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: UB04 Admit Bill Type Code System - XML Representation

Active as of 2022-11-10

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="ub04-admit-bill-type"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <url
       value="http://linuxforhealth.org/fhir/cdm/CodeSystem/ub04-admit-bill-type"/>
  <version value="8.0.0"/>
  <name value="Ub04AdmitBillTypeCodeSystem"/>
  <title value="UB04 Admit Bill Type Code System"/>
  <status value="active"/>
  <date value="2022-11-10T16:00:46+00:00"/>
  <publisher value="LinuxForHealth Team"/>
  <description value="Codes for the UB04 admission billing type"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="540"/>
  <concept>
    <code value="0110"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0111"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0112"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0113"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0114"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0115"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0117"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0118"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0119"/>
    <display
             value="Hospital / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0120"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0121"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0122"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0123"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0124"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0125"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0127"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0128"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0129"/>
    <display
             value="Hospital / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0130"/>
    <display value="Hospital / Outpatient / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0131"/>
    <display value="Hospital / Outpatient / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0132"/>
    <display value="Hospital / Outpatient / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0133"/>
    <display value="Hospital / Outpatient / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0134"/>
    <display value="Hospital / Outpatient / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0135"/>
    <display value="Hospital / Outpatient / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0137"/>
    <display
             value="Hospital / Outpatient / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0138"/>
    <display value="Hospital / Outpatient / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0139"/>
    <display
             value="Hospital / Outpatient / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0140"/>
    <display
             value="Hospital / Other (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0141"/>
    <display
             value="Hospital / Other (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0142"/>
    <display
             value="Hospital / Other (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0143"/>
    <display
             value="Hospital / Other (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0144"/>
    <display
             value="Hospital / Other (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0145"/>
    <display value="Hospital / Other (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0147"/>
    <display
             value="Hospital / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0148"/>
    <display
             value="Hospital / Other (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0149"/>
    <display
             value="Hospital / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0150"/>
    <display
             value="Hospital / Level I Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0151"/>
    <display
             value="Hospital / Level I Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0152"/>
    <display
             value="Hospital / Level I Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0153"/>
    <display
             value="Hospital / Level I Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0154"/>
    <display
             value="Hospital / Level I Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0155"/>
    <display value="Hospital / Level I Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0157"/>
    <display
             value="Hospital / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0158"/>
    <display
             value="Hospital / Level I Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0159"/>
    <display
             value="Hospital / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0160"/>
    <display
             value="Hospital / Level II Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0161"/>
    <display
             value="Hospital / Level II Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0162"/>
    <display
             value="Hospital / Level II Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0163"/>
    <display
             value="Hospital / Level II Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0164"/>
    <display
             value="Hospital / Level II Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0165"/>
    <display
             value="Hospital / Level II Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0167"/>
    <display
             value="Hospital / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0168"/>
    <display
             value="Hospital / Level II Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0169"/>
    <display
             value="Hospital / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0170"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0171"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0172"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0173"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0174"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0175"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0177"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0178"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0179"/>
    <display
             value="Hospital / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0180"/>
    <display value="Hospital / Swing Bed / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0181"/>
    <display value="Hospital / Swing Bed / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0182"/>
    <display value="Hospital / Swing Bed / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0183"/>
    <display value="Hospital / Swing Bed / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0184"/>
    <display value="Hospital / Swing Bed / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0185"/>
    <display value="Hospital / Swing Bed / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0187"/>
    <display
             value="Hospital / Swing Bed / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0188"/>
    <display value="Hospital / Swing Bed / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0189"/>
    <display
             value="Hospital / Swing Bed / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0210"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0211"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0212"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0213"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0214"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0215"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0217"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0218"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0219"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0220"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0221"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0222"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0223"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0224"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0225"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0227"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0228"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0229"/>
    <display
             value="Skilled Nursing Facility / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0230"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0231"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0232"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0233"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0234"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0235"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0237"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0238"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0239"/>
    <display
             value="Skilled Nursing Facility / Outpatient / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0240"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0241"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0242"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0243"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0244"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0245"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0247"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0248"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0249"/>
    <display
             value="Skilled Nursing Facility / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0250"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0251"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0252"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0253"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0254"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0255"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0257"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0258"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0259"/>
    <display
             value="Skilled Nursing Facility / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0260"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0261"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0262"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0263"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0264"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0265"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0267"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0268"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0269"/>
    <display
             value="Skilled Nursing Facility / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0270"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0271"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0272"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0273"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0274"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0275"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0277"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected claim"/>
  </concept>
  <concept>
    <code value="0278"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0279"/>
    <display
             value="Skilled Nursing Facility / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0280"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0281"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0282"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0283"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0284"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0285"/>
    <display value="Skilled Nursing Facility / Swing Bed / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0287"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0288"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0289"/>
    <display
             value="Skilled Nursing Facility / Swing Bed / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0310"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0311"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0312"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0313"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0314"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0315"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0317"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0318"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0319"/>
    <display
             value="Home Health / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0320"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0321"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0322"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0323"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0324"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0325"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0327"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0328"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0329"/>
    <display
             value="Home Health / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0330"/>
    <display value="Home Health / Outpatient / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0331"/>
    <display
             value="Home Health / Outpatient / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0332"/>
    <display value="Home Health / Outpatient / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0333"/>
    <display value="Home Health / Outpatient / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0334"/>
    <display value="Home Health / Outpatient / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0335"/>
    <display value="Home Health / Outpatient / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0337"/>
