REVENUE CODES CODE DESCRIPTION STANDARD ABBREVIATION 100 ALL INCLUSIVE RATE, ROOM AND BOARD PLUS ALL INCL R&B/ANC

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

100

ALL INCLUSIVE RATE,, ROOM AND BOARD PLUS

ALL INCL R&B/ANC

ANCILLARY

101

ALL INCLUSIVE ROOM AND BOARD

ALL INCL R&B

110 111 112 113 114 115 116 117 118 119

ROOM AND BOARD, PRIVATE, GENERAL MEDICAL/SURGICAL/GYNE OB

OTHER

ROOM-BOARD/PVT MED-SUR-GY/PVT OB/PVT PEDS/PVT PSYCH/PVT HOSPICE/PVT DETOX/PVT ONCOLOGY/PVT REHAB/PVT OTHER/PVT

120

ROOM AND BOARD, SEMI-PRIVATE 2 BED,

ROOM-BOARD/SEMI

PEDIATRIC PSYCHIATRIC HOSPICE DETOXIFICATION ONCOLOGY REHABILITATION

GENERAL

121 122 123 124 125 126 127 128 129

MEDICAL/SURGICAL/GYNE

130

ROOM AND BOARD, SEMI-PRIVATE 3-4 BEDS, GENERAL MEDICAL/SURGICAL/GYNE

131 132 133 134 135 136 137 138 139 140

OB PEDIATRIC PSYCHIATRIC HOSPICE DETOXIFICATION ONCOLOGY REHABILITATION OTHER

MED-SUR-GY/2BED OB/2BED PEDS/2BED PSTAY/2BED HOSPICE/2BED DETOX/2BED ONCOLOGY/2BED REHAB/2BED OTHER/2BED ROOM/BOARD/3&4BED

OTHER

MED-SUR-GY/3&4 OB/3&4BED PEDS/3&4BED PSYCH/3&4BED HOSPICE/3&4BED DETOX/3&4BED ONCOLOGY/3&4BED REHAB/3&4BED OTHER/3&4BED

ROOM AND BOARD, PRIVATE, DELUXE,

ROOM BOARD/PVT/DLX

OB PEDIATRIC PSYCHIATRIC HOSPICE DETOXIFICATION ONCOLOGY REHABILITATION

GENERAL

141 142

MEDICAL/SURGICAL/GYNE OB

PAGE 1 OF 16 MARKETING UPDATE: 8/04

MED-SUR-GY/DLX OB/DLX

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

143 144 145 146 147 148 149

PEDIATRIC

PEDS/DLX PSYCH/DLX HOSPICE/DLX DETOX/DLX ONCOLOGY/DLX REHAB/DLX OTHER/DLX

150 151 152 153 154 155 156 157 158 159

ROOM AND BOARD, WARD, GENERAL MEDICAL/SURGICAL/GYNE

160 164 167 169

ROOM AND BOARD, OTHER, GENERAL

170 171 172 173 174 179

ROOM AND BOARD, NURSERY, GENERAL NEWBORN - LEVEL I PREMATURE - LEVEL II NEWBORN - LEVEL III NEO-NATAL ICU - LEVEL IV

180 181 182 183 184 185 189

LEAVE OF ABSENCE, GENERAL

OTHER LEAVE OF ABSENCE

LEAVE OF ABSENCE OR LOA -LOA/PT CONV LOA/THERAPEUTIC -LOA/HOSPITALIZATION LOA/OTHER

190

SUBACUTE CARE, GENERAL

SUBACUTE

191

SUBACUTE CARE LEVEL I

SUBACUTE / LEVEL I

PSYCHIATRIC HOSPICE DETOXIFICATION ONCOLOGY REHABILITATION OTHER

OB PEDIATRIC PSYCHIATRIC HOSPICE DETOXIFICATION ONCOLOGY REHABILITATION OTHER

STERILE ENVIRONMENT SELF CARE OTHER

OTHER

RESERVED PATIENT CONVENIENCE THERAPEUTIC LEAVE RESERVED HOSPITALIZATION

PAGE 2 OF 16 MARKETING UPDATE: 8/04

ROOM-BOARD/WARD MED-SUR-GY/WARD OB/WARD PEDS/WARD PSYCH/WARD HOSPICE/WARD DETOX/WARD ONCOLOGY/WARD REHAB/WARD OTHER/WARD R&B R&B/STERILE R&B/SELF R&B/OTHER NURSERY NURSERY/LEVEL I NURSERY/ LEVEL II NURSERY/LEVEL III NURSERY/LEVEL IV NURSERY/OTHER

