Section title: External Code Lists

Claim Status Codes

508

These codes convey the status of an entire claim or a specific service line.

Maintenance Request Status

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

  1. Received
    The request has been submitted but is not yet under review.
  2. Pending
    Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
  3. In Process
    The CMG has initiated their decision process.
  4. On Hold
    The CMG has initiated their decision process but cannot complete it at this time.
  5. CMG Approved
    The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
  6. CMG Disapproved
    The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
Num. Date Requested Description Type Code Status
3 6/19/2020 Claim could not complete adjudication in real time. Resubmit as a batch request. New code CMG Approved
5 8/4/2020 Resubmit a new claim/encounter, not a void claim/encounter. New code CMG Disapproved
7 8/10/2020 Prior payer’s processing requirements not met

Updated description: Claim submitted prematurely. Please provide the prior payer with the required information so that they can finalize their determination, then resubmit.
New code CMG Approved

Maintenance Request Form

Fields marked with an asterisk (*) are required





*The description you are suggesting for a new code or to replace the description for a current code.

*Explain the business scenario or use case when the requested new code would be used, the reason an existing code is no longer appropriate for the code list’s business purpose, or reason the current description needs to be revised.

11/1/2020
0Cannot provide further status electronically.
Start: 01/01/1995
1For more detailed information, see remittance advice.
Start: 01/01/1995
2More detailed information in letter.
Start: 01/01/1995
3Claim has been adjudicated and is awaiting payment cycle.
Start: 01/01/1995
4This is a subsequent request for information from the original request.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
5This is a final request for information.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
6Balance due from the subscriber.
Start: 01/01/1995
7Claim may be reconsidered at a future date.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
8No payment due to contract/plan provisions.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
9No payment will be made for this claim.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
10All originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
11Some originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
12One or more originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 06/30/2001
13All originally submitted procedure codes have been modified.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
14Some all originally submitted procedure codes have been modified.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
15One or more originally submitted procedure code have been modified.
Start: 01/01/1995 | Last Modified: 06/30/2001
16Claim/encounter has been forwarded to entity. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
17Claim/encounter has been forwarded by third party entity to entity. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
18Entity received claim/encounter, but returned invalid status. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
19Entity acknowledges receipt of claim/encounter. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
20Accepted for processing.
Start: 01/01/1995 | Last Modified: 06/30/2001
21Missing or invalid information. Usage: At least one other status code is required to identify the missing or invalid information.
Start: 01/01/1995 | Last Modified: 07/01/2017
22... before entering the adjudication system.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
23Returned to Entity. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
24Entity not approved as an electronic submitter. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
25Entity not approved. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
26Entity not found. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
27Policy canceled.
Start: 01/01/1995 | Last Modified: 06/30/2001
28Claim submitted to wrong payer.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
29Subscriber and policy number/contract number mismatched.
Start: 01/01/1995
30Subscriber and subscriber id mismatched.
Start: 01/01/1995
31Subscriber and policyholder name mismatched.
Start: 01/01/1995
32Subscriber and policy number/contract number not found.
Start: 01/01/1995
33Subscriber and subscriber id not found.
Start: 01/01/1995
34Subscriber and policyholder name not found.
Start: 01/01/1995
35Claim/encounter not found.
Start: 01/01/1995
37Predetermination is on file, awaiting completion of services.
Start: 01/01/1995
38Awaiting next periodic adjudication cycle.
Start: 01/01/1995
39Charges for pregnancy deferred until delivery.
Start: 01/01/1995
40Waiting for final approval.
Start: 01/01/1995
41Special handling required at payer site.
Start: 01/01/1995
42Awaiting related charges.
Start: 01/01/1995
44Charges pending provider audit.
Start: 01/01/1995
45Awaiting benefit determination.
Start: 01/01/1995
46Internal review/audit.
Start: 01/01/1995
47Internal review/audit - partial payment made.
Start: 01/01/1995
48Referral/authorization.
Start: 01/01/1995 | Last Modified: 02/28/2001 | Stop: 01/01/2012
Notes: Refer to codes 252 and 761.
49Pending provider accreditation review.
Start: 01/01/1995
50Claim waiting for internal provider verification.
Start: 01/01/1995
51Investigating occupational illness/accident.
Start: 01/01/1995
52Investigating existence of other insurance coverage.
Start: 01/01/1995
53Claim being researched for Insured ID/Group Policy Number error.
Start: 01/01/1995
54Duplicate of a previously processed claim/line.
Start: 01/01/1995
55Claim assigned to an approver/analyst.
Start: 01/01/1995
56Awaiting eligibility determination.
Start: 01/01/1995
57Pending COBRA information requested.
Start: 01/01/1995
59Information was requested by a non-electronic method. Usage: At least one other status code is required to identify the requested information.
Start: 01/01/1995 | Last Modified: 07/01/2017
60Information was requested by an electronic method. Usage: At least one other status code is required to identify the requested information.
Start: 01/01/1995 | Last Modified: 07/01/2017
61Eligibility for extended benefits.
Start: 01/01/1995
64Re-pricing information.
Start: 01/01/1995
65Claim/line has been paid.
Start: 01/01/1995
66Payment reflects usual and customary charges.
Start: 01/01/1995
67Payment made in full.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
68Partial payment made for this claim.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
69Payment reflects plan provisions.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
70Payment reflects contract provisions.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
71Periodic installment released.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
72Claim contains split payment.
Start: 01/01/1995
73Payment made to entity, assignment of benefits not on file. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
78Duplicate of an existing claim/line, awaiting processing.
Start: 01/01/1995
81Contract/plan does not cover pre-existing conditions.
Start: 01/01/1995
83No coverage for newborns.
Start: 01/01/1995
84Service not authorized.
Start: 01/01/1995
85Entity not primary. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
86Diagnosis and patient gender mismatch.
Start: 01/01/1995 | Last Modified: 02/28/2000
87Denied: 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
88Entity not eligible for benefits for submitted dates of service. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
89Entity not eligible for dental benefits for submitted dates of service. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
90Entity not eligible for medical benefits for submitted dates of service. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
91Entity not eligible/not approved for dates of service. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
92Entity does not meet dependent or student qualification. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
93Entity is not selected primary care provider. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
94Entity not referred by selected primary care provider. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
95Requested 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.
96No agreement with entity. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
97Patient eligibility not found with entity. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
98Charges applied to deductible.
Start: 01/01/1995
99Pre-treatment review.
Start: 01/01/1995
100Pre-certification penalty taken.
