| Return to Index Tab |
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| Code Key |
|
| Prov=
ider Type
Codes |
|
GOTO Provider Specialty C=
ode
Descriptions |
| Code
Description |
|
| 1 Ge=
neral
Hospital |
|
| 2 Fr=
eestanding
Psychiatric Hospital |
|
GOTO Pricing Action Code
(P.A.C.) Descriptions |
| 4 D=
entist |
|
| 5 Ph=
ysician |
|
| 6 Po=
diatrist |
|
GOTO Type of Service Code
Descriptions |
| 7 O=
ptometrist |
|
| 8 Op=
tician |
|
| 9 Ph=
armacy |
|
GOTO APC Status Code
Descriptions |
| 10 =
Home
Health Agency |
|
| 11
Independent Radiology |
|
| 12
Independent Lab |
|
| 13 =
Ambulance |
|
| 14 =
DME
Supplier |
|
| 15
Prosthetics/Orthotics |
|
| 16 =
Clinic |
|
| 17 =
Licensed
Therapist |
|
| 18
Chiropractor |
|
| 19 =
Masters
Level Psychologist/Counselor |
|
| 20 =
Nursing
Home – Medicare Participating |
|
| 21 =
Nursing
Home - Non-Medicare Participating |
|
| 22 =
Vermont
State Nursing Home |
|
| 27 =
Hospice |
|
| 28 =
ICF-MR
State Facility |
|
| 29 =
ICF-MR
Private Facility |
|
| 30
Psychologist |
|
| 31 =
Rural
Health Clinic |
|
| 32 =
Outpatient
Rehab |
|
| 34 =
State
Mental Health Hospital |
|
| 35
Audiologist |
|
| 36 =
Other |
|
| 37 =
MH Clinic |
|
| 38 =
MR Clinic |
|
| 39 =
MH Waiver |
|
| 39 =
Baird |
|
| 39 =
NFI |
|
| 40 =
MH/DS
Clinic – VHAP |
|
| 42 =
MR Waiver |
|
| 39 =
NF Waiver |
|
| T01
Psychiatric Residential Treatment Center (IMD) |
|
| T02
Freestanding Dialysis |
|
| T03
Ambulatory Surgical Center |
|
| T04=
Personal
Care Aide/Assistant |
|
| T05=
Dental
Lab |
|
| T06=
Nurse
Practitioner |
|
| T07=
Licensed
Nurse |
|
| T08=
School
Nurse |
|
| T09=
Public
Health Nurse |
|
| T10=
Indian
Health Service (100% federally funded, like rural health centers) |
|
| T11=
Federally
Qualified Health Center |
|
| T13=
Nonprofit
Transportation Agency |
|
| T14
Aged/Disabled Waiver (Home Health Waiver) |
|
| T15=
Waiver
Case Manager-Aging and Adult Services |
|
| T16=
Targeted
Case Management |
|
| T17=
Case
Manager/Social Worker |
|
| T18
Developmental Disability Agency (VDH) |
|
| T19
Vocational Rehab Agency |
|
| T20=
SRS |
|
| T21
Children's Medical Services |
|
| T22
Community-Supported Living Arrangement |
|
| T23
Non-Medical Residential Facility |
|
| T24=
Rehab
Nursing Home |
|
| T25=
OADAP
Facility |
|
| T26=
Adult Day
Care |
|
| T27
Department of Education |
|
| T28=
School
District |
|
| T29=
School |
|
| T30=
County
Health Department |
|
| T31=
Sole
Source Eyeglass Lab (Chadwick) |
|
| T32=
Sole
Source Oxygen |
|
| T33=
HMO |
|
| T34=
DDMHS
Case Rate |
|
| T35=
Dental
Clinic (VA Hospital) |
|
| T36
Independently Billing High Tech Nurses |
|
| T37
Physicians Assistant |
|
| T38=
Certified
Adolescent ADAP Counselor |
|
| T39=
Licensed
Midwife (layperson) |
|
| T40=
Ladies
First Program |
|
| 0 A=
ll
providers |
|
| 999 =
Default
Banner Page |
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| Return to Top of page |
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| Provider
Specialty Codes |
|
| Code
Description/Physician |
|
| 1 G=
eneral
Practice |
|
| 2 G=
eneral
Surgery |
|
| 3
Allergy/Immunology |
|
| 4
Otalaryngology |
|
| 5
Anesthesiology |
|
| 6 C=
ardiology |
|
| 7 D=
ermatology |
