Code Description
100
All inclusive room and board plus ancillary (Units required for
all codes)
101
All inclusive room and board
110
Room and Board - Private (Units required for all codes)
111 Medical/Surgical/Gyn - Private
112 OB - Private
113 Pediatric - Private
* 114 Psychiatric - Private
* 115 Hospice - Private
* 116 Detoxification - Private
117 Oncology - Private
119 Other - Private
120 Room and Board - Semi-Private Two Bed (Units required for all
codes)
121 Medical/Surgical/Gyn - 2 Bed
122 OB - 2 Bed
123 Pediatric - 2 Bed
* 124 Psychiatric - 2 Bed
* 125 Hospice - 2 Bed
* 126 Detoxification - 2 Bed
127 Oncology - 2 Bed
129 Other - 2 Bed
130
Semi-Private - Three and Four Beds (Units required for all codes)
131 Medical/Surgical/Gyn - 3 and 4 Beds
132 OB - 3 and 4 Beds
133 Pediatric - 3 and 4 Beds
* 134 Psychiatric - 3 and 4 Beds
* 135 Hospice - 3 and 4 Beds
* 136 Detoxification - 3 and 4 Beds
137 Oncology - 3 and 4 Beds
139 Other - 3 and 4 Beds
140
Private - Deluxe - General Classification (Units required)
150
Room and Board Ward (Medical and General) (Units required for all
codes)
151 Medical/Surgical/Gyn - Ward
152 OB - Ward
153 Pediatric - Ward
* 154 Psychiatric - Ward
* 155 Hospice - Ward
* 156 Detoxification - Ward
157 Oncology - Ward
159 Other - Ward
160
Other Room and Board (Units required for all codes)
161 R&B - Sterile Environment
* 167 R&B - Self Care
169 R&B - Other
170
Nursery (Units required for all codes)
171 Nursery/Newborn
172 Nursery/Premature
* 174 Nursery/Neonatal ICU
179 Nursery/Other
180
Leave of Absence - General Classification (Units required for all
codes)
* 183 Therapeutic Leave
190
Not Assigned
200
Coronary Care - General Classification (Units required for all
codes)
211 CCU/Myocardial Infarction
212 CCU/Pulmonary Care
* 213 CCU/Heart Transplant
* 214 CCU/Post-CCU
219 CCU/Other
220
Special Charges - General Classification
221 Admit Charge
222 Technical Support Charge
223 UR Service Charge
* 224 Late Discharge, Medically Necessary
229 Other Special Charge
230 Incremental Nursing Care Rate - General Classification
231 Nursing Incr/Nursery
232 Nursing Incr/OB
233 Nursing Incr/ICU
234 Nursing Incr/CCU
235 Nursing Incr/Hospice
239 Nursing Incr/Other
240
All Inclusive Ancillary - General Classification
249 All Inclusive Ancillary/Other
250
Pharmacy - General Classification
251 Pharmacy, Generic Drugs
252 Pharmacy, Non-Generic Drugs
* 253 Pharmacy, Take Home Drugs
254 Less than Effective Drugs
* 256 Pharmacy, Experimental Drugs
* 257 Pharmacy, Non-Prescription
* 258 Pharmacy, IV Solutions
259 Pharmacy, Other Pharmacy
260 IV Therapy - General Classification
261 Infusion Pump
269 Other IV Therapy
270
Medical/Surgical Supplies/Devices - General Classification
271 Temp Kit/Prob Covers/Service
272 Sterile Supply
* 273 Take Home Supplies
* 274 Prosthetic Devices
* 275 Pacemaker
* 277 Oxygen-Take Home
278 Other Implants
279 Other Supplies/Devices
280
Oncology - General Classification
289 Other Oncology
290
Durable Medical Equipment (Other Than Renal) - General Classification
* 291 DME/Rental
* 292 DME/Purchase
* 299 DME/Other Equipment
* 300 Laboratory - General Classification (CPT-4/HCPCS Code Required
in Form Locator 50 for Outpatient or Nonpatient Claims)
* 301 Chemistry
* 302 Immunology
* 303 Renal patient (home)
* 304 Non-Routine Dialysis
* 305 Hematology
