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

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

Active as of 2022-11-10

@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:CodeSystem;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "ub04-admit-bill-type"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.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>"
  ];
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     fhir:index 126;
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     fhir:index 127;
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     fhir:index 128;
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     fhir:index 130;
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     fhir:index 131;
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     fhir:index 133;
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     fhir:index 134;
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     fhir:index 135;
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     fhir:index 136;
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     fhir:index 139;
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     fhir:index 140;
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     fhir:index 141;
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     fhir:index 142;
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     fhir:index 143;
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     fhir:index 144;
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     fhir:index 145;
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     fhir:index 146;
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     fhir:index 147;
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     fhir:index 148;
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     fhir:index 149;
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     fhir:index 150;
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     fhir:index 151;
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     fhir:index 152;
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     fhir:index 153;
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     fhir:index 154;
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     fhir:index 155;
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     fhir:index 156;
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     fhir:index 157;
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     fhir:index 158;
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     fhir:index 159;
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     fhir:index 160;
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     fhir:index 161;
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     fhir:index 162;
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     fhir:index 163;
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     fhir:index 164;
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     fhir:index 165;
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     fhir:index 168;
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     fhir:index 169;
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     fhir:index 171;
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     fhir:index 172;
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     fhir:index 173;
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     fhir:index 174;
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     fhir:index 175;
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     fhir:index 176;
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     fhir:index 177;
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     fhir:index 178;
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     fhir:index 179;
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     fhir:index 181;
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     fhir:index 186;
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     fhir:index 187;
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     fhir:index 188;
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     fhir:index 189;
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     fhir:index 190;
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     fhir:index 191;
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     fhir:index 192;
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     fhir:index 193;
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     fhir:index 194;
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     fhir:index 195;
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     fhir:index 196;
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     fhir:index 197;
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     fhir:index 198;
     fhir:CodeSystem.concept.code [ fhir:value "0370" ];
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     fhir:index 199;
     fhir:CodeSystem.concept.code [ fhir:value "0371" ];
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     fhir:index 200;
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     fhir:index 201;
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     fhir:index 202;
     fhir:CodeSystem.concept.code [ fhir:value "0374" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)" ]
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     fhir:index 203;
     fhir:CodeSystem.concept.code [ fhir:value "0375" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only" ]
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     fhir:index 204;
     fhir:CodeSystem.concept.code [ fhir:value "0377" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 205;
     fhir:CodeSystem.concept.code [ fhir:value "0378" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim" ]
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     fhir:index 206;
     fhir:CodeSystem.concept.code [ fhir:value "0379" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 207;
     fhir:CodeSystem.concept.code [ fhir:value "0380" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 208;
     fhir:CodeSystem.concept.code [ fhir:value "0381" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Admit Through Discharge Claim" ]
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     fhir:index 209;
     fhir:CodeSystem.concept.code [ fhir:value "0382" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Interim (First Claim)" ]
  ], [
     fhir:index 210;
     fhir:CodeSystem.concept.code [ fhir:value "0383" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Interim (Continuing Claims)" ]
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     fhir:index 211;
     fhir:CodeSystem.concept.code [ fhir:value "0384" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Interim (Last Claim)" ]
  ], [
     fhir:index 212;
