0 |
Cannot
provide further status electronically.
Start: 01/01/1995 |
1 |
For
more detailed information, see remittance advice.
Start: 01/01/1995 |
2 |
More
detailed information in letter.
Start: 01/01/1995 |
3 |
Claim
has been adjudicated and is awaiting payment cycle.
Start: 01/01/1995 |
4 |
This
is a subsequent request for information from the
original request.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
5 |
This
is a final request for information.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
6 |
Balance
due from the subscriber.
Start: 01/01/1995 |
7 |
Claim
may be reconsidered at a future date.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
8 |
No
payment due to contract/plan provisions.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
9 |
No
payment will be made for this claim.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
10 |
All
originally submitted procedure codes have been
combined.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
11 |
Some
originally submitted procedure codes have been
combined.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
12 |
One
or more originally submitted procedure codes have
been combined.
Start: 01/01/1995
| Last Modified: 06/30/2001 |
13 |
All
originally submitted procedure codes have been
modified.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
14 |
Some
all originally submitted procedure codes have
been modified.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
15 |
One
or more originally submitted procedure code have
been modified.
Start: 01/01/1995
| Last Modified: 06/30/2001 |
16 |
Claim/encounter
has been forwarded to entity. Note: This code
requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
17 |
Claim/encounter
has been forwarded by third party entity to entity.
Note: This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
18 |
Entity
received claim/encounter, but returned invalid
status. Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
19 |
Entity
acknowledges receipt of claim/encounter. Note:
This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
20 |
Accepted
for processing.
Start: 01/01/1995
| Last Modified: 06/30/2001 |
21 |
Missing
or invalid information. Note: At least one other
status code is required to identify the missing
or invalid information.
Start: 01/01/1995
| Last Modified: 07/09/2007 |
22 |
...
before entering the adjudication system.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
23 |
Returned
to Entity. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
24 |
Entity
not approved as an electronic submitter. Note:
This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
25 |
Entity
not approved. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
26 |
Entity
not found. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
27 |
Policy
canceled.
Start: 01/01/1995
| Last Modified: 06/30/2001 |
28 |
Claim
submitted to wrong payer.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
29 |
Subscriber
and policy number/contract number mismatched.
Start: 01/01/1995 |
30 |
Subscriber
and subscriber id mismatched.
Start: 01/01/1995 |
31 |
Subscriber
and policyholder name mismatched.
Start: 01/01/1995 |
32 |
Subscriber
and policy number/contract number not found.
Start: 01/01/1995 |
33 |
Subscriber
and subscriber id not found.
Start: 01/01/1995 |
34 |
Subscriber
and policyholder name not found.
Start: 01/01/1995 |
35 |
Claim/encounter
not found.
Start: 01/01/1995 |
37 |
Predetermination
is on file, awaiting completion of services.
Start: 01/01/1995 |
38 |
Awaiting
next periodic adjudication cycle.
Start: 01/01/1995 |
39 |
Charges
for pregnancy deferred until delivery.
Start: 01/01/1995 |
40 |
Waiting
for final approval.
Start: 01/01/1995 |
41 |
Special
handling required at payer site.
Start: 01/01/1995 |
42 |
Awaiting
related charges.
Start: 01/01/1995 |
44 |
Charges
pending provider audit.
Start: 01/01/1995 |
45 |
Awaiting
benefit determination.
Start: 01/01/1995 |
46 |
Internal
review/audit.
Start: 01/01/1995 |
47 |
Internal
review/audit - partial payment made.
Start: 01/01/1995 |
48 |
Referral/authorization.
Start: 01/01/1995
| Last Modified: 02/28/2001 | Stop: 01/01/2012
Notes: Refer
to codes 252 and 761. |
49 |
Pending
provider accreditation review.
Start: 01/01/1995 |
50 |
Claim
waiting for internal provider verification.
Start: 01/01/1995 |
51 |
Investigating
occupational illness/accident.
Start: 01/01/1995 |
52 |
Investigating
existence of other insurance coverage.
Start: 01/01/1995 |
53 |
Claim
being researched for Insured ID/Group Policy Number
error.
Start: 01/01/1995 |
54 |
Duplicate
of a previously processed claim/line.
Start: 01/01/1995 |
55 |
Claim
assigned to an approver/analyst.
Start: 01/01/1995 |
56 |
Awaiting
eligibility determination.
Start: 01/01/1995 |
57 |
Pending
COBRA information requested.
Start: 01/01/1995 |
59 |
Information
was requested by a non-electronic method. Note:
At least one other status code is required to
identify the requested information.
Start: 01/01/1995
| Last Modified: 10/17/2010 |
60 |
Information
was requested by an electronic method. Note: At
least one other status code is required to identify
the requested information.
Start: 01/01/1995
| Last Modified: 10/17/2010 |
61 |
Eligibility
for extended benefits.
Start: 01/01/1995 |
64 |
Re-pricing
information.
Start: 01/01/1995 |
65 |
Claim/line
has been paid.
Start: 01/01/1995 |
66 |
Payment
reflects usual and customary charges.
Start: 01/01/1995 |
67 |
Payment
made in full.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
68 |
Partial
payment made for this claim.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
69 |
Payment
reflects plan provisions.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
70 |
Payment
reflects contract provisions.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
71 |
Periodic
installment released.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
72 |
Claim
contains split payment.
Start: 01/01/1995 |
73 |
Payment
made to entity, assignment of benefits not on
file. Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
78 |
Duplicate
of an existing claim/line, awaiting processing.
Start: 01/01/1995 |
81 |
Contract/plan
does not cover pre-existing conditions.
Start: 01/01/1995 |
83 |
No
coverage for newborns.
Start: 01/01/1995 |
84 |
Service
not authorized.
Start: 01/01/1995 |
85 |
Entity
not primary. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
86 |
Diagnosis
and patient gender mismatch.
Start: 01/01/1995
| Last Modified: 02/28/2000 |
87 |
Denied:
Entity not found. (Use code 26 with appropriate
Claim Status category Code)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
88 |
Entity
not eligible for benefits for submitted dates
of service. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
89 |
Entity
not eligible for dental benefits for submitted
dates of service. Note: This code requires use
of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
90 |
Entity
not eligible for medical benefits for submitted
dates of service. Note: This code requires use
of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
91 |
Entity
not eligible/not approved for dates of service.
Note: This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
92 |
Entity
does not meet dependent or student qualification.
Note: This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
93 |
Entity
is not selected primary care provider. Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
94 |
Entity
not referred by selected primary care provider.
Note: This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
95 |
Requested
additional information not received.
Start: 01/01/1995
| Last Modified: 07/09/2007
Notes: If
known, the payer must report a second claim status
code identifying the requested information. |
96 |
No
agreement with entity. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
97 |
Patient
eligibility not found with entity. Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
98 |
Charges
applied to deductible.
Start: 01/01/1995 |
99 |
Pre-treatment
review.
Start: 01/01/1995 |
100 |
Pre-certification
penalty taken.
Start: 01/01/1995 |
101 |
Claim
was processed as adjustment to previous claim.
Start: 01/01/1995 |
102 |
Newborn's
charges processed on mother's claim.
Start: 01/01/1995 |
103 |
Claim
combined with other claim(s).
Start: 01/01/1995 |
104 |
Processed
according to plan provisions (Plan refers to provisions
that exist between the Health Plan and the Consumer
or Patient)
Start: 01/01/1995
| Last Modified: 06/01/2008 |
105 |
Claim/line
is capitated.
Start: 01/01/1995 |
106 |
This
amount is not entity's responsibility. Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
107 |
Processed
according to contract provisions (Contract refers
to provisions that exist between the Health Plan
and a Provider of Health Care Services)
Start: 01/01/1995
| Last Modified: 06/01/2008 |
108 |
Coverage
has been canceled for this entity. (Use code 27)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
109 |
Entity
not eligible. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
110 |
Claim
requires pricing information.
Start: 01/01/1995 |
111 |
At
the policyholder's request these claims cannot
be submitted electronically.