Start: 01/01/1995
101Claim was processed as adjustment to previous claim.
Start: 01/01/1995
102Newborn's charges processed on mother's claim.
Start: 01/01/1995
103Claim combined with other claim(s).
Start: 01/01/1995
104Processed 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
105Claim/line is capitated.
Start: 01/01/1995
106This amount is not entity's responsibility. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
107Processed 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
108Coverage has been canceled for this entity. (Use code 27)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
109Entity not eligible. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
110Claim requires pricing information.
Start: 01/01/1995
111At the policyholder's request these claims cannot be submitted electronically.
Start: 01/01/1995
112Policyholder processes their own claims.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
113Cannot process individual insurance policy claims.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
114Claim/service should be processed by entity. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
115Cannot process HMO claims
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
116Claim submitted to incorrect payer.
Start: 01/01/1995
117Claim requires signature-on-file indicator.
Start: 01/01/1995
118TPO 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
119TPO 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
120TPO 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
121Service line number greater than maximum allowable for payer.
Start: 01/01/1995
122Missing/invalid data prevents payer from processing claim. (Use CSC Code 21)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
123Additional information requested from entity. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
124Entity's name, address, phone and id number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
125Entity's name. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
126Entity's address. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
127Entity's Communication Number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
128Entity's tax id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
129Entity's Blue Cross provider id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
130Entity's Blue Shield provider id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
131Entity's Medicare provider id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
132Entity's Medicaid provider id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
133Entity's UPIN. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
134Entity's CHAMPUS provider id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
135Entity's commercial provider id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
136Entity's health industry id number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
137Entity's plan network id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
138Entity's site id . Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
139Entity's health maintenance provider id (HMO). Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
140Entity's preferred provider organization id (PPO). Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
141Entity's administrative services organization id (ASO). Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
142Entity's license/certification number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
143Entity's state license number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
144Entity's specialty license number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
145Entity's specialty/taxonomy code. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
146Entity's anesthesia license number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
147Entity's qualification degree/designation (e.g. RN,PhD,MD). Usage: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 07/01/2017
148Entity's social security number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
149Entity's employer id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
150Entity's drug enforcement agency (DEA) number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
152Pharmacy processor number.
Start: 01/01/1995
153Entity's id number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
154Relationship of surgeon & assistant surgeon.
Start: 01/01/1995
155Entity's relationship to patient. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
156Patient relationship to subscriber
Start: 01/01/1995
157Entity's Gender. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
158Entity's date of birth. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
159Entity's date of death. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
160Entity's marital status. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
161Entity's employment status. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
162Entity's health insurance claim number (HICN). Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
163Entity's policy/group number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
164Entity's contract/member number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
165Entity's employer name, address and phone. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
166Entity's employer name. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
167Entity's employer address. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
168Entity's employer phone number. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
169Entity's employer id.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
170Entity's employee id. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
171Other insurance coverage information (health, liability, auto, etc.).
Start: 01/01/1995
172Other employer name, address and telephone number.
Start: 01/01/1995
173Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
174Entity's student status. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
175Entity's school name. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
176Entity's school address. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
177Transplant recipient's name, date of birth, gender, relationship to insured.
Start: 01/01/1995 | Last Modified: 02/28/2000
178Submitted charges.
Start: 01/01/1995
179Outside lab charges.
Start: 01/01/1995
180Hospital s semi-private room rate.
Start: 01/01/1995
181Hospital s room rate.
Start: 01/01/1995
182Allowable/paid from other entities coverage Usage: This code requires the use of an entity code.
Start: 01/01/1995 | Last Modified: 07/01/2017
183Amount entity has paid. Usage: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
184Purchase price for the rented durable medical equipment.
Start: 01/01/1995
185Rental price for durable medical equipment.
Start: 01/01/1995
186Purchase and rental price of durable medical equipment.
Start: 01/01/1995
187Date(s) of service.
Start: 01/01/1995
188Statement from-through dates.
Start: 01/01/1995
189Facility admission date
Start: 01/01/1995 | Last Modified: 10/31/2006
190Facility discharge date
Start: 01/01/1995 | Last Modified: 10/31/2006
191Date of Last Menstrual Period (LMP)
Start: 02/28/1997
192Date of first service for current series/symptom/illness.
Start: 01/01/1995
193First consultation/evaluation date.
Start: 02/28/1997
194Confinement dates.
Start: 01/01/1995
195Unable to work dates/Disability Dates.
Start: 01/01/1995 | Last Modified: 09/20/2009
196Return to work dates.
Start: 01/01/1995
197Effective coverage date(s).
Start: 01/01/1995
198Medicare effective date.
Start: 01/01/1995
199Date of conception and expected date of delivery.
Start: 01/01/1995
200Date of equipment return.
Start: 01/01/1995
201Date of dental appliance prior placement.
Start: 01/01/1995
202Date of dental prior replacement/reason for replacement.
Start: 01/01/1995
203Date of dental appliance placed.
Start: 01/01/1995
204Date dental canal(s) opened and date service completed.
Start: 01/01/1995
205Date(s) dental root canal therapy previously performed.
Start: 01/01/1995
206Most recent date of curettage, root planing, or periodontal surgery.
Start: 01/01/1995
207Dental impression and seating date.
Start: 01/01/1995
208Most recent date pacemaker was implanted.
Start: 01/01/1995
209Most recent pacemaker battery change date.
Start: 01/01/1995
210Date of the last x-ray.
Start: 01/01/1995
211Date(s) of dialysis training provided to patient.
Start: 01/01/1995
212Date of last routine dialysis.
Start: 01/01/1995
213Date of first routine dialysis.
Start: 01/01/1995
214Original date of prescription/orders/referral.
Start: 02/28/1997
215Date of tooth extraction/evolution.
Start: 01/01/1995
216Drug information.
Start: 01/01/1995
217Drug name, strength and dosage form.
Start: 01/01/1995
218NDC number.
Start: 01/01/1995
219Prescription number.
Start: 01/01/1995
220Drug product id number. (Use code 218)
Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
221Drug days supply and dosage.
Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
222Drug dispensing units and average wholesale price (AWP).
Start: 01/01/1995
223Route of drug/myelogram administration.
Start: 01/01/1995
224Anatomical location for joint injection.
Start: 01/01/1995
225Anatomical location.
Start: 01/01/1995
226Joint injection site.
Start: 01/01/1995
227Hospital information.
Start: 01/01/1995
228Type of bill for UB claim
Start: 01/01/1995 | Last Modified: 10/31/2006
229Hospital admission source.
