| Code | Display |
| 0110 | Hospital / Inpatient (Medicare Part A) / Nonpayment or Zero Claims |
| 0111 | Hospital / Inpatient (Medicare Part A) / Admit Through Discharge Claim |
| 0112 | Hospital / Inpatient (Medicare Part A) / Interim (First Claim) |
| 0113 | Hospital / Inpatient (Medicare Part A) / Interim (Continuing Claims) |
| 0114 | Hospital / Inpatient (Medicare Part A) / Interim (Last Claim) |
| 0115 | Hospital / Inpatient (Medicare Part A) / Late Charge Only |
| 0117 | Hospital / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim |
| 0118 | Hospital / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim |
| 0119 | Hospital / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode |
| 0120 | Hospital / Inpatient (Medicare Part B) / Nonpayment or Zero Claims |
| 0121 | Hospital / Inpatient (Medicare Part B) / Admit Through Discharge Claim |
| 0122 | Hospital / Inpatient (Medicare Part B) / Interim (First Claim) |
| 0123 | Hospital / Inpatient (Medicare Part B) / Interim (Continuing Claims) |
| 0124 | Hospital / Inpatient (Medicare Part B) / Interim (Last Claim) |
| 0125 | Hospital / Inpatient (Medicare Part B) / Late Charge Only |
| 0127 | Hospital / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0128 | Hospital / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0129 | Hospital / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0130 | Hospital / Outpatient / Nonpayment or Zero Claims |
| 0131 | Hospital / Outpatient / Admit Through Discharge Claim |
| 0132 | Hospital / Outpatient / Interim (First Claim) |
| 0133 | Hospital / Outpatient / Interim (Continuing Claims) |
| 0134 | Hospital / Outpatient / Interim (Last Claim) |
| 0135 | Hospital / Outpatient / Late Charge Only |
| 0137 | Hospital / Outpatient / Replacement of Prior Claim or Corrected Claim |
| 0138 | Hospital / Outpatient / Void or Cancel of a Prior Claim |
| 0139 | Hospital / Outpatient / Final Claim for a Home Health PPS Episode |
| 0140 | Hospital / Other (Medicare Part B) / Nonpayment or Zero Claims |
| 0141 | Hospital / Other (Medicare Part B) / Admit Through Discharge Claim |
| 0142 | Hospital / Other (Medicare Part B) / Interim (First Claim) |
| 0143 | Hospital / Other (Medicare Part B) / Interim (Continuing Claims) |
| 0144 | Hospital / Other (Medicare Part B) / Interim (Last Claim) |
| 0145 | Hospital / Other (Medicare Part B) / Late Charge Only |
| 0147 | Hospital / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0148 | Hospital / Other (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0149 | Hospital / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0150 | Hospital / Level I Intermediate Care / Nonpayment or Zero Claims |
| 0151 | Hospital / Level I Intermediate Care / Admit Through Discharge Claim |
| 0152 | Hospital / Level I Intermediate Care / Interim (First Claim) |
| 0153 | Hospital / Level I Intermediate Care / Interim (Continuing Claims) |
| 0154 | Hospital / Level I Intermediate Care / Interim (Last Claim) |
| 0155 | Hospital / Level I Intermediate Care / Late Charge Only |
| 0157 | Hospital / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0158 | Hospital / Level I Intermediate Care / Void or Cancel of a Prior Claim |
| 0159 | Hospital / Level I Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0160 | Hospital / Level II Intermediate Care / Nonpayment or Zero Claims |
| 0161 | Hospital / Level II Intermediate Care / Admit Through Discharge Claim |
| 0162 | Hospital / Level II Intermediate Care / Interim (First Claim) |
| 0163 | Hospital / Level II Intermediate Care / Interim (Continuing Claims) |
| 0164 | Hospital / Level II Intermediate Care / Interim (Last Claim) |
| 0165 | Hospital / Level II Intermediate Care / Late Charge Only |
| 0167 | Hospital / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0168 | Hospital / Level II Intermediate Care / Void or Cancel of a Prior Claim |
| 0169 | Hospital / Level II Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0170 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims |
| 0171 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim |
| 0172 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim) |
| 0173 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims) |
| 0174 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim) |
| 0175 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only |
| 0177 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim |
| 0178 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim |
| 0179 | Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode |
| 0180 | Hospital / Swing Bed / Nonpayment or Zero Claims |
| 0181 | Hospital / Swing Bed / Admit Through Discharge Claim |
| 0182 | Hospital / Swing Bed / Interim (First Claim) |
| 0183 | Hospital / Swing Bed / Interim (Continuing Claims) |
| 0184 | Hospital / Swing Bed / Interim (Last Claim) |
| 0185 | Hospital / Swing Bed / Late Charge Only |
| 0187 | Hospital / Swing Bed / Replacement of Prior Claim or Corrected Claim |
| 0188 | Hospital / Swing Bed / Void or Cancel of a Prior Claim |
| 0189 | Hospital / Swing Bed / Final Claim for a Home Health PPS Episode |
| 0210 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Nonpayment or Zero Claims |
| 0211 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Admit Through Discharge Claim |
| 0212 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (First Claim) |