     fhir:CodeSystem.concept.code [ fhir:value "0385" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Late Charge Only" ]
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     fhir:index 213;
     fhir:CodeSystem.concept.code [ fhir:value "0387" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 214;
     fhir:CodeSystem.concept.code [ fhir:value "0388" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Void or Cancel of a Prior Claim" ]
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     fhir:index 215;
     fhir:CodeSystem.concept.code [ fhir:value "0389" ];
     fhir:CodeSystem.concept.display [ fhir:value "Home Health / Swing Bed / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 216;
     fhir:CodeSystem.concept.code [ fhir:value "0410" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 217;
     fhir:CodeSystem.concept.code [ fhir:value "0411" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 218;
     fhir:CodeSystem.concept.code [ fhir:value "0412" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (First Claim)" ]
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     fhir:index 219;
     fhir:CodeSystem.concept.code [ fhir:value "0413" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Continuing Claims)" ]
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     fhir:index 220;
     fhir:CodeSystem.concept.code [ fhir:value "0414" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Last Claim)" ]
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     fhir:index 221;
     fhir:CodeSystem.concept.code [ fhir:value "0415" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Late Charge Only" ]
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     fhir:index 222;
     fhir:CodeSystem.concept.code [ fhir:value "0417" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 223;
     fhir:CodeSystem.concept.code [ fhir:value "0418" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim" ]
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     fhir:index 224;
     fhir:CodeSystem.concept.code [ fhir:value "0419" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 225;
     fhir:CodeSystem.concept.code [ fhir:value "0420" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Nonpayment or Zero Claims" ]
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     fhir:index 226;
     fhir:CodeSystem.concept.code [ fhir:value "0421" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Admit Through Discharge Claim" ]
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     fhir:index 227;
     fhir:CodeSystem.concept.code [ fhir:value "0422" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (First Claim)" ]
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     fhir:index 228;
     fhir:CodeSystem.concept.code [ fhir:value "0423" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Continuing Claims)" ]
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     fhir:index 229;
     fhir:CodeSystem.concept.code [ fhir:value "0424" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Last Claim)" ]
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     fhir:index 230;
     fhir:CodeSystem.concept.code [ fhir:value "0425" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Late Charge Only" ]
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     fhir:index 231;
     fhir:CodeSystem.concept.code [ fhir:value "0427" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 232;
     fhir:CodeSystem.concept.code [ fhir:value "0428" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim" ]
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     fhir:index 233;
     fhir:CodeSystem.concept.code [ fhir:value "0429" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 234;
     fhir:CodeSystem.concept.code [ fhir:value "0430" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Nonpayment or Zero Claims" ]
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     fhir:index 235;
     fhir:CodeSystem.concept.code [ fhir:value "0431" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Admit Through Discharge Claim" ]
  ], [
     fhir:index 236;
     fhir:CodeSystem.concept.code [ fhir:value "0432" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Interim (First Claim)" ]
  ], [
     fhir:index 237;
     fhir:CodeSystem.concept.code [ fhir:value "0433" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Interim (Continuing Claims)" ]
  ], [
     fhir:index 238;
     fhir:CodeSystem.concept.code [ fhir:value "0434" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Interim (Last Claim)" ]
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     fhir:index 239;
     fhir:CodeSystem.concept.code [ fhir:value "0435" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Late Charge Only" ]
  ], [
     fhir:index 240;
     fhir:CodeSystem.concept.code [ fhir:value "0437" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 241;
     fhir:CodeSystem.concept.code [ fhir:value "0438" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Void or Cancel of a Prior Claim" ]
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     fhir:index 242;
     fhir:CodeSystem.concept.code [ fhir:value "0439" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Outpatient / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 243;
     fhir:CodeSystem.concept.code [ fhir:value "0440" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 244;
     fhir:CodeSystem.concept.code [ fhir:value "0441" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 245;
     fhir:CodeSystem.concept.code [ fhir:value "0442" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (First Claim)" ]
  ], [
     fhir:index 246;
     fhir:CodeSystem.concept.code [ fhir:value "0443" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Continuing Claims)" ]
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     fhir:index 247;
     fhir:CodeSystem.concept.code [ fhir:value "0444" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Last Claim)" ]
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     fhir:index 248;
     fhir:CodeSystem.concept.code [ fhir:value "0445" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Late Charge Only" ]
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     fhir:index 249;
     fhir:CodeSystem.concept.code [ fhir:value "0447" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 250;
     fhir:CodeSystem.concept.code [ fhir:value "0448" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Void or Cancel of a Prior Claim" ]
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     fhir:index 251;
     fhir:CodeSystem.concept.code [ fhir:value "0449" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 252;
     fhir:CodeSystem.concept.code [ fhir:value "0450" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 253;
     fhir:CodeSystem.concept.code [ fhir:value "0451" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Admit Through Discharge Claim" ]
  ], [
     fhir:index 254;
