of covered therapy.
Note: Report units in one hour increments; Revenue Code 0642 relates to the HCPCS code.
|GENERAL CLASSIFICATION||IV THERAPY SVC||0640|
|NON-ROUTINE NURSING, CENTRAL LINE||NON RT NURSING/CENTRL||0641|
|IV SITE CARE, CENTRAL LINE (SEE NOTE)||IV SITE CARE/CENTRAL||0642|
|IV START/CARE, PERIPHERAL LINE||IV STRT CARE/PERIPHRL||0643|
|NON-ROUTINE NURSING, PERIPHERAL LINE||NONRT NURSING/PERIPHRL||0644|
|TRAINING PATIENT/CAREGIVER, CENTRAL LINE||TRNG PT/CAREGVR/CENTRAL||0645|
|TRAINING DISABLED PATIENT, CENTRAL LINE||TRNG DSBLPT/CENTRAL||0646|
|TRAINING PATIENT/CAREGIVER, PERIPHERAL LINE||TRNG/PT/CARGVR/PERIPHRL||0647|
|TRAINING DISABLED PATIENT, PERIPHERAL LINE||TRNG/DSBLPT/PERIPHRL||0648|
|OTHER IV THERAPY SERVICES||OTHER IV THERAPY SVC||0649|
Definition: Charge for hospice care services for a terminally ill patient electing hospice services in lieu of other medical services for their terminal condition.
Note: To receive the continuous home care rate from Medicare use code 0652, a minimum of 8 hours of care, not necessarily consecutive, must be accompanied by a physician procedure code. Enter this information in the HCPCS column (Form Locator 44). This code is used by the hospice to bill for charges for physicians employed by the hospice or receiving compensation from the hospice for services rendered. The unit will be either days or hours depending on subcategory and billing contracts.
|ROUTINE HOME CARE||HOSPICE/RTN HOME||0661|
|CONTINUOUS HOME CARE||HOSPICE CTNS HOME||0652|
|INPATIENT RESPITE CARE||HOSPICE/IP RESPITE||0655|
|GENERAL INPATIENT CARE NON-RESPITE||HOSPICE/IP NON-RESPITE||0656|
|HOSPICE ROOM & BOARD - NURSING FACILITY||HOSPICE/R&B NURSE FAC||0658|
|OTHER HOSPICE SERVICE||HOSPICE/OTHER||0659|
Definition: Charge for non-hospice respite care.
|GENERAL CLASSIFICATION||RESPITE CARE||0660|
|HOURLY CHARGE - NURSING||RESPITE/NURSING||0661|
|HOURLY CHARGE - AIDE/HOMEMAKER/COMPANION||RESPITE/AID/HMEMKR/COMP||0662|
|DAILY RESPITE CHARGE||RESPITE/DAILY||0663|
|OTHER RESPITE CARE||RESPITE/OTHER||0669|
|Outpatient Special Residence Charges
Definition: Residence arrangements for patients requiring continuous outpatient care.
|GENERAL CLASSIFICATION||OP SPEC RES||0670|
|HOSPITAL OWNED||OP SPEC RES/HOSP OWNED||0671|
|CONTRACTED||OP SPEC RES/CONTRACTED||0672|
|OTHER SPECIAL RESIDENCE CHARGE||OP SPEC RES/OTHER||0679|
Definition: Charges representing the activation of the trauma team.
Note: 1. For use by trauma center/hospitals, licensed or designated by the state or local government authority, authorized as a trauma center, or verified by the American College of Surgeons and as a facility with a trauma activation team.
2. Revenue Category 068x is used for patients for whom a trauma activation occurred. A trauma team activation/response is a Notification of key hospital personnel in response to triage information from pre-hospital caregivers in advance of the patients arrival.
3. Revenue Category 068x is for reporting trauma activation costs only. It is an activation fee and not a replacement or a substitute for the emergency room visit fee; if trauma activation occurs, there will normally be both a 045x and 068x revenue code reported.
4. Revenue Category 068x is not limited to admitted patients.
5. Revenue Category 068x must be used in conjunction with FL 14 Priority (Type) of Admission/Visit Code 5 (Trauma Center); however FL 14 Code 5 can be used alone for trauma activations that lack pre-hospital notification.