| 0213 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Continuing Claims) |
| 0214 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Last Claim) |
| 0215 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Late Charge Only |
| 0217 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim |
| 0218 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim |
| 0219 | Skilled Nursing Facility / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode |
| 0220 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Nonpayment or Zero Claims |
| 0221 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Admit Through Discharge Claim |
| 0222 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (First Claim) |
| 0223 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Continuing Claims) |
| 0224 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Last Claim) |
| 0225 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Late Charge Only |
| 0227 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0228 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0229 | Skilled Nursing Facility / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0230 | Skilled Nursing Facility / Outpatient / Nonpayment or Zero Claims |
| 0231 | Skilled Nursing Facility / Outpatient / Admit Through Discharge Claim |
| 0232 | Skilled Nursing Facility / Outpatient / Interim (First Claim) |
| 0233 | Skilled Nursing Facility / Outpatient / Interim (Continuing Claims) |
| 0234 | Skilled Nursing Facility / Outpatient / Interim (Last Claim) |
| 0235 | Skilled Nursing Facility / Outpatient / Late Charge Only |
| 0237 | Skilled Nursing Facility / Outpatient / Replacement of Prior Claim or Corrected Claim |
| 0238 | Skilled Nursing Facility / Outpatient / Void or Cancel of a Prior Claim |
| 0239 | Skilled Nursing Facility / Outpatient / Final Claim for a Home Health PPS Episode |
| 0240 | Skilled Nursing Facility / Other (Medicare Part B) / Nonpayment or Zero Claims |
| 0241 | Skilled Nursing Facility / Other (Medicare Part B) / Admit Through Discharge Claim |
| 0242 | Skilled Nursing Facility / Other (Medicare Part B) / Interim (First Claim) |
| 0243 | Skilled Nursing Facility / Other (Medicare Part B) / Interim (Continuing Claims) |
| 0244 | Skilled Nursing Facility / Other (Medicare Part B) / Interim (Last Claim) |
| 0245 | Skilled Nursing Facility / Other (Medicare Part B) / Late Charge Only |
| 0247 | Skilled Nursing Facility / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0248 | Skilled Nursing Facility / Other (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0249 | Skilled Nursing Facility / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0250 | Skilled Nursing Facility / Level I Intermediate Care / Nonpayment or Zero Claims |
| 0251 | Skilled Nursing Facility / Level I Intermediate Care / Admit Through Discharge Claim |
| 0252 | Skilled Nursing Facility / Level I Intermediate Care / Interim (First Claim) |
| 0253 | Skilled Nursing Facility / Level I Intermediate Care / Interim (Continuing Claims) |
| 0254 | Skilled Nursing Facility / Level I Intermediate Care / Interim (Last Claim) |
| 0255 | Skilled Nursing Facility / Level I Intermediate Care / Late Charge Only |
| 0257 | Skilled Nursing Facility / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0258 | Skilled Nursing Facility / Level I Intermediate Care / Void or Cancel of a Prior Claim |
| 0259 | Skilled Nursing Facility / Level I Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0260 | Skilled Nursing Facility / Level II Intermediate Care / Nonpayment or Zero Claims |
| 0261 | Skilled Nursing Facility / Level II Intermediate Care / Admit Through Discharge Claim |
| 0262 | Skilled Nursing Facility / Level II Intermediate Care / Interim (First Claim) |
| 0263 | Skilled Nursing Facility / Level II Intermediate Care / Interim (Continuing Claims) |
| 0264 | Skilled Nursing Facility / Level II Intermediate Care / Interim (Last Claim) |
| 0265 | Skilled Nursing Facility / Level II Intermediate Care / Late Charge Only |
| 0267 | Skilled Nursing Facility / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0268 | Skilled Nursing Facility / Level II Intermediate Care / Void or Cancel of a Prior Claim |
| 0269 | Skilled Nursing Facility / Level II Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0270 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims |
| 0271 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim |
| 0272 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim) |
| 0273 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims) |
| 0274 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim) |
| 0275 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only |
| 0277 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected claim |
| 0278 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim |
| 0279 | Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode |
| 0280 | Skilled Nursing Facility / Swing Bed / Nonpayment or Zero Claims |
| 0281 | Skilled Nursing Facility / Swing Bed / Admit Through Discharge Claim |
| 0282 | Skilled Nursing Facility / Swing Bed / Interim (First Claim) |
| 0283 | Skilled Nursing Facility / Swing Bed / Interim (Continuing Claims) |
| 0284 | Skilled Nursing Facility / Swing Bed / Interim (Last Claim) |
| 0285 | Skilled Nursing Facility / Swing Bed / Late Charge Only |
