| Return to Index Tab=
|
| Code Key |
| Pro=
vider Type
Codes |
| Code
Description |
| 1 G=
eneral
Hospital |
| 2
Freestanding Psychiatric Hospital |
| 4 D=
entist |
| 5 P=
hysician |
| 6 P=
odiatrist |
| 7 O=
ptometrist |
| 8 O=
ptician |
| 9 P=
harmacy |
| 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 |
|
|
| 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 |
| 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 |
|
|
| Pricing Action Code=
s |
| Lev=
el III
Pricing File (Screen RFPR) |
| Code
Description |
| 3 L=
ower of
billed or allowed |
| 4 P=
ay as
billed |
| 5 M=
anual
Price - Individual consideration |
| 6 M=
anual
Price - No reasonable charge established |
| 9 D=
o not pay |
| A(A=
nesthesia) |
| Low=
er of
billed or (relative value units (RVU) + billed units)*coefficient |
| on =
file |
| Low=
er of
billed or (RVU price * Coeff *units of service |
| Per=
cent: 62%
for Outpatient - type of bill =3D 131 |
| 60%=
for
Nonpatient - type of bill =3D 141 |
| 60%=
for
physician or independent lab. |
| L (=
lab) |
| Thi=
s 60% for
physician or ind lab is for total & TC (not for PC/26) |
| I P=
ercentage
of billed amount |
| P F=
or ICD-9
Surgical Codes (No Effect on Pricing) |
| S P=
ay $1.60
per mile for mileage over full miles (Ambulance) |
| V Re=
lative
Value (RVU * Coefficient) or billed, if lower. |
|
|
| Type of Service Cod=
es |
| 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 |
|
| 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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