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

192

SUBACUTE CARE LEVEL II

SUBACUTE / LEVEL II

193

SUBACUTE CARE LEVEL III

SUBACUTE / LEVEL III

194

SUBACUTE CARE LEVEL IV

SUBACUTE / LEVEL IV

199

OTHER SUBACUTE CARE

SUBACUTE / OTHER

200 201 202 203 204 206 207 208 209

INTENSIVE CARE, GENERAL

INTENSIVE CARE/ICU ICU/SURGICAL ICU/MEDICAL ICU PEDS ICU/PSTAY ICU/INTERMEDIATE ICU/BURN CARE ICU/TRAMA ICU/OTHER

210 211 212 213 214 219

CORONARY CARE, GENERAL

220 221 222 223 224 229

SPECIAL CHARGES, GENERAL

230 231 232 233 234 235 239

INCREMENTAL NURSING, GENERAL

OTHER

NURSING INCREM NUR INCR/NURSERY NUR INCR/OB NUR INCR/ICU NUR INCR/CCU NUR INCR/HOSPICE NUR INCR/OTHER

240 241 242 243

ALL INCLUSIVE ANCILLARY, GENERAL ALL INCLUSIVE ANCILLARY - BASIC AL INCLUSIVE ANCILLARY - COMPREHENSIVE ALL INCLUSIVE ANCILLARY - SPECIALTY

ALL INCL ANCIL ALL INCL ANCIL/BASIC ALL INCL ANCIL/COMP ALL INCL ANCIL/SPEC

SURGICAL MEDICAL PEDIATRIC PSYCHIATRIC INTERMEDIATE ICU BURN CARE TRAUMA OTHER INTENSIVE CARE

MYOCARDIAL INFARCTION PULMONARY HEART TRANSPLANT INTERMEDIATE CCU OTHER CORONARY CARE

ADMISSION CHARGE TECHNICAL SUPPORT CHARGE UTILIZATION REVIEW SERVICE CHARGE LATE DISCHARGE MEDICALLY NECESSARY OTHER SPECIAL CHARGES

NURSERY OB ICU CCU HOSPICE

PAGE 3 OF 16 MARKETING UPDATE: 8/04

CORONARY CARE/CCU CCU/MYO INFARC CCU/PULMONARY CCU/TRANSPLANT CCU/INTERMEDIATE CCU/OTHER SPECIAL CHARGES ADMIT CHARGE TECH SUPPORT CHG UR CHARGE LATE DISCH/MED NEC OTHER SPEC CHG

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

249

OTHER INCLUSIVE ANCILLARY

ALL INCL ANCIL/OTHER

250 251 252 253 254 255 256 257 258 259

PHARMACY, GENERAL

PHARMACY DRUGS/GENERIC DRUGS/NONGENERIC DRUGS/TAKEHOME DRUGS/INCIDNT OTHER DX DRUGS/INCIDENT RAD DRUGS/EXPERIMT DRGS/NONSCRPT IV SOLUTIONS DRGS/OTHER

260 261 262 263 264 269

IV THERAPY, GENERAL

OTHER IV THERAPY

IV THERAPY IV THER/INFSN PUMP IV THER/PHARM/SVC IV THER/DRUG/ SUPPLY DELV IV THER/SUPPLIES IV THERAPY/OTHER

270

MEDICAL/SURGICAL SUPPLIES DEVICES,

MED-SUR SUPPLIES

GENERIC DRUGS NON-GENERIC TAKE HOME DRUGS DRUGS INCIDENT TO OTHER DIAGNOSTIC SERVICES DRUGS INCIDENT TO RADIOLOGY EXPERIMENTAL DRUGS NON-PRESCRIPTION DRUGS IV SOLUTIONS OTHER PHARMACY

INFUSION PUMP IV THERAPY/PHARMACY SERVICES IV THERAPY/DRUG/SUPPLY DELIVERY IV THERAPY/SUPPLIES

GENERAL

271 272 273 274 275 276 277 278 279

NON-STERILE SUPPLY

280 289

ONCOLOGY, GENERAL

290 291 292 293 294

DME (OTHER THAN RENAL), GENERAL

299

OTHER EQUIPMENT

STERILE SUPPLY TAKE HOME SUPPLIES PROSTHETIC/ORTHOTIC DEVICES PACEMAKER INTRAOCULAR LENS OXYGEN, TAKE HOME OTHER IMPLANTS OTHER SUPPLY/DEVICES

OTHER ONCOLOGY

RENTAL PURCHASE OF NEW DME PURCHASE OF USED DME SUPPLIES/DRUGS FOR DME EFFECTIVENESS (HOME HEALTH AGENCY ONLY)

PAGE 4 OF 16 MARKETING UPDATE: 8/04

NON-STER SUPPLY STERILE SUPPLY TAKEHOME SUPPLY PROSTH/ORTH DEV PACEMAKER INTRA OC LENS 02/TAKEHOME SUPPLY/IMPLANTS SUPPLY/OTHER ONCOLOGY ONCOLOGY/OTHER MED EQUIP/DURAB MED EQUIP/RENT MED EQUIP/NEW MED EQUIP/USED MED EQUIP/ SUPPLIES/DRUGS MED EQUIP/OTHER

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

300 301 302 303 304 305 306 307 309

LABORATORY, GENERAL

LABORATORY OR (LAB) LAB/CHEMISTRY LAB/IMMUNOLOGY LAB/RENAL HOME LAB/NR DIALYSIS LAB/HEMATOLOGY LAB/BACT-MICRO LAB/UROLOGY LAB/OTHER

