| 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 |