Only patients for whom there has been pre-hospital notification, who meet either local, state, or American College of Surgeons field triage criteria, or are delivered by inter-hospital transfers, and are given the appropriate team response, can be billed the trauma activation fee charge. Patients who are drive-by or arrive without notification cannot be charged for activations, but can be classified as trauma under Type of Admission Code 5 for statistical and follow-up purposes.
6. Levels I, II, III, or IV refer to designations given to the trauma facility by the state or local government authority or as verified by the American College of Surgeons.
7. Subcategory 9 is for states or local authorities with levels beyond IV.
|LEVEL I TRAUMA||TRAUMA LEVEL I||0681|
|LEVEL II TRAUMA||TRAUMA LEVEL II||0682|
|LEVEL III TRAUMA||TRAUMA LEVEL III||0683|
|LEVEL IV TRAUMA||TRAUMA LEVEL IV||0684|
|OTHER TRAUMA RESPONSE||TRAUMA OTHER||0689|
Definition: Charge for services related to the application, maintenance and removal of casts.
|GENERAL CLASSIFICATION||CAST ROOM||0700|
Definition: Room charge for patient recovery after surgery.
|GENERAL CLASSIFICATION||RECOVERY ROOM||0710|
Definition: Charges for labor and delivery room services provided by specifically trained nursing personnel to patients including prenatal care during labor, assistance during delivery, postnatal care in the recovery room, and minor gynecologic procedures if they are performed in the delivery suite.
|GENERAL CLASSIFICATION||DELIVERY ROOM/LABOR||0720|
|BIRTHING CENTER||BIRTHING CNTR||0724|
|OTHER LABOR ROOM/DELIVERY||OTHER/DELIV-LABOR||0729|
Definition: Charges for operation of specialized equipment to record variations in actions of the heart muscle for diagnosis of heart ailments.
|HOLTER MONITOR||HOLTER MONT||0731|
|OTHER EKG/ECG||OTHER EKG/ECG||0739|
Definition: Charges for operation of specialized equipment to measure impulse frequencies and differences in electrical potential in various areas of the brain to obtain data for use in diagnosing brain disorders.
|Gastro-Intestinal (GI) Services
Definition: Charges for GI procedures not performed in the operating room.
|GENERAL CLASSIFICATION||GASTRO-INTSTL SVCS||0750|
Definition: Charges for patients requiring treatment room services or patients placed under observation.
Note: Observation services are those services furnished by a hospital on the hospital's premises, including use of a bed and periodic monitoring by a hospital's nursing or other staff, which are reasonable and necessary to evaluate an outpatient's condition or determine the need for a possible admission to the hospital or as an inpatient. Such services are covered only when provided by the order of a physician or another individual authorizaed by State licensure law and hospital staff bylaws to admit patients to the hospital or to order outpatient tests. The reason for observation must be stated in the orders for observation. Payers should establish written guidelines, which identify coverage of observation services.
(a) FL 70a-c - Patient's Reason for Visit should be reported in conjunction with 0762.
|GENERAL CLASSIFICATION||SPECIALTY SVC||0760|
|TREATMENT ROOM||TREATMENT RM||0761|
|OBSERVATION HOURS (a)||OBSERVATION||0762|
|OTHER SPECIALTY SERVICES||OTHER SPECIALTY SVC||0769|
|Preventive Care Services
Definition: Revenue Code used to capture preventive care services established by payers (e.g. vaccination).
|GENERAL CLASSIFICATION||PREVENT CARE SVCS||0770|
|VACCINE ADMINISTRATION||VACCINE ADMIN||0771|
Definition: Facility charges related to the use of telemedicine services.
|Extra-Corporeal Shock Wave Therapy (formerly Lithotripsy)
Definition: Charges related to Extra-Corporeal Shock Wave Therapy (ESWT).
|Inpatient Renal Dialysis
Definition: Charges for the use of equipment designed to remove waste when the body's kidneys have failed. The waste may be removed from the booy (hemodialysis) or indirectly from the blood by flushing a special solution between the abdominal covering and the tissue (peritoneal dialysis).
|GENERAL CLASSIFICATION||RENAL DIALYSIS||0800|
|INPATIENT PERITONEAL DIALYSIS (NON-CAPD)||DIALY/IP/PER||0802|
|INPATIENT CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)||DIALY/IP/CAPD||0803|
|INPATIENT CONTINUOUS CYCLING PERITONEAL DIALYSIS (CCPD)||DIALY/IP/CCPD||0804|
|OTHER INPATIENT DIALYSIS||DIALY/IP/OTHER||0809|
|Acquisition of Body Components
Definition: The acquisition and storage costs of body tissue, bone marrow, organs and other body components not otherwise identified used for transplantation.