310 311 312 314 319

LABORATORY PATHOLOGICAL, GENERAL

320 321 322 323 324 329

RADIOLOGY DIAGNOSTIC, GENERAL

330

RADIOLOGY THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION, GENERAL CHEMOTHERAPY ADMINISTRATION-INJECTED CHEMOTHERAPY ADMINISTRATION-ORAL

331 332 333 335 339

CHEMISTRY IMMUNOLOGY RENAL PATIENT (HOME) NON-ROUTINE DIALYSIS HEMATOLOGY BACTERIOLOGY & MICROBIOLOGY UROLOGY OTHER LABORATORY

CYTOLOGY HISTOLOGY BIOPSY OTHER

ANGIOCARDIOGRAPHY ARTHROGRAPHY ARTERIOGRAPHY CHEST X-RAY OTHER

RADIATION THERAPY CHEMOTHERAPY ADMINISTRATION-IV OTHER

340 341 342 343 344 349

NUCLEAR MEDICINE, GENERAL

350 351 352 359

CT SCAN, GENERAL

DIAGNOSTIC THERAPEUTIC DIAGNOSTIC RADIOPHARMACEUTICALS THERAPEUTIC RADIOPHARMACEUTICALS OTHER

HEAD SCAN BODY SCAN OTHER CT SCANS

PAGE 5 OF 16 MARKETING UPDATE: 8/04

PATHOLOGY LAB OR (PATH LAB) PATHOL/CYTOLOGY PATHOL/HYSTOL PATHOL/BIOPSY PATHOL/OTHER DX X-RAY DX X-RAY/ANGIO DX X-RAY/ARTH DX X-RAY/ARTER DX X-RAY/CHEST DX X-RAY/OTHER RX X-RAY CHEMOTHER/INJ CHEMOTHER/ORAL RADIATION RX CHEMOTHERP-IV RX X-RAY/OTHER NUCLEAR MEDICINE OR (NUCMED) NUC MED/DX NUC MED/RX NUC MED/DXRADIOPHARM NUC MED/RXRAIIOPHARM NUC MED/OTHER CT SCAN CT SCAN/HEAD CT SCAN/BODY CT SCAN/OTHER

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

360 361 362 367 369

OPERATING ROOM SERVICES, GENERAL

OR SERVICES OR/MINOR OR/ORGAN TRANS OR/KIDNEY TRANS OR/OTHER

370 371 372 374 379

ANESTHESIA, GENERAL

380 381 382 383 384 385 386 387 389

BLOOD, GENERAL

390

BLOOD AND BLOOD COMPONENT ADMINISTRATION, PROCESSING, AND STORAGE, GENERAL BLOOD ADMINISTRATION (E.G., TRANSFUSIONS) OTHER BLOOD STORAGE & PROCESSING

391 399

MINOR SURGERY ORGAN TRANSPLANT-OTHER THAN KIDNEY KIDNEY TRANSPLANT OTHER OPERATING ROOM SERVICES

ANESTHESIA INCIDENT TO RADIOLOGY ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC SERVICES ACUPUNCTURE OTHER ANESTHESIA

PACKED RED CELLS WHOLE BLOOD PLASMA PLATELETS LEUKOCYTES OTHER COMPONENTS OTHER DERIVATIVES (CRYOPRECIPITATES) OTHER BLOOD

400 401 402 403 404 409

OTHER IMAGING SERVICES, GENERAL

410 412 413 419

RESPIRATORY SERVICES, GENERAL

420 421 422

PHYSICAL THERAPY, GENERAL

DIAGNOSTIC MAMMOGRAPHY ULTRASOUND SCREENING MAMMOGRAPHY POSITRON EMISSION TOMOGRAPHY OTHER IMAGING SERVICES

INHALATION SERVICES HYPERBARIC OXYGEN THERAPY OTHER RESPIRATORY SERVICES

VISIT CHARGE HOURLY CHARGE

PAGE 6 OF 16 MARKETING UPDATE: 8/04

ANESTHESIA ANESTHE/INCIDENT RAD ANESTHE/INCDNT OTHER DX ANESTHE/ACUPUNC ANESTHE/OTHER BLOOD BLOOD/PKD RED BLOOD/WHOLE BLOOD/PLASMA BLOOD/PLATELET BLOOD/LEUCOCYTES BLOOD/COMPONENTS BLOOD/DERIVATIVES BLOOD OTHER BLOOD/STOR-PROC BLOOD/ADMIN BLOOD/OTHER STOR IMAGE SERVICE DIAG MAMMOGRAPHY ULTRASOUND SCRN MAMMOGRAPHY PET SCAN OTHER IMAG SVS RESPIRATORY SVC INHALATION SVC HYPERBARIC 02 OTHER RESPIR SVS PHYSICAL THERP PHYS THERP/VISIT PHYS THERP/HOUR