| 0287 | Skilled Nursing Facility / Swing Bed / Replacement of Prior Claim or Corrected Claim |
| 0288 | Skilled Nursing Facility / Swing Bed / Void or Cancel of a Prior Claim |
| 0289 | Skilled Nursing Facility / Swing Bed / Final Claim for a Home Health PPS Episode |
| 0310 | Home Health / Inpatient (Medicare Part A) / Nonpayment or Zero Claims |
| 0311 | Home Health / Inpatient (Medicare Part A) / Admit Through Discharge Claim |
| 0312 | Home Health / Inpatient (Medicare Part A) / Interim (First Claim) |
| 0313 | Home Health / Inpatient (Medicare Part A) / Interim (Continuing Claims) |
| 0314 | Home Health / Inpatient (Medicare Part A) / Interim (Last Claim) |
| 0315 | Home Health / Inpatient (Medicare Part A) / Late Charge Only |
| 0317 | Home Health / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim |
| 0318 | Home Health / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim |
| 0319 | Home Health / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode |
| 0320 | Home Health / Inpatient (Medicare Part B) / Nonpayment or Zero Claims |
| 0321 | Home Health / Inpatient (Medicare Part B) / Admit Through Discharge Claim |
| 0322 | Home Health / Inpatient (Medicare Part B) / Interim (First Claim) |
| 0323 | Home Health / Inpatient (Medicare Part B) / Interim (Continuing Claims) |
| 0324 | Home Health / Inpatient (Medicare Part B) / Interim (Last Claim) |
| 0325 | Home Health / Inpatient (Medicare Part B) / Late Charge Only |
| 0327 | Home Health / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0328 | Home Health / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0329 | Home Health / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0330 | Home Health / Outpatient / Nonpayment or Zero Claims |
| 0331 | Home Health / Outpatient / Admit Through Discharge Claim |
| 0332 | Home Health / Outpatient / Interim (First Claim) |
| 0333 | Home Health / Outpatient / Interim (Continuing Claims) |
| 0334 | Home Health / Outpatient / Interim (Last Claim) |
| 0335 | Home Health / Outpatient / Late Charge Only |
| 0337 | Home Health / Outpatient / Replacement of Prior Claim or Corrected Claim |
| 0338 | Home Health / Outpatient / Void or Cancel of a Prior Claim |
| 0339 | Home Health / Outpatient / Final Claim for a Home Health PPS Episode |
| 0340 | Home Health / Other (Medicare Part B) / Nonpayment or Zero Claims |
| 0341 | Home Health / Other (Medicare Part B) / Admit Through Discharge Claim |
| 0342 | Home Health / Other (Medicare Part B) / Interim (First Claim) |
| 0343 | Home Health / Other (Medicare Part B) / Interim (Continuing Claims) |
| 0344 | Home Health / Other (Medicare Part B) / Interim (Last Claim) |
| 0345 | Home Health / Other (Medicare Part B) / Late Charge Only |
| 0347 | Home Health / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0348 | Home Health / Other (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0349 | Home Health / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0350 | HomeHealth / Level I Intermediate Care / Nonpayment or Zero Claims |
| 0351 | HomeHealth / Level I Intermediate Care / Admit Through Discharge Claim |
| 0352 | HomeHealth / Level I Intermediate Care / Interim (First Claim) |
| 0353 | HomeHealth / Level I Intermediate Care / Interim (Continuing Claims) |
| 0354 | HomeHealth / Level I Intermediate Care / Interim (Last Claim) |
| 0355 | Home Health / Level I Intermediate Care / Late Charge Only |
| 0357 | Home Health / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0358 | Home Health / Level I Intermediate Care / Void or Cancel of a Prior Claim |
| 0359 | Home Health / Level I Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0360 | Home Health / Level II Intermediate Care / Nonpayment or Zero Claims |
| 0361 | Home Health / Level II Intermediate Care / Admit Through Discharge Claim |
| 0362 | Home Health / Level II Intermediate Care / Interim (First Claim) |
| 0363 | Home Health / Level II Intermediate Care / Interim (Continuing Claims) |
| 0364 | Home Health / Level II Intermediate Care / Interim (Last Claim) |
| 0365 | Home Health / Level II Intermediate Care / Late Charge Only |
| 0367 | Home Health / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0368 | Home Health / Level II Intermediate Care / Void or Cancel of a Prior Claim |
| 0369 | Home Health / Level II Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0370 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims |
| 0371 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim |
| 0372 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim) |
| 0373 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims) |
| 0374 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim) |
| 0375 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only |
| 0377 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim |
| 0378 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim |
| 0379 | Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode |
| 0380 | Home Health / Swing Bed / Nonpayment or Zero Claims |
| 0381 | Home Health / Swing Bed / Admit Through Discharge Claim |
| 0382 | Home Health / Swing Bed / Interim (First Claim) |
| 0383 | Home Health / Swing Bed / Interim (Continuing Claims) |
| 0384 | Home Health / Swing Bed / Interim (Last Claim) |
| 0385 | Home Health / Swing Bed / Late Charge Only |
| 0387 | Home Health / Swing Bed / Replacement of Prior Claim or Corrected Claim |
