Copyright © 2013 - 2020, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also contact us at ub04@aha.org. Revenue Center Code Table CCW Codebook, February, 2018 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, effective 10/00. 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, effective for cost reporting periods beginning on or after 1/1/2002 (dates of service after 12/31/01). 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 Medicare FFS Claims (Version K) Codebook 521 February 2018 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 & Board ward (medical or general)-general classification 0151 = Room & Board ward (medical or general)-medical/surgical/GYN 0152 = Room & Board ward (medical or general)-OB 0153 = Room & Board ward (medical or general)-pediatric 0154 = Room & Board ward (medical or general)-psychiatric 0155 = Room & Board ward (medical or general)-hospice 0156 = Room & Board ward (medical or general)-detoxification 0157 = Room & Board ward (medical or general)-oncology 0158 = Room & Board ward (medical or general)-rehabilitation 0159 = Room & Board ward (medical or general)-other 0160 = Other Room & Board-general classification 0164 = Other Room & Board-sterile environment 0167 = Other Room & Board-self care 0169 = Other Room & Board-other Medicare FFS Claims (Version K) Codebook 522 February 2018 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) Medicare FFS Claims (Version K) Codebook 523 February 2018 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 to 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 see 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-pace maker 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 Medicare FFS Claims (Version K) Codebook 524 February 2018 0302 = Laboratory-immunology 0303 = Laboratory-renal patient (home) 0304 = Laboratory-non-routine dialysis 0305 = Laboratory-hematology 0306 = Laboratory-bacteriology & microbiology 0307 = Laboratory-urology 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 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 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 0367 = Operating room services-kidney transplant 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 Medicare FFS Claims (Version K) Codebook 525 February 2018 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 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 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 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 Medicare FFS Claims (Version K) Codebook 526 February 2018 0460 = Pulmonary function-general classification 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. 7/1/06). Prior to 7/1/06 - Rural Health-Clinic 0522 = Free-standing clinic-Home visit by RHC/FQHC practitioner (eff. 7/1/06). Prior to 7/1/06 - 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. 7/1/06) 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. 7/1/06) 0526 = Free-standing clinic-urgent care (eff 10/96) 0527 = Free-standing clinic-RHC/FQHC visiting nurse service(s) to a member's home when in a home health shortage area. (eff. 7/1/06) 0528 = Free-standing clinic-visit by RHC/FQHC practitioner to other non-RHC/FQHC site (e.g. scene of accident). (eff. 7/1/06) 0529 = Free-standing clinic-other 0530 = Osteopathic services-general classification 0531 = Osteopathic services-osteopathic therapy 0539 = Osteopathic services-other Medicare FFS Claims (Version K) Codebook 527 February 2018 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-telephone 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-general classification 0561 = Medical social services-visit charge 0562 = Medical social services-hourly charges 0569 = Medical social services-other 0570 = Home health aid (home health)-general classification 0571 = Home health aid (home health)-visit charge 0572 = Home health aid (home health)-hourly charge 0579 = Home health aid (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) 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 count 0602 = Oxygen/Home Health-stat/equip/under 1 LPM 0603 = Oxygen/Home Health-stat/equip/over 4 LPM 0604 = Oxygen/Home Health-stat/equip/portable add-on 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 Medicare FFS Claims (Version K) Codebook 528 February 2018 0616 = MRT/MRA-Lower Extremities 0618 = MRT/MRA-other 0619 = MRT/Other MRI 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-EPO under 10,000 units 0635 = Drugs requiring specific identification-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-1/2 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 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 0700 = Cast room-general classification Medicare FFS Claims (Version K) Codebook 529 February 2018 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-general classification 0731 = EKG/ECG-Holter moniter 0732 = EKG/ECG-telemetry 0739 = EKG/ECG-other 0740 = EEG-general classification 0749 = EEG (electroencephalogram)-other 0750 = Gastro-intestinal services-general classification 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 = Preventative care services-general classification 0771 = Preventative care services-vaccine administration 0779 = Preventative care services-other 0780 = Telemedicine - general classification 0789 = Telemedicine - telemedicine 0790 = Lithotripsy-general classification 0799 = 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 CAPD 0804 = Inpatient renal dialysis-inpatient 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 Medicare FFS Claims (Version K) Codebook 530 February 2018 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 = CAPD outpatient-general classification 0841 = CAPD outpatient-CAPD/composite or other rate 0842 = CAPD outpatient-home supplies 0843 = CAPD outpatient-home equipment 0844 = CAPD outpatient-maintenance/100% 0845 = CAPD outpatient-support services 0849 = CAPD outpatient-other 0850 = CCPD outpatient-general classification 0851 = CCPD outpatient-CCPD/composite or other rate 0852 = CCPD outpatient-home supplies 0853 = CCPD outpatient-home equipment 0854 = CCPD outpatient-maintenance/100% 0855 = CCPD outpatient-support services 0859 = CCPD outpatient-other 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 = Other donor bank-bone; changed to reserved for national assignment 0892 = Other donor bank-organ (other than kidney); changed to reserved for national assignment 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 Medicare FFS Claims (Version K) Codebook 531 February 2018 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 Medicare FFS Claims (Version K) Codebook 532 February 2018 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 0949 = Other therapeutic services-other 0951 = Professional Fees-athletic training (extension of 094X) 0952 = Professional Fees-kinesiotherapy (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 & 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 Medicare FFS Claims (Version K) Codebook 533 February 2018 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 2101 = Alternative Therapy Services – Acupuncture 2103 = Alternative Therapy Services – Massage 3101 = Adult Day Care – Medical and Social (hourly) 3103 = Adult Day Care – Medical and Social (daily) 3104 = Adult Day Care –Social (daily) 3109 = Adult Day Care –other NOTE: Following Revenue Codes reported for NHCMQ (RUGS) demo claims effective 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 Medicare FFS Claims (Version K) Codebook 534 February 2018 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 1/1/97 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 Medicare FFS Claims (Version K) Codebook 535 February 2018 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 ResDAC note: The American Hospital Association (the “AHA”) has not reviewed, and is not responsible for the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. 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