"REVENUE_CODE","LO_VERSION","HI_VERSION","DESCRIPTION","STATUS_INDICATOR","NOT_RECOGNIZED","THERAPY","BYPASS_E48","STATUTORY_EXCLUSION","BUNDLED_IN_BIOLOGICAL"
"1","60","65","Total Charge","E","0","0","0","0","0"
"1","66","87","Total Charge","E1","0","0","0","0","0"
"22","60","87","Health Insurance - Prospective Payment System (HIPPS) - Skilled Nursing Facility PPS","B","0","0","0","0","0"
"23","60","87","Health Insurance - Prospective Payment System (HIPPS) - Home Health PPS","B","0","0","0","0","0"
"24","60","87","Health Insurance - Prospective Payment System (HIPPS)/inpatient Rehab Facility PPS","B","0","0","0","0","0"
"100","60","87","All Inclusive Rate - All-inclusive Room and Board Plus Ancillary","B","0","0","0","0","0"
"101","60","87","All Inclusive Rate - All-inclusive Room and Board","B","0","0","0","0","0"
"110","60","87","Room & Board - Private (One Bed) - General Classification","B","0","0","0","0","0"
"111","60","87","Room & Board - Private (One Bed) - Medical/Surgical/Gyn","B","0","0","0","0","0"
"112","60","65","Room & Board - Private (One Bed) - Obstetrics (OB)","E","0","0","0","0","0"
"112","66","87","Room & Board - Private (One Bed) - Obstetrics (OB)","E1","0","0","0","0","0"
"113","60","87","Room & Board - Private (One Bed) - Pediatric","B","0","0","0","0","0"
"114","60","87","Room & Board - Private (One Bed) - Psychiatric","B","0","0","0","0","0"
"115","60","87","Room & Board - Private (One Bed) - Hospice","B","0","0","0","0","0"
"116","60","87","Room & Board - Private (One Bed) - Detoxification","B","0","0","0","0","0"
"117","60","87","Room & Board - Private (One Bed) - Oncology","B","0","0","0","0","0"
"118","60","87","Room & Board - Private (One Bed) - Rehabilitation","B","0","0","0","0","0"
"119","60","87","Room & Board - Private (One Bed) - Other","B","0","0","0","0","0"
"120","60","87","Room & Board - Semi-private (Two Beds) - General Classification","B","0","0","0","0","0"
"121","60","87","Room & Board - Semi-private (Two Beds) - Medical/Surgical/Gyn","B","0","0","0","0","0"
"122","60","65","Room & Board - Semi-private (Two Beds) - Obstetrics (OB)","E","0","0","0","0","0"
"122","66","87","Room & Board - Semi-private (Two Beds) - Obstetrics (OB)","E1","0","0","0","0","0"
"123","60","87","Room & Board - Semi-private (Two Beds) - Pediatric","B","0","0","0","0","0"
"124","60","87","Room & Board - Semi-private (Two Beds) - Psychiatric","B","0","0","0","0","0"
"125","60","87","Room & Board - Semi-private (Two Beds) - Hospice","B","0","0","0","0","0"
"126","60","87","Room & Board - Semi-private (Two Beds) - Detoxification","B","0","0","0","0","0"
"127","60","87","Room & Board - Semi-private (Two Beds) - Oncology","B","0","0","0","0","0"
"128","60","87","Room & Board - Semi-private (Two Beds) - Rehabilitation","B","0","0","0","0","0"
"129","60","87","Room & Board - Semi-private (Two Beds) - Other","B","0","0","0","0","0"
"130","60","87","Room & Board - Semi-private - Three and Four Beds - General Classification","B","0","0","0","0","0"
"131","60","87","Room & Board - Semi-private - Three and Four Beds - Medical/Surgical/Gyn","B","0","0","0","0","0"
"132","60","65","Room & Board - Semi-private - Three and Four Beds - Obstetrics (OB)","E","0","0","0","0","0"
"132","66","87","Room & Board - Semi-private - Three and Four Beds - Obstetrics (OB)","E1","0","0","0","0","0"
"133","60","87","Room & Board - Semi-private - Three and Four Beds - Pediatric","B","0","0","0","0","0"
"134","60","87","Room & Board - Semi-private - Three and Four Beds - Psychiatric","B","0","0","0","0","0"
"135","60","87","Room & Board - Semi-private - Three and Four Beds - Hospice","B","0","0","0","0","0"
"136","60","87","Room & Board - Semi-private - Three and Four Beds - Detoxification","B","0","0","0","0","0"
"137","60","87","Room & Board - Semi-private - Three and Four Beds - Oncology","B","0","0","0","0","0"
"138","60","87","Room & Board - Semi-private - Three and Four Beds - Rehabilitation","B","0","0","0","0","0"
"139","60","87","Room & Board - Semi-private - Three and Four Beds - Other","B","0","0","0","0","0"
"140","60","87","Room & Board - Deluxe Private - General Classification","B","0","0","0","0","0"
"141","60","87","Room & Board - Deluxe Private - Medical/Surgical/Gyn","B","0","0","0","0","0"
"142","60","65","Room & Board - Deluxe Private - Obstetrics (OB)","E","0","0","0","0","0"
"142","66","87","Room & Board - Deluxe Private - Obstetrics (OB)","E1","0","0","0","0","0"
"143","60","87","Room & Board - Deluxe Private - Pediatric","B","0","0","0","0","0"
"144","60","87","Room & Board - Deluxe Private - Psychiatric","B","0","0","0","0","0"
"145","60","87","Room & Board - Deluxe Private - Hospice","B","0","0","0","0","0"
"146","60","87","Room & Board - Deluxe Private - Detoxification","B","0","0","0","0","0"
"147","60","87","Room & Board - Deluxe Private - Oncology","B","0","0","0","0","0"
"148","60","87","Room & Board - Deluxe Private - Rehabilitation","B","0","0","0","0","0"
"149","60","87","Room & Board - Deluxe Private - Other","B","0","0","0","0","0"
"150","60","87","Room & Board - Ward - General Classification","B","0","0","0","0","0"
"151","60","87","Room & Board - Ward - Medical/Surgical/Gyn","B","0","0","0","0","0"
"152","60","65","Room & Board - Ward - Obstetrics (OB)","E","0","0","0","0","0"
"152","66","87","Room & Board - Ward - Obstetrics (OB)","E1","0","0","0","0","0"
"153","60","87","Room & Board - Ward - Pediatric","B","0","0","0","0","0"
"154","60","87","Room & Board - Ward - Psychiatric","B","0","0","0","0","0"
"155","60","87","Room & Board - Ward - Hospice","B","0","0","0","0","0"
"156","60","87","Room & Board - Ward - Detoxification","B","0","0","0","0","0"
"157","60","87","Room & Board - Ward - Oncology","B","0","0","0","0","0"
"158","60","87","Room & Board - Ward - Rehabilitation","B","0","0","0","0","0"
"159","60","87","Room & Board - Ward - Other","B","0","0","0","0","0"
"160","60","87","Room & Board - Other - General Classification","B","0","0","0","0","0"
"164","60","87","Room & Board - Other - Sterile Environment","B","0","0","0","0","0"
"167","60","87","Room & Board - Other - Self Care","B","0","0","0","0","0"
"169","60","87","Room & Board - Other - Other","B","0","0","0","0","0"
"170","60","65","Nursery - General Classification","E","0","0","0","0","0"
"170","66","87","Nursery - General Classification","E1","0","0","0","0","0"
"171","60","65","Nursery - Newborn - Level I","E","0","0","0","0","0"
"171","66","87","Nursery - Newborn - Level I","E1","0","0","0","0","0"
"172","60","65","Nursery - Newborn - Level II","E","0","0","0","0","0"
"172","66","87","Nursery - Newborn - Level II","E1","0","0","0","0","0"
"173","60","65","Nursery - Newborn - Level III","E","0","0","0","0","0"
"173","66","87","Nursery - Newborn - Level III","E1","0","0","0","0","0"
"174","60","65","Nursery - Newborn - Level IV","E","0","0","0","0","0"
"174","66","87","Nursery - Newborn - Level IV","E1","0","0","0","0","0"
"179","60","65","Nursery - Other Nursery","E","0","0","0","0","0"
"179","66","87","Nursery - Other Nursery","E1","0","0","0","0","0"
"180","60","87","Leave of Absence - General Classification","B","0","0","0","0","0"
"182","60","87","Leave of Absence - Patient Convenience","B","0","0","0","0","0"
"183","60","87","Leave of Absence - Therapeutic Leave","B","0","0","0","0","0"
"185","60","87","Leave of Absence - Nursing Home (For Hospitalization)","B","0","0","0","0","0"
"189","60","87","Leave of Absence - Other Loa","B","0","0","0","0","0"
"190","60","87","Subacute Care - General Classification","B","0","0","0","0","0"
"191","60","87","Subacute Care - Subacute Care - Level I","B","0","0","0","0","0"
"192","60","87","Subacute Care - Subacute Care - Level II","B","0","0","0","0","0"
"193","60","87","Subacute Care - Subacute Care - Level III","B","0","0","0","0","0"
"194","60","87","Subacute Care - Subacute Care - Level IV","B","0","0","0","0","0"
"199","60","87","Subacute Care - Other Subacute Care","B","0","0","0","0","0"
"200","60","65","Intensive Care Unit - General Classification","E","0","0","0","0","0"
"200","66","87","Intensive Care Unit - General Classification","E1","0","0","0","0","0"
"201","60","65","Intensive Care Unit - Surgical","E","0","0","0","0","0"
"201","66","87","Intensive Care Unit - Surgical","E1","0","0","0","0","0"
"202","60","65","Intensive Care Unit - Medical","E","0","0","0","0","0"
"202","66","87","Intensive Care Unit - Medical","E1","0","0","0","0","0"
"203","60","65","Intensive Care Unit - Pediatric","E","0","0","0","0","0"
"203","66","87","Intensive Care Unit - Pediatric","E1","0","0","0","0","0"
"204","60","65","Intensive Care Unit - Psychiatric","E","0","0","0","0","0"
"204","66","87","Intensive Care Unit - Psychiatric","E1","0","0","0","0","0"
"206","60","65","Intensive Care Unit - Intermediate ICU","E","0","0","0","0","0"
"206","66","87","Intensive Care Unit - Intermediate ICU","E1","0","0","0","0","0"
"207","60","65","Intensive Care Unit - Burn Care","E","0","0","0","0","0"
"207","66","87","Intensive Care Unit - Burn Care","E1","0","0","0","0","0"
"208","60","65","Intensive Care Unit - Trauma","E","0","0","0","0","0"