Start: 01/01/1995
230Hospital admission hour.
Start: 01/01/1995
231Hospital admission type.
Start: 01/01/1995
232Admitting diagnosis.
Start: 01/01/1995
233Hospital discharge hour.
Start: 01/01/1995
234Patient discharge status.
Start: 01/01/1995
235Units of blood furnished.
Start: 01/01/1995
236Units of blood replaced.
Start: 01/01/1995
237Units of deductible blood.
Start: 01/01/1995
238Separate claim for mother/baby charges.
Start: 01/01/1995
239Dental information.
Start: 01/01/1995
240Tooth surface(s) involved.
Start: 01/01/1995
241List of all missing teeth (upper and lower).
Start: 01/01/1995
242Tooth numbers, surfaces, and/or quadrants involved.
Start: 01/01/1995
243Months of dental treatment remaining.
Start: 01/01/1995
244Tooth number or letter.
Start: 01/01/1995
245Dental quadrant/arch.
Start: 01/01/1995
246Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
Start: 01/01/1995
247Line information.
Start: 01/01/1995
248Accident date, state, description and cause.
Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
249Place of service.
Start: 01/01/1995
250Type of service.
Start: 01/01/1995
251Total anesthesia minutes.
Start: 01/01/1995
252Entity's prior authorization/certification number. Usage: This code requires the use of an Entity Code.
Start: 01/01/1995 | Last Modified: 07/01/2017
253Procedure/revenue code for service(s) rendered. Use codes 454 or 455.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
254Principal diagnosis code.
Start: 01/01/1995 | Last Modified: 01/30/2011
255Diagnosis code.
Start: 01/01/1995
256DRG code(s).
Start: 01/01/1995
257ADSM-III-R code for services rendered.
Start: 01/01/1995
258Days/units for procedure/revenue code.
Start: 01/01/1995
259Frequency of service.
Start: 01/01/1995
260Length of medical necessity, including begin date.
Start: 02/28/1997
261Obesity measurements.
Start: 01/01/1995
262Type of surgery/service for which anesthesia was administered.
Start: 01/01/1995
263Length of time for services rendered.
Start: 01/01/1995
264Number of liters/minute & total hours/day for respiratory support.
Start: 01/01/1995
265Number of lesions excised.
Start: 01/01/1995
266Facility point of origin and destination - ambulance.
Start: 01/01/1995
267Number of miles patient was transported.
Start: 01/01/1995
268Location of durable medical equipment use.
Start: 01/01/1995
269Length/size of laceration/tumor.
Start: 01/01/1995
270Subluxation location.
Start: 01/01/1995
271Number of spine segments.
Start: 01/01/1995
272Oxygen contents for oxygen system rental.
Start: 01/01/1995
273Weight.
Start: 01/01/1995
274Height.
Start: 01/01/1995
275Claim.
Start: 01/01/1995
276UB04/HCFA-1450/1500 claim form
Start: 01/01/1995 | Last Modified: 10/31/2006
277Paper claim.
Start: 01/01/1995
278Signed claim form.
Start: 01/01/1995 | Stop: 11/01/2011
279Claim/service must be itemized
Start: 01/01/1995 | Last Modified: 10/17/2010
280Itemized claim by provider.
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 279
281Related confinement claim.
Start: 01/01/1995
282Copy of prescription.
Start: 01/01/1995
283Medicare entitlement information is required to determine primary coverage
Start: 01/01/1995 | Last Modified: 01/27/2008
284Copy of Medicare ID card.
Start: 01/01/1995
285Vouchers/explanation of benefits (EOB).
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 286
286Other payer's Explanation of Benefits/payment information.
Start: 01/01/1995
287Medical necessity for service.
Start: 01/01/1995
288Hospital late charges
Start: 01/01/1995 | Last Modified: 10/17/2010
289Reason for late discharge.
Start: 01/01/1995 | Stop: 11/01/2011
290Pre-existing information.
Start: 01/01/1995
291Reason for termination of pregnancy.
Start: 01/01/1995
292Purpose of family conference/therapy.
Start: 01/01/1995
293Reason for physical therapy.
Start: 01/01/1995
294Supporting documentation. Usage: At least one other status code is required to identify the supporting documentation.
Start: 01/01/1995 | Last Modified: 07/01/2017
295Attending physician report.
Start: 01/01/1995
296Nurse's notes.
Start: 01/01/1995
297Medical notes/report.
Start: 02/28/1997
298Operative report.
Start: 01/01/1995
299Emergency room notes/report.
Start: 01/01/1995
300Lab/test report/notes/results.
Start: 02/28/1997
301MRI report.
Start: 01/01/1995
302Refer to codes 300 for lab notes and 311 for pathology notes
Start: 01/01/1995 | Stop: 01/31/1997
303Physical therapy notes. Use code 297:6O (6 'OH' - not zero)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
304Reports for service.
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 297, 298, 299, 300
305Radiology/x-ray reports and/or interpretation
Start: 01/01/1995 | Last Modified: 01/30/2011
306Detailed description of service.
Start: 01/01/1995
307Narrative with pocket depth chart.
Start: 01/01/1995
308Discharge summary.
Start: 01/01/1995
309Code was duplicate of code 299
Start: 01/01/1995 | Stop: 01/31/1997
310Progress notes for the six months prior to statement date.
Start: 01/01/1995
311Pathology notes/report.
Start: 01/01/1995
312Dental charting.
Start: 01/01/1995
313Bridgework information.
Start: 01/01/1995
314Dental records for this service.
Start: 01/01/1995
315Past perio treatment history.
Start: 01/01/1995
316Complete medical history.
Start: 01/01/1995
317Patient's medical records.
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 297 or other specific report type codes
318X-rays/radiology films
Start: 01/01/1995 | Last Modified: 10/17/2010
319Pre/post-operative x-rays/photographs.
Start: 02/28/1997
320Study models.
Start: 01/01/1995
321Radiographs or models. (Use codes 318 and/or 320)
Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
322Recent Full Mouth X-rays
Start: 01/01/1995 | Last Modified: 10/17/2010
323Study models, x-rays, and/or narrative.
Start: 01/01/1995
324Recent x-ray of treatment area and/or narrative.
Start: 01/01/1995
325Recent fm x-rays and/or narrative.
Start: 01/01/1995
326Copy of transplant acquisition invoice.
Start: 01/01/1995
327Periodontal case type diagnosis and recent pocket depth chart with narrative.
Start: 01/01/1995
328Speech therapy notes. Use code 297:6R
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
329Exercise notes.
