Health Care Claim Status Codes convey the status of an entire claim or a specific service line.
00 Cannot provide further status electronically. Start: 01/01/1995
01 For more detailed information, see remittance advice. Start: 01/01/1995
02 More detailed information in letter. Start: 01/01/1995
03 Claim has been adjudicated and is awaiting payment cycle. Start: 01/01/1995
04 This is a subsequent request for information from the original request. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
05 This is a final request for information. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
06 Balance due from the subscriber. Start: 01/01/1995
07 Claim may be reconsidered at a future date. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
08 No payment due to contract/plan provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
09 No payment will be made for this claim. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
10 All originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
11 Some originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
12 One or more originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 06/30/2001
13 All originally submitted procedure codes have been modified. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
14 Some all originally submitted procedure codes have been modified. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
15 One or more originally submitted procedure code have been modified. Start: 01/01/1995 | Last Modified: 06/30/2001
16 Claim/encounter has been forwarded to entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
17 Claim/encounter has been forwarded by third party entity to entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
18 Entity received claim/encounter, but returned invalid status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
19 Entity acknowledges receipt of claim/encounter. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
20 Accepted for processing. Start: 01/01/1995 | Last Modified: 06/30/2001
21 Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information. Start: 01/01/1995 | Last Modified: 07/09/2007
22 ... before entering the adjudication system. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
23 Returned to Entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
24 Entity not approved as an electronic submitter. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
25 Entity not approved. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
26 Entity not found. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
27 Policy canceled. Start: 01/01/1995 | Last Modified: 06/30/2001
28 Claim submitted to wrong payer. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
29 Subscriber and policy number/contract number mismatched. Start: 01/01/1995
30 Subscriber and subscriber id mismatched. Start: 01/01/1995
31 Subscriber and policyholder name mismatched. Start: 01/01/1995
32 Subscriber and policy number/contract number not found. Start: 01/01/1995
33 Subscriber and subscriber id not found. Start: 01/01/1995
34 Subscriber and policyholder name not found. Start: 01/01/1995
35 Claim/encounter not found. Start: 01/01/1995
37 Predetermination is on file, awaiting completion of services. Start: 01/01/1995
38 Awaiting next periodic adjudication cycle. Start: 01/01/1995
39 Charges for pregnancy deferred until delivery. Start: 01/01/1995
40 Waiting for final approval. Start: 01/01/1995
41 Special handling required at payer site. Start: 01/01/1995
42 Awaiting related charges. Start: 01/01/1995
44 Charges pending provider audit. Start: 01/01/1995
45 Awaiting benefit determination. Start: 01/01/1995
46 Internal review/audit. Start: 01/01/1995
47 Internal review/audit - partial payment made. Start: 01/01/1995
48 Referral/authorization. Start: 01/01/1995 | Last Modified: 02/28/2001 | Stop: 01/01/2012 Notes: Refer to codes 252 and 761.
49 Pending provider accreditation review. Start: 01/01/1995
50 Claim waiting for internal provider verification. Start: 01/01/1995
51 Investigating occupational illness/accident. Start: 01/01/1995
52 Investigating existence of other insurance coverage. Start: 01/01/1995
53 Claim being researched for Insured ID/Group Policy Number error. Start: 01/01/1995
54 Duplicate of a previously processed claim/line. Start: 01/01/1995
55 Claim assigned to an approver/analyst. Start: 01/01/1995
56 Awaiting eligibility determination. Start: 01/01/1995
57 Pending COBRA information requested. Start: 01/01/1995
59 Information was requested by a non-electronic method. Note: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 10/17/2010
60 Information was requested by an electronic method. Note: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 10/17/2010
61 Eligibility for extended benefits. Start: 01/01/1995
64 Re-pricing information. Start: 01/01/1995
65 Claim/line has been paid. Start: 01/01/1995
66 Payment reflects usual and customary charges. Start: 01/01/1995
67 Payment made in full. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
68 Partial payment made for this claim. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
69 Payment reflects plan provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
70 Payment reflects contract provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
71 Periodic installment released. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
72 Claim contains split payment. Start: 01/01/1995
73 Payment made to entity, assignment of benefits not on file. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
78 Duplicate of an existing claim/line, awaiting processing. Start: 01/01/1995
81 Contract/plan does not cover pre-existing conditions. Start: 01/01/1995
83 No coverage for newborns. Start: 01/01/1995
84 Service not authorized. Start: 01/01/1995
85 Entity not primary. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
86 Diagnosis and patient gender mismatch. Start: 01/01/1995 | Last Modified: 02/28/2000
87 Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
88 Entity not eligible for benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
89 Entity not eligible for dental benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
90 Entity not eligible for medical benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
91 Entity not eligible/not approved for dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
92 Entity does not meet dependent or student qualification. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
93 Entity is not selected primary care provider. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
94 Entity not referred by selected primary care provider. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
95 Requested additional information not received. Start: 01/01/1995 | Last Modified: 07/09/2007 Notes: If known, the payer must report a second claim status code identifying the requested information.
96 No agreement with entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
97 Patient eligibility not found with entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
98 Charges applied to deductible. Start: 01/01/1995
99 Pre-treatment review. Start: 01/01/1995
100 Pre-certification penalty taken. Start: 01/01/1995
101 Claim was processed as adjustment to previous claim. Start: 01/01/1995
102 Newborn's charges processed on mother's claim. Start: 01/01/1995
103 Claim combined with other claim(s). Start: 01/01/1995
104 Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient) Start: 01/01/1995 | Last Modified: 06/01/2008
105 Claim/line is capitated. Start: 01/01/1995
106 This amount is not entity's responsibility. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
107 Processed according to contract provisions (Contract refers to provisions that exist between t he Health Plan and a Provider of Health Care Services) Start: 01/01/1995 | Last Modified: 06/01/2008
108 Coverage has been canceled for this entity. (Use code 27) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
109 Entity not eligible. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
110 Claim requires pricing information. Start: 01/01/1995
111 At the policyholder's request these claims cannot be submitted electronically. Start: 01/01/1995
112 Policyholder processes their own claims. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
113 Cannot process individual insurance policy claims. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
114 Claim/service should be processed by entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
115 Cannot process HMO claims Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
116 Claim submitted to incorrect payer. Start: 01/01/1995
117 Claim requires signature-on-file indicator. Start: 01/01/1995
118 TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
119 TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
120 TPO rejected claim/line because claim does not contain enough information. (Use status code 21) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
121 Service line number greater than maximum allowable for payer. Start: 01/01/1995
122 Missing/invalid data prevents payer from processing claim. (Use CSC Code 21) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
123 Additional information requested from entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
124 Entity's name, address, phone and id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
125 Entity's name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
126 Entity's address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
127 Entity's Communication Number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 06/06/2010
128 Entity's tax id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
129 Entity's Blue Cross provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
130 Entity's Blue Shield provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
131 Entity's Medicare provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
132 Entity's Medicaid provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
133 Entity's UPIN. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
134 Entity's CHAMPUS provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
135 Entity's commercial provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
136 Entity's health industry id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
137 Entity's plan network id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
138 Entity's site id . Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
139 Entity's health maintenance provider id (HMO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
140 Entity's preferred provider organization id (PPO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
141 Entity's administrative services organization id (ASO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
142 Entity's license/certification number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
143 Entity's state license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
144 Entity's specialty license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
145 Entity's specialty/taxonomy code. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
146 Entity's anesthesia license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
147 Entity's qualification degree/designation (e.g. RN,PhD,MD). Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
148 Entity's social security number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
149 Entity's employer id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
150 Entity's drug enforcement agency (DEA) number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
152 Pharmacy processor number. Start: 01/01/1995
153 Entity's id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
154 Relationship of surgeon & assistant surgeon. Start: 01/01/1995
155 Entity's relationship to patient. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
156 Patient relationship to subscriber Start: 01/01/1995
157 Entity's Gender. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
158 Entity's date of birth. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
159 Entity's date of death. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
160 Entity's marital status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
161 Entity's employment status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
162 Entity's health insurance claim number (HICN). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
163 Entity's policy number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
164 Entity's contract/member number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
165 Entity's employer name, address and phone. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
166 Entity's employer name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
167 Entity's employer address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
168 Entity's employer phone number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
169 Entity's employer id. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
170 Entity's employee id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
171 Other insurance coverage information (health, liability, auto, etc.). Start: 01/01/1995
172 Other employer name, address and telephone number. Start: 01/01/1995
173 Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
174 Entity's student status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
175 Entity's school name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
176 Entity's school address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
177 Transplant recipient's name, date of birth, gender, relationship to insured. Start: 01/01/1995 | Last Modified: 02/28/2000
178 Submitted charges. Start: 01/01/1995
179 Outside lab charges. Start: 01/01/1995
180 Hospital s semi-private room rate. Start: 01/01/1995
181 Hospital s room rate. Start: 01/01/1995
182 Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code. Start: 01/01/1995 | Last Modified: 01/24/2010
183 Amount entity has paid. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
184 Purchase price for the rented durable medical equipment. Start: 01/01/1995
185 Rental price for durable medical equipment. Start: 01/01/1995
186 Purchase and rental price of durable medical equipment. Start: 01/01/1995
187 Date(s) of service. Start: 01/01/1995
