Num. | Date | Requested Description | Type | Code | Status |
---|---|---|---|---|---|
120 | 7/23/2024 | Rejected due to internal/external systems failure. Please resubmit. | New | CMG Disapproved | |
121 | 9/6/2024 | Total Claim Charge Amount | Revision | CMG Approved | |
122 | 9/6/2024 | Hospital's semi-private room rate. | Revision | CMG Approved | |
123 | 9/6/2024 | Hospital's room rate. | Revision | CMG Approved | |
124 | 9/6/2024 | Entity referral notes/orders/prescription. Usage: this code requires use of an entity code. | Revision | CMG Approved | |
125 | 9/6/2024 | Entity professional qualification for service(s). Usage: This code requires the use of an Entity Code. | Revision | CMG Approved | |
126 | 9/6/2024 | Revise 485 to: More information available than can be returned in real-time mode. Narrow your current search criteria. | Revision | CMG Approved | |
127 | 9/6/2024 | Revise 494 to: Real-time requests not supported by the information holder, resubmit as batch request. | Revision | CMG Approved | |
128 | 9/12/2024 | Manifestation Principal Diagnosis | New | CMG Approved | |
129 | 9/13/2024 | Revise 95 to: Requested additional information not received. Usage: At least one other status code is required to identify the requested information. | Revision | CMG Approved | |
130 | 7/23/2024 | Revise 152 to: Processor Control Number | Revision | CMG Approved | |
131 | 9/13/2024 | Revise 513 to: HIPPS Rate Code for services rendered | Revision | CMG Approved | |
132 | 9/13/2024 | Revise 667 to: Real-time requests not supported by the information holder, do not resubmit. | Revision | CMG Approved | |
133 | 9/13/2024 | Revise 684 to Rejected. 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 an Acknowledgement. | Revision | CMG Approved | |
134 | 7/23/2024 | Revise 685 to: Claim could not complete adjudication in real-time. Claim will continue processing in a batch mode. Do not resubmit. | Revision | CMG Approved | |
135 | 9/13/2024 | Revise 687 to: Claim predetermination/estimation could not be completed in real-time. Do not resubmit. | Revision | CMG Approved | |
136 | 9/13/2024 | Revise 690 to: Multiple claims or estimate requests cannot be processed in real-time. | Revision | CMG Approved | |
137 | 9/13/2024 | Revise 691 to: Multiple claim status requests cannot be processed in real-time. | Revision | CMG Approved | |
138 | 9/13/2024 | Revise 692 to: Contracted funding agreement. Subscriber is employed by the provider of services. | Revision | CMG Approved | |
139 | 9/13/2024 | Revise 724 to: Drug Quantity | Revision | CMG Approved | |
140 | 7/23/2024 | Revise 733 to: Prefix for entity's contract/member number. Usage: This code requires the use of an Entity Code. | Revision | CMG Approved | |
141 | 9/13/2024 | Revise 788 to: Submit these services to the Pharmacy plan/processor for further consideration/adjudication. | Revision | CMG Approved |
Claim Status Codes - Cloned
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:
- Received
The request has been submitted but is not yet under review. - 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. - In Process
The CMG has initiated their decision process. - On Hold
The CMG has initiated their decision process but cannot complete it at this time. - 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. - CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
17 | Claim/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 |
18 | Entity 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 |
19 | Entity acknowledges receipt of claim/encounter. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
20 | Accepted for processing. Start: 01/01/1995 | Last Modified: 06/30/2001 |
21 | Missing 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 |
23 | Returned to Entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
24 | Entity not approved as an electronic submitter. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
25 | Entity not approved. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
26 | Entity not found. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 07/01/2017 |
60 | Information 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 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
89 | Entity 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 |
90 | Entity 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 |
91 | Entity 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 |
92 | Entity 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 |
93 | Entity is not selected primary care provider. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
94 | Entity 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 |
95 | Requested additional information not received. Usage: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 11/01/2024 Notes: If known, the payer must report a second claim status code identifying the requested information. |
96 | No agreement with entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
97 | Patient eligibility not found with entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
124 | Entity'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 |
125 | Entity's name. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
126 | Entity's address. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
127 | Entity's Communication Number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
128 | Entity's tax id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