"208","66","87","Intensive Care Unit - Trauma","E1","0","0","0","0","0"
"209","60","65","Intensive Care Unit - Other Intensive Care","E","0","0","0","0","0"
"209","66","87","Intensive Care Unit - Other Intensive Care","E1","0","0","0","0","0"
"210","60","65","Coronary Care Unit - General Classification","E","0","0","0","0","0"
"210","66","87","Coronary Care Unit - General Classification","E1","0","0","0","0","0"
"211","60","65","Coronary Care Unit - Myocardial Infarction","E","0","0","0","0","0"
"211","66","87","Coronary Care Unit - Myocardial Infarction","E1","0","0","0","0","0"
"212","60","65","Coronary Care Unit - Pulmonary Care","E","0","0","0","0","0"
"212","66","87","Coronary Care Unit - Pulmonary Care","E1","0","0","0","0","0"
"213","60","65","Coronary Care Unit - Heart Transplant","E","0","0","0","0","0"
"213","66","87","Coronary Care Unit - Heart Transplant","E1","0","0","0","0","0"
"214","60","65","Coronary Care Unit - Intermediate CCU","E","0","0","0","0","0"
"214","66","87","Coronary Care Unit - Intermediate CCU","E1","0","0","0","0","0"
"219","60","65","Coronary Care Unit - Other Coronary CCU","E","0","0","0","0","0"
"219","66","87","Coronary Care Unit - Other Coronary CCU","E1","0","0","0","0","0"
"220","60","65","Special Charges - General Classification","E","0","0","0","0","0"
"220","66","87","Special Charges - General Classification","E1","0","0","0","0","0"
"221","60","65","Special Charges - Admission Charges","E","0","0","0","0","0"
"221","66","87","Special Charges - Admission Charges","E1","0","0","0","0","0"
"222","60","65","Special Charges - Technical Support Charge","E","0","0","0","0","0"
"222","66","87","Special Charges - Technical Support Charge","E1","0","0","0","0","0"
"223","60","65","Special Charges - U.R. Service Charge","E","0","0","0","0","0"
"223","66","87","Special Charges - U.R. Service Charge","E1","0","0","0","0","0"
"224","60","65","Special Charges - Late Discharge, Medically Necessary","E","0","0","0","0","0"
"224","66","87","Special Charges - Late Discharge, Medically Necessary","E1","0","0","0","0","0"
"229","60","65","Special Charges - Other Special Charges","E","0","0","0","0","0"
"229","66","87","Special Charges - Other Special Charges","E1","0","0","0","0","0"
"230","60","87","Incremental Nursing Charge - General Classification","B","0","0","0","0","0"
"231","60","87","Incremental Nursing Charge - Nursery","B","0","0","0","0","0"
"232","60","87","Incremental Nursing Charge - OB","B","0","0","0","0","0"
"233","60","87","Incremental Nursing Charge - ICU","B","0","0","0","0","0"
"234","60","87","Incremental Nursing Charge - CCU","B","0","0","0","0","0"
"235","60","87","Incremental Nursing Charge - Hospice","B","0","0","0","0","0"
"239","60","87","Incremental Nursing Charge - Other","B","0","0","0","0","0"
"240","60","87","All Inclusive Ancillary - General Classification","B","0","0","0","0","0"
"241","60","87","All Inclusive Ancillary - Basic","B","0","0","0","0","0"
"242","60","87","All Inclusive Ancillary - Comprehensive","B","0","0","0","0","0"
"243","60","87","All Inclusive Ancillary - Specialty","B","0","0","0","0","0"
"249","60","87","All Inclusive Ancillary - Other All Inclusive Ancillary","B","0","0","0","0","0"
"250","60","87","Pharmacy (Also See 063x, An Extension of 025x) - General Classification","N","0","0","0","0","0"
"251","60","87","Pharmacy (Also See 063x, An Extension of 025x) - Generic Drugs","N","0","0","0","0","0"
"252","60","87","Pharmacy (Also See 063x, An Extension of 025x) - Non-generic Drugs","N","0","0","0","0","0"
"253","60","65","Pharmacy (Also See 063x, An Extension of 025x) - Take Home Drugs","E","0","0","0","0","0"
"253","66","87","Pharmacy (Also See 063x, An Extension of 025x) - Take Home Drugs","E1","0","0","0","0","0"
"254","60","87","Pharmacy (Also See 063x, An Extension of 025x) - Drugs Incident to Other Diagnostic Services","N","0","0","0","0","0"
"255","60","87","Pharmacy (Also See 063x, An Extension of 025x) - Drugs Incident to Radiology","N","0","0","0","0","0"
"256","60","65","Pharmacy (Also See 063x, An Extension of 025x) - Experimental Drugs","E","0","0","0","0","0"
"256","66","87","Pharmacy (Also See 063x, An Extension of 025x) - Experimental Drugs","E1","0","0","0","0","0"
"257","60","87","Pharmacy (Also See 063x, An Extension of 025x) - Non-prescription","N","0","0","0","0","0"
"258","60","87","Pharmacy (Also See 063x, An Extension of 025x) - IV Solutions","N","0","0","0","0","0"
"259","60","87","Pharmacy (Also See 063x, An Extension of 025x) - Other Pharmacy","N","0","0","0","0","0"
"260","60","87","IV Therapy - General Classification","N","0","0","0","0","0"
"261","60","87","IV Therapy - Infusion Pump","N","0","0","0","0","0"
"262","60","87","IV Therapy - IV Therapy/pharmacy Svcs","N","0","0","0","0","0"
"263","60","87","IV Therapy - IV Therapy/Drug/Supply/ Delivery","N","0","0","0","0","0"
"264","60","87","IV Therapy - IV Therapy/Supplies","N","0","0","0","0","0"
"269","60","87","IV Therapy - Other IV Therapy","N","0","0","0","0","0"
"270","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027) - General Classification","N","0","0","0","0","0"
"271","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Non Sterile Supply","N","0","0","0","0","0"
"272","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Sterile Supply","N","0","0","0","0","0"
"273","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Take Home Supplies","N","0","0","0","0","0"
"274","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Prosthetic/Orthotic Devices","Z","0","0","0","0","0"
"275","60","87","Medical/Surgical Supplies and Devices (Also See 062 X, An Extension of 027x) - Pacemaker","N","0","0","0","0","0"
"276","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Intraocular Lens","N","0","0","0","0","0"
"277","60","65","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Oxygen-take Home","E","0","0","0","0","0"
"277","66","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Oxygen-take Home","E1","0","0","0","0","0"
"278","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Other Implant","N","0","0","0","0","0"
"279","60","87","Medical/Surgical Supplies and Devices (Also See 062x, An Extension of 027x) - Other Supplies/Devices","N","0","0","0","0","0"
"280","60","87","Oncology - General Classification","N","0","0","0","0","0"
"289","60","87","Oncology - Other Oncology","N","0","0","0","0","0"
"290","60","87","Durable Medical Equipment (Other Than Renal) - General Classification","Z","0","0","0","0","0"
"291","60","65","Durable Medical Equipment (Other Than Renal) - Rental","E","0","0","0","0","0"
"291","66","87","Durable Medical Equipment (Other Than Renal) - Rental","E1","0","0","0","0","0"
"292","60","65","Durable Medical Equipment (Other Than Renal) - Purchase of New DME","E","0","0","0","0","0"
"292","66","87","Durable Medical Equipment (Other Than Renal) - Purchase of New DME","E1","0","0","0","0","0"
"293","60","65","Durable Medical Equipment (Other Than Renal) - Purchase of Used DME","E","0","0","0","0","0"
"293","66","87","Durable Medical Equipment (Other Than Renal) - Purchase of Used DME","E1","0","0","0","0","0"
"294","60","65","Durable Medical Equipment (Other Than Renal) - Supplies/Drugs for DME ","E","0","0","0","0","0"
"294","66","87","Durable Medical Equipment (Other Than Renal) - Supplies/Drugs for DME ","E1","0","0","0","0","0"
"299","60","65","Durable Medical Equipment (Other Than Renal) - Other Equipment","E","0","0","0","0","0"
"299","66","87","Durable Medical Equipment (Other Than Renal) - Other Equipment","E1","0","0","0","0","0"
"300","60","65","Laboratory - General Classification","E","0","0","0","0","0"
"300","66","87","Laboratory - General Classification","E1","0","0","0","0","0"
"301","60","65","Laboratory - Chemistry","E","0","0","0","0","0"
"301","66","87","Laboratory - Chemistry","E1","0","0","0","0","0"
"302","60","65","Laboratory - Immunology","E","0","0","0","0","0"
"302","66","87","Laboratory - Immunology","E1","0","0","0","0","0"
"303","60","65","Laboratory - Renal Patient (Home)","E","0","0","0","0","0"
"303","66","87","Laboratory - Renal Patient (Home)","E1","0","0","0","0","0"
"304","60","65","Laboratory - Non-Routine Dialysis","E","0","0","0","0","0"
"304","66","87","Laboratory - Non-Routine Dialysis","E1","0","0","0","0","0"
"305","60","65","Laboratory - Hematology","E","0","0","0","0","0"
"305","66","87","Laboratory - Hematology","E1","0","0","0","0","0"
"306","60","65","Laboratory - Bacteriology & Microbiology","E","0","0","0","0","0"
"306","66","87","Laboratory - Bacteriology & Microbiology","E1","0","0","0","0","0"
"307","60","65","Laboratory - Urology","E","0","0","0","0","0"
"307","66","87","Laboratory - Urology","E1","0","0","0","0","0"
"309","60","65","Laboratory - Other Laboratory","E","0","0","0","0","0"
"309","66","87","Laboratory - Other Laboratory","E1","0","0","0","0","0"
"310","60","65","Laboratory Pathology - General Classification","E","0","0","0","0","0"
"310","66","87","Laboratory Pathology - General Classification","E1","0","0","0","0","0"
"311","60","65","Laboratory Pathology - Cytology","E","0","0","0","0","0"
