Health Care Services Type Codes

$79 / year

Health Care Service Type Codes are used to identify the classification of service or benefits. This external code list is for use in ASC X12 Transaction Sets 270, 271 and 278, versions 006010 and higher. Version 005010 codes are available within the ASC X12 TR3 Implementation Guide. This dataset also contains information on the different service type codes and their descriptions, the start and modified dates, and the status for each code.

Complexity

This dataset under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), describes that if a covered entity conducts one of the adopted transactions electronically, they must use the adopted standard either from ASC X12N or NCPDP (for certain pharmacy transactions). Covered entities must adhere to the content and format requirements of each transaction.

For example, a health care provider will send a claim to a health plan to request payment for medical services. The Health Insurance Portability & Accountability Act of 1996 (HIPAA) named certain types of organizations as covered entities, including health plans, health care clearinghouses, and certain health care providers.

In the HIPAA regulations, the Secretary of Health and Human Services (HHS) adopted certain standard transactions for Electronic Data Interchange (EDI) of health care data. These transactions are: claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, coordination of benefits and premium payment including the Health Care Services Type Codes.

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 Department of Health Services (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

2009-09-20

Last Modified

2017-11-01

Version

2017-11-01

Update Frequency

Irregular

Temporal Coverage

2009 to 2017

Spatial Coverage

United States

Source

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

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Health Care Service Type Codes, Type of Bill Codes, ypes of services, Medicare Specialty Codes, Medicare Insurance Type Codes, Type of Service Codes, ASC X12 Transaction Sets, Insurance Types, Medical Codes

Other Titles

Health Insurance Portability and Accountability Act (HIPAA) Standard Electronic Transactions, Medicare Appropriate Health Care Services Type Codes (HCSTC), Health Care Services Type Codes (HCSTC) Specific Service Lines, Insurance Type and Health Care Services Type Codes, Medical Codes and Health Care Services Type Codes

Name Description Type Constraints
CodeHealth Care Services Type Codesstringunique : 1 required : 1
DescriptionDescription for each Health Care Services Type Codestringunique : 1 required : 1
Start_DateDate the Health Care Services Type Code started usagedaterequired : 1
Last_ModifiedDate the Health Care Services Type Code was changed/modifieddate-
Stop_DateDate the Health Care Services Type Code was stopped/deactivateddate-
StatusCode update whether Active, To be Deactivated or Deactivatedstringrequired : 1
NotesExplanation to redundant and/or replacement Health Care Services Type Codestring-
CodeDescriptionStart_DateLast_ModifiedStop_DateStatusNotes
55Major Medical2009-09-20Active
E9Level of Care 42009-09-20Active
32Plan Waiting Period2009-09-20Active
A7Psychiatric - Inpatient2009-09-20Active
A8Psychiatric - Outpatient2009-09-20Active
43Home Health Prescriptions2009-09-20Active
49Hospital - Room and Board2009-09-20Active
BVObstetrical/Gynecological2009-09-20Active
ABRehabilitation - Inpatient2009-09-20Active
ACRehabilitation - Outpatient2009-09-20Active