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Provider Taxonomy Codes

Code List ID

682

Code List Scope Statement

These codes define the health care service provider type, classification, and area of specialization.

Code List Maintained By

NUCC

Code List Updated Date

Mon, 01/01/2024 - 12:00

Code List Notes

Online Provider Taxonomy code lookup

This code list is a National Uniform Claim Committee (NUCC) property.

Read more about Provider Taxonomy Codes

Provider Adjustment Reason Codes

Code List ID

967

Code List Scope Statement

These codes report payment adjustments that are not related to a specific claim, bill, or service.

Code List Maintained By

CMG01

Code List Updated Date

Fri, 11/01/2024 - 12:00

Code List Table

01	Card interchange fee amount Start: 10/01/2018
02	Advanced or accelerated payment recoupment amount Start: 03/01/2019
03	Claim transmission fee amount Start: 03/01/2019
04	Real-time adjudication resulting in a payment that will follow separately. Start: 04/11/2019
05	Penalty amount withheld due to reports that were not filed Start: 04/11/2019
06	Penalty amount withheld due to reports that were filed incorrectly Start: 04/11/2019
07	Non-Internal Revenue Service third-party withholding amount unrelated to a federal payment levy program Start: 11/01/2019
08	Penalty Withholding for Bankruptcy/Termination Start: 11/01/2019
09	Domestic N95 Respirator Procurement Passthrough Start: 11/01/2024
10	Non-claims-based interim payment of the provider's cost settlement amounts for capital expense. Start: 11/01/2024
11	Domestic N95 Respirator Procurement Passthrough Start: 09/17/2024 \| Stop: 12/18/2024
12	Non-claims-based payment of a manual invoice for temporary payment allowance or settlement for an amount due to the payee which cannot be paid via normal processes. Start: 03/01/2025
13	Supply chain cost pass-through Start: 03/01/2025
50	The amount of the late charge, late claim filing penalty, or Medicare late cost report penalty. Start: 07/01/2018
51	Late filing interest penalty assessment amount Start: 07/01/2018 \| Last Modified: 03/01/2019
72	Provider refund amount This adjustment acknowledges a refund received from a provider for previous overpayment. Start: 07/01/2018 \| Last Modified: 03/01/2019
90	Early payment allowance amount Start: 07/01/2018
AH	Claim transmission fee amount This code is used for transmission fees that are not specific to or dependent upon individual claims. Start: 07/01/2018 \| Last Modified: 03/01/2019
AM	Loan repayment amount Start: 07/01/2018 \| Last Modified: 03/01/2019
AP	Advanced or accelerated payment amount Start: 07/01/2018 \| Last Modified: 04/11/2019
B2	Rebate amount Applies when a provider has remitted an over payment to a health plan in excess of the amount requested by the health plan. Start: 07/01/2018 \| Last Modified: 03/01/2019
B3	Recovery amount This represents the amount received from the provider for an overpayment based on payments from other payers. This code is not used for other provider refund adjustment amounts. Start: 07/01/2018 \| Last Modified: 03/01/2019
BD	Bad debt amount Start: 07/01/2018 \| Last Modified: 03/01/2019
BN	Bonus amount Start: 07/01/2018
CR	Capitation interest amount Start: 07/01/2018
CS	Adjustment amount, detailed information is provided separately to explain the adjustment. Start: 10/01/2018
CT	Capitation payment amount Start: 07/01/2018
E3	Withholding amount Start: 07/01/2018 \| Last Modified: 03/01/2019
FB	Non-claim related balance forward amount Start: 07/01/2018 \| Last Modified: 03/01/2019
FC	Allocation of prepaid funds against which deductions are drawn as services are provided. Start: 03/01/2019
FR	Claim-related balance forward amount Start: 03/01/2019
HM	Hemophilia clotting factor add-on payment amount Start: 03/01/2019
IP	Incentive payment amount Start: 10/01/2018
IR	Internal Revenue Service 1099 withholding amount Start: 03/01/2019
IS	Lump sum based on an interim rate Start: 04/11/2019
J1	Amount not reimbursed based on a demonstration program or other limitation that prevents issuance of payment. Start: 03/01/2019
L3	Penalty amount Start: 10/01/2018
L6	Interest amount Start: 03/01/2019
LE	Internal Revenue Service non-1099 withholding amount Start: 03/01/2019
OB	Affiliated provider(s) offset amount Start: 10/01/2018
PI	Periodic Interim Payment (PIP) lump sum amount Start: 03/01/2019
PL	Final payment or settlement amount Start: 10/01/2018
RA	Retroactive adjustment amount Start: 10/01/2018
SL	Student loan garnishment amount Start: 10/01/2018 \| Last Modified: 03/01/2019
TL	Third party liability determination amount Start: 03/01/2019
WO	Overpayment recovery amount Start: 10/01/2018
WU	Non-Internal Revenue Service withholding amount related to a federal payment levy program Start: 11/01/2019

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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.

Status Last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
140	5/14/2024	A temporary allowance or settlement for an amount due to the payee which cannot be paid via normal processes.	New		CMG Approved
141	12/18/2024	Supply chain cost pass-through	New		CMG Approved

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

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

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

Read more about Provider Adjustment Reason Codes

Payment Type Codes

Code List Scope Statement

These codes identify the type and purpose for a payment amount.