"311","66","87","Laboratory Pathology - Cytology","E1","0","0","0","0","0"
"312","60","65","Laboratory Pathology - Histology","E","0","0","0","0","0"
"312","66","87","Laboratory Pathology - Histology","E1","0","0","0","0","0"
"314","60","65","Laboratory Pathology - Biopsy","E","0","0","0","0","0"
"314","66","87","Laboratory Pathology - Biopsy","E1","0","0","0","0","0"
"319","60","65","Laboratory Pathology - Other Laboratory Pathology","E","0","0","0","0","0"
"319","66","87","Laboratory Pathology - Other Laboratory Pathology","E1","0","0","0","0","0"
"320","60","87","Radiology - Diagnostic - General Classification","B","0","0","0","0","0"
"321","60","65","Radiology - Diagnostic - Angiocardiography","E","0","0","0","0","0"
"321","66","87","Radiology - Diagnostic - Angiocardiography","E1","0","0","0","0","0"
"322","60","65","Radiology - Diagnostic - Arthrography","E","0","0","0","0","0"
"322","66","87","Radiology - Diagnostic - Arthrography","E1","0","0","0","0","0"
"323","60","65","Radiology - Diagnostic - Arteriography","E","0","0","0","0","0"
"323","66","87","Radiology - Diagnostic - Arteriography","E1","0","0","0","0","0"
"324","60","87","Radiology - Diagnostic - Chest X-ray","B","0","0","0","0","0"
"329","60","87","Radiology - Diagnostic - Other Radiology - Diagnostic","B","0","0","0","0","0"
"330","60","65","Radiology - Therapeutic and/or Chemotherapy Administration - General Classification","E","0","0","0","0","0"
"330","66","87","Radiology - Therapeutic and/or Chemotherapy Administration - General Classification","E1","0","0","0","0","0"
"331","60","87","Radiology - Therapeutic and/or Chemotherapy Administration - Chemotherapy Admin - Injected","B","0","0","0","0","0"
"332","60","65","Radiology - Therapeutic and/or Chemotherapy Administration - Chemotherapy Administration - Oral","E","0","0","0","0","0"
"332","66","87","Radiology - Therapeutic and/or Chemotherapy Administration - Chemotherapy Administration - Oral","E1","0","0","0","0","0"
"333","60","65","Radiology - Therapeutic and/or Chemotherapy Administration - Radiation Therapy","E","0","0","0","0","0"
"333","66","87","Radiology - Therapeutic and/or Chemotherapy Administration - Radiation Therapy","E1","0","0","0","0","0"
"335","60","87","Radiology - Therapeutic and/or Chemotherapy Administration - Chemotherapy Admin - IV","B","0","0","0","0","0"
"339","60","65","Radiology - Therapeutic and/or Chemotherapy Administration - Other Radiology - Therapeutic","E","0","0","0","0","0"
"339","66","87","Radiology - Therapeutic and/or Chemotherapy Administration - Other Radiology - Therapeutic","E1","0","0","0","0","0"
"340","60","65","Nuclear Medicine - General Classification","E","0","0","0","0","0"
"340","66","87","Nuclear Medicine - General Classification","E1","0","0","0","0","0"
"341","60","65","Nuclear Medicine - Diagnostic","E","0","0","0","0","0"
"341","66","87","Nuclear Medicine - Diagnostic","E1","0","0","0","0","0"
"342","60","65","Nuclear Medicine - Therapeutic","E","0","0","0","0","0"
"342","66","87","Nuclear Medicine - Therapeutic","E1","0","0","0","0","0"
"343","60","87","Nuclear Medicine - Diagnostic Radiopharmaceuticals","N","0","0","0","0","0"
"344","60","87","Nuclear Medicine - Therapeutic Radiopharmaceuticals","N","0","0","0","0","0"
"349","60","65","Nuclear Medicine - Other Nuclear Medicine","E","0","0","0","0","0"
"349","66","87","Nuclear Medicine - Other Nuclear Medicine","E1","0","0","0","0","0"
"350","60","65","CT Scan - General Classification","E","0","0","0","0","0"
"350","66","87","CT Scan - General Classification","E1","0","0","0","0","0"
"351","60","65","CT Scan - Head Scan","E","0","0","0","0","0"
"351","66","87","CT Scan - Head Scan","E1","0","0","0","0","0"
"352","60","65","CT Scan - Body Scan","E","0","0","0","0","0"
"352","66","87","CT Scan - Body Scan","E1","0","0","0","0","0"
"359","60","65","CT Scan - CT - Other","E","0","0","0","0","0"
"359","66","87","CT Scan - CT - Other","E1","0","0","0","0","0"
"360","60","65","Operating Room Services - General Classification","E","0","0","0","0","0"
"360","66","87","Operating Room Services - General Classification","E1","0","0","0","0","0"
"361","60","65","Operating Room Services - Minor Surgery","E","0","0","0","0","0"
"361","66","87","Operating Room Services - Minor Surgery","E1","0","0","0","0","0"
"362","60","65","Operating Room Services - Organ Transplant-Other Than Kidney","E","0","0","0","0","0"
"362","66","87","Operating Room Services - Organ Transplant-Other Than Kidney","E1","0","0","0","0","0"
"367","60","65","Operating Room Services - Kidney Transplant","E","0","0","0","0","0"
"367","66","87","Operating Room Services - Kidney Transplant","E1","0","0","0","0","0"
"369","60","65","Operating Room Services - Other or Services","E","0","0","0","0","0"
"369","66","87","Operating Room Services - Other or Services","E1","0","0","0","0","0"
"370","60","87","Anesthesia - General Classification","N","0","0","0","0","0"
"371","60","87","Anesthesia - Anesthesia Incident to Radiology","N","0","0","0","0","0"
"372","60","87","Anesthesia - Anesthesia Incident to Other DX Services","N","0","0","0","0","0"
"374","60","65","Anesthesia - Acupuncture","E","0","0","0","0","0"
"374","66","87","Anesthesia - Acupuncture","E1","0","0","0","0","0"
"379","60","87","Anesthesia - Other Anesthesia","N","0","0","0","0","0"
"380","60","65","Blood and Blood Components - General Classification","E","0","0","0","0","0"
"380","66","87","Blood and Blood Components - General Classification","E1","0","0","0","0","0"
"381","60","65","Blood and Blood Components - Packed Red Cells","E","0","0","0","0","0"
"381","66","87","Blood and Blood Components - Packed Red Cells","E1","0","0","0","0","0"
"382","60","65","Blood and Blood Components - Whole Blood","E","0","0","0","0","0"
"382","66","87","Blood and Blood Components - Whole Blood","E1","0","0","0","0","0"
"383","60","65","Blood and Blood Components - Plasma","E","0","0","0","0","0"
"383","66","87","Blood and Blood Components - Plasma","E1","0","0","0","0","0"
"384","60","65","Blood and Blood Components - Platelets","E","0","0","0","0","0"
"384","66","87","Blood and Blood Components - Platelets","E1","0","0","0","0","0"
"385","60","65","Blood and Blood Components - Leucocytes","E","0","0","0","0","0"
"385","66","87","Blood and Blood Components - Leucocytes","E1","0","0","0","0","0"
"386","60","65","Blood and Blood Components - Other Blood Components","E","0","0","0","0","0"
"386","66","87","Blood and Blood Components - Other Blood Components","E1","0","0","0","0","0"
"387","60","65","Blood and Blood Components - Other Derivatives (Cryoprecipitate)","E","0","0","0","0","0"
"387","66","87","Blood and Blood Components - Other Derivatives (Cryoprecipitate)","E1","0","0","0","0","0"
"389","60","65","Blood and Blood Components - Other Blood and Blood Components","E","0","0","0","0","0"
"389","66","87","Blood and Blood Components - Other Blood and Blood Components","E1","0","0","0","0","0"
"390","60","87","Administration, Processing, and Storage for Blood and Blood Components - General Classification","N","0","0","0","0","0"
"391","60","65","Administration, Processing, and Storage for Blood and Blood Components - Administration (E.G. Transfusions)","E","0","0","0","0","0"
"391","66","87","Administration, Processing, and Storage for Blood and Blood Components - Administration (E.G. Transfusions)","E1","0","0","0","0","0"
"392","60","87","Administration, Processing, and Storage for Blood and Blood Components - Processing and Storage","N","0","0","0","0","0"
"399","60","87","Administration, Processing, and Storage for Blood and Blood Components - Other Blood Handling","N","0","0","0","0","0"
"400","60","65","Other Imaging Services - General Classification","E","0","0","0","0","0"
"400","66","87","Other Imaging Services - General Classification","E1","0","0","0","0","0"
"401","60","65","Other Imaging Services - Diagnostic Mammography","E","0","0","0","0","0"
"401","66","87","Other Imaging Services - Diagnostic Mammography","E1","0","0","0","0","0"
"402","60","65","Other Imaging Services - Ultrasound","E","0","0","0","0","0"
"402","66","87","Other Imaging Services - Ultrasound","E1","0","0","0","0","0"
"403","60","87","Other Imaging Services - Screening Mammography","Z","0","0","0","0","0"
"404","60","65","Other Imaging Services - Positron Emission Tomography","E","0","0","0","0","0"
"404","66","87","Other Imaging Services - Positron Emission Tomography","E1","0","0","0","0","0"
"409","60","65","Other Imaging Services - Other Imaging Services","E","0","0","0","0","0"
"409","66","87","Other Imaging Services - Other Imaging Services","E1","0","0","0","0","0"
"410","60","87","Respiratory Services - General Classification","B","0","0","0","0","0"
"412","60","87","Respiratory Services - Inhalation Services","B","0","0","0","0","0"
"413","60","87","Respiratory Services - Hyperbaric Oxygen Therapy","B","0","0","0","0","0"
"419","60","87","Respiratory Services - Other Respiratory Services","B","0","0","0","0","0"
"420","60","65","Physical Therapy - General Classification","E","0","1","0","0","0"