129 | Entity's Blue Cross provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
130 | Entity's Blue Shield provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
131 | Entity's Medicare provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
132 | Entity's Medicaid provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
133 | Entity's UPIN. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
134 | Entity's TRICARE provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 03/01/2022 |
135 | Entity's commercial provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
136 | Entity's health industry id number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
137 | Entity's plan network id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
138 | Entity's site id . Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
139 | Entity's health maintenance provider id (HMO). Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
140 | Entity's preferred provider organization id (PPO). Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
141 | Entity's administrative services organization id (ASO). Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
142 | Entity's license/certification number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
143 | Entity's state license number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
144 | Entity's specialty license number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
145 | Entity's specialty/taxonomy code. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
146 | Entity's anesthesia license number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
147 | Entity'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 |
148 | Entity's social security number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
149 | Entity's employer id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
150 | Entity's drug enforcement agency (DEA) number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
152 | Pharmacy processor number. Start: 01/01/1995 |
153 | Entity's id number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
154 | Relationship of surgeon & assistant surgeon. Start: 01/01/1995 |
155 | Entity's relationship to patient. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
156 | Patient relationship to subscriber Start: 01/01/1995 |
157 | Entity's Gender. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
158 | Entity's date of birth. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
159 | Entity's date of death. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
160 | Entity's marital status. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
161 | Entity's employment status. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
162 | Entity's health insurance claim number (HICN). Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
163 | Entity's policy/group number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
164 | Entity's contract/member number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
165 | Entity's employer name, address and phone. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
166 | Entity's employer name. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
167 | Entity's employer address. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
168 | Entity's employer phone number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
169 | Entity's employer id. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008 |
170 | Entity's employee id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
174 | Entity's student status. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
175 | Entity's school name. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
176 | Entity's school address. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
177 | Transplant recipient's name, date of birth, gender, relationship to insured. Start: 01/01/1995 | Last Modified: 02/28/2000 |
178 | Total Claim Charge Amount Start: 01/01/1995 | Last Modified: 11/01/2024 |
179 | Outside lab charges. Start: 01/01/1995 |
180 | Hospital s semi-private room rate. Start: 01/01/1995 | Last Modified: 11/01/2024 |
181 | Hospital s room rate. Start: 01/01/1995 | Last Modified: 11/01/2024 |
182 | Allowable/paid from other entities coverage Usage: This code requires the use of an entity code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
183 | Amount entity has paid. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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 prior authorization/certification number. Usage: This code requires the use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: At least one other status code is required to identify the supporting documentation. Start: 01/01/1995 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 07/01/2017 |
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 Usage: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 07/01/2017 |
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. 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 |
403 | Entity 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: 11/01/2024 |
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. Usage: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 07/01/2017 |
467 | Entity Signature Date. Usage: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 07/01/2017 |
468 | Patient Signature Source Start: 02/28/1997 |
469 | Purchase Service Charge Start: 02/28/1997 |