     fhir:CodeSystem.concept.code [ fhir:value "0452" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (First Claim)" ]
  ], [
     fhir:index 255;
     fhir:CodeSystem.concept.code [ fhir:value "0453" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Continuing Claims)" ]
  ], [
     fhir:index 256;
     fhir:CodeSystem.concept.code [ fhir:value "0454" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Last Claim)" ]
  ], [
     fhir:index 257;
     fhir:CodeSystem.concept.code [ fhir:value "0455" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Late Charge Only" ]
  ], [
     fhir:index 258;
     fhir:CodeSystem.concept.code [ fhir:value "0457" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 259;
     fhir:CodeSystem.concept.code [ fhir:value "0458" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 260;
     fhir:CodeSystem.concept.code [ fhir:value "0459" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level I Intermediate Care / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 261;
     fhir:CodeSystem.concept.code [ fhir:value "0460" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 262;
     fhir:CodeSystem.concept.code [ fhir:value "0461" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Admit Through Discharge Claim" ]
  ], [
     fhir:index 263;
     fhir:CodeSystem.concept.code [ fhir:value "0462" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (First Claim)" ]
  ], [
     fhir:index 264;
     fhir:CodeSystem.concept.code [ fhir:value "0463" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Continuing Claims)" ]
  ], [
     fhir:index 265;
     fhir:CodeSystem.concept.code [ fhir:value "0464" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Last Claim)" ]
  ], [
     fhir:index 266;
     fhir:CodeSystem.concept.code [ fhir:value "0465" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Late Charge Only" ]
  ], [
     fhir:index 267;
     fhir:CodeSystem.concept.code [ fhir:value "0467" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 268;
     fhir:CodeSystem.concept.code [ fhir:value "0468" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 269;
     fhir:CodeSystem.concept.code [ fhir:value "0469" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Level II Intermediate Care / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 270;
     fhir:CodeSystem.concept.code [ fhir:value "0470" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 271;
     fhir:CodeSystem.concept.code [ fhir:value "0471" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 272;
     fhir:CodeSystem.concept.code [ fhir:value "0472" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)" ]
  ], [
     fhir:index 273;
     fhir:CodeSystem.concept.code [ fhir:value "0473" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 274;
     fhir:CodeSystem.concept.code [ fhir:value "0474" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)" ]
  ], [
     fhir:index 275;
     fhir:CodeSystem.concept.code [ fhir:value "0475" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only" ]
  ], [
     fhir:index 276;
     fhir:CodeSystem.concept.code [ fhir:value "0477" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 277;
     fhir:CodeSystem.concept.code [ fhir:value "0478" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 278;
     fhir:CodeSystem.concept.code [ fhir:value "0479" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 279;
     fhir:CodeSystem.concept.code [ fhir:value "0480" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 280;
     fhir:CodeSystem.concept.code [ fhir:value "0481" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Admit Through Discharge Claim" ]
  ], [
     fhir:index 281;
     fhir:CodeSystem.concept.code [ fhir:value "0482" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Interim (First Claim)" ]
  ], [
     fhir:index 282;
     fhir:CodeSystem.concept.code [ fhir:value "0483" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Interim (Continuing Claims)" ]
  ], [
     fhir:index 283;
     fhir:CodeSystem.concept.code [ fhir:value "0484" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Interim (Last Claim)" ]
  ], [
     fhir:index 284;
     fhir:CodeSystem.concept.code [ fhir:value "0485" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Late Charge Only" ]
  ], [
     fhir:index 285;
     fhir:CodeSystem.concept.code [ fhir:value "0487" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 286;
     fhir:CodeSystem.concept.code [ fhir:value "0488" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 287;
     fhir:CodeSystem.concept.code [ fhir:value "0489" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Hospital) / Swing Bed / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 288;
     fhir:CodeSystem.concept.code [ fhir:value "0510" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 289;
     fhir:CodeSystem.concept.code [ fhir:value "0511" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 290;
     fhir:CodeSystem.concept.code [ fhir:value "0512" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (First Claim)" ]
  ], [
     fhir:index 291;
     fhir:CodeSystem.concept.code [ fhir:value "0513" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 292;
     fhir:CodeSystem.concept.code [ fhir:value "0514" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Last Claim)" ]
  ], [
     fhir:index 293;
     fhir:CodeSystem.concept.code [ fhir:value "0515" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Late Charge Only" ]
  ], [
     fhir:index 294;
     fhir:CodeSystem.concept.code [ fhir:value "0517" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 295;
     fhir:CodeSystem.concept.code [ fhir:value "0518" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 296;
     fhir:CodeSystem.concept.code [ fhir:value "0519" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 297;
     fhir:CodeSystem.concept.code [ fhir:value "0520" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 298;
     fhir:CodeSystem.concept.code [ fhir:value "0521" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 299;
     fhir:CodeSystem.concept.code [ fhir:value "0522" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (First Claim)" ]
  ], [
     fhir:index 300;
     fhir:CodeSystem.concept.code [ fhir:value "0523" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 301;
     fhir:CodeSystem.concept.code [ fhir:value "0524" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Last Claim)" ]
  ], [
     fhir:index 302;
     fhir:CodeSystem.concept.code [ fhir:value "0525" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Late Charge Only" ]
  ], [
     fhir:index 303;
     fhir:CodeSystem.concept.code [ fhir:value "0527" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 304;
     fhir:CodeSystem.concept.code [ fhir:value "0528" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim" ]
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     fhir:index 305;
     fhir:CodeSystem.concept.code [ fhir:value "0529" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 306;