Start: 01/01/1995 |
112 |
Policyholder
processes their own claims.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
113 |
Cannot
process individual insurance policy claims.
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
114 |
Claim/service
should be processed by entity. Note: This code
requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
115 |
Cannot
process HMO claims
Start:
01/01/1995 | Last Modified: 01/27/2008 | Stop:
07/01/2008 |
116 |
Claim
submitted to incorrect payer.
Start: 01/01/1995 |
117 |
Claim
requires signature-on-file indicator.
Start: 01/01/1995 |
118 |
TPO
rejected claim/line because payer name is missing.
(Use status code 21 and status code 125 with entity
code IN)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
119 |
TPO
rejected claim/line because certification information
is missing. (Use status code 21 and status code
252)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
120 |
TPO
rejected claim/line because claim does not contain
enough information. (Use status code 21)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
121 |
Service
line number greater than maximum allowable for
payer.
Start: 01/01/1995 |
122 |
Missing/invalid
data prevents payer from processing claim. (Use
CSC Code 21)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
123 |
Additional
information requested from entity. Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
124 |
Entity's
name, address, phone and id number. Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
125 |
Entity's
name. Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
126 |
Entity's
address. Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
127 |
Entity's
Communication Number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 06/06/2010 |
128 |
Entity's
tax id. Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
129 |
Entity's
Blue Cross provider id. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
130 |
Entity's
Blue Shield provider id. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
131 |
Entity's
Medicare provider id. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
132 |
Entity's
Medicaid provider id. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
133 |
Entity's
UPIN. Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
134 |
Entity's
CHAMPUS provider id. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
135 |
Entity's
commercial provider id. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
136 |
Entity's
health industry id number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
137 |
Entity's
plan network id. Note: This code requires use
of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
138 |
Entity's
site id . Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
139 |
Entity's
health maintenance provider id (HMO). Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
140 |
Entity's
preferred provider organization id (PPO). Note:
This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
141 |
Entity's
administrative services organization id (ASO).
Note: This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
142 |
Entity's
license/certification number. Note: This code
requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
143 |
Entity's
state license number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
144 |
Entity's
specialty license number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
145 |
Entity's
specialty/taxonomy code. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
146 |
Entity's
anesthesia license number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
147 |
Entity's
qualification degree/designation (e.g. RN,PhD,MD).
Note: This code requires use of an Entity Code.
Start: 02/28/1997
| Last Modified: 02/11/2010 |
148 |
Entity's
social security number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
149 |
Entity's
employer id. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
150 |
Entity's
drug enforcement agency (DEA) number. Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
152 |
Pharmacy
processor number.
Start: 01/01/1995 |
153 |
Entity's
id number. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
154 |
Relationship
of surgeon & assistant surgeon.
Start: 01/01/1995 |
155 |
Entity's
relationship to patient. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
156 |
Patient
relationship to subscriber
Start: 01/01/1995 |
157 |
Entity's
Gender. Note: This code requires use of an Entity
Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
158 |
Entity's
date of birth. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
159 |
Entity's
date of death. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
160 |
Entity's
marital status. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
161 |
Entity's
employment status. Note: This code requires use
of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
162 |
Entity's
health insurance claim number (HICN). Note: This
code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
163 |
Entity's
policy number. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
164 |
Entity's
contract/member number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
165 |
Entity's
employer name, address and phone. Note: This code
requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
166 |
Entity's
employer name. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
167 |
Entity's
employer address. Note: This code requires use
of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
168 |
Entity's
employer phone number. Note: This code requires
use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
169 |
Entity's
employer id.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
170 |
Entity's
employee id. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
171 |
Other
insurance coverage information (health, liability,
auto, etc.).
Start: 01/01/1995 |
172 |
Other
employer name, address and telephone number.
Start: 01/01/1995 |
173 |
Entity's
name, address, phone, gender, DOB, marital status,
employment status and relation to subscriber.
Note: This code requires use of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
174 |
Entity's
student status. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
175 |
Entity's
school name. Note: This code requires use of an
Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
176 |
Entity's
school address. Note: This code requires use of
an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
177 |
Transplant
recipient's name, date of birth, gender, relationship
to insured.
Start: 01/01/1995
| Last Modified: 02/28/2000 |
178 |
Submitted
charges.
Start: 01/01/1995 |
179 |
Outside
lab charges.
Start: 01/01/1995 |
180 |
Hospital
s semi-private room rate.
Start: 01/01/1995 |
181 |
Hospital
s room rate.
Start: 01/01/1995 |
182 |
Allowable/paid
from other entities coverage NOTE: This code requires
the use of an entity code.
Start: 01/01/1995
| Last Modified: 01/24/2010 |
183 |
Amount
entity has paid. Note: This code requires use
of an Entity Code.
Start: 01/01/1995
| Last Modified: 02/11/2010 |
184 |
Purchase
price for the rented durable medical equipment.
Start: 01/01/1995 |
185 |
Rental
price for durable medical equipment.
Start: 01/01/1995 |
186 |
Purchase
and rental price of durable medical equipment.
Start: 01/01/1995 |
187 |
Date(s)
of service.
Start: 01/01/1995 |
188 |
Statement
from-through dates.
Start: 01/01/1995 |
189 |
Facility
admission date
Start: 01/01/1995
| Last Modified: 10/31/2006 |
190 |
Facility
discharge date
Start: 01/01/1995
| Last Modified: 10/31/2006 |
191 |
Date
of Last Menstrual Period (LMP)
Start: 02/28/1997 |
192 |
Date
of first service for current series/symptom/illness.
Start: 01/01/1995 |
193 |
First
consultation/evaluation date.
Start: 02/28/1997 |
194 |
Confinement
dates.
Start: 01/01/1995 |
195 |
Unable
to work dates/Disability Dates.
Start: 01/01/1995
| Last Modified: 09/20/2009 |
196 |
Return
to work dates.
Start: 01/01/1995 |
197 |
Effective
coverage date(s).
Start: 01/01/1995 |
198 |
Medicare
effective date.
Start: 01/01/1995 |
199 |
Date
of conception and expected date of delivery.
Start: 01/01/1995 |
200 |
Date
of equipment return.
Start: 01/01/1995 |
201 |
Date
of dental appliance prior placement.
Start: 01/01/1995 |
202 |
Date
of dental prior replacement/reason for replacement.
Start: 01/01/1995 |
203 |
Date
of dental appliance placed.
Start: 01/01/1995 |
204 |
Date
dental canal(s) opened and date service completed.
Start: 01/01/1995 |
205 |
Date(s)
dental root canal therapy previously performed.
Start: 01/01/1995 |
206 |
Most
recent date of curettage, root planing, or periodontal
surgery.
Start: 01/01/1995 |
207 |
Dental
impression and seating date.
Start: 01/01/1995 |
208 |
Most
recent date pacemaker was implanted.
Start: 01/01/1995 |
209 |
Most
recent pacemaker battery change date.
Start: 01/01/1995 |
210 |
Date
of the last x-ray.
Start: 01/01/1995 |
211 |
Date(s)
of dialysis training provided to patient.
Start: 01/01/1995 |
212 |
Date
of last routine dialysis.
Start: 01/01/1995 |
213 |
Date
of first routine dialysis.
Start: 01/01/1995 |
214 |
Original
date of prescription/orders/referral.
Start: 02/28/1997 |
215 |
Date
of tooth extraction/evolution.
Start: 01/01/1995 |
216 |
Drug
information.
Start: 01/01/1995 |
217 |
Drug
name, strength and dosage form.
Start: 01/01/1995 |
218 |
NDC
number.
Start: 01/01/1995 |
219 |
Prescription
number.
Start: 01/01/1995 |
220 |
Drug
product id number. (Use code 218)
Start:
01/01/1995 | Last Modified: 10/17/2010 | Stop:
07/01/2011 |
221 |
Drug
days supply and dosage.
Start: 01/01/1995
| Last Modified: 01/24/2010 | Stop: 01/01/2012 |
222 |
Drug
dispensing units and average wholesale price (AWP).
Start: 01/01/1995 |
223 |
Route
of drug/myelogram administration.