188 Statement from-through dates. Start: 01/01/1995
189 Facility admission date Start: 01/01/1995 | Last Modified: 10/31/2006
190 Facility discharge date Start: 01/01/1995 | Last Modified: 10/31/2006
191 Date of Last Menstrual Period (LMP) Start: 02/28/1997
192 Date of first service for current series/symptom/illness. Start: 01/01/1995
193 First consultation/evaluation date. Start: 02/28/1997
194 Confinement dates. Start: 01/01/1995
195 Unable to work dates/Disability Dates. Start: 01/01/1995 | Last Modified: 09/20/2009
196 Return to work dates. Start: 01/01/1995
197 Effective coverage date(s). Start: 01/01/1995
198 Medicare effective date. Start: 01/01/1995
199 Date of conception and expected date of delivery. Start: 01/01/1995
200 Date of equipment return. Start: 01/01/1995
201 Date of dental appliance prior placement. Start: 01/01/1995
202 Date of dental prior replacement/reason for replacement. Start: 01/01/1995
203 Date of dental appliance placed. Start: 01/01/1995
204 Date dental canal(s) opened and date service completed. Start: 01/01/1995
205 Date(s) dental root canal therapy previously performed. Start: 01/01/1995
206 Most recent date of curettage, root planing, or periodontal surgery. Start: 01/01/1995
207 Dental impression and seating date. Start: 01/01/1995
208 Most recent date pacemaker was implanted. Start: 01/01/1995
209 Most recent pacemaker battery change date. Start: 01/01/1995
210 Date of the last x-ray. Start: 01/01/1995
211 Date(s) of dialysis training provided to patient. Start: 01/01/1995
212 Date of last routine dialysis. Start: 01/01/1995
213 Date of first routine dialysis. Start: 01/01/1995
214 Original date of prescription/orders/referral. Start: 02/28/1997
215 Date of tooth extraction/evolution. Start: 01/01/1995
216 Drug information. Start: 01/01/1995
217 Drug name, strength and dosage form. Start: 01/01/1995
218 NDC number. Start: 01/01/1995
219 Prescription number. Start: 01/01/1995
220 Drug product id number. (Use code 218) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
221 Drug days supply and dosage. Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
222 Drug dispensing units and average wholesale price (AWP). Start: 01/01/1995
223 Route of drug/myelogram administration. Start: 01/01/1995
224 Anatomical location for joint injection. Start: 01/01/1995
225 Anatomical location. Start: 01/01/1995
226 Joint injection site. Start: 01/01/1995
227 Hospital information. Start: 01/01/1995
228 Type of bill for UB claim Start: 01/01/1995 | Last Modified: 10/31/2006
229 Hospital admission source. Start: 01/01/1995
230 Hospital admission hour. Start: 01/01/1995
231 Hospital admission type. Start: 01/01/1995
232 Admitting diagnosis. Start: 01/01/1995
233 Hospital discharge hour Start: 01/01/1995
234 Patient discharge status. Start: 01/01/1995
235 Units of blood furnished. Start: 01/01/1995
236 Units of blood replaced. Start: 01/01/1995
237 Units of deductible blood. Start: 01/01/1995
238 Separate claim for mother/baby charges. Start: 01/01/1995
239 Dental information. Start: 01/01/1995
240 Tooth surface(s) involved. Start: 01/01/1995
241 List of all missing teeth (upper and lower). Start: 01/01/1995
242 Tooth numbers, surfaces, and/or quadrants involved. Start: 01/01/1995
243 Months of dental treatment remaining. Start: 01/01/1995
244 Tooth number or letter. Start: 01/01/1995
245 Dental quadrant/arch. Start: 01/01/1995
246 Total orthodontic service fee, initial appliance fee, monthly fee, length of service. Start: 01/01/1995
247 Line information. Start: 01/01/1995
248 Accident date, state, description and cause. Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
249 Place of service. Start: 01/01/1995
250 Type of service. Start: 01/01/1995
251 Total anesthesia minutes. Start: 01/01/1995
252 Authorization/certification number. This change effective 11/1/2011: Entity's authorization/certification number. Note: This code requires the use of an Entity Code. Start: 01/01/1995 | Last Modified: 01/30/2011
253 Procedure/revenue code for service(s) rendered. Use codes 454 or 455. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
254 Primary diagnosis code. This change effective 11/1/2011: Principal doagnosis code. Start: 01/01/1995 | Last Modified: 01/30/2011
255 Diagnosis code. Start: 01/01/1995
256 DRG code(s). Start: 01/01/1995
257 ADSM-III-R code for services rendered. Start: 01/01/1995
258 Days/units for procedure/revenue code. Start: 01/01/1995
259 Frequency of service. Start: 01/01/1995
260 Length of medical necessity, including begin date. Start: 02/28/1997
261 Obesity measurements. Start: 01/01/1995
262 Type of surgery/service for which anesthesia was administered. Start: 01/01/1995
263 Length of time for services rendered. Start: 01/01/1995
264 Number of liters/minute & total hours/day for respiratory support. Start: 01/01/1995
265 Number of lesions excised. Start: 01/01/1995
266 Facility point of origin and destination - ambulance. Start: 01/01/1995
267 Number of miles patient was transported. Start: 01/01/1995
268 Location of durable medical equipment use. Start: 01/01/1995
269 Length/size of laceration/tumor. Start: 01/01/1995
270 Subluxation location. Start: 01/01/1995
271 Number of spine segments. Start: 01/01/1995
272 Oxygen contents for oxygen system rental. Start: 01/01/1995
273 Weight. Start: 01/01/1995
274 Height. Start: 01/01/1995
275 Claim. Start: 01/01/1995
276 UB04/HCFA-1450/1500 claim form Start: 01/01/1995 | Last Modified: 10/31/2006
277 Paper claim. Start: 01/01/1995
278 Signed claim form. Start: 01/01/1995 | Stop: 11/01/2011
279 Claim/service must be itemized Start: 01/01/1995 | Last Modified: 10/17/2010
280 Itemized claim by provider. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 279
281 Related confinement claim. Start: 01/01/1995
282 Copy of prescription. Start: 01/01/1995
283 Medicare entitlement information is required to determine primary coverage Start: 01/01/1995 | Last Modified: 01/27/2008
284 Copy of Medicare ID card. Start: 01/01/1995
285 Vouchers/explanation of benefits (EOB). Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 286
286 Other payer's Explanation of Benefits/payment information. Start: 01/01/1995
287 Medical necessity for service. Start: 01/01/1995
288 Hospital late charges Start: 01/01/1995 | Last Modified: 10/17/2010
289 Reason for late discharge. Start: 01/01/1995 | Stop: 11/01/2011
290 Pre-existing information. Start: 01/01/1995
291 Reason for termination of pregnancy. Start: 01/01/1995
292 Purpose of family conference/therapy. Start: 01/01/1995
293 Reason for physical therapy. Start: 01/01/1995
294 Supporting documentation. Note: At least one other status code is required to identify the supporting documentation. Start: 01/01/1995 | Last Modified: 10/17/2010
295 Attending physician report. Start: 01/01/1995
296 Nurse's notes. Start: 01/01/1995
297 Medical notes/report. Start: 02/28/1997
298 Operative report. Start: 01/01/1995
299 Emergency room notes/report. Start: 01/01/1995
300 Lab/test report/notes/results. Start: 02/28/1997
301 MRI report. Start: 01/01/1995
302 Refer to codes 300 for lab notes and 311 for pathology notes Start: 01/01/1995 | Stop: 01/31/1997
303 Physical therapy notes. Use code 297:6O (6 'OH' - not zero) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
304 Reports for service. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 297, 298, 299, 300
305 Radiology/x-ray reports and/or interpretation Start: 01/01/1995 | Last Modified: 01/30/2011
306 Detailed description of service. Start: 01/01/1995
307 Narrative with pocket depth chart. Start: 01/01/1995
308 Discharge summary. Start: 01/01/1995
309 Code was duplicate of code 299 Start: 01/01/1995 | Stop: 01/31/1997
310 Progress notes for the six months prior to statement date. Start: 01/01/1995
311 Pathology notes/report. Start: 01/01/1995
312 Dental charting. Start: 01/01/1995
313 Bridgework information. Start: 01/01/1995
314 Dental records for this service. Start: 01/01/1995
315 Past perio treatment history. Start: 01/01/1995
316 Complete medical history. Start: 01/01/1995
317 Patient's medical records. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
318 X-rays/radiology films Start: 01/01/1995 | Last Modified: 10/17/2010
319 Pre/post-operative x-rays/photographs. Start: 02/28/1997
320 Study models. Start: 01/01/1995
321 Radiographs or models. (Use codes 318 and/or 320) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
322 Recent Full Mouth X-rays Start: 01/01/1995 | Last Modified: 10/17/2010
323 Study models, x-rays, and/or narrative. Start: 01/01/1995
324 Recent x-ray of treatment area and/or narrative. Start: 01/01/1995
325 Recent fm x-rays and/or narrative. Start: 01/01/1995
326 Copy of transplant acquisition invoice. Start: 01/01/1995
327 Periodontal case type diagnosis and recent pocket depth chart with narrative. Start: 01/01/1995
328 Speech therapy notes. Use code 297:6R Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
329 Exercise notes. Start: 01/01/1995
330 Occupational notes. Start: 01/01/1995
331 History and physical. Start: 01/01/1995 | Last Modified: 08/01/2007
332 Authorization/certification (include period covered). (Use code 252) Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
333 Patient release of information authorization. Start: 01/01/1995
334 Oxygen certification. Start: 01/01/1995
335 Durable medical equipment certification. Start: 01/01/1995
336 Chiropractic certification. Start: 01/01/1995
337 Ambulance certification/documentation. Start: 01/01/1995
338 Home health certification. Use code 332:4Y Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
339 Enteral/parenteral certification. Start: 01/01/1995
340 Pacemaker certification. Start: 01/01/1995
341 Private duty nursing certification. Start: 01/01/1995
342 Podiatric certification. Start: 01/01/1995
343 Documentation that facility is state licensed and Medicare approved as a surgical facility. Start: 01/01/1995
344 Documentation that provider of physical therapy is Medicare Part B approved. Start: 01/01/1995
345 Treatment plan for service/diagnosis Start: 01/01/1995
346 Proposed treatment plan for next 6 months. Start: 01/01/1995
347 Refer to code 345 for treatment plan and code 282 for prescription Start: 01/01/1995 | Stop: 01/31/1997
348 Chiropractic treatment plan. (Use 345:QL) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
349 Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
350 Speech pathology treatment plan. Use code 345:6R Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
351 Physical/occupational therapy treatment plan. Use codes 345:6O (6 'OH' - not zero), 6N Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
352 Duration of treatment plan. Start: 01/01/1995
353 Orthodontics treatment plan. Start: 01/01/1995
354 Treatment plan for replacement of remaining missing teeth. Start: 01/01/1995
355 Has claim been paid? Start: 01/01/1995 | Stop: 11/01/2011
356 Was blood furnished? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 235
357 Has or will blood be replaced? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 236
358 Does provider accept assignment of benefits? (Use code 589) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
359 Is there a release of information signature on file? (Use code 333) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
360 Benefits Assignment Certification Indicator Start: 01/01/1995 | Last Modified: 10/17/2010
361 Is there other insurance? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 171 and 550
362 Is the dental patient covered by medical insurance? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 171
363 Possible Workers' Compensation Start: 01/01/1995 | Last Modified: 10/17/2010
364 Is accident/illness/condition employment related? Start: 01/01/1995
365 Is service the result of an accident? Start: 01/01/1995
366 Is injury due to auto accident? Start: 01/01/1995 367 Is service performed for a recurring condition or new condition? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 397
368 Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 676
369 Does patient condition preclude use of ordinary bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335
370 Can patient operate controls of bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335
371 Is patient confined to room? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
372 Is patient confined to bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
373 Is patient an insulin diabetic? Start: 01/01/1995 | Stop: 11/01/2011
374 Is prescribed lenses a result of cataract surgery? Start: 01/01/1995
375 Was refraction performed? Start: 01/01/1995
376 Was charge for ambulance for a round-trip? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 453
377 Was durable medical equipment purchased new or used? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 184, 185, 186, 335
378 Is pacemaker temporary or permanent? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 340
379 Were services performed supervised by a physician? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 453, 454, 666 & procedure code
380 CRNA supervision/medical direction. Start: 01/01/1995 | Last Modified: 10/17/2010
381 Is drug generic? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 216
382 Did provider authorize generic or brand name dispensing? Start: 01/01/1995
383 Nerve block use (surgery vs. pain management) Start: 01/01/1995 | Last Modified: 10/17/2010
384 Is prosthesis/crown/inlay placement an initial placement or a replacement? Start: 01/01/1995
385 Is appliance upper or lower arch & is appliance fixed or removable? Start: 01/01/1995
386 Orthodontic Treatment/Purpose Indicator Start: 01/01/1995 | Last Modified: 10/17/2010
387 Date patient last examined by entity. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
388 Date post-operative care assumed Start: 02/28/1997
389 Date post-operative care relinquished Start: 02/28/1997
390 Date of most recent medical event necessitating service(s) Start: 02/28/1997
391 Date(s) dialysis conducted Start: 02/28/1997
392 Date(s) of blood transfusion(s) Start: 02/28/1997 | Stop: 11/01/2011
393 Date of previous pacemaker check Start: 02/28/1997 | Stop: 11/01/2011
394 Date(s) of most recent hospitalization related to service Start: 02/28/1997
395 Date entity signed certification/recertification Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
