• Include these codes as defined in http://terminology.hl7.org/CodeSystem/v2-0153 version 2.9

  Code	Display
  ...	See NUBC codes
  01	Most common semi-private rate
  02	Hospital has no semi-private rooms
  04	Inpatient professional component charges which are combined billed
  05	Professional component included in charges and also billed separate to carrier
  06	Medicare blood deductible
  08	Medicare life time reserve amount in the first calendar year
  09	Medicare co-insurance amount in the first calendar year
  10	Lifetime reserve amount in the second calendar year
  11	Co-insurance amount in the second calendar year
  12	Working aged beneficiary/spouse with employer group health plan
  13	ESRD beneficiary in a Medicare coordination period with an employer group health plan
  14	No Fault including auto/other
  15	Worker's Compensation
  16	PHS, or other federal agency
  17	Payer code
  21	Catastrophic
  22	Surplus
  23	Recurring monthly incode
  24	Medicaid rate code
  30	Pre-admission testing
  31	Patient liability amount
  37	Pints of blood furnished
  38	Blood deductible pints
  39	Pints of blood replaced
  40	New coverage not implemented by HMO (for inpatient service only)
  41	Black lung
  42	VA
  43	Disabled beneficiary under age 64 with LGHP
  44	Amount provider agreed to accept from primary payer when this amount is less than charges but higher than payment received,, then a Medicare secondary payment is due
  45	Accident hour
  46	Number of grace days
  47	Any liability insurance
  48	Hemoglobin reading
  49	Hematocrit reading
  50	Physical therapy visits
  51	Occupational therapy visits
  52	Speech therapy visits
  53	Cardiac rehab visits
  56	Skilled nurse - home visit hours
  57	Home health aide - home visit hours
  58	Arterial blood gas
  59	Oxygen saturation
  60	HHA branch MSA
  67	Peritoneal dialysis
  68	EPO-drug
  70	Payer codes
  70 ... 72	Payer codes
  71	Payer codes
  72	Payer codes
  75	Payer codes
  75 ... 79	Payer codes
  76	Payer codes
  77	Payer codes
  78	Payer codes
  79	Payer codes
  80	Psychiatric visits
  81	Visits subject to co-payment
  A1	Deductible payer A
  A2	Coinsurance payer A
  A3	Estimated responsibility payer A
  X0	Service excluded on primary policy
  X4	Supplemental coverage
  …	See NUBC codes

This value set expansion contains 64 concepts.