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

423 424 429

GROUP RATE

PHYS THERP/GROUP PHYS THERP/EVAL OTHER PHYS THERP

430 431 432 433 434 439

OCCUPATIONAL THERAPY, GENERAL

440 441 442 443 444 449

SPEECH LANGUAGE PATHOLOGY, GENERAL

450 451 452 456 459

EMERGENCY ROOM, GENERAL

460 469

PULMONARY FUNCTION, GENERAL

470 471 472 479

AUDIOLOGY, GENERAL

480

CARDIOLOGY, GENERAL (I.E., CORONARY ANGIOGRAPHY, SWAN-GANZ CATHETERIZATION)

CARDIOLOGY

481 482 483 489

CARDIAC CATHETERIZATION LAB

CARDIAC CATH LAB STRESS TEST ECHOCARDIOLOGY OTHER CARDIOL

490 499

AMBULATORY SURGICAL CARE, GENERAL OTHER AMBULATORY SURGICAL CARE

AMBUL SURG OTHER AMBL SURG

500

OUTPATIENT SERVICES, GENERAL

OUTPATIENT SVS

EVALUATION OR RE-EVALUATION OTHER PHYSICAL THERAPY

VISIT CHARGE HOURLY RATE GROUP RATE EVALUATION OR RE-EVALUATION OTHER OCCUPATIONAL THERAPY

VISIT CHARGE HOURLY RATE GROUP RATE EVALUATION OR RE-EVALUATION OTHER SPEECH-LANGUAGE PATHOLOGY

EMTALA EMERGENCY MEDICAL SCREENING SERVICES ER BEYOND EMTALA SCREENING SERVICES URGENT CARE OTHER EMERGENCY ROOM

OTHER PULMONARY FUNCTION

DIAGNOSTIC TREATMENT OTHER AUDIOLOGY

STRESS TEST ECHOCARDIOLOGY OTHER CARDIOLOGY

PAGE 7 OF 16 MARKETING UPDATE: 8/04

OCCUPATION THER OCCUP THERP/VISIT OCCUP THERP/HOUR OCCUP THERP/GROUP OCCUP THERP/EVAL OTHER OCCUP THER SPEECH PATHOL SPEECH PATH/VISIT SPEECH PATH/HOUR SPEECH PATH/GROUP SPEECH PATH/EVAL OTHER SPEECH PAT EMERG ROOM ER/EMTALA ER/BEYOND EMTALA URGENT CARE OTHER EMER ROOM PULMONARY FUNC OTHER PULMON FUNC AUDIOLOGY AUDIOLOGY/DX AUDIOLOGY/RX OTHER AUDIOL

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

509

OTHER OUTPATIENT SERVICES

OUTPATIENT/OTHER

510 511 512 513 514 515 516 517 519

CLINIC, GENERAL

CLINIC CHRONIC PAIN CL DENTAL CLINIC PSYCH CLINIC OB-GYN CLINIC PEDS CLINIC URGENT CLINIC FAMILY CLINIC OTHER CLINIC

520 521 522 523 526 529

FREE-STANDING CLINIC, GENERAL

530 531 539

OSTEOPATHIC SERVICES, GENERAL

540 541 542 543 544 545 546 547 548 549

AMBULANCE, GENERAL

550 551 552 559

SKILLED NURSING, GENERAL

560 561 562 569

MEDICAL SOCIAL SERVICES, GENERAL

CHRONIC PAIN CENTER DENTAL CLINIC PSYCHIATRIC CLINIC OB-GYN CLINIC PEDIATRIC CLINIC URGENT CARE CLINIC FAMILY PRACTICE CLINIC OTHER CLINIC

RURAL HEALTH CLINIC RURAL HEALTH HOME FAMILY PRACTICE CLINIC URGENT CARE CLINIC OTHER FREESTANDING CLINIC

OSTEOPATHIC THERAPY OTHER OSTEOPATHIC SERVICES

SUPPLIES MEDICAL TRANSPORT HEART MOBILE OXYGEN AIR AMBULANCE NEO-NATAL AMBULANCE SERVICES PHARMACY (AMBULANCE) TELEPHONE TRANSMISSION EKG OTHER AMBULANCE

VISIT CHARGE HOURLY CHARGE OTHER SKILLED NURSING

VISIT CHARGE HOURLY CHARGE OTHER MEDICAL SOCIAL SERVICES

PAGE 8 OF 16 MARKETING UPDATE: 8/04

FREESTAND CLINIC RURAL/CLINIC RURAL/HOME FAMILY PRACTICE URGENT CLINIC OTHER FR/STD CLINIC OSTEOPATH SVS OSTEOPATH RX OTHER OSTEOPATH AMBULANCE AMBUL/SUPPLY AMBUL/MED TRANS AMBUL/HEARTMOBL AMBUL/OXY AIR AMBULANCE AMBUL/NEONAT AMBUL/PHARMACY AMBUL/TELEPHONIC EKG OTHER AMBULANCE SKILLED NURSING SKILLED NURS/VISIT SKILLED NURS/HOUR SKILLED NURS/OTHER MED SOCIAL SVS MED SOC SERVS/VISIT MED SOC SERV/HOUR MED SOC SERV/OTHER