396 Date home dialysis began Start: 02/28/1997
397 Date of onset/exacerbation of illness/condition Start: 02/28/1997
398 Visual field test results Start: 02/28/1997
399 Report of prior testing related to this service, including dates Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 417
400 Claim is out of balance Start: 02/28/1997
401 Source of payment is not valid Start: 02/28/1997
402 Amount must be greater than zero. Note: At least one other status code is required to identify which amount element is in error. Start: 02/28/1997 | Last Modified: 09/20/2009
403 Entity referral notes/orders/prescription Start: 02/28/1997
404 Specific findings, complaints, or symptoms necessitating service Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to codes 287, 488
405 Summary of services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 306
406 Brief medical history as related to service(s) Start: 02/28/1997
407 Complications/mitigating circumstances Start: 02/28/1997
408 Initial certification Start: 02/28/1997
409 Medication logs/records (including medication therapy) Start: 02/28/1997
410 Explain differences between treatment plan and patient's condition Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
411 Medical necessity for non-routine service(s) Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 287
412 Medical records to substantiate decision of non-coverage Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
413 Explain/justify differences between treatment plan and services rendered. Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
414 Necessity for concurrent care (more than one physician treating the patient) Start: 02/28/1997 | Last Modified: 10/17/2010
415 Justify services outside composite rate Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 287
416 Verification of patient's ability to retain and use information Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
417 Prior testing, including result(s) and date(s) as related to service(s) Start: 02/28/1997
418 Indicating why medications cannot be taken orally Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
419 Individual test(s) comprising the panel and the charges for each test Start: 02/28/1997
420 Name, dosage and medical justification of contrast material used for radiology procedure Start: 02/28/1997
421 Medical review attachment/information for service(s) Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
422 Homebound status Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 575
423 Prognosis Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
424 Statement of non-coverage including itemized bill Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
425 Itemize non-covered services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
426 All current diagnoses Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 255, 232 & 488
427 Emergency care provided during transport Start: 02/28/1997 | Stop: 11/01/2011
428 Reason for transport by ambulance Start: 02/28/1997
429 Loaded miles and charges for transport to nearest facility with appropriate services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to codes 267, 178, 430
430 Nearest appropriate facility Start: 02/28/1997
431 Patient's condition/functional status at time of service. Start: 02/28/1997 | Last Modified: 10/17/2010
432 Date benefits exhausted Start: 02/28/1997
433 Copy of patient revocation of hospice benefits Start: 02/28/1997
434 Reasons for more than one transfer per entitlement period Start: 02/28/1997
435 Notice of Admission Start: 02/28/1997
436 Short term goals Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
437 Long term goals Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
438 Number of patients attending session Start: 02/28/1997 | Stop: 11/01/2011
439 Size, depth, amount, and type of drainage wounds Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
440 why non-skilled caregiver has not been taught procedure Start: 02/28/1997 | Stop: 11/01/2011
441 Entity professional qualification for service(s) Start: 02/28/1997
442 Modalities of service Start: 02/28/1997
443 Initial evaluation report Start: 02/28/1997
444 Method used to obtain test sample Start: 02/28/1997 | Stop: 11/01/2011
445 Explain why hearing loss not correctable by hearing aid Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 287
446 Documentation from prior claim(s) related to service(s) Start: 02/28/1997 | Stop: 11/01/2011
447 Plan of teaching Start: 02/28/1997 | Stop: 11/01/2011
448 Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used. Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
449 Projected date to discontinue service(s) Start: 02/28/1997
450 Awaiting spend down determination Start: 02/28/1997
451 Preoperative and post-operative diagnosis Start: 02/28/1997
452 Total visits in total number of hours/day and total number of hours/week Start: 02/28/1997
453 Procedure Code Modifier(s) for Service(s) Rendered Start: 02/28/1997
454 Procedure code for services rendered. Start: 02/28/1997
455 Revenue code for services rendered. Start: 02/28/1997
456 Covered Day(s) Start: 02/28/1997
457 Non-Covered Day(s) Start: 02/28/1997
458 Coinsurance Day(s) Start: 02/28/1997
459 Lifetime Reserve Day(s) Start: 02/28/1997
460 NUBC Condition Code(s) Start: 02/28/1997
461 NUBC Occurrence Code(s) and Date(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
462 NUBC Occurrence Span Code(s) and Date(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
463 NUBC Value Code(s) and/or Amount(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
464 Payer Assigned Claim Control Number Start: 02/28/1997 | Last Modified: 10/31/2004
465 Principal Procedure Code for Service(s) Rendered Start: 02/28/1997
466 Entities Original Signature. Note: This code requires use of an Entity Code. This change effective 11/1/2011: Entity's Original Signature. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 01/30/2011
467 Entity Signature Date. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
468 Patient Signature Source Start: 02/28/1997
469 Purchase Service Charge Start: 02/28/1997
470 Was service purchased from another entity? Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
471 Were services related to an emergency? Start: 02/28/1997
472 Ambulance Run Sheet Start: 02/28/1997
473 Missing or invalid lab indicator Start: 06/30/1998
474 Procedure code and patient gender mismatch Start: 06/30/1998 | Last Modified: 02/29/2000
475 Procedure code not valid for patient age Start: 06/30/1998 | Last Modified: 02/29/2000
476 Missing or invalid units of service Start: 06/30/1998
477 Diagnosis code pointer is missing or invalid Start: 06/30/1998
478 Claim submitter's identifier Start: 06/30/1998 | Last Modified: 01/24/2010
479 Other Carrier payer ID is missing or invalid Start: 06/30/1998
480 Entity's claim filing indicator. Note: This code requires use of an Entity Code. Start: 06/30/1998 | Last Modified: 06/06/2010
481 Claim/submission format is invalid. Start: 10/31/1998
482 Date Error, Century Missing Start: 02/28/1999 | Last Modified: 09/20/2009 | Stop: 10/01/2010
483 Maximum coverage amount met or exceeded for benefit period. Start: 06/30/1999
484 Business Application Currently Not Available Start: 02/29/2000
485 More information available than can be returned in real time mode. Narrow your current search criteria. Start: 02/28/2001
486 Principal Procedure Date Start: 10/31/2001 | Last Modified: 07/01/2009
487 Claim not found, claim should have been submitted to/through 'entity'. Note: This code requires use of an Entity Code. Start: 02/28/2002 | Last Modified: 02/11/2010
488 Diagnosis code(s) for the services rendered. Start: 06/30/2002
489 Attachment Control Number Start: 10/31/2002
490 Other Procedure Code for Service(s) Rendered Start: 02/28/2003
491 Entity not eligible for encounter submission. Note: This code requires use of an Entity Code. Start: 02/28/2003 | Last Modified: 02/11/2010
492 Other Procedure Date Start: 02/28/2003
493 Version/Release/Industry ID code not currently supported by information holder Start: 02/28/2003
494 Real-Time requests not supported by the information holder, resubmit as batch request Start: 02/28/2003
495 Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit. Start: 10/31/2003
496 Submitter not approved for electronic claim submissions on behalf of this entity. Note: This code requires use of an Entity Code. Start: 02/29/2004 | Last Modified: 02/11/2010
497 Sales tax not paid Start: 06/30/2004
498 Maximum leave days exhausted Start: 06/30/2004
499 No rate on file with the payer for this service for this entity Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
500 Entity's Postal/Zip Code. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
501 Entity's State/Province. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
502 Entity's City. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
503 Entity's Street Address. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
504 Entity's Last Name. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
505 Entity's First Name. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
506 Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
507 HCPCS Start: 10/31/2004
508 ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 10/31/2004 | Last Modified: 07/01/2009
509 E-Code. This change effective 11/1/2011: External Cause of Injury Code (E-code). Start: 10/31/2004 | Last Modified: 01/30/2011
510 Future date. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
511 Invalid character. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
512 Length invalid for receiver's application system. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
513 HIPPS Rate Code for services Rendered Start: 10/31/2004
514 Entities Middle Name Note: This code requires use of an Entity Code. This change effective 11/1/2011: Entity's Middle Name Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 01/30/2011
515 Managed Care review Start: 10/31/2004
516 Other Entity's Adjudication or Payment/Remittance Date. Note: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary. Start: 10/31/2004 | Last Modified: 11/29/2009
517 Adjusted Repriced Claim Reference Number Start: 10/31/2004
518 Adjusted Repriced Line item Reference Number Start: 10/31/2004
519 Adjustment Amount Start: 10/31/2004
520 Adjustment Quantity Start: 10/31/2004
521 Adjustment Reason Code Start: 10/31/2004
522 Anesthesia Modifying Units Start: 10/31/2004
523 Anesthesia Unit Count Start: 10/31/2004
524 Arterial Blood Gas Quantity Start: 10/31/2004
525 Begin Therapy Date Start: 10/31/2004
526 Bundled or Unbundled Line Number Start: 10/31/2004
527 Certification Condition Indicator Start: 10/31/2004
528 Certification Period Projected Visit Count Start: 10/31/2004
529 Certification Revision Date Start: 10/31/2004
530 Claim Adjustment Indicator Start: 10/31/2004
531 Claim Disproportinate Share Amount Start: 10/31/2004
532 Claim DRG Amount Start: 10/31/2004
533 Claim DRG Outlier Amount Start: 10/31/2004
534 Claim ESRD Payment Amount Start: 10/31/2004
535 Claim Frequency Code Start: 10/31/2004
536 Claim Indirect Teaching Amount Start: 10/31/2004
537 Claim MSP Pass-through Amount Start: 10/31/2004
538 Claim or Encounter Identifier Start: 10/31/2004
539 Claim PPS Capital Amount Start: 10/31/2004
540 Claim PPS Capital Outlier Amount Start: 10/31/2004
541 Claim Submission Reason Code Start: 10/31/2004
542 Claim Total Denied Charge Amount Start: 10/31/2004
543 Clearinghouse or Value Added Network Trace Start: 10/31/2004
544 Clinical Laboratory Improvement Amendment Start: 10/31/2004
545 Contract Amount Start: 10/31/2004
546 Contract Code Start: 10/31/2004
547 Contract Percentage Start: 10/31/2004
548 Contract Type Code Start: 10/31/2004
549 Contract Version Identifier Start: 10/31/2004
550 Coordination of Benefits Code Start: 10/31/2004
551 Coordination of Benefits Total Submitted Charge Start: 10/31/2004
552 Cost Report Day Count Start: 10/31/2004
553 Covered Amount Start: 10/31/2004
554 Date Claim Paid Start: 10/31/2004
555 Delay Reason Code Start: 10/31/2004
556 Demonstration Project Identifier Start: 10/31/2004
557 Diagnosis Date Start: 10/31/2004
558 Discount Amount Start: 10/31/2004
559 Document Control Identifier Start: 10/31/2004
560 Entity's Additional/Secondary Identifier. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
561 Entity's Contact Name. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
562 Entity's National Provider Identifier (NPI). Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
563 Entity's Tax Amount. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
564 EPSDT Indicator Start: 10/31/2004
565 Estimated Claim Due Amount Start: 10/31/2004
566 Exception Code Start: 10/31/2004
567 Facility Code Qualifier Start: 10/31/2004
568 Family Planning Indicator Start: 10/31/2004
569 Fixed Format Information Start: 10/31/2004
570 Free Form Message Text Start: 10/31/2004
571 Frequency Count Start: 10/31/2004
572 Frequency Period Start: 10/31/2004
573 Functional Limitation Code Start: 10/31/2004
574 HCPCS Payable Amount Home Health Start: 10/31/2004
575 Homebound Indicator Start: 10/31/2004
576 Immunization Batch Number Start: 10/31/2004
577 Industry Code Start: 10/31/2004
578 Insurance Type Code Start: 10/31/2004
579 Investigational Device Exemption Identifier Start: 10/31/2004
580 Last Certification Date Start: 10/31/2004
581 Last Worked Date Start: 10/31/2004
582 Lifetime Psychiatric Days Count Start: 10/31/2004
583 Line Item Charge Amount Start: 10/31/2004
584 Line Item Control Number Start: 10/31/2004
585 Denied Charge or Non-covered Charge Start: 10/31/2004 | Last Modified: 07/09/2007
586 Line Note Text Start: 10/31/2004
587 Measurement Reference Identification Code Start: 10/31/2004
588 Medical Record Number Start: 10/31/2004
589 Provider Accept Assignment Code Start: 10/31/2004 | Last Modified: 10/17/2010
590 Medicare Coverage Indicator Start: 10/31/2004
591 Medicare Paid at 100% Amount Start: 10/31/2004
592 Medicare Paid at 80% Amount Start: 10/31/2004
593 Medicare Section 4081 Indicator Start: 10/31/2004
594 Mental Status Code Start: 10/31/2004
595 Monthly Treatment Count Start: 10/31/2004
596 Non-covered Charge Amount Start: 10/31/2004
597 Non-payable Professional Component Amount Start: 10/31/2004
598 Non-payable Professional Component Billed Amount Start: 10/31/2004
599 Note Reference Code Start: 10/31/2004