"420","66","87","Physical Therapy - General Classification","E1","0","1","0","0","0"
"421","60","65","Physical Therapy - Visit","E","0","1","0","0","0"
"421","66","87","Physical Therapy - Visit","E1","0","1","0","0","0"
"422","60","65","Physical Therapy - Hourly","E","0","1","0","0","0"
"422","66","87","Physical Therapy - Hourly","E1","0","1","0","0","0"
"423","60","65","Physical Therapy - Group","E","0","1","0","0","0"
"423","66","87","Physical Therapy - Group","E1","0","1","0","0","0"
"424","60","65","Physical Therapy - Evaluation or Re-Evaluation","E","0","1","0","0","0"
"424","66","87","Physical Therapy - Evaluation or Re-Evaluation","E1","0","1","0","0","0"
"429","60","65","Physical Therapy - Other Physical Therapy","E","0","1","0","0","0"
"429","66","87","Physical Therapy - Other Physical Therapy","E1","0","1","0","0","0"
"430","60","65","Occupational Therapy - General Classification","E","0","1","0","0","0"
"430","66","87","Occupational Therapy - General Classification","E1","0","1","0","0","0"
"431","60","65","Occupational Therapy - Visit","E","0","1","0","0","0"
"431","66","87","Occupational Therapy - Visit","E1","0","1","0","0","0"
"432","60","65","Occupational Therapy - Hourly","E","0","1","0","0","0"
"432","66","87","Occupational Therapy - Hourly","E1","0","1","0","0","0"
"433","60","65","Occupational Therapy - Group","E","0","1","0","0","0"
"433","66","87","Occupational Therapy - Group","E1","0","1","0","0","0"
"434","60","65","Occupational Therapy - Evaluation or Reevaluation","E","0","1","0","0","0"
"434","66","87","Occupational Therapy - Evaluation or Reevaluation","E1","0","1","0","0","0"
"439","60","65","Occupational Therapy - Other Occupational Therapy","E","0","1","0","0","0"
"439","66","87","Occupational Therapy - Other Occupational Therapy","E1","0","1","0","0","0"
"440","60","65","Speech-language Pathology - General Classification","E","0","1","0","0","0"
"440","66","87","Speech-language Pathology - General Classification","E1","0","1","0","0","0"
"441","60","65","Speech-language Pathology - Visit","E","0","1","0","0","0"
"441","66","87","Speech-language Pathology - Visit","E1","0","1","0","0","0"
"442","60","65","Speech-language Pathology - Hourly","E","0","1","0","0","0"
"442","66","87","Speech-language Pathology - Hourly","E1","0","1","0","0","0"
"443","60","65","Speech-language Pathology - Group","E","0","1","0","0","0"
"443","66","87","Speech-language Pathology - Group","E1","0","1","0","0","0"
"444","60","65","Speech-language Pathology - Evaluation or Reevaluation","E","0","1","0","0","0"
"444","66","87","Speech-language Pathology - Evaluation or Reevaluation","E1","0","1","0","0","0"
"449","60","65","Speech-language Pathology - Other Speech Therapy","E","0","1","0","0","0"
"449","66","87","Speech-language Pathology - Other Speech Therapy","E1","0","1","0","0","0"
"450","60","65","Emergency Room - General Classification","E","0","0","0","0","0"
"450","66","87","Emergency Room - General Classification","E1","0","0","0","0","0"
"451","60","65","Emergency Room - Emtala Emergency Medical Screening Services","E","0","0","0","0","0"
"451","66","87","Emergency Room - Emtala Emergency Medical Screening Services","E1","0","0","0","0","0"
"452","60","65","Emergency Room - Er Beyond Emtala Screening","E","0","0","0","0","0"
"452","66","87","Emergency Room - Er Beyond Emtala Screening","E1","0","0","0","0","0"
"456","60","65","Emergency Room - Urgent Care","E","0","0","0","0","0"
"456","66","87","Emergency Room - Urgent Care","E1","0","0","0","0","0"
"459","60","65","Emergency Room - Other Emergency Room","E","0","0","0","0","0"
"459","66","87","Emergency Room - Other Emergency Room","E1","0","0","0","0","0"
"460","60","87","Pulmonary Function - General Classification","B","0","0","0","0","0"
"469","60","87","Pulmonary Function - Other Pulmonary Function","B","0","0","0","0","0"
"470","60","65","Audiology - General Classification","E","0","0","0","0","0"
"470","66","87","Audiology - General Classification","E1","0","0","0","0","0"
"471","60","87","Audiology - Diagnostic","B","0","0","0","0","0"
"472","60","87","Audiology - Treatment","B","0","0","0","0","0"
"479","60","87","Audiology - Other Audiology","B","0","0","0","0","0"
"480","60","65","Cardiology - General Classification","E","0","0","0","0","0"
"480","66","87","Cardiology - General Classification","E1","0","0","0","0","0"
"481","60","65","Cardiology - Cardiac Cath Lab","E","0","0","0","0","0"
"481","66","87","Cardiology - Cardiac Cath Lab","E1","0","0","0","0","0"
"482","60","65","Cardiology - Stress Test","E","0","0","0","0","0"
"482","66","87","Cardiology - Stress Test","E1","0","0","0","0","0"
"483","60","65","Cardiology - Echocardiology","E","0","0","0","0","0"
"483","66","87","Cardiology - Echocardiology","E1","0","0","0","0","0"
"489","60","65","Cardiology - Other Cardiology","E","0","0","0","0","0"
"489","66","87","Cardiology - Other Cardiology","E1","0","0","0","0","0"
"490","60","65","Ambulatory Surgical Care - General Classification","E","0","0","0","0","0"
"490","66","87","Ambulatory Surgical Care - General Classification","E1","0","0","0","0","0"
"499","60","65","Ambulatory Surgical Care - Other Ambulatory Surgical Care","E","0","0","0","0","0"
"499","66","87","Ambulatory Surgical Care - Other Ambulatory Surgical Care","E1","0","0","0","0","0"
"500","60","87","Outpatient Services - General Classification","Z","1","0","1","0","0"
"509","60","87","Outpatient Services - Other Outpatient Service","Z","1","0","1","0","0"
"510","60","65","Clinic - General Classification","E","0","0","0","0","0"
"510","66","87","Clinic - General Classification","E1","0","0","0","0","0"
"511","60","65","Clinic - Chronic Pain Center","E","0","0","0","0","0"
"511","66","87","Clinic - Chronic Pain Center","E1","0","0","0","0","0"
"512","60","65","Clinic - Dental Clinic","E","0","0","0","0","0"
"512","66","87","Clinic - Dental Clinic","E1","0","0","0","0","0"
"513","60","65","Clinic - Psychiatric Clinic","E","0","0","0","0","0"
"513","66","87","Clinic - Psychiatric Clinic","E1","0","0","0","0","0"
"514","60","65","Clinic - Ob-gyn Clinic","E","0","0","0","0","0"
"514","66","87","Clinic - Ob-gyn Clinic","E1","0","0","0","0","0"
"515","60","65","Clinic - Pediatric Clinic","E","0","0","0","0","0"
"515","66","87","Clinic - Pediatric Clinic","E1","0","0","0","0","0"
"516","60","65","Clinic - Urgent Care Clinic","E","0","0","0","0","0"
"516","66","87","Clinic - Urgent Care Clinic","E1","0","0","0","0","0"
"517","60","65","Clinic - Family Practice Clinic","E","0","0","0","0","0"
"517","66","87","Clinic - Family Practice Clinic","E1","0","0","0","0","0"
"519","60","65","Clinic - Other Clinic","E","0","0","0","0","0"
"519","66","87","Clinic - Other Clinic","E1","0","0","0","0","0"
"520","60","65","Freestanding Clinic - General Classification","E","0","0","0","0","0"
"520","66","87","Freestanding Clinic - General Classification","E1","0","0","0","0","0"
"521","60","87","Freestanding Clinic - Clinic Visit by Member to RHC/FQHC","B","0","0","1","0","0"
"522","60","87","Freestanding Clinic - Home Visit by RHC/FQHC Practitioner","B","0","0","1","0","0"
"523","60","65","Freestanding Clinic - Family Practice Clinic","E","0","0","0","0","0"
"523","66","87","Freestanding Clinic - Family Practice Clinic","E1","0","0","0","0","0"
"524","60","87","Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF or Skilled Swing Bed in a Covered Part A Stay","B","0","0","1","0","0"
"525","60","87","Freestanding 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","B","0","0","1","0","0"
"526","60","65","Freestanding Clinic - Urgent Care Clinic","E","0","0","0","0","0"
"526","66","87","Freestanding Clinic - Urgent Care Clinic","E1","0","0","0","0","0"
"527","60","87","Freestanding Clinic - Visiting Nurse Service(S) to a Member's Home When in a Home Health Shortage Area","B","0","0","1","0","0"
"528","60","87","Freestanding Clinic - Visit by RHC/FQHC Practitioner to Other Non-RHC/FQHC Site (E.G. Scene of Accident)","B","0","0","1","0","0"
"529","60","65","Freestanding Clinic - Other Freestanding Clinic","E","0","0","0","0","0"
"529","66","87","Freestanding Clinic - Other Freestanding Clinic","E1","0","0","0","0","0"
"530","60","65","Osteopathic Services - General Classification","E","0","0","0","0","0"
"530","66","87","Osteopathic Services - General Classification","E1","0","0","0","0","0"
"531","60","65","Osteopathic Services - Osteopathic Therapy","E","0","0","0","0","0"
"531","66","87","Osteopathic Services - Osteopathic Therapy","E1","0","0","0","0","0"
"539","60","65","Osteopathic Services - Other Osteopathic Services","E","0","0","0","0","0"
"539","66","87","Osteopathic Services - Other Osteopathic Services","E1","0","0","0","0","0"
"540","60","65","Ambulance - General Classification","E","0","0","0","0","0"
"540","66","87","Ambulance - General Classification","E1","0","0","0","0","0"
"541","60","65","Ambulance - Supplies","E","0","0","0","0","0"
"541","66","87","Ambulance - Supplies","E1","0","0","0","0","0"
"542","60","65","Ambulance - Medical Transport","E","0","0","0","0","0"