470 | Was service purchased from another entity? Usage: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 06/30/1998 | Last Modified: 07/01/2017 |
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 | Last Modified: 11/01/2024 |
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'. Usage: This code requires use of an Entity Code. Start: 02/28/2002 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 02/28/2003 | Last Modified: 07/01/2017 |
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 | Last Modified: 11/01/2024 |
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. Usage: This code requires use of an Entity Code. Start: 02/29/2004 | Last Modified: 07/01/2017 |
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 Usage: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 07/01/2017 |
500 | Entity's Postal/Zip Code. Usage: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 07/01/2017 |
501 | Entity's State/Province. Usage: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 07/01/2017 |
502 | Entity's City. Usage: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 07/01/2017 |
503 | Entity's Street Address. Usage: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 07/01/2017 |
504 | Entity's Last Name. Usage: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 07/01/2017 |
505 | Entity's First Name. Usage: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 07/01/2017 |
506 | Entity 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 |
507 | HCPCS Start: 10/31/2004 |
508 | ICD9 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 |
509 | External Cause of Injury Code. Start: 10/31/2004 | Last Modified: 03/01/2016 |
510 | Future 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 |
511 | Invalid 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 |
512 | Length 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 |
513 | HIPPS Rate Code for services Rendered Start: 10/31/2004 |
514 | Entity's Middle Name Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
515 | Managed Care review Start: 10/31/2004 |
516 | Other 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 |
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 (CLIA) Number Start: 10/31/2004 | Last Modified: 03/01/2018 |
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. Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
561 | Entity's Contact Name. Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
562 | Entity's National Provider Identifier (NPI). Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
563 | Entity's Tax Amount. Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
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 | Stop: 01/01/2013 |
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. Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
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 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 |
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. Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
677 | Entity not affiliated. Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
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. Usage: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 07/01/2017 |
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. (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: 11/01/2024 |
685 | Claim 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: 11/01/2024 |
686 | The claim/ encounter has completed the adjudication cycle and the entire claim has been voided Start: 01/27/2008 |
687 | Claim predetermination/estimation could not be completed in real-time. Do not resubmit. Start: 01/27/2008 | Last Modified: 11/01/2024 |
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. Usage: This code requires use of an Entity Code. Start: 06/01/2008 | Last Modified: 07/01/2017 |
690 | Multiple claims or estimate requests cannot be processed in real-time. Start: 06/01/2008 | Last Modified: 11/01/2024 |
691 | Multiple claim status requests cannot be processed in real-time. Start: 06/01/2008 | Last Modified: 11/01/2024 |
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. 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 |
694 | Amount 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 |
695 | Entity's Country Subdivision Code. Usage: This code requires use of an Entity Code. Start: 01/25/2009 | Last Modified: 07/01/2017 |
696 | Claim Adjustment Group Code. Start: 01/25/2009 |
697 | Invalid 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 |
698 | Form Type Identification Start: 07/01/2009 |
699 | Question/Response from Supporting Documentation Form Start: 07/01/2009 |
700 | ICD10. 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 |
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. 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 |
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. This change effective 5/01/2017: Drug Quantity Start: 01/24/2010 | Last Modified: 11/01/2016 |
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. Usage: At least one other status code is required to identify the inconsistent information. Start: 01/24/2010 | Last Modified: 07/01/2017 |
733 | Prefix for entity's contract/member number. Usage: This code requires the use of an Entity Code. Start: 01/24/2010 | Last Modified: 11/01/2024 |
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. Usage: This code requires use of an Entity Code. Start: 06/06/2010 | Last Modified: 07/01/2017 |