600 Oxygen Saturation Qty Start: 10/31/2004
601 Oxygen Test Condition Code Start: 10/31/2004
602 Oxygen Test Date Start: 10/31/2004
603 Old Capital Amount Start: 10/31/2004
604 Originator Application Transaction Identifier Start: 10/31/2004
605 Orthodontic Treatment Months Count Start: 10/31/2004
606 Paid From Part A Medicare Trust Fund Amount Start: 10/31/2004
607 Paid From Part B Medicare Trust Fund Amount Start: 10/31/2004
608 Paid Service Unit Count Start: 10/31/2004
609 Participation Agreement Start: 10/31/2004
610 Patient Discharge Facility Type Code Start: 10/31/2004
611 Peer Review Authorization Number Start: 10/31/2004
612 Per Day Limit Amount Start: 10/31/2004
613 Physician Contact Date Start: 10/31/2004
614 Physician Order Date Start: 10/31/2004
615 Policy Compliance Code Start: 10/31/2004
616 Policy Name Start: 10/31/2004
617 Postage Claimed Amount Start: 10/31/2004
618 PPS-Capital DSH DRG Amount Start: 10/31/2004
619 PPS-Capital Exception Amount Start: 10/31/2004
620 PPS-Capital FSP DRG Amount Start: 10/31/2004
621 PPS-Capital HSP DRG Amount Start: 10/31/2004
622 PPS-Capital IME Amount Start: 10/31/2004
623 PPS-Operating Federal Specific DRG Amount Start: 10/31/2004
624 PPS-Operating Hospital Specific DRG Amount Start: 10/31/2004
625 Predetermination of Benefits Identifier Start: 10/31/2004
626 Pregnancy Indicator Start: 10/31/2004
627 Pre-Tax Claim Amount Start: 10/31/2004
628 Pricing Methodology Start: 10/31/2004
629 Property Casualty Claim Number Start: 10/31/2004
630 Referring CLIA Number Start: 10/31/2004
631 Reimbursement Rate Start: 10/31/2004
632 Reject Reason Code Start: 10/31/2004
633 Related Causes Code (Accident, auto accident, employment) Start: 10/31/2004 | Last Modified: 10/17/2010
634 Remark Code Start: 10/31/2004
635 Repriced Ambulatory Patient Group Code Start: 10/31/2004
636 Repriced Line Item Reference Number Start: 10/31/2004
637 Repriced Saving Amount Start: 10/31/2004
638 Repricing Per Diem or Flat Rate Amount Start: 10/31/2004
639 Responsibility Amount Start: 10/31/2004
640 Sales Tax Amount Start: 10/31/2004
641 Service Adjudication or Payment Date. Note: Use code 516. Start: 10/31/2004 | Last Modified: 09/20/2009 | Stop: 10/01/2010
642 Service Authorization Exception Code Start: 10/31/2004
643 Service Line Paid Amount Start: 10/31/2004
644 Service Line Rate Start: 10/31/2004
645 Service Tax Amount Start: 10/31/2004
646 Ship, Delivery or Calendar Pattern Code Start: 10/31/2004
647 Shipped Date Start: 10/31/2004
648 Similar Illness or Symptom Date Start: 10/31/2004
649 Skilled Nursing Facility Indicator Start: 10/31/2004
650 Special Program Indicator Start: 10/31/2004
651 State Industrial Accident Provider Number Start: 10/31/2004
652 Terms Discount Percentage Start: 10/31/2004
653 Test Performed Date Start: 10/31/2004
654 Total Denied Charge Amount Start: 10/31/2004
655 Total Medicare Paid Amount Start: 10/31/2004
656 Total Visits Projected This Certification Count Start: 10/31/2004
657 Total Visits Rendered Count Start: 10/31/2004
658 Treatment Code Start: 10/31/2004
659 Unit or Basis for Measurement Code Start: 10/31/2004
660 Universal Product Number Start: 10/31/2004
661 Visits Prior to Recertification Date Count CR702 Start: 10/31/2004
662 X-ray Availability Indicator Start: 10/31/2004
663 Entity's Group Name. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
664 Orthodontic Banding Date Start: 10/31/2004
665 Surgery Date Start: 10/31/2004
666 Surgical Procedure Code Start: 10/31/2004
667 Real-Time requests not supported by the information holder, do not resubmit Start: 02/28/2005
668 Missing Endodontics treatment history and prognosis Start: 06/30/2005
669 Dental service narrative needed. Start: 10/31/2005
670 Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 | Last Modified: 02/28/2007
671 Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 | Last Modified: 02/28/2007
672 Other Payer's payment information is out of balance Start: 10/31/2006
673 Patient Reason for Visit Start: 10/31/2006
674 Authorization exceeded Start: 10/31/2006
675 Facility admission through discharge dates Start: 10/31/2006
676 Entity possibly compensated by facility. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
677 Entity not affiliated. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
678 Revenue code and patient gender mismatch Start: 10/31/2006
679 Submit newborn services on mother's claim Start: 10/31/2006
680 Entity's Country. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
681 Claim currency not supported Start: 10/31/2006
682 Cosmetic procedure Start: 02/28/2007
683 Awaiting Associated Hospital Claims Start: 02/28/2007
684 Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Note: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement.) Start: 11/05/2007
685 Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit. Start: 01/27/2008
686 The claim/ encounter has completed the adjudication cycle and the entire claim has been voided Start: 01/27/2008
687 Claim estimation can not be completed in real time. Do not resubmit. Start: 01/27/2008
688 Present on Admission Indicator for reported diagnosis code(s). Start: 01/27/2008
689 Entity was unable to respond within the expected time frame. Note: This code requires use of an Entity Code. Start: 06/01/2008 | Last Modified: 02/11/2010
690 Multiple claims or estimate requests cannot be processed in real time. Start: 06/01/2008
691 Multiple claim status requests cannot be processed in real time. Start: 06/01/2008
692 Contracted funding agreement-Subscriber is employed by the provider of services Start: 09/21/2008
693 Amount must be greater than or equal to zero. Note: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009
694 Amount must not be equal to zero. Note: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009
695 Entity's Country Subdivision Code. Note: This code requires use of an Entity Code. Start: 01/25/2009 | Last Modified: 02/11/2010
696 Claim Adjustment Group Code. Start: 01/25/2009
697 Invalid Decimal Precision. Note: At least one other status code is required to identify the data element in error. Start: 07/01/2009
698 Form Type Identification Start: 07/01/2009
699 Question/Response from Supporting Documentation Form Start: 07/01/2009
700 ICD10. Note: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 07/01/2009
701 Initial Treatment Date Start: 07/01/2009
702 Repriced Claim Reference Number Start: 11/01/2009
703 Advanced Billing Concepts (ABC) code Start: 01/24/2010
704 Claim Note Text Start: 01/24/2010
705 Repriced Allowed Amount Start: 01/24/2010
706 Repriced Approved Amount Start: 01/24/2010
707 Repriced Approved Ambulatory Patient Group Amount Start: 01/24/2010
708 Repriced Approved Revenue Code Start: 01/24/2010
709 Repriced Approved Service Unit Count Start: 01/24/2010
710 Line Adjudication Information. Note: At least one other status code is required to identify the data element in error. Start: 01/24/2010
711 Stretcher purpose Start: 01/24/2010
712 Obstetric Additional Units Start: 01/24/2010
713 Patient Condition Description Start: 01/24/2010
714 Care Plan Oversight Number Start: 01/24/2010
715 Acute Manifestation Date Start: 01/24/2010
716 Repriced Approved DRG Code Start: 01/24/2010
717 This claim has been split for processing. Start: 01/24/2010
718 Claim/service not submitted within the required timeframe (timely filing). Start: 01/24/2010
719 NUBC Occurrence Code(s) Start: 01/24/2010
720 NUBC Occurrence Code Date(s) Start: 01/24/2010
721 NUBC Occurrence Span Code(s) Start: 01/24/2010
722 NUBC Occurrence Span Code Date(s) Start: 01/24/2010
723 Drug days supply Start: 01/24/2010
724 Drug dosage Start: 01/24/2010
725 NUBC Value Code(s) Start: 01/24/2010
726 NUBC Value Code Amount(s) Start: 01/24/2010
727 Accident date Start: 01/24/2010
728 Accident state Start: 01/24/2010
729 Accident description Start: 01/24/2010
730 Accident cause Start: 01/24/2010
731 Measurement value/test result Start: 01/24/2010
732 Information submitted inconsistent with billing guidelines. Note: At least one other status code is required to identify the inconsistent information. Start: 01/24/2010
733 Prefix for entity's contract/member number. Start: 01/24/2010
734 Verifying premium payment Start: 06/06/2010
735 This service/claim is included in the allowance for another service or claim. Start: 06/06/2010
736 A related or qualifying service/claim has not been received/adjudicated. Start: 06/06/2010
737 Current Dental Terminology (CDT) Code Start: 06/06/2010
738 Home Infusion EDI Coalition (HEIC) Product/Service Code Start: 06/06/2010
739 Jurisdiction Specific Procedure or Supply Code Start: 06/06/2010
740 Drop-Off Location Start: 06/06/2010
741 Entity must be a person. Note: This code requires use of an Entity Code. Start: 06/06/2010
742 Payer Responsibility Sequence Number Code Start: 06/06/2010
743 Entity's credential/enrollment information. Note: This code requires use of an Entity Code. Start: 10/17/2010
744 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. Start: 10/17/2010
745 Identifier Qualifier Note: At least one other status code is required to identify the specific identifier qualifier in error. Start: 10/17/2010
746 Duplicate Submission Note: use only at the information receiver level in the Health Care Claim Acknowledgement transaction. Start: 10/17/2010
747 Hospice Employee Indicator Start: 10/17/2010
748 Corrected Data Note: Requires a second status code to identify the corrected data. Start: 10/17/2010
749 Date of Injury/Illness Start: 10/17/2010
750 Invalid Auto Accident State or Province Code. This change effective 11/1/2011: Auto Accident State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
751 Invalid Ambulance Pick-up State or Province Code. This change effective 11/1/2011: Ambulance Pick-up State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
752 Invalid Ambulance Drop-off State or Province Code. This change effective 11/1/2011: Ambulance Drop-off State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
753 Co-pay status code. Start: 01/30/2011
754 Entity Name Suffix. Note: This code requires the use of an Entity Code. Start: 01/30/2011
755 Entity's primary identifier. Note: This code requires the use of an Entity Code. Start: 01/30/2011
756 Entity's Received Date. Note: This code requires the use of an Entity Code. Start: 01/30/2011
757 Last seen date. Start: 01/30/2011
758 Repriced approved HCPCS code. Start: 01/30/2011
759 Round trip purpose description. Start: 01/30/2011
760 Tooth status code. Start: 01/30/2011
761 Entity's referral number. Note: This code requires the use of an Entity Code. Start: 01/30/2011
00 Cannot provide further status electronically. Start: 01/01/1995
01 For more detailed information, see remittance advice. Start: 01/01/1995
02 More detailed information in letter. Start: 01/01/1995
03 Claim has been adjudicated and is awaiting payment cycle. Start: 01/01/1995
04 This is a subsequent request for information from the original request. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
05 This is a final request for information. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
06 Balance due from the subscriber. Start: 01/01/1995
07 Claim may be reconsidered at a future date. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
08 No payment due to contract/plan provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
09 No payment will be made for this claim. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
10 All originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
11 Some originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
12 One or more originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 06/30/2001
13 All originally submitted procedure codes have been modified. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
14 Some all originally submitted procedure codes have been modified. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
15 One or more originally submitted procedure code have been modified. Start: 01/01/1995 | Last Modified: 06/30/2001
16 Claim/encounter has been forwarded to entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
17 Claim/encounter has been forwarded by third party entity to entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
18 Entity received claim/encounter, but returned invalid status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
19 Entity acknowledges receipt of claim/encounter. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
20 Accepted for processing. Start: 01/01/1995 | Last Modified: 06/30/2001
21 Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information. Start: 01/01/1995 | Last Modified: 07/09/2007
22 ... before entering the adjudication system. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
23 Returned to Entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
24 Entity not approved as an electronic submitter. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
25 Entity not approved. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
26 Entity not found. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
27 Policy canceled. Start: 01/01/1995 | Last Modified: 06/30/2001
28 Claim submitted to wrong payer. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
29 Subscriber and policy number/contract number mismatched. Start: 01/01/1995
30 Subscriber and subscriber id mismatched. Start: 01/01/1995
31 Subscriber and policyholder name mismatched. Start: 01/01/1995
32 Subscriber and policy number/contract number not found. Start: 01/01/1995
33 Subscriber and subscriber id not found. Start: 01/01/1995
34 Subscriber and policyholder name not found. Start: 01/01/1995
35 Claim/encounter not found. Start: 01/01/1995
37 Predetermination is on file, awaiting completion of services. Start: 01/01/1995
38 Awaiting next periodic adjudication cycle. Start: 01/01/1995
39 Charges for pregnancy deferred until delivery. Start: 01/01/1995
40 Waiting for final approval. Start: 01/01/1995
41 Special handling required at payer site. Start: 01/01/1995
42 Awaiting related charges. Start: 01/01/1995
44 Charges pending provider audit. Start: 01/01/1995
45 Awaiting benefit determination. Start: 01/01/1995
46 Internal review/audit. Start: 01/01/1995
47 Internal review/audit - partial payment made. Start: 01/01/1995
48 Referral/authorization. Start: 01/01/1995 | Last Modified: 02/28/2001 | Stop: 01/01/2012 Notes: Refer to codes 252 and 761.
