00 = (Unknown value – rarely populated)
05 = Therapy change. Physician determined that a change in therapy was required – either the
medication was used faster than expected, or a different dosage form is needed.
07 = Emergency supply of non-formulary drugs (or formulary drugs which typically require step
therapy or prior authorization). Medication has been determined by the physician to be medically necessary.
08 = Process compound for approved ingredients
14 = LTC leave of absence – short fill required for take-home use
16 = LTC emergency box (e box) /automated dispensing machine
17 = LTC emergency supply remainder (remainder of drug from the emergency supply)
18 = LTC patient admit/readmission indicator. This status required new dispensing of medication.
19 = Split billing. The quantity dispensed is the remainder billed to a subsequent payer after Medicare
Part A benefits expired (partial payment under Part A).
21 = LTC dispensing rule for <=14 day supply is not applicable due to CMS exclusion or the fact that the
manufacturer’s packaging does not allow for special dispensing
22 = LTC dispensing, 7-day supply
23 = LTC dispensing, 4-day supply
24 = LTC dispensing, 3-day supply
25 = LTC dispensing, 2-day supply
26 = LTC dispensing, 1-day supply
27 = LTC dispensing, 4-day supply, then 3-day supply
28 = LTC dispensing, 2-day supply, then 2-day supply, then 3-day supply
29 = LTC dispensing, daily during the week then multiple days (3) for weekend
30 = LTC dispensing, per shift (multiple medication passes)
31 = LTC dispensing, per medication pass
32 = LTC dispensing, PRN on demand
33 = LTC dispensing, other <=7 day cycle
34 = LTC dispensing, 14-day supply
35 = LTC dispensing, other 8–14 day dispensing not listed above
36 = LTC dispensing, outside short cycle, determined to be Part D after originally submitted to another payer
42 = The prescriber ID submitted has been validated and is active (rarely populated)
43 = For the prescriber ID submitted, the associated DEA number has been renewed or the renewal is
in progress (rarely populated)
44 = (Unknown value – rarely populated)
45 = For the prescriber ID submitted, the associated DEA number is a valid hospital DEA number with
suffix (rarely populated)
Null = Not applicable, beneficiary not in an LTC setting (or in the first two months of 2013, the
presumption is there was greater than a 14-day supply)