LINUXFORHEALTH.FHIR.IG\UB04 Admit Bill Type Code System - JSON Representation

LinuxForHealth FHIR Implementation Guide - Local Development build (v8.0.0). See the Directory of published versions
: UB04 Admit Bill Type Code System - JSON Representation

Active as of 2022-11-10

{
  "resourceType" : "CodeSystem",
  "id" : "ub04-admit-bill-type",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system <code>http://linuxforhealth.org/fhir/cdm/CodeSystem/ub04-admit-bill-type</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td style=\"white-space:nowrap\">0110<a name=\"ub04-admit-bill-type-0110\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0111<a name=\"ub04-admit-bill-type-0111\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0112<a name=\"ub04-admit-bill-type-0112\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0113<a name=\"ub04-admit-bill-type-0113\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0114<a name=\"ub04-admit-bill-type-0114\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0115<a name=\"ub04-admit-bill-type-0115\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0117<a name=\"ub04-admit-bill-type-0117\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0118<a name=\"ub04-admit-bill-type-0118\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0119<a name=\"ub04-admit-bill-type-0119\"> </a></td><td>Hospital / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0120<a name=\"ub04-admit-bill-type-0120\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0121<a name=\"ub04-admit-bill-type-0121\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0122<a name=\"ub04-admit-bill-type-0122\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0123<a name=\"ub04-admit-bill-type-0123\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0124<a name=\"ub04-admit-bill-type-0124\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0125<a name=\"ub04-admit-bill-type-0125\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0127<a name=\"ub04-admit-bill-type-0127\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0128<a name=\"ub04-admit-bill-type-0128\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0129<a name=\"ub04-admit-bill-type-0129\"> </a></td><td>Hospital / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0130<a name=\"ub04-admit-bill-type-0130\"> </a></td><td>Hospital / Outpatient / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0131<a name=\"ub04-admit-bill-type-0131\"> </a></td><td>Hospital / Outpatient / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0132<a name=\"ub04-admit-bill-type-0132\"> </a></td><td>Hospital / Outpatient / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0133<a name=\"ub04-admit-bill-type-0133\"> </a></td><td>Hospital / Outpatient / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0134<a name=\"ub04-admit-bill-type-0134\"> </a></td><td>Hospital / Outpatient / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0135<a name=\"ub04-admit-bill-type-0135\"> </a></td><td>Hospital / Outpatient / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0137<a name=\"ub04-admit-bill-type-0137\"> </a></td><td>Hospital / Outpatient / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0138<a name=\"ub04-admit-bill-type-0138\"> </a></td><td>Hospital / Outpatient / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0139<a name=\"ub04-admit-bill-type-0139\"> </a></td><td>Hospital / Outpatient / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0140<a name=\"ub04-admit-bill-type-0140\"> </a></td><td>Hospital / Other (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0141<a name=\"ub04-admit-bill-type-0141\"> </a></td><td>Hospital / Other (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0142<a name=\"ub04-admit-bill-type-0142\"> </a></td><td>Hospital / Other (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0143<a name=\"ub04-admit-bill-type-0143\"> </a></td><td>Hospital / Other (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0144<a name=\"ub04-admit-bill-type-0144\"> </a></td><td>Hospital / Other (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0145<a name=\"ub04-admit-bill-type-0145\"> </a></td><td>Hospital / Other (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0147<a name=\"ub04-admit-bill-type-0147\"> </a></td><td>Hospital / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0148<a name=\"ub04-admit-bill-type-0148\"> </a></td><td>Hospital / Other (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0149<a name=\"ub04-admit-bill-type-0149\"> </a></td><td>Hospital / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0150<a name=\"ub04-admit-bill-type-0150\"> </a></td><td>Hospital / Level I Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0151<a name=\"ub04-admit-bill-type-0151\"> </a></td><td>Hospital / Level I Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0152<a name=\"ub04-admit-bill-type-0152\"> </a></td><td>Hospital / Level I Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0153<a name=\"ub04-admit-bill-type-0153\"> </a></td><td>Hospital / Level I Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0154<a name=\"ub04-admit-bill-type-0154\"> </a></td><td>Hospital / Level I Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0155<a name=\"ub04-admit-bill-type-0155\"> </a></td><td>Hospital / Level I Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0157<a name=\"ub04-admit-bill-type-0157\"> </a></td><td>Hospital / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0158<a name=\"ub04-admit-bill-type-0158\"> </a></td><td>Hospital / Level I Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0159<a name=\"ub04-admit-bill-type-0159\"> </a></td><td>Hospital / Level I Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0160<a name=\"ub04-admit-bill-type-0160\"> </a></td><td>Hospital / Level II Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0161<a name=\"ub04-admit-bill-type-0161\"> </a></td><td>Hospital / Level II Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0162<a name=\"ub04-admit-bill-type-0162\"> </a></td><td>Hospital / Level II Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0163<a name=\"ub04-admit-bill-type-0163\"> </a></td><td>Hospital / Level II Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0164<a name=\"ub04-admit-bill-type-0164\"> </a></td><td>Hospital / Level II Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0165<a name=\"ub04-admit-bill-type-0165\"> </a></td><td>Hospital / Level II Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0167<a name=\"ub04-admit-bill-type-0167\"> </a></td><td>Hospital / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0168<a name=\"ub04-admit-bill-type-0168\"> </a></td><td>Hospital / Level II Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0169<a name=\"ub04-admit-bill-type-0169\"> </a></td><td>Hospital / Level II Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0170<a name=\"ub04-admit-bill-type-0170\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0171<a name=\"ub04-admit-bill-type-0171\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0172<a name=\"ub04-admit-bill-type-0172\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0173<a name=\"ub04-admit-bill-type-0173\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0174<a name=\"ub04-admit-bill-type-0174\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0175<a name=\"ub04-admit-bill-type-0175\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0177<a name=\"ub04-admit-bill-type-0177\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0178<a name=\"ub04-admit-bill-type-0178\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0179<a name=\"ub04-admit-bill-type-0179\"> </a></td><td>Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0180<a name=\"ub04-admit-bill-type-0180\"> </a></td><td>Hospital / Swing Bed / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0181<a name=\"ub04-admit-bill-type-0181\"> </a></td><td>Hospital / Swing Bed / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0182<a name=\"ub04-admit-bill-type-0182\"> </a></td><td>Hospital / Swing Bed / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0183<a name=\"ub04-admit-bill-type-0183\"> </a></td><td>Hospital / Swing Bed / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0184<a name=\"ub04-admit-bill-type-0184\"> </a></td><td>Hospital / Swing Bed / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0185<a name=\"ub04-admit-bill-type-0185\"> </a></td><td>Hospital / Swing Bed / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0187<a name=\"ub04-admit-bill-type-0187\"> </a></td><td>Hospital / Swing Bed / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0188<a name=\"ub04-admit-bill-type-0188\"> </a></td><td>Hospital / Swing Bed / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0189<a name=\"ub04-admit-bill-type-0189\"> </a></td><td>Hospital / Swing Bed / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0210<a name=\"ub04-admit-bill-type-0210\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0211<a name=\"ub04-admit-bill-type-0211\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0212<a name=\"ub04-admit-bill-type-0212\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0213<a name=\"ub04-admit-bill-type-0213\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0214<a name=\"ub04-admit-bill-type-0214\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0215<a name=\"ub04-admit-bill-type-0215\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0217<a name=\"ub04-admit-bill-type-0217\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0218<a name=\"ub04-admit-bill-type-0218\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0219<a name=\"ub04-admit-bill-type-0219\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0220<a name=\"ub04-admit-bill-type-0220\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0221<a name=\"ub04-admit-bill-type-0221\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0222<a name=\"ub04-admit-bill-type-0222\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0223<a name=\"ub04-admit-bill-type-0223\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0224<a name=\"ub04-admit-bill-type-0224\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0225<a name=\"ub04-admit-bill-type-0225\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0227<a name=\"ub04-admit-bill-type-0227\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0228<a name=\"ub04-admit-bill-type-0228\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0229<a name=\"ub04-admit-bill-type-0229\"> </a></td><td>Skilled Nursing Facility / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0230<a name=\"ub04-admit-bill-type-0230\"> </a></td><td>Skilled Nursing Facility / Outpatient / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0231<a name=\"ub04-admit-bill-type-0231\"> </a></td><td>Skilled Nursing Facility / Outpatient / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0232<a name=\"ub04-admit-bill-type-0232\"> </a></td><td>Skilled Nursing Facility / Outpatient / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0233<a name=\"ub04-admit-bill-type-0233\"> </a></td><td>Skilled Nursing Facility / Outpatient / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0234<a name=\"ub04-admit-bill-type-0234\"> </a></td><td>Skilled Nursing Facility / Outpatient / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0235<a name=\"ub04-admit-bill-type-0235\"> </a></td><td>Skilled Nursing Facility / Outpatient / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0237<a name=\"ub04-admit-bill-type-0237\"> </a></td><td>Skilled Nursing Facility / Outpatient / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0238<a name=\"ub04-admit-bill-type-0238\"> </a></td><td>Skilled Nursing Facility / Outpatient / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0239<a name=\"ub04-admit-bill-type-0239\"> </a></td><td>Skilled Nursing Facility / Outpatient / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0240<a name=\"ub04-admit-bill-type-0240\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0241<a name=\"ub04-admit-bill-type-0241\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0242<a name=\"ub04-admit-bill-type-0242\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0243<a name=\"ub04-admit-bill-type-0243\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0244<a name=\"ub04-admit-bill-type-0244\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0245<a name=\"ub04-admit-bill-type-0245\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0247<a name=\"ub04-admit-bill-type-0247\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0248<a name=\"ub04-admit-bill-type-0248\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0249<a name=\"ub04-admit-bill-type-0249\"> </a></td><td>Skilled Nursing Facility / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0250<a name=\"ub04-admit-bill-type-0250\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0251<a name=\"ub04-admit-bill-type-0251\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0252<a name=\"ub04-admit-bill-type-0252\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0253<a name=\"ub04-admit-bill-type-0253\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0254<a name=\"ub04-admit-bill-type-0254\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0255<a name=\"ub04-admit-bill-type-0255\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0257<a