EDI claim status code – Full list

Here is the full list of EDI claim status code. It may be a denial, rejection and Acknowledgement.

0	Cannot provide further status electronically. Start: 01/01/1995
1	For more detailed information, see remittance advice. Start: 01/01/1995
2	More detailed information in letter. Start: 01/01/1995
3	Claim has been adjudicated and is awaiting payment cycle. Start: 01/01/1995
4	This is a subsequent request for information from the original request. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
5	This is a final request for information. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
6	Balance due from the subscriber. Start: 01/01/1995
7	Claim may be reconsidered at a future date. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
8	No payment due to contract/plan provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
9	No payment will be made for this claim. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
10	All originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
11	Some originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
12	One or more originally submitted procedure codes have been combined. Start: 01/01/1995 | Last Modified: 06/30/2001
13	All originally submitted procedure codes have been modified. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
14	Some all originally submitted procedure codes have been modified. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
15	One or more originally submitted procedure code have been modified. Start: 01/01/1995 | Last Modified: 06/30/2001
16	Claim/encounter has been forwarded to entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
17	Claim/encounter has been forwarded by third party entity to entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
18	Entity received claim/encounter, but returned invalid status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
19	Entity acknowledges receipt of claim/encounter. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
20	Accepted for processing. Start: 01/01/1995 | Last Modified: 06/30/2001
21	Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information. Start: 01/01/1995 | Last Modified: 07/09/2007
22	… before entering the adjudication system. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
23	Returned to Entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
24	Entity not approved as an electronic submitter. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
25	Entity not approved. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
26	Entity not found. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
27	Policy canceled. Start: 01/01/1995 | Last Modified: 06/30/2001
28	Claim submitted to wrong payer. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
29	Subscriber and policy number/contract number mismatched. Start: 01/01/1995
30	Subscriber and subscriber id mismatched. Start: 01/01/1995
31	Subscriber and policyholder name mismatched. Start: 01/01/1995
32	Subscriber and policy number/contract number not found. Start: 01/01/1995
33	Subscriber and subscriber id not found. Start: 01/01/1995
34	Subscriber and policyholder name not found. Start: 01/01/1995
35	Claim/encounter not found. Start: 01/01/1995
37	Predetermination is on file, awaiting completion of services. Start: 01/01/1995
38	Awaiting next periodic adjudication cycle. Start: 01/01/1995
39	Charges for pregnancy deferred until delivery. Start: 01/01/1995
40	Waiting for final approval. Start: 01/01/1995
41	Special handling required at payer site. Start: 01/01/1995
42	Awaiting related charges. Start: 01/01/1995
44	Charges pending provider audit. Start: 01/01/1995
45	Awaiting benefit determination. Start: 01/01/1995
46	Internal review/audit. Start: 01/01/1995
47	Internal review/audit – partial payment made. Start: 01/01/1995
48	Referral/authorization. Start: 01/01/1995 | Last Modified: 02/28/2001 | Stop: 01/01/2012 Notes: Refer to codes 252 and 761.
49	Pending provider accreditation review. Start: 01/01/1995
50	Claim waiting for internal provider verification. Start: 01/01/1995
51	Investigating occupational illness/accident. Start: 01/01/1995
52	Investigating existence of other insurance coverage. Start: 01/01/1995
53	Claim being researched for Insured ID/Group Policy Number error. Start: 01/01/1995
54	Duplicate of a previously processed claim/line. Start: 01/01/1995
55	Claim assigned to an approver/analyst. Start: 01/01/1995
56	Awaiting eligibility determination. Start: 01/01/1995
57	Pending COBRA information requested. Start: 01/01/1995
59	Information was requested by a non-electronic method. Note: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 10/17/2010
60	Information was requested by an electronic method. Note: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 10/17/2010
61	Eligibility for extended benefits. Start: 01/01/1995
64	Re-pricing information. Start: 01/01/1995
65	Claim/line has been paid. Start: 01/01/1995
66	Payment reflects usual and customary charges. Start: 01/01/1995
67	Payment made in full. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
68	Partial payment made for this claim. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
69	Payment reflects plan provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
70	Payment reflects contract provisions. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
71	Periodic installment released. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
72	Claim contains split payment. Start: 01/01/1995
73	Payment made to entity, assignment of benefits not on file. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
78	Duplicate of an existing claim/line, awaiting processing. Start: 01/01/1995
81	Contract/plan does not cover pre-existing conditions. Start: 01/01/1995
83	No coverage for newborns. Start: 01/01/1995
84	Service not authorized. Start: 01/01/1995
85	Entity not primary. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
86	Diagnosis and patient gender mismatch. Start: 01/01/1995 | Last Modified: 02/28/2000
87	Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
88	Entity not eligible for benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
89	Entity not eligible for dental benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
90	Entity not eligible for medical benefits for submitted dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
91	Entity not eligible/not approved for dates of service. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
92	Entity does not meet dependent or student qualification. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
93	Entity is not selected primary care provider. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
94	Entity not referred by selected primary care provider. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
95	Requested additional information not received. Start: 01/01/1995 | Last Modified: 07/09/2007 Notes: If known, the payer must report a second claim status code identifying the requested information.