    <display
             value="Home Health / Outpatient / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0338"/>
    <display
             value="Home Health / Outpatient / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0339"/>
    <display
             value="Home Health / Outpatient / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0340"/>
    <display
             value="Home Health / Other (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0341"/>
    <display
             value="Home Health / Other (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0342"/>
    <display
             value="Home Health / Other (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0343"/>
    <display
             value="Home Health / Other (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0344"/>
    <display
             value="Home Health / Other (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0345"/>
    <display
             value="Home Health / Other (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0347"/>
    <display
             value="Home Health / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0348"/>
    <display
             value="Home Health / Other (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0349"/>
    <display
             value="Home Health / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0350"/>
    <display
             value="HomeHealth / Level I Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0351"/>
    <display
             value="HomeHealth / Level I Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0352"/>
    <display
             value="HomeHealth / Level I Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0353"/>
    <display
             value="HomeHealth / Level I Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0354"/>
    <display
             value="HomeHealth / Level I Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0355"/>
    <display
             value="Home Health / Level I Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0357"/>
    <display
             value="Home Health / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0358"/>
    <display
             value="Home Health / Level I Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0359"/>
    <display
             value="Home Health / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0360"/>
    <display
             value="Home Health / Level II Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0361"/>
    <display
             value="Home Health / Level II Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0362"/>
    <display
             value="Home Health / Level II Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0363"/>
    <display
             value="Home Health / Level II Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0364"/>
    <display
             value="Home Health / Level II Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0365"/>
    <display
             value="Home Health / Level II Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0367"/>
    <display
             value="Home Health / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0368"/>
    <display
             value="Home Health / Level II Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0369"/>
    <display
             value="Home Health / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0370"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0371"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0372"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0373"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0374"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0375"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0377"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0378"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0379"/>
    <display
             value="Home Health / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0380"/>
    <display value="Home Health / Swing Bed / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0381"/>
    <display value="Home Health / Swing Bed / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0382"/>
    <display value="Home Health / Swing Bed / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0383"/>
    <display value="Home Health / Swing Bed / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0384"/>
    <display value="Home Health / Swing Bed / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0385"/>
    <display value="Home Health / Swing Bed / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0387"/>
    <display
             value="Home Health / Swing Bed / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0388"/>
    <display
             value="Home Health / Swing Bed / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0389"/>
    <display
             value="Home Health / Swing Bed / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0410"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0411"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0412"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0413"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0414"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0415"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0417"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0418"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0419"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0420"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0421"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0422"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0423"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0424"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0425"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0427"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0428"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0429"/>
    <display
             value="Religious Nonmedical (Hospital) / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0430"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0431"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0432"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0433"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0434"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0435"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0437"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0438"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0439"/>
    <display
             value="Religious Nonmedical (Hospital) / Outpatient / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0440"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0441"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0442"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0443"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0444"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0445"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0447"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0448"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0449"/>
    <display
             value="Religious Nonmedical (Hospital) / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0450"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0451"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0452"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0453"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0454"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0455"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0457"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0458"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0459"/>
    <display
             value="Religious Nonmedical (Hospital) / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0460"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0461"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0462"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0463"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0464"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0465"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0467"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0468"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0469"/>
    <display
             value="Religious Nonmedical (Hospital) / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0470"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0471"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0472"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0473"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0474"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0475"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0477"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0478"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0479"/>
    <display
             value="Religious Nonmedical (Hospital) / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0480"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0481"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0482"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0483"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0484"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0485"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0487"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0488"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0489"/>
    <display
             value="Religious Nonmedical (Hospital) / Swing Bed / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0510"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0511"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0512"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0513"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0514"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0515"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0517"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0518"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0519"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0520"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0521"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0522"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0523"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0524"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0525"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0527"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0528"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0529"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0530"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0531"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0532"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0533"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0534"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0535"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0537"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0538"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0539"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Outpatient / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0540"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0541"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0542"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0543"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0544"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0545"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0547"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0548"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0549"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0550"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0551"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0552"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0553"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0554"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0555"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0557"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0558"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0559"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0560"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0561"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0562"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0563"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0564"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0565"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0567"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0568"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0569"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0570"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0571"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0572"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0573"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0574"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0575"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0577"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0578"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0579"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0580"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0581"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0582"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0583"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0584"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0585"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0587"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0588"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0589"/>
