| Type of Bill UB04 Codes | Second Digit: Type of Facility | Thrid Digit: Type of Care | Fourth Digit: Frequency |
|---|---|---|---|
| Bill Type 110 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 111 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 112 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 113 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 114 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 115 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 117 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 118 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 119 | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 120 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 121 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 122 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 123 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 124 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 125 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 127 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 128 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 129 | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 130 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 131 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 132 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 133 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 134 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 135 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 137 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 138 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 139 | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 140 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 141 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 142 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 143 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 144 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 145 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 147 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 148 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 149 | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 150 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 151 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 152 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 153 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 154 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 155 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 157 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 158 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 159 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 160 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 161 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 162 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 163 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 164 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 165 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 167 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 168 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 169 | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 170 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 171 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 172 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 173 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 174 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 175 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 177 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 178 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 179 | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 180 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 181 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 182 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 183 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 184 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 185 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 187 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 188 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 189 | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 190 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 191 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 192 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 193 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 194 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 195 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 197 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 198 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 199 | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 210 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 211 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 212 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 213 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 214 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 215 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 217 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 218 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 219 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 220 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 221 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 222 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 223 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 224 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 225 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 227 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 228 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 229 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 230 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 231 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 232 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 233 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 234 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 235 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 237 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 238 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 239 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 240 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 241 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 242 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 243 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 244 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 245 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 247 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 248 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 249 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 250 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 251 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 252 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 253 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 254 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 255 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 257 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 258 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 259 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 260 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 261 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 262 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 263 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 264 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 265 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 267 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 268 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 269 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 270 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 271 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 272 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 273 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 274 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 275 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 277 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 278 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 279 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 280 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 281 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 282 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 283 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 284 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 285 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 287 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 288 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 289 | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 290 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 291 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 292 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 293 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 294 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 295 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 297 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 298 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 299 | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 310 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 311 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 312 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 313 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 314 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 315 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 317 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 318 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 319 | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 320 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 321 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 322 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 323 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 324 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 325 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 327 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 328 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 329 | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 330 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 331 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 332 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 333 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 334 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 335 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 337 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 338 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 339 | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 340 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 341 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 342 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 343 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 344 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 345 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 347 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 348 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 349 | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 350 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 351 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 352 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 353 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 354 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 355 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 357 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 358 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 359 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 360 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 361 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 362 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 363 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 364 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 365 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 367 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 368 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 369 | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 370 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 371 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 372 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 373 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 374 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 375 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 377 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 378 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 379 | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 380 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 381 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 382 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 383 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 384 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 385 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 387 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 388 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 389 | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 390 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 391 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 392 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 393 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 394 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 395 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 397 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 398 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 399 | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 410 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 411 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 412 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 413 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 414 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 415 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 417 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 418 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 419 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 420 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 421 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 422 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 423 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 424 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 425 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 427 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 428 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 429 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 430 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 431 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 432 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 433 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 434 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 435 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 437 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 438 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 439 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 440 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 441 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 442 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 443 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 444 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 445 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 447 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 448 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 449 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 450 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 451 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 452 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 453 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 454 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 455 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 457 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 458 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 459 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 460 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 461 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 