96	No agreement with entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
97	Patient eligibility not found with entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
98	Charges applied to deductible. Start: 01/01/1995
99	Pre-treatment review. Start: 01/01/1995
100	Pre-certification penalty taken. Start: 01/01/1995
101	Claim was processed as adjustment to previous claim. Start: 01/01/1995
102	Newborn’s charges processed on mother’s claim. Start: 01/01/1995
103	Claim combined with other claim(s). Start: 01/01/1995
104	Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient) Start: 01/01/1995 | Last Modified: 06/01/2008
105	Claim/line is capitated. Start: 01/01/1995
106	This amount is not entity’s responsibility. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
107	Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services) Start: 01/01/1995 | Last Modified: 06/01/2008
108	Coverage has been canceled for this entity. (Use code 27) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
109	Entity not eligible. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
110	Claim requires pricing information. Start: 01/01/1995
111	At the policyholder’s request these claims cannot be submitted electronically. Start: 01/01/1995
112	Policyholder processes their own claims. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
113	Cannot process individual insurance policy claims. Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
114	Claim/service should be processed by entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
115	Cannot process HMO claims Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
116	Claim submitted to incorrect payer. Start: 01/01/1995
117	Claim requires signature-on-file indicator. Start: 01/01/1995
118	TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
119	TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
120	TPO rejected claim/line because claim does not contain enough information. (Use status code 21) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
121	Service line number greater than maximum allowable for payer. Start: 01/01/1995
122	Missing/invalid data prevents payer from processing claim. (Use CSC Code 21) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
123	Additional information requested from entity. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
124	Entity’s name, address, phone and id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
125	Entity’s name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
126	Entity’s address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
127	Entity’s Communication Number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 06/06/2010
128	Entity’s tax id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
129	Entity’s Blue Cross provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
130	Entity’s Blue Shield provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
131	Entity’s Medicare provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
132	Entity’s Medicaid provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
133	Entity’s UPIN. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
134	Entity’s CHAMPUS provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
135	Entity’s commercial provider id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
136	Entity’s health industry id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
137	Entity’s plan network id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
138	Entity’s site id . Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
139	Entity’s health maintenance provider id (HMO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
140	Entity’s preferred provider organization id (PPO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
141	Entity’s administrative services organization id (ASO). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
142	Entity’s license/certification number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
143	Entity’s state license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
144	Entity’s specialty license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
145	Entity’s specialty/taxonomy code. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
146	Entity’s anesthesia license number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
147	Entity’s qualification degree/designation (e.g. RN,PhD,MD). Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
148	Entity’s social security number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
149	Entity’s employer id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
150	Entity’s drug enforcement agency (DEA) number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