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

570 571 572 579

HOME HEALTH AIDE, GENERAL

AID/HOME HEALTH AIDE/HOME HLTH/VISIT AIDE/HOME HLTH/HOUR AIDE/HOME HLTH/OTHER

580 581 582 583 589

OTHER VISITS (HOME HEALTH), GENERAL

590 599

UNITS OF SERVICE (HOME HEALTH), GENERAL

600 601 602

OXYGEN (HOME HEALTH), GENERAL OXYGEN - STATE/EQUIP/SUPPL/OR CONT OXYGEN - STATE/EQUIP/SUPPL/UNDER 1 LPM (LITERS PER MINUTE) OXYGEN - STATE/EQUIP/OVER 4 LPM (LITERS PER MINUTE) OXYGEN - PORTABLE ADD-ON OXYGEN - OTHER

603 604 609 610 611 612 613 614 615 616 617 618 619 621

VISIT CHARGE HOURLY CHARGE OTHER HOME HEALTH AIDE

VISIT CHARGE HOURLY CHARGE

ASSESSMENT OTHER HOME HEALTH VISITS

OTHER HOME HEALTH UNITS

MAGNETIC RESONANCE TECHNOLOGY (MRT), GENERAL MRI BRAIN (INCLUDING BRAINSTEM) MRI SPINAL CORD (INCLUDING SPINE)

VISIT/HOME HEALTH VISIT/HOME HLTH/VISIT VISIT/HOME HLTH/HOUR VISIT/HOME HLTH/ASSESS VISIT/HOME HLTH/OTHER UNIT/HOME HEALTH UNIT/HOME HLTH/OTHER 02/HOME HEALTH 02/STAT EQUIP/SUPPL/CONT 02/STAT EQUIP/UNDER 1 LPM 02/STAT EQUIP/OVER 4 LPM 02/PORTABLE ADD-ON 02/OTHER MRT

MRT OTHER

MRI - BRAIN MRI - SPINE -MRI OTHER MRA - HEAD AND NECK MRA - LOWER EXT -MRA - OTHER MRT - OTHER

MEDICAL/SURGICAL SUPPLIES,

MED-SUR SUPP/INCDNT RAD

RESERVED MRI OTHER MRA - HEAD AND NECK MRA - LOWER EXTREMITIES RESERVED MRA - OTHER

SUPPLIES INCIDENT TO RADIOLOGY

622 623 624

SUPPLIES INCIDENT TO OTHER DIAGNOSTIC SERVICES

630

DRUGS REQUIRING SPECIFIC IDENTIFICATION (PHARMACY), GENERAL

SURGICAL DRESSINGS FDA INVESTIGATIONAL DEVICES

PAGE 9 OF 16 MARKETING UPDATE: 8/04

MED-SUR SUP/INCDNTODX SURG DRESSING FDA INVEST DEVICE DRUGS

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

631 632 633 634 635 636 637

SINGLE SOURCE DRUG

DRUG/SNGLE DRUG/MULT DRUG/RSTR DRUG/EPO10,000 UNITS DRUGS/DETAIL CODE SELF ADMIN/DRUG

640 641 642 643 644 645 646 647 648 649

HOME IV THERAPY SERVICES, GENERAL NON-ROUTINE NURSING, CENTRAL LINE IV SITE CARE, CENTRAL LINE IV START/CHANGE, PERIPHERAL LINE NON-ROUTINE NURSING, PERIPHERAL LINE TRAINING PATIENT/CAREGIVER, CENTRAL LINE TRAINING DISABLED PATIENT, CENTRAL LINE TRAINING PATIENT/CAREGIVER, PERIPHERAL LINE TRAINING, DISABLED PATIENT, PERIPHERAL LINE

650 651 652 653 654 655 656 657 658 659

HOSPICE SERVICES, GENERAL

660 661 662 663 669

RESPITE CARE, GENERAL HOURLY CHARGE/NURSING HOURLY CHARGE/AIDE/HOMEMAKER/COMPANION OTHER RESPITE CARE

RESPITE CARE RESPITE/NURSE RESPITE/AIDE/ HMEMKR/COMP RESPITE DAILY RESPITE/OTHER

670

OUTPATIENT SPECIAL RESIDENCE CHARGES,

OP SPEC RES

671 672 679

HOSPITAL BASED OTHER SPECIAL RESIDENCE CHARGES

OP SPEC RES/HOSP BASED OP SPEC RES/CONTRACTED OP SPEC RES/OTHER

680

TRAUMA RESPONSE, (THIS CODE IS NOT USED)

--

MULTIPLE SOURCE DRUG RESTRICTIVE PRESCRIPTION ERYTHROPOIETIN (EPO) LESS THAN 10,000 UNITS ERYTHROPOIETIN (EPO) 10,000 OR MORE UNITS DRUGS REQUIRING DETAILED CODING SELF-ADMINISTERED DRUGS

OTHER IV THERAPY SERVICES

ROUTINE HOME CARE CONTINUOUS HOME CARE RESERVED RESERVED INPATIENT RESPITE CARE GENERAL INPATIENT CARE (NON-RESPITE) PHYSICIAN SERVICES HOSPICE ROOM & BOARD – NURSING FACILITY OTHER HOSPICE