462 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 463 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 464 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 465 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 467 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 468 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 469 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 470 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 471 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 472 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 473 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 474 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 475 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 477 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 478 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 479 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 480 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 481 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 482 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 483 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 484 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 485 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 487 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 488 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 489 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 490 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 491 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 492 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 493 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 494 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 495 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 497 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 498 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 499 | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 510 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 511 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 512 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 513 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 514 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 515 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 517 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 518 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 519 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 520 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 521 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 522 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 523 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 524 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 525 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 527 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 528 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 529 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 530 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 531 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 532 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 533 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 534 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 535 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 537 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 538 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 539 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 540 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 541 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 542 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 543 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 544 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 545 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 547 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 548 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 549 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 550 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 551 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 552 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 553 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 554 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 555 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 557 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 558 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 559 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 560 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 561 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 562 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 563 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 564 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 565 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 567 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 568 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 569 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 570 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 571 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 572 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 573 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 574 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 575 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 577 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 578 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 579 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 580 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 581 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 582 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 583 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 584 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 585 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 587 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 588 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 589 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 590 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 591 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 592 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 593 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 594 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 595 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 597 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 598 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 599 | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 610 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 611 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 612 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 613 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 614 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 615 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 617 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 618 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 619 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 620 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 621 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 622 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 623 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 624 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 625 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 627 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 628 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 629 | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 630 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 631 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 632 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 633 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 634 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 635 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 637 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 638 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 639 | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 640 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 641 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 642 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 643 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 644 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 645 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 647 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 648 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 649 | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 650 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 651 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 652 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 653 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 654 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 655 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 657 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 658 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 659 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 660 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 661 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 662 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 663 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 664 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 665 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 667 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 668 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 669 | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 670 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 671 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 672 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 673 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 674 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 675 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 677 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 678 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 679 | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 680 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 681 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 682 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 683 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 684 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 685 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 687 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 688 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 689 | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 690 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 691 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 692 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 693 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 694 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 695 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 697 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 698 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 699 | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 710 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 711 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 712 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 713 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 714 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 715 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 717 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 718 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 719 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 720 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 721 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 722 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 723 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 724 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 725 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 727 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 728 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 729 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 730 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 731 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 732 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 733 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 734 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 735 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 737 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 738 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 739 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 740 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 741 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 742 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 743 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 744 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 745 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 747 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 748 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 749 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 750 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 751 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 752 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 753 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 754 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 755 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 757 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 758 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 759 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 760 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 761 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 762 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 763 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 764 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 765 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 767 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 768 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 769 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 770 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 771 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 772 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 773 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 774 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 775 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 777 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 778 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 779 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 780 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 781 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 782 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 783 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 784 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 785 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 787 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 788 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 789 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 790 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 791 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 792 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 793 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 794 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 795 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 797 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 798 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 799 | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 810 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 811 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 812 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 813 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 814 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 815 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 817 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 818 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 819 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 820 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 821 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 822 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 823 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 824 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 825 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 827 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 