152	Pharmacy processor number. Start: 01/01/1995
153	Entity’s id number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
154	Relationship of surgeon & assistant surgeon. Start: 01/01/1995
155	Entity’s relationship to patient. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
156	Patient relationship to subscriber Start: 01/01/1995
157	Entity’s Gender. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
158	Entity’s date of birth. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
159	Entity’s date of death. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
160	Entity’s marital status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
161	Entity’s employment status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
162	Entity’s health insurance claim number (HICN). Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
163	Entity’s policy number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
164	Entity’s contract/member number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
165	Entity’s employer name, address and phone. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
166	Entity’s employer name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
167	Entity’s employer address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
168	Entity’s employer phone number. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
169	Entity’s employer id. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
170	Entity’s employee id. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
171	Other insurance coverage information (health, liability, auto, etc.). Start: 01/01/1995
172	Other employer name, address and telephone number. Start: 01/01/1995
173	Entity’s name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
174	Entity’s student status. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
175	Entity’s school name. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
176	Entity’s school address. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
177	Transplant recipient’s name, date of birth, gender, relationship to insured. Start: 01/01/1995 | Last Modified: 02/28/2000
178	Submitted charges. Start: 01/01/1995
179	Outside lab charges. Start: 01/01/1995
180	Hospital s semi-private room rate. Start: 01/01/1995
181	Hospital s room rate. Start: 01/01/1995
182	Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code. Start: 01/01/1995 | Last Modified: 01/24/2010
183	Amount entity has paid. Note: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 02/11/2010
184	Purchase price for the rented durable medical equipment. Start: 01/01/1995
185	Rental price for durable medical equipment. Start: 01/01/1995
186	Purchase and rental price of durable medical equipment. Start: 01/01/1995
187	Date(s) of service. Start: 01/01/1995
188	Statement from-through dates. Start: 01/01/1995
189	Facility admission date Start: 01/01/1995 | Last Modified: 10/31/2006
190	Facility discharge date Start: 01/01/1995 | Last Modified: 10/31/2006
191	Date of Last Menstrual Period (LMP) Start: 02/28/1997
192	Date of first service for current series/symptom/illness. Start: 01/01/1995
193	First consultation/evaluation date. Start: 02/28/1997
194	Confinement dates. Start: 01/01/1995
195	Unable to work dates/Disability Dates. Start: 01/01/1995 | Last Modified: 09/20/2009
196	Return to work dates. Start: 01/01/1995
197	Effective coverage date(s). Start: 01/01/1995
198	Medicare effective date. Start: 01/01/1995
199	Date of conception and expected date of delivery. Start: 01/01/1995
200	Date of equipment return. Start: 01/01/1995
201	Date of dental appliance prior placement. Start: 01/01/1995
202	Date of dental prior replacement/reason for replacement. Start: 01/01/1995
203	Date of dental appliance placed. Start: 01/01/1995
204	Date dental canal(s) opened and date service completed. Start: 01/01/1995
205	Date(s) dental root canal therapy previously performed. Start: 01/01/1995
206	Most recent date of curettage, root planing, or periodontal surgery. Start: 01/01/1995
207	Dental impression and seating date. Start: 01/01/1995
208	Most recent date pacemaker was implanted. Start: 01/01/1995
209	Most recent pacemaker battery change date. Start: 01/01/1995
210	Date of the last x-ray. Start: 01/01/1995
211	Date(s) of dialysis training provided to patient. Start: 01/01/1995
212	Date of last routine dialysis. Start: 01/01/1995
213	Date of first routine dialysis. Start: 01/01/1995
214	Original date of prescription/orders/referral. Start: 02/28/1997
215	Date of tooth extraction/evolution. Start: 01/01/1995
216	Drug information. Start: 01/01/1995
217	Drug name, strength and dosage form. Start: 01/01/1995
218	NDC number. Start: 01/01/1995
219	Prescription number. Start: 01/01/1995