Note: Living donor is a living person from whom an organ is collected and used for transplantation purposes.
Cadaver is an individual pronounced dead according to medical and legal criteria, and whose organs may be harvested for transplantation.
Unknown is used whenever the status of the individual source cannot be determined. Use the other category whenever the organ is non-human.
Revenue Code 0814 is used only when costs incurred for an organ search do not result in an eventual organ aquisition and transplantation.
|GENERAL CLASSIFICATION||ORGAN ACQUISIT||0810|
|LIVING DONOR||LIVING DONOR||0811|
|CADAVER DONOR||CADAVER DONOR||0812|
|UNKNOWN DONOR||UNKNOWN DONOR||0813|
|UNSUCCESSFUL ORGAN SEARCH - DONOR BANK CHARGES||UNSUCCESSFUL SEARCH||0814|
|OTHER DONOR||OTHER DONOR||0819|
|Hemodialysis - Outpatient or Home
Definition: A waste removal process, performed in an outpatient or home setting, necessary when the body's own kidneys have failed. Waste is removed directly from the blood.
|GENERAL CLASSIFICATION||HEMO/OP OR HOME||0820|
|HEMODIALYSYS/COMPOSITE OR OTHER RATE||HEMO/COMPOSITE||0821|
|MAINTENANCE - 100%||HEMO/HOME/100%||0824|
|OTHER OP HEMODIALYSIS||HEMO-OTHER OP||0829|
|Peritoneal Dialysis - Outpatient or Home
Definition: Charges for a waste removal process performed in an outpatient or home setting, necessary when the body's own kidneys have failed. Waste is removed indirectly by flushing a special solution between the abdominal covering and the tissue.
|GENERAL CLASSIFICATION||PERITONEAL/OP OR HOME||0830|
|PERITONEAL/COMPOSITE OR OTHER RATE||PERTNL/COMPOSITE||0831|
|MAINTENANCE - 100%||PERTNL/HOME/100%||0834|
|OTHER OP PERITONEAL DIALYSIS||PERTNL/HOME/OTHER||0839|
|Continuous Ambulatory Peritoneal Dialysis (CAPD) - Outpatient or Home
Definition: Charges for continuous dialysis process performed in an outpatient or home setting which uses the patient peritoneal membrane as a dialyzer.
|GENERAL CLASSIFICATION||CAPD/OP OR HOME||0840|
|CAPD/COMPOSITE OR OTHER RATE||CAPD/COMPOSITE||0841|
|MAINTENANCE - 100%||CAPD/HOME/100%||0844|
|OTHER OUTPATIENT CAPD||CAPD/HOME/OTHER||0849|
|Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home
Definition: Charges for continuous dialysis process performed in an outpatient or home setting which uses a machine to make automatic exchanges at night.
|GENERAL CLASSIFICATION||CCPD/OP OR HOME||0850|
|CCPD/COMPOSITE OR OTHER RATE||CCPD/COMPOSITE||0851|
|MAINTENANCE - 100%||CCPD/HOME/100%||0854|
|OTHER OUTPATIENT CCPD||CCPD/HOME/OTHER||0859|
Definition: Charges for operation of specialized medical equipment to measure the magnetic fields generated by brain activity.
Definition: Charges for dialysis services not identified elsewhere.