DAILY RESPITE CHARGE

IV THERAPY SVC NON RT NURSING/CENTRAL IV SITE CARE/CENTRAL IV STRT/CHNG/ PERIPHAL NONRT NURSING/PERIPHRL TRNG PT/ CAREGVR/CENTRL TRNG DSBLPT/CENTRAL TRNG/PT/ CAREGVR/PERIPHRL TRNG/DSBLPAT/ PERIPHRL OTHER IV THERAPY SVC HOSPICE HOSPICE/RTN HOME HOSPICE/CTNS HOME --HOSPICE/IP RESPITE NON-RESPITE HOSPICE/PHYSICIAN HOSPICE/R&B/NURS FAC HOSPICE/OTHER

GENERAL CONTRACTED

PAGE 10 OF 16 MARKETING UPDATE: 8/04

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

681 682 683 684 689

LEVEL I

TRAUMA/LEVEL I TRAUMA/LEVEL II TRAUMA/LEVEL III TRAUMA/LEVEL IV TRAUMA/OTHER

700 709

CAST ROOM, GENERAL

710 719

RECOVERY ROOM, GENERAL

720 721 722 723 724 729

LABOR ROOM/DELIVERY ROOM, GENERAL

730 731 732 739

EKG/ECG (ELECTROCARDIOGRAM), GENERAL

740

EEG (ELECTROENCEPHALOGRAM), GENERAL ENG (ELECTRONYSTAGMOGRAM)

LEVEL II LEVEL III LEVEL IV OTHER TRAUMA RESPONSE

OTHER CAST ROOM

OTHER RECOVERY

LABOR DELIVERY CIRCUMCISION BIRTHING CENTER OTHER LABOR ROOM/DELIVERY

HOLTER MONITOR TELEMETRY OTHER EKG/ECG

CAST ROOM OTHER CAST ROOM RECOVERY ROOM OTHER RECOV RM DELIVEROOM/LABOR LABOR DELIVERY ROOM CIRCUMCISION BIRTHING CENTER OTHER/DELIV-LABOR EKG/ECG HOLTER MONT TELEMETRY OTHER EKG-ECG EEG

DIAGNOSTIC SLEEP DISORDER STUDY

749

OTHER EEG

OTHER EEG

750 759

GASTRO INTESTINAL SERVICES, GENERAL OTHER GASTRO-INTESTINAL

GASTR-INST SVS OTHER GASTRO-INTS

760

TREATMENT OR OBSERVATION ROOM,

TREATMENT/ OBSERVATION RM

GENERAL

761 762 769

TREATMENT ROOM

770 771 779

PREVENTIVE CARE SERVICES, GENERAL

OBSERVATION ROOM OTHER TREATMENT/OBSERVATION ROOM

VACCINE ADMINISTRATION OTHER

PAGE 11 OF 16 MARKETING UPDATE: 8/04

TREATMENT RM OBSERVATION RM OTHER TREAT/ OBSERV RM PREVENT CARE SVS VACCINE ADMIN OTHER PREVENT

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

780

TELEMEDICINE, GENERAL

TELEMEDICINE

789

OTHER TELEMEDICINE

TLELMEDICENE / OTHER

790

EXTRA CORPOREAL SHOCK WAVE THERAPY (FORMERLY LITHOTRIPSY), GENERAL

ESWT

799

OTHER ESWT

ESWT/OTHER

800 801 802 803

INPATIENT RENAL DIALYSIS, GENERAL

RENAL DIALYSIS DIALY/INPT/ DIALY/INPT/PER DIALY/INPT/CAPD

804

INPATIENT CONTINUOUS CYCLING PERITONEAL DIALYSIS (CCPD)

DIALY/INPT/CCPD

809

OTHER INPATIENT DIALYSIS

DIALY/INPT/OTHER

ACQUISITION OF BODY COMPONENTS,

ORGAN ACQUISIT

810

INPATIENT HEMODIALYSIS INPATIENT PERITONEAL (NON-CAPD) INPATIENT CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)

GENERAL

811 812 813 814 819

LIVING DONOR

OTHER DONOR

LIVING DONOR CADAVER/DONOR UNKNOWN DONOR UNSUCCESSFUL SEARCH OTHER DONOR

820

HEMODIALYSIS OUTPATIENT OR HOME,

HEMO/OP OR HOME

821 822 823 824 825 829

HEMODIALYSIS/COMPOSITE OR OTHER RATE

830

PERITONEAL DIALYSIS OUTPATIENT OR HOME, GENERAL PERITONEAL/COMPOSITE OR OTHER RATE

CADAVER DONOR UNKNOWN DONOR UNSUCCESSFUL ORGAN SEARCH – DONER BANK CHARGES

GENERAL

831 832 833 834 835 839

HOME SUPPLIES HOME EQUIPMENT MAINTENANCE/100% (HOME) SUPPORT SERVICES (HOME) OTHER OUTPATIENT HEMODIALYSIS (HOME)

HOME SUPPLIES HOME EQUIPMENT MAINTENANCE/100% (HOME) SUPPORT SERVICE (HOME) OTHER OUTPATIENT PERITONEAL DIALYSIS (HOME)