220	Drug product id number. (Use code 218) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
221	Drug days supply and dosage. Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
222	Drug dispensing units and average wholesale price (AWP). Start: 01/01/1995
223	Route of drug/myelogram administration. Start: 01/01/1995
224	Anatomical location for joint injection. Start: 01/01/1995
225	Anatomical location. Start: 01/01/1995
226	Joint injection site. Start: 01/01/1995
227	Hospital information. Start: 01/01/1995
228	Type of bill for UB claim Start: 01/01/1995 | Last Modified: 10/31/2006
229	Hospital admission source. Start: 01/01/1995
230	Hospital admission hour. Start: 01/01/1995
231	Hospital admission type. Start: 01/01/1995
232	Admitting diagnosis. Start: 01/01/1995
233	Hospital discharge hour. Start: 01/01/1995
234	Patient discharge status. Start: 01/01/1995
235	Units of blood furnished. Start: 01/01/1995
236	Units of blood replaced. Start: 01/01/1995
237	Units of deductible blood. Start: 01/01/1995
238	Separate claim for mother/baby charges. Start: 01/01/1995
239	Dental information. Start: 01/01/1995
240	Tooth surface(s) involved. Start: 01/01/1995
241	List of all missing teeth (upper and lower). Start: 01/01/1995
242	Tooth numbers, surfaces, and/or quadrants involved. Start: 01/01/1995
243	Months of dental treatment remaining. Start: 01/01/1995
244	Tooth number or letter. Start: 01/01/1995
245	Dental quadrant/arch. Start: 01/01/1995
246	Total orthodontic service fee, initial appliance fee, monthly fee, length of service. Start: 01/01/1995
247	Line information. Start: 01/01/1995
248	Accident date, state, description and cause. Start: 01/01/1995 | Last Modified: 01/24/2010 | Stop: 01/01/2012
249	Place of service. Start: 01/01/1995
250	Type of service. Start: 01/01/1995
251	Total anesthesia minutes. Start: 01/01/1995
252	Entity’s authorization/certification number. Note: This code requires the use of an Entity Code. Start: 01/01/1995 | Last Modified: 01/30/2011
253	Procedure/revenue code for service(s) rendered. Use codes 454 or 455. Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
254	Principal diagnosis code. Start: 01/01/1995 | Last Modified: 01/30/2011
255	Diagnosis code. Start: 01/01/1995
256	DRG code(s). Start: 01/01/1995
257	ADSM-III-R code for services rendered. Start: 01/01/1995
258	Days/units for procedure/revenue code. Start: 01/01/1995
259	Frequency of service. Start: 01/01/1995
260	Length of medical necessity, including begin date. Start: 02/28/1997
261	Obesity measurements. Start: 01/01/1995
262	Type of surgery/service for which anesthesia was administered. Start: 01/01/1995
263	Length of time for services rendered. Start: 01/01/1995
264	Number of liters/minute & total hours/day for respiratory support. Start: 01/01/1995
265	Number of lesions excised. Start: 01/01/1995
266	Facility point of origin and destination – ambulance. Start: 01/01/1995
267	Number of miles patient was transported. Start: 01/01/1995
268	Location of durable medical equipment use. Start: 01/01/1995
269	Length/size of laceration/tumor. Start: 01/01/1995
270	Subluxation location. Start: 01/01/1995
271	Number of spine segments. Start: 01/01/1995
272	Oxygen contents for oxygen system rental. Start: 01/01/1995
273	Weight. Start: 01/01/1995
274	Height. Start: 01/01/1995
275	Claim. Start: 01/01/1995
276	UB04/HCFA-1450/1500 claim form Start: 01/01/1995 | Last Modified: 10/31/2006
277	Paper claim. Start: 01/01/1995
278	Signed claim form. Start: 01/01/1995 | Stop: 11/01/2011
279	Claim/service must be itemized Start: 01/01/1995 | Last Modified: 10/17/2010
280	Itemized claim by provider. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 279
281	Related confinement claim. Start: 01/01/1995
282	Copy of prescription. Start: 01/01/1995
283	Medicare entitlement information is required to determine primary coverage Start: 01/01/1995 | Last Modified: 01/27/2008
284	Copy of Medicare ID card. Start: 01/01/1995
285	Vouchers/explanation of benefits (EOB). Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 286
286	Other payer’s Explanation of Benefits/payment information. Start: 01/01/1995
287	Medical necessity for service. Start: 01/01/1995
288	Hospital late charges Start: 01/01/1995 | Last Modified: 10/17/2010
289	Reason for late discharge. Start: 01/01/1995 | Stop: 11/01/2011
290	Pre-existing information. Start: 01/01/1995
291	Reason for termination of pregnancy. Start: 01/01/1995
292	Purpose of family conference/therapy. Start: 01/01/1995
293	Reason for physical therapy. Start: 01/01/1995
294	Supporting documentation. Note: At least one other status code is required to identify the supporting documentation. Start: 01/01/1995 | Last Modified: 10/17/2010
