This code set is an external code set maintained by the National Uniform Billing Committee (NUBCTM) https://www.nubc.org/ The values listed below may not be complete or current 0001 = Total charge 0022 = SNF claim paid under PPS submitted as type of bill (TOB) 21X NOTE: This code may appear multiple times on a claim to identify different HIPPS Rate Code/assessment periods. 0023 = Home health services paid under PPS submitted as TOB 32X and 33X, eff. 10/2000. This code may appear multiple times on a claim to identify different HIPPS/home health Resource Groups (HRG) 0024 = Inpatient rehabilitation facility services paid under PPS submitted as TOB 11X, eff. for cost reporting periods beginning on or after 1/1/2002 (dates of service after 12/31/2001). This code may appear only once on a claim 0100 = All-inclusive rate — room and board plus ancillary 0101 = All-inclusive rate — room and board 0110 = Private medical or general — general classification 0111 = Private medical or general — medical/surgical/GYN 0112 = Private medical or general — OB 0113 = Private medical or general — pediatric 0114 = Private medical or general — psychiatric 0115 = Private medical or general — hospice 0116 = Private medical or general — detoxification 0117 = Private medical or general — oncology 0118 = Private medical or general — rehabilitation 0119 = Private medical or general — other 0120 = Semi-private 2 bed (medical or general) general classification 0121 = Semi-private 2 bed (medical or general) medical/surgical/GYN 0122 = Semi-private 2 bed (medical or general) — OB 0123 = Semi-private 2 bed (medical or general) — pediatric 0124 = Semi-private 2 bed (medical or general) — psychiatric 0125 = Semi-private 2 bed (medical or general) — hospice 0126 = Semi-private 2 bed (medical or general) — detoxification 0127 = Semi-private 2 bed (medical or general) — oncology 0128 = Semi-private 2 bed (medical or general) — rehabilitation 0129 = Semi-private 2 bed (medical or general) — other 0130 = Semi-private 3 and 4 beds — general classification 0131 = Semi-private 3 and 4 beds — medical/surgical/GYN 0132 = Semi-private 3 and 4 beds — OB 0133 = Semi-private 3 and 4 beds — pediatric 0134 = Semi-private 3 and 4 beds — psychiatric 0135 = Semi-private 3 and 4 beds — hospice 0136 = Semi-private 3 and 4 beds — detoxification 0137 = Semi-private 3 and 4 beds — oncology 0138 = Semi-private 3 and 4 beds — rehabilitation 0139 = Semi-private 3 and 4 beds — other 0140 = Private (deluxe)-general classification 0141 = Private (deluxe) — medical/surgical/GYN 0142 = Private (deluxe) — OB 0143 = Private (deluxe) — pediatric 0144 = Private (deluxe) — psychiatric 0145 = Private (deluxe) — hospice 0146 = Private (deluxe) — detoxification 0147 = Private (deluxe) — oncology 0148 = Private (deluxe) — rehabilitation 0149 = Private (deluxe) — other 0150 = Room and Board ward (medical or general) — general classification 0151 = Room and Board ward (medical or general) — medical/surgical/GYN 0152 = Room and Board ward (medical or general) — OB 0153 = Room and Board ward (medical or general) — pediatric 0154 = Room and Board ward (medical or general) — psychiatric 0155 = Room and Board ward (medical or general) — hospice 0156 = Room and Board ward (medical or general) — detoxification 0157 = Room and Board ward (medical or general) — oncology 0158 = Room and Board ward (medical or general) — rehabilitation 0159 = Room and Board ward (medical or general) — other 0160 = Other Room and Board — general classification 0161 = Hospital at home, RandB/hospital at home (eff. for claims received on or after July 1, 2022) 0164 = Other Room and Board — sterile environment 0167 = Other Room and Board — self care 0169 = Other Room and Board — other 0170 = Nursery-general classification 0171 = Nursery — newborn level I (routine) 0172 = Nursery — premature newborn-level II (continuing care) 0173 = Nursery — newborn-level III (intermediate care) 0174 = Nursery — newborn-level IV (intensive care) 0179 = Nursery — other 0180 = Leave of absence — general classification 0182 = Leave of absence — patient convenience charges billable 0183 = Leave of absence — therapeutic leave 0184 = Leave of absence-ICF mentally retarded — any reason 0185 = Leave of absence nursing home (hospitalization) 0189 = Leave of absence — other leave of absence 0190 = Subacute care — general classification 0191 = Subacute care — level I 0192 = Subacute care — level II 0193 = Subacute care — level