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.