name=\"ub04-admit-bill-type-0257\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0258<a name=\"ub04-admit-bill-type-0258\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0259<a name=\"ub04-admit-bill-type-0259\"> </a></td><td>Skilled Nursing Facility / Level I Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0260<a name=\"ub04-admit-bill-type-0260\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0261<a name=\"ub04-admit-bill-type-0261\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0262<a name=\"ub04-admit-bill-type-0262\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0263<a name=\"ub04-admit-bill-type-0263\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0264<a name=\"ub04-admit-bill-type-0264\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0265<a name=\"ub04-admit-bill-type-0265\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0267<a name=\"ub04-admit-bill-type-0267\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0268<a name=\"ub04-admit-bill-type-0268\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0269<a name=\"ub04-admit-bill-type-0269\"> </a></td><td>Skilled Nursing Facility / Level II Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0270<a name=\"ub04-admit-bill-type-0270\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0271<a name=\"ub04-admit-bill-type-0271\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0272<a name=\"ub04-admit-bill-type-0272\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0273<a name=\"ub04-admit-bill-type-0273\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0274<a name=\"ub04-admit-bill-type-0274\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0275<a name=\"ub04-admit-bill-type-0275\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0277<a name=\"ub04-admit-bill-type-0277\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected claim</td></tr><tr><td style=\"white-space:nowrap\">0278<a name=\"ub04-admit-bill-type-0278\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0279<a name=\"ub04-admit-bill-type-0279\"> </a></td><td>Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0280<a name=\"ub04-admit-bill-type-0280\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0281<a name=\"ub04-admit-bill-type-0281\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0282<a name=\"ub04-admit-bill-type-0282\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0283<a name=\"ub04-admit-bill-type-0283\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0284<a name=\"ub04-admit-bill-type-0284\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0285<a name=\"ub04-admit-bill-type-0285\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0287<a name=\"ub04-admit-bill-type-0287\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0288<a name=\"ub04-admit-bill-type-0288\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0289<a name=\"ub04-admit-bill-type-0289\"> </a></td><td>Skilled Nursing Facility / Swing Bed / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0310<a name=\"ub04-admit-bill-type-0310\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0311<a name=\"ub04-admit-bill-type-0311\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0312<a name=\"ub04-admit-bill-type-0312\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0313<a name=\"ub04-admit-bill-type-0313\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0314<a name=\"ub04-admit-bill-type-0314\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0315<a name=\"ub04-admit-bill-type-0315\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0317<a name=\"ub04-admit-bill-type-0317\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0318<a name=\"ub04-admit-bill-type-0318\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0319<a name=\"ub04-admit-bill-type-0319\"> </a></td><td>Home Health / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0320<a name=\"ub04-admit-bill-type-0320\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0321<a name=\"ub04-admit-bill-type-0321\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0322<a name=\"ub04-admit-bill-type-0322\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0323<a name=\"ub04-admit-bill-type-0323\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0324<a name=\"ub04-admit-bill-type-0324\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0325<a name=\"ub04-admit-bill-type-0325\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0327<a name=\"ub04-admit-bill-type-0327\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0328<a name=\"ub04-admit-bill-type-0328\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0329<a name=\"ub04-admit-bill-type-0329\"> </a></td><td>Home Health / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0330<a name=\"ub04-admit-bill-type-0330\"> </a></td><td>Home Health / Outpatient / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0331<a name=\"ub04-admit-bill-type-0331\"> </a></td><td>Home Health / Outpatient / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0332<a name=\"ub04-admit-bill-type-0332\"> </a></td><td>Home Health / Outpatient / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0333<a name=\"ub04-admit-bill-type-0333\"> </a></td><td>Home Health / Outpatient / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0334<a name=\"ub04-admit-bill-type-0334\"> </a></td><td>Home Health / Outpatient / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0335<a name=\"ub04-admit-bill-type-0335\"> </a></td><td>Home Health / Outpatient / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0337<a name=\"ub04-admit-bill-type-0337\"> </a></td><td>Home Health / Outpatient / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0338<a name=\"ub04-admit-bill-type-0338\"> </a></td><td>Home Health / Outpatient / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0339<a name=\"ub04-admit-bill-type-0339\"> </a></td><td>Home Health / Outpatient / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0340<a name=\"ub04-admit-bill-type-0340\"> </a></td><td>Home Health / Other (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0341<a name=\"ub04-admit-bill-type-0341\"> </a></td><td>Home Health / Other (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0342<a name=\"ub04-admit-bill-type-0342\"> </a></td><td>Home Health / Other (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0343<a name=\"ub04-admit-bill-type-0343\"> </a></td><td>Home Health / Other (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0344<a name=\"ub04-admit-bill-type-0344\"> </a></td><td>Home Health / Other (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0345<a name=\"ub04-admit-bill-type-0345\"> </a></td><td>Home Health / Other (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0347<a name=\"ub04-admit-bill-type-0347\"> </a></td><td>Home Health / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0348<a name=\"ub04-admit-bill-type-0348\"> </a></td><td>Home Health / Other (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0349<a name=\"ub04-admit-bill-type-0349\"> </a></td><td>Home Health / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0350<a name=\"ub04-admit-bill-type-0350\"> </a></td><td>HomeHealth / Level I Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0351<a name=\"ub04-admit-bill-type-0351\"> </a></td><td>HomeHealth / Level I Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0352<a name=\"ub04-admit-bill-type-0352\"> </a></td><td>HomeHealth / Level I Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0353<a name=\"ub04-admit-bill-type-0353\"> </a></td><td>HomeHealth / Level I Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0354<a name=\"ub04-admit-bill-type-0354\"> </a></td><td>HomeHealth / Level I Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0355<a name=\"ub04-admit-bill-type-0355\"> </a></td><td>Home Health / Level I Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0357<a name=\"ub04-admit-bill-type-0357\"> </a></td><td>Home Health / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0358<a name=\"ub04-admit-bill-type-0358\"> </a></td><td>Home Health / Level I Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0359<a name=\"ub04-admit-bill-type-0359\"> </a></td><td>Home Health / Level I Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0360<a name=\"ub04-admit-bill-type-0360\"> </a></td><td>Home Health / Level II Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0361<a name=\"ub04-admit-bill-type-0361\"> </a></td><td>Home Health / Level II Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0362<a name=\"ub04-admit-bill-type-0362\"> </a></td><td>Home Health / Level II Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0363<a name=\"ub04-admit-bill-type-0363\"> </a></td><td>Home Health / Level II Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0364<a name=\"ub04-admit-bill-type-0364\"> </a></td><td>Home Health / Level II Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0365<a name=\"ub04-admit-bill-type-0365\"> </a></td><td>Home Health / Level II Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0367<a name=\"ub04-admit-bill-type-0367\"> </a></td><td>Home Health / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0368<a name=\"ub04-admit-bill-type-0368\"> </a></td><td>Home Health / Level II Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0369<a name=\"ub04-admit-bill-type-0369\"> </a></td><td>Home Health / Level II Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0370<a name=\"ub04-admit-bill-type-0370\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0371<a name=\"ub04-admit-bill-type-0371\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0372<a name=\"ub04-admit-bill-type-0372\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0373<a name=\"ub04-admit-bill-type-0373\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0374<a name=\"ub04-admit-bill-type-0374\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0375<a name=\"ub04-admit-bill-type-0375\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0377<a name=\"ub04-admit-bill-type-0377\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0378<a name=\"ub04-admit-bill-type-0378\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0379<a name=\"ub04-admit-bill-type-0379\"> </a></td><td>Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0380<a name=\"ub04-admit-bill-type-0380\"> </a></td><td>Home Health / Swing Bed / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0381<a name=\"ub04-admit-bill-type-0381\"> </a></td><td>Home Health / Swing Bed / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0382<a name=\"ub04-admit-bill-type-0382\"> </a></td><td>Home Health / Swing Bed / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0383<a name=\"ub04-admit-bill-type-0383\"> </a></td><td>Home Health / Swing Bed / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0384<a name=\"ub04-admit-bill-type-0384\"> </a></td><td>Home Health / Swing Bed / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0385<a name=\"ub04-admit-bill-type-0385\"> </a></td><td>Home Health / Swing Bed / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0387<a name=\"ub04-admit-bill-type-0387\"> </a></td><td>Home Health / Swing Bed / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0388<a name=\"ub04-admit-bill-type-0388\"> </a></td><td>Home Health / Swing Bed / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0389<a name=\"ub04-admit-bill-type-0389\"> </a></td><td>Home Health / Swing Bed / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0410<a name=\"ub04-admit-bill-type-0410\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0411<a name=\"ub04-admit-bill-type-0411\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0412<a name=\"ub04-admit-bill-type-0412\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0413<a name=\"ub04-admit-bill-type-0413\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0414<a name=\"ub04-admit-bill-type-0414\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0415<a name=\"ub04-admit-bill-type-0415\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0417<a name=\"ub04-admit-bill-type-0417\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0418<a name=\"ub04-admit-bill-type-0418\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0419<a name=\"ub04-admit-bill-type-0419\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0420<a name=\"ub04-admit-bill-type-0420\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0421<a name=\"ub04-admit-bill-type-0421\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0422<a name=\"ub04-admit-bill-type-0422\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0423<a name=\"ub04-admit-bill-type-0423\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0424<a name=\"ub04-admit-bill-type-0424\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0425<a name=\"ub04-admit-bill-type-0425\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0427<a name=\"ub04-admit-bill-type-0427\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0428<a name=\"ub04-admit-bill-type-0428\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0429<a name=\"ub04-admit-bill-type-0429\"> </a></td><td>Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0430<a name=\"ub04-admit-bill-type-0430\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0431<a name=\"ub04-admit-bill-type-0431\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0432<a