III 0194 = Subacute care — level IV 0199 = Subacute care — other 0200 = Intensive care — general classification 0201 = Intensive care — surgical 0202 = Intensive care — medical 0203 = Intensive care — pediatric 0204 = Intensive care — psychiatric 0206 = Intensive care—post ICU; redefined as intermediate ICU 0207 = Intensive care — burn care 0208 = Intensive care — trauma 0209 = Intensive care — other intensive care 0210 = Coronary care — general classification 0211 = Coronary care — myocardial infraction 0212 = Coronary care — pulmonary care 0213 = Coronary care — heart transplant 0214 = Coronary care — post CCU; redefined as intermediate CCU 0219 = Coronary care — other coronary care 0220 = Special charges — general classification 0221 = Special charges — admission charge 0222 = Special charges — technical support charge 0223 = Special charges — UR service charge 0224 = Special charges — late discharge, medically necessary 0229 = Special charges — other special charges 0230 = Incremental nursing charge rate — general classification 0231 = Incremental nursing charge rate — nursery 0232 = Incremental nursing charge rate — OB 0233 = Incremental nursing charge rate — ICU (include transitional care) 0234 = Incremental nursing charge rate — CCU (include transitional care) 0235 = Incremental nursing charge rate — hospice 0239 = Incremental nursing charge rate — other 0240 = All-inclusive ancillary — general classification 0241 = All-inclusive ancillary — basic 0242 = All-inclusive ancillary — comprehensive 0243 = All-inclusive ancillary — specialty 0249 = All-inclusive ancillary — other inclusive ancillary 0250 = Pharmacy — general classification 0251 = Pharmacy — generic drugs 0252 = Pharmacy — nongeneric drugs 0253 = Pharmacy — take home drugs 0254 = Pharmacy — drugs incident to other diagnostic service-subject payment limit 0255 = Pharmacy — drugs incident to radiology-subject to payment limit 0256 = Pharmacy — experimental drugs 0257 = Pharmacy — non-prescription 0258 = Pharmacy — IV solutions 0259 = Pharmacy — other pharmacy 0260 = IV therapy — general classification 0261 = IV therapy — infusion pump 0262 = IV therapy — pharmacy services 0263 = IV therapy — drug supply/delivery 0264 = IV therapy — supplies 0269 = IV therapy — other IV therapy 0270 = Medical/surgical supplies — general classification (also reference 062X) 0271 = Medical/surgical supplies — nonsterile supply 0272 = Medical/surgical supplies — sterile supply 0273 = Medical/surgical supplies — take home supplies 0274 = Medical/surgical supplies — prosthetic/orthotic devices 0275 = Medical/surgical supplies — pacemaker 0276 = Medical/surgical supplies — intraocular lens 0277 = Medical/surgical supplies — oxygen-take home 0278 = Medical/surgical supplies — other implants 0279 = Medical/surgical supplies — other devices 0280 = Oncology — general classification 0289 = Oncology — other oncology 0290 = DME (other than renal) — general classification 0291 = DME (other than renal) — rental 0292 = DME (other than renal) — purchase of new DME 0293 = DME (other than renal) — purchase of used DME 0294 = DME (other than renal) — related to and listed as DME 0299 = DME (other than renal) — other 0300 = Laboratory — general classification 0301 = Laboratory — chemistry 0302 = Laboratory — immunology 0303 = Laboratory — renal patient (home) 0304 = Laboratory — non-routine dialysis 0305 = Laboratory — hematology 0306 = Laboratory — bacteriology and microbiology 0307 = Laboratory — urology 0308 = Reserved laboratory 0309 = Laboratory — other laboratory 0310 = Laboratory pathological — general classification 0311 = Laboratory pathological — cytology 0312 = Laboratory pathological — histology 0314 = Laboratory pathological — biopsy 0319 = Laboratory pathological — other 0320 = Radiology diagnostic — general classification 0321 = Radiology diagnostic — angiocardiography 0322 = Radiology diagnostic — arthrography 0323 = Radiology diagnostic — arteriography 0324 = Radiology diagnostic — chest X-ray 0327 = Reserved radiology, diagnostic 0329 = Radiology diagnostic — other 0330 = Radiology therapeutic — general classification 0331 = Radiology therapeutic — chemotherapy injected 0332 = Radiology therapeutic — chemotherapy oral 0333 = Radiology therapeutic — radiation therapy 0335 = Radiology therapeutic — chemotherapy IV 0339 = Radiology therapeutic — other 0340 = Nuclear medicine — general classification 0341 = Nuclear medicine — diagnostic 0342 = Nuclear