|
| 8 F=
amily
Practice |
|
| 10
Gastroenterology |
|
| 11 =
Internal
Medicine |
|
| 12
Osteopathic Manipulative Therapy |
|
| 13 =
Neurology |
|
| 14
Neurosurgery |
|
| 16
Obstetrics/Gynecology |
|
| 17 =
PPNE
Gynecology |
|
| 18
Ophthalmology |
|
| 19 =
Oral
Surgery (Dentistonly) |
|
| 20 =
Orthopedic
Surgery |
|
| 22 =
Pathology |
|
| 24 =
Plastic
And Reconstructive Surgery |
|
| 25 =
Physical
Medicine And Rehabilitation |
|
| 26
Psychiatric |
|
| 28 =
Colorectal
Surgery (Formerly Proctology) |
|
| 29 =
Pulmonary
Disease |
|
| 30 =
Diagnostic
Radiology |
|
| 33 =
Thoracic
Surgery |
|
| 34 =
Urology |
|
| 35
Chiropractic |
|
| 36 =
Nuclear
Medicine |
|
| 37 =
Pediatric
Medicine |
|
| 38 =
Geriatric
Medicine |
|
| 39 =
Nephrology |
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| 40 =
Hand
Surgery |
|
| 41
Optometrist |
|
| 42 =
Certified
Nurse Midwife |
|
| 43 =
Certified
Registered Nurse Anesthetist, Anesthesia Assistant |
|
| 44 =
Infectious
Disease |
|
| 46
Endocrinology |
|
| 48 =
Podiatry |
|
| 50 =
Nurse
Practitioner |
|
| 51 =
Medical
Supply Company with Certified Orthotist |
|
| 52 =
Medical
Supply Company with Certified Prosthetist |
|
| 53 =
Medical
Supply Company with Certified Orthotist-Prosthetist |
|
| 54 =
Medical
Supply Company Not Included In 51, 52, Or 53 |
|
| 55 =
Individual
Certified Orthotist |
|
| 56 =
Individual
Certified Prosthetic |
|
| 57 =
Individual
Certified Orthotist/Prosthetic |
|
| 58 =
Individual
Not Included In 55, 56, Or 57 |
|
| 59 =
Ambulance
Service Center |
|
| 60 =
Public
Health Or Welfare Agency |
|
| 61 =
Voluntary
Health Or Charitable Agencies |
|
| 62
Independently-Billing Psychologist |
|
| 63 =
Portable
X-Ray Supplier |
|
| 64
Independently-Billing Audiologist |
|
| 65
Independently-Practicing Physical Therapist |
|
| 66
Rheumatology |
|
| 67 =
Licensed
Occupational Therapist - PCP |
|
| 68 =
Clinical
Psychologist |
|
| 69
Independantly-Billing Clinical Laboratory |
|
| 76 =
Peripheral
Vascular Disease |
|
| 77 =
Vascular
Surgery |
|
| 78 =
Cardiac
Surgery |
|
| 79 =
Addiction
Medicine |
|
| 80 =
LCSW/LCMHC |
|
| 81 =
Critical
Care (Intensiveness) |
|
| 82
Ophthalmology |
|
| 83
Hematology/Oncology |
|
| 84 =
Preventive
Medicine |
|
| 85
Maxillofacial Surgery |
|
| 86
Neuropsychiatry |
|
| 87 =
All Other
Suppliers |
|
| 89 =
Certified
Clinical Nurse Specialist |
|
| 90 =
Medical
Oncology |
|
| 93 =
Emergency
Medicine |
|
| 94
Interventional Radiology |
|
| 98 =
Diabetic
Counselors |
|
| 99 =
Unknown
Supplier/Provider |
|
| S01=
Hospital
with Swing Bed |
|
| S02=
Teaching
Hospital |
|
| S03=
Non
Teaching Hospital Without Swing Beds |
|
| S04
Rehabilitation |
|
| S05
Psychiatric Hospital |
|
| S06=
General
Dentistry |
|
| S07=
Pharmacy |
|
| S08=
Air
Ambulance |
|
| S09=
Medicare
Participating |
|
| S11=
Medicare
Non-Participating |
|
| S12=
Mental
Health Services |
|
| S13=
Mental
Retardation Services |
|
| S14=
Cost
Based Clinic |
|
| S15=
Certified
Family Practitioner |
|
| S16=
Certified
Pediatric Practitioner |
|
| S17=
Other
Certified Nurse Practitioner |
|
| S18=
Substance
Abuse Treatment Facility |
|
| S19=
Private |
|
| S20
Non-Profit |
|
| S21=
Aide or
Attendant |