Start: 01/01/1995 |
224 |
Anatomical
location for joint injection.
Start: 01/01/1995 |
225 |
Anatomical
location.
Start: 01/01/1995 |
226 |
Joint
injection site.
Start: 01/01/1995 |
227 |
Hospital
information.
Start: 01/01/1995 |
228 |
Type
of bill for UB claim
Start: 01/01/1995
| Last Modified: 10/31/2006 |
229 |
Hospital
admission source.
Start: 01/01/1995 |
230 |
Hospital
admission hour.
Start: 01/01/1995 |
231 |
Hospital
admission type.
Start: 01/01/1995 |
232 |
Admitting
diagnosis.
Start: 01/01/1995 |
233 |
Hospital
discharge hour.
Start: 01/01/1995 |
234 |
Patient
discharge status.
Start: 01/01/1995 |
235 |
Units
of blood furnished.
Start: 01/01/1995 |
236 |
Units
of blood replaced.
Start: 01/01/1995 |
237 |
Units
of deductible blood.
Start: 01/01/1995 |
238 |
Separate
claim for mother/baby charges.
Start: 01/01/1995 |
239 |
Dental
information.
Start: 01/01/1995 |
240 |
Tooth
surface(s) involved.
Start: 01/01/1995 |
241 |
List
of all missing teeth (upper and lower).
Start: 01/01/1995 |
242 |
Tooth
numbers, surfaces, and/or quadrants involved.
Start: 01/01/1995 |
243 |
Months
of dental treatment remaining.
Start: 01/01/1995 |
244 |
Tooth
number or letter.
Start: 01/01/1995 |
245 |
Dental
quadrant/arch.
Start: 01/01/1995 |
246 |
Total
orthodontic service fee, initial appliance fee,
monthly fee, length of service.
Start: 01/01/1995 |
247 |
Line
information.
Start: 01/01/1995 |
248 |
Accident
date, state, description and cause.
Start: 01/01/1995
| Last Modified: 01/24/2010 | Stop: 01/01/2012 |
249 |
Place
of service.
Start: 01/01/1995 |
250 |
Type
of service.
Start: 01/01/1995 |
251 |
Total
anesthesia minutes.
Start: 01/01/1995 |
252 |
Entity's
authorization/certification number. Note: This
code requires the use of an Entity Code.
Start: 01/01/1995
| Last Modified: 01/30/2011 |
253 |
Procedure/revenue
code for service(s) rendered. Use codes 454 or
455.
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
02/28/1997 |
254 |
Principal
diagnosis code.
Start: 01/01/1995
| Last Modified: 01/30/2011 |
255 |
Diagnosis
code.
Start: 01/01/1995 |
256 |
DRG
code(s).
Start: 01/01/1995 |
257 |
ADSM-III-R
code for services rendered.
Start: 01/01/1995 |
258 |
Days/units
for procedure/revenue code.
Start: 01/01/1995 |
259 |
Frequency
of service.
Start: 01/01/1995 |
260 |
Length
of medical necessity, including begin date.
Start: 02/28/1997 |
261 |
Obesity
measurements.
Start: 01/01/1995 |
262 |
Type
of surgery/service for which anesthesia was administered.
Start: 01/01/1995 |
263 |
Length
of time for services rendered.
Start: 01/01/1995 |
264 |
Number
of liters/minute & total hours/day for respiratory
support.
Start: 01/01/1995 |
265 |
Number
of lesions excised.
Start: 01/01/1995 |
266 |
Facility
point of origin and destination - ambulance.
Start: 01/01/1995 |
267 |
Number
of miles patient was transported.
Start: 01/01/1995 |
268 |
Location
of durable medical equipment use.
Start: 01/01/1995 |
269 |
Length/size
of laceration/tumor.
Start: 01/01/1995 |
270 |
Subluxation
location.
Start: 01/01/1995 |
271 |
Number
of spine segments.
Start: 01/01/1995 |
272 |
Oxygen
contents for oxygen system rental.
Start: 01/01/1995 |
273 |
Weight.
Start: 01/01/1995 |
274 |
Height.
Start: 01/01/1995 |
275 |
Claim.
Start: 01/01/1995 |
276 |
UB04/HCFA-1450/1500
claim form
Start: 01/01/1995
| Last Modified: 10/31/2006 |
277 |
Paper
claim.
Start: 01/01/1995 |
278 |
Signed
claim form.
Start:
01/01/1995 | Stop: 11/01/2011 |
279 |
Claim/service
must be itemized
Start: 01/01/1995
| Last Modified: 10/17/2010 |
280 |
Itemized
claim by provider.
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 279 |
281 |
Related
confinement claim.
Start: 01/01/1995 |
282 |
Copy
of prescription.
Start: 01/01/1995 |
283 |
Medicare
entitlement information is required to determine
primary coverage
Start: 01/01/1995
| Last Modified: 01/27/2008 |
284 |
Copy
of Medicare ID card.
Start: 01/01/1995 |
285 |
Vouchers/explanation
of benefits (EOB).
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 286 |
286 |
Other
payer's Explanation of Benefits/payment information.
Start: 01/01/1995 |
287 |
Medical
necessity for service.
Start: 01/01/1995 |
288 |
Hospital
late charges
Start: 01/01/1995
| Last Modified: 10/17/2010 |
289 |
Reason
for late discharge.
Start:
01/01/1995 | Stop: 11/01/2011 |
290 |
Pre-existing
information.
Start: 01/01/1995 |
291 |
Reason
for termination of pregnancy.
Start: 01/01/1995 |
292 |
Purpose
of family conference/therapy.
Start: 01/01/1995 |
293 |
Reason
for physical therapy.
Start: 01/01/1995 |
294 |
Supporting
documentation. Note: At least one other status
code is required to identify the supporting documentation.
Start: 01/01/1995
| Last Modified: 10/17/2010 |
295 |
Attending
physician report.
Start: 01/01/1995 |
296 |
Nurse's
notes.
Start: 01/01/1995 |
297 |
Medical
notes/report.
Start: 02/28/1997 |
298 |
Operative
report.
Start: 01/01/1995 |
299 |
Emergency
room notes/report.
Start: 01/01/1995 |
300 |
Lab/test
report/notes/results.
Start: 02/28/1997 |
301 |
MRI
report.
Start: 01/01/1995 |
302 |
Refer
to codes 300 for lab notes and 311 for pathology
notes
Start:
01/01/1995 | Stop: 01/31/1997 |
303 |
Physical
therapy notes. Use code 297:6O (6 'OH' - not zero)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
02/28/1997 |
304 |
Reports
for service.
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 297, 298, 299, 300 |
305 |
Radiology/x-ray
reports and/or interpretation
Start: 01/01/1995
| Last Modified: 01/30/2011 |
306 |
Detailed
description of service.
Start: 01/01/1995 |
307 |
Narrative
with pocket depth chart.
Start: 01/01/1995 |
308 |
Discharge
summary.
Start: 01/01/1995 |
309 |
Code
was duplicate of code 299
Start:
01/01/1995 | Stop: 01/31/1997 |
310 |
Progress
notes for the six months prior to statement date.
Start: 01/01/1995 |
311 |
Pathology
notes/report.
Start: 01/01/1995 |
312 |
Dental
charting.
Start: 01/01/1995 |
313 |
Bridgework
information.
Start: 01/01/1995 |
314 |
Dental
records for this service.
Start: 01/01/1995 |
315 |
Past
perio treatment history.
Start: 01/01/1995 |
316 |
Complete
medical history.
Start: 01/01/1995 |
317 |
Patient's
medical records.
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
318 |
X-rays/radiology
films
Start: 01/01/1995
| Last Modified: 10/17/2010 |
319 |
Pre/post-operative
x-rays/photographs.
Start: 02/28/1997 |
320 |
Study
models.
Start: 01/01/1995 |
321 |
Radiographs
or models. (Use codes 318 and/or 320)
Start:
01/01/1995 | Last Modified: 10/17/2010 | Stop:
07/01/2011 |
322 |
Recent
Full Mouth X-rays
Start: 01/01/1995
| Last Modified: 10/17/2010 |
323 |
Study
models, x-rays, and/or narrative.