name=\"ub04-admit-bill-type-0432\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0433<a name=\"ub04-admit-bill-type-0433\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0434<a name=\"ub04-admit-bill-type-0434\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0435<a name=\"ub04-admit-bill-type-0435\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0437<a name=\"ub04-admit-bill-type-0437\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0438<a name=\"ub04-admit-bill-type-0438\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0439<a name=\"ub04-admit-bill-type-0439\"> </a></td><td>Religious Nonmedical (Hospital) / Outpatient / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0440<a name=\"ub04-admit-bill-type-0440\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0441<a name=\"ub04-admit-bill-type-0441\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0442<a name=\"ub04-admit-bill-type-0442\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0443<a name=\"ub04-admit-bill-type-0443\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0444<a name=\"ub04-admit-bill-type-0444\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0445<a name=\"ub04-admit-bill-type-0445\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0447<a name=\"ub04-admit-bill-type-0447\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0448<a name=\"ub04-admit-bill-type-0448\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0449<a name=\"ub04-admit-bill-type-0449\"> </a></td><td>Religious Nonmedical (Hospital) / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0450<a name=\"ub04-admit-bill-type-0450\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0451<a name=\"ub04-admit-bill-type-0451\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0452<a name=\"ub04-admit-bill-type-0452\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0453<a name=\"ub04-admit-bill-type-0453\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0454<a name=\"ub04-admit-bill-type-0454\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0455<a name=\"ub04-admit-bill-type-0455\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0457<a name=\"ub04-admit-bill-type-0457\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0458<a name=\"ub04-admit-bill-type-0458\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0459<a name=\"ub04-admit-bill-type-0459\"> </a></td><td>Religious Nonmedical (Hospital) / Level I Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0460<a name=\"ub04-admit-bill-type-0460\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0461<a name=\"ub04-admit-bill-type-0461\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0462<a name=\"ub04-admit-bill-type-0462\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0463<a name=\"ub04-admit-bill-type-0463\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0464<a name=\"ub04-admit-bill-type-0464\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0465<a name=\"ub04-admit-bill-type-0465\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0467<a name=\"ub04-admit-bill-type-0467\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0468<a name=\"ub04-admit-bill-type-0468\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0469<a name=\"ub04-admit-bill-type-0469\"> </a></td><td>Religious Nonmedical (Hospital) / Level II Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0470<a name=\"ub04-admit-bill-type-0470\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0471<a name=\"ub04-admit-bill-type-0471\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0472<a name=\"ub04-admit-bill-type-0472\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0473<a name=\"ub04-admit-bill-type-0473\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0474<a name=\"ub04-admit-bill-type-0474\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0475<a name=\"ub04-admit-bill-type-0475\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0477<a name=\"ub04-admit-bill-type-0477\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0478<a name=\"ub04-admit-bill-type-0478\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0479<a name=\"ub04-admit-bill-type-0479\"> </a></td><td>Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0480<a name=\"ub04-admit-bill-type-0480\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0481<a name=\"ub04-admit-bill-type-0481\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0482<a name=\"ub04-admit-bill-type-0482\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0483<a name=\"ub04-admit-bill-type-0483\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0484<a name=\"ub04-admit-bill-type-0484\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0485<a name=\"ub04-admit-bill-type-0485\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0487<a name=\"ub04-admit-bill-type-0487\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0488<a name=\"ub04-admit-bill-type-0488\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0489<a name=\"ub04-admit-bill-type-0489\"> </a></td><td>Religious Nonmedical (Hospital) / Swing Bed / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0510<a name=\"ub04-admit-bill-type-0510\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0511<a name=\"ub04-admit-bill-type-0511\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0512<a name=\"ub04-admit-bill-type-0512\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0513<a name=\"ub04-admit-bill-type-0513\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0514<a name=\"ub04-admit-bill-type-0514\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0515<a name=\"ub04-admit-bill-type-0515\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0517<a name=\"ub04-admit-bill-type-0517\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0518<a name=\"ub04-admit-bill-type-0518\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0519<a name=\"ub04-admit-bill-type-0519\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0520<a name=\"ub04-admit-bill-type-0520\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0521<a name=\"ub04-admit-bill-type-0521\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0522<a name=\"ub04-admit-bill-type-0522\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0523<a name=\"ub04-admit-bill-type-0523\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0524<a name=\"ub04-admit-bill-type-0524\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0525<a name=\"ub04-admit-bill-type-0525\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0527<a name=\"ub04-admit-bill-type-0527\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0528<a name=\"ub04-admit-bill-type-0528\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0529<a name=\"ub04-admit-bill-type-0529\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0530<a name=\"ub04-admit-bill-type-0530\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0531<a name=\"ub04-admit-bill-type-0531\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0532<a name=\"ub04-admit-bill-type-0532\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0533<a name=\"ub04-admit-bill-type-0533\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0534<a name=\"ub04-admit-bill-type-0534\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0535<a name=\"ub04-admit-bill-type-0535\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0537<a name=\"ub04-admit-bill-type-0537\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0538<a name=\"ub04-admit-bill-type-0538\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0539<a name=\"ub04-admit-bill-type-0539\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0540<a name=\"ub04-admit-bill-type-0540\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0541<a name=\"ub04-admit-bill-type-0541\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0542<a name=\"ub04-admit-bill-type-0542\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0543<a name=\"ub04-admit-bill-type-0543\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0544<a name=\"ub04-admit-bill-type-0544\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0545<a name=\"ub04-admit-bill-type-0545\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0547<a name=\"ub04-admit-bill-type-0547\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0548<a name=\"ub04-admit-bill-type-0548\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0549<a name=\"ub04-admit-bill-type-0549\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0550<a name=\"ub04-admit-bill-type-0550\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0551<a name=\"ub04-admit-bill-type-0551\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0552<a name=\"ub04-admit-bill-type-0552\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0553<a name=\"ub04-admit-bill-type-0553\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0554<a name=\"ub04-admit-bill-type-0554\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0555<a name=\"ub04-admit-bill-type-0555\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0557<a name=\"ub04-admit-bill-type-0557\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0558<a name=\"ub04-admit-bill-type-0558\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0559<a name=\"ub04-admit-bill-type-0559\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0560<a name=\"ub04-admit-bill-type-0560\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0561<a name=\"ub04-admit-bill-type-0561\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0562<a name=\"ub04-admit-bill-type-0562\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0563<a name=\"ub04-admit-bill-type-0563\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0564<a name=\"ub04-admit-bill-type-0564\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0565<a name=\"ub04-admit-bill-type-0565\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0567<a name=\"ub04-admit-bill-type-0567\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0568<a name=\"ub04-admit-bill-type-0568\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0569<a name=\"ub04-admit-bill-type-0569\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0570<a name=\"ub04-admit-bill-type-0570\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0571<a name=\"ub04-admit-bill-type-0571\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0572<a name=\"ub04-admit-bill-type-0572\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0573<a name=\"ub04-admit-bill-type-0573\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0574<a name=\"ub04-admit-bill-type-0574\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0575<a name=\"ub04-admit-bill-type-0575\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0577<a name=\"ub04-admit-bill-type-0577\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0578<a name=\"ub04-admit-bill-type-0578\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0579<a name=\"ub04-admit-bill-type-0579\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0580<a name=\"ub04-admit-bill-type-0580\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0581<a name=\"ub04-admit-bill-type-0581\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0582<a name=\"ub04-admit-bill-type-0582\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0583<a name=\"ub04-admit-bill-type-0583\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0584<a name=\"ub04-admit-bill-type-0584\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0585<a name=\"ub04-admit-bill-type-0585\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0587<a name=\"ub04-admit-bill-type-0587\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0588<a name=\"ub04-admit-bill-type-0588\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0589<a name=\"ub04-admit-bill-type-0589\"> </a></td><td>Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0610<a name=\"ub04-admit-bill-type-0610\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0611<a name=\"ub04-admit-bill-type-0611\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0612<a name=\"ub04-admit-bill-type-0612\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0613<a name=\"ub04-admit-bill-type-0613\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0614<a name=\"ub04-admit-bill-type-0614\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0615<a name=\"ub04-admit-bill-type-0615\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0617<a name=\"ub04-admit-bill-type-0617\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0618<a name=\"ub04-admit-bill-type-0618\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0619<a name=\"ub04-admit-bill-type-0619\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0620<a name=\"ub04-admit-bill-type-0620\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0621<a name=\"ub04-admit-bill-type-0621\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0622<a name=\"ub04-admit-bill-type-0622\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0623<a name=\"ub04-admit-bill-type-0623\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0624<a name=\"ub04-admit-bill-type-0624\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0625<a name=\"ub04-admit-bill-type-0625\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0627<a name=\"ub04-admit-bill-type-0627\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0628<a