"542","66","87","Ambulance - Medical Transport","E1","0","0","0","0","0"
"543","60","65","Ambulance - Heart Mobile","E","0","0","0","0","0"
"543","66","87","Ambulance - Heart Mobile","E1","0","0","0","0","0"
"544","60","65","Ambulance - Oxygen","E","0","0","0","0","0"
"544","66","87","Ambulance - Oxygen","E1","0","0","0","0","0"
"545","60","65","Ambulance - Air Ambulance","E","0","0","0","0","0"
"545","66","87","Ambulance - Air Ambulance","E1","0","0","0","0","0"
"546","60","65","Ambulance - Neonatal Ambulance Services","E","0","0","0","0","0"
"546","66","87","Ambulance - Neonatal Ambulance Services","E1","0","0","0","0","0"
"547","60","65","Ambulance - Pharmacy","E","0","0","0","0","0"
"547","66","87","Ambulance - Pharmacy","E1","0","0","0","0","0"
"548","60","65","Ambulance - EKG Transmission","E","0","0","0","0","0"
"548","66","87","Ambulance - EKG Transmission","E1","0","0","0","0","0"
"549","60","65","Ambulance - Other Ambulance","E","0","0","0","0","0"
"549","66","87","Ambulance - Other Ambulance","E1","0","0","0","0","0"
"550","60","87","Skilled Nursing - General Classification","B","0","0","0","0","0"
"551","60","87","Skilled Nursing - Visit Charge","B","0","0","0","0","0"
"552","60","87","Skilled Nursing - Hourly Charge","B","0","0","0","0","0"
"559","60","87","Skilled Nursing - Other Skilled Nursing","B","0","0","0","0","0"
"560","60","87","Home Health (HH) Medical Social Services - General Classification","Z","0","0","0","0","0"
"561","60","87","Home Health (HH) Medical Social Services - Visit Charge","B","0","0","0","0","0"
"562","60","87","Home Health (HH) Medical Social Services - Hourly Charge","B","0","0","0","0","0"
"569","60","87","Home Health (HH) Medical Social Services - Other Med. Social Service","Z","0","0","0","0","0"
"570","60","65","Home Health (HH) Aide - General Classification","E","0","0","0","0","0"
"570","66","87","Home Health (HH) Aide - General Classification","E1","0","0","0","0","0"
"571","60","65","Home Health (HH) Aide - Visit Charge","E","0","0","0","0","0"
"571","66","87","Home Health (HH) Aide - Visit Charge","E1","0","0","0","0","0"
"572","60","65","Home Health (HH) Aide - Hourly Charge","E","0","0","0","0","0"
"572","66","87","Home Health (HH) Aide - Hourly Charge","E1","0","0","0","0","0"
"579","60","65","Home Health (HH) - Other HH Aide","E","0","0","0","0","0"
"579","66","87","Home Health (HH) - Other HH Aide","E1","0","0","0","0","0"
"580","60","65","Home Health (HH) - Other Visits - General Classification","E","0","0","0","0","0"
"580","66","87","Home Health (HH) - Other Visits - General Classification","E1","0","0","0","0","0"
"581","60","65","Home Health (HH) - Other Visits - Visit Charge","E","0","0","0","0","0"
"581","66","87","Home Health (HH) - Other Visits - Visit Charge","E1","0","0","0","0","0"
"582","60","65","Home Health (HH) - Other Visits - Hourly Charge","E","0","0","0","0","0"
"582","66","87","Home Health (HH) - Other Visits - Hourly Charge","E1","0","0","0","0","0"
"583","60","87","Home Health (HH) - Other Visits - Assessment","B","1","0","1","0","0"
"589","60","65","Home Health (HH) - Other Visits - Other Home Health Visit","E","0","0","0","0","0"
"589","66","87","Home Health (HH) - Other Visits - Other Home Health Visit","E1","0","0","0","0","0"
"590","60","65","Home Health (HH) - Units of Service - General Classification","E","0","0","0","0","0"
"590","66","87","Home Health (HH) - Units of Service - General Classification","E1","0","0","0","0","0"
"600","60","65","Home Health (HH) - Oxygen - General Classification","E","0","0","0","0","0"
"600","66","87","Home Health (HH) - Oxygen - General Classification","E1","0","0","0","0","0"
"601","60","65","Home Health (HH) - Oxygen - Oxygen - Stat Equip/Supply/Content","E","0","0","0","0","0"
"601","66","87","Home Health (HH) - Oxygen - Oxygen - Stat Equip/Supply/Content","E1","0","0","0","0","0"
"602","60","65","Home Health (HH) - Oxygen - Oxygen - Stat Equip/Supply < 1 LPM","E","0","0","0","0","0"
"602","66","87","Home Health (HH) - Oxygen - Oxygen - Stat Equip/Supply < 1 LPM","E1","0","0","0","0","0"
"603","60","65","Home Health (HH) - Oxygen - Oxygen - Stat Equip/Supply > 4 LPM","E","0","0","0","0","0"
"603","66","87","Home Health (HH) - Oxygen - Oxygen - Stat Equip/Supply > 4 LPM","E1","0","0","0","0","0"
"604","60","65","Home Health (HH) - Oxygen - Oxygen - Port Add-on","E","0","0","0","0","0"
"604","66","87","Home Health (HH) - Oxygen - Oxygen - Port Add-on","E1","0","0","0","0","0"
"609","60","65","Home Health (HH) - Oxygen - Oxygen - Other","E","0","0","0","0","0"
"609","66","87","Home Health (HH) - Oxygen - Oxygen - Other","E1","0","0","0","0","0"
"610","60","65","Magnetic Resonance Technology (MRT) - General Classification","E","0","0","0","0","0"
"610","66","87","Magnetic Resonance Technology (MRT) - General Classification","E1","0","0","0","0","0"
"611","60","65","Magnetic Resonance Technology (MRT) - MRI - Brain/Brainstem","E","0","0","0","0","0"
"611","66","87","Magnetic Resonance Technology (MRT) - MRI - Brain/Brainstem","E1","0","0","0","0","0"
"612","60","65","Magnetic Resonance Technology (MRT) - MRI - Spinal Cord/Spine","E","0","0","0","0","0"
"612","66","87","Magnetic Resonance Technology (MRT) - MRI - Spinal Cord/Spine","E1","0","0","0","0","0"
"614","60","65","Magnetic Resonance Technology (MRT) - MRI - Other","E","0","0","0","0","0"
"614","66","87","Magnetic Resonance Technology (MRT) - MRI - Other","E1","0","0","0","0","0"
"615","60","65","Magnetic Resonance Technology (MRT) - Mra - Head and Neck","E","0","0","0","0","0"
"615","66","87","Magnetic Resonance Technology (MRT) - Mra - Head and Neck","E1","0","0","0","0","0"
"616","60","65","Magnetic Resonance Technology (MRT) - Mra - Lower Extremities","E","0","0","0","0","0"
"616","66","87","Magnetic Resonance Technology (MRT) - Mra - Lower Extremities","E1","0","0","0","0","0"
"618","60","65","Magnetic Resonance Technology (MRT) - Mra - Other","E","0","0","0","0","0"
"618","66","87","Magnetic Resonance Technology (MRT) - Mra - Other","E1","0","0","0","0","0"
"619","60","65","Magnetic Resonance Technology (MRT) - Other MRT","E","0","0","0","0","0"
"619","66","87","Magnetic Resonance Technology (MRT) - Other MRT","E1","0","0","0","0","0"
"621","60","87","Medical/Surgical Supplies and Devices - Extension of 027x - Supplies Incident to Radiology","N","0","0","0","0","0"
"622","60","87","Medical/Surgical Supplies and Devices - Extension of 027x - Supplies Incident to Other DX Services","N","0","0","0","0","0"
"623","60","87","Medical/Surgical Supplies and Devices - Extension of 027x - Surgical Dressings","N","0","0","0","0","0"
"624","60","87","Medical/Surgical Supplies and Devices - Extension of 027x - FDA Investigational Devices","N","0","0","0","0","0"
"630","60","87","Reserved for National Assignment","N","0","0","0","0","0"
"631","60","87","Pharmacy - Extension of 025x - Single Source Drug","N","0","0","0","0","0"
"632","60","87","Pharmacy - Extension of 025x - Multiple Source Drug","N","0","0","0","0","0"
"633","60","87","Pharmacy - Extension of 025x - Restrictive Prescription","N","0","0","0","0","0"
"634","60","87","Pharmacy - Extension of 025x - Erythropoietin (EPO) <10,000 Units","B","0","0","0","0","0"
"635","60","87","Pharmacy - Extension of 025x - Erythropoietin (EPO) >=10,000 Units","B","0","0","0","0","0"
"636","60","65","Pharmacy - Extension of 025x - Drugs Requiring Detailed Coding","E","0","0","0","0","0"
"636","66","87","Pharmacy - Extension of 025x - Drugs Requiring Detailed Coding","E1","0","0","0","0","0"
"637","60","65","Pharmacy - Extension of 025x - Self-Administrable Drugs","E","0","0","1","1","0"
"637","66","87","Pharmacy - Extension of 025x - Self-Administrable Drugs","E1","0","0","1","1","0"
"640","60","87","Home IV Therapy Services - General Classification","B","0","0","0","0","0"
"641","60","87","Home IV Therapy Services - Non-Routine Nursing, Central Line","B","0","0","0","0","0"
"642","60","87","Home IV Therapy Services - IV Site Care, Central Line","B","0","0","0","0","0"
"643","60","87","Home IV Therapy Services - IV Start/Change, Peripheral Line","B","0","0","0","0","0"
"644","60","87","Home IV Therapy Services - Non-Routine Nursing, Peripheral Line","B","0","0","0","0","0"
"645","60","87","Home IV Therapy Services - Training Patient/Caregiver, Central Line","B","0","0","0","0","0"
"646","60","87","Home IV Therapy Services - Training Disabled Patient, Central Line","B","0","0","0","0","0"
"647","60","87","Home IV Therapy Services - Training Patient/Caregiver, Peripheral Line","B","0","0","0","0","0"
"648","60","87","Home IV Therapy Services - Training Disabled Patient, Peripheral Line","B","0","0","0","0","0"
"649","60","87","Home IV Therapy Services - Other IV Therapy Services","B","0","0","0","0","0"
"650","60","87","Hospice Service - General Classification","B","0","0","0","0","0"
"651","60","87","Hospice Service - Routine Home Care","B","0","0","0","0","0"
"652","60","87","Hospice Service - Continuous Home Care","B","0","0","0","0","0"
"655","60","65","Hospice Service - Inpatient Respite Care","E","0","0","0","0","0"