Code List Maintained By

CMS

Code List Updated Date

Mon, 03/01/2021 - 12:00

Code List Table

ADM	Administrative Fees used for a debt owed by the payee. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. The Administrative Fee is $15. Negative Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
APTC	Advance Payment of Premium Tax Credit. RMR04 will be positive. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
APTCADJ	Advance Payment of Premium Tax Credit Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
APTCMADJ	APTC Manual Adjustment. Used to show APTC manual adjustment when enrollment group level information is not applicable. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
BAL	When an AR invoice is split between multiple HIX 820 reports, this adjustment balances the reports. Negative Amounts & Positive Amounts Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
CSR	Advance Payment of Cost Sharing Reduction. RMR04 will be positive. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
CSRADJ	Advance Payment of Cost Sharing Reduction Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
CSRMADJ	CSR Manual Adjustment. Used to show CSR manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
CSRN	Cost Sharing Reduction Reconciliation. Negative Amounts & Positive Amounts Start: 01/01/2015 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
CSRNADJ	Cost Sharing Reduction Reconciliation Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
DDVC	Default Data Validation Charge or Allocation Payment. If DDVC is the Payment Type Code, a corresponding Report Type Code of DDVCRPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 02/01/2021 Notes: All Markets
DEBTADJ	Payee's debt amount covered by an affiliate's payment. RMR04 will be positive. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. When used to report that a prior debt was covered, RMR04 with the payment type code of BAL will also be used. Start: 10/01/2013 \| Last Modified: 11/01/2014 \| Stop: 05/01/2015 Notes: CMS
DEPENDENTPREM	Dependent responsible premium amount. RMR04 will be positive. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
DEPENDENTPREMADJCANCEL	Dependent premium amount adjustment due to cancellation. RMR04 will positive or negative Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
DEPENDENTPREMADJNSF	Dependent responsible premium amount due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
DEPENDENTPREMADJTERMINATE	Dependent responsible premium amount due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREM	Employee responsible premium amount. RMR04 will be positive. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREMADJCANCEL	Employee responsible premium amount adjustment due to cancellation. RMR04 will be positive or negative Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREMADJNSF	Employee responsible premium amount adjustment due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREMADJTERMINATE	Employee responsible premium amount adjustment due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREM	Employer responsible premium amount. RMR04 will be positive. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREMADJCANCEL	Employer responsible premium amount adjustment due to cancellation. RMR04 will be positive or negative Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREMADJNSF	Employer responsible premium amount adjustment due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREMADJTERMINATE	Employer responsible premium amount adjustment due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EXTLOAN	Payment Offsets For Co-op Loan. Negative Amounts Only Start: 10/18/2016 Notes: CMS Co-ops Only
HCRPC	High Cost Risk Pool Contribution Amount. Negative Amounts & Positive Amounts Start: 08/01/2019 Notes: All Markets
HCRPP	High Cost Risk Pool Payment Amount. Negative Amounts & Positive Amounts Start: 08/01/2019 Notes: All Markets
HCRPPYREF	High Cost Risk Pool Refund For Prior Fiscal Years. Positive Amounts Only Start: 08/01/2019 Notes: All Markets
HCRPADMIN	High Cost Risk Pool Refund of Admin Charge. Positive Amounts Only Start: 08/01/2019 Notes: All Markets
HCRPINT	High Cost Risk Pool Refund of Interest Charge. Positive Amounts Only Start: 08/01/2019 Notes: All Markets
INT	Interest charges for a debt owed by the payee. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. The Secretary of Treasury certifies and updates an interest rate on a quarterly basis. Negative Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
INVOICE	Used to show a total amount that will be billed or otherwise collected. Only used when BPR02 would otherwise be negative. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
PEN	Penalty charges for a debt owed by the payee. The Treasury will add additional administrative fees of up to 30 percent and accrue the required penalty charge of 6 percent per year on any amount outstanding. Interest will continue to accrue. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
RA	Risk Adjustment Charge or Payment. If RA is the Payment Type Code, a corresponding Report Type Code of RARPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 01/01/2015 \| Last Modified: 03/01/2021 Notes: All Markets
RAADJ	Risk Adjustment Payment or Charge Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RAAR	Risk Adjustment Administration Fee Refund. A Risk Adjustment Admin Fee is only charged if an Issuer does not pay their RA Charges within 30 days. Positive Amounts Only Start: 10/01/2015 \| Last Modified: 05/01/2017 Notes: All Markets
RACR	Risk Adjustment Refund For Prior Fiscal Years. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAD	Risk Adjustment Default Charge or Allocation Payment. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 05/01/2015 \| Last Modified: 03/01/2021 Notes: All Markets
RADV	Risk Adjustment Data Validation Adjustment Charge or Payment. If RADV is the Payment Type Code, a corresponding Report Type Code of RADVRPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 02/01/2021 Notes: All Markets
RAIR	Risk Adjustment Interest Charge Refund. A Risk Adjustment Interest Charge is only assessed if an Issuer does not pay their RA Charges within 30 days. Negative Amounts & Positive Amounts Start: 10/01/2015 \| Last Modified: 05/01/2017 Notes: All Markets
RAREF	Risk Adjustment Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUF	Risk Adjustment User Fee. Negative Amounts Only Start: 01/01/2015 \| Last Modified: 05/01/2017 Notes: All Markets
RAUFADJ	Risk Adjustment User Fee Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RAUFAR	Risk Adjustment User Fee Refund of admin charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFIR	Risk Adjustment User Fee Refund of interest charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFR	Risk Adjustment User Fee Refund. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFR2PY	Risk Adjustment User Fee Refund. Positive Amounts Only Start: 10/18/2016 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: All Markets
RAUFREF	Risk Adjustment User Fee refund for current fiscal year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFRN	Risk Adjustment User Fee Refund. Positive Amounts Only Start: 05/01/2015 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: All Markets
RC	Risk Corridor Program payment or charge amount. Negative Amounts & Positive Amounts Start: 01/01/2015 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
RC15	Risk Corridors Charges. Negative Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCADJ	Risk Corridor Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RCAR	Risk Corridors Refund Of Admin Charge. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCCR15	Risk Corridors Refund For Prior Fiscal Years. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCCR16	Risk Corridors Refund For Current Fiscal Year. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCIR	Risk Corridors Refund Of Interest Charge. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
RCREF	Risk Corridors Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
REDUCED	Payment reduced to cover a debt owed by the payee. RMR04 will be negative. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
RIC	Reinsurance Contribution Amount. Negative Amounts & Positive Amounts Start: 06/01/2014 \| Last Modified: 05/01/2017 Notes: All Markets
RICADJ	Reinsurance Contribution Adjustment. RMR04 will be positive or negative. Start: 06/01/2014 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RICAR	Reinsurance Contribution Refund Of Admin Charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RICIR	Reinsurance Contribution Refund Of Interest Charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RICR	Reinsurance Contribution Refund For Prior Fiscal Years. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RICREF	Reinsurance Contribution Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RIP	Reinsurance Payment Amount. Negative Amounts & Positive Amounts Start: 06/01/2014 \| Last Modified: 05/01/2017 Notes: CMS Individual Market Only
RIPADJ	Reinsurance Payment Adjustment. RMR04 will be positive or negative. Start: 06/01/2014 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
SHOPUF	Federally-facilitated Marketplace User Fee for SHOP plans. (SHOP HIX 820 Trace Number may be provided in the Document Control Number in the payment reports). Negative Amounts & Positive Amounts Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS SHOP Market
SHOPUFADJ	Federally-facilitated Marketplace User Fee Adjustment for SHOP plans. RMR04 will be positive or negative. This code will not be used. Start: 10/01/2013 \| Last Modified: 11/01/2015 \| Stop: 11/01/2015 Notes: CMS Individual Market Only
SHOPUFMADJ	Federally-facilitated Marketplace User Fee Manual Adjustment for SHOP Plans. Start: 10/01/2013 \| Last Modified: 11/01/2015 \| Stop: 11/01/2015 Notes: CMS Individual Market Only
UF	Federally-facilitated Marketplace User Fee. RMR04 will be negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
UFADJ	Federally-facilitated Marketplace User Fee Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
UFAR	FFM User Fee refund of admin charges. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
UFIR	FFM User Fee Refund of interest charges. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
UFMADJ	Federally-facilitated Marketplace User Fee Manual Adjustment. Used to show user fee manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
UFR	Federally-facilitated Marketplace User Fee Adjustment related to providing contraceptive care coverage. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Positive Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
UFR2PY	FFM User Fee Refund. Positive Amounts Only Start: 10/18/2016 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: CMS Exchange Markets
UFRP	FFM User Fee Refund. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
UFRPN	FFM User Fee Refund. Positive Amounts Only Start: 05/01/2015 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: CMS Exchange Markets
COMM	Any commissions withheld by the Exchange. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
COMMADJ	Any commissions adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
DEDUCT	Deductible amount due to the Payer. RMR04 will be positive or negative. Start: 10/01/2015 Notes: SBM Only
INTPREM	Initial premium payment received by the Exchange from the customer. This amount will be the gross premium received from the customer. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
MDCAID	State Medicaid Subsidy. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
MDCAIDADJ	State Medicaid Subsidy Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
MISC	Used to indicate miscellaneous amounts (i.e. write-offs, etc.) RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
MRF	Marketplace-Related Fee. This is the amount that is being paid not attributable to an individual coverage but at a plan or carrier level. If negative, the fee was withheld from carrier payments. If positive, the fee was paid to the carrier. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
MRFADJ	Adjustments to a previously sent MRF. The MRFADJ is not attributable to an individual coverage level but at a plan or carrier level. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
NONPAYADJ	Code use to indicate an adjustment is being made due to a NSF or stop payment. Amount will always be negative. Start: 10/01/2013 Notes: SBM Only
OPMUF	OPM Multi-State Plan user fee. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
OPMUFADJ	OPM Multi-State Plan user fee manual adjustment. Used to show user fee manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. Start: 10/01/2013 Notes: SBM Only
PREM	Premium payment amount received for the enrollment group for coverage (excluding APTC and Exchange-Related Fees). RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
PREMADJ	Adjustments to premium payment amount received for the enrollment group for coverage (excluding APTC and Marketplace-Related Fees). RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
PREMALL	Premium payment amount received for the enrollment group for coverage (including APTC and Marketplace-Related Fees). RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
PREMALLADJ	Adjustments to premium payment amount received for the enrollment group for coverage (including APTC and Marketplace-Related Fees). RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
REFUND	Total refunded amount sent back to the customer. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
RETURN	Total returned payment (i.e. returned due to non-sufficient funds). RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
SBMUF	State Based Marketplace User Fee. RMR04 will be negative. Start: 05/01/2015 Notes: SBM Only
SBMUFADJ	State Based Marketplace User Fee Adjustment. RMR04 will be positive or negative. Start: 05/01/2015 Notes: SBM Only
SMAND	State Mandate Benefit Subsidy. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
SMANDADJ	State Mandate Benefit Subsidy Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
TPP	Money paid by a third party payer as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
TPPADJ	Adjustments to Money paid by a third party payer as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
TRIBE	Money paid by a registered Tribe as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
TRIBEADJ	Adjustments to Money paid by a registered Tribe as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
WRITEOFF	Write off amount Start: 06/01/2014 Notes: SBM Only

Code List Notes

Exchange Payment Type codes are transmitted in 005010X306, loop 2300, RMR02. They identify the type and purpose for the payment amount transmitted in ASC X12 005010X306, loop 2300, RMR04.

Note:

Catastrophic is included in Individual Market and Merged is Individual and Small Group Markets combined.
All markets include both on and off exchange issuers.
Exchange markets include Individual/Small Group/Catastrophic/Merged.
Specific transaction detail may be provided in the Document Control Number in the payment reports effective July 2017.

Code List Filters Block Reference

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Read more about Payment Type Codes

Industry Specific Remark Codes

Code List ID

973

Code List Scope Statement

These codes convey information about remittance processing or further explain an adjustment already described by a Claim Adjustment Reason Code (CARC) from ECL 139.