     fhir:CodeSystem.concept.code [ fhir:value "0530" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Nonpayment or Zero Claims" ]
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     fhir:index 307;
     fhir:CodeSystem.concept.code [ fhir:value "0531" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Admit Through Discharge Claim" ]
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     fhir:index 308;
     fhir:CodeSystem.concept.code [ fhir:value "0532" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (First Claim)" ]
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     fhir:index 309;
     fhir:CodeSystem.concept.code [ fhir:value "0533" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Continuing Claims)" ]
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     fhir:index 310;
     fhir:CodeSystem.concept.code [ fhir:value "0534" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Last Claim)" ]
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     fhir:index 311;
     fhir:CodeSystem.concept.code [ fhir:value "0535" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Late Charge Only" ]
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     fhir:index 312;
     fhir:CodeSystem.concept.code [ fhir:value "0537" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 313;
     fhir:CodeSystem.concept.code [ fhir:value "0538" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Void or Cancel of a Prior Claim" ]
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     fhir:index 314;
     fhir:CodeSystem.concept.code [ fhir:value "0539" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 315;
     fhir:CodeSystem.concept.code [ fhir:value "0540" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Nonpayment or Zero Claims" ]
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     fhir:index 316;
     fhir:CodeSystem.concept.code [ fhir:value "0541" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Admit Through Discharge Claim" ]
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     fhir:index 317;
     fhir:CodeSystem.concept.code [ fhir:value "0542" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (First Claim)" ]
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     fhir:index 318;
     fhir:CodeSystem.concept.code [ fhir:value "0543" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Continuing Claims)" ]
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     fhir:index 319;
     fhir:CodeSystem.concept.code [ fhir:value "0544" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Last Claim)" ]
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     fhir:index 320;
     fhir:CodeSystem.concept.code [ fhir:value "0545" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Late Charge Only" ]
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     fhir:index 321;
     fhir:CodeSystem.concept.code [ fhir:value "0547" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 322;
     fhir:CodeSystem.concept.code [ fhir:value "0548" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Void or Cancel of a Prior Claim" ]
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     fhir:index 323;
     fhir:CodeSystem.concept.code [ fhir:value "0549" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 324;
     fhir:CodeSystem.concept.code [ fhir:value "0550" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Nonpayment or Zero Claims" ]
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     fhir:index 325;
     fhir:CodeSystem.concept.code [ fhir:value "0551" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Admit Through Discharge Claim" ]
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     fhir:index 326;
     fhir:CodeSystem.concept.code [ fhir:value "0552" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (First Claim)" ]
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     fhir:index 327;
     fhir:CodeSystem.concept.code [ fhir:value "0553" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Continuing Claims)" ]
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     fhir:index 328;
     fhir:CodeSystem.concept.code [ fhir:value "0554" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Last Claim)" ]
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     fhir:index 329;
     fhir:CodeSystem.concept.code [ fhir:value "0555" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Late Charge Only" ]
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     fhir:index 330;
     fhir:CodeSystem.concept.code [ fhir:value "0557" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 331;
     fhir:CodeSystem.concept.code [ fhir:value "0558" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Void or Cancel of a Prior Claim" ]
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     fhir:index 332;
     fhir:CodeSystem.concept.code [ fhir:value "0559" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 333;
     fhir:CodeSystem.concept.code [ fhir:value "0560" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Nonpayment or Zero Claims" ]
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     fhir:index 334;
     fhir:CodeSystem.concept.code [ fhir:value "0561" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Admit Through Discharge Claim" ]
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     fhir:index 335;
     fhir:CodeSystem.concept.code [ fhir:value "0562" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (First Claim)" ]
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     fhir:index 336;
     fhir:CodeSystem.concept.code [ fhir:value "0563" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Continuing Claims)" ]
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     fhir:index 337;
     fhir:CodeSystem.concept.code [ fhir:value "0564" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Last Claim)" ]
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     fhir:index 338;
     fhir:CodeSystem.concept.code [ fhir:value "0565" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Late Charge Only" ]
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     fhir:index 339;
     fhir:CodeSystem.concept.code [ fhir:value "0567" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 340;
     fhir:CodeSystem.concept.code [ fhir:value "0568" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Void or Cancel of a Prior Claim" ]
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     fhir:index 341;
     fhir:CodeSystem.concept.code [ fhir:value "0569" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 342;
     fhir:CodeSystem.concept.code [ fhir:value "0570" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims" ]
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     fhir:index 343;
     fhir:CodeSystem.concept.code [ fhir:value "0571" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 344;
     fhir:CodeSystem.concept.code [ fhir:value "0572" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)" ]