"655","66","87","Hospice Service - Inpatient Respite Care","E1","0","0","0","0","0"
"656","60","65","Hospice Service - General Inpatient Care Non-Respite","E","0","0","0","0","0"
"656","66","87","Hospice Service - General Inpatient Care Non-Respite","E1","0","0","0","0","0"
"657","60","87","Hospice Service - Physician Services","B","0","0","0","0","0"
"658","60","87","Hospice Service - Hospice Room & Board - Nursing Facility","B","0","0","0","0","0"
"659","60","87","Hospice Service - Other Hospice Service","B","0","0","0","0","0"
"660","60","87","Respite Care - General Classification","Z","1","0","1","0","0"
"661","60","87","Respite Care - Hourly Charge - Nursing","Z","1","0","1","0","0"
"662","60","87","Respite Care - Hourly Charge - Aide/Homemaker/Companion","Z","1","0","1","0","0"
"663","60","87","Respite Care - Daily Respite Charge","Z","1","0","1","0","0"
"669","60","87","Respite Care - Other Respite Care","Z","1","0","1","0","0"
"670","60","87","Outpatient Special Residence Charges - General Classification","B","0","0","0","0","0"
"671","60","87","Outpatient Special Residence Charges - Hospital Owned","B","0","0","0","0","0"
"672","60","87","Outpatient Special Residence Charges - Contracted","B","0","0","0","0","0"
"679","60","87","Outpatient Special Residence Charges - Other Special Residence Charge","B","0","0","0","0","0"
"681","60","87","Trauma Response - Level I Trauma","N","0","0","0","0","0"
"682","60","87","Trauma Response - Level II Trauma","N","0","0","0","0","0"
"683","60","87","Trauma Response - Level III Trauma","N","0","0","0","0","0"
"684","60","87","Trauma Response - Level IV Trauma","N","0","0","0","0","0"
"689","60","87","Trauma Response - Other Trauma Response","N","0","0","0","0","0"
"690","60","87","Pre-hospice/palliative Care Services - General Classification","Z","0","0","0","0","0"
"691","60","87","Pre-hospice/palliative Care Services - Visit Charge","Z","0","0","0","0","0"
"692","60","87","Pre-hospice/palliative Care Services - Hourly Charge","Z","0","0","0","0","0"
"693","60","87","Pre-hospice/palliative Care Services - Evaluation","Z","0","0","0","0","0"
"694","60","87","Pre-hospice/palliative Care Services - Evaluation","Z","0","0","0","0","0"
"695","60","87","Pre-hospice/palliative Care Services - Inpatient Care","Z","0","0","0","0","0"
"696","60","87","Pre-hospice/palliative Care Services - Physician Services","Z","0","0","0","0","0"
"699","60","87","Pre-hospice/palliative Care Services - Other Pre-hospice/palliative Care Services","Z","0","0","0","0","0"
"700","60","87","Cast Room - General Classification","N","0","0","0","0","0"
"710","60","87","Recovery Room - General Classification","N","0","0","0","0","0"
"720","60","87","Labor Room/Delivery - General Classification","N","0","0","0","0","0"
"721","60","87","Labor Room/Delivery - Labor","N","0","0","0","0","0"
"722","60","65","Labor Room/Delivery - Delivery Room","E","0","0","0","0","0"
"722","66","87","Labor Room/Delivery - Delivery Room","E1","0","0","0","0","0"
"723","60","65","Labor Room/Delivery - Circumcision","E","0","0","0","0","0"
"723","66","87","Labor Room/Delivery - Circumcision","E1","0","0","0","0","0"
"724","60","65","Labor Room/Delivery - Birthing Center","E","0","0","0","0","0"
"724","66","87","Labor Room/Delivery - Birthing Center","E1","0","0","0","0","0"
"729","60","65","Labor Room/Delivery - Other Labor Room/Delivery","E","0","0","0","0","0"
"729","66","87","Labor Room/Delivery - Other Labor Room/Delivery","E1","0","0","0","0","0"
"730","60","87","EKG/ecg (Electrocardiogram) - General Classification","B","0","0","0","0","0"
"731","60","87","EKG/ecg (Electrocardiogram) - Holter Monitor","B","0","0","0","0","0"
"732","60","87","EKG/ecg (Electrocardiogram) - Telemetry","N","0","0","0","0","0"
"739","60","87","EKG/ecg (Electrocardiogram) - Other EKG/ecg","B","0","0","0","0","0"
"740","60","87","EEG (Electroencephalogram) - General Classification","B","0","0","0","0","0"
"750","60","87","Gastro - Intestinal (Gi) Services - General Classification","B","0","0","0","0","0"
"760","60","87","Specialty Services - General Classification","B","0","0","1","0","0"
"761","60","65","Specialty Services - Treatment Room","E","0","0","0","0","0"
"761","66","87","Specialty Services - Treatment Room","E1","0","0","0","0","0"
"762","60","87","Specialty Services - Observation Hours","N","0","0","0","0","0"
"769","60","87","Specialty Services - Other Specialty Services","B","0","0","0","0","0"
"770","60","87","Preventive Care Services - General Classification","B","0","0","0","0","0"
"771","60","87","Preventive Care Services - Vaccine Administration","B","0","0","0","0","0"
"780","60","87","Telemedicine - General Classification","B","0","0","0","0","0"
"790","60","65","Extra-corporeal Shock Wave Therapy (Formerly Lithotripsy) - General Classification","E","0","0","0","0","0"
"790","66","87","Extra-corporeal Shock Wave Therapy (Formerly Lithotripsy) - General Classification","E1","0","0","0","0","0"
"800","60","65","Inpatient Renal Dialysis - General Classification","E","0","0","0","0","0"
"800","66","87","Inpatient Renal Dialysis - General Classification","E1","0","0","0","0","0"
"801","60","87","Inpatient Renal Dialysis - Inpatient Hemodialysis","N","0","0","0","0","0"
"802","60","87","Inpatient Renal Dialysis - Inpatient Peritoneal (Non-CAPPD)","N","0","0","0","0","0"
"803","60","87","Inpatient Renal Dialysis - Inpatient Continuous Ambulatory Peritoneal Dialysis (CAPPD)","N","0","0","0","0","0"
"804","60","87","Inpatient Renal Dialysis - Inpatient Continuous Cycling Peritoneal Dialysis (CCPD)","N","0","0","0","0","0"
"809","60","87","Inpatient Renal Dialysis - Other Inpatient Dialysis","N","0","0","0","0","0"
"810","60","87","Acquisition of Body Components - General Classification","N","0","0","0","0","0"
"811","60","65","Acquisition of Body Components - Living Donor","E","0","0","0","0","0"
"811","66","87","Acquisition of Body Components - Living Donor","E1","0","0","0","0","0"
"812","60","65","Acquisition of Body Components - Cadaver Donor","E","0","0","0","0","0"
"812","66","87","Acquisition of Body Components - Cadaver Donor","E1","0","0","0","0","0"
"813","60","65","Acquisition of Body Components - Unknown Donor","E","0","0","0","0","0"
"813","66","87","Acquisition of Body Components - Unknown Donor","E1","0","0","0","0","0"
"814","60","65","Acquisition of Body Components - Unsuccessful Organ Search - Donor Bank Charges","E","0","0","0","0","0"
"814","66","87","Acquisition of Body Components - Unsuccessful Organ Search - Donor Bank Charges","E1","0","0","0","0","0"
"815","66","87","Acquisition of Body Components - Stem Cell Acquisition - Allogeneic","N","0","0","0","0","0"
"819","60","87","Acquisition of Body Components - Other Donor","N","0","0","0","0","0"
"820","60","87","Hemodialysis - Outpatient or Home - General Classification","Z","0","0","0","0","0"
"821","60","87","Hemodialysis - Outpatient or Home - Hemodialysis Composite or Other Rate","N","0","0","0","0","0"
"822","60","65","Hemodialysis - Outpatient or Home - Home Supplies","E","0","0","0","0","0"
"822","66","87","Hemodialysis - Outpatient or Home - Home Supplies","E1","0","0","0","0","0"
"823","60","65","Hemodialysis - Outpatient or Home - Home Equipment","E","0","0","0","0","0"
"823","66","87","Hemodialysis - Outpatient or Home - Home Equipment","E1","0","0","0","0","0"
"824","60","87","Hemodialysis - Outpatient or Home - Maintenance - 100%","N","0","0","0","0","0"
"825","60","87","Hemodialysis - Outpatient or Home - Support Services","N","0","0","0","0","0"
"829","60","87","Hemodialysis - Outpatient or Home - Other Op Hemodialysis","N","0","0","0","0","0"
"830","60","87","Peritoneal Dialysis - Outpatient or Home - General Classification","Z","0","0","0","0","0"
"831","60","87","Peritoneal Dialysis - Outpatient or Home - Peritoneal/Composite or Other Rate","Z","0","0","0","0","0"
"832","60","87","Peritoneal Dialysis - Outpatient or Home - Home Supplies","B","0","0","0","0","0"
"833","60","87","Peritoneal Dialysis - Outpatient or Home - Home Equipment","Z","0","0","0","0","0"
"834","60","87","Peritoneal Dialysis - Outpatient or Home - Maintenance - 100%","B","0","0","0","0","0"
"835","60","87","Peritoneal Dialysis - Outpatient or Home - Support Services","B","0","0","0","0","0"
"839","60","87","Peritoneal Dialysis - Outpatient or Home - Other Outpatient Peritoneal Dialysis","Z","0","0","0","0","0"
"840","60","87","Continuous Ambulatory Peritoneal Dialysis (CAPPD) - Outpatient or Home - General Classification","Z","0","0","0","0","0"
"841","60","87","Continuous Ambulatory Peritoneal Dialysis (CAPPD) - Outpatient or Home - CAPPD/Composite or Other Rate","Z","0","0","0","0","0"
"842","60","87","Continuous Ambulatory Peritoneal Dialysis (CAPPD) - Outpatient or Home - Home Supplies","B","0","0","0","0","0"
"843","60","87","Continuous Ambulatory Peritoneal Dialysis (CAPPD) - Outpatient or Home - Home Equipment","B","0","0","0","0","0"
"844","60","87","Continuous Ambulatory Peritoneal Dialysis (CAPPD) - Outpatient or Home - Maintenance - 100%","B","0","0","0","0","0"
"845","60","87","Continuous Ambulatory Peritoneal Dialysis (CAPPD) - Outpatient or Home - Support Services","B","0","0","0","0","0"