Start: 01/01/1995 |
324 |
Recent
x-ray of treatment area and/or narrative.
Start: 01/01/1995 |
325 |
Recent
fm x-rays and/or narrative.
Start: 01/01/1995 |
326 |
Copy
of transplant acquisition invoice.
Start: 01/01/1995 |
327 |
Periodontal
case type diagnosis and recent pocket depth chart
with narrative.
Start: 01/01/1995 |
328 |
Speech
therapy notes. Use code 297:6R
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
02/28/1997 |
329 |
Exercise
notes.
Start: 01/01/1995 |
330 |
Occupational
notes.
Start: 01/01/1995 |
331 |
History
and physical.
Start: 01/01/1995
| Last Modified: 08/01/2007 |
332 |
Authorization/certification
(include period covered). (Use code 252)
Start:
02/28/1997 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
333 |
Patient
release of information authorization.
Start: 01/01/1995 |
334 |
Oxygen
certification.
Start: 01/01/1995 |
335 |
Durable
medical equipment certification.
Start: 01/01/1995 |
336 |
Chiropractic
certification.
Start: 01/01/1995 |
337 |
Ambulance
certification/documentation.
Start: 01/01/1995 |
338 |
Home
health certification. Use code 332:4Y
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
02/28/1997 |
339 |
Enteral/parenteral
certification.
Start: 01/01/1995 |
340 |
Pacemaker
certification.
Start: 01/01/1995 |
341 |
Private
duty nursing certification.
Start: 01/01/1995 |
342 |
Podiatric
certification.
Start: 01/01/1995 |
343 |
Documentation
that facility is state licensed and Medicare approved
as a surgical facility.
Start: 01/01/1995 |
344 |
Documentation
that provider of physical therapy is Medicare
Part B approved.
Start: 01/01/1995 |
345 |
Treatment
plan for service/diagnosis
Start: 01/01/1995 |
346 |
Proposed
treatment plan for next 6 months.
Start: 01/01/1995 |
347 |
Refer
to code 345 for treatment plan and code 282 for
prescription
Start:
01/01/1995 | Stop: 01/31/1997 |
348 |
Chiropractic
treatment plan. (Use 345:QL)
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
349 |
Psychiatric
treatment plan. Use codes 345:5I, 5J, 5K, 5L,
5M, 5N, 5O (5 'OH' - not zero), 5P
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
02/28/1997 |
350 |
Speech
pathology treatment plan. Use code 345:6R
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
02/28/1997 |
351 |
Physical/occupational
therapy treatment plan. Use codes 345:6O (6 'OH'
- not zero), 6N
Start:
01/01/1995 | Last Modified: 07/09/2007 | Stop:
02/28/1997 |
352 |
Duration
of treatment plan.
Start: 01/01/1995 |
353 |
Orthodontics
treatment plan.
Start: 01/01/1995 |
354 |
Treatment
plan for replacement of remaining missing teeth.
Start: 01/01/1995 |
355 |
Has
claim been paid?
Start:
01/01/1995 | Stop: 11/01/2011 |
356 |
Was
blood furnished?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 235 |
357 |
Has
or will blood be replaced?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 236 |
358 |
Does
provider accept assignment of benefits? (Use code
589)
Start:
01/01/1995 | Last Modified: 10/17/2010 | Stop:
07/01/2011 |
359 |
Is
there a release of information signature on file?
(Use code 333)
Start:
01/01/1995 | Last Modified: 10/17/2010 | Stop:
07/01/2011 |
360 |
Benefits
Assignment Certification Indicator
Start: 01/01/1995
| Last Modified: 10/17/2010 |
361 |
Is
there other insurance?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 171 and 550 |
362 |
Is
the dental patient covered by medical insurance?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 171 |
363 |
Possible
Workers' Compensation
Start: 01/01/1995
| Last Modified: 10/17/2010 |
364 |
Is
accident/illness/condition employment related?
Start: 01/01/1995 |
365 |
Is
service the result of an accident?
Start: 01/01/1995 |
366 |
Is
injury due to auto accident?
Start: 01/01/1995 |
367 |
Is
service performed for a recurring condition or
new condition?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 397 |
368 |
Is
medical doctor (MD) or doctor of osteopath (DO)
on staff of this facility?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 676 |
369 |
Does
patient condition preclude use of ordinary bed?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 287, 335 |
370 |
Can
patient operate controls of bed?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 287, 335 |
371 |
Is
patient confined to room?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 287, 335, 527 |
372 |
Is
patient confined to bed?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 287, 335, 527 |
373 |
Is
patient an insulin diabetic?
Start:
01/01/1995 | Stop: 11/01/2011 |
374 |
Is
prescribed lenses a result of cataract surgery?
Start: 01/01/1995 |
375 |
Was
refraction performed?
Start: 01/01/1995 |
376 |
Was
charge for ambulance for a round-trip?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 453 |
377 |
Was
durable medical equipment purchased new or used?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 184, 185, 186, 335 |
378 |
Is
pacemaker temporary or permanent?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 340 |
379 |
Were
services performed supervised by a physician?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to codes 453, 454, 666 & procedure code |
380 |
CRNA
supervision/medical direction.
Start: 01/01/1995
| Last Modified: 10/17/2010 |
381 |
Is
drug generic?
Start:
01/01/1995 | Stop: 11/01/2011
Notes:
Refer to code 216 |
382 |
Did
provider authorize generic or brand name dispensing?
Start: 01/01/1995 |
383 |
Nerve
block use (surgery vs. pain management)
Start: 01/01/1995
| Last Modified: 10/17/2010 |
384 |
Is
prosthesis/crown/inlay placement an initial placement
or a replacement?
Start: 01/01/1995 |
385 |
Is
appliance upper or lower arch & is appliance
fixed or removable?
Start: 01/01/1995 |
386 |
Orthodontic
Treatment/Purpose Indicator
Start: 01/01/1995
| Last Modified: 10/17/2010 |
387 |
Date
patient last examined by entity. Note: This code
requires use of an Entity Code.
Start: 02/28/1997
| Last Modified: 02/11/2010 |
388 |
Date
post-operative care assumed
Start: 02/28/1997 |
389 |
Date
post-operative care relinquished
Start: 02/28/1997 |
390 |
Date
of most recent medical event necessitating service(s)
Start: 02/28/1997 |
391 |
Date(s)
dialysis conducted
Start: 02/28/1997 |
392 |
Date(s)
of blood transfusion(s)
Start:
02/28/1997 | Stop: 11/01/2011 |
393 |
Date
of previous pacemaker check
Start:
02/28/1997 | Stop: 11/01/2011 |
394 |
Date(s)
of most recent hospitalization related to service
Start: 02/28/1997 |
395 |
Date
entity signed certification/recertification Note:
This code requires use of an Entity Code.
Start: 02/28/1997
| Last Modified: 02/11/2010 |
396 |
Date
home dialysis began
Start: 02/28/1997 |
397 |
Date
of onset/exacerbation of illness/condition
Start: 02/28/1997 |
398 |
Visual
field test results
Start: 02/28/1997 |
399 |
Report
of prior testing related to this service, including
dates
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 417 |
400 |
Claim
is out of balance
Start: 02/28/1997 |
401 |
Source
of payment is not valid
Start: 02/28/1997 |
402 |
Amount
must be greater than zero. Note: At least one
other status code is required to identify which
amount element is in error.
Start: 02/28/1997
| Last Modified: 09/20/2009 |
403 |
Entity
referral notes/orders/prescription
Start: 02/28/1997 |
404 |
Specific
findings, complaints, or symptoms necessitating
service
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to codes 287, 488 |
405 |
Summary
of services
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 306 |
406 |
Brief
medical history as related to service(s)
Start: 02/28/1997 |
407 |
Complications/mitigating
circumstances
Start: 02/28/1997 |
408 |
Initial
certification
Start: 02/28/1997 |
409 |
Medication
logs/records (including medication therapy)
Start: 02/28/1997 |
410 |
Explain
differences between treatment plan and patient's
condition
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
411 |
Medical
necessity for non-routine service(s)
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 287 |
412 |
Medical
records to substantiate decision of non-coverage
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
413 |
Explain/justify
differences between treatment plan and services
rendered.