Code List Maintained By

CMG01

Code List Updated Date

Mon, 06/01/2020 - 12:00

Code List Table

01	The injured employee or other party has not signed the required attestation document therefore Florida Statute 440.105(7) requires that benefits and payments be suspended until such signature is obtained. Start: 06/01/2020
02	Coverage based on a property and casualty Excess Insurance policy which is governed by state statute or regulation. Start: 06/01/2020
03	Reimbursement based on the treating hospital's designation as a lien hospital with billing precedence. Start: 06/01/2020
04	Reimbursement based on state-specific Workers' Compensation requirements for timely submission of bills for services rendered. Start: 06/01/2020
05	Reimbursement based on a state-specific Workers' Compensation limitation that the procedure code be billed only once, regardless of the number of limbs tested. Start: 06/01/2020
06	The provider's preliminary notice of injury and treatment was not furnished by the close of the third business day following the first treatment in accordance with Florida Statute Section 440.13(4)(a), therefore this claim is not considered valid. Start: 06/01/2020

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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.

Status Last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

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

Read more about Industry Specific Remark Codes

Insurance Descriptor Codes

Code List ID

979

Code List Scope Statement

These codes describe, identify, or clarify the insurance being reported in an eligibility and benefits response.

Code List Maintained By

CMG01

Code List Updated Date

Fri, 11/01/2024 - 12:00

Code List Table

01	Short Term Insurance Start: 11/01/2022
02	TRICARE Start: 11/01/2024
03	Medicare and Medicaid Dual Eligible Start: 11/01/2024
D	Disability Insurance Start: 05/17/2018
M	Medicare Advantage Point of Service (POS) Plan that excludes Part D coverage Start: 05/17/2018
12	Medicare is secondary, Working Aged Beneficiary or Spouse with employer group health plan is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
13	Medicare is secondary, End-Stage Renal Disease Beneficiary in the mandated coordination period with an employer's group health plan is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
14	Medicare is secondary, no-fault insurance, including auto, is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
15	Medicare is secondary, Worker's Compensation is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
16	Medicare is secondary, Public Health Service (PHS) or Other Federal Agency is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
17	Dental Insurance Start: 05/17/2018
18	Vision Insurance Start: 05/17/2018
19	Prescription Drug Insurance Start: 05/17/2018
41	Medicare is secondary, Black Lung is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
42	Medicare is secondary, Veteran's Administration is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
43	Medicare is secondary, Disabled Beneficiary Under Age 65 with a large group health plan (LGHP) is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
47	Medicare is secondary, other liability insurance is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
48	Medicaid Start: 11/01/2023
49	Medicare and Medicaid Dual Eligible. Start: 07/01/2024
AP	Automobile Insurance Start: 05/17/2018
C1	Commercial Insurance Start: 05/17/2018
CO	Beneficiary is under Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
EP	Exclusive Provider Organization (EPO) Plan Start: 05/17/2018
HB	Health Insurance Exchange (HIX) Bronze Start: 05/17/2018
HD	High Deductible Health Plan (HDHP) Start: 05/17/2018
HG	Health Insurance Exchange (HIX) Gold Start: 05/17/2018
HM	Health Maintenance Organization (HMO) Plan Start: 05/17/2018
HP	Health Insurance Exchange (HIX) Platinum Start: 05/17/2018
HS	Health Insurance Exchange (HIX) Silver An individual eligible for Medicare for whom Medicaid pays only Medicare premiums. Start: 05/17/2018
IN	Indemnity Plan Gives a subscriber the choice to select any provider. Payment is fixed percentage of the cost for covered care after satisfying an annual deductible. Start: 05/17/2018
LC	Long Term Care Insurance Coverage designed to help pay for some or all long term care costs, reducing the risk that a policy-holder would need to deplete all of his or her assets to pay for long term care. Start: 05/17/2018
LI	Life Insurance Start: 05/17/2018
LT	Impacted by litigation Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
MA	Medicare Part A Start: 05/17/2018
MB	Medicare Part B Start: 05/17/2018
MD	Medicare Part D Start: 05/17/2018
ME	Medicare Advantage Preferred Provider Organization (PPO) Plan that excludes Part D Coverage Start: 05/17/2018
MJ	Medicare Advantage Health Maintenance Organization (HMO) Plan that includes Part D Coverage Start: 05/17/2018
MK	Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that includes Part D Coverage Start: 05/17/2018
ML	Medicare Advantage Indemnity Plan that includes Part D Coverage Start: 05/17/2018
MM	Medicare Advantage Preferred Provider Organization (PPO) Plan that includes Part D Coverage Start: 05/17/2018
MN	Medicare Advantage Indemnity Plan that excludes Part D coverage Start: 05/17/2018
MO	Medicare Advantage Point of Service (POS) Plan that includes Part D Coverage Start: 05/17/2018
MR	Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that excludes Part D coverage Start: 05/17/2018
MT	Medicare Advantage Health Maintenance Organization (HMO) Plan that excludes Part D coverage Start: 05/17/2018
OA	Open Access Point of Service Plan (POS) Plan Start: 05/17/2018
PE	Property Insurance - Personal Start: 05/17/2018
PR	Preferred Provider Organization (PPO) Plan Start: 05/17/2018
PS	Point of Service (POS) Plan Start: 05/17/2018
RP	Property Insurance - Real Start: 05/17/2018
SA	Set Aside Arrangement Set aside funds arrangement that exists for patients that are identified for Insurance Type Code 14, 15 or 47. Start: 11/01/2023
SP	Supplemental Insurance An insurance policy intended to cover non-covered charges of another insurance policy. Start: 05/17/2018
WC	Workers Compensation Insurance Coverage provides medical treatment, rehabilitation, lost wages and related expenses arising from a job related injury or disease. Start: 05/17/2018
WU	Wrap-Up Insurance A Workers Compensation Policy written for a specific job site, which will include or cover more than one insured. Start: 05/17/2018

Code List Filters Block Reference

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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.

Status last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

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Request Type

Current Code Value

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

Read more about Insurance Descriptor Codes

Insurance Business Process Application Error Codes

Code List ID

895

Code List Scope Statement

These codes report application warnings and errors for insurance business processes.