| 0388 | Home Health / Swing Bed / Void or Cancel of a Prior Claim |
| 0389 | Home Health / Swing Bed / Final Claim for a Home Health PPS Episode |
| 0410 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Nonpayment or Zero Claims |
| 0411 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Admit Through Discharge Claim |
| 0412 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (First Claim) |
| 0413 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Continuing Claims) |
| 0414 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Last Claim) |
| 0415 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Late Charge Only |
| 0417 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim |
| 0418 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim |
| 0419 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode |
| 0420 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Nonpayment or Zero Claims |
| 0421 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Admit Through Discharge Claim |
| 0422 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (First Claim) |
| 0423 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Continuing Claims) |
| 0424 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Last Claim) |
| 0425 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Late Charge Only |
| 0427 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0428 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0429 | Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0430 | Religious Nonmedical (Hospital) / Outpatient / Nonpayment or Zero Claims |
| 0431 | Religious Nonmedical (Hospital) / Outpatient / Admit Through Discharge Claim |
| 0432 | Religious Nonmedical (Hospital) / Outpatient / Interim (First Claim) |
| 0433 | Religious Nonmedical (Hospital) / Outpatient / Interim (Continuing Claims) |
| 0434 | Religious Nonmedical (Hospital) / Outpatient / Interim (Last Claim) |
| 0435 | Religious Nonmedical (Hospital) / Outpatient / Late Charge Only |
| 0437 | Religious Nonmedical (Hospital) / Outpatient / Replacement of Prior Claim or Corrected Claim |
| 0438 | Religious Nonmedical (Hospital) / Outpatient / Void or Cancel of a Prior Claim |
| 0439 | Religious Nonmedical (Hospital) / Outpatient / Final Claim for a Home Health PPS Episode |
| 0440 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Nonpayment or Zero Claims |
| 0441 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Admit Through Discharge Claim |
| 0442 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (First Claim) |
| 0443 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Continuing Claims) |
| 0444 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Last Claim) |
| 0445 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Late Charge Only |
| 0447 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0448 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0449 | Religious Nonmedical (Hospital) / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0450 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Nonpayment or Zero Claims |
| 0451 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Admit Through Discharge Claim |
| 0452 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (First Claim) |
| 0453 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Continuing Claims) |
| 0454 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Last Claim) |
| 0455 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Late Charge Only |
| 0457 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0458 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Void or Cancel of a Prior Claim |
| 0459 | Religious Nonmedical (Hospital) / Level I Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0460 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Nonpayment or Zero Claims |
| 0461 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Admit Through Discharge Claim |
| 0462 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (First Claim) |
| 0463 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Continuing Claims) |
| 0464 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Last Claim) |
| 0465 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Late Charge Only |
| 0467 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0468 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Void or Cancel of a Prior Claim |
| 0469 | Religious Nonmedical (Hospital) / Level II Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0470 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims |
| 0471 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim |
| 0472 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim) |
| 0473 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims) |
| 0474 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim) |
| 0475 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only |
| 0477 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim |
| 0478 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim |
| 0479 | Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode |
| 0480 | Religious Nonmedical (Hospital) / Swing Bed / Nonpayment or Zero Claims |
| 0481 | Religious Nonmedical (Hospital) / Swing Bed / Admit Through Discharge Claim |
| 0482 | Religious Nonmedical (Hospital) / Swing Bed / Interim (First Claim) |
| 0483 | Religious Nonmedical (Hospital) / Swing Bed / Interim (Continuing Claims) |