medicine — therapeutic 0343 = Nuclear medicine — diagnostic radiopharmaceuticals 0344 = Nuclear medicine — therapeutic radiopharmaceuticals 0349 = Nuclear medicine — other 0350 = Computed tomographic (CT) scan — general classification 0351 = CT scan — head scan 0352 = CT scan — body scan 0359 = CT scan — other CT scans 0360 = Operating room services — general classification 0361 = Operating room services — minor surgery 0362 = Operating room services — organ transplant, other than kidney 0363 = Reserved operating room services 0367 = Operating room services — kidney transplant 0368 = Reserved operating room services 0369 = Operating room services — other operating room services 0370 = Anesthesia — general classification 0371 = Anesthesia — incident to RAD and subject to the payment limit 0372 = Anesthesia — incident to other diagnostic service and subject to the payment limit 0374 = Anesthesia — acupuncture 0379 = Anesthesia — other anesthesia 0380 = Blood — general classification 0381 = Blood — packed red cells 0382 = Blood — whole blood 0383 = Blood — plasma 0384 = Blood — platelets 0385 = Blood — leukocytes 0386 = Blood — other components 0387 = Blood — other derivatives (cryoprecipitates) 0389 = Blood — other blood 0390 = Blood storage and processing — general classification 0391 = Blood storage and processing — blood administration 0392 = Blood storage and processing — storage and processing 0399 = Blood storage and processing — other 0400 = Other imaging services — general classification 0401 = Other imaging services — diagnostic mammography 0402 = Other imaging services — ultrasound 0403 = Other imaging services — screening mammography 0404 = Other imaging services — positron emission tomography 0405 = Reserved imaging services 0409 = Other imaging services — other 0410 = Respiratory services — general classification 0412 = Respiratory services — inhalation services 0413 = Respiratory services — hyperbaric oxygen therapy 0419 = Respiratory services — other 0420 = Physical therapy — general classification 0421 = Physical therapy — visit charge 0422 = Physical therapy — hourly charge 0423 = Physical therapy — group rate 0424 = Physical therapy — evaluation or re-evaluation 0429 = Physical therapy — other 0430 = Occupational therapy — general classification 0431 = Occupational therapy — visit charge 0432 = Occupational therapy — hourly charge 0433 = Occupational therapy — group rate 0434 = Occupational therapy — evaluation or re-evaluation 0439 = Occupational therapy — other (may include restorative therapy) 0440 = Speech language pathology — general classification 0441 = Speech language pathology — visit charge 0442 = Speech language pathology — hourly charge 0443 = Speech language pathology — group rate 0444 = Speech language pathology — evaluation or re-evaluation 0445 = Reserved speech therapy 0449 = Speech language pathology — other 0450 = Emergency room — general classification 0451 = Emergency room — EMTALA emergency medical screening services 0452 = Emergency room — ER beyond EMTALA screening 0456 = Emergency room — urgent care 0459 = Emergency room — other 0460 = Pulmonary function — general classification 0461 = Reserved pulmonary function 0469 = Pulmonary function — other 0470 = Audiology — general classification 0471 = Audiology — diagnostic 0472 = Audiology — treatment 0479 = Audiology — other 0480 = Cardiology — general classification 0481 = Cardiology — cardiac cath lab 0482 = Cardiology — stress test 0483 = Cardiology — Echocardiology 0489 = Cardiology — other 0490 = Ambulatory surgical care — general classification 0499 = Ambulatory surgical care — other 0500 = Outpatient services — general classification 0509 = Outpatient services — other 0510 = Clinic — general classification 0511 = Clinic — chronic pain center 0512 = Clinic — dental center 0513 = Clinic — psychiatric 0514 = Clinic — OB-GYN 0515 = Clinic — pediatric 0516 = Clinic — urgent care clinic 0517 = Clinic — family practice clinic 0519 = Clinic — other 0520 = Free-standing clinic — general classification 0521 = Free-standing clinic — clinic visit by a member to RHC/FQHC (eff. 7/1/2006). Prior to 7/1/2006 — rural health clinic 0522 = Free-standing clinic — home visit by RHC/FQHC practitioner (eff. 7/2006). Prior to 7/2006 — rural health home 0523 = Free-standing clinic — family practice 0524 = Free-standing clinic — visit by RHC/FQHC practitioner to a member in a covered Part A stay at the SNF. (eff. 7/2006) 0525 = Free-standing clinic — visit by RHC/FQHC practitioner to a member in a SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility. (eff. 7/2006) 0526 = Free-standing clinic — urgent care (eff. 10/1996) 0527 = Free-standing clinic — RHC/FQHC visiting nurse service(s) to a member's home when in a home health shortage area. (eff. 7/2006) 0528 = Free-standing clinic — visit by RHC/FQHC practitioner to other non- RHC/FQHC site (e.g., scene of accident). (eff. 7/2006) 0529 = Free-standing clinic — other 0530 = Osteopathic services — general classification 0531 = Osteopathic services — osteopathic therapy 0539 = Osteopathic services — other 0540 = Ambulance — general classification 0541 = Ambulance — supplies 0542 = Ambulance — medical transport 0543 = Ambulance — heart mobile 0544 = Ambulance — oxygen 0545 = Ambulance — air ambulance 0546 = Ambulance — neo-natal ambulance 0547 = Ambulance — pharmacy 0548 = Ambulance —transmission EKG 0549 = Ambulance — other 0550 = Skilled nursing — general classification 0551 = Skilled nursing — visit charge 0552 = Skilled nursing — hourly charge 0559 = Skilled nursing — other 0560 = Medical social services (home health) — general classification 0561 = Medical social services (home health) — visit charge 0562 = Medical social services (home health) — hourly charges 0569 = Medical social services (home health) — other 0570 = Home health aide (home health) — general classification 0571 = Home health aide (home health) — visit charge 0572 = Home health aide (home health) — hourly charge 0579 = Home health aide (home health) — other 0580 = Other visits (home health) — general classification (under HHPPS, not allowed as covered charges) 0581 = Other visits (home health) — visit charge (under HHPPS, not allowed as covered charges) 0582 = Other visits (home health) — hourly charge (under HHPPS, not allowed as covered charges) 0583 = Other visits (home health) — assessments under HHPPS, not allow as covered charges) 0589 = Other visits (home health) — other (under HHPPS, not allowed as covered charges) 0590 = Units of service (home health) — general classification (under HHPPS, not allowed as covered charges) 0599 = Units of service (home health) — other (under HHPPS, not allowed as covered charges) 0600 = Oxygen (home health) — general classification 0601 = Oxygen (home health) — stat or port equip/supply or contents 0602 = Oxygen (home health)— stat/equip/supply under 1 LPM 0603 = Oxygen (home health) — stat/equip/over 4 LPM 0604 = Oxygen (home health) — stat/equip/portable add-on 0609 = Oxygen (home health) — other 0610 =Magnetic resonance technology (MRT) — general classification 0611 = MRT/MRI — brain (including brainstem) 0612 = MRT/MRI — spinal cord (including spine) 0614 = MRT/MRI — other 0615 = MRT/MRA — Head and Neck 0616 = MRT/MRA — Lower Extremities 0618 = MRT/MRA — other 0619 = MRT/Other MRI 0620 = Reserved (Use 0270 for general classification) 0621 = Medical/surgical supplies — incident to radiology-subject to the payment limit — extension of 027X 0622 = Medical/surgical supplies — incident to other diagnostic service-subject to the payment limit — extension of 027X 0623 = Medical/surgical supplies — surgical dressings — extension of 027X 0624 = Medical/surgical supplies — medical investigational devices and procedures with FDA approved IDE's — extension of 027X 0630 = Reserved 0631 = Drugs requiring specific identification — single drug source 0632 = Drugs requiring specific identification — multiple drug source 0633 = Drugs requiring specific identification — restrictive prescription 0634 = Drugs requiring specific identification — Erythropoietin (EPO) under 10,000 units 0635 = Drugs requiring specific identification — Erythropoietin (EPO) 10,000 units or more 0636 = Drugs requiring specific identification — detailed coding 0637 = Self-administered drugs administered in an emergency situation — not requiring detailed coding 0640 = Home IV therapy — general classification 0641 = Home IV therapy — nonroutine nursing 0642 = Home IV therapy — IV site care, central line 0643 = Home IV therapy — IV start/change peripheral line 0644 = Home IV therapy — nonroutine nursing, peripheral line 0645 = Home IV therapy — train patient/caregiver, central line 0646 = Home IV therapy — train disabled patient, central line 0647 = Home IV therapy — train patient/caregiver, peripheral line 0648 = Home IV therapy — train disabled patient, peripheral line 0649 = Home IV therapy — other IV therapy services 0650 = Hospice services — general classification 0651 = Hospice services — routine home care 0652 = Hospice services — continuous home care- 0655 = Hospice services — inpatient care 0656 = Hospice services — general inpatient care (non-respite) 0657 = Hospice services — physician services 0659 = Hospice services — other 0660 = Respite care (HHA) — general classification 0661 = Respite care (HHA) — hourly charge/skilled nursing 0662 = Respite care (HHA) — hourly charge/home health aide/homemaker 0663 = Respite care (HHA) - daily respite charge 0670 = OP special residence charges — general classification 0671 = OP special residence charges — hospital based 0672 = OP special residence charges — contracted 0679 = OP special residence charges — other special residence charges 0680 = Trauma Response — not used 0681 = Trauma response — Level I Trauma 0682 = Trauma response — Level II Trauma 0683 = Trauma response — Level III Trauma 0684 = Trauma response — Level IV Trauma 0689 = Trauma response — Other trauma response 0690 = Pre-hospice/Palliative Care Services — general (eff. 7/2017) 0691 = Pre-hospice/Palliative Care Services — visit (eff. 7/2017) 0692 = Pre-hospice/Palliative Care Services — hourly (eff. 7/2017) 0693 = Pre-hospice/Palliative Care Services — evaluation (eff. 7/2017) 0694 = Pre-hospice/Palliative Care Services — consultation and education (eff. 7/2017) 0695 = Pre-hospice/Palliative Care Services — Inpatient (eff. 7/2017) 0696 = Pre-hospice/Palliative Care Services — Physician (eff. 7/2017) 0699 = Pre-hospice/Palliative Care Services — Other (eff. 7/2017) 0700 = Cast room — general classification 0709 = Cast room — other 0710 = Recovery room — general classification 0719 = Recovery room — other 0720 = Labor room/delivery — general classification 0721 = Labor room/delivery — labor 0722 = Labor room/delivery — delivery 0723 = Labor room/delivery — circumcision 0724 = Labor room/delivery — birthing center 0729 = Labor room/delivery — other 0730 = EKG/ECG Electrocardiogram — general classification 0731 = EKG/ECG — Holter monitor 0732 = EKG/ECG — telemetry 0739 = EKG/ECG — other 0740 = EEG Electroencephalogram — general classification 0743 = Reserved electroencephalogram (EEG) 0749 = EEG (electroencephalogram) — other 0750 = Gastro-intestinal services — general classification 0751 = Reserved gastrointestinal (GI) services 0759 = Gastro-intestinal services — other 0760 = Treatment or observation room — general classification 0761 = Treatment or observation room — treatment room 0762 = Treatment or observation room — observation room 0769 = Treatment or observation room — other 0770 = Preventive care services — general classification 0771 = Preventive care services — vaccine administration 0779 = Preventive care services — other 0780 = Telemedicine — general classification 0789 = Telemedicine — telemedicine 0790 = Extra-Corporeal Shock Wave Therapy (formerly Lithotripsy) — general classification 0799 = Extra-Corporeal Shock Wave Therapy (formerly Lithotripsy) — other 0800 = Inpatient renal dialysis — general classification 0801 = Inpatient renal dialysis — inpatient hemodialysis 0802 = Inpatient renal dialysis — inpatient peritoneal (non-CAPD) 0803 = Inpatient renal dialysis — inpatient Continuous Ambulatory Peritoneal Dialysis (CAPD) 0804 = Inpatient renal dialysis — inpatient Continuous Cycling Peritoneal Dialysis (CCPD) 0809 = Inpatient renal dialysis — other inpatient dialysis 0810 = Organ acquisition — general classification 0811 = Organ acquisition — living donor 0812 = Organ acquisition — cadaver donor 0813 = Organ acquisition — unknown donor 0814 = Organ acquisition — unsuccessful organ search-donor bank charges 0815 = Allogeneic Stem Cell Acquisition/Donor Services 0819 = Organ acquisition — other donor 0820 = Hemodialysis OP or home dialysis — general classification 0821 = Hemodialysis OP or home dialysis — hemodialysis-composite or other rate 0822 = Hemodialysis OP or home dialysis — home supplies 0823 = Hemodialysis OP or home dialysis — home equipment 0824 = Hemodialysis OP or home dialysis — maintenance/100% 0825 = Hemodialysis OP or home dialysis — support services 0829 = Hemodialysis OP or home dialysis — other 0830 = Peritoneal dialysis OP or home — general classification 0831 = Peritoneal dialysis OP or home — peritoneal-composite or other rate 0832 = Peritoneal dialysis OP or home — home supplies 0833 = Peritoneal dialysis OP or home — home