PAGE 12 OF 16 MARKETING UPDATE: 8/04

HEMO/COMPOSITE HEMO/HOME/SUPPL HEMO/HOME/EQUIP HEMO/HOME/100% HEMO/HOME/ SUPSERV HEMO/HOME/OTHER PERITONEAL/OP OR HOME PERTNL/COMPOSITE PERTNL/HOME/SUPPL PERTNL/HOME/EQUIP PERTNL/HOME/100% PERTNL/HOME/ SUPSERV PERTNL/HOME/OTHER

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

840

CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD) OUTPATIENT OR HOME,

CAPD/OP OR HOME

GENERAL

841 842 843 844 845 849

CAPD/COMPOSITE OR OTHER RATE

850

CONTINUOUS CYCLING PERITONEAL DIALYSIS (CCPD) OUTPATIENT OR HOME,

HOME SUPPLIES HOME EQUIPMENT MAINTENANCE/100% (HOME) SUPPORT SERVICES (HOME) OTHER OUTPATIENT CAPD (HOME)

CAPD/COMPOSITE CAPD/HOME/SUPPL CAPD/HOME/EQUIP CAPD/HOME/100% CAPD/HOME/SUPSERV CAPD/HOME/OTHER CCPD/OP OR HOME

GENERAL

851 852 853 854 855 859

CCPD/COMPOSITE OR OTHER RATE

880 881 882 889

MISCELLANEOUS DIALYSIS, GENERAL MISC. DIALYSIS OTHER

DIALY/MISC DIALY/ULTRAFILT HOME DIALYSISAID VISIT DIALY/MISC/OTHER

890

OTHER DONOR BANK, GENERAL

NOW RESERVED FOR NATIONAL

891

BONE

892

ORGAN (OTHER THAN KIDNEY)

893

SKIN

899

OTHER DONOR BANK

HOME SUPPLIES HOME EQUIPMENT MAINTENANCE/100% (HOME) SUPPORT SERVICES (HOME) OTHER OUTPATIENT CCPD (HOME)

ULTRAFILTRATION HOME DIALYSIS AID VISIT

CCPD/COMPOSITE CCPD/HOME/SUPPL CCPD/HOME/EQUIP CCPD/HOME/100% CCPD/HOME/SUPSERV CCPD/HOME/OTHER

ASSIGNMENT

NOW RESERVED FOR NATIONAL ASSIGNMENT

NOW RESERVED FOR NATIONAL ASSIGNMENT

NOW RESERVED FOR NATIONAL ASSIGNMENT

NOW RESERVED FOR NATIONAL ASSIGNMENT

900

BEHAVIORAL HEALTH TREATMENTS/SERVICES, GENERAL

BH

901 902 903 904

ELECTROSHOCK TREATMENT

ELECTRO SHOCK MILIEU THERAPY PLAY THERAPY ACTIVITY THERAPY

MILIEU THERAPY PLAY THERAPY ACTIVITY THERAPY

PAGE 13 OF 16 MARKETING UPDATE: 8/04

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

905

INTENSIVE OUTPATIENT SERVICES, CHEMICAL DEPENDENCY

BH/INTENS OP/PSYCH

906

INTENSIVE OUTPATIENT SERVICES, CHEMICAL DEPENDENCY

BH/INTENS OP/CHEM DEP

907

COMMUNITY BEHAVIORAL HEALTH PROGRAM, DAY TREATMENT

BH/COMMUNITY

908 909

RESERVED

-BH/OTHER PSYCH RX

910

BEHAVIORAL HEALTH TREATMENTS/SERVICES, GENERAL

PSYCH SERVICES

911 912

REHABILITATION

913 914 915 916 917 918 919

PARTIAL HOSPITALIZATION, INTENSIVE

BH/PSYCH/REHAB BH/PSYCH/PARTIAL /LESS INTENSIVE BH/PSYCH/PARTIAL/INTENSIVE BH/PSYCH/INDIV RX BH/PSYCH/GROUP RX BH/PSYCH/FAMILY RX BH/PSYCH/BIOFEED BH/PSYCH/TESTING BH/PSYCH/OTHER

920 921 922 923 924 925 929

OTHER DIAGNOSTIC SERVICES,

OTHER DIAGNOSTIC SERVICES

OTHER DX SVS PERI VASCUL LAB EMG PAP SMEAR ALLERGY TEST PREG TEST ADDITIONAL DX SVS

931

MEDICAL REHABILITATION DAY PROGRAM,

HALF DAY

932

FULL DAY

FULL DAY

940 941 942 943 944 945 946 947 949

OTHER THERAPEUTIC SERVICES, GENERAL

OTHER RX SVS RECREATION RX EDUC/TRAINING CARDIAC REHAB DRUG REHAB ALCOHOL REHAB CMPLX MED EQUIP-ROUT CMPLX MED EQUIP-ANC ADDITIONAL RX SVS