49 Pending provider accreditation review. Start: 01/01/1995
50 Claim waiting for internal provider verification. Start: 01/01/1995
51 Investigating occupational illness/accident. Start: 01/01/1995
52 Investigating existence of other insurance coverage. Start: 01/01/1995
53 Claim being researched for Insured ID/Group Policy Number error. Start: 01/01/1995
54 Duplicate of a previously processed claim/line. Start: 01/01/1995
55 Claim assigned to an approver/analyst. Start: 01/01/1995
56 Awaiting eligibility determination. Start: 01/01/1995
57 Pending COBRA information requested. Start: 01/01/1995
59 Information was requested by a non-electronic method. Note: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 10/17/2010
60 Information was requested by an electronic method. Note: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 10/17/2010
61 Eligibility for extended benefits. Start: 01/01/1995
64 Re-pricing information. Start: 01/01/1995
65 Claim/line has been paid. Start: 01/01/1995
66 Payment reflects usual and customary charges. Start: 01/01/1995
67 Payment made in full. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
68 Partial payment made for this claim. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
69 Payment reflects plan provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
70 Payment reflects contract provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
71 Periodic installment released. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
72 Claim contains split payment. Start: 01/01/1995
73 Payment made to entity, assignment of benefits not on file. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
78 Duplicate of an existing claim/line, awaiting processing. Start: 01/01/1995
81 Contract/plan does not cover pre-existing conditions. Start: 01/01/1995
83 No coverage for newborns. Start: 01/01/1995
84 Service not authorized. Start: 01/01/1995
85 Entity not primary. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
86 Diagnosis and patient gender mismatch. Start: 01/01/1995 | Last Modified: 02/28/2000
87 Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
88 Entity not eligible for benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
89 Entity not eligible for dental benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
90 Entity not eligible for medical benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
91 Entity not eligible/not approved for dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
92 Entity does not meet dependent or student qualification. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
93 Entity is not selected primary care provider. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
94 Entity not referred by selected primary care provider. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
95 Requested additional information not received. Start: 01/01/1995 | Last Modified: 07/09/2007 Notes: If known, the payer must report a second claim status code identifying the requested information.
96 No agreement with entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
97 Patient eligibility not found with entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
98 Charges applied to deductible. Start: 01/01/1995
99 Pre-treatment review. Start: 01/01/1995
100 Pre-certification penalty taken. Start: 01/01/1995
101 Claim was processed as adjustment to previous claim. Start: 01/01/1995
102 Newborn's charges processed on mother's claim. Start: 01/01/1995
103 Claim combined with other claim(s). Start: 01/01/1995
104 Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient) Start: 01/01/1995 | Last Modified: 06/01/2008
105 Claim/line is capitated. Start: 01/01/1995
106 This amount is not entity's responsibility. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
107 Processed according to contract provisions (Contract refers to provisions that exist between t he Health Plan and a Provider of Health Care Services) Start: 01/01/1995 | Last Modified: 06/01/2008
108 Coverage has been canceled for this entity. (Use code 27) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
109 Entity not eligible. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
110 Claim requires pricing information. Start: 01/01/1995
111 At the policyholder's request these claims cannot be submitted electronically. Start: 01/01/1995
112 Policyholder processes their own claims. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
113 Cannot process individual insurance policy claims. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
114 Claim/service should be processed by entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
115 Cannot process HMO claims Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
116 Claim submitted to incorrect payer. Start: 01/01/1995
117 Claim requires signature-on-file indicator. Start: 01/01/1995
118 TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
119 TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
120 TPO rejected claim/line because claim does not contain enough information. (Use status code 21) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
121 Service line number greater than maximum allowable for payer. Start: 01/01/1995
122 Missing/invalid data prevents payer from processing claim. (Use CSC Code 21) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
123 Additional information requested from entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
124 Entity's name, address, phone and id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
125 Entity's name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
126 Entity's address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
127 Entity's Communication Number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 06/06/2010
128 Entity's tax id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
129 Entity's Blue Cross provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
130 Entity's Blue Shield provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
131 Entity's Medicare provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
132 Entity's Medicaid provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
133 Entity's UPIN. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
134 Entity's CHAMPUS provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
135 Entity's commercial provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
136 Entity's health industry id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
137 Entity's plan network id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
138 Entity's site id . Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
139 Entity's health maintenance provider id (HMO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
140 Entity's preferred provider organization id (PPO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
141 Entity's administrative services organization id (ASO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
142 Entity's license/certification number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
143 Entity's state license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
144 Entity's specialty license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
145 Entity's specialty/taxonomy code. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
146 Entity's anesthesia license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
147 Entity's qualification degree/designation (e.g. RN,PhD,MD). Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
148 Entity's social security number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
149 Entity's employer id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
150 Entity's drug enforcement agency (DEA) number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
152 Pharmacy processor number. Start: 01/01/1995
153 Entity's id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
154 Relationship of surgeon & assistant surgeon. Start: 01/01/1995
155 Entity's relationship to patient. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
156 Patient relationship to subscriber Start: 01/01/1995
157 Entity's Gender. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
158 Entity's date of birth. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
159 Entity's date of death. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
160 Entity's marital status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
161 Entity's employment status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
162 Entity's health insurance claim number (HICN). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
163 Entity's policy number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
164 Entity's contract/member number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
165 Entity's employer name, address and phone. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
166 Entity's employer name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
167 Entity's employer address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
168 Entity's employer phone number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
169 Entity's employer id. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
170 Entity's employee id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
171 Other insurance coverage information (health, liability, auto, etc.). Start: 01/01/1995
172 Other employer name, address and telephone number. Start: 01/01/1995
173 Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
174 Entity's student status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
175 Entity's school name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
176 Entity's school address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
177 Transplant recipient's name, date of birth, gender, relationship to insured. Start: 01/01/1995 | Last Modified: 02/28/2000
178 Submitted charges. Start: 01/01/1995
179 Outside lab charges. Start: 01/01/1995
180 Hospital s semi-private room rate. Start: 01/01/1995
181 Hospital s room rate. Start: 01/01/1995
182 Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code. Start: 01/01/1995 | Last Modified: 01/24/2010
183 Amount entity has paid. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
184 Purchase price for the rented durable medical equipment. Start: 01/01/1995
185 Rental price for durable medical equipment. Start: 01/01/1995
186 Purchase and rental price of durable medical equipment. Start: 01/01/1995
187 Date(s) of service. Start: 01/01/1995
188 Statement from-through dates. Start: 01/01/1995
189 Facility admission date Start: 01/01/1995 | Last Modified: 10/31/2006
190 Facility discharge date Start: 01/01/1995 | Last Modified: 10/31/2006
191 Date of Last Menstrual Period (LMP) Start: 02/28/1997
192 Date of first service for current series/symptom/illness. Start: 01/01/1995
193 First consultation/evaluation date. Start: 02/28/1997
194 Confinement dates. Start: 01/01/1995
195 Unable to work dates/Disability Dates. Start: 01/01/1995 | Last Modified: 09/20/2009
196 Return to work dates. Start: 01/01/1995
197 Effective coverage date(s). Start: 01/01/1995
198 Medicare effective date. Start: 01/01/1995
199 Date of conception and expected date of delivery. Start: 01/01/1995
200 Date of equipment return. Start: 01/01/1995
201 Date of dental appliance prior placement. Start: 01/01/1995
202 Date of dental prior replacement/reason for replacement. Start: 01/01/1995
203 Date of dental appliance placed. Start: 01/01/1995
204 Date dental canal(s) opened and date service completed. Start: 01/01/1995
205 Date(s) dental root canal therapy previously performed. Start: 01/01/1995
206 Most recent date of curettage, root planing, or periodontal surgery. Start: 01/01/1995
207 Dental impression and seating date. Start: 01/01/1995
208 Most recent date pacemaker was implanted. Start: 01/01/1995
209 Most recent pacemaker battery change date. Start: 01/01/1995
210 Date of the last x-ray. Start: 01/01/1995
211 Date(s) of dialysis training provided to patient. Start: 01/01/1995
212 Date of last routine dialysis. Start: 01/01/1995
213 Date of first routine dialysis. Start: 01/01/1995
214 Original date of prescription/orders/referral. Start: 02/28/1997
215 Date of tooth extraction/evolution. Start: 01/01/1995
216 Drug information. Start: 01/01/1995
217 Drug name, strength and dosage form. Start: 01/01/1995
218 NDC number. Start: 01/01/1995
219 Prescription number. Start: 01/01/1995
220 Drug product id number. (Use code 218) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