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     fhir:index 345;
     fhir:CodeSystem.concept.code [ fhir:value "0573" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)" ]
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     fhir:index 346;
     fhir:CodeSystem.concept.code [ fhir:value "0574" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)" ]
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     fhir:index 347;
     fhir:CodeSystem.concept.code [ fhir:value "0575" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only" ]
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     fhir:index 348;
     fhir:CodeSystem.concept.code [ fhir:value "0577" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 349;
     fhir:CodeSystem.concept.code [ fhir:value "0578" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim" ]
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     fhir:index 350;
     fhir:CodeSystem.concept.code [ fhir:value "0579" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 351;
     fhir:CodeSystem.concept.code [ fhir:value "0580" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 352;
     fhir:CodeSystem.concept.code [ fhir:value "0581" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Admit Through Discharge Claim" ]
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     fhir:index 353;
     fhir:CodeSystem.concept.code [ fhir:value "0582" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (First Claim)" ]
  ], [
     fhir:index 354;
     fhir:CodeSystem.concept.code [ fhir:value "0583" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Continuing Claims)" ]
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     fhir:index 355;
     fhir:CodeSystem.concept.code [ fhir:value "0584" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Last Claim)" ]
  ], [
     fhir:index 356;
     fhir:CodeSystem.concept.code [ fhir:value "0585" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Late Charge Only" ]
  ], [
     fhir:index 357;
     fhir:CodeSystem.concept.code [ fhir:value "0587" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 358;
     fhir:CodeSystem.concept.code [ fhir:value "0588" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Void or Cancel of a Prior Claim" ]
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     fhir:index 359;
     fhir:CodeSystem.concept.code [ fhir:value "0589" ];
     fhir:CodeSystem.concept.display [ fhir:value "Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 360;
     fhir:CodeSystem.concept.code [ fhir:value "0610" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Nonpayment or Zero Claims" ]
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     fhir:index 361;
     fhir:CodeSystem.concept.code [ fhir:value "0611" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Admit Through Discharge Claim" ]
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     fhir:index 362;
     fhir:CodeSystem.concept.code [ fhir:value "0612" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Interim (First Claim)" ]
  ], [
     fhir:index 363;
     fhir:CodeSystem.concept.code [ fhir:value "0613" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Interim (Continuing Claims)" ]
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     fhir:index 364;
     fhir:CodeSystem.concept.code [ fhir:value "0614" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Interim (Last Claim)" ]
  ], [
     fhir:index 365;
     fhir:CodeSystem.concept.code [ fhir:value "0615" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Late Charge Only" ]
  ], [
     fhir:index 366;
     fhir:CodeSystem.concept.code [ fhir:value "0617" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 367;
     fhir:CodeSystem.concept.code [ fhir:value "0618" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim" ]
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     fhir:index 368;
     fhir:CodeSystem.concept.code [ fhir:value "0619" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 369;
     fhir:CodeSystem.concept.code [ fhir:value "0620" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 370;
     fhir:CodeSystem.concept.code [ fhir:value "0621" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 371;
     fhir:CodeSystem.concept.code [ fhir:value "0622" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Interim (First Claim)" ]
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     fhir:index 372;
     fhir:CodeSystem.concept.code [ fhir:value "0623" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Interim (Continuing Claims)" ]
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     fhir:index 373;
     fhir:CodeSystem.concept.code [ fhir:value "0624" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Interim (Last Claim)" ]
  ], [
     fhir:index 374;
     fhir:CodeSystem.concept.code [ fhir:value "0625" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Late Charge Only" ]
  ], [
     fhir:index 375;
     fhir:CodeSystem.concept.code [ fhir:value "0627" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 376;
     fhir:CodeSystem.concept.code [ fhir:value "0628" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim" ]
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     fhir:index 377;
     fhir:CodeSystem.concept.code [ fhir:value "0629" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 378;
     fhir:CodeSystem.concept.code [ fhir:value "0630" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 379;
     fhir:CodeSystem.concept.code [ fhir:value "0631" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Admit Through Discharge Claim" ]
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     fhir:index 380;
     fhir:CodeSystem.concept.code [ fhir:value "0632" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Interim (First Claim)" ]
  ], [
     fhir:index 381;
     fhir:CodeSystem.concept.code [ fhir:value "0633" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Interim (Continuing Claims)" ]
  ], [
     fhir:index 382;
     fhir:CodeSystem.concept.code [ fhir:value "0634" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Interim (Last Claim)" ]
  ], [
     fhir:index 383;
     fhir:CodeSystem.concept.code [ fhir:value "0635" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Late Charge Only" ]
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     fhir:index 384;
     fhir:CodeSystem.concept.code [ fhir:value "0637" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Replacement of Prior Claim or Corrected Claim" ]
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     fhir:index 385;
     fhir:CodeSystem.concept.code [ fhir:value "0638" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 386;
     fhir:CodeSystem.concept.code [ fhir:value "0639" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Outpatient / Final Claim for a Home Health PPS Episode" ]
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     fhir:index 387;