Note: Ultrafiltration is the process of removing excess fluid from the blood of dialysis patients by using a dialysis machine but without the dialysate solution. The designation is only used when the procedure is not performed as part of a normal dialysis session.
|HOME DIALYSIS||HOME DIALYSIS AID VISIT||0882|
|OTHER MISCELLANEOUS DIALYSIS||DIALY/MISC/OTHER||0889|
|Behavioral Health Treatment/Services (also see 091x, an extension of 090x)
Definition: Charges for prevention, intervention, and treatment services in the areas of mental health, substance abuse, developmental disabilities, and sexuality. Behavioral Health Care services are individualized, holistic, and culturally competent and may include on-going care and support and non-traditional services.
|ELECTROSHOCK TREATMENT||BH/ELECTRO SHOCK||0901|
|MILIEU THERAPY||BH/MILIEU THERAPY||0902|
|PLAY THERAPY||BH/PLAY THERAPY||0903|
|ACTIVITY THERAPY||BH/ACTIVITY THERAPY||0904|
|INTENSIVE OUTPATIENT SERVICES-PSYCHIATRIC||BH/INTENS OP/PSYCH||0905|
|INTENSIVE OUTPATIENT SERVICES-CHEMICAL DEPENDENCY||BH/INTENS OP/CHEM DEP||0906|
|COMMUNITY BEHAVIORAL HEALTH PROGRAM (DAY TREATMENT)||BH/COMMUNITY||0907|
|Behavioral Health Treatment/Services - Extension of 090x
Definition: See Revenue Code 090x.
|PARTIAL HOSPITALIZATION - LESS INTENSIVE||BH/PARTIAL HOSP||0912|
|PARTIAL HOSPITALIZATION - INTENSIVE||BH/PARTIAL INTENSV||0913|
|INDIVIDUAL THERAPY||BH/INDIV RX||0914|
|GROUP THERAPY||BH/GROUP RX||0915|
|FAMILY THERAPY||BH/FAMILY RX||0916|
|OTHER BEHAVIORAL HEALTH TREATMENTS||BH/OTHER||0919|
|Other Diagnostic Services
Definition: Charges for various diagnostic services specific to common screenings for disease, illness or medical condition.
|GENERAL CLASSIFICATION||OTHER DX SVCS||0920|
|PERIPHERAL VASCULAR LAB||PERI VASCUL LAB||0921|
|PAP SMEAR||PAP SMEAR||0923|
|ALLERGY TEST||ALLERGY TEST||0924|
|PREGNANCY TEST||PREG TEST||0925|
|OTHER DIAGNOSTIC SERVICE||OTHER DX SVCS||0929|
|Medical Rehabilitation Day Program
Definition: Medical rehabilitation services as contracted with a payer and/or certified by the state. Services may include physical therapy, occupational therapy, and speech therapy.
Note:The subcategories of 093x are designed as a zero-bill revenue code (i.e., no dollars are reported in the Total Charge column (FL 47) for this revenue code). It should be used as a vehicle to supply program information as defined in the provider/payer contract. Therefore, zero would be reported in the Total Charge column and the number of hours provided would be reported in the Units field. The specific rehabilitation services would be reported under the applicable therapy revenue codes as normal.
|HALF DAY||HALF DAY||0931|
|FULL DAY||FULL DAY||0932|
|Other Therapeutic Services (also see 095x, an extension of 094x)
Definition: Charges for other therapeutic services not otherwise categorized.
|GENERAL CLASSIFICATION||OTHER RX SVCS||0940|
|RECREATIONAL THERAPY||RECREATION RX||0941|
|CARDIAC REHABILITATION||CARDIAC REHAB||0943|
|DRUG REHABILITATION||DRUG REHAB||0944|
|ALCOHOL REHABILITATION||ALCOHOL REHAB||0945|
|COMPLEX MEDICAL EQUIPMENT - ROUTINE||CMPLX MED EQUIP-ROUT||0946|
|COMPLEX MEDICAL EQUIPMENT - ANCILLARY||CMPLX MED EQUIP-ANC||0947|
|PULMONARY REHABILITATION||PULMONARY REHAB||0948|
|OTHER THERAPEUTIC SERVICES||ADDITIONAL RX SVCS||0949|
|Other Therapeutic Services (extension of 094x)
Definition: See Revenue Code 094x.
|ATHLETIC TRAINING||ATHLETIC TRAINING||0951|
|Professional Fees (also see 097x and 098x)
Definition: Charges for medical professionals that the institutional health care provider along with the third-party payer require the professional fee component to be billed on the UB. The professional fee component is separately identified by this revenue code. Generally used by Critical Access Hospitals (CAH) that bill both the technical and professional service components on the UB.