name=\"ub04-admit-bill-type-0628\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0629<a name=\"ub04-admit-bill-type-0629\"> </a></td><td>Intermediate Care / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0630<a name=\"ub04-admit-bill-type-0630\"> </a></td><td>Intermediate Care / Outpatient / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0631<a name=\"ub04-admit-bill-type-0631\"> </a></td><td>Intermediate Care / Outpatient / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0632<a name=\"ub04-admit-bill-type-0632\"> </a></td><td>Intermediate Care / Outpatient / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0633<a name=\"ub04-admit-bill-type-0633\"> </a></td><td>Intermediate Care / Outpatient / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0634<a name=\"ub04-admit-bill-type-0634\"> </a></td><td>Intermediate Care / Outpatient / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0635<a name=\"ub04-admit-bill-type-0635\"> </a></td><td>Intermediate Care / Outpatient / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0637<a name=\"ub04-admit-bill-type-0637\"> </a></td><td>Intermediate Care / Outpatient / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0638<a name=\"ub04-admit-bill-type-0638\"> </a></td><td>Intermediate Care / Outpatient / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0639<a name=\"ub04-admit-bill-type-0639\"> </a></td><td>Intermediate Care / Outpatient / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0640<a name=\"ub04-admit-bill-type-0640\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0641<a name=\"ub04-admit-bill-type-0641\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0642<a name=\"ub04-admit-bill-type-0642\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0643<a name=\"ub04-admit-bill-type-0643\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0644<a name=\"ub04-admit-bill-type-0644\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0645<a name=\"ub04-admit-bill-type-0645\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0647<a name=\"ub04-admit-bill-type-0647\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0648<a name=\"ub04-admit-bill-type-0648\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0649<a name=\"ub04-admit-bill-type-0649\"> </a></td><td>Intermediate Care / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0650<a name=\"ub04-admit-bill-type-0650\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0651<a name=\"ub04-admit-bill-type-0651\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0652<a name=\"ub04-admit-bill-type-0652\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0653<a name=\"ub04-admit-bill-type-0653\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0654<a name=\"ub04-admit-bill-type-0654\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0655<a name=\"ub04-admit-bill-type-0655\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0657<a name=\"ub04-admit-bill-type-0657\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0658<a name=\"ub04-admit-bill-type-0658\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0659<a name=\"ub04-admit-bill-type-0659\"> </a></td><td>Intermediate Care / Level I Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0660<a name=\"ub04-admit-bill-type-0660\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0661<a name=\"ub04-admit-bill-type-0661\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0662<a name=\"ub04-admit-bill-type-0662\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0663<a name=\"ub04-admit-bill-type-0663\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0664<a name=\"ub04-admit-bill-type-0664\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0665<a name=\"ub04-admit-bill-type-0665\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0667<a name=\"ub04-admit-bill-type-0667\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0668<a name=\"ub04-admit-bill-type-0668\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0669<a name=\"ub04-admit-bill-type-0669\"> </a></td><td>Intermediate Care / Level II Intermediate Care / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0670<a name=\"ub04-admit-bill-type-0670\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0671<a name=\"ub04-admit-bill-type-0671\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0672<a name=\"ub04-admit-bill-type-0672\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0673<a name=\"ub04-admit-bill-type-0673\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0674<a name=\"ub04-admit-bill-type-0674\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0675<a name=\"ub04-admit-bill-type-0675\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0677<a name=\"ub04-admit-bill-type-0677\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0678<a name=\"ub04-admit-bill-type-0678\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0679<a name=\"ub04-admit-bill-type-0679\"> </a></td><td>Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0680<a name=\"ub04-admit-bill-type-0680\"> </a></td><td>Intermediate Care / Swing Bed / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0681<a name=\"ub04-admit-bill-type-0681\"> </a></td><td>Intermediate Care / Swing Bed / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0682<a name=\"ub04-admit-bill-type-0682\"> </a></td><td>Intermediate Care / Swing Bed / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0683<a name=\"ub04-admit-bill-type-0683\"> </a></td><td>Intermediate Care / Swing Bed / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0684<a name=\"ub04-admit-bill-type-0684\"> </a></td><td>Intermediate Care / Swing Bed / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0685<a name=\"ub04-admit-bill-type-0685\"> </a></td><td>Intermediate Care / Swing Bed / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0687<a name=\"ub04-admit-bill-type-0687\"> </a></td><td>Intermediate Care / Swing Bed / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0688<a name=\"ub04-admit-bill-type-0688\"> </a></td><td>Intermediate Care / Swing Bed / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0689<a name=\"ub04-admit-bill-type-0689\"> </a></td><td>Intermediate Care / Swing Bed / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0710<a name=\"ub04-admit-bill-type-0710\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0711<a name=\"ub04-admit-bill-type-0711\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0712<a name=\"ub04-admit-bill-type-0712\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0713<a name=\"ub04-admit-bill-type-0713\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0714<a name=\"ub04-admit-bill-type-0714\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0715<a name=\"ub04-admit-bill-type-0715\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0717<a name=\"ub04-admit-bill-type-0717\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0718<a name=\"ub04-admit-bill-type-0718\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0719<a name=\"ub04-admit-bill-type-0719\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0720<a name=\"ub04-admit-bill-type-0720\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0721<a name=\"ub04-admit-bill-type-0721\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0722<a name=\"ub04-admit-bill-type-0722\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0723<a name=\"ub04-admit-bill-type-0723\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0724<a name=\"ub04-admit-bill-type-0724\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0725<a name=\"ub04-admit-bill-type-0725\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0727<a name=\"ub04-admit-bill-type-0727\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0728<a name=\"ub04-admit-bill-type-0728\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0729<a name=\"ub04-admit-bill-type-0729\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0730<a name=\"ub04-admit-bill-type-0730\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0731<a name=\"ub04-admit-bill-type-0731\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0732<a name=\"ub04-admit-bill-type-0732\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0733<a name=\"ub04-admit-bill-type-0733\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0734<a name=\"ub04-admit-bill-type-0734\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0735<a name=\"ub04-admit-bill-type-0735\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0737<a name=\"ub04-admit-bill-type-0737\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0738<a name=\"ub04-admit-bill-type-0738\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0739<a name=\"ub04-admit-bill-type-0739\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0740<a name=\"ub04-admit-bill-type-0740\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0741<a name=\"ub04-admit-bill-type-0741\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0742<a name=\"ub04-admit-bill-type-0742\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0743<a name=\"ub04-admit-bill-type-0743\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0744<a name=\"ub04-admit-bill-type-0744\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0745<a name=\"ub04-admit-bill-type-0745\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0747<a name=\"ub04-admit-bill-type-0747\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0748<a name=\"ub04-admit-bill-type-0748\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0749<a name=\"ub04-admit-bill-type-0749\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0750<a name=\"ub04-admit-bill-type-0750\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0751<a name=\"ub04-admit-bill-type-0751\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0752<a name=\"ub04-admit-bill-type-0752\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0753<a name=\"ub04-admit-bill-type-0753\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0754<a name=\"ub04-admit-bill-type-0754\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0755<a name=\"ub04-admit-bill-type-0755\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0757<a name=\"ub04-admit-bill-type-0757\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0758<a name=\"ub04-admit-bill-type-0758\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0759<a name=\"ub04-admit-bill-type-0759\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0760<a name=\"ub04-admit-bill-type-0760\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0761<a name=\"ub04-admit-bill-type-0761\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0762<a name=\"ub04-admit-bill-type-0762\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0763<a name=\"ub04-admit-bill-type-0763\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0764<a name=\"ub04-admit-bill-type-0764\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0765<a name=\"ub04-admit-bill-type-0765\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0767<a name=\"ub04-admit-bill-type-0767\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Replacement of Prior Claim or Corrected Claim</td></tr><tr><td style=\"white-space:nowrap\">0768<a name=\"ub04-admit-bill-type-0768\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Void or Cancel of a Prior Claim</td></tr><tr><td style=\"white-space:nowrap\">0769<a name=\"ub04-admit-bill-type-0769\"> </a></td><td>Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Final Claim for a Home Health PPS Episode</td></tr><tr><td style=\"white-space:nowrap\">0810<a name=\"ub04-admit-bill-type-0810\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0811<a name=\"ub04-admit-bill-type-0811\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0812<a name=\"ub04-admit-bill-type-0812\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0813<a name=\"ub04-admit-bill-type-0813\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0814<a name=\"ub04-admit-bill-type-0814\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0815<a name=\"ub04-admit-bill-type-0815\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0817<a name=\"ub04-admit-bill-type-0817\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0818<a name=\"ub04-admit-bill-type-0818\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0819<a name=\"ub04-admit-bill-type-0819\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0820<a name=\"ub04-admit-bill-type-0820\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Nonpayment or Zero Claims</td></tr><tr><td style=\"white-space:nowrap\">0821<a name=\"ub04-admit-bill-type-0821\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Admit Through Discharge Claim</td></tr><tr><td style=\"white-space:nowrap\">0822<a name=\"ub04-admit-bill-type-0822\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0823<a name=\"ub04-admit-bill-type-0823\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0824<a name=\"ub04-admit-bill-type-0824\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0825<a name=\"ub04-admit-bill-type-0825\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0827<a name=\"ub04-admit-bill-type-0827\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0828<a name=\"ub04-admit-bill-type-0828\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0829<a name=\"ub04-admit-bill-type-0829\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0830<a name=\"ub04-admit-bill-type-0830\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0831<a