828 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 829 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 830 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 831 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 832 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 833 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 834 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 835 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 837 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 838 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 839 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 840 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 841 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 842 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 843 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 844 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 845 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 847 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 848 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 849 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 850 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 851 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 852 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 853 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 854 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 855 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 857 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 858 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 859 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 860 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 861 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 862 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 863 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 864 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 865 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 867 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 868 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 869 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 870 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 871 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 872 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 873 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 874 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 875 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 877 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 878 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 879 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 880 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 881 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 882 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 883 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 884 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 885 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 887 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 888 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 889 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 890 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 891 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 892 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 893 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 894 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 895 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 897 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 898 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 899 | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 910 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Non-payment/Zero Claim |
| Bill Type 911 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admit Through Discharge |
| Bill Type 912 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - First Claim |
| Bill Type 913 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 914 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 915 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Late Charge Only |
| Bill Type 917 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 918 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 919 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 920 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Non-payment/Zero Claim |
| Bill Type 921 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admit Through Discharge |
| Bill Type 922 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - First Claim |
| Bill Type 923 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 924 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 925 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Late Charge Only |
| Bill Type 927 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 928 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 929 | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Final claim for a Home Health PPS Period |
| Bill Type 930 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Non-payment/Zero Claim |
| Bill Type 931 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admit Through Discharge |
| Bill Type 932 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - First Claim |
| Bill Type 933 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 934 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 935 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Late Charge Only |
| Bill Type 937 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 938 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 939 | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Final claim for a Home Health PPS Period |
| Bill Type 940 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Non-payment/Zero Claim |
| Bill Type 941 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admit Through Discharge |
| Bill Type 942 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - First Claim |
| Bill Type 943 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 944 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 945 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Late Charge Only |
| Bill Type 947 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 948 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 949 | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Final claim for a Home Health PPS Period |
| Bill Type 950 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Non-payment/Zero Claim |
| Bill Type 951 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admit Through Discharge |
| Bill Type 952 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - First Claim |
| Bill Type 953 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 954 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 955 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Late Charge Only |
| Bill Type 957 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 958 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 959 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Final claim for a Home Health PPS Period |
| Bill Type 960 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Non-payment/Zero Claim |
| Bill Type 961 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admit Through Discharge |
| Bill Type 962 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - First Claim |
| Bill Type 963 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 964 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 965 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Late Charge Only |
| Bill Type 967 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 968 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 969 | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Final claim for a Home Health PPS Period |
| Bill Type 970 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 971 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 972 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 973 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 974 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 975 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 977 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 978 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 979 | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 980 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Non-payment/Zero Claim |
| Bill Type 981 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admit Through Discharge |
| Bill Type 982 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - First Claim |
| Bill Type 983 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 984 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 985 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Late Charge Only |
| Bill Type 987 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 988 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 989 | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Final claim for a Home Health PPS Period |
| Bill Type 990 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Non-payment/Zero Claim |
| Bill Type 991 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admit Through Discharge |
| Bill Type 992 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - First Claim |
| Bill Type 993 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim-Continuing Claims (Not valid for Prospective Payment System (PPS) Bills) |
| Bill Type 994 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Interim - Last Claim (Not valid for PPS Bills) |
| Bill Type 995 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Late Charge Only |
| Bill Type 997 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Claim (See adjustment third digit) |
| Bill Type 998 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel of Prior Claim (See adjustment third digit) |
| Bill Type 999 | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Final claim for a Home Health PPS Period |
| Bill Type 11A | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 11B | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 11C | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 11D | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 11E | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 11F | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 11G | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 11H | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 11I | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 11J | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 11K | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 11M | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 11O | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 11P | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 11Q | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 11X | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 11Y | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 11Z | Hospital | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 12A | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 12B | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 12C | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 12D | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 12E | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 12F | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 12G | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 12H | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 12I | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 12J | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 12K | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 12M | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 12O | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 12P | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 12Q | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 12X | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 12Y | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 12Z | Hospital | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 13A | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 13B | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 13C | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 13D | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 13E | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 13F | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 13G | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 13H | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 13I | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 13J | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 13K | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 13M | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 13O | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 13P | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 13Q | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 13X | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 13Y | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 13Z | Hospital | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 14A | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 14B | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 14C | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 14D | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 14E | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 14F | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 14G | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 14H | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 14I | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 14J | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 14K | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 14M | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 14O | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 14P | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 14Q | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 14X | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 14Y | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 14Z | Hospital | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 15A | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 15B | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 15C | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 15D | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 15E | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 15F | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 15G | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 15H | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 15I | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 15J | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 15K | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 15M | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 15O | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 15P | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 15Q | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 15X | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 15Y | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 15Z | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 16A | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 16B | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 16C | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 16D | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 16E | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 16F | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 16G | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 16H | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 16I | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 16J | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 16K | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 16M | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 16O | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 16P | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 16Q | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 16X | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 16Y | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 16Z | Hospital | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 17A | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 17B | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 17C | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 17D | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 17E | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 17F | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 17G | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 17H | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 17I | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 17J | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 17K | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 17M | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 17O | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 17P | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 17Q | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 17X | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 17Y | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 17Z | Hospital | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 18A | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 18B | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 18C | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 18D | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 18E | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 18F | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 18G | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 18H | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 18I | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 18J | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 18K | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 18M | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 18O | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 18P | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 18Q | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 18X | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 18Y | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 18Z | Hospital | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 19A | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 19B | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 19C | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 19D | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 19E | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 19F | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 19G | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 19H | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 19I | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 19J | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 19K | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 19M | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 19O | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 19P | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 19Q | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 19X | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 19Y | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 19Z | Hospital | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 21A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 21B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 21C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 21D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 21E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 21F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 21G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 21H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 21I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 21J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 21K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 21M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 21O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 21P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 21Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 21X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 21Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 21Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 22A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 22B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 22C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 22D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 22E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 22F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 22G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 22H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 22I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 22J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 22K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 22M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 22O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 22P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 22Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 22X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 22Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 22Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 23A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 23B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 23C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 23D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 23E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 23F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 23G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 23H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 23I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 23J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 23K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 23M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 23O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 23P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 23Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 23X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 23Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 23Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 24A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 24B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 24C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 24D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 24E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 24F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 24G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 24H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 24I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 24J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 24K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 24M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 24O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 24P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 24Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 24X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 24Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 24Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 25A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 25B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 25C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 25D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 25E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 25F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 25G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 25H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 25I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 25J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 25K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 25M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 25O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 25P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 25Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 25X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 25Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 25Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 26A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 26B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 26C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 26D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 26E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 26F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 26G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 26H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 26I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 26J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 26K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 26M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 26O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 26P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 26Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 26X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 26Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 26Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 27A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 27B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 27C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 27D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 27E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 27F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 27G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 27H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 27I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 27J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 27K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 27M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 27O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 27P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 27Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 27X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 27Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 27Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 28A | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 28B | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 28C | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 28D | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 28E | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 28F | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 28G | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 28H | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 28I | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 28J | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 28K | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 28M | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 28O | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 28P | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 28Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 28X | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 28Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 28Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 29A | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 29B | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 29C | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 29D | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 29E | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 29F | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 29G | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 29H | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 29I | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 29J | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 29K | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 29M | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 29O | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 29P | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 29Q | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 29X | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 29Y | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 29Z | Skilled Nursing Facility | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 31A | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 31B | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 31C | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 31D | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 31E | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 31F | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 31G | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 31H | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 31I | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 31J | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 31K | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 31M | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 31O | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 31P | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 31Q | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 31X | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 31Y | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 31Z | Home Health | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 32A | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 32B | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 32C | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 32D | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 32E | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 32F | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 32G | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 32H | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 32I | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 32J | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 32K | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 32M | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 32O | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 32P | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 32Q | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 32X | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 32Y | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 32Z | Home Health | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 33A | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 33B | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 33C | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 33D | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 33E | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 33F | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 33G | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 33H | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 33I | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 33J | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 33K | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 33M | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 33O | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 33P | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 33Q | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 33X | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 33Y | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 33Z | Home Health | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 34A | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 34B | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 34C | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 34D | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 34E | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 34F | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 34G | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 34H | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 34I | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 34J | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 34K | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 34M | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 34O | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 34P | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 34Q | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 34X | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 34Y | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 34Z | Home Health | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 35A | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 35B | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 35C | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 35D | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 35E | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 35F | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 35G | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 35H | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 35I | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 35J | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 35K | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 35M | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 35O | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 35P | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 35Q | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 35X | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 35Y | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 35Z | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 36A | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 36B | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 36C | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 36D | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 36E | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 36F | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 36G | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 36H | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 36I | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 36J | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 36K | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 36M | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 36O | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 36P | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 36Q | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 36X | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 36Y | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 36Z | Home Health | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 37A | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 37B | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 37C | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 37D | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 37E | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 37F | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 37G | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 37H | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 37I | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 37J | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 37K | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 37M | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 37O | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 37P | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 37Q | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 37X | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 37Y | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 37Z | Home Health | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 38A | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 38B | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 38C | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 38D | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 38E | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 38F | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 38G | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 38H | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 38I | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 38J | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 38K | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 38M | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 38O | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 38P | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 38Q | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 38X | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 38Y | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 38Z | Home Health | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 39A | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 39B | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 39C | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 39D | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 39E | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 39F | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 39G | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 39H | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 39I | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 39J | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 39K | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 39M | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 39O | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 39P | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 39Q | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 39X | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 39Y | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 39Z | Home Health | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 41A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 41B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 41C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 41D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 41E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 41F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 41G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 41H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 41I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 41J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 41K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 41M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 41O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 41P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 41Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 41X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 41Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 41Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 42A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 42B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 42C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 42D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 42E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 42F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 42G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 42H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 42I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 42J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 42K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 42M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 42O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 42P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 42Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 42X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 42Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 42Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 43A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 43B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 43C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 43D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 43E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 43F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 43G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 43H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 43I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 43J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 43K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 43M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 43O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 43P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 43Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 43X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 43Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 43Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 44A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 44B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 44C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 44D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 44E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 44F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 44G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 44H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 44I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 44J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 44K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 44M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 44O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 44P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 44Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 44X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 44Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 44Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 45A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 45B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 45C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 45D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 45E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 45F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 45G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 45H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 45I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 45J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 45K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 45M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 45O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 45P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 45Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 45X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 45Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 45Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 46A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 46B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 46C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 46D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 46E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 46F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 46G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 46H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 46I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 46J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 46K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 46M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 46O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 46P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 46Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 46X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 46Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 46Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 47A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 47B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 47C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 47D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 47E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 47F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 47G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 47H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 47I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 47J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 47K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 47M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 47O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 47P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 47Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 47X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 47Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 47Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 48A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 48B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 48C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 48D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 48E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 48F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 48G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 48H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 48I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 48J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 48K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 48M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 48O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 48P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 48Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 48X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 48Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 48Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 49A | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 49B | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 49C | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 49D | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 49E | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 49F | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 49G | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 49H | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 49I | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 49J | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 49K | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 49M | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 49O | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 49P | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 49Q | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 49X | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 49Y | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 49Z | Religious Nonmedical(Hospital) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 51A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 51B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 51C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 51D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 51E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 51F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 51G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 51H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 51I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 51J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 51K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 51M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 51O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 51P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 51Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 51X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 51Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 51Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 52A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 52B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 52C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 52D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 52E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 52F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 52G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 52H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 52I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 52J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 52K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 52M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 52O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 52P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 52Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 52X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 52Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 52Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 53A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 53B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 53C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 53D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 53E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 53F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 53G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 53H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 53I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 53J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 53K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 53M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 53O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 53P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 53Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 