295	Attending physician report. Start: 01/01/1995
296	Nurse’s notes. Start: 01/01/1995
297	Medical notes/report. Start: 02/28/1997
298	Operative report. Start: 01/01/1995
299	Emergency room notes/report. Start: 01/01/1995
300	Lab/test report/notes/results. Start: 02/28/1997
301	MRI report. Start: 01/01/1995
302	Refer to codes 300 for lab notes and 311 for pathology notes Start: 01/01/1995 | Stop: 01/31/1997
303	Physical therapy notes. Use code 297:6O (6 ‘OH’ – not zero) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
304	Reports for service. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 297, 298, 299, 300
305	Radiology/x-ray reports and/or interpretation Start: 01/01/1995 | Last Modified: 01/30/2011
306	Detailed description of service. Start: 01/01/1995
307	Narrative with pocket depth chart. Start: 01/01/1995
308	Discharge summary. Start: 01/01/1995
309	Code was duplicate of code 299 Start: 01/01/1995 | Stop: 01/31/1997
310	Progress notes for the six months prior to statement date. Start: 01/01/1995
311	Pathology notes/report. Start: 01/01/1995
312	Dental charting. Start: 01/01/1995
313	Bridgework information. Start: 01/01/1995
314	Dental records for this service. Start: 01/01/1995
315	Past perio treatment history. Start: 01/01/1995
316	Complete medical history. Start: 01/01/1995
317	Patient’s medical records. Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
318	X-rays/radiology films Start: 01/01/1995 | Last Modified: 10/17/2010
319	Pre/post-operative x-rays/photographs. Start: 02/28/1997
320	Study models. Start: 01/01/1995
321	Radiographs or models. (Use codes 318 and/or 320) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
322	Recent Full Mouth X-rays Start: 01/01/1995 | Last Modified: 10/17/2010
323	Study models, x-rays, and/or narrative. Start: 01/01/1995
324	Recent x-ray of treatment area and/or narrative. Start: 01/01/1995
325	Recent fm x-rays and/or narrative. Start: 01/01/1995
326	Copy of transplant acquisition invoice. Start: 01/01/1995
327	Periodontal case type diagnosis and recent pocket depth chart with narrative. Start: 01/01/1995
328	Speech therapy notes. Use code 297:6R Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
329	Exercise notes. Start: 01/01/1995
330	Occupational notes. Start: 01/01/1995
331	History and physical. Start: 01/01/1995 | Last Modified: 08/01/2007
332	Authorization/certification (include period covered). (Use code 252) Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
333	Patient release of information authorization. Start: 01/01/1995
334	Oxygen certification. Start: 01/01/1995
335	Durable medical equipment certification. Start: 01/01/1995
336	Chiropractic certification. Start: 01/01/1995
337	Ambulance certification/documentation. Start: 01/01/1995
338	Home health certification. Use code 332:4Y Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
339	Enteral/parenteral certification. Start: 01/01/1995
340	Pacemaker certification. Start: 01/01/1995
341	Private duty nursing certification. Start: 01/01/1995
342	Podiatric certification. Start: 01/01/1995
343	Documentation that facility is state licensed and Medicare approved as a surgical facility. Start: 01/01/1995
344	Documentation that provider of physical therapy is Medicare Part B approved. Start: 01/01/1995
345	Treatment plan for service/diagnosis Start: 01/01/1995
346	Proposed treatment plan for next 6 months. Start: 01/01/1995
347	Refer to code 345 for treatment plan and code 282 for prescription Start: 01/01/1995 | Stop: 01/31/1997
348	Chiropractic treatment plan. (Use 345:QL) Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
349	Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 ‘OH’ – not zero), 5P Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
350	Speech pathology treatment plan. Use code 345:6R Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
351	Physical/occupational therapy treatment plan. Use codes 345:6O (6 ‘OH’ – not zero), 6N Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
352	Duration of treatment plan. Start: 01/01/1995
353	Orthodontics treatment plan. Start: 01/01/1995
354	Treatment plan for replacement of remaining missing teeth. Start: 01/01/1995
355	Has claim been paid? Start: 01/01/1995 | Stop: 11/01/2011
356	Was blood furnished? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 235
357	Has or will blood be replaced? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 236
358	Does provider accept assignment of benefits? (Use code 589) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
359	Is there a release of information signature on file? (Use code 333) Start: 01/01/1995 | Last Modified: 10/17/2010 | Stop: 07/01/2011
360	Benefits Assignment Certification Indicator Start: 01/01/1995 | Last Modified: 10/17/2010