* 306 Laboratory-Bacteriology and Microbiology
* 307 Laboratory - Urology
* 309 Laboratory - Other Laboratory
* 310
Laboratory Pathological - General Classification (CPT-R/HCPCS
Code Required in Form Locator 50 for Outpatient or Nonpatient Claims)
* 311 Laboratory Pathological/Cytology
* 312 Laboratory Pathological/Histology
* 314 Laboratory Pathological/Biopsy
* 319 Laboratory Pathological/Other
320
Radiology - Diagnostic - General Classification (Units required
for Outpatient for all codes)
* 321 Radiology - Dx - Angiocardiography
* 324 Radiology - Dx - Chest
* 329 Radiology - Dx - Other
330
Radiology-Therapeutic/General Classification (Units required for
Outpatient for all codes)
* 331 Chemotherapy-injected
* 332
Chemotherapy-oral
* 333
Radiation Therapy
* 335 Chemotherapy-IV
* 339 Other
340
Nuclear Medicine/General Classification
* 341 Diagnostic
* 342 Therapeutic
349
Other
350
CT Scan-General Classification
351
Head Scan
352
Body Scan
359
Other CT Scans
* 360
Operating Room Services - General Classification
361
Operating Room Services - Minor Surgery
* 362 Operating Room Services - Organ Transplant - Other Than Kidney
* 367 Operating Room Services - Kidney Transplant
369
Operating Room Services - Other
370
Anesthesia - General Classification
* 374 Acupuncture
379 Other Anesthesia
380
Blood - General Classification (Units required for all codes)
* 381 Packed Red Cells
* 382 Whole Blood
383 Plasma
384 Platelets
385
Leukocytes
386 Other Components
387 Other Derivatives (cyopricipitates)
389 Other Blood
390
Blood/Storage-Processing - General Classification
391 Blood/Administration
399 Blood/Other Storage and Processing
400
Other Imaging Services - General Classification
401 Mammography
* 402 Ultrasound
403 Screening Mammography
409 Other Imaging Services
410
Respiratory Services - General Classification (Units required for
Outpatient for all codes)
* 412 Inhalation Services
* 413 Hyperbaric Oxygen Therapy
419 Other Respiratory Services
* 420 Physical Therapy - General Classification (Units required for
Outpatient)
* 421 Visit Charge
* 422 Hourly Charge
* 423 Group Rate
* 424 Evaluation or Re-Evaluation
429 Other Physical Therapy
* 430 Occupational Therapy - General Classification (Units required
for Outpatient)
* 431 Visit Charge
* 432 Hourly Charge
* 433 Group Rate
* 434 Evaluation or Re-Evaluation
439 Other Occupational Therapy
440
Speech-Language Pathology-General Classification (Units required
for Outpatient)
* 441 Visit Charge
* 442 Hourly Charge
* 443 Group Rate
* 444 Evaluation or Re-Evaluation
449 Other Speech-Language Pathology
450
Emergency Room - General Classification
459 Other Emergency Room
460
Pulmonary Function - General Classification
469 Other Pulmonary Function
470
Audiology - General Classification
* 471 Diagnostic
* 472 Treatment
Other Audiology
480
Cardiology - General Classification
* 481 Cardiac Cath Lab
* 482 Stress Test
489 Other Cardiology
490
Ambulatory Surgical Care - General Classification
499 Other Ambulatory Surgical Care
* 510 Clinic - General Classification (Units required for all codes)
511 Chronic Pain Center
* 512 Dental Clinic
519 Other Clinic
520
Free-standing Clinic - General Classification (Units required)
530
Osteopathic Services - General Classification
540
Ambulance - General Classification (Units required for all codes)
541 Supplies
542 Medical Transport
543 Heart Mobile