53X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 53Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 53Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 54A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 54B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 54C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 54D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 54E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 54F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 54G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 54H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 54I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 54J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 54K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 54M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 54O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 54P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 54Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 54X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 54Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 54Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 55A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 55B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 55C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 55D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 55E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 55F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 55G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 55H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 55I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 55J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 55K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 55M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 55O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 55P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 55Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 55X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 55Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 55Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 56A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 56B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 56C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 56D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 56E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 56F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 56G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 56H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 56I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 56J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 56K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 56M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 56O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 56P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 56Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 56X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 56Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 56Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 57A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 57B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 57C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 57D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 57E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 57F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 57G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 57H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 57I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 57J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 57K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 57M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 57O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 57P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 57Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 57X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 57Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 57Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 58A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 58B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 58C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 58D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 58E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 58F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 58G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 58H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 58I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 58J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 58K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 58M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 58O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 58P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 58Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 58X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 58Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 58Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 59A | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 59B | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 59C | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 59D | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 59E | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 59F | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 59G | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 59H | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 59I | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 59J | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 59K | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 59M | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 59O | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 59P | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 59Q | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 59X | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 59Y | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 59Z | Religious Nonmedical (Extended Care) discontinued 10/1/05 | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 61A | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 61B | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 61C | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 61D | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 61E | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 61F | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 61G | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 61H | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 61I | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 61J | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 61K | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 61M | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 61O | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 61P | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 61Q | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 61X | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 61Y | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 61Z | Intermediate Care | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 62A | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 62B | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 62C | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 62D | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 62E | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 62F | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 62G | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 62H | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 62I | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 62J | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 62K | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 62M | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 62O | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 62P | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 62Q | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 62X | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 62Y | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 62Z | Intermediate Care | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 63A | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 63B | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 63C | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 63D | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 63E | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 63F | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 63G | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 63H | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 63I | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 63J | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 63K | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 63M | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 63O | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 63P | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 63Q | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 63X | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 63Y | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 63Z | Intermediate Care | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 64A | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 64B | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 64C | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 64D | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 64E | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 64F | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 64G | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 64H | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 64I | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 64J | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 64K | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 64M | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 64O | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 64P | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 64Q | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 64X | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 64Y | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 64Z | Intermediate Care | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 65A | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 65B | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 65C | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 65D | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 65E | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 65F | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 65G | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 65H | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 65I | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 65J | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 65K | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 65M | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 65O | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 65P | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 65Q | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 65X | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 65Y | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 65Z | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 66A | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 66B | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 66C | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 66D | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 66E | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 66F | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 66G | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 66H | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 66I | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 66J | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 66K | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 66M | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 66O | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 66P | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 66Q | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 66X | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 66Y | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 66Z | Intermediate Care | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 67A | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 67B | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 67C | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 67D | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 67E | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 67F | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 67G | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 67H | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 67I | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 67J | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 67K | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 67M | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 67O | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 67P | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 67Q | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 67X | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 67Y | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 67Z | Intermediate Care | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 68A | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 68B | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 68C | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 68D | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 68E | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 68F | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 68G | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 68H | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 68I | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 68J | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 68K | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 68M | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 68O | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 68P | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 68Q | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 68X | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 68Y | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 68Z | Intermediate Care | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 69A | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 69B | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 69C | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 69D | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 69E | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 69F | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 69G | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 69H | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 69I | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 69J | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 69K | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 69M | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 69O | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 69P | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 69Q | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 69X | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 69Y | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 69Z | Intermediate Care | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 71A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 71B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 71C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 71D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 71E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 71F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 71G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 71H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 71I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 71J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 71K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 71M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 71O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 71P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 71Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 