| 0484 | Religious Nonmedical (Hospital) / Swing Bed / Interim (Last Claim) |
| 0485 | Religious Nonmedical (Hospital) / Swing Bed / Late Charge Only |
| 0487 | Religious Nonmedical (Hospital) / Swing Bed / Replacement of Prior Claim or Corrected Claim |
| 0488 | Religious Nonmedical (Hospital) / Swing Bed / Void or Cancel of a Prior Claim |
| 0489 | Religious Nonmedical (Hospital) / Swing Bed / Final Claim for a Home Health PPS Episode |
| 0510 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Nonpayment or Zero Claims |
| 0511 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Admit Through Discharge Claim |
| 0512 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (First Claim) |
| 0513 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Continuing Claims) |
| 0514 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Last Claim) |
| 0515 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Late Charge Only |
| 0517 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim |
| 0518 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim |
| 0519 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode |
| 0520 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Nonpayment or Zero Claims |
| 0521 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Admit Through Discharge Claim |
| 0522 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (First Claim) |
| 0523 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Continuing Claims) |
| 0524 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Last Claim) |
| 0525 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Late Charge Only |
| 0527 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0528 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0529 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0530 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Nonpayment or Zero Claims |
| 0531 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Admit Through Discharge Claim |
| 0532 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (First Claim) |
| 0533 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Continuing Claims) |
| 0534 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Last Claim) |
| 0535 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Late Charge Only |
| 0537 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Replacement of Prior Claim or Corrected Claim |
| 0538 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Void or Cancel of a Prior Claim |
| 0539 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Final Claim for a Home Health PPS Episode |
| 0540 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Nonpayment or Zero Claims |
| 0541 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Admit Through Discharge Claim |
| 0542 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (First Claim) |
| 0543 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Continuing Claims) |
| 0544 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Last Claim) |
| 0545 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Late Charge Only |
| 0547 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0548 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0549 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0550 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Nonpayment or Zero Claims |
| 0551 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Admit Through Discharge Claim |
| 0552 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (First Claim) |
| 0553 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Continuing Claims) |
| 0554 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Last Claim) |
| 0555 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Late Charge Only |
| 0557 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0558 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Void or Cancel of a Prior Claim |
| 0559 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0560 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Nonpayment or Zero Claims |
| 0561 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Admit Through Discharge Claim |
| 0562 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (First Claim) |
| 0563 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Continuing Claims) |
| 0564 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Last Claim) |
| 0565 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Late Charge Only |
| 0567 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0568 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Void or Cancel of a Prior Claim |
| 0569 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0570 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims |
| 0571 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim |
| 0572 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim) |
| 0573 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims) |
| 0574 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim) |
| 0575 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only |
| 0577 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim |
| 0578 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim |
| 0579 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode |
| 0580 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Nonpayment or Zero Claims |