Code List Maintained By

CMG02

Code List Updated Date

Fri, 07/12/2024 - 12:00

Code List Table

E001	Missing/Invalid submitter identifier Start: 05/01/2004
W001	Missing/Invalid submitter identifier Start: 05/01/2004
E002	Missing/Invalid receiver identifier Start: 05/01/2004
W002	Missing/Invalid receiver identifier Start: 05/01/2004
E003	Missing/Invalid member identifier Start: 05/01/2004
W003	Missing/Invalid member identifier Start: 05/01/2004
E004	Missing/Invalid subscriber identifier Start: 05/01/2004
W004	Missing/Invalid subscriber identifier Start: 05/01/2004
E005	Missing/Invalid patient identifier Start: 05/01/2004
W005	Missing/Invalid patient identifier Start: 05/01/2004
E006	Missing/Invalid plan sponsor identifier Start: 05/01/2004
W006	Missing/Invalid plan sponsor identifier Start: 05/01/2004
E007	Missing/invalid payee identifier Start: 05/01/2004
W007	Missing/invalid payee identifier Start: 05/01/2004
E008	Missing/Invalid TPA/broker identifier Start: 05/01/2004
W008	Missing/Invalid TPA/broker identifier Start: 05/01/2004
E009	Missing/Invalid premium receiver identifier Start: 05/01/2004
W009	Missing/Invalid premium receiver identifier Start: 05/01/2004
E010	Missing/Invalid premium payer identifier Start: 05/01/2004
W010	Missing/Invalid premium payer identifier Start: 05/01/2004
E011	Missing/Invalid payer identifier Start: 05/01/2004
W011	Missing/Invalid payer identifier Start: 05/01/2004
E012	Missing/Invalid billing provider identifier Start: 05/01/2004
W012	Missing/Invalid billing provider identifier Start: 05/01/2004
E013	Missing/Invalid pay to provider identifier Start: 05/01/2004
W013	Missing/Invalid pay to provider identifier Start: 05/01/2004
E014	Missing/Invalid rendering provider identifier Start: 05/01/2004
W014	Missing/Invalid rendering provider identifier Start: 05/01/2004
E015	Missing/Invalid supervising provider identifier Start: 05/01/2004
W015	Missing/Invalid supervising provider identifier Start: 05/01/2004
E016	Missing/Invalid attending provider identifier Start: 05/01/2004
W016	Missing/Invalid attending provider identifier Start: 05/01/2004
E017	Missing/Invalid other provider identifier Start: 05/01/2004
W017	Missing/Invalid other provider identifier Start: 05/01/2004
E018	Missing/Invalid operating provider identifier Start: 05/01/2004
W018	Missing/Invalid operating provider identifier Start: 05/01/2004
E019	Missing/Invalid referring provider identifier Start: 05/01/2004
W019	Missing/Invalid referring provider identifier Start: 05/01/2004
E020	Missing/Invalid purchased service provider identifier Start: 05/01/2004
W020	Missing/Invalid purchased service provider identifier Start: 05/01/2004
E021	Missing/Invalid service facility identifier Start: 05/01/2004
W021	Missing/Invalid service facility identifier Start: 05/01/2004
E022	Missing/Invalid ordering provider identifier Start: 05/01/2004
W022	Missing/Invalid ordering provider identifier Start: 05/01/2004
E023	Missing/Invalid assistant surgeon identifier Start: 05/01/2004
W023	Missing/Invalid assistant surgeon identifier Start: 05/01/2004
E024	Amount/Quantity out of balance Start: 05/01/2004
W024	Amount/Quantity out of balance Start: 05/01/2004
E025	Duplicate Start: 05/01/2004
W025	Duplicate Start: 05/01/2004
E026	Billing date predates service date Start: 05/01/2004
W026	Billing date predates service date Start: 05/01/2004
E027	Business application currently not available Start: 05/01/2004
W027	Business application currently not available Start: 05/01/2004
E028	Sender not authorized for this transaction Start: 05/01/2004
W028	Sender not authorized for this transaction Start: 05/01/2004
E029	Number of errors exceeds permitted threshold Start: 05/01/2004
W029	Number of errors exceeds permitted threshold Start: 05/01/2004
E030	Required loop missing Start: 05/01/2004
W030	Required loop missing Start: 05/01/2004
E031	Required segment missing Start: 05/01/2004
W031	Required segment missing Start: 05/01/2004
E032	Required element missing Start: 05/01/2004
W032	Required element missing Start: 05/01/2004
E033	Situational required loop is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
W033	Situational required loop is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
E034	Situational required segment is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
W034	Situational required segment is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
E035	Situational required element is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
W035	Situational required element is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
E036	Data too long Start: 05/01/2004
W036	Data too long Start: 05/01/2004
E037	Data too short Start: 05/01/2004
W037	Data too short Start: 05/01/2004
E038	Invalid external code value Start: 05/01/2004
W038	Invalid external code value Start: 05/01/2004
E039	Data value out of sequence Start: 05/01/2004
W039	Data value out of sequence Start: 05/01/2004
E040	"Not Used" data element present Start: 05/01/2004
W040	"Not Used" data element present Start: 05/01/2004
E041	Too many sub-elements in composite Start: 05/01/2004
W041	Too many sub-elements in composite Start: 05/01/2004
E042	Unexpected segment Start: 05/01/2004
W042	Unexpected segment Start: 05/01/2004
E043	Missing data Start: 05/01/2004
W043	Missing data Start: 05/01/2004
E044	Out of range Start: 05/01/2004
W044	Out of range Start: 05/01/2004
E045	Invalid date Start: 05/01/2004
W045	Invalid date Start: 05/01/2004
E046	Not matching Start: 05/01/2004
W046	Not matching Start: 05/01/2004
E047	Invalid combination Start: 05/01/2004
W047	Invalid combination Start: 05/01/2004
E048	Customer identification number does not exist Start: 05/01/2004
W048	Customer identification number does not exist Start: 05/01/2004
E049	Duplicate batch Start: 05/01/2004
W049	Duplicate batch Start: 05/01/2004
E050	Incorrect data Start: 05/01/2004
W050	Incorrect data Start: 05/01/2004
E051	Incorrect date Start: 05/01/2004
W051	Incorrect date Start: 05/01/2004
E052	Duplicate transmission Start: 05/01/2004
W052	Duplicate transmission Start: 05/01/2004
E053	Invalid claim amount Start: 05/01/2004
W053	Invalid claim amount Start: 05/01/2004
E054	Invalid identification code Start: 05/01/2004
W054	Invalid identification code Start: 05/01/2004
E055	Missing or invalid issuer identification Start: 05/01/2004
W055	Missing or invalid issuer identification Start: 05/01/2004
E056	Missing or invalid item quantity Start: 05/01/2004
W056	Missing or invalid item quantity Start: 05/01/2004
E057	Missing or invalid item identification Start: 05/01/2004
W057	Missing or invalid item identification Start: 05/01/2004
E058	Missing or unauthorized transaction type code Start: 05/01/2004
W058	Missing or unauthorized transaction type code Start: 05/01/2004
E059	Unknown claim number Start: 05/01/2004
W059	Unknown claim number Start: 05/01/2004
E060	Bin segment contentes not in MIME format Start: 05/01/2004
W060	Bin segment contents not in MIME format Start: 05/01/2004
E061	Missing/invalid MIME header Start: 05/01/2004
W061	Missing/Invalid MIME header Start: 05/01/2004
E062	Missing/Invalid MIME boundary Start: 05/01/2004
W062	Missing/Invalid MIME boundary Start: 05/01/2004
E063	Missing/Invalid MIME transfer encoding Start: 05/01/2004
W063	Missing/Invalid MIME transfer encoding Start: 05/01/2004
E064	Missing/Invalid MIME content type Start: 05/01/2004
W064	Missing/Invalid MIME content type Start: 05/01/2004
E065	Missing/Invalid MIME content disposition (filename) Start: 05/01/2004
W065	Missing/Invalid MIME content disposition (filename) Start: 05/01/2004
E066	Missing/Invalid file name extension Start: 05/01/2004
W066	Missing/Invalid file name extension Start: 05/01/2004
E067	Invalid MIME base64 encoding Start: 05/01/2004
W067	Invalid MIME base64 encoding Start: 05/01/2004
E068	Invalid MIME quoted-printable encoding Start: 05/01/2004
W068	Invalid MIME quoted-printable encoding Start: 05/01/2004
E069	Missing/Invalid MIME line terminator (should be CR+LF) Start: 05/01/2004
W069	Missing/Invalid MIME line terminator (should be CR+LF) Start: 05/01/2004
E070	Missing/Invalid "end of MIME" headers Start: 05/01/2004
W070	Missing/Invalid "end of MIME" headers Start: 05/01/2004
E071	Missing/Invalid CDA in first MIME body parts Start: 05/01/2004
W071	Missing/Invalid CDA in first MIME body parts Start: 05/01/2004
E072	Missing/Invalid XML tag Start: 05/01/2004
W072	Missing/Invalid XML tag Start: 05/01/2004
E073	Unrecoverable XML error Start: 05/01/2004
W073	Unrecoverable XML error Start: 05/01/2004
E074	Invalid Data format for HL7 data type Start: 05/01/2004
W074	Invalid Data format for HL7 data type Start: 05/01/2004
E075	Missing/Invalid required LOINC answer part(s) in the CDA Start: 05/01/2004
W075	Missing/Invalid required LOINC answer part(s) in the CDA Start: 05/01/2004
E076	Missing/Invalid Provider information in the CDA Start: 05/01/2004
W076	Missing/Invalid Provider information in the CDA Start: 05/01/2004
E077	Missing/Invalid Patient information in the CDA Start: 05/01/2004
W077	Missing/Invalid Patient information in the CDA Start: 05/01/2004
E078	Missing/Invalid Attachment Control information in the CDA Start: 05/01/2004
W078	Missing/Invalid Attachment Control information in the CDA Start: 05/01/2004
E079	Missing/Invalid LOINC Start: 05/01/2004
W079	Missing/Invalid LOINC Start: 05/01/2004
E080	Missing/Invalid LOINC Modifier Start: 05/01/2004
W080	Missing/Invalid LOINC Modifier Start: 05/01/2004
E081	Missing/Invalid LOINC code for this attachment type Start: 05/01/2004
W081	Missing/Invalid LOINC code for this attachment type Start: 05/01/2004
E082	Missing/Invalid LOINC Modifier for this attachment type Start: 05/01/2004
W082	Missing/Invalid LOINC Modifier for this attachment type Start: 05/01/2004
E083	Situational prohibited element is present Start: 05/01/2004 \| Last Modified: 11/20/2008
W083	Situational prohibited element is present Start: 05/01/2004 \| Last Modified: 11/20/2008
E084	Duplicate qualifier value in repeated segment within a single loop Start: 05/01/2009
W084	Duplicate qualifier value in repeated segment within a single loop Start: 05/01/2009
E085	Situational required composite element is missing Start: 05/01/2009
W085	Situational required composite element is missing Start: 05/01/2009
E086	Situational required repeating element is missing Start: 05/01/2009
W086	Situational required repeating element is missing Start: 05/01/2009
E087	Situational prohibited loop is present Start: 05/01/2009
W087	Situational prohibited loop is present Start: 05/01/2009
E088	Situational prohibited segment is present Start: 05/01/2009
W088	Situational prohibited segment is present Start: 05/01/2009
E089	Situational prohibited composite element is present Start: 05/01/2009
W089	Situational prohibited composite element is present Start: 05/01/2009
E090	Situational prohibited repeating element is present Start: 05/01/2009
W090	Situational prohibited repeating element is present Start: 05/01/2009
E091	Transaction successfully received but not processed as applicable business function not performed. Start: 01/30/2011
W091	Transaction successfully received but not processed as applicable business function not performed. Start: 01/30/2011
E092	Missing/Invalid required SNOMED CT answer part(s) in the CDA Start: 06/05/2011
W092	Missing/Invalid required SNOMED CT answer part(s) in the CDA Start: 06/05/2011
E093	Matching Policy Information/Document not found. Start: 06/01/2014
W093	Matching Policy Information/Document not found. Start: 06/01/2014
E094	Financial Assistance not permitted across multiple marketplaces - Double Dip Check Edit Identified. Start: 06/01/2014
W094	Financial Assistance not permitted across multiple marketplaces - Double Dip Check Edit Identified. Start: 06/01/2014
E095	Business Process transaction out of sequence. Start: 01/25/2015
W095	Business Process transaction out of sequence. Start: 01/25/2015
E096	Advanced Premium Tax Credit is more than Total Premium. Start: 01/25/2015
W096	Advanced Premium Tax Credit is more than Total Premium. Start: 01/25/2015
E097	Marketplace, Off Market Variant. Start: 01/25/2015
W097	Marketplace, Off Market Variant. Start: 01/25/2015
E098	Maintenance Type Code Start: 07/01/2015
W098	Maintenance Type Code Start: 07/01/2015
E099	Maintenance Reason Code Start: 07/01/2015
W099	Maintenance Reason Code Start: 07/01/2015