    <display
             value="Religious Nonmedical (Extended Care) discontinued 10/1/2005 / Swing Bed / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0610"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0611"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0612"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0613"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0614"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0615"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0617"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0618"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0619"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part A) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0620"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0621"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0622"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0623"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0624"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0625"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0627"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0628"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0629"/>
    <display
             value="Intermediate Care / Inpatient (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0630"/>
    <display
             value="Intermediate Care / Outpatient / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0631"/>
    <display
             value="Intermediate Care / Outpatient / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0632"/>
    <display value="Intermediate Care / Outpatient / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0633"/>
    <display
             value="Intermediate Care / Outpatient / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0634"/>
    <display value="Intermediate Care / Outpatient / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0635"/>
    <display value="Intermediate Care / Outpatient / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0637"/>
    <display
             value="Intermediate Care / Outpatient / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0638"/>
    <display
             value="Intermediate Care / Outpatient / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0639"/>
    <display
             value="Intermediate Care / Outpatient / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0640"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0641"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0642"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0643"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0644"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0645"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0647"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0648"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0649"/>
    <display
             value="Intermediate Care / Other (Medicare Part B) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0650"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0651"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0652"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0653"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0654"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0655"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0657"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0658"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0659"/>
    <display
             value="Intermediate Care / Level I Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0660"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0661"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0662"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0663"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0664"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0665"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0667"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0668"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0669"/>
    <display
             value="Intermediate Care / Level II Intermediate Care / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0670"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0671"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0672"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0673"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0674"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0675"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0677"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0678"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0679"/>
    <display
             value="Intermediate Care / Subacute Inpatient (for use with Revenue Code 019X) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0680"/>
    <display
             value="Intermediate Care / Swing Bed / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0681"/>
    <display
             value="Intermediate Care / Swing Bed / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0682"/>
    <display value="Intermediate Care / Swing Bed / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0683"/>
    <display
             value="Intermediate Care / Swing Bed / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0684"/>
    <display value="Intermediate Care / Swing Bed / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0685"/>
    <display value="Intermediate Care / Swing Bed / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0687"/>
    <display
             value="Intermediate Care / Swing Bed / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0688"/>
    <display
             value="Intermediate Care / Swing Bed / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0689"/>
    <display
             value="Intermediate Care / Swing Bed / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0710"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0711"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0712"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0713"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0714"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0715"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0717"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0718"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0719"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Rural Health Clinic / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0720"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0721"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0722"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0723"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0724"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0725"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Hospital Based or Independent Renal Dialysis Facility / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0727"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0728"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0729"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0730"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0731"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0732"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0733"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0734"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0735"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Federally Qualified Health Center (FQHC), Free Standing Provider-Based / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0737"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0738"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0739"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0740"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0741"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0742"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0743"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0744"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0745"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0747"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0748"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0749"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Other Rehabilitation Facility (ORF) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0750"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0751"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0752"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0753"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0754"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0755"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0757"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0758"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0759"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Comprehensive Outpatient Rehabilitation Facility (CORF) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0760"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Nonpayment or Zero Claims"/>
  </concept>
  <concept>
    <code value="0761"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Admit Through Discharge Claim"/>
  </concept>
  <concept>
    <code value="0762"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0763"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0764"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0765"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0767"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Replacement of Prior Claim or Corrected Claim"/>
  </concept>
  <concept>
    <code value="0768"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Void or Cancel of a Prior Claim"/>
  </concept>
  <concept>
    <code value="0769"/>
    <display
             value="Clinic or Hospital based End Stage Renal Disease (ESRD) facility / Community Mental Health Center (CMHC) / Final Claim for a Home Health PPS Episode"/>
  </concept>
  <concept>
    <code value="0810"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0811"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0812"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0813"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0814"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0815"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Nonhospital Based Hospice / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0817"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0818"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0819"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0820"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0821"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0822"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (First Claim)"/>
  </concept>
  <concept>
    <code value="0823"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Continuing Claims)"/>
  </concept>
  <concept>
    <code value="0824"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Interim (Last Claim)"/>
  </concept>
  <concept>
    <code value="0825"/>
    <display
             value="Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) / Hospital Based Hospice / Late Charge Only"/>
  </concept>
  <concept>
    <code value="0827"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0828"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0829"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0830"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0831"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0832"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0833"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0834"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0835"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0837"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0838"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0839"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0840"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0841"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0842"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0843"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0844"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0845"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0847"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0848"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0849"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0850"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0851"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0852"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0853"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0854"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0855"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0857"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0858"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0859"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0860"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0861"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0862"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0863"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0864"/>
    <display
             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)"/>
  </concept>
  <concept>
    <code value="0865"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0867"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0868"/>
    <display
             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"/>
  </concept>
  <concept>
    <code value="0869"/>
    <display
             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"/>
  </concept>
</CodeSystem>