| 0581 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Admit Through Discharge Claim |
| 0582 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (First Claim) |
| 0583 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Continuing Claims) |
| 0584 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Last Claim) |
| 0585 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Late Charge Only |
| 0587 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Replacement of Prior Claim or Corrected Claim |
| 0588 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Void or Cancel of a Prior Claim |
| 0589 | Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Final Claim for a Home Health PPS Episode |
| 0610 | Intermediate Care / Inpatient (Medicare Part A) / Nonpayment or Zero Claims |
| 0611 | Intermediate Care / Inpatient (Medicare Part A) / Admit Through Discharge Claim |
| 0612 | Intermediate Care / Inpatient (Medicare Part A) / Interim (First Claim) |
| 0613 | Intermediate Care / Inpatient (Medicare Part A) / Interim (Continuing Claims) |
| 0614 | Intermediate Care / Inpatient (Medicare Part A) / Interim (Last Claim) |
| 0615 | Intermediate Care / Inpatient (Medicare Part A) / Late Charge Only |
| 0617 | Intermediate Care / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim |
| 0618 | Intermediate Care / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim |
| 0619 | Intermediate Care / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode |
| 0620 | Intermediate Care / Inpatient (Medicare Part B) / Nonpayment or Zero Claims |
| 0621 | Intermediate Care / Inpatient (Medicare Part B) / Admit Through Discharge Claim |
| 0622 | Intermediate Care / Inpatient (Medicare Part B) / Interim (First Claim) |
| 0623 | Intermediate Care / Inpatient (Medicare Part B) / Interim (Continuing Claims) |
| 0624 | Intermediate Care / Inpatient (Medicare Part B) / Interim (Last Claim) |
| 0625 | Intermediate Care / Inpatient (Medicare Part B) / Late Charge Only |
| 0627 | Intermediate Care / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0628 | Intermediate Care / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0629 | Intermediate Care / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0630 | Intermediate Care / Outpatient / Nonpayment or Zero Claims |
| 0631 | Intermediate Care / Outpatient / Admit Through Discharge Claim |
| 0632 | Intermediate Care / Outpatient / Interim (First Claim) |
| 0633 | Intermediate Care / Outpatient / Interim (Continuing Claims) |
| 0634 | Intermediate Care / Outpatient / Interim (Last Claim) |
| 0635 | Intermediate Care / Outpatient / Late Charge Only |
| 0637 | Intermediate Care / Outpatient / Replacement of Prior Claim or Corrected Claim |
| 0638 | Intermediate Care / Outpatient / Void or Cancel of a Prior Claim |
| 0639 | Intermediate Care / Outpatient / Final Claim for a Home Health PPS Episode |
| 0640 | Intermediate Care / Other (Medicare Part B) / Nonpayment or Zero Claims |
| 0641 | Intermediate Care / Other (Medicare Part B) / Admit Through Discharge Claim |
| 0642 | Intermediate Care / Other (Medicare Part B) / Interim (First Claim) |
| 0643 | Intermediate Care / Other (Medicare Part B) / Interim (Continuing Claims) |
| 0644 | Intermediate Care / Other (Medicare Part B) / Interim (Last Claim) |
| 0645 | Intermediate Care / Other (Medicare Part B) / Late Charge Only |
| 0647 | Intermediate Care / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim |
| 0648 | Intermediate Care / Other (Medicare Part B) / Void or Cancel of a Prior Claim |
| 0649 | Intermediate Care / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode |
| 0650 | Intermediate Care / Level I Intermediate Care / Nonpayment or Zero Claims |
| 0651 | Intermediate Care / Level I Intermediate Care / Admit Through Discharge Claim |
| 0652 | Intermediate Care / Level I Intermediate Care / Interim (First Claim) |
| 0653 | Intermediate Care / Level I Intermediate Care / Interim (Continuing Claims) |
| 0654 | Intermediate Care / Level I Intermediate Care / Interim (Last Claim) |
| 0655 | Intermediate Care / Level I Intermediate Care / Late Charge Only |
| 0657 | Intermediate Care / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0658 | Intermediate Care / Level I Intermediate Care / Void or Cancel of a Prior Claim |
| 0659 | Intermediate Care / Level I Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0660 | Intermediate Care / Level II Intermediate Care / Nonpayment or Zero Claims |
| 0661 | Intermediate Care / Level II Intermediate Care / Admit Through Discharge Claim |
| 0662 | Intermediate Care / Level II Intermediate Care / Interim (First Claim) |
| 0663 | Intermediate Care / Level II Intermediate Care / Interim (Continuing Claims) |
| 0664 | Intermediate Care / Level II Intermediate Care / Interim (Last Claim) |
| 0665 | Intermediate Care / Level II Intermediate Care / Late Charge Only |
| 0667 | Intermediate Care / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim |
| 0668 | Intermediate Care / Level II Intermediate Care / Void or Cancel of a Prior Claim |
| 0669 | Intermediate Care / Level II Intermediate Care / Final Claim for a Home Health PPS Episode |
| 0670 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims |
| 0671 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim |
| 0672 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim) |