E100	Additional Maintenance Reason Code Start: 07/01/2015
W100	Additional Maintenance Reason Code Start: 07/01/2015
E101	Enrollment Group member(s) count on transaction does not match Enrollment Group member(s) count found on file of record Start: 07/01/2015
W101	Enrollment Group member(s) count on transaction does not match Enrollment Group member(s) count found on file of record Start: 07/01/2015
E102	Effective Start Date Start: 07/01/2015
W102	Effective Start Date Start: 07/01/2015
E103	Advanced Payment for Tax Credit (APTC) Start: 07/01/2015
W103	Advanced Payment for Tax Credit (APTC) Start: 07/01/2015
E104	Total Individual Responsibility Amount Start: 07/01/2015
W104	Total Individual Responsibility Amount Start: 07/01/2015
E105	Other Payment Amount 1 Start: 07/01/2015
W105	Other Payment Amount 1 Start: 07/01/2015
E106	Other Payment Amount 2 Start: 07/01/2015
W106	Other Payment Amount 2 Start: 07/01/2015
E107	Total Premium Amount Start: 07/01/2015
W107	Total Premium Amount Start: 07/01/2015
E108	Individual Premium Amount Start: 07/01/2015
W108	Individual Premium Amount Start: 07/01/2015
E109	Total Employer Responsibility Amount Start: 07/01/2015
W109	Total Employer Responsibility Amount Start: 07/01/2015
E110	Financial Date Precedes Premium Date Start: 07/01/2015
W110	Financial Date Precedes Premium Date Start: 07/01/2015
E111	Exceeds Unique Start Date(s) Start: 07/01/2015
W111	Exceeds Unique Start Date(s) Start: 07/01/2015
E112	Exceeds Allowable Changes Start: 07/01/2015
W112	Exceeds Allowable Changes Start: 07/01/2015
E113	Cost Sharing Reduction (CSR) Date precedes the Total Premium Amount Effective Start Date Start: 07/01/2015
W113	Cost Sharing Reduction (CSR) Date precedes the Total Premium Amount Effective Start Date Start: 07/01/2015
E114	Renewal Transaction cannot be processed as it is outside of allocated time period Start: 07/01/2015
W114	Renewal Transaction cannot be processed as it is outside of allocated time period Start: 07/01/2015
E115	Financial Amounts Unchanged by newly reported data Start: 07/01/2015
W115	Financial Amounts Unchanged by newly reported data Start: 07/01/2015
E116	Effective Start Date does not align with Previous Effective End Date Start: 07/01/2015
W116	Effective Start Date does not align with Previous Effective End Date Start: 07/01/2015
E117	Duplicate Payment of Advanced Premium Tax Credit Start: 08/24/2015
W117	Duplicate Payment of Advanced Premium Tax Credit Start: 08/24/2015
E118	Duplicate Payment of Cost Sharing Reduction Start: 08/24/2015
W118	Duplicate Payment of Cost Sharing Reduction Start: 08/24/2015
E119	Duplicate Payment of User Fee Start: 08/24/2015
W119	Duplicate Payment of User Fee Start: 08/24/2015
E120	Missing Payment of Advanced Premium Tax Credit Start: 08/24/2015
W120	Missing Payment of Advanced Premium Tax Credit Start: 08/24/2015
E121	Missing Payment of Cost Sharing Reduction Start: 08/24/2015
W121	Missing Payment of Cost Sharing Reduction Start: 08/24/2015
E122	Missing Payment of User Fee Start: 08/24/2015
W122	Missing Payment of User Fee Start: 08/24/2015
E123	Advanced Premium Tax Credit (APTC) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) APTC amount and the Health Plan APTC amount are equal but do not match the APTC payment amount received Start: 08/24/2015
W123	Advanced Premium Tax Credit (APTC) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) APTC amount and the Health Plan APTC amount are equal but do not match the APTC payment amount received Start: 08/24/2015
E124	Cost Shared Reduction (CSR) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) CSR amount and the Health Plan CSR amount are equal but do not match the CSR payment amount received Start: 08/24/2015
W124	Cost Shared Reduction (CSR) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) CSR amount and the Health Plan CSR amount are equal but do not match the CSR payment amount received Start: 08/24/2015
E125	User Fee Payment Mismatch - The calculated Federally Facilitated Marketplace (FFM) User Fee amount and the calculated Health Plan User Fee amount are equal but do not match the User Fee payment amount received Start: 08/24/2015
W125	User Fee Payment Mismatch - The calculated Federally Facilitated Marketplace (FFM) User Fee amount and the calculated Health Plan User Fee amount are equal but do not match the User Fee payment amount received Start: 08/24/2015
E126	Effectuation Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W126	Effectuation Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E127	Cancel Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W127	Cancel Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E128	Termination Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W128	Termination Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E129	Maintenance Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W129	Maintenance Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E130	Policy level cancel/terminations shall not contain health coverage information Start: 03/01/2016
W130	Policy level cancel/terminations shall not contain health coverage information Start: 03/01/2016
E131	Dependent/Member not included in current coverage Start: 07/01/2016
W131	Dependent/Member not included in current coverage Start: 07/01/2016
E132	The data in the transaction does not match the exchange/marketplace type Start: 07/01/2017
W132	The data in the transaction does not match the exchange/marketplace type Start: 07/01/2017
E133	Policy Cancelled - cannot be processed Start: 07/01/2017
W133	Policy Cancelled - cannot be processed Start: 07/01/2017
E134	Policy Non-Effectuated - cannot be processed Start: 07/01/2017
W134	Policy Non-Effectuated - cannot be processed Start: 07/01/2017
E135	Policy ID Start: 07/01/2017
W135	Policy ID Start: 07/01/2017
E136	Subscriber ID Start: 07/01/2017
W136	Subscriber ID Start: 07/01/2017
E137	Member ID Start: 07/01/2017
W137	Member ID Start: 07/01/2017
E138	No Longer Eligible (NLE) Start: 07/01/2017
W138	No Longer Eligible (NLE) Start: 07/01/2017
E139	Exchange Assigned Start: 07/01/2017
W139	Exchange Assigned Start: 07/01/2017
E140	Issuer Assigned Start: 07/01/2017
W140	Issuer Assigned Start: 07/01/2017
E141	Issuer Prior Assigned Start: 07/01/2017
W141	Issuer Prior Assigned Start: 07/01/2017
E142	Action results already match current information on file Start: 07/01/2017
W142	Action results already match current information on file Start: 07/01/2017
E143	Action results do not match current information on file Start: 07/01/2017
W143	Action results do not match current information on file Start: 07/01/2017
E144	Cancellation Transaction Start: 07/01/2017
W144	Cancellation Transaction Start: 07/01/2017
E145	Initial Enrollment Transaction Start: 07/01/2017
W145	Initial Enrollment Transaction Start: 07/01/2017
E146	Maintenance Transaction Start: 07/01/2017
W146	Maintenance Transaction Start: 07/01/2017
E147	Reinstatement Transaction Start: 07/01/2017
W147	Reinstatement Transaction Start: 07/01/2017
E148	Termination Transaction Start: 07/01/2017
W148	Termination Transaction Start: 07/01/2017
E149	Email Address Start: 07/01/2017
W149	Email Address Start: 07/01/2017
E150	Mailing Address Start: 07/01/2017
W150	Mailing Address Start: 07/01/2017
E151	Telephone Number Start: 07/01/2017
W151	Telephone Number Start: 07/01/2017
E152	Consumer executed voluntary withdrawal of coverage Start: 11/01/2017
W152	Consumer executed voluntary withdrawal of coverage Start: 11/01/2017
E153	Unable to be processed causing a gap or overlap in coverage dates Start: 11/01/2017
W153	Unable to be processed causing a gap or overlap in coverage dates Start: 11/01/2017
E154	Invoke the Enrollment Resolution and Reconciliation (ER&R) manual process Start: 11/01/2017
W154	Invoke the Enrollment Resolution and Reconciliation (ER&R) manual process Start: 11/01/2017
E155	Marketplace Coverage in Effect Start: 11/01/2017
W155	Marketplace Coverage in Effect Start: 11/01/2017
E156	Reinstatement transaction cannot be processed as it is outside of the allocated time period Start: 11/01/2017
W156	Reinstatement transaction cannot be processed as it is outside of the allocated time period Start: 11/01/2017
E157	Coverage Start Date Start: 11/01/2017
W157	Coverage Start Date Start: 11/01/2017
E158	Coverage End Date Start: 11/01/2017
W158	Coverage End Date Start: 11/01/2017
E159	Dependent/Member shall not be included in Policy Level Start: 03/01/2018
W159	Dependent/Member shall not be included in Policy Level Start: 03/01/2018
E160	One day coverage Start: 07/01/2018
W160	One day coverage Start: 07/01/2018
E161	Invalid Start: 07/01/2018
W161	Invalid Start: 07/01/2018
E162	Eligibility Begin Date Start: 06/02/2019
W162	Eligibility Begin Date Start: 06/02/2019
E163	Associated submission not found Start: 12/01/2020
W163	Associated submission not found Start: 12/01/2020
E164	Exceeds Receiver Allowed Occurrences Start: 12/01/2020
W164	Exceeds Receiver Allowed Occurrences Start: 12/01/2020
E165	HL7 US Realm Header Legal Authenticator data is missing Start: 07/01/2021
W165	HL7 US Realm Header Legal Authenticator data is missing Start: 07/01/2021
E166	HL7 US Realm Header Author data is missing Start: 07/01/2021
W166	HL7 US Realm Header Author data is missing Start: 07/01/2021
E167	HL7 US Realm Header SetID data is missing Start: 07/01/2021
W167	HL7 US Realm Header SetID data is missing Start: 07/01/2021
E168	HL7 US Realm Header VersionNumber data is missing Start: 07/01/2021
W168	HL7 US Realm Header VersionNumber data is missing Start: 07/01/2021
E169	HL7 C-CDA Structured document sections name data is missing Start: 07/01/2021
W169	HL7 C-CDA Structured document sections name data is missing Start: 07/01/2021
E170	HL7 C-CDA Structured document sections title data is missing Start: 07/01/2021
W170	HL7 C-CDA Structured document sections title data is missing Start: 07/01/2021
E171	HL7 C-CDA Structured document narrative block (text) data is missing Start: 07/01/2021
W171	HL7 C-CDA Structured document narrative block (text) data is missing Start: 07/01/2021
E172	HL7 C-CDA Unstructured document LOINC Code is missing Start: 07/01/2021
W172	HL7 C-CDA Unstructured document LOINC Code is missing Start: 07/01/2021
E173	HL7 C-CDA Unstructured document contained a reference to a URL or URI Start: 07/01/2021
W173	HL7 C-CDA Unstructured document contained a reference to a URL or URI Start: 07/01/2021
E174	HL7 C-CDA Unstructured document @mediaType (MIME type) is missing Start: 07/01/2021
W174	HL7 C-CDA Unstructured document @mediaType (MIME type) is missing Start: 07/01/2021
E175	HL7 C-CDA Unstructured document included more than 1 @mediaType (MIME type) Start: 07/01/2021
W175	HL7 C-CDA Unstructured document included more than 1 @mediaType (MIME type) Start: 07/01/2021
E176	HL7 C-CDA Unstructured document Base64 encoding does not meet the RFC 4648 requirements Start: 07/01/2021
W176	HL7 C-CDA Unstructured document Base64 encoding does not meet the RFC 4648 requirements Start: 07/01/2021
E177	HL7 C-CDA Unstructured document compression does not meet the RFC 1951 requirements Start: 07/01/2021
W177	HL7 C-CDA Unstructured document compression does not meet the RFC 1951 requirements Start: 07/01/2021
E178	HL7 C-CDA LOINC code does not match the LOINC code in the request Start: 07/01/2021
W178	HL7 C-CDA LOINC code does not match the LOINC code in the request Start: 07/01/2021
E179	HL7 Attachment Control Number is missing Start: 07/01/2021
W179	HL7 Attachment Control Number is missing Start: 07/01/2021
E180	Missing Billing provider affiliation for the Rendering provider(s). Start: 11/01/2022
W180	Missing Billing provider affiliation for the Rendering provider(s). Start: 11/01/2022
E181	Invalid affiliation between Rendering and Billing providers. Start: 11/01/2022
W181	Invalid affiliation between Rendering and Billing providers. Start: 11/01/2022
E182	System Delay-No Additional Action Required Start: 11/01/2022
W182	System Delay-No Additional Action Required Start: 11/01/2022
E183	System Delay-Resubmission Required Start: 11/01/2022
W183	System Delay-Resubmission Required Start: 11/01/2022
E184	Fully Subsidized Policy - Policy's total premium is provided for by the Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) Start: 07/11/2024
W184	Fully Subsidized Policy - Policy's total premium is provided for by the Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) Start: 07/11/2024

