Code
|
Description
|
Comment
|
Version
|
...
|
No suggested values defined |
|
added v2.5.1 |
01
|
Military service related |
deprecated |
added v2.3.1, removed after v2.4 |
02
|
Condition is employment related |
deprecated |
added v2.3.1, removed after v2.4 |
03
|
Patient covered by insurance not reflected here |
deprecated |
added v2.3.1, removed after v2.4 |
04
|
HMO enrollee |
deprecated |
added v2.3.1, removed after v2.4 |
05
|
Lien has been filed |
deprecated |
added v2.3.1, removed after v2.4 |
06
|
ESRD patient in first 18 months of entitlement covered by employer group health insurance |
deprecated |
added v2.3.1, removed after v2.4 |
07
|
Treatment of non-terminal condition for hospice patient |
deprecated |
added v2.3.1, removed after v2.4 |
08
|
Beneficiary would not provide information concerning other insurance coverage |
deprecated |
added v2.3.1, removed after v2.4 |
09
|
Neither patient nor spouse is employed |
deprecated |
added v2.3.1, removed after v2.4 |
10
|
Patient and/or spouse is employed but no EGHP exists |
deprecated |
added v2.3.1, removed after v2.4 |
11
|
Disabled beneficiary but no LGHP |
deprecated |
added v2.3.1, removed after v2.4 |
12
|
Payer codes. |
deprecated |
added v2.3.1, removed after v2.4 |
12 ... 16
|
Payer codes. |
deprecated |
added v2.3.1, removed after v2.4 |
13
|
Payer codes. |
deprecated |
added v2.3.1, removed after v2.4 |
14
|
Payer codes. |
deprecated |
added v2.3.1, removed after v2.4 |
15
|
Payer codes. |
deprecated |
added v2.3.1, removed after v2.4 |
16
|
Payer codes. |
deprecated |
added v2.3.1, removed after v2.4 |
18
|
Maiden name retained |
deprecated |
added v2.3.1, removed after v2.4 |
19
|
Child retains mother's name |
deprecated |
added v2.3.1, removed after v2.4 |
20
|
Beneficiary requested billing |
deprecated |
added v2.3.1, removed after v2.4 |
21
|
Billing for Denial Notice |
deprecated |
added v2.3.1, removed after v2.4 |
26
|
VA eligible patient chooses to receive services in a Medicare certified facility |
deprecated |
added v2.3.1, removed after v2.4 |
27
|
Patient referred to a sole community hospital for a diagnostic laboratory test |
deprecated |
added v2.3.1, removed after v2.4 |
28
|
Patient and/or spouse's EGHP is secondary to Medicare |
deprecated |
added v2.3.1, removed after v2.4 |
29
|
Disabled beneficiary and/or family member's LGHP is secondary to Medicare |
deprecated |
added v2.3.1, removed after v2.4 |
31
|
Patient is student (full time-day) |
deprecated |
added v2.3.1, removed after v2.4 |
32
|
Patient is student (cooperative/work study program) |
deprecated |
added v2.3.1, removed after v2.4 |
33
|
Patient is student (full time-night) |
deprecated |
added v2.3.1, removed after v2.4 |
34
|
Patient is student (Part time) |
deprecated |
added v2.3.1, removed after v2.4 |
36
|
General care patient in a special unit |
deprecated |
added v2.3.1, removed after v2.4 |
37
|
Ward accommodation as patient request |
deprecated |
added v2.3.1, removed after v2.4 |
38
|
Semi-private room not available |
deprecated |
added v2.3.1, removed after v2.4 |
39
|
Private room medically necessary |
deprecated |
added v2.3.1, removed after v2.4 |
40
|
Same day transfer |
deprecated |
added v2.3.1, removed after v2.4 |
41
|
Partial hospitalization |
deprecated |
added v2.3.1, removed after v2.4 |
46
|
Non-availability statement on file |
deprecated |
added v2.3.1, removed after v2.4 |
48
|
Psychiatric residential treatment centers for children and adolescents |
deprecated |
added v2.3.1, removed after v2.4 |
55
|
SNF bed not available |
deprecated |
added v2.3.1, removed after v2.4 |
56
|
Medical appropriateness |
deprecated |
added v2.3.1, removed after v2.4 |
57
|
SNF readmission |
deprecated |
added v2.3.1, removed after v2.4 |
60
|
Day outlier |
deprecated |
added v2.3.1, removed after v2.4 |
61
|
Cost outlier |
deprecated |
added v2.3.1, removed after v2.4 |
62
|
Payer code |
deprecated |
added v2.3.1, removed after v2.4 |
66
|
Provider does not wish cost outlier payment |
deprecated |
added v2.3.1, removed after v2.4 |
67
|
Beneficiary elects not to use life time reserve (LTR) days |
deprecated |
added v2.3.1, removed after v2.4 |
68
|
Beneficiary elects to use life time reserve (LTR) days |
deprecated |
added v2.3.1, removed after v2.4 |
70
|
Self-administered EPO |
deprecated |
added v2.3.1, removed after v2.4 |
71
|
Full care in unit |
deprecated |
added v2.3.1, removed after v2.4 |
72
|
Self-care in unit |
deprecated |
added v2.3.1, removed after v2.4 |
73
|
Self-care training |
deprecated |
added v2.3.1, removed after v2.4 |
74
|
Home |
deprecated |
added v2.3.1, removed after v2.4 |
75
|
Home - 100% reimbursement |
deprecated |
added v2.3.1, removed after v2.4 |
76
|
Back-up in facility dialysis |
deprecated |
added v2.3.1, removed after v2.4 |
77
|
Provider accepts or is obligated/required due to a contractual arrangement or law to accept payment by a primary payer as payment in full |
deprecated |
added v2.3.1, removed after v2.4 |
78
|
New coverage not implemented by HMO |
deprecated |
added v2.3.1, removed after v2.4 |
79
|
Corf services provided off-site |
deprecated |
added v2.3.1, removed after v2.4 |
80
|
Pregnant |
deprecated |
added v2.3.1, removed after v2.4 |