|GENERAL CLASSIFICATION||PRO FEE||0960|
|ANESTHESIOLOGIST (MD)||PRO FEE/ ANEST MD||0963|
|ANESTHETIST (CRNA)||PRO FEE/ ANEST CRNA||0964|
|OTHER PROFESSIONAL FEE||PRO FEE/OTHER||0969|
|Professional Fees (extension of 096x)
Definition: See Revenue Code 096x.
|RADIOLOGY-NUCLEAR||PRO FEE/NUC MED||0974|
|OPERATING ROOM||PRO FEE/OR||0975|
|RESPIRATORY THERAPY||PRO FEE/RESPIR||0976|
|PHYSICAL THERAPY||PRO FEE/PHYSI||0977|
|OCCUPATIONAL THERAPY||PRO FEE/OCCUPA||0978|
|SPEECH PATHOLOGY||PRO FEE/SPEECH||0979|
|Professional Fees (extension of 096x and 097x)
Definition: Charges for medical professionals that the institutional health care provider along with the third-party payer require the professional fee component to be billed on the UB. The professional fee component is separately identified by this revenue code. Generally used by Critical Access Hospitals (CAH).
|EMERGENCY ROOM SERVICES||PRO FEE/ER||0981|
|OUTPATIENT SERVICES||PRO FEE/OUTPT||0982|
|MEDICAL SOCIAL SERVICES||PRO FEE/SOC SVC||0984|
|HOSPITAL VISIT||PRO FEE/HOS VIS||0987|
|PRIVATE DUTY NURSE||PRO FEE/PVT NURSE||0989|
|Patient Convenience Items
Definition: Charges for items that are generally considered by the third-party payers to be strictly convenience items and therefore are not covered by many health plans.
|GENERAL CLASSIFICATION||PT CONVENIENCE||0990|
|PRIVATE LINEN SERVICE||LINEN||0992|
|NON-PATIENT ROOM RENTALS||NONPT ROOM RENT||0995|
|LATE DISCHARGE||LATE DISCHARGE||0996|
|ADMISSION KITS||ADM KITS||0997|
|OTHER CONVENIENCE ITEMS||PT CONV/OTHER||0999|
|Behavioral Health Accomodations
Definition: Charges for routine accomodations at specific behavioral health facilities.
|GENERAL CLASSIFICATION||BH R&B||1000|
|RESIDENTIAL TREATMENT - PSYCHIATRIC||BH R&B RES/PSYCH||1001|
|RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY||BH R&B RES/CHEM||1002|
|SUPERVISED LIVING||BH R&B SUP LIVING||1003|
|HALFWAY HOUSE||BH R&B HALFWAY HOUSE||1004|
|GROUP HOME||BH R&B GROUP HOME||1005|
|Reserved||101x to 209x|
|Alternative Therapy Services
Definition: Charges for therapies not elsewhere categorized under other therapeutic service revenue codes (042x, 043x, 044x, 091x, 094x, 095x) or services such as anesthesia or clinic (0374, 0511).
|OTHER ALTERNATIVE THERAPY SERVICES||OTHER ALTTHERAPY||2109|
|Reserved||211x to 309x|
Definition: Charges for personal, medical, psycho-social, and/or therapeutic services in a special community setting for adults needing supervision and/or assistance with Activities of Daily Living (ADL).
|ADULT DAY CARE, MEDICAL AND SOCIAL - HOURLY||ADULT MED/SOC HR||3101|
|ADULT DAY CARE SOCIAL - HOURLY||ADULT SOC HR||3102|
|ADULT DAY CARE, MEDICAL AND SOCIAL - DAILY||ADULT MED/SOC DAY||3103|
|ADULT DAY CARE, SOCIAL - DAILY||ADULT SOC DAY||3104|
|ADULT FOSTER CARE - DAILY||ADULT FOSTER DAY||3105|
|OTHER ADULT CARE||OTHER ADULT||3109|
|Reserved||311x to 999x|
|<< Previous Appendix||AS, ED, IP X12-837 Input / IP Output / OP Output||Next Appendix >>|