Start: 01/01/1995
330Occupational notes.
Start: 01/01/1995
331History and physical.
Start: 01/01/1995 | Last Modified: 08/01/2007
332Authorization/certification (include period covered). (Use code 252)
Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
333Patient release of information authorization.
Start: 01/01/1995
334Oxygen certification.
Start: 01/01/1995
335Durable medical equipment certification.
Start: 01/01/1995
336Chiropractic certification.
Start: 01/01/1995
337Ambulance certification/documentation.
Start: 01/01/1995
338Home health certification. Use code 332:4Y
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
339Enteral/parenteral certification.
Start: 01/01/1995
340Pacemaker certification.
Start: 01/01/1995
341Private duty nursing certification.
Start: 01/01/1995
342Podiatric certification.
Start: 01/01/1995
343Documentation that facility is state licensed and Medicare approved as a surgical facility.
Start: 01/01/1995
344Documentation that provider of physical therapy is Medicare Part B approved.
Start: 01/01/1995
345Treatment plan for service/diagnosis
Start: 01/01/1995
346Proposed treatment plan for next 6 months.
Start: 01/01/1995
347Refer to code 345 for treatment plan and code 282 for prescription
Start: 01/01/1995 | Stop: 01/31/1997
348Chiropractic treatment plan. (Use 345:QL)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
349Psychiatric 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
350Speech pathology treatment plan. Use code 345:6R
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
351Physical/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
352Duration of treatment plan.
Start: 01/01/1995
353Orthodontics treatment plan.
Start: 01/01/1995
354Treatment plan for replacement of remaining missing teeth.
Start: 01/01/1995
355Has claim been paid?
Start: 01/01/1995 | Stop: 11/01/2011
356Was blood furnished?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 235
357Has or will blood be replaced?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 236
358Does provider accept assignment of benefits? (Use code 589)
Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
359Is there a release of information signature on file? (Use code 333)
Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
360Benefits Assignment Certification Indicator
Start: 01/01/1995 | Last Modified: 10/17/2010
361Is there other insurance?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 171 and 550
362Is the dental patient covered by medical insurance?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 171
363Possible Workers' Compensation
Start: 01/01/1995 | Last Modified: 10/17/2010
364Is accident/illness/condition employment related?
Start: 01/01/1995
365Is service the result of an accident?
Start: 01/01/1995
366Is injury due to auto accident?
Start: 01/01/1995
367Is service performed for a recurring condition or new condition?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 397
368Is 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
369Does patient condition preclude use of ordinary bed?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 287, 335
370Can patient operate controls of bed?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 287, 335
371Is patient confined to room?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 287, 335, 527
372Is patient confined to bed?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 287, 335, 527
373Is patient an insulin diabetic?
Start: 01/01/1995 | Stop: 11/01/2011
374Is prescribed lenses a result of cataract surgery?
Start: 01/01/1995
375Was refraction performed?
Start: 01/01/1995
376Was charge for ambulance for a round-trip?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 453
377Was durable medical equipment purchased new or used?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 184, 185, 186, 335
378Is pacemaker temporary or permanent?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 340
379Were services performed supervised by a physician?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to codes 453, 454, 666 & procedure code
380CRNA supervision/medical direction.
Start: 01/01/1995 | Last Modified: 10/17/2010
381Is drug generic?
Start: 01/01/1995 | Stop: 11/01/2011
Notes: Refer to code 216
382Did provider authorize generic or brand name dispensing?
Start: 01/01/1995
383Nerve block use (surgery vs. pain management)
Start: 01/01/1995 | Last Modified: 10/17/2010
384Is prosthesis/crown/inlay placement an initial placement or a replacement?
Start: 01/01/1995
385Is appliance upper or lower arch & is appliance fixed or removable?
Start: 01/01/1995
386Orthodontic Treatment/Purpose Indicator
Start: 01/01/1995 | Last Modified: 10/17/2010
387Date patient last examined by entity. Usage: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 07/01/2017
388Date post-operative care assumed
Start: 02/28/1997
389Date post-operative care relinquished
Start: 02/28/1997
390Date of most recent medical event necessitating service(s)
Start: 02/28/1997
391Date(s) dialysis conducted
Start: 02/28/1997
392Date(s) of blood transfusion(s)
Start: 02/28/1997 | Stop: 11/01/2011
393Date of previous pacemaker check
Start: 02/28/1997 | Stop: 11/01/2011
394Date(s) of most recent hospitalization related to service
Start: 02/28/1997
395Date entity signed certification/recertification Usage: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 07/01/2017
396Date home dialysis began
Start: 02/28/1997
397Date of onset/exacerbation of illness/condition
Start: 02/28/1997
398Visual field test results
Start: 02/28/1997
399Report of prior testing related to this service, including dates
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 417
400Claim is out of balance
Start: 02/28/1997
401Source of payment is not valid
Start: 02/28/1997
402Amount must be greater than zero. Usage: At least one other status code is required to identify which amount element is in error.
Start: 02/28/1997 | Last Modified: 07/01/2017
403Entity referral notes/orders/prescription. Effective 05/01/2018: Entity referral notes/orders/prescription. Usage: this code requires use of an entity code.
Start: 02/28/1997 | Last Modified: 11/01/2017
404Specific findings, complaints, or symptoms necessitating service
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to codes 287, 488
405Summary of services
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 306
406Brief medical history as related to service(s)
Start: 02/28/1997
407Complications/mitigating circumstances
Start: 02/28/1997
408Initial certification
Start: 02/28/1997
409Medication logs/records (including medication therapy)
Start: 02/28/1997
410Explain 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
411Medical necessity for non-routine service(s)
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 287
412Medical 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
413Explain/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
414Necessity for concurrent care (more than one physician treating the patient)
Start: 02/28/1997 | Last Modified: 10/17/2010
415Justify services outside composite rate
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 287
416Verification 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
417Prior testing, including result(s) and date(s) as related to service(s)
Start: 02/28/1997
418Indicating 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
419Individual test(s) comprising the panel and the charges for each test
Start: 02/28/1997
420Name, dosage and medical justification of contrast material used for radiology procedure
Start: 02/28/1997
421Medical 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
422Homebound status
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 575
423Prognosis
Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
424Statement of non-coverage including itemized bill
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 279 & 286
425Itemize non-covered services
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 279 & 286
426All current diagnoses
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 255, 232 & 488
427Emergency care provided during transport
Start: 02/28/1997 | Stop: 11/01/2011
428Reason for transport by ambulance
Start: 02/28/1997
429Loaded 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
430Nearest appropriate facility
Start: 02/28/1997
431Patient's condition/functional status at time of service.