     fhir:CodeSystem.concept.code [ fhir:value "0640" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Nonpayment or Zero Claims" ]
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     fhir:index 388;
     fhir:CodeSystem.concept.code [ fhir:value "0641" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Admit Through Discharge Claim" ]
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     fhir:index 389;
     fhir:CodeSystem.concept.code [ fhir:value "0642" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Interim (First Claim)" ]
  ], [
     fhir:index 390;
     fhir:CodeSystem.concept.code [ fhir:value "0643" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Interim (Continuing Claims)" ]
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     fhir:index 391;
     fhir:CodeSystem.concept.code [ fhir:value "0644" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Interim (Last Claim)" ]
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     fhir:index 392;
     fhir:CodeSystem.concept.code [ fhir:value "0645" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Late Charge Only" ]
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     fhir:index 393;
     fhir:CodeSystem.concept.code [ fhir:value "0647" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 394;
     fhir:CodeSystem.concept.code [ fhir:value "0648" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 395;
     fhir:CodeSystem.concept.code [ fhir:value "0649" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 396;
     fhir:CodeSystem.concept.code [ fhir:value "0650" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 397;
     fhir:CodeSystem.concept.code [ fhir:value "0651" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Admit Through Discharge Claim" ]
  ], [
     fhir:index 398;
     fhir:CodeSystem.concept.code [ fhir:value "0652" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Interim (First Claim)" ]
  ], [
     fhir:index 399;
     fhir:CodeSystem.concept.code [ fhir:value "0653" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Interim (Continuing Claims)" ]
  ], [
     fhir:index 400;
     fhir:CodeSystem.concept.code [ fhir:value "0654" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Interim (Last Claim)" ]
  ], [
     fhir:index 401;
     fhir:CodeSystem.concept.code [ fhir:value "0655" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Late Charge Only" ]
  ], [
     fhir:index 402;
     fhir:CodeSystem.concept.code [ fhir:value "0657" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 403;
     fhir:CodeSystem.concept.code [ fhir:value "0658" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 404;
     fhir:CodeSystem.concept.code [ fhir:value "0659" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level I Intermediate Care / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 405;
     fhir:CodeSystem.concept.code [ fhir:value "0660" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 406;
     fhir:CodeSystem.concept.code [ fhir:value "0661" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Admit Through Discharge Claim" ]
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     fhir:index 407;
     fhir:CodeSystem.concept.code [ fhir:value "0662" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Interim (First Claim)" ]
  ], [
     fhir:index 408;
     fhir:CodeSystem.concept.code [ fhir:value "0663" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Interim (Continuing Claims)" ]
  ], [
     fhir:index 409;
     fhir:CodeSystem.concept.code [ fhir:value "0664" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Interim (Last Claim)" ]
  ], [
     fhir:index 410;
     fhir:CodeSystem.concept.code [ fhir:value "0665" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Late Charge Only" ]
  ], [
     fhir:index 411;
     fhir:CodeSystem.concept.code [ fhir:value "0667" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 412;
     fhir:CodeSystem.concept.code [ fhir:value "0668" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 413;
     fhir:CodeSystem.concept.code [ fhir:value "0669" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Level II Intermediate Care / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 414;
     fhir:CodeSystem.concept.code [ fhir:value "0670" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 415;
     fhir:CodeSystem.concept.code [ fhir:value "0671" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 416;
     fhir:CodeSystem.concept.code [ fhir:value "0672" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)" ]
  ], [
     fhir:index 417;
     fhir:CodeSystem.concept.code [ fhir:value "0673" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 418;
     fhir:CodeSystem.concept.code [ fhir:value "0674" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)" ]
  ], [
     fhir:index 419;
     fhir:CodeSystem.concept.code [ fhir:value "0675" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only" ]
  ], [
     fhir:index 420;
     fhir:CodeSystem.concept.code [ fhir:value "0677" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 421;
     fhir:CodeSystem.concept.code [ fhir:value "0678" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 422;
     fhir:CodeSystem.concept.code [ fhir:value "0679" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 423;
     fhir:CodeSystem.concept.code [ fhir:value "0680" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 424;
     fhir:CodeSystem.concept.code [ fhir:value "0681" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Admit Through Discharge Claim" ]
  ], [
     fhir:index 425;
     fhir:CodeSystem.concept.code [ fhir:value "0682" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Interim (First Claim)" ]
  ], [
     fhir:index 426;
     fhir:CodeSystem.concept.code [ fhir:value "0683" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Interim (Continuing Claims)" ]
  ], [
     fhir:index 427;
     fhir:CodeSystem.concept.code [ fhir:value "0684" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Interim (Last Claim)" ]
  ], [
     fhir:index 428;
     fhir:CodeSystem.concept.code [ fhir:value "0685" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Late Charge Only" ]
  ], [
     fhir:index 429;
     fhir:CodeSystem.concept.code [ fhir:value "0687" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 430;
     fhir:CodeSystem.concept.code [ fhir:value "0688" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 431;
     fhir:CodeSystem.concept.code [ fhir:value "0689" ];
     fhir:CodeSystem.concept.display [ fhir:value "Intermediate Care / Swing Bed / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 432;
     fhir:CodeSystem.concept.code [ fhir:value "0710" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 433;
     fhir:CodeSystem.concept.code [ fhir:value "0711" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Admit Through Discharge Claim" ]
  ], [
     fhir:index 434;
