Health Care Provider Characteristics Codes

$179 / year

This Healthcare Provider Characteristics Codes list is for use with health care provider information for enrollment and credentialing transactions and their corresponding responses. This dataset also contains information on the different provider characteristics codes and their descriptions, the start and modified dates and the status of each code.


Healthcare Provider Characteristics Codes is intended to provide codified responses to questions presented to a health care provider applying to or registering with an entity and to report the outcome of such application or registration. It may also be used for responses to inquiries regarding provider participation or registration in a program or plan.

The Centers for Medicare & Medicaid Services (CMS) maintain and annually update a List of Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) Codes (Code List), which identifies all the items and services included within certain DHS categories. CMS updates the Code List to conform the list to the most recent publications of CPT and HCPCS and to account for changes in Medicare coverage and payment policies. The updated Code List is published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. That rule is usually published in November and generally becomes effective January 1 of the following year. In addition, we may publish other rules or correction notices that may change the Code List. CMS posts any changes to the Code List on its webpage as soon as possible after publication in the Federal Register.

The DHS categories defined by the Code List are:
– Clinical laboratory services;
– Physical therapy services, occupational therapy services, outpatient speech-language pathology services;
– Radiology and certain other imaging services; and
– Radiation therapy services and supplies.

**NOTE**: The following DHS categories are defined at 42 CFR §411.351 without reference to the Code List:
– Durable medical equipment and supplies;
– Parenteral and enteral nutrients, equipment and supplies;
– Prosthetics, orthotics, and prosthetic devices and supplies;
– Home health services;
– Outpatient prescription drugs; and
– Inpatient and outpatient hospital services.

Date Created


Last Modified




Update Frequency


Temporal Coverage

2004 to 2015

Spatial Coverage

United States


John Snow Labs; Centers of Medicare and Medicaid Services (CMS);

Source License URL

Source License Requirements


Source Citation



Healthcare Provider Characteristics Codes, healthcare provider information, HCPCS Codes credentialing transactions, HCPC code enrollment and credentialing transactions, responses to health application inquiries, responses to health application registrations, Health Code

Other Titles

Health Insurance Portability and Accountability Act (HIPAA) standard electronic transactions, Medicare appropriate Health Care Provider Characteristics Codes, Healthcare Provider Characteristics Codes and health care provider information, Healthcare Application Inquiries, Health Code and Health Care Provider Characteristics Codes

CodeHealthcare Provider Characteristics Codesstringunique : 1 required : 1
DescriptionDescription for each Healthcare Provider Characteristics Codestringrequired : 1
Start_DateDate the Healthcare Provider Characteristics Code started usagedaterequired : 1
Stop_DateDate the Healthcare Provider Characteristics Code was deactivated/stoppeddate-
StatusCode update whether Active, To be Deactivated or Deactivatedstringrequired : 1
NotesProvides other explanations and/or information about the Health Care Provider Characteristics Codestring-
CodeDescriptionStart DateStop DateStatusNotes
10Provider has a medical condition that impairs or limits him/her to practice2004-01-01Active
11Provider receives public funding2004-01-01Active
12This is a multi-specialty group2004-01-012005-10-01Deactivated
13This is a primary care provider2004-01-01Active
14Provider has ownership or financial interest in another medical establishment2004-01-01Active
15Professional liability coverage has been restricted/terminated/or modified2004-01-01Active
16This is the provider’s primary insurance coverage2004-01-01Active
17This is the provider’s excess insurance coverage2004-01-01Active
18Excess insurance coverage exists for this provider2004-01-01Active
19Provider is self-insured2004-01-01Active