"849","60","87","Continuous Ambulatory Peritoneal Dialysis (CAPPD) - Outpatient or Home - Other Outpatient CAPPD","Z","0","0","0","0","0"
"850","60","87","Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - General Classification","Z","0","0","0","0","0"
"851","60","87","Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - CCPD/Composite or Other Rate","Z","0","0","0","0","0"
"852","60","87","Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - Home Supplies","B","0","0","0","0","0"
"853","60","87","Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - Home Equipment","B","0","0","0","0","0"
"854","60","87","Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - Maintenance - 100%","B","0","0","0","0","0"
"855","60","87","Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - Support Services","B","0","0","0","0","0"
"859","60","87","Continuous Cycling Peritoneal Dialysis (CCPD) - Outpatient or Home - Other Outpatient CCPD","Z","0","0","0","0","0"
"860","60","87","Magnetoencephalography (Meg) - General Classification","N","0","0","0","0","0"
"861","60","87","Magnetoencephalography (MEG) - MEG","N","0","0","0","0","0"
"870","75","87","Cell/Gene Therapy - General Classification","B","0","0","1","0","1"
"871","75","87","Cell/Gene Therapy - Cell Collection","B","0","0","1","0","1"
"872","75","87","Cell/Gene Therapy - Specialized Biologic Processing and Storage - Prior to Transport","B","0","0","1","0","1"
"873","75","87","Cell/Gene Therapy - Storage and Processing After Receipt of Cells From Manufacturer","B","0","0","1","0","1"
"874","75","87","Cell/Gene Therapy - Infusion of Modified Cells","B","0","0","1","0","0"
"875","75","87","Cell/Gene Therapy - Injection of Modified Cells","B","0","0","1","0","0"
"880","60","87","Miscellaneous Dialysis - General Classification","Z","0","0","0","0","0"
"881","60","87","Miscellaneous Dialysis - Ultrafiltration","Z","0","0","0","0","0"
"882","60","87","Miscellaneous Dialysis - Home Dialysis Aid Visit","B","0","0","0","0","0"
"889","60","87","Miscellaneous Dialysis - Other Miscellaneous Dialysis","Z","0","0","0","0","0"
"890","75","87","Pharmacy - Extension of 025x and 063x - Reserved","B","0","0","1","0","0"
"891","75","87","Pharmacy - Extension of 025x and 063x - Special Processed Drugs - FDA Approved Cell Therapy","B","0","0","1","0","0"
"892","79","87","Pharmacy - Extension of 025x and 063x - Special Processed Drugs - FDA Approved Gene Therapy","B","0","0","0","0","0"
"900","60","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - General Classification","B","0","0","0","0","0"
"901","60","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Electroshock Treatment","B","0","0","0","0","0"
"902","60","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Milieu Therapy","B","0","0","0","0","0"
"903","60","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Play Therapy","B","0","0","0","0","0"
"904","60","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Activity Therapy","B","0","0","0","0","0"
"905","60","65","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Intensive Outpatient Services - Psychiatric","E","1","0","1","0","0"
"905","66","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Intensive Outpatient Services - Psychiatric","E1","1","0","1","0","0"
"906","60","65","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Intensive Outpatient Services - Chemical Dependency","E","1","0","1","0","0"
"906","66","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Intensive Outpatient Services - Chemical Dependency","E1","1","0","1","0","0"
"907","60","65","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Community Behavioral Health Program (Day Treatment)","E","1","0","1","0","0"
"907","66","87","Behavioral Health Treatment/Services (Also See 091x, An Extension of 090x) - Community Behavioral Health Program (Day Treatment)","E1","1","0","1","0","0"
"911","60","87","Behavioral Health Treatment/Services - Extension of 090x - Rehabilitation","B","0","0","0","0","0"
"912","60","87","Behavioral Health Treatment/Services - Extension of 090x - Partial Hospitalization - Less Intensive","B","0","0","0","0","0"
"913","60","87","Behavioral Health Treatment/Services - Extension of 090x - Partial Hospitalization - Intensive","B","0","0","0","0","0"
"914","60","87","Behavioral Health Treatment/Services - Extension of 090x - Individual Therapy","B","0","0","0","0","0"
"915","60","87","Behavioral Health Treatment/Services - Extension of 090x - Group Therapy","B","0","0","0","0","0"
"916","60","87","Behavioral Health Treatment/Services - Extension of 090x - Family Therapy","B","0","0","0","0","0"
"917","60","65","Behavioral Health Treatment/Services - Extension of 090x - Bio Feedback","E","0","0","0","0","0"
"917","66","87","Behavioral Health Treatment/Services - Extension of 090x - Bio Feedback","E1","0","0","0","0","0"
"918","60","87","Behavioral Health Treatment/Services - Extension of 090x - Testing","B","0","0","0","0","0"
"919","60","87","Behavioral Health Treatment/Services - Extension of 090x - Other Behavioral Health Treatments","B","0","0","0","0","0"
"920","60","87","Other Diagnostic Services - General Classification","B","0","0","0","0","0"
"921","60","87","Other Diagnostic Services - Peripheral Vascular Lab","B","0","0","0","0","0"
"922","60","87","Other Diagnostic Services - Electromyogram","B","0","0","0","0","0"
"923","60","65","Other Diagnostic Services - Pap Smear","E","0","0","0","0","0"
"923","66","87","Other Diagnostic Services - Pap Smear","E1","0","0","0","0","0"
"924","60","87","Other Diagnostic Services - Allergy Test","B","0","0","0","0","0"
"925","60","87","Other Diagnostic Services - Pregnancy Test","Z","0","0","0","0","0"
"929","60","87","Other Diagnostic Services - Other Diagnostic Service","B","0","0","0","0","0"
"931","60","87","Medical Rehabilitation Day Program - Half Day","Z","1","0","1","0","0"
"932","60","87","Medical Rehabilitation Day Program - Full Day","Z","1","0","1","0","0"
"940","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - General Classification","N","0","0","0","0","0"
"941","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Recreational Therapy","B","0","0","0","0","0"
"942","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Education/training","N","0","0","0","0","0"
"943","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Cardiac Rehabilitation","N","0","0","0","0","0"
"944","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Drug Rehabilitation","B","0","0","0","0","0"
"945","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Alcohol Rehabilitation","B","0","0","0","0","0"
"946","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Complex Medical Equipment - Routine","B","0","0","0","0","0"
"947","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Complex Medical Equipment - Ancillary","B","0","0","0","0","0"
"948","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Pulmonary Rehabilitation","N","0","0","1","0","0"
"949","60","87","Other Therapeutic Services (Also See 095x, An Extension of 094x) - Other Therapeutic Service","B","0","0","0","0","0"
"951","60","65","Other Therapeutic Services (Extension of 094x) - Athletic Training","E","0","0","0","0","0"
"951","66","87","Other Therapeutic Services (Extension of 094x) - Athletic Training","E1","0","0","0","0","0"
"952","60","65","Other Therapeutic Services (Extension of 094x) - Kinesiotherapy","E","0","0","0","0","0"
"952","66","87","Other Therapeutic Services (Extension of 094x) - Kinesiotherapy","E1","0","0","0","0","0"
"953","60","87","Other Therapeutic Services (Extension of 094x) - Chemical Dependency (Drug and Alcohol)","B","0","0","0","0","0"
"960","60","65","Professional Fees (Also See 097x and 098x) - General Classification","E","0","0","0","0","0"
"960","66","87","Professional Fees (Also See 097x and 098x) - General Classification","E1","0","0","0","0","0"
"961","60","65","Professional Fees (Also See 097x and 098x) - Psychiatric","E","0","0","0","0","0"
"961","66","87","Professional Fees (Also See 097x and 098x) - Psychiatric","E1","0","0","0","0","0"
"962","60","65","Professional Fees (Also See 097x and 098x) - Ophthalmology","E","0","0","0","0","0"
"962","66","87","Professional Fees (Also See 097x and 098x) - Ophthalmology","E1","0","0","0","0","0"
"963","60","65","Professional Fees (Also See 097x and 098x) - Anesthesiologist (MD)","E","0","0","0","0","0"
"963","66","87","Professional Fees (Also See 097x and 098x) - Anesthesiologist (MD)","E1","0","0","0","0","0"
"964","60","87","Professional Fees (Also See 097x and 098x) - Anesthetist (CRNA)","F","0","0","0","0","0"
"969","60","65","Professional Fees (Also See 097x and 098x) - Other Professional Fee","E","0","0","0","0","0"
"969","66","87","Professional Fees (Also See 097x and 098x) - Other Professional Fee","E1","0","0","0","0","0"
"971","60","65","Professional Fees (Extension of 096x) - Laboratory","E","0","0","0","0","0"
"971","66","87","Professional Fees (Extension of 096x) - Laboratory","E1","0","0","0","0","0"