| 0673 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims) |
| 0674 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim) |
| 0675 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only |
| 0677 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim |
| 0678 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim |
| 0679 | Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode |
| 0680 | Intermediate Care / Swing Bed / Nonpayment or Zero Claims |
| 0681 | Intermediate Care / Swing Bed / Admit Through Discharge Claim |
| 0682 | Intermediate Care / Swing Bed / Interim (First Claim) |
| 0683 | Intermediate Care / Swing Bed / Interim (Continuing Claims) |
| 0684 | Intermediate Care / Swing Bed / Interim (Last Claim) |
| 0685 | Intermediate Care / Swing Bed / Late Charge Only |
| 0687 | Intermediate Care / Swing Bed / Replacement of Prior Claim or Corrected Claim |
| 0688 | Intermediate Care / Swing Bed / Void or Cancel of a Prior Claim |
| 0689 | Intermediate Care / Swing Bed / Final Claim for a Home Health PPS Episode |
| 0710 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Nonpayment or Zero Claims |
| 0711 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Admit Through Discharge Claim |
| 0712 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (First Claim) |
| 0713 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Continuing Claims) |
| 0714 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Last Claim) |
| 0715 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Late Charge Only |
| 0717 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Replacement of Prior Claim or Corrected Claim |
| 0718 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Void or Cancel of a Prior Claim |
| 0719 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Final Claim for a Home Health PPS Episode |
| 0720 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Nonpayment or Zero Claims |
| 0721 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Admit Through Discharge Claim |
| 0722 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (First Claim) |
| 0723 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Continuing Claims) |
| 0724 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Last Claim) |
| 0725 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Late Charge Only |
| 0727 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Replacement of Prior Claim or Corrected Claim |
| 0728 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Void or Cancel of a Prior Claim |
| 0729 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Final Claim for a Home Health PPS Episode |
| 0730 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Nonpayment or Zero Claims |
| 0731 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Admit Through Discharge Claim |
| 0732 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (First Claim) |
| 0733 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Continuing Claims) |
| 0734 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Last Claim) |
| 0735 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Late Charge Only |
| 0737 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Replacement of Prior Claim or Corrected Claim |
| 0738 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Void or Cancel of a Prior Claim |
| 0739 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Final Claim for a Home Health PPS Episode |
| 0740 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Nonpayment or Zero Claims |
| 0741 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Admit Through Discharge Claim |
| 0742 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (First Claim) |
| 0743 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims) |
| 0744 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Last Claim) |
| 0745 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Late Charge Only |
| 0747 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Replacement of Prior Claim or Corrected Claim |
| 0748 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Void or Cancel of a Prior Claim |
| 0749 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Final Claim for a Home Health PPS Episode |
| 0750 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Nonpayment or Zero Claims |
| 0751 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Admit Through Discharge Claim |
| 0752 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (First Claim) |
| 0753 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Continuing Claims) |
| 0754 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Last Claim) |
| 0755 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Late Charge Only |
| 0757 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Replacement of Prior Claim or Corrected Claim |
| 0758 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Void or Cancel of a Prior Claim |
| 0759 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Final Claim for a Home Health PPS Episode |
| 0760 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Nonpayment or Zero Claims |
| 0761 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Admit Through Discharge Claim |
| 0762 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (First Claim) |
| 0763 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Continuing Claims) |
| 0764 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Last Claim) |