Start: 02/28/1997 | Last Modified: 10/17/2010
432Date benefits exhausted
Start: 02/28/1997
433Copy of patient revocation of hospice benefits
Start: 02/28/1997
434Reasons for more than one transfer per entitlement period
Start: 02/28/1997
435Notice of Admission
Start: 02/28/1997
436Short term goals
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 345
437Long term goals
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 345
438Number of patients attending session
Start: 02/28/1997 | Stop: 11/01/2011
439Size, 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
440why non-skilled caregiver has not been taught procedure
Start: 02/28/1997 | Stop: 11/01/2011
441Entity professional qualification for service(s)
Start: 02/28/1997
442Modalities of service
Start: 02/28/1997
443Initial evaluation report
Start: 02/28/1997
444Method used to obtain test sample
Start: 02/28/1997 | Stop: 11/01/2011
445Explain why hearing loss not correctable by hearing aid
Start: 02/28/1997 | Stop: 11/01/2011
Notes: Refer to code 287
446Documentation from prior claim(s) related to service(s)
Start: 02/28/1997 | Stop: 11/01/2011
447Plan of teaching
Start: 02/28/1997 | Stop: 11/01/2011
448Invalid 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
449Projected date to discontinue service(s)
Start: 02/28/1997
450Awaiting spend down determination
Start: 02/28/1997
451Preoperative and post-operative diagnosis
Start: 02/28/1997
452Total visits in total number of hours/day and total number of hours/week
Start: 02/28/1997
453Procedure Code Modifier(s) for Service(s) Rendered
Start: 02/28/1997
454Procedure code for services rendered.
Start: 02/28/1997
455Revenue code for services rendered.
Start: 02/28/1997
456Covered Day(s)
Start: 02/28/1997
457Non-Covered Day(s)
Start: 02/28/1997
458Coinsurance Day(s)
Start: 02/28/1997
459Lifetime Reserve Day(s)
Start: 02/28/1997
460NUBC Condition Code(s)
Start: 02/28/1997
461NUBC Occurrence Code(s) and Date(s)
Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
462NUBC Occurrence Span Code(s) and Date(s)
Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
463NUBC Value Code(s) and/or Amount(s)
Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
464Payer Assigned Claim Control Number
Start: 02/28/1997 | Last Modified: 10/31/2004
465Principal Procedure Code for Service(s) Rendered
Start: 02/28/1997
466Entity's Original Signature. Usage: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 07/01/2017
467Entity Signature Date. Usage: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 07/01/2017
468Patient Signature Source
Start: 02/28/1997
469Purchase Service Charge
Start: 02/28/1997
470Was service purchased from another entity? Usage: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 07/01/2017
471Were services related to an emergency?
Start: 02/28/1997
472Ambulance Run Sheet
Start: 02/28/1997
473Missing or invalid lab indicator
Start: 06/30/1998
474Procedure code and patient gender mismatch
Start: 06/30/1998 | Last Modified: 02/29/2000
475Procedure code not valid for patient age
Start: 06/30/1998 | Last Modified: 02/29/2000
476Missing or invalid units of service
Start: 06/30/1998
477Diagnosis code pointer is missing or invalid
Start: 06/30/1998
478Claim submitter's identifier
Start: 06/30/1998 | Last Modified: 01/24/2010
479Other Carrier payer ID is missing or invalid
Start: 06/30/1998
480Entity's claim filing indicator. Usage: This code requires use of an Entity Code.
Start: 06/30/1998 | Last Modified: 07/01/2017
481Claim/submission format is invalid.
Start: 10/31/1998
482Date Error, Century Missing
Start: 02/28/1999 | Last Modified: 09/20/2009 | Stop: 10/01/2010
483Maximum coverage amount met or exceeded for benefit period.
Start: 06/30/1999
484Business Application Currently Not Available
Start: 02/29/2000
485More information available than can be returned in real time mode. Narrow your current search criteria. This change effective September 1, 2017: More information available than can be returned in real-time mode. Narrow your current search criteria.
Start: 02/28/2001 | Last Modified: 03/01/2017
486Principal Procedure Date
Start: 10/31/2001 | Last Modified: 07/01/2009
487Claim not found, claim should have been submitted to/through 'entity'. Usage: This code requires use of an Entity Code.
Start: 02/28/2002 | Last Modified: 07/01/2017
488Diagnosis code(s) for the services rendered.
Start: 06/30/2002
489Attachment Control Number
Start: 10/31/2002
490Other Procedure Code for Service(s) Rendered
Start: 02/28/2003
491Entity not eligible for encounter submission. Usage: This code requires use of an Entity Code.
Start: 02/28/2003 | Last Modified: 07/01/2017
492Other Procedure Date
Start: 02/28/2003
493Version/Release/Industry ID code not currently supported by information holder
Start: 02/28/2003
494Real-Time requests not supported by the information holder, resubmit as batch request This change effective September 1, 2017: Real-time requests not supported by the information holder, resubmit as batch request
Start: 02/28/2003 | Last Modified: 03/01/2017
495Requests 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
496Submitter not approved for electronic claim submissions on behalf of this entity. Usage: This code requires use of an Entity Code.
Start: 02/29/2004 | Last Modified: 07/01/2017
497Sales tax not paid
Start: 06/30/2004
498Maximum leave days exhausted
Start: 06/30/2004
499No rate on file with the payer for this service for this entity Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
500Entity's Postal/Zip Code. Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
501Entity's State/Province. Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
502Entity's City. Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
503Entity's Street Address. Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
504Entity's Last Name. Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
505Entity's First Name. Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
506Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Usage: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 07/01/2017
507HCPCS
Start: 10/31/2004
508ICD9 Usage: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 10/31/2004 | Last Modified: 07/01/2017
509External Cause of Injury Code.
Start: 10/31/2004 | Last Modified: 03/01/2016
510Future date. Usage: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 07/01/2017
511Invalid character. Usage: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 07/01/2017
512Length invalid for receiver's application system. Usage: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 07/01/2017
513HIPPS Rate Code for services Rendered
Start: 10/31/2004
514Entity's Middle Name Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
515Managed Care review
Start: 10/31/2004
516Other Entity's Adjudication or Payment/Remittance Date. Usage: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary.