742 | Payer Responsibility Sequence Number Code Start: 06/06/2010 |
743 | Entity's credential/enrollment information. Usage: This code requires use of an Entity Code. Start: 10/17/2010 | Last Modified: 07/01/2017 |
744 | Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. Start: 10/17/2010 |
745 | Identifier 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 |
746 | Duplicate 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 |
747 | Hospice Employee Indicator Start: 10/17/2010 |
748 | Corrected Data Usage: Requires a second status code to identify the corrected data. Start: 10/17/2010 | Last Modified: 07/01/2017 |
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. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 | Last Modified: 07/01/2017 |
755 | Entity's primary identifier. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 | Last Modified: 07/01/2017 |
756 | Entity's Received Date. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 | Last Modified: 07/01/2017 |
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. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 | Last Modified: 07/01/2017 |
762 | Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider Start: 01/20/2013 |
763 | Ambulance Pickup ZipCode Start: 01/20/2013 |
764 | Professional charges are non covered. Start: 06/02/2013 |
765 | Institutional charges are non covered. Start: 06/02/2013 |
766 | Services were performed during a Health Insurance Exchange (HIX) premium payment grace period. Start: 11/01/2013 |
767 | Qualifications for emergent/urgent care Start: 01/26/2014 |
768 | Service date outside the accidental injury coverage period. Start: 01/26/2014 |
769 | DME Repair or Maintenance Start: 06/01/2014 |
770 | Duplicate of a claim processed or in process as a crossover/coordination of benefits claim. Start: 09/28/2014 |
771 | Claim submitted prematurely. Please resubmit after crossover/payer to payer COB allotted waiting period. Start: 09/28/2014 |
772 | The greatest level of diagnosis code specificity is required. Start: 03/01/2016 |
773 | One calendar year per claim. Start: 11/01/2016 |
774 | Experimental/Investigational Start: 11/01/2016 |
775 | Entity Type Qualifier (Person/Non-Person Entity). Usage: this code requires use of an entity code. Start: 07/01/2017 |
776 | Pre/Post-operative care Start: 07/01/2017 |
777 | Processed based on multiple or concurrent procedure rules. Start: 07/01/2017 |
778 | Non-Compensable incident/event. Usage: To be used for Property and Casualty only. Start: 07/01/2017 |
779 | Service submitted for the same/similar service within a set timeframe. Start: 11/01/2017 |
780 | Lifetime benefit maximum Start: 11/01/2017 |
781 | Claim has been identified as a readmission Start: 11/01/2017 |
782 | Second surgical opinion Start: 03/01/2018 |
783 | Federal sequestration adjustment Start: 11/01/2018 |
784 | Electronic Visit Verification criteria do not match. Start: 03/01/2019 |
785 | Missing/Invalid Sterilization/Abortion/Hospital Consent Form. Start: 07/01/2019 |
786 | Submit claim to the third party property and casualty automobile insurer. Start: 07/01/2019 |
787 | Resubmit a new claim, not a replacement claim. Start: 07/01/2019 |
788 | Submit these services to the Pharmacy plan/processor for further consideration/adjudication. Start: 07/01/2019 | Last Modified: 11/01/2024 |
789 | Submit these services to the patient's Medical Plan for further consideration. Start: 07/01/2019 |
790 | Submit these services to the patient's Dental Plan for further consideration. Start: 07/01/2019 |
791 | Submit these services to the patient's Vision Plan for further consideration. Start: 07/01/2019 |
792 | Submit these services to the patient's Behavioral Health Plan for further consideration. Start: 07/01/2019 |
793 | Submit these services to the patient's Property and Casualty Plan for further consideration. Start: 07/01/2019 |
794 | Claim could not complete adjudication in real time. Resubmit as a batch request. Start: 11/01/2020 |
795 | Claim submitted prematurely. Please provide the prior payer's final adjudication. Start: 11/01/2020 |
796 | Procedure code not valid for date of service. Start: 11/01/2021 |
797 | Entity's TRICARE provider id. Usage: This code requires use of an Entity Code. Start: 11/01/2021 | Last Modified: 03/01/2022 | Stop: 03/01/2022 |
798 | Claim predetermination/estimation could not be completed in real time. Claim requires manual review upon submission. Do not resubmit. Start: 08/01/2022 |
799 | Resubmit a replacement claim, not a new claim. Start: 08/01/2022 |
800 | Entity's required reporting has been forwarded to the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. Start: 03/01/2023 |
801 | Entity's required reporting was accepted by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. Start: 03/01/2023 |
802 | Entity's required reporting was rejected by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. Start: 03/01/2023 |
803 | Provider reporting has been rejected due to non-compliance with the jurisdiction's mandated registration. To be used for Property and Casualty only. Start: 03/01/2023 |
804 | Exceeds inquiry limit for batch. Start: 07/01/2024 |
805 | Mammography Certification Number Start: 07/01/2024 |
806 | Residential county does not match the county of the service location. Start: 07/01/2024 |
807 | Health Risk Assessment Start: 07/01/2024 |
808 | Manifestation diagnosis code cannot be billed as a Principal Diagnosis. Start: 11/01/2024 |