name=\"ub04-admit-bill-type-0831\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0832<a name=\"ub04-admit-bill-type-0832\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0833<a name=\"ub04-admit-bill-type-0833\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0834<a name=\"ub04-admit-bill-type-0834\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0835<a name=\"ub04-admit-bill-type-0835\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0837<a name=\"ub04-admit-bill-type-0837\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0838<a name=\"ub04-admit-bill-type-0838\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0839<a name=\"ub04-admit-bill-type-0839\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0840<a name=\"ub04-admit-bill-type-0840\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0841<a name=\"ub04-admit-bill-type-0841\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0842<a name=\"ub04-admit-bill-type-0842\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (First Claim)</td></tr><tr><td style=\"white-space:nowrap\">0843<a name=\"ub04-admit-bill-type-0843\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims)</td></tr><tr><td style=\"white-space:nowrap\">0844<a name=\"ub04-admit-bill-type-0844\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Last Claim)</td></tr><tr><td style=\"white-space:nowrap\">0845<a name=\"ub04-admit-bill-type-0845\"> </a></td><td>Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Late Charge Only</td></tr><tr><td style=\"white-space:nowrap\">0847<a name=\"ub04-admit-bill-type-0847\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0848<a name=\"ub04-admit-bill-type-0848\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0849<a name=\"ub04-admit-bill-type-0849\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0850<a name=\"ub04-admit-bill-type-0850\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0851<a name=\"ub04-admit-bill-type-0851\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0852<a name=\"ub04-admit-bill-type-0852\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0853<a name=\"ub04-admit-bill-type-0853\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0854<a name=\"ub04-admit-bill-type-0854\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0855<a name=\"ub04-admit-bill-type-0855\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0857<a name=\"ub04-admit-bill-type-0857\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0858<a name=\"ub04-admit-bill-type-0858\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0859<a name=\"ub04-admit-bill-type-0859\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0860<a name=\"ub04-admit-bill-type-0860\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0861<a name=\"ub04-admit-bill-type-0861\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0862<a name=\"ub04-admit-bill-type-0862\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0863<a name=\"ub04-admit-bill-type-0863\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0864<a name=\"ub04-admit-bill-type-0864\"> </a></td><td>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)</td></tr><tr><td style=\"white-space:nowrap\">0865<a name=\"ub04-admit-bill-type-0865\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0867<a name=\"ub04-admit-bill-type-0867\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0868<a name=\"ub04-admit-bill-type-0868\"> </a></td><td>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</td></tr><tr><td style=\"white-space:nowrap\">0869<a name=\"ub04-admit-bill-type-0869\"> </a></td><td>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</td></tr></table></div>"
  },
  "url" : "http://linuxforhealth.org/fhir/cdm/CodeSystem/ub04-admit-bill-type",
  "version" : "8.0.0",
  "name" : "Ub04AdmitBillTypeCodeSystem",
  "title" : "UB04 Admit Bill Type Code System",
  "status" : "active",
  "date" : "2022-11-10T16:00:46+00:00",
  "publisher" : "LinuxForHealth Team",
  "description" : "Codes for the UB04 admission billing type",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "caseSensitive" : true,
  "content" : "complete",
  "count" : 540,
  "concept" : [
    {
      "code" : "0110",
      "display" : "Hospital / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0111",
      "display" : "Hospital / Inpatient (Medicare Part A) / Admit Through Discharge Claim"
    },
    {
      "code" : "0112",
      "display" : "Hospital / Inpatient (Medicare Part A) / Interim (First Claim)"
    },
    {
      "code" : "0113",
      "display" : "Hospital / Inpatient (Medicare Part A) / Interim (Continuing Claims)"
    },
    {
      "code" : "0114",
      "display" : "Hospital / Inpatient (Medicare Part A) / Interim (Last Claim)"
    },
    {
      "code" : "0115",
      "display" : "Hospital / Inpatient (Medicare Part A) / Late Charge Only"
    },
    {
      "code" : "0117",
      "display" : "Hospital / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0118",
      "display" : "Hospital / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0119",
      "display" : "Hospital / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0120",
      "display" : "Hospital / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0121",
      "display" : "Hospital / Inpatient (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0122",
      "display" : "Hospital / Inpatient (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0123",
      "display" : "Hospital / Inpatient (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0124",
      "display" : "Hospital / Inpatient (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0125",
      "display" : "Hospital / Inpatient (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0127",
      "display" : "Hospital / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0128",
      "display" : "Hospital / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0129",
      "display" : "Hospital / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0130",
      "display" : "Hospital / Outpatient / Nonpayment or Zero Claims"
    },
    {
      "code" : "0131",
      "display" : "Hospital / Outpatient / Admit Through Discharge Claim"
    },
    {
      "code" : "0132",
      "display" : "Hospital / Outpatient / Interim (First Claim)"
    },
    {
      "code" : "0133",
      "display" : "Hospital / Outpatient / Interim (Continuing Claims)"
    },
    {
      "code" : "0134",
      "display" : "Hospital / Outpatient / Interim (Last Claim)"
    },
    {
      "code" : "0135",
      "display" : "Hospital / Outpatient / Late Charge Only"
    },
    {
      "code" : "0137",
      "display" : "Hospital / Outpatient / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0138",
      "display" : "Hospital / Outpatient / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0139",
      "display" : "Hospital / Outpatient / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0140",
      "display" : "Hospital / Other (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0141",
      "display" : "Hospital / Other (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0142",
      "display" : "Hospital / Other (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0143",
      "display" : "Hospital / Other (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0144",
      "display" : "Hospital / Other (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0145",
      "display" : "Hospital / Other (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0147",
      "display" : "Hospital / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0148",
      "display" : "Hospital / Other (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0149",
      "display" : "Hospital / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0150",
      "display" : "Hospital / Level I Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0151",
      "display" : "Hospital / Level I Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0152",
      "display" : "Hospital / Level I Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0153",
      "display" : "Hospital / Level I Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0154",
      "display" : "Hospital / Level I Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0155",
      "display" : "Hospital / Level I Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0157",
      "display" : "Hospital / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0158",
      "display" : "Hospital / Level I Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0159",
      "display" : "Hospital / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0160",
      "display" : "Hospital / Level II Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0161",
      "display" : "Hospital / Level II Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0162",
      "display" : "Hospital / Level II Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0163",
      "display" : "Hospital / Level II Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0164",
      "display" : "Hospital / Level II Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0165",
      "display" : "Hospital / Level II Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0167",
      "display" : "Hospital / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0168",
      "display" : "Hospital / Level II Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0169",
      "display" : "Hospital / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0170",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0171",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"
    },
    {
      "code" : "0172",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"
    },
    {
      "code" : "0173",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"
    },
    {
      "code" : "0174",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"
    },
    {
      "code" : "0175",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"
    },
    {
      "code" : "0177",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0178",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0179",
      "display" : "Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0180",
      "display" : "Hospital / Swing Bed / Nonpayment or Zero Claims"
    },
    {
      "code" : "0181",
      "display" : "Hospital / Swing Bed / Admit Through Discharge Claim"
    },
    {
      "code" : "0182",
      "display" : "Hospital / Swing Bed / Interim (First Claim)"
    },
    {
      "code" : "0183",
      "display" : "Hospital / Swing Bed / Interim (Continuing Claims)"
    },
    {
      "code" : "0184",
      "display" : "Hospital / Swing Bed / Interim (Last Claim)"
    },
    {
      "code" : "0185",
      "display" : "Hospital / Swing Bed / Late Charge Only"
    },
    {
      "code" : "0187",
      "display" : "Hospital / Swing Bed / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0188",
      "display" : "Hospital / Swing Bed / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0189",
      "display" : "Hospital / Swing Bed / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0210",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0211",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Admit Through Discharge Claim"
    },
    {
      "code" : "0212",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (First Claim)"
    },
    {
      "code" : "0213",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Continuing Claims)"
    },
    {
      "code" : "0214",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Last Claim)"
    },
    {
      "code" : "0215",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Late Charge Only"
    },
    {
      "code" : "0217",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0218",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0219",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0220",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0221",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0222",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0223",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0224",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0225",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0227",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0228",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0229",
      "display" : "Skilled Nursing Facility / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0230",
      "display" : "Skilled Nursing Facility / Outpatient / Nonpayment or Zero Claims"
    },
    {
      "code" : "0231",
      "display" : "Skilled Nursing Facility / Outpatient / Admit Through Discharge Claim"
    },
    {
      "code" : "0232",
      "display" : "Skilled Nursing Facility / Outpatient / Interim (First Claim)"
    },
    {
      "code" : "0233",
      "display" : "Skilled Nursing Facility / Outpatient / Interim (Continuing Claims)"
    },
    {
      "code" : "0234",
      "display" : "Skilled Nursing Facility / Outpatient / Interim (Last Claim)"
    },
    {
      "code" : "0235",
      "display" : "Skilled Nursing Facility / Outpatient / Late Charge Only"
    },
    {
      "code" : "0237",
      "display" : "Skilled Nursing Facility / Outpatient / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0238",