71X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 71Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 71Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 72A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 72B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 72C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 72D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 72E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 72F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 72G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 72H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 72I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 72J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 72K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 72M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 72O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 72P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 72Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 72X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 72Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 72Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 73A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 73B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 73C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 73D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 73E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 73F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 73G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 73H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 73I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 73J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 73K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 73M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 73O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 73P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 73Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 73X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 73Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 73Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 74A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 74B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 74C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 74D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 74E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 74F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 74G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 74H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 74I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 74J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 74K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 74M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 74O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 74P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 74Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 74X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 74Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 74Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 75A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 75B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 75C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 75D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 75E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 75F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 75G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 75H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 75I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 75J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 75K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 75M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 75O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 75P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 75Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 75X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 75Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 75Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 76A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 76B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 76C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 76D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 76E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 76F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 76G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 76H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 76I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 76J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 76K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 76M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 76O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 76P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 76Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 76X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 76Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 76Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 77A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 77B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 77C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 77D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 77E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 77F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 77G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 77H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 77I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 77J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 77K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 77M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 77O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 77P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 77Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 77X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 77Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 77Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 78A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 78B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 78C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 78D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 78E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 78F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 78G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 78H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 78I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 78J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 78K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 78M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 78O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 78P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 78Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 78X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 78Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 78Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 79A | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 79B | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 79C | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 79D | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 79E | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 79F | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 79G | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 79H | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 79I | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 79J | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 79K | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 79M | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 79O | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 79P | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 79Q | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 79X | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 79Y | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 79Z | Clinic or Hospital based End Stage Renal Disease (ESRD) facility (requires Special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 81A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 81B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 81C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 81D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 81E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 81F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 81G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 81H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 81I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 81J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 81K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 81M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 81O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 81P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 81Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 81X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 81Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 81Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 82A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 82B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 82C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 82D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 82E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 82F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 82G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 82H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 82I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 82J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 82K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 82M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 82O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 82P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 82Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 82X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 82Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 82Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 83A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 83B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 83C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 83D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 83E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 83F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 83G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 83H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 83I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 83J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 83K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 83M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 83O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 83P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 83Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 83X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 83Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 83Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 84A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 84B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 84C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 84D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 84E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 84F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 84G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 84H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 84I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 84J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 84K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 84M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 84O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 84P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 84Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 84X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 84Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 84Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 85A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 85B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 85C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 85D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 85E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 85F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 85G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 85H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 85I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 85J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 85K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 85M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 85O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 85P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 85Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 85X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 85Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 85Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 86A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 86B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 86C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 86D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 86E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 86F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 86G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 86H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 86I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 86J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 86K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 86M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 86O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 86P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 86Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 86X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 86Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 86Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 87A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 87B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 87C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 87D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 87E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 87F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 87G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 87H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 87I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 87J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 87K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 87M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 87O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 87P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 87Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 87X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 87Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 87Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 88A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 88B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 88C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 88D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 88E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 88F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 88G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 88H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 88I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 88J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 88K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 88M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 88O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 88P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 88Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 88X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 88Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 88Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 89A | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 89B | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 89C | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 89D | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 89E | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 89F | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 89G | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 89H | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 89I | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 89J | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 89K | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 89M | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 89O | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 89P | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 89Q | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 89X | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 89Y | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 89Z | Special facility or hospital (Critical Access Hospital (CAH)) (Ambulatory Surgical Center (ASC)) surgery (requires special second digit) | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