|
| S22=
RN |
|
| S23=
LPN |
|
| S24=
School
Nurse |
|
| S25=
Waiver
(Any & all who have waiver programs =3D DDMHS, Home Health, etc.) |
|
| S26=
Case
Management |
|
| S27=
Other
Medical Care |
|
| S28=
DME
Supplier (High Tech) |
|
| S29=
Clinic
Multidisciplinary Organization |
|
| S30=
Speech
Pathologist |
|
| S31=
DDMHS
Case Rate |
|
| S32=
Day
Hospital Services |
|
| S34=
Ladies
First Non-Facility |
|
| S35 =
Ladies
First Facility |
|
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| Return to Top of page |
|
| Pricing
Action Codes |
|
| Lev=
el III
Pricing File (Screen RFPR) |
|
| Code
Description |
|
| A LOWER OF BILLED OR (RELATIVE VAL=
UE
UNITS (RVU) + BILLED UNITS)*COEFFICIENT ON FILE |
|
| Return to Top of page |
|
| Type of
Service Codes |
|
| Code
Description |
|
| 1 M=
edical
Care |
|
| 2 S=
urgery |
|
| 3
Consultation |
|
| 4 D=
iagnostic
X-ray |
|
| 5 D=
iagnostic
Lab |
|
| 6 X=
-ray
Therapy |
|
| 7 A=
nesthesia |
|
| 8 A=
ssistant
Surgeon |
|
| 9 M=
ental
Health/Psychotherapy/Psychiatry |
|
| A D=
ME Rental |
|
| B D=
ME
Purchase |
|
| C A=
mbulance |
|
| D R=
egular
Drugs |
|
| E U=
nit Dose
Drugs |
|
| H S=
upplies
Purchase |
|
| K P=
rosthetics |
|
| L O=
rthotics |
|
| M P=
hysician's
Assistant |
|
| N N=
urse
Midwife |
|
| Q L=
ong Term
Care |
|
| S S=
ervice
Codes |
|
| U D=
efault -
Unassigned Procedure |
|
| X C=
rossover |
|
| Y I=
CD-9
Surgical Procedure |
|
| Z De=
ntal |
|
|
|
| Return to Top of page |
|
| APC Status Code |
|
| Code
Description |
|
| T SIGNIFICANT PROCEDURE, MULTIPLE
REDUCTION APPLIES |
|
| A FEE SCHEDULE OTHER THAN OPPS |
|
| B NOT RECOG. BY OPPS WHEN SUBMITTE=
D ON
AN OUTPAT CLAIM |
|
| C INPATIENT PROCEDURE, NOT PAID UN=
DER
OPPS. |
|
| D DISCONTINUED CODES, NOT PAID UND=
ER
OPPS. |
|
| F CORNEAL TISSUE ACQ, CERTAIN CRNA=
SCVS,
& HEPATITIS B VAC |
|
| G PASS-THROUGH DRUGS AND BIOLOGICA=
LS |
|
| H PASS-THROUGH DEVICE CAT, OR
RADIOPHARM. AGENTS |
|
| K DRUGS, BIOLOGICALS, BRACHYTHERP,=
BLOOD
AND BLOOD PROD. |
|
| E NOT COV BY MCARE,PER STATUTE RSN
INC/EXC,OR AN ALT CDE EXIST |
|
| L INFLUENZA VACCINE: PNEUMONOCOCCAL
PNEUMONIA VACCINE |
|
| M ITEMS OR SRV NOT BILLABLE TO FIS=
CAL
INTERMEDIARY |
|
| N ITEMS AND SCVS PACKAGED INTO APC=
RATES |
|
| P PARTIAL HOSPITALIZATION |
|
| Q PACKAGED SCVS SUBJECT TO SEP PAY=
UNDER
OPPS |
|
| S SIGNIFICANT PROCEDURE, NOT DISCO=
UNTED
WHEN MULTIPLE |
|
| V CLINIC OR EMERGENCY DEPT VISIT
| |
| Y NON-IMPLANTABLE DURABLE MED EQUI=
P |
|
| X ANCILLARY SERVICES |
|
|
|
| CPT codes, descript=
ions and
other data only are copyright 2007 American Medical Association. All righ=
ts |
|
| reserved. |
|
| CPT is a registered=
trademark
of the American Medical Association. |
|
| Applicable FARS\DFA=
RS
Restrictions Apply to Government Use. |
|
| Fee schedules, rela=
tive value
units, conversion factors and/or related components are not assigned by t=
he |
|
| AMA, are not part o=
f CPT, and
the AMA is not recommending their use. The AMA does not directly or |
|
| indirectly practice=
medicine
or dispense medical services. The AMA assumes no liability for data |
|
| contained or not co=
ntained
herein. |
|
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