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
414 |
Necessity
for concurrent care (more than one physician treating
the patient)
Start: 02/28/1997
| Last Modified: 10/17/2010 |
415 |
Justify
services outside composite rate
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 287 |
416 |
Verification
of patient's ability to retain and use information
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
417 |
Prior
testing, including result(s) and date(s) as related
to service(s)
Start: 02/28/1997 |
418 |
Indicating
why medications cannot be taken orally
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
419 |
Individual
test(s) comprising the panel and the charges for
each test
Start: 02/28/1997 |
420 |
Name,
dosage and medical justification of contrast material
used for radiology procedure
Start: 02/28/1997 |
421 |
Medical
review attachment/information for service(s)
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
422 |
Homebound
status
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 575 |
423 |
Prognosis
Start:
02/28/1997 | Last Modified: 07/09/2007 | Stop:
01/01/2008 |
424 |
Statement
of non-coverage including itemized bill
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 279 & 286 |
425 |
Itemize
non-covered services
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 279 & 286 |
426 |
All
current diagnoses
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 255, 232 & 488 |
427 |
Emergency
care provided during transport
Start:
02/28/1997 | Stop: 11/01/2011 |
428 |
Reason
for transport by ambulance
Start: 02/28/1997 |
429 |
Loaded
miles and charges for transport to nearest facility
with appropriate services
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to codes 267, 178, 430 |
430 |
Nearest
appropriate facility
Start: 02/28/1997 |
431 |
Patient's
condition/functional status at time of service.
Start: 02/28/1997
| Last Modified: 10/17/2010 |
432 |
Date
benefits exhausted
Start: 02/28/1997 |
433 |
Copy
of patient revocation of hospice benefits
Start: 02/28/1997 |
434 |
Reasons
for more than one transfer per entitlement period
Start: 02/28/1997 |
435 |
Notice
of Admission
Start: 02/28/1997 |
436 |
Short
term goals
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 345 |
437 |
Long
term goals
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 345 |
438 |
Number
of patients attending session
Start:
02/28/1997 | Stop: 11/01/2011 |
439 |
Size,
depth, amount, and type of drainage wounds
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 297 or other specific report type
codes |
440 |
why
non-skilled caregiver has not been taught procedure
Start:
02/28/1997 | Stop: 11/01/2011 |
441 |
Entity
professional qualification for service(s)
Start: 02/28/1997 |
442 |
Modalities
of service
Start: 02/28/1997 |
443 |
Initial
evaluation report
Start: 02/28/1997 |
444 |
Method
used to obtain test sample
Start:
02/28/1997 | Stop: 11/01/2011 |
445 |
Explain
why hearing loss not correctable by hearing aid
Start:
02/28/1997 | Stop: 11/01/2011
Notes:
Refer to code 287 |
446 |
Documentation
from prior claim(s) related to service(s)
Start:
02/28/1997 | Stop: 11/01/2011 |
447 |
Plan
of teaching
Start:
02/28/1997 | Stop: 11/01/2011 |
448 |
Invalid
billing combination. See STC12 for details. This
code should only be used to indicate an inconsistency
between two or more data elements on the claim.
A detailed explanation is required in STC12 when
this code is used.
Start: 02/28/1997
| Last Modified: 01/24/2010 | Stop: 01/01/2012 |
449 |
Projected
date to discontinue service(s)
Start: 02/28/1997 |
450 |
Awaiting
spend down determination
Start: 02/28/1997 |
451 |
Preoperative
and post-operative diagnosis
Start: 02/28/1997 |
452 |
Total
visits in total number of hours/day and total
number of hours/week
Start: 02/28/1997 |
453 |
Procedure
Code Modifier(s) for Service(s) Rendered
Start: 02/28/1997 |
454 |
Procedure
code for services rendered.
Start: 02/28/1997 |
455 |
Revenue
code for services rendered.
Start: 02/28/1997 |
456 |
Covered
Day(s)
Start: 02/28/1997 |
457 |
Non-Covered
Day(s)
Start: 02/28/1997 |
458 |
Coinsurance
Day(s)
Start: 02/28/1997 |
459 |
Lifetime
Reserve Day(s)
Start: 02/28/1997 |
460 |
NUBC
Condition Code(s)
Start: 02/28/1997 |
461 |
NUBC
Occurrence Code(s) and Date(s)
Start: 02/28/1997
| Last Modified: 01/24/2010 | Stop: 01/01/2012 |
462 |
NUBC
Occurrence Span Code(s) and Date(s)
Start: 02/28/1997
| Last Modified: 01/24/2010 | Stop: 01/01/2012 |
463 |
NUBC
Value Code(s) and/or Amount(s)
Start: 02/28/1997
| Last Modified: 01/24/2010 | Stop: 01/01/2012 |
464 |
Payer
Assigned Claim Control Number
Start: 02/28/1997
| Last Modified: 10/31/2004 |
465 |
Principal
Procedure Code for Service(s) Rendered
Start: 02/28/1997 |
466 |
Entity's
Original Signature. Note: This code requires use
of an Entity Code.
Start: 02/28/1997
| Last Modified: 01/30/2011 |
467 |
Entity
Signature Date. Note: This code requires use of
an Entity Code.
Start: 02/28/1997
| Last Modified: 02/11/2010 |
468 |
Patient
Signature Source
Start: 02/28/1997 |
469 |
Purchase
Service Charge
Start: 02/28/1997 |
470 |
Was
service purchased from another entity? Note: This
code requires use of an Entity Code.
Start: 02/28/1997
| Last Modified: 02/11/2010 |
471 |
Were
services related to an emergency?
Start: 02/28/1997 |
472 |
Ambulance
Run Sheet
Start: 02/28/1997 |
473 |
Missing
or invalid lab indicator
Start: 06/30/1998 |
474 |
Procedure
code and patient gender mismatch
Start: 06/30/1998
| Last Modified: 02/29/2000 |
475 |
Procedure
code not valid for patient age
Start: 06/30/1998
| Last Modified: 02/29/2000 |
476 |
Missing
or invalid units of service
Start: 06/30/1998 |
477 |
Diagnosis
code pointer is missing or invalid
Start: 06/30/1998 |
478 |
Claim
submitter's identifier
Start: 06/30/1998
| Last Modified: 01/24/2010 |
479 |
Other
Carrier payer ID is missing or invalid
Start: 06/30/1998 |
480 |
Entity's
claim filing indicator. Note: This code requires
use of an Entity Code.
Start: 06/30/1998
| Last Modified: 06/06/2010 |
481 |
Claim/submission
format is invalid.
Start: 10/31/1998 |
482 |
Date
Error, Century Missing
Start:
02/28/1999 | Last Modified: 09/20/2009 | Stop:
10/01/2010 |
483 |
Maximum
coverage amount met or exceeded for benefit period.
Start: 06/30/1999 |
484 |
Business
Application Currently Not Available
Start: 02/29/2000 |
485 |
More
information available than can be returned in
real time mode. Narrow your current search criteria.
Start: 02/28/2001 |
486 |
Principal
Procedure Date
Start: 10/31/2001
| Last Modified: 07/01/2009 |
487 |
Claim
not found, claim should have been submitted to/through
'entity'. Note: This code requires use of an Entity
Code.
Start: 02/28/2002
| Last Modified: 02/11/2010 |
488 |
Diagnosis
code(s) for the services rendered.
Start: 06/30/2002 |
489 |
Attachment
Control Number
Start: 10/31/2002 |
490 |
Other
Procedure Code for Service(s) Rendered
Start: 02/28/2003 |
491 |
Entity
not eligible for encounter submission. Note: This
code requires use of an Entity Code.