      "display" : "Skilled Nursing Facility / Outpatient / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0239",
      "display" : "Skilled Nursing Facility / Outpatient / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0240",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0241",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0242",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0243",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0244",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0245",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0247",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0248",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0249",
      "display" : "Skilled Nursing Facility / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0250",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0251",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0252",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0253",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0254",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0255",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0257",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0258",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0259",
      "display" : "Skilled Nursing Facility / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0260",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0261",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0262",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0263",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0264",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0265",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0267",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0268",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0269",
      "display" : "Skilled Nursing Facility / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0270",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0271",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"
    },
    {
      "code" : "0272",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"
    },
    {
      "code" : "0273",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"
    },
    {
      "code" : "0274",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"
    },
    {
      "code" : "0275",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"
    },
    {
      "code" : "0277",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected claim"
    },
    {
      "code" : "0278",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0279",
      "display" : "Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0280",
      "display" : "Skilled Nursing Facility / Swing Bed / Nonpayment or Zero Claims"
    },
    {
      "code" : "0281",
      "display" : "Skilled Nursing Facility / Swing Bed / Admit Through Discharge Claim"
    },
    {
      "code" : "0282",
      "display" : "Skilled Nursing Facility / Swing Bed / Interim (First Claim)"
    },
    {
      "code" : "0283",
      "display" : "Skilled Nursing Facility / Swing Bed / Interim (Continuing Claims)"
    },
    {
      "code" : "0284",
      "display" : "Skilled Nursing Facility / Swing Bed / Interim (Last Claim)"
    },
    {
      "code" : "0285",
      "display" : "Skilled Nursing Facility / Swing Bed / Late Charge Only"
    },
    {
      "code" : "0287",
      "display" : "Skilled Nursing Facility / Swing Bed / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0288",
      "display" : "Skilled Nursing Facility / Swing Bed / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0289",
      "display" : "Skilled Nursing Facility / Swing Bed / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0310",
      "display" : "Home Health / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0311",
      "display" : "Home Health / Inpatient (Medicare Part A) / Admit Through Discharge Claim"
    },
    {
      "code" : "0312",
      "display" : "Home Health / Inpatient (Medicare Part A) / Interim (First Claim)"
    },
    {
      "code" : "0313",
      "display" : "Home Health / Inpatient (Medicare Part A) / Interim (Continuing Claims)"
    },
    {
      "code" : "0314",
      "display" : "Home Health / Inpatient (Medicare Part A) / Interim (Last Claim)"
    },
    {
      "code" : "0315",
      "display" : "Home Health / Inpatient (Medicare Part A) / Late Charge Only"
    },
    {
      "code" : "0317",
      "display" : "Home Health / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0318",
      "display" : "Home Health / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0319",
      "display" : "Home Health / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0320",
      "display" : "Home Health / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0321",
      "display" : "Home Health / Inpatient (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0322",
      "display" : "Home Health / Inpatient (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0323",
      "display" : "Home Health / Inpatient (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0324",
      "display" : "Home Health / Inpatient (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0325",
      "display" : "Home Health / Inpatient (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0327",
      "display" : "Home Health / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0328",
      "display" : "Home Health / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0329",
      "display" : "Home Health / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0330",
      "display" : "Home Health / Outpatient / Nonpayment or Zero Claims"
    },
    {
      "code" : "0331",
      "display" : "Home Health / Outpatient / Admit Through Discharge Claim"
    },
    {
      "code" : "0332",
      "display" : "Home Health / Outpatient / Interim (First Claim)"
    },
    {
      "code" : "0333",
      "display" : "Home Health / Outpatient / Interim (Continuing Claims)"
    },
    {
      "code" : "0334",
      "display" : "Home Health / Outpatient / Interim (Last Claim)"
    },
    {
      "code" : "0335",
      "display" : "Home Health / Outpatient / Late Charge Only"
    },
    {
      "code" : "0337",
      "display" : "Home Health / Outpatient / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0338",
      "display" : "Home Health / Outpatient / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0339",
      "display" : "Home Health / Outpatient / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0340",
      "display" : "Home Health / Other (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0341",
      "display" : "Home Health / Other (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0342",
      "display" : "Home Health / Other (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0343",
      "display" : "Home Health / Other (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0344",
      "display" : "Home Health / Other (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0345",
      "display" : "Home Health / Other (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0347",
      "display" : "Home Health / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0348",
      "display" : "Home Health / Other (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0349",
      "display" : "Home Health / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0350",
      "display" : "HomeHealth / Level I Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0351",
      "display" : "HomeHealth / Level I Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0352",
      "display" : "HomeHealth / Level I Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0353",
      "display" : "HomeHealth / Level I Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0354",
      "display" : "HomeHealth / Level I Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0355",
      "display" : "Home Health / Level I Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0357",
      "display" : "Home Health / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0358",
      "display" : "Home Health / Level I Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0359",
      "display" : "Home Health / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0360",
      "display" : "Home Health / Level II Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0361",
      "display" : "Home Health / Level II Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0362",
      "display" : "Home Health / Level II Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0363",
      "display" : "Home Health / Level II Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0364",
      "display" : "Home Health / Level II Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0365",
      "display" : "Home Health / Level II Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0367",
      "display" : "Home Health / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0368",
      "display" : "Home Health / Level II Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0369",
      "display" : "Home Health / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0370",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0371",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"
    },
    {
      "code" : "0372",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"
    },
    {
      "code" : "0373",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"
    },
    {
      "code" : "0374",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"
    },
    {
      "code" : "0375",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"
    },
    {
      "code" : "0377",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0378",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0379",
      "display" : "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0380",
      "display" : "Home Health / Swing Bed / Nonpayment or Zero Claims"
    },
    {
      "code" : "0381",
      "display" : "Home Health / Swing Bed / Admit Through Discharge Claim"
    },
    {
      "code" : "0382",
      "display" : "Home Health / Swing Bed / Interim (First Claim)"
    },
    {
      "code" : "0383",
      "display" : "Home Health / Swing Bed / Interim (Continuing Claims)"
    },
    {
      "code" : "0384",
      "display" : "Home Health / Swing Bed / Interim (Last Claim)"
    },
    {
      "code" : "0385",
      "display" : "Home Health / Swing Bed / Late Charge Only"
    },
    {
      "code" : "0387",
      "display" : "Home Health / Swing Bed / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0388",
      "display" : "Home Health / Swing Bed / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0389",
      "display" : "Home Health / Swing Bed / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0410",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0411",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Admit Through Discharge Claim"
    },
    {
      "code" : "0412",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (First Claim)"
    },
    {
      "code" : "0413",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Continuing Claims)"
    },
    {
      "code" : "0414",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Last Claim)"
    },
    {
      "code" : "0415",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Late Charge Only"
    },
    {
      "code" : "0417",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0418",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0419",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0420",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0421",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0422",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0423",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0424",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0425",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0427",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0428",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0429",
      "display" : "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0430",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Nonpayment or Zero Claims"
    },
    {
      "code" : "0431",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Admit Through Discharge Claim"
    },
    {
      "code" : "0432",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Interim (First Claim)"
    },
    {
      "code" : "0433",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Interim (Continuing Claims)"
    },
    {
      "code" : "0434",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Interim (Last Claim)"
    },
    {
      "code" : "0435",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Late Charge Only"
    },
    {
      "code" : "0437",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0438",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0439",
      "display" : "Religious Nonmedical (Hospital) / Outpatient / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0440",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0441",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0442",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0443",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0444",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0445",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0447",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0448",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0449",