equipment 0834 = Peritoneal dialysis OP or home — maintenance/100% 0835 = Peritoneal dialysis OP or home — support services 0839 = Peritoneal dialysis OP or home — other 0840 = Continuous Ambulatory Peritoneal Dialysis (CAPD) outpatient — general classification 0841 = Continuous Ambulatory Peritoneal Dialysis (CAPD) outpatient — CAPD/composite or other rate 0842 = Continuous Ambulatory Peritoneal Dialysis (CAPD) outpatient — home supplies 0843 = Continuous Ambulatory Peritoneal Dialysis (CAPD) outpatient — home equipment 0844 = Continuous Ambulatory Peritoneal Dialysis (CAPD) outpatient — maintenance/100% 0845 = Continuous Ambulatory Peritoneal Dialysis (CAPD) outpatient — support services 0849 = Continuous Ambulatory Peritoneal Dialysis (CAPD) outpatient — other 0850 = Continuous Cycling Peritoneal Dialysis (CCPD) outpatient — general classification 0851 = Continuous Cycling Peritoneal Dialysis (CCPD) outpatient — CCPD/composite or other rate 0852 = Continuous Cycling Peritoneal Dialysis (CCPD) outpatient — home supplies 0853 = Continuous Cycling Peritoneal Dialysis (CCPD) outpatient — home equipment 0854 = Continuous Cycling Peritoneal Dialysis (CCPD) outpatient — maintenance/100% 0855 = Continuous Cycling Peritoneal Dialysis (CCPD) outpatient — support services 0859 = Continuous Cycling Peritoneal Dialysis (CCPD) outpatient — other 0860 = Magnetoencephalography (MEG) — general classification 0861 = Magnetoencephalography (MEG) — MEG 0870 = Cell/Gene Therapy — General 0871 = Cell/Gene Therapy — Cell Collection 0872 = Cell/Gene Therapy — Specialized Biologic Processing and Storage — Prior To Transport 0873 = Cell/Gene Therapy — Storage and Processing After Receipt of Cells from Manufacturer 0874 = Cell/Gene Therapy — Infusion of Modified Cells (eff. 4/2019) 0875 = Cell/Gene Therapy — Injection of Modified Cells (eff. 4/2019) 0880 = Miscellaneous dialysis — general classification 0881 = Miscellaneous dialysis — ultrafiltration 0882 = Miscellaneous dialysis — home dialysis aide visit 0889 = Miscellaneous dialysis — other 0890 = Other donor bank — general classification; changed to reserved for national assignment 0891 = Special Processed Drugs - FDA Approved Cell Therapy (eff. 4/2019);Other donor bank — bone (retired 4/2019) 0892 = Special Processed Drugs — FDA Approved Gene Therapy (eff. 4/2020); Other donor bank- organ (other than kidney); changed to reserved for national assignment (terminated 3/2020) 0893 = Other donor bank — skin; changed to reserved for national assignment 0899 = Other donor bank — other; changed to reserved for national assignment 0900 = Behavior Health Treatment/ Services — general classification (eff. 10/2004); prior to 10/2004 defined as Psychiatric/ psychological treatments — general classification 0901 = Behavior Health Treatment/ Services — electroshock treatment (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments — electroshock treatment 0902 = Behavior Health Treatment/ Services — milieu therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments — milieu therapy 0903 = Behavior Health Treatment/Services — play therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments — play therapy 0904 = Behavior Health Treatment/Services — activity therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments — activity therapy 0905 = Behavior Health Treatment/Services — intensive outpatient services — psychiatric (eff. 10/2004) 0906 = Behavior Health Treatment/Services — intensive outpatient services — chemical dependency (eff. 10/2004) 0907 = Behavior Health Treatment/Services — community behavioral health program — day treatment (eff. 10/2004) 0909 = Reserved for National Use (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments — other 0910 = Behavioral Health Treatment/Services — Reserved for National Assignment (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — general classification 0911 = Behavioral Health Treatment/Services — rehabilitation (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — rehabilitation 0912 = Behavioral Health Treatment/Services — partial hospitalization — less intensive (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — less intensive 0913 = Behavioral Health Treatment/Services — partial hospitalization — intensive (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — intensive 0914 = Behavioral Health Treatment/Services — individual therapy (eff. 10/2004) prior to 10/2004 defined as Psychiatric/psychological