221 Drug days supply and dosage. Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
222 Drug dispensing units and average wholesale price (AWP). Start: 01/01/1995
223 Route of drug/myelogram administration. Start: 01/01/1995
224 Anatomical location for joint injection. Start: 01/01/1995
225 Anatomical location. Start: 01/01/1995
226 Joint injection site. Start: 01/01/1995
227 Hospital information. Start: 01/01/1995
228 Type of bill for UB claim Start: 01/01/1995 | Last Modified: 10/31/2006
229 Hospital admission source. Start: 01/01/1995
230 Hospital admission hour. Start: 01/01/1995
231 Hospital admission type. Start: 01/01/1995
232 Admitting diagnosis. Start: 01/01/1995
233 Hospital discharge hour Start: 01/01/1995
234 Patient discharge status. Start: 01/01/1995
235 Units of blood furnished. Start: 01/01/1995
236 Units of blood replaced. Start: 01/01/1995
237 Units of deductible blood. Start: 01/01/1995
238 Separate claim for mother/baby charges. Start: 01/01/1995
239 Dental information. Start: 01/01/1995
240 Tooth surface(s) involved. Start: 01/01/1995
241 List of all missing teeth (upper and lower). Start: 01/01/1995
242 Tooth numbers, surfaces, and/or quadrants involved. Start: 01/01/1995
243 Months of dental treatment remaining. Start: 01/01/1995
244 Tooth number or letter. Start: 01/01/1995
245 Dental quadrant/arch. Start: 01/01/1995
246 Total orthodontic service fee, initial appliance fee, monthly fee, length of service. Start: 01/01/1995
247 Line information. Start: 01/01/1995
248 Accident date, state, description and cause. Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
249 Place of service. Start: 01/01/1995
250 Type of service. Start: 01/01/1995
251 Total anesthesia minutes. Start: 01/01/1995
252 Authorization/certification number. This change effective 11/1/2011: Entity's authorization/certification number. Note: This code requires the use of an Entity Code. Start: 01/01/1995 | Last Modified: 01/30/2011
253 Procedure/revenue code for service(s) rendered. Use codes 454 or 455. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
254 Primary diagnosis code. This change effective 11/1/2011: Principal doagnosis code. Start: 01/01/1995 | Last Modified: 01/30/2011
255 Diagnosis code. Start: 01/01/1995
256 DRG code(s). Start: 01/01/1995
257 ADSM-III-R code for services rendered. Start: 01/01/1995
258 Days/units for procedure/revenue code. Start: 01/01/1995
259 Frequency of service. Start: 01/01/1995
260 Length of medical necessity, including begin date. Start: 02/28/1997
261 Obesity measurements. Start: 01/01/1995
262 Type of surgery/service for which anesthesia was administered. Start: 01/01/1995
263 Length of time for services rendered. Start: 01/01/1995
264 Number of liters/minute & total hours/day for respiratory support. Start: 01/01/1995
265 Number of lesions excised. Start: 01/01/1995
266 Facility point of origin and destination - ambulance. Start: 01/01/1995
267 Number of miles patient was transported. Start: 01/01/1995
268 Location of durable medical equipment use. Start: 01/01/1995
269 Length/size of laceration/tumor. Start: 01/01/1995
270 Subluxation location. Start: 01/01/1995
271 Number of spine segments. Start: 01/01/1995
272 Oxygen contents for oxygen system rental. Start: 01/01/1995
273 Weight. Start: 01/01/1995
274 Height. Start: 01/01/1995
275 Claim. Start: 01/01/1995
276 UB04/HCFA-1450/1500 claim form Start: 01/01/1995 | Last Modified: 10/31/2006
277 Paper claim. Start: 01/01/1995
278 Signed claim form. Start: 01/01/1995 | Stop: 11/01/2011
279 Claim/service must be itemized Start: 01/01/1995 | Last Modified: 10/17/2010
280 Itemized claim by provider. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 279
281 Related confinement claim. Start: 01/01/1995
282 Copy of prescription. Start: 01/01/1995
283 Medicare entitlement information is required to determine primary coverage Start: 01/01/1995 | Last Modified: 01/27/2008
284 Copy of Medicare ID card. Start: 01/01/1995
285 Vouchers/explanation of benefits (EOB). Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 286
286 Other payer's Explanation of Benefits/payment information. Start: 01/01/1995
287 Medical necessity for service. Start: 01/01/1995
288 Hospital late charges Start: 01/01/1995 | Last Modified: 10/17/2010
289 Reason for late discharge. Start: 01/01/1995 | Stop: 11/01/2011
290 Pre-existing information. Start: 01/01/1995
291 Reason for termination of pregnancy. Start: 01/01/1995
292 Purpose of family conference/therapy. Start: 01/01/1995
293 Reason for physical therapy. Start: 01/01/1995
294 Supporting documentation. Note: At least one other status code is required to identify the supporting documentation. Start: 01/01/1995 | Last Modified: 10/17/2010
295 Attending physician report. Start: 01/01/1995
296 Nurse's notes. Start: 01/01/1995
297 Medical notes/report. Start: 02/28/1997
298 Operative report. Start: 01/01/1995
299 Emergency room notes/report. Start: 01/01/1995
300 Lab/test report/notes/results. Start: 02/28/1997
301 MRI report. Start: 01/01/1995
302 Refer to codes 300 for lab notes and 311 for pathology notes Start: 01/01/1995 | Stop: 01/31/1997
303 Physical therapy notes. Use code 297:6O (6 'OH' - not zero) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
304 Reports for service. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 297, 298, 299, 300
305 Radiology/x-ray reports and/or interpretation Start: 01/01/1995 | Last Modified: 01/30/2011
306 Detailed description of service. Start: 01/01/1995
307 Narrative with pocket depth chart. Start: 01/01/1995
308 Discharge summary. Start: 01/01/1995
309 Code was duplicate of code 299 Start: 01/01/1995 | Stop: 01/31/1997
310 Progress notes for the six months prior to statement date. Start: 01/01/1995
311 Pathology notes/report. Start: 01/01/1995
312 Dental charting. Start: 01/01/1995
313 Bridgework information. Start: 01/01/1995
314 Dental records for this service. Start: 01/01/1995
315 Past perio treatment history. Start: 01/01/1995
316 Complete medical history. Start: 01/01/1995
317 Patient's medical records. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
318 X-rays/radiology films Start: 01/01/1995 | Last Modified: 10/17/2010
319 Pre/post-operative x-rays/photographs. Start: 02/28/1997
320 Study models. Start: 01/01/1995
321 Radiographs or models. (Use codes 318 and/or 320) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
322 Recent Full Mouth X-rays Start: 01/01/1995 | Last Modified: 10/17/2010
323 Study models, x-rays, and/or narrative. Start: 01/01/1995
324 Recent x-ray of treatment area and/or narrative. Start: 01/01/1995
325 Recent fm x-rays and/or narrative. Start: 01/01/1995
326 Copy of transplant acquisition invoice. Start: 01/01/1995
327 Periodontal case type diagnosis and recent pocket depth chart with narrative. Start: 01/01/1995
328 Speech therapy notes. Use code 297:6R Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
329 Exercise notes. Start: 01/01/1995
330 Occupational notes. Start: 01/01/1995
331 History and physical. Start: 01/01/1995 | Last Modified: 08/01/2007
332 Authorization/certification (include period covered). (Use code 252) Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
333 Patient release of information authorization. Start: 01/01/1995
334 Oxygen certification. Start: 01/01/1995
335 Durable medical equipment certification. Start: 01/01/1995
336 Chiropractic certification. Start: 01/01/1995
337 Ambulance certification/documentation. Start: 01/01/1995
338 Home health certification. Use code 332:4Y Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
339 Enteral/parenteral certification. Start: 01/01/1995
340 Pacemaker certification. Start: 01/01/1995
341 Private duty nursing certification. Start: 01/01/1995
342 Podiatric certification. Start: 01/01/1995
343 Documentation that facility is state licensed and Medicare approved as a surgical facility. Start: 01/01/1995
344 Documentation that provider of physical therapy is Medicare Part B approved. Start: 01/01/1995
345 Treatment plan for service/diagnosis Start: 01/01/1995
346 Proposed treatment plan for next 6 months. Start: 01/01/1995
347 Refer to code 345 for treatment plan and code 282 for prescription Start: 01/01/1995 | Stop: 01/31/1997
348 Chiropractic treatment plan. (Use 345:QL) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
349 Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
350 Speech pathology treatment plan. Use code 345:6R Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
351 Physical/occupational therapy treatment plan. Use codes 345:6O (6 'OH' - not zero), 6N Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
352 Duration of treatment plan. Start: 01/01/1995
353 Orthodontics treatment plan. Start: 01/01/1995
354 Treatment plan for replacement of remaining missing teeth. Start: 01/01/1995
355 Has claim been paid? Start: 01/01/1995 | Stop: 11/01/2011
356 Was blood furnished? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 235
357 Has or will blood be replaced? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 236
358 Does provider accept assignment of benefits? (Use code 589) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
359 Is there a release of information signature on file? (Use code 333) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
360 Benefits Assignment Certification Indicator Start: 01/01/1995 | Last Modified: 10/17/2010
361 Is there other insurance? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 171 and 550
362 Is the dental patient covered by medical insurance? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 171
363 Possible Workers' Compensation Start: 01/01/1995 | Last Modified: 10/17/2010
364 Is accident/illness/condition employment related? Start: 01/01/1995
365 Is service the result of an accident? Start: 01/01/1995
366 Is injury due to auto accident? Start: 01/01/1995 367 Is service performed for a recurring condition or new condition? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 397
368 Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 676
369 Does patient condition preclude use of ordinary bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335
370 Can patient operate controls of bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335
371 Is patient confined to room? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
372 Is patient confined to bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
373 Is patient an insulin diabetic? Start: 01/01/1995 | Stop: 11/01/2011
374 Is prescribed lenses a result of cataract surgery? Start: 01/01/1995
375 Was refraction performed? Start: 01/01/1995
376 Was charge for ambulance for a round-trip? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 453
377 Was durable medical equipment purchased new or used? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 184, 185, 186, 335
378 Is pacemaker temporary or permanent? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 340
379 Were services performed supervised by a physician? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 453, 454, 666 & procedure code
380 CRNA supervision/medical direction. Start: 01/01/1995 | Last Modified: 10/17/2010
381 Is drug generic? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 216
382 Did provider authorize generic or brand name dispensing? Start: 01/01/1995
383 Nerve block use (surgery vs. pain management) Start: 01/01/1995 | Last Modified: 10/17/2010
384 Is prosthesis/crown/inlay placement an initial placement or a replacement? Start: 01/01/1995
385 Is appliance upper or lower arch & is appliance fixed or removable? Start: 01/01/1995
386 Orthodontic Treatment/Purpose Indicator Start: 01/01/1995 | Last Modified: 10/17/2010
387 Date patient last examined by entity. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
388 Date post-operative care assumed Start: 02/28/1997
389 Date post-operative care relinquished Start: 02/28/1997
390 Date of most recent medical event necessitating service(s) Start: 02/28/1997
391 Date(s) dialysis conducted Start: 02/28/1997
392 Date(s) of blood transfusion(s) Start: 02/28/1997 | Stop: 11/01/2011
393 Date of previous pacemaker check Start: 02/28/1997 | Stop: 11/01/2011
394 Date(s) of most recent hospitalization related to service Start: 02/28/1997
395 Date entity signed certification/recertification Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
396 Date home dialysis began Start: 02/28/1997
397 Date of onset/exacerbation of illness/condition Start: 02/28/1997
