1 | Medical Care | 74 | Private Duty Nursing |
2 | Surgical | 75 | Prosthetic Device |
3 | Consultation | 76 | Dialysis |
4 | Diagnostic X-Ray | 77 | Otological Exam |
5 | Diagnostic Lab | 78 | Chemotherapy |
5 | Radiation Therapy | 79 | Allergy Testing |
7 | Anesthesia | 80 | Immunizations |
8 | Surgical Assistance | 81 | Routine Physical |
9 | Other Medical | 82 | Family Planning |
10 | Blood Charges | 83 | Infertility |
11 | Used Durable Medical Equipment | 84 | Abortion |
12 | Durable Medical Equipment Purchase | 85 | AIDS |
13 | Ambulatory Service Center Facility | 86 | Emergency Services |
14 | Renal Supplies in the Home | 87 | Cancer |
15 | Alternate Method Dialysis | 88 | Pharmacy |
16 | Chronic Renal Disease (CRD) Equipment | 89 | Free Standing Prescription Drug |
17 | Pre-Admission Testing | 90 | Mail Order Prescription Drug |
18 | Durable Medical Equipment Rental | 91 | Brand Name Prescription Drug |
19 | Pneumonia Vaccine | 92 | Generic Prescription Drug |
20 | Second Surgical Opinion | 93 | Podiatry |
21 | Third Surgical Opinion | 94 | Podiatry – Office Visits |
22 | Social Work | 95 | Podiatry – Nursing Home Visits |
23 | Diagnostic Dental | 96 | Professional ( Physician ) |
24 | Periodontics | 97 | Anesthesiologist |
25 | Restorative | 98 | Professional ( Physician ) Visit – Office |
26 | Endodontics | 99 | Professional ( Physician ) Visit – Inpatient |
27 | Maxillofacial Prosthetics | A0 | Professional ( Physician ) Visit – Outpatient |
28 | Adjunctive Dental Services | A1 | Professional ( Physician ) Visit – Nursing Home |
30 | Health Benefit Plan Coverage If Only a Single Category of Inquiry Can Be Supported, Use This Code | A2 | Professional ( Physician ) Visit – Skilled Nursing Facility |
32 | Plan Waiting Period | A3 | Professional ( Physician ) Visit – Home |
33 | Chiropractic | A4 | Psychiatric |
34 | Chiropractic Office Visits | A5 | Psychiatric – Room and Board |
35 | Dental Care | A6 | Psychotherapy |
36 | Dental Crowns | A7 | Psychiatric – Inpatient |
37 | Dental Accident | A8 | Psychiatric – Outpatient |
38 | Orthodontics | A9 | Rehabilitation |
39 | Prosthodontics | AA | Rehabilitation – Room and Board |
40 | Oral Surgery | AB | Rehabilitation – Inpatient |
41 | Routine (Preventive) Dental | AC | Rehabilitation – Outpatient |
42 | Home Health Care | AD | Occupational Therapy |
43 | Home Health Prescriptions | AE | Physical Medicine |
44 | Home Health Visits | AF | Speech Therapy |
45 | Hospice | AG | Skilled Nursing Care |
46 | Respite Care | AH | Skilled Nursing Care – Room and Board |
47 | Hospital | AI | Substance Abuse |
48 | Hospital – Inpatient | AJ | Alcoholism |
49 | Hospital – Room and Board | AK | Drug Addiction |
50 | Hospital – Outpatient | AL | Vision ( Optometry ) |
51 | Hospital – Emergency Accident | AM | Frames |
52 | Hospital – Emergency Medical | AN | Routine Exam |
53 | Hospital – Ambulatory Surgical | AO | Lenses |
54 | Long Term Care | AQ | Nonmedically Necessary Physical |
55 | Major Medical | AR | Experimental Drug Therapy |
56 | Medically Related Transportation | BA | Independent Medical Evaluation |
57 | Air Transportation | BB | Partial Hospitalization ( Psychiatric ) |
58 | Ambulance | BC | Day Care ( Psychiatric ) |
59 | Licensed Ambulance | BD | Cognitive Therapy |
60 | General Benefits | BE | Massage Therapy |
61 | In-Vitro Fertilization | BF | Pulmonary Rehabilitation |
62 | MRI/CAT Scan | BG | Cardiac Rehabilitation |
63 | Donor Procedures | BH | Pediatric |
64 | Acupuncture | BI | Nursery |
65 | Newborn Care | BJ | Skin |
66 | Pathology | BK | Orthopedic |
67 | Smoking Cessation | BL | Cardiac |
68 | Well Baby Care | BM | Lymphatic |
69 | Maternity | BN | Gastrointestinal |
70 | Transplants | BP | Endocrine |
71 | Audiology Exam | BQ | Neurology |
72 | Inhalation Therapy | BR | Eye |
73 | Diagnostic Medical | BS | Invasive Procedures |