Start: 10/31/2004 | Last Modified: 07/01/2017
517Adjusted Repriced Claim Reference Number
Start: 10/31/2004
518Adjusted Repriced Line item Reference Number
Start: 10/31/2004
519Adjustment Amount
Start: 10/31/2004
520Adjustment Quantity
Start: 10/31/2004
521Adjustment Reason Code
Start: 10/31/2004
522Anesthesia Modifying Units
Start: 10/31/2004
523Anesthesia Unit Count
Start: 10/31/2004
524Arterial Blood Gas Quantity
Start: 10/31/2004
525Begin Therapy Date
Start: 10/31/2004
526Bundled or Unbundled Line Number
Start: 10/31/2004
527Certification Condition Indicator
Start: 10/31/2004
528Certification Period Projected Visit Count
Start: 10/31/2004
529Certification Revision Date
Start: 10/31/2004
530Claim Adjustment Indicator
Start: 10/31/2004
531Claim Disproportinate Share Amount
Start: 10/31/2004
532Claim DRG Amount
Start: 10/31/2004
533Claim DRG Outlier Amount
Start: 10/31/2004
534Claim ESRD Payment Amount
Start: 10/31/2004
535Claim Frequency Code
Start: 10/31/2004
536Claim Indirect Teaching Amount
Start: 10/31/2004
537Claim MSP Pass-through Amount
Start: 10/31/2004
538Claim or Encounter Identifier
Start: 10/31/2004
539Claim PPS Capital Amount
Start: 10/31/2004
540Claim PPS Capital Outlier Amount
Start: 10/31/2004
541Claim Submission Reason Code
Start: 10/31/2004
542Claim Total Denied Charge Amount
Start: 10/31/2004
543Clearinghouse or Value Added Network Trace
Start: 10/31/2004
544Clinical Laboratory Improvement Amendment (CLIA) Number
Start: 10/31/2004 | Last Modified: 03/01/2018
545Contract Amount
Start: 10/31/2004
546Contract Code
Start: 10/31/2004
547Contract Percentage
Start: 10/31/2004
548Contract Type Code
Start: 10/31/2004
549Contract Version Identifier
Start: 10/31/2004
550Coordination of Benefits Code
Start: 10/31/2004
551Coordination of Benefits Total Submitted Charge
Start: 10/31/2004
552Cost Report Day Count
Start: 10/31/2004
553Covered Amount
Start: 10/31/2004
554Date Claim Paid
Start: 10/31/2004
555Delay Reason Code
Start: 10/31/2004
556Demonstration Project Identifier
Start: 10/31/2004
557Diagnosis Date
Start: 10/31/2004
558Discount Amount
Start: 10/31/2004
559Document Control Identifier
Start: 10/31/2004
560Entity's Additional/Secondary Identifier. Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
561Entity's Contact Name. Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
562Entity's National Provider Identifier (NPI). Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
563Entity's Tax Amount. Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
564EPSDT Indicator
Start: 10/31/2004
565Estimated Claim Due Amount
Start: 10/31/2004
566Exception Code
Start: 10/31/2004
567Facility Code Qualifier
Start: 10/31/2004
568Family Planning Indicator
Start: 10/31/2004
569Fixed Format Information
Start: 10/31/2004
570Free Form Message Text
Start: 10/31/2004 | Stop: 01/01/2013
571Frequency Count
Start: 10/31/2004
572Frequency Period
Start: 10/31/2004
573Functional Limitation Code
Start: 10/31/2004
574HCPCS Payable Amount Home Health
Start: 10/31/2004
575Homebound Indicator
Start: 10/31/2004
576Immunization Batch Number
Start: 10/31/2004
577Industry Code
Start: 10/31/2004
578Insurance Type Code
Start: 10/31/2004
579Investigational Device Exemption Identifier
Start: 10/31/2004
580Last Certification Date
Start: 10/31/2004
581Last Worked Date
Start: 10/31/2004
582Lifetime Psychiatric Days Count
Start: 10/31/2004
583Line Item Charge Amount
Start: 10/31/2004
584Line Item Control Number
Start: 10/31/2004
585Denied Charge or Non-covered Charge
Start: 10/31/2004 | Last Modified: 07/09/2007
586Line Note Text
Start: 10/31/2004
587Measurement Reference Identification Code
Start: 10/31/2004
588Medical Record Number
Start: 10/31/2004
589Provider Accept Assignment Code
Start: 10/31/2004 | Last Modified: 10/17/2010
590Medicare Coverage Indicator
Start: 10/31/2004
591Medicare Paid at 100% Amount
Start: 10/31/2004
592Medicare Paid at 80% Amount
Start: 10/31/2004
593Medicare Section 4081 Indicator
Start: 10/31/2004
594Mental Status Code
Start: 10/31/2004
595Monthly Treatment Count
Start: 10/31/2004
596Non-covered Charge Amount
Start: 10/31/2004
597Non-payable Professional Component Amount
Start: 10/31/2004
598Non-payable Professional Component Billed Amount
Start: 10/31/2004
599Note Reference Code
Start: 10/31/2004
600Oxygen Saturation Qty
Start: 10/31/2004
601Oxygen Test Condition Code
Start: 10/31/2004
602Oxygen Test Date
Start: 10/31/2004
603Old Capital Amount
Start: 10/31/2004
604Originator Application Transaction Identifier
Start: 10/31/2004
605Orthodontic Treatment Months Count
Start: 10/31/2004
606Paid From Part A Medicare Trust Fund Amount
Start: 10/31/2004
607Paid From Part B Medicare Trust Fund Amount
Start: 10/31/2004
608Paid Service Unit Count
Start: 10/31/2004
609Participation Agreement
Start: 10/31/2004
610Patient Discharge Facility Type Code
Start: 10/31/2004
611Peer Review Authorization Number
Start: 10/31/2004
612Per Day Limit Amount
Start: 10/31/2004
613Physician Contact Date
Start: 10/31/2004
614Physician Order Date
Start: 10/31/2004
615Policy Compliance Code
Start: 10/31/2004
616Policy Name
Start: 10/31/2004
617Postage Claimed Amount
Start: 10/31/2004
618PPS-Capital DSH DRG Amount
Start: 10/31/2004
619PPS-Capital Exception Amount
Start: 10/31/2004
620PPS-Capital FSP DRG Amount
Start: 10/31/2004
621PPS-Capital HSP DRG Amount
Start: 10/31/2004
622PPS-Capital IME Amount
Start: 10/31/2004
623PPS-Operating Federal Specific DRG Amount
Start: 10/31/2004
624PPS-Operating Hospital Specific DRG Amount
Start: 10/31/2004
625Predetermination of Benefits Identifier
Start: 10/31/2004
626Pregnancy Indicator
Start: 10/31/2004
627Pre-Tax Claim Amount
Start: 10/31/2004
628Pricing Methodology
Start: 10/31/2004
629Property Casualty Claim Number
Start: 10/31/2004
630Referring CLIA Number
Start: 10/31/2004
631Reimbursement Rate
Start: 10/31/2004
632Reject Reason Code
Start: 10/31/2004
633Related Causes Code (Accident, auto accident, employment)
Start: 10/31/2004 | Last Modified: 10/17/2010
634Remark Code
Start: 10/31/2004
635Repriced Ambulatory Patient Group Code
Start: 10/31/2004
636Repriced Line Item Reference Number
Start: 10/31/2004
637Repriced Saving Amount
Start: 10/31/2004
638Repricing Per Diem or Flat Rate Amount
Start: 10/31/2004
639Responsibility Amount
Start: 10/31/2004
640Sales Tax Amount
Start: 10/31/2004
641Service Adjudication or Payment Date. Note: Use code 516.