"972","60","65","Professional Fees (Extension of 096x) - Radiology - Diagnostic","E","0","0","0","0","0"
"972","66","87","Professional Fees (Extension of 096x) - Radiology - Diagnostic","E1","0","0","0","0","0"
"973","60","65","Professional Fees (Extension of 096x) - Radiology - Therapeutic","E","0","0","0","0","0"
"973","66","87","Professional Fees (Extension of 096x) - Radiology - Therapeutic","E1","0","0","0","0","0"
"974","60","65","Professional Fees (Extension of 096x) - Radiology - Nuclear","E","0","0","0","0","0"
"974","66","87","Professional Fees (Extension of 096x) - Radiology - Nuclear","E1","0","0","0","0","0"
"975","60","65","Professional Fees (Extension of 096x) - Operating Room","E","0","0","0","0","0"
"975","66","87","Professional Fees (Extension of 096x) - Operating Room","E1","0","0","0","0","0"
"976","60","65","Professional Fees (Extension of 096x) - Respiratory Therapy","E","0","0","0","0","0"
"976","66","87","Professional Fees (Extension of 096x) - Respiratory Therapy","E1","0","0","0","0","0"
"977","60","65","Professional Fees (Extension of 096x) - Physical Therapy","E","0","0","0","0","0"
"977","66","87","Professional Fees (Extension of 096x) - Physical Therapy","E1","0","0","0","0","0"
"978","60","65","Professional Fees (Extension of 096x) - Occupational Therapy","E","0","0","0","0","0"
"978","66","87","Professional Fees (Extension of 096x) - Occupational Therapy","E1","0","0","0","0","0"
"979","60","65","Professional Fees (Extension of 096x) - Speech Pathology","E","0","0","0","0","0"
"979","66","87","Professional Fees (Extension of 096x) - Speech Pathology","E1","0","0","0","0","0"
"981","60","65","Professional Fees (Extension of 096x and 097x) - Emergency Room Services","E","0","0","0","0","0"
"981","66","87","Professional Fees (Extension of 096x and 097x) - Emergency Room Services","E1","0","0","0","0","0"
"982","60","65","Professional Fees (Extension of 096x and 097x) - Outpatient Services","E","0","0","0","0","0"
"982","66","87","Professional Fees (Extension of 096x and 097x) - Outpatient Services","E1","0","0","0","0","0"
"983","60","65","Professional Fees (Extension of 096x and 097x) - Clinic","E","0","0","0","0","0"
"983","66","87","Professional Fees (Extension of 096x and 097x) - Clinic","E1","0","0","0","0","0"
"984","60","65","Professional Fees (Extension of 096x and 097x) - Medical Social Services","E","0","0","0","0","0"
"984","66","87","Professional Fees (Extension of 096x and 097x) - Medical Social Services","E1","0","0","0","0","0"
"985","60","65","Professional Fees (Extension of 096x and 097x) - EKG","E","0","0","0","0","0"
"985","66","87","Professional Fees (Extension of 096x and 097x) - EKG","E1","0","0","0","0","0"
"986","60","65","Professional Fees (Extension of 096x and 097x) - EEG","E","0","0","0","0","0"
"986","66","87","Professional Fees (Extension of 096x and 097x) - EEG","E1","0","0","0","0","0"
"987","60","65","Professional Fees (Extension of 096x and 097x) - Hospital Visit","E","0","0","0","0","0"
"987","66","87","Professional Fees (Extension of 096x and 097x) - Hospital Visit","E1","0","0","0","0","0"
"988","60","65","Professional Fees (Extension of 096x and 097x) - Consultation","E","0","0","0","0","0"
"988","66","87","Professional Fees (Extension of 096x and 097x) - Consultation","E1","0","0","0","0","0"
"989","60","65","Professional Fees (Extension of 096x and 097x) - Private Duty Nurse","E","0","0","0","0","0"
"989","66","87","Professional Fees (Extension of 096x and 097x) - Private Duty Nurse","E1","0","0","0","0","0"
"990","60","65","Patient Convenience Items - General Classification","E","0","0","1","0","0"
"990","66","87","Patient Convenience Items - General Classification","E1","0","0","1","0","0"
"991","60","65","Patient Convenience Items - Cafeteria/Guest Tray","E","0","0","1","0","0"
"991","66","87","Patient Convenience Items - Cafeteria/Guest Tray","E1","0","0","1","0","0"
"992","60","65","Patient Convenience Items - Private Linen Service","E","0","0","1","0","0"
"992","66","87","Patient Convenience Items - Private Linen Service","E1","0","0","1","0","0"
"993","60","65","Patient Convenience Items - Telephone/telecom","E","0","0","1","0","0"
"993","66","87","Patient Convenience Items - Telephone/telecom","E1","0","0","1","0","0"
"994","60","65","Patient Convenience Items - Tv/radio","E","0","0","1","0","0"
"994","66","87","Patient Convenience Items - Tv/radio","E1","0","0","1","0","0"
"995","60","65","Patient Convenience Items - Non-patient Room Rentals","E","0","0","1","0","0"
"995","66","87","Patient Convenience Items - Non-patient Room Rentals","E1","0","0","1","0","0"
"996","60","65","Patient Convenience Items - Late Discharge","E","0","0","1","0","0"
"996","66","87","Patient Convenience Items - Late Discharge","E1","0","0","1","0","0"
"997","60","65","Patient Convenience Items - Admission Kits","E","0","0","1","0","0"
"997","66","87","Patient Convenience Items - Admission Kits","E1","0","0","1","0","0"
"998","60","65","Patient Convenience Items - Beauty Shop/Barber","E","0","0","1","0","0"
"998","66","87","Patient Convenience Items - Beauty Shop/Barber","E1","0","0","1","0","0"
"999","60","65","Patient Convenience Items - Other Convenience Items","E","0","0","1","0","0"
"999","66","87","Patient Convenience Items - Other Convenience Items","E1","0","0","1","0","0"
"1000","60","65","Behavioral Health Accommodations - General Classification","E","1","0","1","0","0"
"1000","66","87","Behavioral Health Accommodations - General Classification","E1","1","0","1","0","0"
"1001","60","65","Behavioral Health Accommodations - Residential - Psychiatric","E","1","0","1","0","0"
"1001","66","87","Behavioral Health Accommodations - Residential - Psychiatric","E1","1","0","1","0","0"
"1002","60","65","Behavioral Health Accommodations - Residential - Chemical Dependency","E","1","0","1","0","0"
"1002","66","87","Behavioral Health Accommodations - Residential - Chemical Dependency","E1","1","0","1","0","0"
"1003","60","65","Behavioral Health Accommodations - Supervised Living","E","1","0","1","0","0"
"1003","66","87","Behavioral Health Accommodations - Supervised Living","E1","1","0","1","0","0"
"1004","60","65","Behavioral Health Accommodations - Halfway House","E","1","0","1","0","0"
"1004","66","87","Behavioral Health Accommodations - Halfway House","E1","1","0","1","0","0"
"1005","60","65","Behavioral Health Accommodations - Group Home","E","1","0","1","0","0"
"1005","66","87","Behavioral Health Accommodations - Group Home","E1","1","0","1","0","0"
"1006","68","87","Behavioral Health Accommodations - Outdoor/wilderness Behavioral Health","E1","1","0","1","0","0"
"2100","60","65","Alternative Therapy Services - General Classification","E","1","0","1","0","0"
"2100","66","87","Alternative Therapy Services - General Classification","E1","1","0","1","0","0"
"2101","60","65","Alternative Therapy Services - Acupuncture","E","1","0","1","0","0"
"2101","66","87","Alternative Therapy Services - Acupuncture","E1","1","0","1","0","0"
"2102","60","65","Alternative Therapy Services - Acupressure","E","1","0","1","0","0"
"2102","66","87","Alternative Therapy Services - Acupressure","E1","1","0","1","0","0"
"2103","60","65","Alternative Therapy Services - Massage","E","1","0","1","0","0"
"2103","66","87","Alternative Therapy Services - Massage","E1","1","0","1","0","0"
"2104","60","65","Alternative Therapy Services - Reflexology","E","1","0","1","0","0"
"2104","66","87","Alternative Therapy Services - Reflexology","E1","1","0","1","0","0"
"2105","60","65","Alternative Therapy Services - Biofeedback","E","1","0","1","0","0"
"2105","66","87","Alternative Therapy Services - Biofeedback","E1","1","0","1","0","0"
"2106","60","65","Alternative Therapy Services - Hypnosis","E","1","0","1","0","0"
"2106","66","87","Alternative Therapy Services - Hypnosis","E1","1","0","1","0","0"
"2109","60","65","Alternative Therapy Services - Other Alternative Therapy Services","E","1","0","1","0","0"
"2109","66","87","Alternative Therapy Services - Other Alternative Therapy Services","E1","1","0","1","0","0"
"3101","60","65","Adult Care - Adult Day Care, Medical and Social - Hourly","E","1","0","1","0","0"
"3101","66","87","Adult Care - Adult Day Care, Medical and Social - Hourly","E1","1","0","1","0","0"
"3102","60","65","Adult Care - Adult Day Care, Social - Hourly","E","1","0","1","0","0"
"3102","66","87","Adult Care - Adult Day Care, Social - Hourly","E1","1","0","1","0","0"
"3103","60","65","Adult Care - Adult Day Care, Medical and Social - Daily","E","1","0","1","0","0"
"3103","66","87","Adult Care - Adult Day Care, Medical and Social - Daily","E1","1","0","1","0","0"
"3104","60","65","Adult Care - Adult Day Care, Social - Daily","E","1","0","1","0","0"
"3104","66","87","Adult Care - Adult Day Care, Social - Daily","E1","1","0","1","0","0"
"3105","60","65","Adult Care - Adult Foster Care - Daily","E","1","0","1","0","0"
"3105","66","87","Adult Care - Adult Foster Care - Daily","E1","1","0","1","0","0"
"3109","60","65","Adult Care - Other Adult Care","E","1","0","1","0","0"
"3109","66","87","Adult Care - Other Adult Care","E1","1","0","1","0","0"