services — individual therapy 0915 = Behavioral Health Treatment/Services — group therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — group therapy 0916 = Behavioral Health Treatment/Services — family therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — family therapy 0917 = Behavioral Health Treatment/Services — biofeedback (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — biofeedback 0918 = Behavioral Health Treatment/Services — testing (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — testing 0919 = Behavioral Health Treatment/Services — other (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services — other 0920 = Other diagnostic services — general classification 0921 = Other diagnostic services — peripheral vascular lab 0922 = Other diagnostic services — electromyelogram 0923 = Other diagnostic services — pap smear 0924 = Other diagnostic services — allergy test 0925 = Other diagnostic services — pregnancy test 0929 = Other diagnostic services — other 0931 = Medical Rehabilitation Day Program — half day 0932 = Medical Rehabilitation Day Program — Full Day 0940 = Other therapeutic services — general classification 0941 = Other therapeutic services — recreational therapy 0942 = Other therapeutic services — education/training (include diabetes diet training) 0943 = Other therapeutic services — cardiac rehabilitation 0944 = Other therapeutic services — drug rehabilitation 0945 = Other therapeutic services — alcohol rehabilitation 0946 = Other therapeutic services — routine complex medical equipment 0947 = Other therapeutic services — ancillary complex medical equipment 0948 = Other therapeutic services — pulmonary rehab 0949 = Other therapeutic services — other 0951 = Other therapeutic services — athletic training (extension of 094X) 0952 = Other therapeutic services — kinesiotherapy (extension of 094X) 0953 = Other therapeutic services — chemical dependency (drug and alcohol) (extension of 094X) 0958 = Reserved other, therapeutic services, extension of 094X 0960 = Professional fees — general classification 0961 = Professional fees — psychiatric 0962 = Professional fees — ophthalmology 0963 = Professional fees — anesthesiologist (MD) 0964 = Professional fees — anesthetist (CRNA) 0969 = Professional fees — other (NOTE: 097X is an extension of 096X) 0971 = Professional fees — laboratory 0972 = Professional fees — radiology diagnostic 0973 = Professional fees — radiology therapeutic 0974 = Professional fees — nuclear medicine 0975 = Professional fees — operating room 0976 = Professional fees — respiratory therapy 0977 = Professional fees — physical therapy 0978 = Professional fees — occupational therapy 0979 = Professional fees — speech pathology (NOTE: 098X is an extension of 096X and 097X) 0981 = Professional fees — emergency room 0982 = Professional fees — outpatient services 0983 = Professional fees — clinic 0984 = Professional fees — medical social services 0985 = Professional fees — EKG 0986 = Professional fees — EEG 0987 = Professional fees — hospital visit 0988 = Professional fees — consultation 0989 = Professional fees — private duty nurse 0990 = Patient convenience items — general classification 0991 = Patient convenience items — cafeteria/guest tray 0992 = Patient convenience items — private linen service 0993 = Patient convenience items — telephone/telegraph 0994 = Patient convenience items — tv/radio 0995 = Patient convenience items — nonpatient room rentals 0996 = Patient convenience items — late discharge charge 0997 = Patient convenience items — admission kits 0998 = Patient convenience items — beauty shop/barber 0999 = Patient convenience items — other 1000 = Behavioral health Accommodations — general 1001 = Behavioral health Accommodations — residential treatment psychiatric 1002 = Behavioral health Accommodations — residential treatment chemical dependency 1003= Behavioral health Accommodations — Supervised living 1004 = Behavioral health Accommodations — Halfway House 1005 = Behavioral health Accommodations — Group Home 1006 = Behavioral health Accommodations — Outdoor/wilderness behavioral health (eff. 7/1/17) 2100 = Alternative Therapy Services — General 2101 = Alternative Therapy Services — Acupuncture 2102 = Alternative Therapy Services — Acupressure 2103 = Alternative Therapy Services — Massage 2104 = Alternative Therapy Services — Reflexology 2105 = Alternative Therapy Services — Biofeedback 2106 = Alternative Therapy Services — Hypnosis 