361	Is there other insurance? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 171 and 550
362	Is the dental patient covered by medical insurance? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 171
363	Possible Workers’ Compensation Start: 01/01/1995 | Last Modified: 10/17/2010
364	Is accident/illness/condition employment related? Start: 01/01/1995
365	Is service the result of an accident? Start: 01/01/1995
366	Is injury due to auto accident? Start: 01/01/1995
367	Is service performed for a recurring condition or new condition? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 397
368	Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 676
369	Does patient condition preclude use of ordinary bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335
370	Can patient operate controls of bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335
371	Is patient confined to room? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
372	Is patient confined to bed? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
373	Is patient an insulin diabetic? Start: 01/01/1995 | Stop: 11/01/2011
374	Is prescribed lenses a result of cataract surgery? Start: 01/01/1995
375	Was refraction performed? Start: 01/01/1995
376	Was charge for ambulance for a round-trip? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 453
377	Was durable medical equipment purchased new or used? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 184, 185, 186, 335
378	Is pacemaker temporary or permanent? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 340
379	Were services performed supervised by a physician? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to codes 453, 454, 666 & procedure code
380	CRNA supervision/medical direction. Start: 01/01/1995 | Last Modified: 10/17/2010
381	Is drug generic? Start: 01/01/1995 | Stop: 11/01/2011 Notes: Refer to code 216
382	Did provider authorize generic or brand name dispensing? Start: 01/01/1995
383	Nerve block use (surgery vs. pain management) Start: 01/01/1995 | Last Modified: 10/17/2010
384	Is prosthesis/crown/inlay placement an initial placement or a replacement? Start: 01/01/1995
385	Is appliance upper or lower arch & is appliance fixed or removable? Start: 01/01/1995
386	Orthodontic Treatment/Purpose Indicator Start: 01/01/1995 | Last Modified: 10/17/2010
387	Date patient last examined by entity. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
388	Date post-operative care assumed Start: 02/28/1997
389	Date post-operative care relinquished Start: 02/28/1997
390	Date of most recent medical event necessitating service(s) Start: 02/28/1997
391	Date(s) dialysis conducted Start: 02/28/1997
392	Date(s) of blood transfusion(s) Start: 02/28/1997 | Stop: 11/01/2011
393	Date of previous pacemaker check Start: 02/28/1997 | Stop: 11/01/2011
394	Date(s) of most recent hospitalization related to service Start: 02/28/1997
395	Date entity signed certification/recertification Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
396	Date home dialysis began Start: 02/28/1997
397	Date of onset/exacerbation of illness/condition Start: 02/28/1997
398	Visual field test results Start: 02/28/1997
399	Report of prior testing related to this service, including dates Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 417
400	Claim is out of balance Start: 02/28/1997
401	Source of payment is not valid Start: 02/28/1997
402	Amount must be greater than zero. Note: At least one other status code is required to identify which amount element is in error. Start: 02/28/1997 | Last Modified: 09/20/2009
403	Entity referral notes/orders/prescription Start: 02/28/1997
404	Specific findings, complaints, or symptoms necessitating service Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to codes 287, 488
405	Summary of services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 306
406	Brief medical history as related to service(s) Start: 02/28/1997
407	Complications/mitigating circumstances Start: 02/28/1997
408	Initial certification Start: 02/28/1997
409	Medication logs/records (including medication therapy) Start: 02/28/1997
410	Explain differences between treatment plan and patient’s condition Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
411	Medical necessity for non-routine service(s) Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 287
412	Medical records to substantiate decision of non-coverage Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
413	Explain/justify differences between treatment plan and services rendered. Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
414	Necessity for concurrent care (more than one physician treating the patient) Start: 02/28/1997 | Last Modified: 10/17/2010