Code List Filters Block Reference

Filter by code:

Filter codes by 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.

Status last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

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

Read more about Insurance Business Process Application Error Codes

Service Review Decision Reason Codes

Code List ID

886

Code List Scope Statement

These codes communicate the reason for the health care services review outcome.

Code List Maintained By

CMG01

Code List Updated Date

Mon, 08/01/2022 - 12:00

Code List Table

01	Price Authorization Expired Start: 01/10/2001
02	Price authorization no longer required Start: 01/10/2001
03	Product not on the price authorization Start: 01/10/2001
04	Authorized Quantity Exceeded Start: 01/10/2001
05	Special Cost Incorrect Start: 01/10/2001
06	No Credit Allowed Start: 01/10/2001
07	Administrative Cancellation Start: 01/10/2001
08	Unit resale higher than authorized Start: 01/10/2001
09	Out of Network Start: 01/10/2001
0A	Testing not Included Start: 01/10/2001
0B	Request Forwarded To and Decision Response Forthcoming From an External Review Organization Start: 01/10/2001
0C	Authorization/Access Restrictions Start: 01/10/2001
0D	Requires PCP authorization Start: 01/10/2001
0E	Provider is Not Primary Care Physician Start: 01/10/2001
0F	Not Medically Necessary Start: 01/10/2001
0G	Level of Care Not Appropriate Start: 01/10/2001
0H	Certification Not Required for this Service Start: 01/10/2001
0J	Certification Responsibility of External Review Organization Start: 01/10/2001
0K	Primary Care Service Start: 01/10/2001
0L	Exceeds Plan Maximums Start: 01/10/2001
0M	Non-covered Service Start: 01/10/2001
0N	No Prior Approval Start: 01/10/2001
0P	Requested Information Not Received Start: 01/10/2001
0Q	Duplicate Request Start: 01/10/2001
0R	Service Inconsistent with Diagnosis Start: 01/10/2001
0S	Pre-existing Condition Start: 01/10/2001
0T	Experimental Service or Procedure Start: 01/10/2001
0U	Additional Patient Information required Start: 01/10/2001
0V	Requires Medical Review Start: 01/10/2001
0W	Disposition pending review Start: 01/10/2001
0X	Service Inconsistent with Provider Type Start: 01/10/2001
0Y	Service inconsistent with Patient's Age Start: 01/10/2001
0Z	Service inconsistent with Patient's Gender Start: 01/10/2001
10	Product/service/procedure delivery pattern (e.g., units, days, visits, weeks, hours, months) Start: 01/10/2001
11	Pricing Start: 01/10/2001
12	Patient is restricted to specific provider Start: 01/10/2001
13	Service authorized for another provider Start: 01/10/2001
14	Plan/contractual guidelines not followed Start: 01/10/2001
15	Plan/contractual geographic restriction Start: 01/10/2001
16	Inappropriate facility type Start: 01/10/2001
17	Time limits not met Start: 02/01/2002
18	Notification received Start: 06/01/2002
19	Cosmetic Start: 06/01/2002
20	Once in a lifetime restriction applies Start: 02/01/2004
21	Transport Request Denied Start: 06/01/2004
22	Ambulance Certification Segment information doesn't correspond to Transport Address Segment Start: 06/01/2004
23	Mileage cannot be computed based on data submitted Start: 06/01/2004
24	Computed mileage is inconsistent with transport information or service units submitted Start: 06/01/2004
25	Services were not considered due to other errors in the request. Start: 06/06/2010
26	Missing Provider Role Start: 06/05/2011
27	Patient is currently in a Health Insurance Exchange premium payment grace period -- first month. Usage: Use only for Individual Market Qualified Health Plans. Start: 06/01/2014 \| Last Modified: 07/01/2017
28	Patient is currently in a Health Insurance Exchange premium payment grace period -- second month. Usage: Use only for Individual Market Qualified Health Plans. Start: 06/01/2014 \| Last Modified: 07/01/2017
29	Patient is currently in a Health Insurance Exchange premium payment grace period -- third month. Usage: Use only for Individual Market Qualified Health Plans. Start: 06/01/2014 \| Last Modified: 07/01/2017
30	Initial Utilization Review In Progress Start: 11/01/2017
31	Escalated Utilization Review in Progress Start: 11/01/2017
32	Excluded benefit, a service which is specifically excluded from the benefit plan. Start: 10/01/2020
33	Appeal Denied Start: 03/01/2022
34	Payer-initiated Void Start: 03/01/2022
35	The documentation submitted is not legible. Start: 03/01/2022
36	Signed documentation is required to support medical necessity. Start: 03/01/2022
37	A signed Order or Intent-to-Order is required. Start: 03/01/2022
38	A physician certification statement is required. Start: 03/01/2022
39	An order that supports this service is required. Start: 03/01/2022
40	The supporting documentation does not match the patient identified in the preauthorization request. Start: 03/01/2022
41	The supporting documentation does not support the number of units requested. Start: 03/01/2022
42	A nutritional status assessment is required. Start: 03/01/2022
43	Initial and repeated wound measurements are required. Start: 03/01/2022
44	Documentation of conservative treatment failure is required. Start: 03/01/2022
45	Documentation of a diabetes diagnosis is required. Start: 03/01/2022
46	Documentation that treatment is an adjunct to conventional therapy is required. Start: 03/01/2022
47	Documentation of measurable signs of improvement is required. Start: 08/01/2022
48	Documentation of a diabetic wound classification is required. Start: 08/01/2022
49	Patient was not admitted within the authorized timeframe. Start: 08/01/2022