Start: 10/31/2004 | Last Modified: 09/20/2009 | Stop: 10/01/2010
642Service Authorization Exception Code
Start: 10/31/2004
643Service Line Paid Amount
Start: 10/31/2004
644Service Line Rate
Start: 10/31/2004
645Service Tax Amount
Start: 10/31/2004
646Ship, Delivery or Calendar Pattern Code
Start: 10/31/2004
647Shipped Date
Start: 10/31/2004
648Similar Illness or Symptom Date
Start: 10/31/2004
649Skilled Nursing Facility Indicator
Start: 10/31/2004
650Special Program Indicator
Start: 10/31/2004
651State Industrial Accident Provider Number
Start: 10/31/2004
652Terms Discount Percentage
Start: 10/31/2004
653Test Performed Date
Start: 10/31/2004
654Total Denied Charge Amount
Start: 10/31/2004
655Total Medicare Paid Amount
Start: 10/31/2004
656Total Visits Projected This Certification Count
Start: 10/31/2004
657Total Visits Rendered Count
Start: 10/31/2004
658Treatment Code
Start: 10/31/2004
659Unit or Basis for Measurement Code
Start: 10/31/2004
660Universal Product Number
Start: 10/31/2004
661Visits Prior to Recertification Date Count CR702
Start: 10/31/2004
662X-ray Availability Indicator
Start: 10/31/2004
663Entity's Group Name. Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
664Orthodontic Banding Date
Start: 10/31/2004
665Surgery Date
Start: 10/31/2004
666Surgical Procedure Code
Start: 10/31/2004
667Real-Time requests not supported by the information holder, do not resubmit This change effective September 1, 2017: Real-time requests not supported by the information holder, do not resubmit
Start: 02/28/2005 | Last Modified: 03/01/2017
668Missing Endodontics treatment history and prognosis
Start: 06/30/2005
669Dental service narrative needed.
Start: 10/31/2005
670Funds 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
671Funds 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
672Other Payer's payment information is out of balance
Start: 10/31/2006
673Patient Reason for Visit
Start: 10/31/2006
674Authorization exceeded
Start: 10/31/2006
675Facility admission through discharge dates
Start: 10/31/2006
676Entity possibly compensated by facility. Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
677Entity not affiliated. Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
678Revenue code and patient gender mismatch
Start: 10/31/2006
679Submit newborn services on mother's claim
Start: 10/31/2006
680Entity's Country. Usage: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 07/01/2017
681Claim currency not supported
Start: 10/31/2006
682Cosmetic procedure
Start: 02/28/2007
683Awaiting Associated Hospital Claims
Start: 02/28/2007
684Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Usage: 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 | Last Modified: 07/01/2017
685Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit. This change effective September 1, 2017: Claim could not complete adjudication in real-time. Claim will continue processing in a batch mode. Do not resubmit.
Start: 01/27/2008 | Last Modified: 03/01/2017
686The claim/ encounter has completed the adjudication cycle and the entire claim has been voided
Start: 01/27/2008
687Claim estimation can not be completed in real time. Do not resubmit. This change effective September 1, 2017: Claim predetermination/estimation could not be completed in real-time. Do not resubmit.
Start: 01/27/2008 | Last Modified: 03/01/2017
688Present on Admission Indicator for reported diagnosis code(s).
Start: 01/27/2008
689Entity was unable to respond within the expected time frame. Usage: This code requires use of an Entity Code.
Start: 06/01/2008 | Last Modified: 07/01/2017
690Multiple claims or estimate requests cannot be processed in real time. This change effective September 1, 2017: Multiple claims or estimate requests cannot be processed in real-time.
Start: 06/01/2008 | Last Modified: 03/01/2017
691Multiple claim status requests cannot be processed in real time. This change effective September 1, 2017: Multiple claim status requests cannot be processed in real-time.
Start: 06/01/2008 | Last Modified: 03/01/2017
692Contracted funding agreement-Subscriber is employed by the provider of services
Start: 09/21/2008
693Amount must be greater than or equal to zero. Usage: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009 | Last Modified: 07/01/2017
694Amount must not be equal to zero. Usage: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009 | Last Modified: 07/01/2017
695Entity's Country Subdivision Code. Usage: This code requires use of an Entity Code.
Start: 01/25/2009 | Last Modified: 07/01/2017
696Claim Adjustment Group Code.
Start: 01/25/2009
697Invalid Decimal Precision. Usage: At least one other status code is required to identify the data element in error.
Start: 07/01/2009 | Last Modified: 07/01/2017
698Form Type Identification
Start: 07/01/2009
699Question/Response from Supporting Documentation Form
Start: 07/01/2009
700ICD10. Usage: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 07/01/2009 | Last Modified: 07/01/2017
701Initial Treatment Date
Start: 07/01/2009
702Repriced Claim Reference Number
Start: 11/01/2009
703Advanced Billing Concepts (ABC) code
Start: 01/24/2010
704Claim Note Text
Start: 01/24/2010
705Repriced Allowed Amount
Start: 01/24/2010
706Repriced Approved Amount
Start: 01/24/2010
707Repriced Approved Ambulatory Patient Group Amount
Start: 01/24/2010
708Repriced Approved Revenue Code
Start: 01/24/2010
709Repriced Approved Service Unit Count
Start: 01/24/2010
710Line Adjudication Information. Usage: At least one other status code is required to identify the data element in error.
Start: 01/24/2010 | Last Modified: 07/01/2017
711Stretcher purpose
Start: 01/24/2010
712Obstetric Additional Units
Start: 01/24/2010
713Patient Condition Description
Start: 01/24/2010
714Care Plan Oversight Number
Start: 01/24/2010
715Acute Manifestation Date
Start: 01/24/2010
716Repriced Approved DRG Code
Start: 01/24/2010
717This claim has been split for processing.