398 Visual field test results Start: 02/28/1997
399 Report of prior testing related to this service, including dates Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 417
400 Claim is out of balance Start: 02/28/1997
401 Source of payment is not valid Start: 02/28/1997
402 Amount must be greater than zero. Note: At least one other status code is required to identify which amount element is in error. Start: 02/28/1997 | Last Modified: 09/20/2009
403 Entity referral notes/orders/prescription Start: 02/28/1997
404 Specific findings, complaints, or symptoms necessitating service Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to codes 287, 488
405 Summary of services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 306
406 Brief medical history as related to service(s) Start: 02/28/1997
407 Complications/mitigating circumstances Start: 02/28/1997
408 Initial certification Start: 02/28/1997
409 Medication logs/records (including medication therapy) Start: 02/28/1997
410 Explain differences between treatment plan and patient's condition Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
411 Medical necessity for non-routine service(s) Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 287
412 Medical records to substantiate decision of non-coverage Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
413 Explain/justify differences between treatment plan and services rendered. Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
414 Necessity for concurrent care (more than one physician treating the patient) Start: 02/28/1997 | Last Modified: 10/17/2010
415 Justify services outside composite rate Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 287
416 Verification of patient's ability to retain and use information Start: 02/28/1997 | Stop: 11/01/2011Notes: Refer to code 297 or other specific report type codes
417 Prior testing, including result(s) and date(s) as related to service(s) Start: 02/28/1997
418 Indicating why medications cannot be taken orally Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
419 Individual test(s) comprising the panel and the charges for each test Start: 02/28/1997
420 Name, dosage and medical justification of contrast material used for radiology procedure Start: 02/28/1997
421 Medical review attachment/information for service(s) Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
422 Homebound status Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 575
423 Prognosis Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
424 Statement of non-coverage including itemized bill Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
425 Itemize non-covered services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
426 All current diagnoses Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 255, 232 & 488
427 Emergency care provided during transport Start: 02/28/1997 | Stop: 11/01/2011
428 Reason for transport by ambulance Start: 02/28/1997
429 Loaded miles and charges for transport to nearest facility with appropriate services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to codes 267, 178, 430
430 Nearest appropriate facility Start: 02/28/1997
431 Patient's condition/functional status at time of service. Start: 02/28/1997 | Last Modified: 10/17/2010
432 Date benefits exhausted Start: 02/28/1997
433 Copy of patient revocation of hospice benefits Start: 02/28/1997
434 Reasons for more than one transfer per entitlement period Start: 02/28/1997
435 Notice of Admission Start: 02/28/1997
436 Short term goals Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
437 Long term goals Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
438 Number of patients attending session Start: 02/28/1997 | Stop: 11/01/2011
439 Size, depth, amount, and type of drainage wounds Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
440 why non-skilled caregiver has not been taught procedure Start: 02/28/1997 | Stop: 11/01/2011
441 Entity professional qualification for service(s) Start: 02/28/1997
442 Modalities of service Start: 02/28/1997
443 Initial evaluation report Start: 02/28/1997
444 Method used to obtain test sample Start: 02/28/1997 | Stop: 11/01/2011
445 Explain why hearing loss not correctable by hearing aid Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 287
446 Documentation from prior claim(s) related to service(s) Start: 02/28/1997 | Stop: 11/01/2011
447 Plan of teaching Start: 02/28/1997 | Stop: 11/01/2011
448 Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used. Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
449 Projected date to discontinue service(s) Start: 02/28/1997
450 Awaiting spend down determination Start: 02/28/1997
451 Preoperative and post-operative diagnosis Start: 02/28/1997
452 Total visits in total number of hours/day and total number of hours/week Start: 02/28/1997
453 Procedure Code Modifier(s) for Service(s) Rendered Start: 02/28/1997
454 Procedure code for services rendered. Start: 02/28/1997
455 Revenue code for services rendered. Start: 02/28/1997
456 Covered Day(s) Start: 02/28/1997
457 Non-Covered Day(s) Start: 02/28/1997
458 Coinsurance Day(s) Start: 02/28/1997
459 Lifetime Reserve Day(s) Start: 02/28/1997
460 NUBC Condition Code(s) Start: 02/28/1997
461 NUBC Occurrence Code(s) and Date(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
462 NUBC Occurrence Span Code(s) and Date(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
463 NUBC Value Code(s) and/or Amount(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
464 Payer Assigned Claim Control Number Start: 02/28/1997 | Last Modified: 10/31/2004
465 Principal Procedure Code for Service(s) Rendered Start: 02/28/1997
466 Entities Original Signature. Note: This code requires use of an Entity Code. This change effective 11/1/2011: Entity's Original Signature. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 01/30/2011
467 Entity Signature Date. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
468 Patient Signature Source Start: 02/28/1997
469 Purchase Service Charge Start: 02/28/1997
470 Was service purchased from another entity? Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
471 Were services related to an emergency? Start: 02/28/1997
472 Ambulance Run Sheet Start: 02/28/1997
473 Missing or invalid lab indicator Start: 06/30/1998
474 Procedure code and patient gender mismatch Start: 06/30/1998 | Last Modified: 02/29/2000
475 Procedure code not valid for patient age Start: 06/30/1998 | Last Modified: 02/29/2000
476 Missing or invalid units of service Start: 06/30/1998
477 Diagnosis code pointer is missing or invalid Start: 06/30/1998
478 Claim submitter's identifier Start: 06/30/1998 | Last Modified: 01/24/2010
479 Other Carrier payer ID is missing or invalid Start: 06/30/1998
480 Entity's claim filing indicator. Note: This code requires use of an Entity Code. Start: 06/30/1998 | Last Modified: 06/06/2010
481 Claim/submission format is invalid. Start: 10/31/1998
482 Date Error, Century Missing Start: 02/28/1999 | Last Modified: 09/20/2009 | Stop: 10/01/2010
483 Maximum coverage amount met or exceeded for benefit period. Start: 06/30/1999
484 Business Application Currently Not Available Start: 02/29/2000
485 More information available than can be returned in real time mode. Narrow your current search criteria. Start: 02/28/2001
486 Principal Procedure Date Start: 10/31/2001 | Last Modified: 07/01/2009
487 Claim not found, claim should have been submitted to/through 'entity'. Note: This code requires use of an Entity Code. Start: 02/28/2002 | Last Modified: 02/11/2010
488 Diagnosis code(s) for the services rendered. Start: 06/30/2002
489 Attachment Control Number Start: 10/31/2002
490 Other Procedure Code for Service(s) Rendered Start: 02/28/2003
491 Entity not eligible for encounter submission. Note: This code requires use of an Entity Code. Start: 02/28/2003 | Last Modified: 02/11/2010
492 Other Procedure Date Start: 02/28/2003
493 Version/Release/Industry ID code not currently supported by information holder Start: 02/28/2003
494 Real-Time requests not supported by the information holder, resubmit as batch request Start: 02/28/2003
495 Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit. Start: 10/31/2003
496 Submitter not approved for electronic claim submissions on behalf of this entity. Note: This code requires use of an Entity Code. Start: 02/29/2004 | Last Modified: 02/11/2010
497 Sales tax not paid Start: 06/30/2004
498 Maximum leave days exhausted Start: 06/30/2004
499 No rate on file with the payer for this service for this entity Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
500 Entity's Postal/Zip Code. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
501 Entity's State/Province. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
502 Entity's City. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
503 Entity's Street Address. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
504 Entity's Last Name. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
505 Entity's First Name. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
506 Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
507 HCPCS Start: 10/31/2004
508 ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 10/31/2004 | Last Modified: 07/01/2009
509 E-Code. This change effective 11/1/2011: External Cause of Injury Code (E-code). Start: 10/31/2004 | Last Modified: 01/30/2011
510 Future date. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
511 Invalid character. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
512 Length invalid for receiver's application system. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
513 HIPPS Rate Code for services Rendered Start: 10/31/2004
514 Entities Middle Name Note: This code requires use of an Entity Code. This change effective 11/1/2011: Entity's Middle Name Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 01/30/2011
515 Managed Care review Start: 10/31/2004
516 Other Entity's Adjudication or Payment/Remittance Date. Note: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary. Start: 10/31/2004 | Last Modified: 11/29/2009
517 Adjusted Repriced Claim Reference Number Start: 10/31/2004
518 Adjusted Repriced Line item Reference Number Start: 10/31/2004
519 Adjustment Amount Start: 10/31/2004
520 Adjustment Quantity Start: 10/31/2004
521 Adjustment Reason Code Start: 10/31/2004
522 Anesthesia Modifying Units Start: 10/31/2004
523 Anesthesia Unit Count Start: 10/31/2004
524 Arterial Blood Gas Quantity Start: 10/31/2004
525 Begin Therapy Date Start: 10/31/2004
526 Bundled or Unbundled Line Number Start: 10/31/2004
527 Certification Condition Indicator Start: 10/31/2004
528 Certification Period Projected Visit Count Start: 10/31/2004
529 Certification Revision Date Start: 10/31/2004
530 Claim Adjustment Indicator Start: 10/31/2004
531 Claim Disproportinate Share Amount Start: 10/31/2004
532 Claim DRG Amount Start: 10/31/2004
533 Claim DRG Outlier Amount Start: 10/31/2004
534 Claim ESRD Payment Amount Start: 10/31/2004
535 Claim Frequency Code Start: 10/31/2004
536 Claim Indirect Teaching Amount Start: 10/31/2004
537 Claim MSP Pass-through Amount Start: 10/31/2004
538 Claim or Encounter Identifier Start: 10/31/2004
539 Claim PPS Capital Amount Start: 10/31/2004
540 Claim PPS Capital Outlier Amount Start: 10/31/2004
541 Claim Submission Reason Code Start: 10/31/2004
542 Claim Total Denied Charge Amount Start: 10/31/2004
543 Clearinghouse or Value Added Network Trace Start: 10/31/2004
544 Clinical Laboratory Improvement Amendment Start: 10/31/2004
545 Contract Amount Start: 10/31/2004
546 Contract Code Start: 10/31/2004
547 Contract Percentage Start: 10/31/2004
548 Contract Type Code Start: 10/31/2004
549 Contract Version Identifier Start: 10/31/2004
550 Coordination of Benefits Code Start: 10/31/2004
551 Coordination of Benefits Total Submitted Charge Start: 10/31/2004
552 Cost Report Day Count Start: 10/31/2004
553 Covered Amount Start: 10/31/2004
554 Date Claim Paid Start: 10/31/2004
555 Delay Reason Code Start: 10/31/2004
556 Demonstration Project Identifier Start: 10/31/2004
557 Diagnosis Date Start: 10/31/2004
558 Discount Amount Start: 10/31/2004
559 Document Control Identifier Start: 10/31/2004
560 Entity's Additional/Secondary Identifier. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
561 Entity's Contact Name. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
562 Entity's National Provider Identifier (NPI). Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