415	Justify services outside composite rate Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 287
416	Verification of patient’s ability to retain and use information Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
417	Prior testing, including result(s) and date(s) as related to service(s) Start: 02/28/1997
418	Indicating why medications cannot be taken orally Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
419	Individual test(s) comprising the panel and the charges for each test Start: 02/28/1997
420	Name, dosage and medical justification of contrast material used for radiology procedure Start: 02/28/1997
421	Medical review attachment/information for service(s) Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
422	Homebound status Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 575
423	Prognosis Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
424	Statement of non-coverage including itemized bill Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
425	Itemize non-covered services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 279 & 286
426	All current diagnoses Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 255, 232 & 488
427	Emergency care provided during transport Start: 02/28/1997 | Stop: 11/01/2011
428	Reason for transport by ambulance Start: 02/28/1997
429	Loaded miles and charges for transport to nearest facility with appropriate services Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to codes 267, 178, 430
430	Nearest appropriate facility Start: 02/28/1997
431	Patient’s condition/functional status at time of service. Start: 02/28/1997 | Last Modified: 10/17/2010
432	Date benefits exhausted Start: 02/28/1997
433	Copy of patient revocation of hospice benefits Start: 02/28/1997
434	Reasons for more than one transfer per entitlement period Start: 02/28/1997
435	Notice of Admission Start: 02/28/1997
436	Short term goals Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
437	Long term goals Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 345
438	Number of patients attending session Start: 02/28/1997 | Stop: 11/01/2011
439	Size, depth, amount, and type of drainage wounds Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
440	why non-skilled caregiver has not been taught procedure Start: 02/28/1997 | Stop: 11/01/2011
441	Entity professional qualification for service(s) Start: 02/28/1997
442	Modalities of service Start: 02/28/1997
443	Initial evaluation report Start: 02/28/1997
444	Method used to obtain test sample Start: 02/28/1997 | Stop: 11/01/2011
445	Explain why hearing loss not correctable by hearing aid Start: 02/28/1997 | Stop: 11/01/2011 Notes: Refer to code 287
446	Documentation from prior claim(s) related to service(s) Start: 02/28/1997 | Stop: 11/01/2011
447	Plan of teaching Start: 02/28/1997 | Stop: 11/01/2011
448	Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used. Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
449	Projected date to discontinue service(s) Start: 02/28/1997
450	Awaiting spend down determination Start: 02/28/1997
451	Preoperative and post-operative diagnosis Start: 02/28/1997
452	Total visits in total number of hours/day and total number of hours/week Start: 02/28/1997
453	Procedure Code Modifier(s) for Service(s) Rendered Start: 02/28/1997
454	Procedure code for services rendered. Start: 02/28/1997
455	Revenue code for services rendered. Start: 02/28/1997
456	Covered Day(s) Start: 02/28/1997
457	Non-Covered Day(s) Start: 02/28/1997
458	Coinsurance Day(s) Start: 02/28/1997
459	Lifetime Reserve Day(s) Start: 02/28/1997
460	NUBC Condition Code(s) Start: 02/28/1997
461	NUBC Occurrence Code(s) and Date(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
462	NUBC Occurrence Span Code(s) and Date(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
463	NUBC Value Code(s) and/or Amount(s) Start: 02/28/1997 | Last Modified: 01/24/2010 | Stop: 01/01/2012
464	Payer Assigned Claim Control Number Start: 02/28/1997 | Last Modified: 10/31/2004
465	Principal Procedure Code for Service(s) Rendered Start: 02/28/1997
466	Entity’s Original Signature. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 01/30/2011
467	Entity Signature Date. Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
468	Patient Signature Source Start: 02/28/1997
469	Purchase Service Charge Start: 02/28/1997
470	Was service purchased from another entity? Note: This code requires use of an Entity Code. Start: 02/28/1997 | Last Modified: 02/11/2010
471	Were services related to an emergency? Start: 02/28/1997
472	Ambulance Run Sheet Start: 02/28/1997
473	Missing or invalid lab indicator Start: 06/30/1998
474	Procedure code and patient gender mismatch Start: 06/30/1998 | Last Modified: 02/29/2000