      "display" : "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0450",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0451",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0452",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0453",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0454",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0455",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0457",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0458",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0459",
      "display" : "Religious Nonmedical (Hospital) / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0460",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0461",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0462",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0463",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0464",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0465",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0467",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0468",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0469",
      "display" : "Religious Nonmedical (Hospital) / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0470",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0471",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"
    },
    {
      "code" : "0472",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"
    },
    {
      "code" : "0473",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"
    },
    {
      "code" : "0474",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"
    },
    {
      "code" : "0475",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"
    },
    {
      "code" : "0477",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0478",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0479",
      "display" : "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0480",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Nonpayment or Zero Claims"
    },
    {
      "code" : "0481",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Admit Through Discharge Claim"
    },
    {
      "code" : "0482",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Interim (First Claim)"
    },
    {
      "code" : "0483",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Interim (Continuing Claims)"
    },
    {
      "code" : "0484",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Interim (Last Claim)"
    },
    {
      "code" : "0485",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Late Charge Only"
    },
    {
      "code" : "0487",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0488",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0489",
      "display" : "Religious Nonmedical (Hospital) / Swing Bed / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0510",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0511",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Admit Through Discharge Claim"
    },
    {
      "code" : "0512",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (First Claim)"
    },
    {
      "code" : "0513",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Continuing Claims)"
    },
    {
      "code" : "0514",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Last Claim)"
    },
    {
      "code" : "0515",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Late Charge Only"
    },
    {
      "code" : "0517",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0518",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0519",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0520",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0521",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0522",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0523",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0524",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0525",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0527",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0528",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0529",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0530",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Nonpayment or Zero Claims"
    },
    {
      "code" : "0531",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Admit Through Discharge Claim"
    },
    {
      "code" : "0532",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (First Claim)"
    },
    {
      "code" : "0533",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Continuing Claims)"
    },
    {
      "code" : "0534",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Last Claim)"
    },
    {
      "code" : "0535",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Late Charge Only"
    },
    {
      "code" : "0537",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0538",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0539",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0540",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0541",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0542",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0543",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0544",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0545",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0547",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0548",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0549",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0550",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0551",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0552",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0553",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0554",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0555",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0557",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0558",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0559",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0560",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0561",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0562",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0563",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0564",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0565",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0567",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0568",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0569",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0570",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0571",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"
    },
    {
      "code" : "0572",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"
    },
    {
      "code" : "0573",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"
    },
    {
      "code" : "0574",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"
    },
    {
      "code" : "0575",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"
    },
    {
      "code" : "0577",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0578",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0579",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0580",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Nonpayment or Zero Claims"
    },
    {
      "code" : "0581",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Admit Through Discharge Claim"
    },
    {
      "code" : "0582",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (First Claim)"
    },
    {
      "code" : "0583",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Continuing Claims)"
    },
    {
      "code" : "0584",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Last Claim)"
    },
    {
      "code" : "0585",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Late Charge Only"
    },
    {
      "code" : "0587",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0588",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0589",
      "display" : "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0610",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0611",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Admit Through Discharge Claim"
    },
    {
      "code" : "0612",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Interim (First Claim)"
    },
    {
      "code" : "0613",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Interim (Continuing Claims)"
    },
    {
      "code" : "0614",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Interim (Last Claim)"
    },
    {
      "code" : "0615",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Late Charge Only"
    },
    {
      "code" : "0617",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0618",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0619",
      "display" : "Intermediate Care / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0620",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0621",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0622",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0623",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0624",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0625",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0627",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0628",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0629",
      "display" : "Intermediate Care / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0630",
      "display" : "Intermediate Care / Outpatient / Nonpayment or Zero Claims"
    },
    {
      "code" : "0631",
      "display" : "Intermediate Care / Outpatient / Admit Through Discharge Claim"
    },
    {
      "code" : "0632",
      "display" : "Intermediate Care / Outpatient / Interim (First Claim)"
    },
    {
      "code" : "0633",
      "display" : "Intermediate Care / Outpatient / Interim (Continuing Claims)"
    },
    {
      "code" : "0634",
      "display" : "Intermediate Care / Outpatient / Interim (Last Claim)"
    },
    {
      "code" : "0635",
      "display" : "Intermediate Care / Outpatient / Late Charge Only"
    },
    {
      "code" : "0637",
      "display" : "Intermediate Care / Outpatient / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0638",
      "display" : "Intermediate Care / Outpatient / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0639",
      "display" : "Intermediate Care / Outpatient / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0640",
      "display" : "Intermediate Care / Other (Medicare Part B) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0641",
      "display" : "Intermediate Care / Other (Medicare Part B) / Admit Through Discharge Claim"
    },
    {
      "code" : "0642",
      "display" : "Intermediate Care / Other (Medicare Part B) / Interim (First Claim)"
    },
    {
      "code" : "0643",
      "display" : "Intermediate Care / Other (Medicare Part B) / Interim (Continuing Claims)"
    },
    {
      "code" : "0644",
      "display" : "Intermediate Care / Other (Medicare Part B) / Interim (Last Claim)"
    },
    {
      "code" : "0645",
      "display" : "Intermediate Care / Other (Medicare Part B) / Late Charge Only"
    },
    {
      "code" : "0647",
      "display" : "Intermediate Care / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0648",
      "display" : "Intermediate Care / Other (Medicare Part B) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0649",
      "display" : "Intermediate Care / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0650",
      "display" : "Intermediate Care / Level I Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0651",
      "display" : "Intermediate Care / Level I Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0652",
      "display" : "Intermediate Care / Level I Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0653",
      "display" : "Intermediate Care / Level I Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0654",
      "display" : "Intermediate Care / Level I Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0655",
      "display" : "Intermediate Care / Level I Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0657",
      "display" : "Intermediate Care / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0658",
      "display" : "Intermediate Care / Level I Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0659",
      "display" : "Intermediate Care / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0660",
      "display" : "Intermediate Care / Level II Intermediate Care / Nonpayment or Zero Claims"
    },
    {
      "code" : "0661",
      "display" : "Intermediate Care / Level II Intermediate Care / Admit Through Discharge Claim"
    },
    {
      "code" : "0662",
      "display" : "Intermediate Care / Level II Intermediate Care / Interim (First Claim)"
    },
    {
      "code" : "0663",
      "display" : "Intermediate Care / Level II Intermediate Care / Interim (Continuing Claims)"
    },
    {
      "code" : "0664",
      "display" : "Intermediate Care / Level II Intermediate Care / Interim (Last Claim)"