     fhir:CodeSystem.concept.code [ fhir:value "0712" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (First Claim)" ]
  ], [
     fhir:index 435;
     fhir:CodeSystem.concept.code [ fhir:value "0713" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Continuing Claims)" ]
  ], [
     fhir:index 436;
     fhir:CodeSystem.concept.code [ fhir:value "0714" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Last Claim)" ]
  ], [
     fhir:index 437;
     fhir:CodeSystem.concept.code [ fhir:value "0715" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Late Charge Only" ]
  ], [
     fhir:index 438;
     fhir:CodeSystem.concept.code [ fhir:value "0717" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 439;
     fhir:CodeSystem.concept.code [ fhir:value "0718" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 440;
     fhir:CodeSystem.concept.code [ fhir:value "0719" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 441;
     fhir:CodeSystem.concept.code [ fhir:value "0720" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 442;
     fhir:CodeSystem.concept.code [ fhir:value "0721" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Admit Through Discharge Claim" ]
  ], [
     fhir:index 443;
     fhir:CodeSystem.concept.code [ fhir:value "0722" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (First Claim)" ]
  ], [
     fhir:index 444;
     fhir:CodeSystem.concept.code [ fhir:value "0723" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Continuing Claims)" ]
  ], [
     fhir:index 445;
     fhir:CodeSystem.concept.code [ fhir:value "0724" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Last Claim)" ]
  ], [
     fhir:index 446;
     fhir:CodeSystem.concept.code [ fhir:value "0725" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Late Charge Only" ]
  ], [
     fhir:index 447;
     fhir:CodeSystem.concept.code [ fhir:value "0727" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 448;
     fhir:CodeSystem.concept.code [ fhir:value "0728" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 449;
     fhir:CodeSystem.concept.code [ fhir:value "0729" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 450;
     fhir:CodeSystem.concept.code [ fhir:value "0730" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 451;
     fhir:CodeSystem.concept.code [ fhir:value "0731" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Admit Through Discharge Claim" ]
  ], [
     fhir:index 452;
     fhir:CodeSystem.concept.code [ fhir:value "0732" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (First Claim)" ]
  ], [
     fhir:index 453;
     fhir:CodeSystem.concept.code [ fhir:value "0733" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Continuing Claims)" ]
  ], [
     fhir:index 454;
     fhir:CodeSystem.concept.code [ fhir:value "0734" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Last Claim)" ]
  ], [
     fhir:index 455;
     fhir:CodeSystem.concept.code [ fhir:value "0735" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Late Charge Only" ]
  ], [
     fhir:index 456;
     fhir:CodeSystem.concept.code [ fhir:value "0737" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 457;
     fhir:CodeSystem.concept.code [ fhir:value "0738" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 458;
     fhir:CodeSystem.concept.code [ fhir:value "0739" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 459;
     fhir:CodeSystem.concept.code [ fhir:value "0740" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 460;
     fhir:CodeSystem.concept.code [ fhir:value "0741" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 461;
     fhir:CodeSystem.concept.code [ fhir:value "0742" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (First Claim)" ]
  ], [
     fhir:index 462;
     fhir:CodeSystem.concept.code [ fhir:value "0743" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 463;
     fhir:CodeSystem.concept.code [ fhir:value "0744" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Last Claim)" ]
  ], [
     fhir:index 464;
     fhir:CodeSystem.concept.code [ fhir:value "0745" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Late Charge Only" ]
  ], [
     fhir:index 465;
     fhir:CodeSystem.concept.code [ fhir:value "0747" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 466;
     fhir:CodeSystem.concept.code [ fhir:value "0748" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 467;
     fhir:CodeSystem.concept.code [ fhir:value "0749" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 468;
     fhir:CodeSystem.concept.code [ fhir:value "0750" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 469;
     fhir:CodeSystem.concept.code [ fhir:value "0751" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 470;
     fhir:CodeSystem.concept.code [ fhir:value "0752" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (First Claim)" ]
  ], [
     fhir:index 471;
     fhir:CodeSystem.concept.code [ fhir:value "0753" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 472;
     fhir:CodeSystem.concept.code [ fhir:value "0754" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Last Claim)" ]
  ], [
     fhir:index 473;
     fhir:CodeSystem.concept.code [ fhir:value "0755" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Late Charge Only" ]
  ], [
     fhir:index 474;
     fhir:CodeSystem.concept.code [ fhir:value "0757" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 475;
     fhir:CodeSystem.concept.code [ fhir:value "0758" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 476;
     fhir:CodeSystem.concept.code [ fhir:value "0759" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 477;
     fhir:CodeSystem.concept.code [ fhir:value "0760" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 478;
     fhir:CodeSystem.concept.code [ fhir:value "0761" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Admit Through Discharge Claim" ]
  ], [
     fhir:index 479;
     fhir:CodeSystem.concept.code [ fhir:value "0762" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (First Claim)" ]
  ], [
     fhir:index 480;
     fhir:CodeSystem.concept.code [ fhir:value "0763" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 481;
     fhir:CodeSystem.concept.code [ fhir:value "0764" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Last Claim)" ]
  ], [
     fhir:index 482;
     fhir:CodeSystem.concept.code [ fhir:value "0765" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Late Charge Only" ]
  ], [
     fhir:index 483;
     fhir:CodeSystem.concept.code [ fhir:value "0767" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Replacement of Prior Claim or Corrected Claim" ]
  ], [
     fhir:index 484;
     fhir:CodeSystem.concept.code [ fhir:value "0768" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Void or Cancel of a Prior Claim" ]
  ], [
     fhir:index 485;
     fhir:CodeSystem.concept.code [ fhir:value "0769" ];
     fhir:CodeSystem.concept.display [ fhir:value "Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Final Claim for a Home Health PPS Episode" ]
  ], [