Start: 01/24/2010
718Claim/service not submitted within the required timeframe (timely filing).
Start: 01/24/2010
719NUBC Occurrence Code(s)
Start: 01/24/2010
720NUBC Occurrence Code Date(s)
Start: 01/24/2010
721NUBC Occurrence Span Code(s)
Start: 01/24/2010
722NUBC Occurrence Span Code Date(s)
Start: 01/24/2010
723Drug days supply
Start: 01/24/2010
724Drug dosage. This change effective 5/01/2017: Drug Quantity
Start: 01/24/2010 | Last Modified: 11/01/2016
725NUBC Value Code(s)
Start: 01/24/2010
726NUBC Value Code Amount(s)
Start: 01/24/2010
727Accident date
Start: 01/24/2010
728Accident state
Start: 01/24/2010
729Accident description
Start: 01/24/2010
730Accident cause
Start: 01/24/2010
731Measurement value/test result
Start: 01/24/2010
732Information submitted inconsistent with billing guidelines. Usage: At least one other status code is required to identify the inconsistent information.
Start: 01/24/2010 | Last Modified: 07/01/2017
733Prefix for entity's contract/member number.
Start: 01/24/2010
734Verifying premium payment
Start: 06/06/2010
735This service/claim is included in the allowance for another service or claim.
Start: 06/06/2010
736A related or qualifying service/claim has not been received/adjudicated.
Start: 06/06/2010
737Current Dental Terminology (CDT) Code
Start: 06/06/2010
738Home Infusion EDI Coalition (HEIC) Product/Service Code
Start: 06/06/2010
739Jurisdiction Specific Procedure or Supply Code
Start: 06/06/2010
740Drop-Off Location
Start: 06/06/2010
741Entity must be a person. Usage: This code requires use of an Entity Code.
Start: 06/06/2010 | Last Modified: 07/01/2017
742Payer Responsibility Sequence Number Code
Start: 06/06/2010
743Entity's credential/enrollment information. Usage: This code requires use of an Entity Code.
Start: 10/17/2010 | Last Modified: 07/01/2017
744Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
Start: 10/17/2010
745Identifier Qualifier Usage: At least one other status code is required to identify the specific identifier qualifier in error.
Start: 10/17/2010 | Last Modified: 07/01/2017
746Duplicate Submission Usage: use only at the information receiver level in the Health Care Claim Acknowledgement transaction.
Start: 10/17/2010 | Last Modified: 07/01/2017
747Hospice Employee Indicator
Start: 10/17/2010
748Corrected Data Usage: Requires a second status code to identify the corrected data.
Start: 10/17/2010 | Last Modified: 07/01/2017
749Date of Injury/Illness
Start: 10/17/2010
750Auto Accident State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
751Ambulance Pick-up State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
752Ambulance Drop-off State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
753Co-pay status code.
Start: 01/30/2011
754Entity Name Suffix. Usage: This code requires the use of an Entity Code.
Start: 01/30/2011 | Last Modified: 07/01/2017
755Entity's primary identifier. Usage: This code requires the use of an Entity Code.
Start: 01/30/2011 | Last Modified: 07/01/2017
756Entity's Received Date. Usage: This code requires the use of an Entity Code.
Start: 01/30/2011 | Last Modified: 07/01/2017
757Last seen date.
Start: 01/30/2011
758Repriced approved HCPCS code.
Start: 01/30/2011
759Round trip purpose description.
Start: 01/30/2011
760Tooth status code.
Start: 01/30/2011
761Entity's referral number. Usage: This code requires the use of an Entity Code.
Start: 01/30/2011 | Last Modified: 07/01/2017
762Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider
Start: 01/20/2013
763Ambulance Pickup ZipCode
Start: 01/20/2013
764Professional charges are non covered.
Start: 06/02/2013
765Institutional charges are non covered.
Start: 06/02/2013
766Services were performed during a Health Insurance Exchange (HIX) premium payment grace period.
Start: 11/01/2013
767Qualifications for emergent/urgent care
Start: 01/26/2014
768Service date outside the accidental injury coverage period.
Start: 01/26/2014
769DME Repair or Maintenance
Start: 06/01/2014
770Duplicate of a claim processed or in process as a crossover/coordination of benefits claim.
Start: 09/28/2014
771Claim submitted prematurely. Please resubmit after crossover/payer to payer COB allotted waiting period.
Start: 09/28/2014
772The greatest level of diagnosis code specificity is required.
Start: 03/01/2016
773One calendar year per claim.
Start: 11/01/2016
774Experimental/Investigational
Start: 11/01/2016
775Entity Type Qualifier (Person/Non-Person Entity). Usage: this code requires use of an entity code.
Start: 07/01/2017
776Pre/Post-operative care
Start: 07/01/2017
777Processed based on multiple or concurrent procedure rules.
Start: 07/01/2017
778Non-Compensable incident/event. Usage: To be used for Property and Casualty only.
Start: 07/01/2017
779Service submitted for the same/similar service within a set timeframe.
Start: 11/01/2017
780Lifetime benefit maximum
Start: 11/01/2017
781Claim has been identified as a readmission
Start: 11/01/2017
782Second surgical opinion
Start: 03/01/2018
783Federal sequestration adjustment
Start: 11/01/2018
784Electronic Visit Verification criteria do not match.
Start: 03/01/2019
785Missing/Invalid Sterilization/Abortion/Hospital Consent Form.
Start: 07/01/2019
786Submit claim to the third party property and casualty automobile insurer.
Start: 07/01/2019
787Resubmit a new claim, not a replacement claim.
Start: 07/01/2019
788Submit these services to the patient's Pharmacy Plan for further consideration.
Start: 07/01/2019
789Submit these services to the patient's Medical Plan for further consideration.
Start: 07/01/2019
790Submit these services to the patient's Dental Plan for further consideration.
Start: 07/01/2019
791Submit these services to the patient's Vision Plan for further consideration.
Start: 07/01/2019
792Submit these services to the patient's Behavioral Health Plan for further consideration.
Start: 07/01/2019
793Submit these services to the patient's Property and Casualty Plan for further consideration.
Start: 07/01/2019
794Claim could not complete adjudication in real time. Resubmit as a batch request.
Start: 11/01/2020
795Claim submitted prematurely. Please provide the prior payer’s final adjudication.
Start: 11/01/2020