OTHER

PARTIAL HOSPITALIZATION, LESS INTENSIVE

INDIVIDUAL THERAPY GROUP THERAPY FAMILY THERAPY BIOFEEDBACK TESTING OTHER GENERAL

PERIPHERAL VASCULAR LAB ELECTROMYOGRAM PAP SMEAR ALLERGY TEST PREGNANCY TEST

HALF DAY

RECREATIONAL THERAPY EDUCATION/TRAINING CARDIAC REHABILITATION DRUG REHABILITATION ALCOHOL REHABILITATION COMPLEX MEDICAL EQUIPMENT-ROUTINE COMPLEX MEDICAL EQUIPMENT-ANCILLARY OTHER THERAPEUTIC SERVICES

PAGE 14 OF 16 MARKETING UPDATE: 8/04

REVENUE CODES CODE

DESCRIPTION

950 951 952

OTHER THERAPEUTIC SERVICES

960 961 962 963 964 969

PROFESSIONAL FEES, GENERAL

971 972 973 974 975 976 977 978 979

PROFESSIONAL FEES, LAB RADIOLOGY-DIAGNOSTIC RADIOLOGY-THERAPEUTIC RADIOLOGY-NUCLEAR MEDICINE

981 982 983 984 985 986 987 988 989

PROFESSIONAL FEES, EMERGENCY ROOM

990 991 992 993 994 995 996 997 998 999

PATIENT CONVENIENCE ITEMS, GENERAL CAFETERIA / GUEST TRAY

ATHLETIC TRAINING KINESIOTHERAPY

PSYCHIATRIC OPTHALMOLOGY ANESTHESIOLOGIST (MD) ANESTHETIST (CRNA) OTHER PROFESSIONAL FEES

OPERATING ROOM RESPIRATORY THERAPY PHYSICAL THERAPY OCCUPATIONAL THERAPY SPEECH PATHOLOGY

OUTPATIENT SERVICES CLINIC MEDICAL SOCIAL SERVICES EKG EEG HOSPITAL VISIT CONSULTATION PRIVATE DUTY NURSE

PRIVATE LINEN SERVICE TELEPHONE/TELEGRAPH TV/RADIO NON-PATIENT ROOM RENTALS LATE DISCHARGE CHARGE ADMISSION KITS BEAUTY SHOP/BARBER OTHER PATIENT CONVENIENCE ITEMS

PAGE 15 OF 16 MARKETING UPDATE: 8/04

STANDARD ABBREVIATION ATHLETIC TRAINING KINESIOTHERAPY PRO FEE PRO FEE/PSYCH PRO FEE/EYE PRO FEE/ANES MD PRO FEE/ANES CRNA OTHER PRO FEE PRO FEE/LAB PRO FEE/RAD/DX PRO FEE/RAD/RX PRO FEE/NUC/MED PRO FEE/OR PRO FEE/RESPIR PRO FEE/PHYSI PRO FEE/OCCUPA PRO FEE/SPEECH PRO FEE/ER PRO FEE/OUTPT PRO FEE/CLINIC PRO FEE/SOC SVC PRO FEE/EKG PRO FEE/EEG PRO FEE/HOS VIS PRO FEE/CONSULT FEE/PVT NURSE PT CONVENIENCE CAFETERIA LINEN TELEPHONE TV/RADIO NONPT ROOM RENT LATE DISCHARGE ADMIT KITS BARBER/BEAUTY PT CONVENCE/OTH

REVENUE CODES CODE

DESCRIPTION

STANDARD ABBREVIATION

1000 1001 1002 1003 1004 1005

BEHAVIORAL HEALTH ACCOMMODATIONS RESIDENTIAL TREATMENT-PSYCHIATRIC RESIDENTIAL TREATMENT-CHEMICAL DEPENDENCY

BH R&B BH R&B/PSYCH BH R&B/CHEM DEP BH R&B/SUP LIVING BH R&B/HALFWAY HOUSE BH R&B/GROUP HOME

2100 2101 2102 2103 2104 2105 2106 2109

ALTERNATIVE THERAPY SERVICES, GENERAL

3100 3101 3102 3103 3104 3105 3109

ADULT CARE, NOT IN USE ADULT DAY CARE/MEDICAL AND SOCIAL/HOURLY ADULT DAY CARE/SOCIAL/HOURLY ADULT DAY CARE/MEDICAL AND SOCIAL/DAILY ADULT DAY CARE/SOCIAL/DAILY ADULT FOSTER CARE/DAILY

SUPERVISED LIVING HALFWAY HOUSE GROUP HOME

ACUPUNCTURE ACUPRESSURE MASSAGE REFLEXOLOGY BIOFEEDBACK HYPNOSIS OTHER ALTERNATIVE THERAPY SERVICES

OTHER ADULT CARE

PAGE 16 OF 16 MARKETING UPDATE: 8/04

ALTTHERAPY ACUPUNCTURE ACUPRESSURE MASSAGE REFLEXOLOGY BIOFEEDBACK HYPNOSIS OTHER ALTTHERAPY ADULT MED/SOC HR ADULT SOC HR ADULT MED/SOC DAY ADULT SOC DAY ADULT FOSTER DAY OTHER ADULT