Start: 02/28/2003
| Last Modified: 02/11/2010 |
492 |
Other
Procedure Date
Start: 02/28/2003 |
493 |
Version/Release/Industry
ID code not currently supported by information
holder
Start: 02/28/2003 |
494 |
Real-Time
requests not supported by the information holder,
resubmit as batch request
Start: 02/28/2003 |
495 |
Requests
for re-adjudication must reference the newly assigned
payer claim control number for this previously
adjusted claim. Correct the payer claim control
number and re-submit.
Start: 10/31/2003 |
496 |
Submitter
not approved for electronic claim submissions
on behalf of this entity. Note: This code requires
use of an Entity Code.
Start: 02/29/2004
| Last Modified: 02/11/2010 |
497 |
Sales
tax not paid
Start: 06/30/2004 |
498 |
Maximum
leave days exhausted
Start: 06/30/2004 |
499 |
No
rate on file with the payer for this service for
this entity Note: This code requires use of an
Entity Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
500 |
Entity's
Postal/Zip Code. Note: This code requires use
of an Entity Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
501 |
Entity's
State/Province. Note: This code requires use of
an Entity Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
502 |
Entity's
City. Note: This code requires use of an Entity
Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
503 |
Entity's
Street Address. Note: This code requires use of
an Entity Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
504 |
Entity's
Last Name. Note: This code requires use of an
Entity Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
505 |
Entity's
First Name. Note: This code requires use of an
Entity Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
506 |
Entity
is changing processor/clearinghouse. This claim
must be submitted to the new processor/clearinghouse.
Note: This code requires use of an Entity Code.
Start: 06/30/2004
| Last Modified: 02/11/2010 |
507 |
HCPCS
Start: 10/31/2004 |
508 |
ICD9
NOTE: At least one other status code is required
to identify the related procedure code or diagnosis
code.
Start: 10/31/2004
| Last Modified: 07/01/2009 |
509 |
External
Cause of Injury Code (E-code).
Start: 10/31/2004
| Last Modified: 01/30/2011 |
510 |
Future
date. Note: At least one other status code is
required to identify the data element in error.
Start: 10/31/2004
| Last Modified: 09/20/2009 |
511 |
Invalid
character. Note: At least one other status code
is required to identify the data element in error.
Start: 10/31/2004
| Last Modified: 09/20/2009 |
512 |
Length
invalid for receiver's application system. Note:
At least one other status code is required to
identify the data element in error.
Start: 10/31/2004
| Last Modified: 09/20/2009 |
513 |
HIPPS
Rate Code for services Rendered
Start: 10/31/2004 |
514 |
Entity's
Middle Name Note: This code requires use of an
Entity Code.
Start: 10/31/2004
| Last Modified: 01/30/2011 |
515 |
Managed
Care review
Start: 10/31/2004 |
516 |
Other
Entity's Adjudication or Payment/Remittance Date.
Note: An Entity code is required to identify the
Other Payer Entity, i.e. primary, secondary.
Start: 10/31/2004
| Last Modified: 11/29/2009 |
517 |
Adjusted
Repriced Claim Reference Number
Start: 10/31/2004 |
518 |
Adjusted
Repriced Line item Reference Number
Start: 10/31/2004 |
519 |
Adjustment
Amount
Start: 10/31/2004 |
520 |
Adjustment
Quantity
Start: 10/31/2004 |
521 |
Adjustment
Reason Code
Start: 10/31/2004 |
522 |
Anesthesia
Modifying Units
Start: 10/31/2004 |
523 |
Anesthesia
Unit Count
Start: 10/31/2004 |
524 |
Arterial
Blood Gas Quantity
Start: 10/31/2004 |
525 |
Begin
Therapy Date
Start: 10/31/2004 |
526 |
Bundled
or Unbundled Line Number
Start: 10/31/2004 |
527 |
Certification
Condition Indicator
Start: 10/31/2004 |
528 |
Certification
Period Projected Visit Count
Start: 10/31/2004 |
529 |
Certification
Revision Date
Start: 10/31/2004 |
530 |
Claim
Adjustment Indicator
Start: 10/31/2004 |
531 |
Claim
Disproportinate Share Amount
Start: 10/31/2004 |
532 |
Claim
DRG Amount
Start: 10/31/2004 |
533 |
Claim
DRG Outlier Amount
Start: 10/31/2004 |
534 |
Claim
ESRD Payment Amount
Start: 10/31/2004 |
535 |
Claim
Frequency Code
Start: 10/31/2004 |
536 |
Claim
Indirect Teaching Amount
Start: 10/31/2004 |
537 |
Claim
MSP Pass-through Amount
Start: 10/31/2004 |
538 |
Claim
or Encounter Identifier
Start: 10/31/2004 |
539 |
Claim
PPS Capital Amount
Start: 10/31/2004 |
540 |
Claim
PPS Capital Outlier Amount
Start: 10/31/2004 |
541 |
Claim
Submission Reason Code
Start: 10/31/2004 |
542 |
Claim
Total Denied Charge Amount
Start: 10/31/2004 |
543 |
Clearinghouse
or Value Added Network Trace
Start: 10/31/2004 |
544 |
Clinical
Laboratory Improvement Amendment
Start: 10/31/2004 |
545 |
Contract
Amount
Start: 10/31/2004 |
546 |
Contract
Code
Start: 10/31/2004 |
547 |
Contract
Percentage
Start: 10/31/2004 |
548 |
Contract
Type Code
Start: 10/31/2004 |
549 |
Contract
Version Identifier
Start: 10/31/2004 |
550 |
Coordination
of Benefits Code
Start: 10/31/2004 |
551 |
Coordination
of Benefits Total Submitted Charge
Start: 10/31/2004 |
552 |
Cost
Report Day Count
Start: 10/31/2004 |
553 |
Covered
Amount
Start: 10/31/2004 |
554 |
Date
Claim Paid
Start: 10/31/2004 |
555 |
Delay
Reason Code
Start: 10/31/2004 |
556 |
Demonstration
Project Identifier
Start: 10/31/2004 |
557 |
Diagnosis
Date
Start: 10/31/2004 |
558 |
Discount
Amount
Start: 10/31/2004 |
559 |
Document
Control Identifier
Start: 10/31/2004 |
560 |
Entity's
Additional/Secondary Identifier. Note: This code
requires use of an Entity Code.
Start: 10/31/2004
| Last Modified: 02/11/2010 |
561 |
Entity's
Contact Name. Note: This code requires use of
an Entity Code.
Start: 10/31/2004
| Last Modified: 02/11/2010 |
562 |
Entity's
National Provider Identifier (NPI). Note: This
code requires use of an Entity Code.
Start: 10/31/2004
| Last Modified: 02/11/2010 |
563 |
Entity's
Tax Amount. Note: This code requires use of an
Entity Code.