Code List Filters Block Reference

Filter by code:

Filter codes by 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.

Status Last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

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

Read more about Service Review Decision Reason Codes

Claim Status Codes

Code List ID

508

Code List Scope Statement

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

Code List Maintained By

CMG03

Code List Updated Date

Sat, 03/01/2025 - 12:00

Code List Table

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
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: 03/01/2025
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	Processor Control Number Start: 01/01/1995 \| Last Modified: 11/01/2024
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. 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). Usage: This code requires the use of an Entity Code.” Start: 02/28/1997 \| Last Modified: 11/01/2024
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 \| Last Modified: 11/01/2024
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. Start: 02/28/2005 \| Last Modified: 11/01/2024
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. 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 \| Last Modified: 11/01/2024
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 Quantity Start: 01/24/2010 \| Last Modified: 11/01/2024
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

Code List Filters Block Reference

Filter by code:

Filter codes by 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.

Status last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
142	11/11/2024	Revise from "Entity's site id . Usage: This code requires use of an Entity Code." to "Entity's site id. Usage: This code requires use of an Entity Code."	Revision		Closed as a Duplicate
143	11/26/2024	Entity's site id. Usage: This code requires use of an Entity Code.	Revision		CMG Approved

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

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

Read more about Claim Status Codes

Claim Status Category Codes

Code List ID

507

Code List Scope Statement

These codes organize the Claim Status Codes (ECL 508) into logical groupings.

Code List Maintained By

CMG03

Code List Updated Date

Tue, 03/03/2020 - 12:00

Code List Table

Supplemental
X0	Supplemental Messages Start: 01/01/1995 \| Stop: 10/16/2003
Acknowledgements
A0	Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity. Start: 01/01/1995
A1	Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication. Start: 01/01/1995
A2	Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system. Start: 01/01/1995
A3	Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Start: 01/01/1995
A4	Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system. Start: 01/01/1995
A5	Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system. Start: 02/28/2002
A6	Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. Start: 10/31/2002
A7	Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Start: 10/31/2002
A8	Acknowledgement/Rejected for relational field in error. Start: 10/31/2004
Data Reporting Acknowledgments
DR01	Acknowledgement/Receipt - The claim/encounter has been received. This does not mean the claim has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgement Transaction. Start: 07/01/2018
DR02	Acknowledgement/Acceptance into the data reporting/processing system - The claim/encounter has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR03	Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR04	Acknowledgement/Not Found - The claim/encounter can not be found in the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR05	Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR06	Acknowledgment/Rejected for invalid information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR07	Acknowledgement/Rejected for relational field in error. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR08	Acknowledgement/Warning - The claim/encounter has been accepted into the data reporting/processing system but has received a warning as specified in the Status details. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
Pending
P0	Pending: Adjudication/Details-This is a generic message about a pended claim. A pended claim is one for which no remittance advice has been issued, or only part of the claim has been paid. Start: 01/01/1995
P1	Pending/In Process-The claim or encounter is in the adjudication system. Start: 01/01/1995
P2	Pending/Payer Review-The claim/encounter is suspended and is pending review (e.g. medical review, repricing, Third Party Administrator processing). Start: 01/01/1995 \| Last Modified: 01/27/2008
P3	Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider. (Usage: A Claim Status Code identifying the type of information requested, must be reported) Start: 01/01/1995 \| Last Modified: 07/01/2017
P4	Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient. (Usage: A status code identifying the type of information requested must be sent) Start: 01/01/1995 \| Last Modified: 07/01/2017
P5	Pending/Payer Administrative/System hold Start: 10/31/2006
Finalized
F0	Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken. Start: 01/01/1995
F1	Finalized/Payment-The claim/line has been paid. Start: 01/01/1995
F2	Finalized/Denial-The claim/line has been denied. Start: 01/01/1995
F3	Finalized/Revised - Adjudication information has been changed Start: 02/28/2001
F3F	Finalized/Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made and the claim/encounter has been forwarded to a subsequent entity as identified on the original claim or in this payer's records. Start: 01/01/1995
F3N	Finalized/Not Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made. The claim/encounter has NOT been forwarded to any subsequent entity identified on the original claim. Start: 01/01/1995
F4	Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming. Start: 01/01/1995
F5	Finalized/Cannot Process Start: 01/01/1995 \| Stop: 10/16/2003
Requests for additional information
R0	Requests for additional Information/General Requests-Requests that don't fall into other R-type categories. Start: 01/01/1995
R1	Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers). Start: 01/01/1995
R3	Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim. Start: 01/01/1995 \| Last Modified: 02/28/1998
R4	Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes. Start: 01/01/1995 \| Last Modified: 02/28/1998
R5	Request for additional information/more specific detail-Additional information as a follow up to a previous request is needed. The original information was received but is inadequate. More specific/detailed information is requested. Start: 01/01/1995 \| Last Modified: 06/30/1998
R6	Requests for additional information – Regulatory requirements Start: 02/28/2007
R7	Requests for additional information – Confirm care is consistent with Health Plan policy coverage Start: 02/28/2007
R8	Requests for additional information – Confirm care is consistent with health plan coverage exceptions Start: 02/28/2007
R9	Requests for additional information – Determination of medical necessity Start: 02/28/2007
R10	Requests for additional information – Support a filed grievance or appeal Start: 02/28/2007
R11	Requests for additional information – Pre-payment review of claims Start: 02/28/2007
R12	Requests for additional information – Clarification or justification of use for specified procedure code Start: 02/28/2007
R13	Requests for additional information – Original documents submitted are not readable. Used only for subsequent request(s). Start: 02/28/2007
R14	Requests for additional information – Original documents received are not what was requested. Used only for subsequent request(s). Start: 02/28/2007
R15	Requests for additional information – Workers Compensation coverage determination. Start: 02/28/2007
R16	Requests for additional information – Eligibility determination Start: 02/28/2007
R17	Replacement of a Prior Request. Used to indicate that the current attachment request replaces a prior attachment request. Start: 01/20/2013
General
RQ	General Questions (Yes/No Responses)-Questions that may be answered by a simple 'yes' or 'no'. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
Error
E0	Response not possible - error on submitted request data Start: 01/01/1995 \| Last Modified: 02/28/2002
E1	Response not possible - System Status Start: 02/29/2000
E2	Information Holder is not responding; resubmit at a later time. Start: 06/30/2003
E3	Correction required - relational fields in error. Start: 01/24/2010
E4	Trading partner agreement specific requirement not met: Data correction required. (Usage: A status code identifying the type of information requested must be sent) Start: 01/30/2011 \| Last Modified: 07/01/2017
Searches
D0	Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria. Start: 01/01/1995 \| Last Modified: 09/20/2009

Code List Filters Block Reference

Filter by code:

Filter codes by 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.