     fhir:index 486;
     fhir:CodeSystem.concept.code [ fhir:value "0810" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 487;
     fhir:CodeSystem.concept.code [ fhir:value "0811" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Admit Through Discharge Claim" ]
  ], [
     fhir:index 488;
     fhir:CodeSystem.concept.code [ fhir:value "0812" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (First Claim)" ]
  ], [
     fhir:index 489;
     fhir:CodeSystem.concept.code [ fhir:value "0813" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Continuing Claims)" ]
  ], [
     fhir:index 490;
     fhir:CodeSystem.concept.code [ fhir:value "0814" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Last Claim)" ]
  ], [
     fhir:index 491;
     fhir:CodeSystem.concept.code [ fhir:value "0815" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Late Charge Only" ]
  ], [
     fhir:index 492;
     fhir:CodeSystem.concept.code [ fhir:value "0817" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 493;
     fhir:CodeSystem.concept.code [ fhir:value "0818" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 494;
     fhir:CodeSystem.concept.code [ fhir:value "0819" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 495;
     fhir:CodeSystem.concept.code [ fhir:value "0820" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Nonpayment or Zero Claims" ]
  ], [
     fhir:index 496;
     fhir:CodeSystem.concept.code [ fhir:value "0821" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Admit Through Discharge Claim" ]
  ], [
     fhir:index 497;
     fhir:CodeSystem.concept.code [ fhir:value "0822" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (First Claim)" ]
  ], [
     fhir:index 498;
     fhir:CodeSystem.concept.code [ fhir:value "0823" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Continuing Claims)" ]
  ], [
     fhir:index 499;
     fhir:CodeSystem.concept.code [ fhir:value "0824" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Last Claim)" ]
  ], [
     fhir:index 500;
     fhir:CodeSystem.concept.code [ fhir:value "0825" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Late Charge Only" ]
  ], [
     fhir:index 501;
     fhir:CodeSystem.concept.code [ fhir:value "0827" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 502;
     fhir:CodeSystem.concept.code [ fhir:value "0828" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 503;
     fhir:CodeSystem.concept.code [ fhir:value "0829" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 504;
     fhir:CodeSystem.concept.code [ fhir:value "0830" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 505;
     fhir:CodeSystem.concept.code [ fhir:value "0831" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 506;
     fhir:CodeSystem.concept.code [ fhir:value "0832" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 507;
     fhir:CodeSystem.concept.code [ fhir:value "0833" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 508;
     fhir:CodeSystem.concept.code [ fhir:value "0834" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 509;
     fhir:CodeSystem.concept.code [ fhir:value "0835" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 510;
     fhir:CodeSystem.concept.code [ fhir:value "0837" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 511;
     fhir:CodeSystem.concept.code [ fhir:value "0838" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 512;
     fhir:CodeSystem.concept.code [ fhir:value "0839" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 513;
     fhir:CodeSystem.concept.code [ fhir:value "0840" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 514;
     fhir:CodeSystem.concept.code [ fhir:value "0841" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 515;
     fhir:CodeSystem.concept.code [ fhir:value "0842" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (First Claim)" ]
  ], [
     fhir:index 516;
     fhir:CodeSystem.concept.code [ fhir:value "0843" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims)" ]
  ], [
     fhir:index 517;
     fhir:CodeSystem.concept.code [ fhir:value "0844" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Interim (Last Claim)" ]
  ], [
     fhir:index 518;
     fhir:CodeSystem.concept.code [ fhir:value "0845" ];
     fhir:CodeSystem.concept.display [ fhir:value "Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Other Rehabilitation Facility (ORF) / Late Charge Only" ]
  ], [
     fhir:index 519;
     fhir:CodeSystem.concept.code [ fhir:value "0847" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 520;
     fhir:CodeSystem.concept.code [ fhir:value "0848" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 521;
     fhir:CodeSystem.concept.code [ fhir:value "0849" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 522;
     fhir:CodeSystem.concept.code [ fhir:value "0850" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 523;
     fhir:CodeSystem.concept.code [ fhir:value "0851" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 524;
     fhir:CodeSystem.concept.code [ fhir:value "0852" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 525;
     fhir:CodeSystem.concept.code [ fhir:value "0853" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 526;
     fhir:CodeSystem.concept.code [ fhir:value "0854" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 527;
     fhir:CodeSystem.concept.code [ fhir:value "0855" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 528;
     fhir:CodeSystem.concept.code [ fhir:value "0857" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 529;
     fhir:CodeSystem.concept.code [ fhir:value "0858" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 530;
     fhir:CodeSystem.concept.code [ fhir:value "0859" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 531;
     fhir:CodeSystem.concept.code [ fhir:value "0860" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 532;
     fhir:CodeSystem.concept.code [ fhir:value "0861" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 533;
     fhir:CodeSystem.concept.code [ fhir:value "0862" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 534;
     fhir:CodeSystem.concept.code [ fhir:value "0863" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 535;
     fhir:CodeSystem.concept.code [ fhir:value "0864" ];
     fhir:CodeSystem.concept.display [ fhir:value "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)" ]
  ], [
     fhir:index 536;
     fhir:CodeSystem.concept.code [ fhir:value "0865" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 537;
     fhir:CodeSystem.concept.code [ fhir:value "0867" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 538;
     fhir:CodeSystem.concept.code [ fhir:value "0868" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ], [
     fhir:index 539;
     fhir:CodeSystem.concept.code [ fhir:value "0869" ];
     fhir:CodeSystem.concept.display [ fhir:value "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" ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.