Start: 10/31/2004
| Last Modified: 02/11/2010 |
564 |
EPSDT
Indicator
Start: 10/31/2004 |
565 |
Estimated
Claim Due Amount
Start: 10/31/2004 |
566 |
Exception
Code
Start: 10/31/2004 |
567 |
Facility
Code Qualifier
Start: 10/31/2004 |
568 |
Family
Planning Indicator
Start: 10/31/2004 |
569 |
Fixed
Format Information
Start: 10/31/2004 |
570 |
Free
Form Message Text
Start: 10/31/2004 |
571 |
Frequency
Count
Start: 10/31/2004 |
572 |
Frequency
Period
Start: 10/31/2004 |
573 |
Functional
Limitation Code
Start: 10/31/2004 |
574 |
HCPCS
Payable Amount Home Health
Start: 10/31/2004 |
575 |
Homebound
Indicator
Start: 10/31/2004 |
576 |
Immunization
Batch Number
Start: 10/31/2004 |
577 |
Industry
Code
Start: 10/31/2004 |
578 |
Insurance
Type Code
Start: 10/31/2004 |
579 |
Investigational
Device Exemption Identifier
Start: 10/31/2004 |
580 |
Last
Certification Date
Start: 10/31/2004 |
581 |
Last
Worked Date
Start: 10/31/2004 |
582 |
Lifetime
Psychiatric Days Count
Start: 10/31/2004 |
583 |
Line
Item Charge Amount
Start: 10/31/2004 |
584 |
Line
Item Control Number
Start: 10/31/2004 |
585 |
Denied
Charge or Non-covered Charge
Start: 10/31/2004
| Last Modified: 07/09/2007 |
586 |
Line
Note Text
Start: 10/31/2004 |
587 |
Measurement
Reference Identification Code
Start: 10/31/2004 |
588 |
Medical
Record Number
Start: 10/31/2004 |
589 |
Provider
Accept Assignment Code
Start: 10/31/2004
| Last Modified: 10/17/2010 |
590 |
Medicare
Coverage Indicator
Start: 10/31/2004 |
591 |
Medicare
Paid at 100% Amount
Start: 10/31/2004 |
592 |
Medicare
Paid at 80% Amount
Start: 10/31/2004 |
593 |
Medicare
Section 4081 Indicator
Start: 10/31/2004 |
594 |
Mental
Status Code
Start: 10/31/2004 |
595 |
Monthly
Treatment Count
Start: 10/31/2004 |
596 |
Non-covered
Charge Amount
Start: 10/31/2004 |
597 |
Non-payable
Professional Component Amount
Start: 10/31/2004 |
598 |
Non-payable
Professional Component Billed Amount
Start: 10/31/2004 |
599 |
Note
Reference Code
Start: 10/31/2004 |
600 |
Oxygen
Saturation Qty
Start: 10/31/2004 |
601 |
Oxygen
Test Condition Code
Start: 10/31/2004 |
602 |
Oxygen
Test Date
Start: 10/31/2004 |
603 |
Old
Capital Amount
Start: 10/31/2004 |
604 |
Originator
Application Transaction Identifier
Start: 10/31/2004 |
605 |
Orthodontic
Treatment Months Count
Start: 10/31/2004 |
606 |
Paid
From Part A Medicare Trust Fund Amount
Start: 10/31/2004 |
607 |
Paid
From Part B Medicare Trust Fund Amount
Start: 10/31/2004 |
608 |
Paid
Service Unit Count
Start: 10/31/2004 |
609 |
Participation
Agreement
Start: 10/31/2004 |
610 |
Patient
Discharge Facility Type Code
Start: 10/31/2004 |
611 |
Peer
Review Authorization Number
Start: 10/31/2004 |
612 |
Per
Day Limit Amount
Start: 10/31/2004 |
613 |
Physician
Contact Date
Start: 10/31/2004 |
614 |
Physician
Order Date
Start: 10/31/2004 |
615 |
Policy
Compliance Code
Start: 10/31/2004 |
616 |
Policy
Name
Start: 10/31/2004 |
617 |
Postage
Claimed Amount
Start: 10/31/2004 |
618 |
PPS-Capital
DSH DRG Amount
Start: 10/31/2004 |
619 |
PPS-Capital
Exception Amount
Start: 10/31/2004 |
620 |
PPS-Capital
FSP DRG Amount
Start: 10/31/2004 |
621 |
PPS-Capital
HSP DRG Amount
Start: 10/31/2004 |
622 |
PPS-Capital
IME Amount
Start: 10/31/2004 |
623 |
PPS-Operating
Federal Specific DRG Amount
Start: 10/31/2004 |
624 |
PPS-Operating
Hospital Specific DRG Amount
Start: 10/31/2004 |
625 |
Predetermination
of Benefits Identifier
Start: 10/31/2004 |
626 |
Pregnancy
Indicator
Start: 10/31/2004 |
627 |
Pre-Tax
Claim Amount
Start: 10/31/2004 |
628 |
Pricing
Methodology
Start: 10/31/2004 |
629 |
Property
Casualty Claim Number
Start: 10/31/2004 |
630 |
Referring
CLIA Number
Start: 10/31/2004 |
631 |
Reimbursement
Rate
Start: 10/31/2004 |
632 |
Reject
Reason Code
Start: 10/31/2004 |
633 |
Related
Causes Code (Accident, auto accident, employment)
Start: 10/31/2004
| Last Modified: 10/17/2010 |
634 |
Remark
Code
Start: 10/31/2004 |
635 |
Repriced
Ambulatory Patient Group Code
Start: 10/31/2004 |
636 |
Repriced
Line Item Reference Number
Start: 10/31/2004 |
637 |
Repriced
Saving Amount
Start: 10/31/2004 |
638 |
Repricing
Per Diem or Flat Rate Amount
Start: 10/31/2004 |
639 |
Responsibility
Amount
Start: 10/31/2004 |
640 |
Sales
Tax Amount
Start: 10/31/2004 |
641 |
Service
Adjudication or Payment Date. Note: Use code 516.
Start:
10/31/2004 | Last Modified: 09/20/2009 | Stop:
10/01/2010 |
642 |
Service
Authorization Exception Code
Start: 10/31/2004 |
643 |
Service
Line Paid Amount
Start: 10/31/2004 |
644 |
Service
Line Rate
Start: 10/31/2004 |
645 |
Service
Tax Amount
Start: 10/31/2004 |
646 |
Ship,
Delivery or Calendar Pattern Code
Start: 10/31/2004 |
647 |
Shipped
Date
Start: 10/31/2004 |
648 |
Similar
Illness or Symptom Date
Start: 10/31/2004 |
649 |
Skilled
Nursing Facility Indicator
Start: 10/31/2004 |
650 |
Special
Program Indicator
Start: 10/31/2004 |
651 |
State
Industrial Accident Provider Number
Start: 10/31/2004 |
652 |
Terms
Discount Percentage
Start: 10/31/2004 |
653 |
Test
Performed Date
Start: 10/31/2004 |
654 |
Total
Denied Charge Amount
Start: 10/31/2004 |
655 |
Total
Medicare Paid Amount
Start: 10/31/2004 |
656 |
Total
Visits Projected This Certification Count
Start: 10/31/2004 |
657 |
Total
Visits Rendered Count
Start: 10/31/2004 |
658 |
Treatment
Code
Start: 10/31/2004 |
659 |
Unit
or Basis for Measurement Code
Start: 10/31/2004 |
660 |
Universal
Product Number
Start: 10/31/2004 |
661 |
Visits
Prior to Recertification Date Count CR702
Start: 10/31/2004 |
662 |
X-ray
Availability Indicator
Start: 10/31/2004 |
663 |
Entity's
Group Name. Note: This code requires use of an
Entity Code.
Start: 10/31/2004
| Last Modified: 02/11/2010 |
664 |
Orthodontic
Banding Date
Start: 10/31/2004 |
665 |
Surgery
Date
Start: 10/31/2004 |
666 |
Surgical
Procedure Code
Start: 10/31/2004 |
667 |
Real-Time
requests not supported by the information holder,
do not resubmit
Start: 02/28/2005 |
668 |
Missing
Endodontics treatment history and prognosis
Start: 06/30/2005 |
669 |
Dental
service narrative needed.
Start: 10/31/2005 |
670 |
Funds
applied from a consumer spending account such
as consumer directed/driven health plan (CDHP),
Health savings account (H S A) and or other similar
accounts
Start: 06/30/2006
| Last Modified: 02/28/2007 |
671 |
Funds
may be available from a consumer spending account
such as consumer directed/driven health plan (CDHP),
Health savings account (H S A) and or other similar
accounts
Start: 06/30/2006
| Last Modified: 02/28/2007 |
672 |
Other
Payer's payment information is out of balance
Start: 10/31/2006 |
673 |
Patient
Reason for Visit
Start: 10/31/2006 |
674 |
Authorization
exceeded
Start: 10/31/2006 |
675 |
Facility
admission through discharge dates
Start: 10/31/2006 |
676 |
Entity
possibly compensated by facility. Note: This code
requires use of an Entity Code.
Start: 10/31/2006
| Last Modified: 02/11/2010 |
677 |
Entity
not affiliated. Note: This code requires use of
an Entity Code.