Status Last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Claim Status Category Codes

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

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

Read more about Claim Status Category Codes

Error Reason Codes

Code List ID

977

Code List Scope Statement

These codes describe a processing error related to a particular EDI transmission.

Code List Maintained By

CMG02

Code List Updated Date

Thu, 07/01/2021 - 12:00

Code List Table

01	Inappropriate combination of service type code and service type code descriptor. Activation Date: 11/01/2017
02	Inappropriate service type code(s) Activation Date: 11/01/2017
03	The submitted procedure code(s) is not supported. Activation Date: 11/01/2017
04	Inquiries related to procedure codes are not supported. Activation Date: 11/01/2017
05	The submitted modifier code(s) is not supported. Activation Date: 11/01/2017
06	Inquiries related to modifier codes are not supported. Activation Date: 11/01/2017
07	The submitted diagnosis code(s) is not supported. Activation Date: 11/01/2017
08	Inquiries related to diagnosis codes are not supported. Activation Date: 11/01/2017
09	Duplicate ID Activation Date: 11/01/2017 \| Deactivation Date: 08/01/2019
10	Invalid subscriber or insured ID Activation Date: 11/01/2017
11	Missing subscriber or insured ID Activation Date: 11/01/2017
12	Missing subscriber or insured name Activation Date: 11/01/2017
13	Invalid date of death Activation Date: 11/01/2017
14	Missing date of death Activation Date: 11/01/2017
15	Missing provider name Activation Date: 11/01/2017
16	Invalid taxonomy Activation Date: 11/01/2017
17	Missing taxonomy Activation Date: 11/01/2017
18	Missing provider state Activation Date: 11/01/2017
19	Invalid referring provider ID Activation Date: 11/01/2017
20	Missing referring provider ID Activation Date: 11/01/2017
21	The request date(s) is not within the provider's plan enrollment period. Activation Date: 11/01/2017
22	The request date(s) precedes the date of birth. Activation Date: 11/01/2017
23	The date of death in our records precedes the request date(s). Activation Date: 11/01/2017
24	The request date(s) is not within the allowable inquiry period. Activation Date: 11/01/2017
25	The request date(s) is in the future. Activation Date: 11/01/2017
26	Invalid request date(s) Activation Date: 11/01/2017
27	Invalid patient ID Activation Date: 11/01/2017
28	Missing patient ID Activation Date: 11/01/2017
29	Missing patient name Activation Date: 11/01/2017
30	Invalid case number Activation Date: 11/01/2017
31	Missing case number Activation Date: 11/01/2017
32	Invalid provider address Activation Date: 11/01/2017
33	Missing provider address Activation Date: 11/01/2017
34	The referral number was not found. Activation Date: 11/01/2017
35	Invalid diagnosis code(s) Activation Date: 11/01/2017
36	Missing diagnosis code(s) Activation Date: 11/01/2017
37	Invalid procedure code(s) Activation Date: 11/01/2017
38	Missing procedure code(s) Activation Date: 11/01/2017
39	Invalid modifier code(s) Activation Date: 11/01/2017
40	Missing modifier code(s) Activation Date: 11/01/2017
41	Invalid authorization number Activation Date: 11/01/2017
42	Invalid referral number Activation Date: 11/01/2017
43	Missing referral number Activation Date: 11/01/2017
44	The authorized quantity of patient requests was exceeded. Activation Date: 11/01/2017
45	The provider is out of network for the member. Activation Date: 11/01/2017
46	The responding system is unable to complete the request at the current time. Activation Date: 11/01/2017
47	The provider ID does not match our records and we were not able to identify the provider. Activation Date: 11/01/2017
48	Inappropriate combination of qualifier and product or service code. Activation Date: 11/01/2017
49	Inappropriate combination of provider ID and taxonomy. Activation Date: 11/01/2017
50	Inappropriate combination of place of service and product or service code. Activation Date: 11/01/2017
51	Duplicate patient ID Activation Date: 11/01/2017 \| Deactivation Date: 08/01/2019
52	The service is inconsistent with the patient's age. Activation Date: 11/01/2017
53	The diagnosis is inconsistent with the patient's age. Activation Date: 11/01/2017
54	The patient's date of birth does not match our records. Activation Date: 11/01/2017
55	The subscriber or insured was not found. Activation Date: 11/01/2017
56	The subscriber ID or insured ID is not unique (returns multiple matches) in our records. Activation Date: 11/01/2017 \| Deactivation Date: 08/01/2019
57	Although the subscriber was found, the patient was not found. Activation Date: 11/01/2017
58	The submitted group or plan does not match our records. Activation Date: 11/01/2017
59	A response was not received from the information source's system. Activation Date: 11/01/2017
60	The submitted services are inconsistent with the submitted diagnosis code(s). Activation Date: 11/01/2017
61	Invalid provider ID Activation Date: 11/01/2017
62	Missing provider ID Activation Date: 11/01/2017
63	This service is not medically appropriate for this patient. Activation Date: 11/01/2017
64	The submitted authorization number does not match our records. Activation Date: 11/01/2017
65	Invalid date of birth Activation Date: 11/01/2017
66	Missing date of birth Activation Date: 11/01/2017
67	Missing gender code Activation Date: 11/01/2017
68	The provider ID does not match our records but we were able to identify the provider. Activation Date: 11/01/2017
69	Invalid member ID Activation Date: 11/01/2017
70	The responding system is unable to respond within the alloted time. Activation Date: 11/01/2017
71	Missing last name Activation Date: 11/01/2017
72	Missing first name Activation Date: 11/01/2017
73	Missing member ID Activation Date: 11/01/2017
74	The member ID does not match our records. Activation Date: 11/01/2017
75	The gender code does not match our records. Activation Date: 11/01/2017
76	The first name does not match our records. Activation Date: 11/01/2017
77	The last name does not match our records. Activation Date: 11/01/2017
78	The middle name does not match our records. Activation Date: 11/01/2017
79	Invalid name suffix Activation Date: 11/01/2017
80	Missing name suffix Activation Date: 11/01/2017
81	The name suffix does not match our records. Activation Date: 11/01/2017
82	There were duplicates within the minimum number of service types supported (ten), so there are fewer than ten responses. Activation Date: 11/01/2017
83	There were duplicate service type inquiries so the number of responses does not match the number of inquiries. Activation Date: 11/01/2017
84	The number of service type inquiries exceeds the number of responses we can return. Activation Date: 11/01/2017
85	We have responded with general benefit information, however the submitted procedure code requires separate medical review. Activation Date: 11/01/2017
86	We have responded, however the submitted procedure code requires separate medical review and prior authorization. Activation Date: 11/01/2017
87	We have responded with general benefit information, however the submitted service type code requires separate medical review. Activation Date: 11/01/2017
88	We have responded, however the submitted service type code requires separate medical review and prior authorization. Activation Date: 11/01/2017
89	Invalid group number Activation Date: 11/01/2017
90	Missing group number Activation Date: 11/01/2017
91	The responding system cannot process this real-time inquiry in real-time mode. Activation Date: 11/01/2017
92	Duplicate first name Activation Date: 08/24/2018
93	Duplicate last name Activation Date: 08/24/2018
94	Duplicate date of birth Activation Date: 08/24/2018
95	Duplicate policy(s) Activation Date: 08/24/2018
96	A date range greater than 12 months is not supported. Activation Date: 08/24/2018
97	The date range of the inquiry exceeds the period of time supported. Activation Date: 08/24/2018
98	The member ID is not unique (returns multiple matches) in our records. Activation Date: 08/01/2019
99	Inappropriate combination of service type codes Activation Date: 08/01/2019
100	Service type code(s) on this request is valid only for responses and is not valid on requests. Activation Date: 08/01/2019
101	The provider ID does match our records but has not met the eligibility requirements to send or receive this transaction. Activation Date: 08/01/2019
102	Benefit utilization information for this response, such as remaining or accumulator amounts, is restricted by the responding system. Activation Date: 10/01/2019
103	Information source is not responding; clearinghouse/intermediary has temporarily suspended request submissions. Activation Date: 07/01/2021
104	Information Source's system encountered errors preventing benefit related information from being returned. Activation Date: 07/01/2021
105	Information Source's system encountered errors preventing eligibility, coverage and/or policy related information from being returned. Activation Date: 07/01/2021

Code List Filters Block Reference

Filter by code:

Filter codes by 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.

Status Last Reviewed: 3/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.
790	1/7/2025	Dependents are not supported	New code		Pending

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

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

Read more about Error Reason Codes

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