563 Entity's Tax Amount. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
564 EPSDT Indicator Start: 10/31/2004
565 Estimated Claim Due Amount Start: 10/31/2004
566 Exception Code Start: 10/31/2004
567 Facility Code Qualifier Start: 10/31/2004
568 Family Planning Indicator Start: 10/31/2004
569 Fixed Format Information Start: 10/31/2004
570 Free Form Message Text Start: 10/31/2004
571 Frequency Count Start: 10/31/2004
572 Frequency Period Start: 10/31/2004
573 Functional Limitation Code Start: 10/31/2004
574 HCPCS Payable Amount Home Health Start: 10/31/2004
575 Homebound Indicator Start: 10/31/2004
576 Immunization Batch Number Start: 10/31/2004
577 Industry Code Start: 10/31/2004
578 Insurance Type Code Start: 10/31/2004
579 Investigational Device Exemption Identifier Start: 10/31/2004
580 Last Certification Date Start: 10/31/2004
581 Last Worked Date Start: 10/31/2004
582 Lifetime Psychiatric Days Count Start: 10/31/2004
583 Line Item Charge Amount Start: 10/31/2004
584 Line Item Control Number Start: 10/31/2004
585 Denied Charge or Non-covered Charge Start: 10/31/2004 | Last Modified: 07/09/2007
586 Line Note Text Start: 10/31/2004
587 Measurement Reference Identification Code Start: 10/31/2004
588 Medical Record Number Start: 10/31/2004
589 Provider Accept Assignment Code Start: 10/31/2004 | Last Modified: 10/17/2010
590 Medicare Coverage Indicator Start: 10/31/2004
591 Medicare Paid at 100% Amount Start: 10/31/2004
592 Medicare Paid at 80% Amount Start: 10/31/2004
593 Medicare Section 4081 Indicator Start: 10/31/2004
594 Mental Status Code Start: 10/31/2004
595 Monthly Treatment Count Start: 10/31/2004
596 Non-covered Charge Amount Start: 10/31/2004
597 Non-payable Professional Component Amount Start: 10/31/2004
598 Non-payable Professional Component Billed Amount Start: 10/31/2004
599 Note Reference Code Start: 10/31/2004
600 Oxygen Saturation Qty Start: 10/31/2004
601 Oxygen Test Condition Code Start: 10/31/2004
602 Oxygen Test Date Start: 10/31/2004
603 Old Capital Amount Start: 10/31/2004
604 Originator Application Transaction Identifier Start: 10/31/2004
605 Orthodontic Treatment Months Count Start: 10/31/2004
606 Paid From Part A Medicare Trust Fund Amount Start: 10/31/2004
607 Paid From Part B Medicare Trust Fund Amount Start: 10/31/2004
608 Paid Service Unit Count Start: 10/31/2004
609 Participation Agreement Start: 10/31/2004
610 Patient Discharge Facility Type Code Start: 10/31/2004
611 Peer Review Authorization Number Start: 10/31/2004
612 Per Day Limit Amount Start: 10/31/2004
613 Physician Contact Date Start: 10/31/2004
614 Physician Order Date Start: 10/31/2004
615 Policy Compliance Code Start: 10/31/2004
616 Policy Name Start: 10/31/2004
617 Postage Claimed Amount Start: 10/31/2004
618 PPS-Capital DSH DRG Amount Start: 10/31/2004
619 PPS-Capital Exception Amount Start: 10/31/2004
620 PPS-Capital FSP DRG Amount Start: 10/31/2004
621 PPS-Capital HSP DRG Amount Start: 10/31/2004
622 PPS-Capital IME Amount Start: 10/31/2004
623 PPS-Operating Federal Specific DRG Amount Start: 10/31/2004
624 PPS-Operating Hospital Specific DRG Amount Start: 10/31/2004
625 Predetermination of Benefits Identifier Start: 10/31/2004
626 Pregnancy Indicator Start: 10/31/2004
627 Pre-Tax Claim Amount Start: 10/31/2004
628 Pricing Methodology Start: 10/31/2004
629 Property Casualty Claim Number Start: 10/31/2004
630 Referring CLIA Number Start: 10/31/2004
631 Reimbursement Rate Start: 10/31/2004
632 Reject Reason Code Start: 10/31/2004
633 Related Causes Code (Accident, auto accident, employment) Start: 10/31/2004 | Last Modified: 10/17/2010
634 Remark Code Start: 10/31/2004
635 Repriced Ambulatory Patient Group Code Start: 10/31/2004
636 Repriced Line Item Reference Number Start: 10/31/2004
637 Repriced Saving Amount Start: 10/31/2004
638 Repricing Per Diem or Flat Rate Amount Start: 10/31/2004
639 Responsibility Amount Start: 10/31/2004
640 Sales Tax Amount Start: 10/31/2004
641 Service Adjudication or Payment Date. Note: Use code 516. Start: 10/31/2004 | Last Modified: 09/20/2009 | Stop: 10/01/2010
642 Service Authorization Exception Code Start: 10/31/2004
643 Service Line Paid Amount Start: 10/31/2004
644 Service Line Rate Start: 10/31/2004
645 Service Tax Amount Start: 10/31/2004
646 Ship, Delivery or Calendar Pattern Code Start: 10/31/2004
647 Shipped Date Start: 10/31/2004
648 Similar Illness or Symptom Date Start: 10/31/2004
649 Skilled Nursing Facility Indicator Start: 10/31/2004
650 Special Program Indicator Start: 10/31/2004
651 State Industrial Accident Provider Number Start: 10/31/2004
652 Terms Discount Percentage Start: 10/31/2004
653 Test Performed Date Start: 10/31/2004
654 Total Denied Charge Amount Start: 10/31/2004
655 Total Medicare Paid Amount Start: 10/31/2004
656 Total Visits Projected This Certification Count Start: 10/31/2004
657 Total Visits Rendered Count Start: 10/31/2004
658 Treatment Code Start: 10/31/2004
659 Unit or Basis for Measurement Code Start: 10/31/2004
660 Universal Product Number Start: 10/31/2004
661 Visits Prior to Recertification Date Count CR702 Start: 10/31/2004
662 X-ray Availability Indicator Start: 10/31/2004
663 Entity's Group Name. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
664 Orthodontic Banding Date Start: 10/31/2004
665 Surgery Date Start: 10/31/2004
666 Surgical Procedure Code Start: 10/31/2004
667 Real-Time requests not supported by the information holder, do not resubmit Start: 02/28/2005
668 Missing Endodontics treatment history and prognosis Start: 06/30/2005
669 Dental service narrative needed. Start: 10/31/2005
670 Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 | Last Modified: 02/28/2007
671 Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 | Last Modified: 02/28/2007
672 Other Payer's payment information is out of balance Start: 10/31/2006
673 Patient Reason for Visit Start: 10/31/2006
674 Authorization exceeded Start: 10/31/2006
675 Facility admission through discharge dates Start: 10/31/2006
676 Entity possibly compensated by facility. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
677 Entity not affiliated. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
678 Revenue code and patient gender mismatch Start: 10/31/2006
679 Submit newborn services on mother's claim Start: 10/31/2006
680 Entity's Country. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
681 Claim currency not supported Start: 10/31/2006
682 Cosmetic procedure Start: 02/28/2007
683 Awaiting Associated Hospital Claims Start: 02/28/2007
684 Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Note: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement.) Start: 11/05/2007
685 Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit. Start: 01/27/2008
686 The claim/ encounter has completed the adjudication cycle and the entire claim has been voided Start: 01/27/2008
687 Claim estimation can not be completed in real time. Do not resubmit. Start: 01/27/2008
688 Present on Admission Indicator for reported diagnosis code(s). Start: 01/27/2008
689 Entity was unable to respond within the expected time frame. Note: This code requires use of an Entity Code. Start: 06/01/2008 | Last Modified: 02/11/2010
690 Multiple claims or estimate requests cannot be processed in real time. Start: 06/01/2008
691 Multiple claim status requests cannot be processed in real time. Start: 06/01/2008
692 Contracted funding agreement-Subscriber is employed by the provider of services Start: 09/21/2008
693 Amount must be greater than or equal to zero. Note: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009
694 Amount must not be equal to zero. Note: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009
695 Entity's Country Subdivision Code. Note: This code requires use of an Entity Code. Start: 01/25/2009 | Last Modified: 02/11/2010
696 Claim Adjustment Group Code. Start: 01/25/2009
697 Invalid Decimal Precision. Note: At least one other status code is required to identify the data element in error. Start: 07/01/2009
698 Form Type Identification Start: 07/01/2009
699 Question/Response from Supporting Documentation Form Start: 07/01/2009
700 ICD10. Note: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 07/01/2009
701 Initial Treatment Date Start: 07/01/2009
702 Repriced Claim Reference Number Start: 11/01/2009
703 Advanced Billing Concepts (ABC) code Start: 01/24/2010
704 Claim Note Text Start: 01/24/2010
705 Repriced Allowed Amount Start: 01/24/2010
706 Repriced Approved Amount Start: 01/24/2010
707 Repriced Approved Ambulatory Patient Group Amount Start: 01/24/2010
708 Repriced Approved Revenue Code Start: 01/24/2010
709 Repriced Approved Service Unit Count Start: 01/24/2010
710 Line Adjudication Information. Note: At least one other status code is required to identify the data element in error. Start: 01/24/2010
711 Stretcher purpose Start: 01/24/2010
712 Obstetric Additional Units Start: 01/24/2010
713 Patient Condition Description Start: 01/24/2010
714 Care Plan Oversight Number Start: 01/24/2010
715 Acute Manifestation Date Start: 01/24/2010
716 Repriced Approved DRG Code Start: 01/24/2010
717 This claim has been split for processing. Start: 01/24/2010
718 Claim/service not submitted within the required timeframe (timely filing). Start: 01/24/2010
719 NUBC Occurrence Code(s) Start: 01/24/2010
720 NUBC Occurrence Code Date(s) Start: 01/24/2010
721 NUBC Occurrence Span Code(s) Start: 01/24/2010
722 NUBC Occurrence Span Code Date(s) Start: 01/24/2010
723 Drug days supply Start: 01/24/2010
724 Drug dosage Start: 01/24/2010
725 NUBC Value Code(s) Start: 01/24/2010
726 NUBC Value Code Amount(s) Start: 01/24/2010
727 Accident date Start: 01/24/2010
728 Accident state Start: 01/24/2010
729 Accident description Start: 01/24/2010
730 Accident cause Start: 01/24/2010
731 Measurement value/test result Start: 01/24/2010
732 Information submitted inconsistent with billing guidelines. Note: At least one other status code is required to identify the inconsistent information. Start: 01/24/2010
733 Prefix for entity's contract/member number. Start: 01/24/2010
734 Verifying premium payment Start: 06/06/2010
735 This service/claim is included in the allowance for another service or claim. Start: 06/06/2010
736 A related or qualifying service/claim has not been received/adjudicated. Start: 06/06/2010
737 Current Dental Terminology (CDT) Code Start: 06/06/2010
738 Home Infusion EDI Coalition (HEIC) Product/Service Code Start: 06/06/2010
739 Jurisdiction Specific Procedure or Supply Code Start: 06/06/2010
740 Drop-Off Location Start: 06/06/2010
741 Entity must be a person. Note: This code requires use of an Entity Code. Start: 06/06/2010
742 Payer Responsibility Sequence Number Code Start: 06/06/2010
743 Entity's credential/enrollment information. Note: This code requires use of an Entity Code. Start: 10/17/2010
744 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. Start: 10/17/2010
745 Identifier Qualifier Note: At least one other status code is required to identify the specific identifier qualifier in error. Start: 10/17/2010
746 Duplicate Submission Note: use only at the information receiver level in the Health Care Claim Acknowledgement transaction. Start: 10/17/2010
747 Hospice Employee Indicator Start: 10/17/2010
748 Corrected Data Note: Requires a second status code to identify the corrected data. Start: 10/17/2010
749 Date of Injury/Illness Start: 10/17/2010
750 Invalid Auto Accident State or Province Code. This change effective 11/1/2011: Auto Accident State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
751 Invalid Ambulance Pick-up State or Province Code. This change effective 11/1/2011: Ambulance Pick-up State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
752 Invalid Ambulance Drop-off State or Province Code. This change effective 11/1/2011: Ambulance Drop-off State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
753 Co-pay status code. Start: 01/30/2011
754 Entity Name Suffix. Note: This code requires the use of an Entity Code. Start: 01/30/2011
755 Entity's primary identifier. Note: This code requires the use of an Entity Code. Start: 01/30/2011
756 Entity's Received Date. Note: This code requires the use of an Entity Code. Start: 01/30/2011
757 Last seen date. Start: 01/30/2011
758 Repriced approved HCPCS code. Start: 01/30/2011
759 Round trip purpose description. Start: 01/30/2011
760 Tooth status code. Start: 01/30/2011
761 Entity's referral number. Note: This code requires the use of an Entity Code. Start: 01/30/2011
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