| 0765 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Late Charge Only |
| 0767 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Replacement of Prior Claim or Corrected Claim |
| 0768 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Void or Cancel of a Prior Claim |
| 0769 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Final Claim for a Home Health PPS Episode |
| 0810 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Nonpayment or Zero Claims |
| 0811 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Admit Through Discharge Claim |
| 0812 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (First Claim) |
| 0813 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Continuing Claims) |
| 0814 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Last Claim) |
| 0815 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Late Charge Only |
| 0817 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Replacement of Prior Claim or Corrected Claim |
| 0818 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Void or Cancel of a Prior Claim |
| 0819 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Final Claim for a Home Health PPS Episode |
| 0820 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Nonpayment or Zero Claims |
| 0821 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Admit Through Discharge Claim |
| 0822 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (First Claim) |
| 0823 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Continuing Claims) |
| 0824 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Last Claim) |
| 0825 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Late Charge Only |
| 0827 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Replacement of Prior Claim or Corrected Claim |
| 0828 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Void or Cancel of a Prior Claim |
| 0829 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Final Claim for a Home Health PPS Episode |
| 0830 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Nonpayment or Zero Claims |
| 0831 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Admit Through Discharge Claim |
| 0832 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Interim (First Claim) |
| 0833 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Interim (Continuing Claims) |
| 0834 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Interim (Last Claim) |
| 0835 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Late Charge Only |
| 0837 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Replacement of Prior Claim or Corrected Claim |
| 0838 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Void or Cancel of a Prior Claim |
| 0839 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Ambulatory Surgical Center Services to Hospital Patients / Final Claim for a Home Health PPS Episode |
| 0840 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Nonpayment or Zero Claims |
| 0841 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Admit Through Discharge Claim |
| 0842 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (First Claim) |
| 0843 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims) |
| 0844 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Last Claim) |
| 0845 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Late Charge Only |
| 0847 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Replacement of Prior Claim or Corrected Claim |
| 0848 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Void or Cancel of a Prior Claim |
| 0849 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Final Claim for a Home Health PPS Episode |
| 0850 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Nonpayment or Zero Claims |
| 0851 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Admit Through Discharge Claim |
| 0852 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (First Claim) |
| 0853 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Continuing Claims) |
| 0854 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Last Claim) |
| 0855 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Late Charge Only |
| 0857 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Replacement of Prior Claim or Corrected Claim |
| 0858 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Void or Cancel of a Prior Claim |
| 0859 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Comprehensive Outpatient Rehabilitation Facility (CORF) / Final Claim for a Home Health PPS Episode |
| 0860 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Nonpayment or Zero Claims |
| 0861 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Admit Through Discharge Claim |
| 0862 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Interim (First Claim) |
| 0863 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Interim (Continuing Claims) |
| 0864 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Interim (Last Claim) |
| 0865 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Late Charge Only |
| 0867 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Replacement of Prior Claim or Corrected Claim |
| 0868 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Void or Cancel of a Prior Claim |
| 0869 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Community Mental Health Center (CMHC) / Final Claim for a Home Health PPS Episode |