2109 = Alternative Therapy Services — Other 3101 = Adult Day Care — Medical and Social (hourly) 3103 = Adult Day Care — Medical and Social (daily) 3104 = Adult Day Care — Social (daily) 3105 = Adult Foster Care (daily) 3109 = Adult Day Care — other NOTE: Following Revenue Codes reported for NHCMQ (RUGS) demo claims eff. 2/96 9000 = RUGS — no MDS assessment available 9001 = Reduced physical functions — RUGS PA1/ADL index of 4–5 9002 = Reduced physical functions — RUGS PA2/ADL index of 4–5 9003 = Reduced physical functions — RUGS PB1/ADL index of 6–8 9004 = Reduced physical functions — RUGS PB2/ADL index of 6–8 9005 = Reduced physical functions — RUGS PC1/ADL index of 9–10 9006 = Reduced physical functions — RUGS PC2/ADL index of 9–10 9007 = Reduced physical functions — RUGS PD1/ADL index of 11–15 9008 = Reduced physical functions — RUGS PD2/ADL index of 11–15 9009 = Reduced physical functions — RUGS PE1/ADL index of 16–18 9010 = Reduced physical functions — RUGS PE2/ADL index of 16–18 9011 = Behavior only problems — RUGS BA1/ADL index of 4–5 9012 = Behavior only problems — RUGS BA2/ADL index of 4–5 9013 = Behavior only problems — RUGS BB1/ADL index of 6–10 9014 = Behavior only problems — RUGS BB2/ADL index of 6–10 9015 = Impaired cognition — RUGS IA1/ADL index of 4–5 9016 = Impaired cognition — RUGS IA2/ADL index of 4–5 9017 = Impaired cognition — RUGS IB1/ADL index of 6–10 9018 = Impaired cognition — RUGS IB2/ADL index of 6–10 9019 = Clinically complex — RUGS CA1/ADL index of 4–5 9020 = Clinically complex — RUGS CA2/ADL index of 4–5d 9021 = Clinically complex — RUGS CB1/ADL index of 6–10 9022 = Clinically complex — RUGS CB2/ADL index of 6–10d 9023 = Clinically complex — RUGS CC1/ADL index of 11–16 9024 = Clinically complex — RUGS CC2/ADL index of 11–16d 9025 = Clinically complex — RUGS CD1/ADL index of 17–18 9026 = Clinically complex — RUGS CD2/ADL index of 17–18d 9027 = Special care — RUGS SSA/ADL index of 7–13 9028 = Special care — RUGS SSB/ADL index of 14–16 9029 = Special care — RUGS SSC/ADL index of 17-–18 9030 = Extensive services — RUGS SE1/1 procedure 9031 = Extensive services — RUGS SE2/2 procedures 9032 = Extensive services — RUGS SE3/3 procedures 9033 = Low rehabilitation — RUGS RLA/ADL index of 4–11 9034 = Low rehabilitation — RUGS RLB/ADL index of 12–18 9035 = Medium rehabilitation — RUGS RMA/ADL index of 4-7 9036 = Medium rehabilitation — RUGS RMB/ADL index of 8–15 9037 = Medium rehabilitation — RUGS RMC/ADL index of 16–18 9038 = High rehabilitation — RUGS RHA/ADL index of 4–7 9039 = High rehabilitation — RUGS RHB/ADL index of 8–11 9040 = High rehabilitation — RUGS RHC/ADL index of 12–14 9041 = High rehabilitation — RUGS RHD/ADL index of 15–18 9042 = Very high rehabilitation — RUGS RVA/ADL index of 4–7 9043 = Very high rehabilitation — RUGS RVB/ADL index of 8–13 9044 = Very high rehabilitation — RUGS RVC/ADL index of 14–18 ***Changes effective for providers entering*** **RUGS Demo Phase III as of 1/1/1997 or later** 9019 = Clinically complex — RUGS CA1/ADL index of 11 9020 = Clinically complex — RUGS CA2/ADL index of 11D 9021 = Clinically complex — RUGS CB1/ADL index of 12-16 9022 = Clinically complex — RUGS CB2/ADL index of 12-16D 9023 = Clinically complex — RUGS CC1/ADL index of 17-18 9024 = Clinically complex — RUGS CC2/ADL index of 17-18D 9025 = Special care — RUGS SSA/ADL index of 14 9026 = Special care — RUGS SSB/ADL index of 15–16 9027 = Special care — RUGS SSC/ADL index of 17–18 9028 = Extensive services — RUGS SE1/ADL index 7–18/1 procedure 9029 = Extensive services — RUGS SE2/ADL index 7–18/2 procedures 9030 = Extensive services — RUGS SE3/ADL index 7–18/3 procedures 9031 = Low rehabilitation — RUGS RLA/ADL index of 4–13 9032 = Low rehabilitation — RUGS RLB/ADL index of 14–18 9033 = Low rehabilitation — RUGS RLA/ADL index of 4–11 9034 = Medium rehabilitation — RUGS RMB/ADL index of 8–14 9035 = Medium rehabilitation — RUGS RMC/ADL index of 15–18 9036 = High rehabilitation — RUGS RHA/ADL index of 4–7 9037 = High rehabilitation — RUGS RHB/ADL index of 8–12 9038 = High rehabilitation — RUGS RHC/ADL index of 13–18 9039 = Very High rehabilitation — RUGS RVA/ADL index of 4–8 9040 = Very high rehabilitation-RUGS RVB/ADL index of 9–15 9041 = Very high rehabilitation — RUGS RVC/ADL index of 16 9042 = Very high rehabilitation — RUGS RUA/ADL index of 4–8 9043 = Very high rehabilitation — RUGS RUB/ADL index of 9–15 9044 = Ultra high rehabilitation — RUGS RUC/ADL index of 16–18