| Bill Type 91A | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Admission/Election Notice for Hospice |
| Bill Type 91B | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 91C | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Provider Notice |
| Bill Type 91D | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Election Void/Cancel |
| Bill Type 91E | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Hospice Change of Ownership |
| Bill Type 91F | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 91G | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 91H | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 91I | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 91J | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 91K | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 91M | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 91O | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Nonpayment/Zero Claims |
| Bill Type 91P | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | QIO Adjustment Claim |
| Bill Type 91Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Reopening/Adjustment |
| Bill Type 91X | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 91Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 91Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient Part A. *Clinics Only - Rural Health Center (RHC). *Special Facilities Only - Hospice (non-hospital based). | New Abbreviated Encounter Submission |
| Bill Type 92A | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Admission/Election Notice for Hospice |
| Bill Type 92B | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Termination/ Revocation Notice |
| Bill Type 92C | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Provider Notice |
| Bill Type 92D | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Election Void/Cancel |
| Bill Type 92E | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Hospice Change of Ownership |
| Bill Type 92F | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Beneficiary Initiated Adjustment Claim |
| Bill Type 92G | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CWF Initiated Adjustment Claim |
| Bill Type 92H | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | CMS Initiated Adjustment Claim |
| Bill Type 92I | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 92J | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Initiated Adjustment Claim/Other |
| Bill Type 92K | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | OIG Initiated Adjustment Claim |
| Bill Type 92M | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | MSP Initiated Adjustment Claim |
| Bill Type 92O | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Nonpayment/Zero Claims |
| Bill Type 92P | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | QIO Adjustment Claim |
| Bill Type 92Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Reopening/Adjustment |
| Bill Type 92X | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 92Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 92Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Inpatient (Part B) (includes Home Health Agency (HHA) visits under a Part B plan of treatment). *Clinics Only - Hospital based or Independent Renal Dialysis Center. *Special Facilities Only - Hospice (hospital based). | New Abbreviated Encounter Submission |
| Bill Type 93A | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Admission/Election Notice for Hospice |
| Bill Type 93B | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Termination/ Revocation Notice |
| Bill Type 93C | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Provider Notice |
| Bill Type 93D | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Election Void/Cancel |
| Bill Type 93E | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Hospice Change of Ownership |
| Bill Type 93F | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Beneficiary Initiated Adjustment Claim |
| Bill Type 93G | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CWF Initiated Adjustment Claim |
| Bill Type 93H | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | CMS Initiated Adjustment Claim |
| Bill Type 93I | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 93J | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Initiated Adjustment Claim/Other |
| Bill Type 93K | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | OIG Initiated Adjustment Claim |
| Bill Type 93M | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | MSP Initiated Adjustment Claim |
| Bill Type 93O | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Nonpayment/Zero Claims |
| Bill Type 93P | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | QIO Adjustment Claim |
| Bill Type 93Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Reopening/Adjustment |
| Bill Type 93X | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 93Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 93Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Outpatient (includes HHA visits under a Part A plan of treatment and use of HHA DME under a Part A plan of treatment). *Special Facilities Only - ASC Services to Hospital Outpatients. | New Abbreviated Encounter Submission |
| Bill Type 94A | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Admission/Election Notice for Hospice |
| Bill Type 94B | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Termination/ Revocation Notice |
| Bill Type 94C | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Provider Notice |
| Bill Type 94D | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Election Void/Cancel |
| Bill Type 94E | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Hospice Change of Ownership |
| Bill Type 94F | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Beneficiary Initiated Adjustment Claim |
| Bill Type 94G | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CWF Initiated Adjustment Claim |
| Bill Type 94H | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | CMS Initiated Adjustment Claim |
| Bill Type 94I | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 94J | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Initiated Adjustment Claim/Other |
| Bill Type 94K | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | OIG Initiated Adjustment Claim |
| Bill Type 94M | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | MSP Initiated Adjustment Claim |
| Bill Type 94O | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Nonpayment/Zero Claims |
| Bill Type 94P | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | QIO Adjustment Claim |
| Bill Type 94Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Reopening/Adjustment |
| Bill Type 94X | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 94Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 94Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Other (Part B) (includes HHA medical and other health services not under a plan of treatment, SNF diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services). *Clinics Only - Other Rehabilitation Facility (ORF). *Special Facilities Only - Free Standing Birthing Center. | New Abbreviated Encounter Submission |
| Bill Type 95A | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Admission/Election Notice for Hospice |
| Bill Type 95B | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Termination/ Revocation Notice |
| Bill Type 95C | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Provider Notice |
| Bill Type 95D | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Election Void/Cancel |
| Bill Type 95E | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Hospice Change of Ownership |
| Bill Type 95F | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Beneficiary Initiated Adjustment Claim |
| Bill Type 95G | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CWF Initiated Adjustment Claim |
| Bill Type 95H | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | CMS Initiated Adjustment Claim |
| Bill Type 95I | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 95J | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Initiated Adjustment Claim/Other |
| Bill Type 95K | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | OIG Initiated Adjustment Claim |
| Bill Type 95M | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | MSP Initiated Adjustment Claim |
| Bill Type 95O | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Nonpayment/Zero Claims |
| Bill Type 95P | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | QIO Adjustment Claim |
| Bill Type 95Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Reopening/Adjustment |
| Bill Type 95X | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 95Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 95Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level I. *Clinics Only - Comprehensive Outpatient Rehabilitation Facility (CORF). *Special Facilities Only - CAH. | New Abbreviated Encounter Submission |
| Bill Type 96A | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Admission/Election Notice for Hospice |
| Bill Type 96B | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Termination/ Revocation Notice |
| Bill Type 96C | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Provider Notice |
| Bill Type 96D | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Election Void/Cancel |
| Bill Type 96E | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Hospice Change of Ownership |
| Bill Type 96F | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Beneficiary Initiated Adjustment Claim |
| Bill Type 96G | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CWF Initiated Adjustment Claim |
| Bill Type 96H | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | CMS Initiated Adjustment Claim |
| Bill Type 96I | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 96J | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Initiated Adjustment Claim/Other |
| Bill Type 96K | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | OIG Initiated Adjustment Claim |
| Bill Type 96M | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | MSP Initiated Adjustment Claim |
| Bill Type 96O | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Nonpayment/Zero Claims |
| Bill Type 96P | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | QIO Adjustment Claim |
| Bill Type 96Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Reopening/Adjustment |
| Bill Type 96X | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 96Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 96Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Intermediate Care - Level II. *Clinics Only - Community Mental Health Center (CMHC). *Special Facilities Only - Residential Facility (not used for Medicare). | New Abbreviated Encounter Submission |
| Bill Type 97A | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 97B | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 97C | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 97D | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 97E | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 97F | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 97G | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 97H | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 97I | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 97J | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 97K | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 97M | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 97O | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 97P | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 97Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 97X | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 97Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 97Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Subacute Inpatient (Revenue Code 019X required) Eight Swing Beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement.). *Clinics Only - Free-standing Provider-based Federally Qualified Health Center (FQHC). *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 98A | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Admission/Election Notice for Hospice |
| Bill Type 98B | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Termination/ Revocation Notice |
| Bill Type 98C | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Provider Notice |
| Bill Type 98D | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Election Void/Cancel |
| Bill Type 98E | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Hospice Change of Ownership |
| Bill Type 98F | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Beneficiary Initiated Adjustment Claim |
| Bill Type 98G | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CWF Initiated Adjustment Claim |
| Bill Type 98H | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | CMS Initiated Adjustment Claim |
| Bill Type 98I | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 98J | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Initiated Adjustment Claim/Other |
| Bill Type 98K | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | OIG Initiated Adjustment Claim |
| Bill Type 98M | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | MSP Initiated Adjustment Claim |
| Bill Type 98O | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Nonpayment/Zero Claims |
| Bill Type 98P | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | QIO Adjustment Claim |
| Bill Type 98Q | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Reopening/Adjustment |
| Bill Type 98X | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 98Y | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 98Z | Reserved for National Assignment | *Except Clinics & Special Facilities - NA. *Clinics Only - Reserved for National Assignment. *Special Facilities Only - Reserved for National Assignment. | New Abbreviated Encounter Submission |
| Bill Type 99A | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Admission/Election Notice for Hospice |
| Bill Type 99B | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Termination/ Revocation Notice |
| Bill Type 99C | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Provider Notice |
| Bill Type 99D | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Election Void/Cancel |
| Bill Type 99E | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Hospice Change of Ownership |
| Bill Type 99F | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Beneficiary Initiated Adjustment Claim |
| Bill Type 99G | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CWF Initiated Adjustment Claim |
| Bill Type 99H | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | CMS Initiated Adjustment Claim |
| Bill Type 99I | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | FI Adjustment Claim (Other than QIO or Provider) |
| Bill Type 99J | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Initiated Adjustment Claim/Other |
| Bill Type 99K | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | OIG Initiated Adjustment Claim |
| Bill Type 99M | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | MSP Initiated Adjustment Claim |
| Bill Type 99O | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Nonpayment/Zero Claims |
| Bill Type 99P | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | QIO Adjustment Claim |
| Bill Type 99Q | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Reopening/Adjustment |
| Bill Type 99X | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Void/Cancel a Prior Abbreviated Encounter Submission |
| Bill Type 99Y | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | Replacement of Prior Abbreviated Encounter Submission |
| Bill Type 99Z | Reserved for National Assignment | *Except Clinics & Special Facilities - Reserved for National Assignment. *Clinics Only - Other. *Special Facilities Only - Other. | New Abbreviated Encounter Submission |
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