Examples: 011x and 012x= inpatient hospital (where “x” is any digit in the 4th position)
1st Digit = 0

2nd Digit — Type of Facility
1 = Hospital
2 = Skilled Nursing
3 = Home Health
4 = Religious Nonmedical (Hospital)
5 = Reserved for national assignment (discontinued effective 10/1/05).
6 = Intermediate Care
7 = Clinic or Hospital Based Renal Dialysis Facility (requires special information in second digit below).
8 = Special facility or hospital ASC surgery (requires special information in second digit below).
9 = Reserved for National Assignment

3rd Digit — Bill Classification (Except Clinics and Special Facilities)
1 = Inpatient
2 = Inpatient
3 = Outpatient
4 = Other
5 = Intermediate Care — Level I
6 = Intermediate Care — Level II
7 = Reserved for national assignment (discontinued effective 10/1/05).
8 = Swing Bed (may be used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement).
9 = Reserved for National Assignment

3rd Digit — Classification (Clinics Only)
1 = Rural Health Clinic (RHC)
2 = Hospital Based or Independent Renal Dialysis Facility
3 = Free Standing Provider-Based Federally Qualified Health Center (FQHC)
4 = Other Rehabilitation Facility (ORF)
5 = Comprehensive Outpatient Rehabilitation Facility (CORF)
6 = Community Mental Health Center (CMHC)
7 = Federally Qualified Health Center (FQHC)
8 = Licensed Freestanding Emergency Medical Facility
9 = Other

3rd Digit — Classification (Special Facilities Only)
1 = Hospice (Nonhospital Based)
2 = Hospice (Hospital Based)
3 = Ambulatory Surgical Center Services to Hospital Outpatients
4 = Free Standing Birthing Center
5 = Critical Access Hospital
6 = Residential Facility
7 = Freestanding Non-residential Opioid Treatment Program (effective 1/1/21)
8 = Reserved for National Assignment
9 = Other

4th Digit — Frequency
A = Admission/Election Notice
B = Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Termination/Revocation Notice
C = Hospice Change of Provider Notice
D = Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Void/Cancel
E = Hospice Change of Ownership
F = Beneficiary Initiated Adjustment Claim
G = CWF Initiated Adjustment Claim
H = CMS Initiated Adjustment Claim
I = FI Adjustment Claim (Other than QIO or Provider
J = Initiated Adjustment Claim — Other
K = OIG Initiated Adjustment Claim
M = MSP Initiated Adjustment Claim
P = QIO Adjustment Claim
0 = Nonpayment/Zero Claims
1 = Admit Through Discharge Claim
2 = Interim — First Claim
3 = Interim — Continuing Claims (Not valid for PPS Bills)
4 = Interim — Last Claim (Not valid for PPS Bills)
5 = Late Charge Only
7 = Replacement of Prior Claim
8 = Void/Cancel of a Prior Claim
9 = Final Claim for a Home Health PPS Episode
Null/missing = source value is missing or unknown