544 Oxygen
545 Air Ambulance
546 Neonatal Ambulance Service
549 Other Ambulance
550 Skilled Nursing - General Classification
560
Medical Social Services - General Classification
610
MRI - General Classification
600-649 Not Assigned
650
Hospice Services - General Classification
660-699 Not Assigned
700
Cast Room - General Classification
710
Recovery Room - General Classification
719 Other Recovery Room
720
Labor Room/Delivery - General Classification
721 Labor
722 Delivery
723 Circumcision
* 724 Birthing Center (Units required)
729 Other Labor Room/Delivery
730
EKG ECG (Electrocardiogram) - General Classification
* 731 Holter Monitor
732 Telemetry
739 Other EKG/ECG
740
EEG (Electroencephalogram) - General Classification
741 Other EEG
750
Gastro-Intestinal Services - General Classification
759 Other Gastro-Intestinal
** 760
Treatment Room/Observation Room (see page XI-32)
761 Treatment/Inpatient/Endo
762 Treatment Room/Outpatient/Endo
763 Treatment Room/Inpatient/Non-Endo
764 Treatment Room/Outpatient/Non-Endo
769 Treatment Room/Other
880
Dialysis/Miscellaneous
881 Dialy/Ultrafiltration
889 Dialy/Misc/Other
890
Donor Bank - General Classification
891 Donor Bank/Bone
892 Donor Bank/Organ (Other Than Kidney)
893 Donor Bank/Skin
899 Other Donor Bank
900
Psychiatric/Psychological Treatments - General Classification
910
Psychiatric/Psychological Services - General Classification
* 920
Other Diagnostic Services - General Classification
* 921 Peripheral Vascular Lab
* 922 Electromyelogram
923 PAP Smear (Revenue Code 300 must be used with the CPT-4/HCPCS procedure
code identified in Form Locator 50.)
* 924 Allergy Test
* 925 Pregnancy Test
* 926 Other Diagnostic Service
93X Not Assigned
* 940 Other Therapeutic Service - General Classification
941 Recreational Therapy
942 Education/Training
943 Cardiac Rehabilitation
944 Drug Rehabilitation
945 Alcohol Rehabilitation
949 Other Therapeutic Services
95X Not Assigned
960
Professional Fees - General Classification (These codes (960-989)
may not be used for billing Medicaid. Professional fees must be billed on a
Physician claim form (HCFA-1500.)
961 Psychiatric
962 Ophthalmology
963 Anesthesiologist
964 Anesthetist
969 Other Professional Fees
97X Professional Fees
Subcategory
971 Laboratory
972 Radiology - Diagnostic
973 Radiology - Therapeutic
974 Radiology - Nuclear Medicine
975 Operating Room
976 Respiratory - Therapy
977 Physical Therapy
978 Occupational Therapy
979 Speech Pathology
98X
Subcategory
981 Emergency Room
982 Outpatient Services
983 Clinic
984 Medical Social Services
985 EKG
986 EEG
987 Hospital Visit
988 Consultation
989 Private Duty Nurse
990
Patient Convenience Items - General Classification
991 Cafeteria/Guest Tray
992 Private Linen Service
993 Telephone
994 TV/Radio
995 Nonpatient Room Rentals
996 Late Discharge Charge
997 Admission Kits
998 Beauty Shop/Barber
999 Other Patient Convenience Items
* DETAIL REQUIRED
**
Medicaid does not track Medicare's definition for outpatient services
which permits services beyond 24 hours duration to be billed as outpatient.
Under Medicaid criteria, any outpatient service less than 24 hours in duration
may be billed as outpatient if the patient is not admitted as an inpatient. In
such instances, if the 24- hour time period is exceeded, then the patient is
"deemed inpatient" and must be billed as an inpatient.