Start: 10/31/2006
| Last Modified: 02/11/2010 |
678 |
Revenue
code and patient gender mismatch
Start: 10/31/2006 |
679 |
Submit
newborn services on mother's claim
Start: 10/31/2006 |
680 |
Entity's
Country. Note: This code requires use of an Entity
Code.
Start: 10/31/2006
| Last Modified: 02/11/2010 |
681 |
Claim
currency not supported
Start: 10/31/2006 |
682 |
Cosmetic
procedure
Start: 02/28/2007 |
683 |
Awaiting
Associated Hospital Claims
Start: 02/28/2007 |
684 |
Rejected.
Syntax error noted for this claim/service/inquiry.
See Functional or Implementation Acknowledgement
for details. (Note: Only for use to reject claims
or status requests in transactions that were 'accepted
with errors' on a 997 or 999 Acknowledgement.)
Start: 11/05/2007 |
685 |
Claim
could not complete adjudication in real time.
Claim will continue processing in a batch mode.
Do not resubmit.
Start: 01/27/2008 |
686 |
The
claim/ encounter has completed the adjudication
cycle and the entire claim has been voided
Start: 01/27/2008 |
687 |
Claim
estimation can not be completed in real time.
Do not resubmit.
Start: 01/27/2008 |
688 |
Present
on Admission Indicator for reported diagnosis
code(s).
Start: 01/27/2008 |
689 |
Entity
was unable to respond within the expected time
frame. Note: This code requires use of an Entity
Code.
Start: 06/01/2008
| Last Modified: 02/11/2010 |
690 |
Multiple
claims or estimate requests cannot be processed
in real time.
Start: 06/01/2008 |
691 |
Multiple
claim status requests cannot be processed in real
time.
Start: 06/01/2008 |
692 |
Contracted
funding agreement-Subscriber is employed by the
provider of services
Start: 09/21/2008 |
693 |
Amount
must be greater than or equal to zero. Note: At
least one other status code is required to identify
which amount element is in error.
Start: 01/25/2009 |
694 |
Amount
must not be equal to zero. Note: At least one
other status code is required to identify which
amount element is in error.
Start: 01/25/2009 |
695 |
Entity's
Country Subdivision Code. Note: This code requires
use of an Entity Code.
Start: 01/25/2009
| Last Modified: 02/11/2010 |
696 |
Claim
Adjustment Group Code.
Start: 01/25/2009 |
697 |
Invalid
Decimal Precision. Note: At least one other status
code is required to identify the data element
in error.
Start: 07/01/2009 |
698 |
Form
Type Identification
Start: 07/01/2009 |
699 |
Question/Response
from Supporting Documentation Form
Start: 07/01/2009 |
700 |
ICD10.
Note: At least one other status code is required
to identify the related procedure code or diagnosis
code.
Start: 07/01/2009 |
701 |
Initial
Treatment Date
Start: 07/01/2009 |
702 |
Repriced
Claim Reference Number
Start: 11/01/2009 |
703 |
Advanced
Billing Concepts (ABC) code
Start: 01/24/2010 |
704 |
Claim
Note Text
Start: 01/24/2010 |
705 |
Repriced
Allowed Amount
Start: 01/24/2010 |
706 |
Repriced
Approved Amount
Start: 01/24/2010 |
707 |
Repriced
Approved Ambulatory Patient Group Amount
Start: 01/24/2010 |
708 |
Repriced
Approved Revenue Code
Start: 01/24/2010 |
709 |
Repriced
Approved Service Unit Count
Start: 01/24/2010 |
710 |
Line
Adjudication Information. Note: At least one other
status code is required to identify the data element
in error.
Start: 01/24/2010 |
711 |
Stretcher
purpose
Start: 01/24/2010 |
712 |
Obstetric
Additional Units
Start: 01/24/2010 |
713 |
Patient
Condition Description
Start: 01/24/2010 |
714 |
Care
Plan Oversight Number
Start: 01/24/2010 |
715 |
Acute
Manifestation Date
Start: 01/24/2010 |
716 |
Repriced
Approved DRG Code
Start: 01/24/2010 |
717 |
This
claim has been split for processing.
Start: 01/24/2010 |
718 |
Claim/service
not submitted within the required timeframe (timely
filing).
Start: 01/24/2010 |
719 |
NUBC
Occurrence Code(s)
Start: 01/24/2010 |
720 |
NUBC
Occurrence Code Date(s)
Start: 01/24/2010 |
721 |
NUBC
Occurrence Span Code(s)
Start: 01/24/2010 |
722 |
NUBC
Occurrence Span Code Date(s)
Start: 01/24/2010 |
723 |
Drug
days supply
Start: 01/24/2010 |
724 |
Drug
dosage
Start: 01/24/2010 |
725 |
NUBC
Value Code(s)
Start: 01/24/2010 |
726 |
NUBC
Value Code Amount(s)
Start: 01/24/2010 |
727 |
Accident
date
Start: 01/24/2010 |
728 |
Accident
state
Start: 01/24/2010 |
729 |
Accident
description
Start: 01/24/2010 |
730 |
Accident
cause
Start: 01/24/2010 |
731 |
Measurement
value/test result
Start: 01/24/2010 |
732 |
Information
submitted inconsistent with billing guidelines.
Note: At least one other status code is required
to identify the inconsistent information.
Start: 01/24/2010 |
733 |
Prefix
for entity's contract/member number.
Start: 01/24/2010 |
734 |
Verifying
premium payment
Start: 06/06/2010 |
735 |
This
service/claim is included in the allowance for
another service or claim.
Start: 06/06/2010 |
736 |
A
related or qualifying service/claim has not been
received/adjudicated.
Start: 06/06/2010 |
737 |
Current
Dental Terminology (CDT) Code
Start: 06/06/2010 |
738 |
Home
Infusion EDI Coalition (HEIC) Product/Service
Code
Start: 06/06/2010 |
739 |
Jurisdiction
Specific Procedure or Supply Code
Start: 06/06/2010 |
740 |
Drop-Off
Location
Start: 06/06/2010 |
741 |
Entity
must be a person. Note: This code requires use
of an Entity Code.
Start: 06/06/2010 |
742 |
Payer
Responsibility Sequence Number Code
Start: 06/06/2010 |
743 |
Entity’s
credential/enrollment information. Note: This
code requires use of an Entity Code.
Start: 10/17/2010 |
744 |
Services/charges
related to the treatment of a hospital-acquired
condition or preventable medical error.
Start: 10/17/2010 |
745 |
Identifier
Qualifier Note: At least one other status code
is required to identify the specific identifier
qualifier in error.
Start: 10/17/2010 |
746 |
Duplicate
Submission Note: use only at the information receiver
level in the Health Care Claim Acknowledgement
transaction.
Start: 10/17/2010 |
747 |
Hospice
Employee Indicator
Start: 10/17/2010 |
748 |
Corrected
Data Note: Requires a second status code to identify
the corrected data.
Start: 10/17/2010 |
749 |
Date
of Injury/Illness
Start: 10/17/2010 |
750 |
Auto
Accident State or Province Code
Start: 10/17/2010
| Last Modified: 01/30/2011 |
751 |
Ambulance
Pick-up State or Province Code
Start: 10/17/2010
| Last Modified: 01/30/2011 |
752 |
Ambulance
Drop-off State or Province Code
Start: 10/17/2010
| Last Modified: 01/30/2011 |
753 |
Co-pay
status code.
Start: 01/30/2011 |
754 |
Entity
Name Suffix. Note: This code requires the use
of an Entity Code.
Start: 01/30/2011 |
755 |
Entity's
primary identifier. Note: This code requires the
use of an Entity Code.
Start: 01/30/2011 |
756 |
Entity's
Received Date. Note: This code requires the use
of an Entity Code.
Start: 01/30/2011 |
757 |
Last
seen date.
Start: 01/30/2011 |
758 |
Repriced
approved HCPCS code.
Start: 01/30/2011 |
759 |
Round
trip purpose description.
Start: 01/30/2011 |
760 |
Tooth
status code.
Start: 01/30/2011 |
761 |
Entity's
referral number. Note: This code requires the
use of an Entity Code.
Start: 01/30/2011 |