    },
    {
      "code" : "0665",
      "display" : "Intermediate Care / Level II Intermediate Care / Late Charge Only"
    },
    {
      "code" : "0667",
      "display" : "Intermediate Care / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0668",
      "display" : "Intermediate Care / Level II Intermediate Care / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0669",
      "display" : "Intermediate Care / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0670",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0671",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"
    },
    {
      "code" : "0672",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"
    },
    {
      "code" : "0673",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"
    },
    {
      "code" : "0674",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"
    },
    {
      "code" : "0675",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"
    },
    {
      "code" : "0677",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0678",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0679",
      "display" : "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0680",
      "display" : "Intermediate Care / Swing Bed / Nonpayment or Zero Claims"
    },
    {
      "code" : "0681",
      "display" : "Intermediate Care / Swing Bed / Admit Through Discharge Claim"
    },
    {
      "code" : "0682",
      "display" : "Intermediate Care / Swing Bed / Interim (First Claim)"
    },
    {
      "code" : "0683",
      "display" : "Intermediate Care / Swing Bed / Interim (Continuing Claims)"
    },
    {
      "code" : "0684",
      "display" : "Intermediate Care / Swing Bed / Interim (Last Claim)"
    },
    {
      "code" : "0685",
      "display" : "Intermediate Care / Swing Bed / Late Charge Only"
    },
    {
      "code" : "0687",
      "display" : "Intermediate Care / Swing Bed / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0688",
      "display" : "Intermediate Care / Swing Bed / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0689",
      "display" : "Intermediate Care / Swing Bed / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0710",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Nonpayment or Zero Claims"
    },
    {
      "code" : "0711",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Admit Through Discharge Claim"
    },
    {
      "code" : "0712",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (First Claim)"
    },
    {
      "code" : "0713",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Continuing Claims)"
    },
    {
      "code" : "0714",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Last Claim)"
    },
    {
      "code" : "0715",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Late Charge Only"
    },
    {
      "code" : "0717",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0718",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0719",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0720",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Nonpayment or Zero Claims"
    },
    {
      "code" : "0721",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Admit Through Discharge Claim"
    },
    {
      "code" : "0722",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (First Claim)"
    },
    {
      "code" : "0723",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Continuing Claims)"
    },
    {
      "code" : "0724",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Last Claim)"
    },
    {
      "code" : "0725",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Late Charge Only"
    },
    {
      "code" : "0727",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0728",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0729",
      "display" : "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"
    },
    {
      "code" : "0730",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Nonpayment or Zero Claims"
    },
    {
      "code" : "0731",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Admit Through Discharge Claim"
    },
    {
      "code" : "0732",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (First Claim)"
    },
    {
      "code" : "0733",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Continuing Claims)"
    },
    {
      "code" : "0734",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Last Claim)"
    },
    {
      "code" : "0735",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Late Charge Only"
    },
    {
      "code" : "0737",
      "display" : "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"
    },
    {
      "code" : "0738",
      "display" : "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"
    },
    {
      "code" : "0739",
      "display" : "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"
    },
    {
      "code" : "0740",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0741",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Admit Through Discharge Claim"
    },
    {
      "code" : "0742",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (First Claim)"
    },
    {
      "code" : "0743",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims)"
    },
    {
      "code" : "0744",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Last Claim)"
    },
    {
      "code" : "0745",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Late Charge Only"
    },
    {
      "code" : "0747",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0748",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0749",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0750",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0751",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Admit Through Discharge Claim"
    },
    {
      "code" : "0752",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (First Claim)"
    },
    {
      "code" : "0753",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Continuing Claims)"
    },
    {
      "code" : "0754",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Last Claim)"
    },
    {
      "code" : "0755",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Late Charge Only"
    },
    {
      "code" : "0757",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0758",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0759",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0760",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Nonpayment or Zero Claims"
    },
    {
      "code" : "0761",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Admit Through Discharge Claim"
    },
    {
      "code" : "0762",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (First Claim)"
    },
    {
      "code" : "0763",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Continuing Claims)"
    },
    {
      "code" : "0764",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Last Claim)"
    },
    {
      "code" : "0765",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Late Charge Only"
    },
    {
      "code" : "0767",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Replacement of Prior Claim or Corrected Claim"
    },
    {
      "code" : "0768",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Void or Cancel of a Prior Claim"
    },
    {
      "code" : "0769",
      "display" : "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Final Claim for a Home Health PPS Episode"
    },
    {
      "code" : "0810",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Nonpayment or Zero Claims"
    },
    {
      "code" : "0811",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Admit Through Discharge Claim"
    },
    {
      "code" : "0812",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (First Claim)"
    },
    {
      "code" : "0813",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Continuing Claims)"
    },
    {
      "code" : "0814",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Last Claim)"
    },
    {
      "code" : "0815",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Late Charge Only"
    },
    {
      "code" : "0817",
      "display" : "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"
    },
    {
      "code" : "0818",
      "display" : "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"
    },
    {
      "code" : "0819",
      "display" : "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"
    },
    {
      "code" : "0820",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Nonpayment or Zero Claims"
    },
    {
      "code" : "0821",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Admit Through Discharge Claim"
    },
    {
      "code" : "0822",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (First Claim)"
    },
    {
      "code" : "0823",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Continuing Claims)"
    },
    {
      "code" : "0824",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Last Claim)"
    },
    {
      "code" : "0825",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Late Charge Only"
    },
    {
      "code" : "0827",
      "display" : "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"
    },
    {
      "code" : "0828",
      "display" : "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"
    },
    {
      "code" : "0829",
      "display" : "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"
    },
    {
      "code" : "0830",
      "display" : "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"
    },
    {
      "code" : "0831",
      "display" : "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"
    },
    {
      "code" : "0832",
      "display" : "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)"
    },
    {
      "code" : "0833",
      "display" : "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)"
    },
    {
      "code" : "0834",
      "display" : "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)"
    },
    {
      "code" : "0835",
      "display" : "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"
    },
    {
      "code" : "0837",
      "display" : "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"
    },
    {
      "code" : "0838",
      "display" : "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"
    },
    {
      "code" : "0839",
      "display" : "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"
    },
    {
      "code" : "0840",
      "display" : "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"
    },
    {
      "code" : "0841",
      "display" : "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"
    },
    {
      "code" : "0842",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (First Claim)"
    },
    {
      "code" : "0843",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims)"
    },
    {
      "code" : "0844",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Last Claim)"
    },
    {
      "code" : "0845",
      "display" : "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Late Charge Only"
    },
    {
      "code" : "0847",
      "display" : "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"
    },
    {
      "code" : "0848",
      "display" : "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"
    },
    {
      "code" : "0849",
      "display" : "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"
    },
    {
      "code" : "0850",
      "display" : "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"
    },
    {
      "code" : "0851",
      "display" : "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"
    },
    {
      "code" : "0852",
      "display" : "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)"
    },
    {
      "code" : "0853",
      "display" : "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)"
    },
    {
      "code" : "0854",
      "display" : "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)"
    },
    {
      "code" : "0855",
      "display" : "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"
    },
    {
      "code" : "0857",
      "display" : "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"
    },
    {
      "code" : "0858",
      "display" : "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"
    },
    {
      "code" : "0859",
      "display" : "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"
    },
    {
      "code" : "0860",
      "display" : "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"
    },
    {
      "code" : "0861",
      "display" : "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"
    },
    {
      "code" : "0862",
      "display" : "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)"
    },
    {
      "code" : "0863",
      "display" : "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)"
    },
    {
      "code" : "0864",
      "display" : "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)"
    },
    {
      "code" : "0865",
      "display" : "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"
    },
    {
      "code" : "0867",
      "display" : "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"
    },
    {
      "code" : "0868",
      "display" : "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"
    },
    {
      "code" : "0869",
      "display" : "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"
    }
  ]
}