475	Procedure code not valid for patient age Start: 06/30/1998 | Last Modified: 02/29/2000
476	Missing or invalid units of service Start: 06/30/1998
477	Diagnosis code pointer is missing or invalid Start: 06/30/1998
478	Claim submitter’s identifier Start: 06/30/1998 | Last Modified: 01/24/2010
479	Other Carrier payer ID is missing or invalid Start: 06/30/1998
480	Entity’s claim filing indicator. Note: This code requires use of an Entity Code. Start: 06/30/1998 | Last Modified: 06/06/2010
481	Claim/submission format is invalid. Start: 10/31/1998
482	Date Error, Century Missing Start: 02/28/1999 | Last Modified: 09/20/2009 | Stop: 10/01/2010
483	Maximum coverage amount met or exceeded for benefit period. Start: 06/30/1999
484	Business Application Currently Not Available Start: 02/29/2000
485	More information available than can be returned in real time mode. Narrow your current search criteria. Start: 02/28/2001
486	Principal Procedure Date Start: 10/31/2001 | Last Modified: 07/01/2009
487	Claim not found, claim should have been submitted to/through ‘entity’. Note: This code requires use of an Entity Code. Start: 02/28/2002 | Last Modified: 02/11/2010
488	Diagnosis code(s) for the services rendered. Start: 06/30/2002
489	Attachment Control Number Start: 10/31/2002
490	Other Procedure Code for Service(s) Rendered Start: 02/28/2003
491	Entity not eligible for encounter submission. Note: This code requires use of an Entity Code. Start: 02/28/2003 | Last Modified: 02/11/2010
492	Other Procedure Date Start: 02/28/2003
493	Version/Release/Industry ID code not currently supported by information holder Start: 02/28/2003
494	Real-Time requests not supported by the information holder, resubmit as batch request Start: 02/28/2003
495	Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit. Start: 10/31/2003
496	Submitter not approved for electronic claim submissions on behalf of this entity. Note: This code requires use of an Entity Code. Start: 02/29/2004 | Last Modified: 02/11/2010
497	Sales tax not paid Start: 06/30/2004
498	Maximum leave days exhausted Start: 06/30/2004
499	No rate on file with the payer for this service for this entity Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
500	Entity’s Postal/Zip Code. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
501	Entity’s State/Province. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
502	Entity’s City. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
503	Entity’s Street Address. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
504	Entity’s Last Name. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
505	Entity’s First Name. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
506	Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Note: This code requires use of an Entity Code. Start: 06/30/2004 | Last Modified: 02/11/2010
507	HCPCS Start: 10/31/2004
508	ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 10/31/2004 | Last Modified: 07/01/2009
509	External Cause of Injury Code (E-code). Start: 10/31/2004 | Last Modified: 01/30/2011
510	Future date. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
511	Invalid character. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
512	Length invalid for receiver’s application system. Note: At least one other status code is required to identify the data element in error. Start: 10/31/2004 | Last Modified: 09/20/2009
513	HIPPS Rate Code for services Rendered Start: 10/31/2004
514	Entity’s Middle Name Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 01/30/2011
515	Managed Care review Start: 10/31/2004
516	Other Entity’s Adjudication or Payment/Remittance Date. Note: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary. Start: 10/31/2004 | Last Modified: 11/29/2009
517	Adjusted Repriced Claim Reference Number Start: 10/31/2004
518	Adjusted Repriced Line item Reference Number Start: 10/31/2004
519	Adjustment Amount Start: 10/31/2004
520	Adjustment Quantity Start: 10/31/2004
521	Adjustment Reason Code Start: 10/31/2004
522	Anesthesia Modifying Units Start: 10/31/2004
523	Anesthesia Unit Count Start: 10/31/2004
524	Arterial Blood Gas Quantity Start: 10/31/2004
525	Begin Therapy Date Start: 10/31/2004
526	Bundled or Unbundled Line Number Start: 10/31/2004
527	Certification Condition Indicator Start: 10/31/2004
528	Certification Period Projected Visit Count Start: 10/31/2004
529	Certification Revision Date Start: 10/31/2004
530	Claim Adjustment Indicator Start: 10/31/2004
531	Claim Disproportinate Share Amount Start: 10/31/2004
532	Claim DRG Amount Start: 10/31/2004
533	Claim DRG Outlier Amount Start: 10/31/2004
534	Claim ESRD Payment Amount Start: 10/31/2004
535	Claim Frequency Code Start: 10/31/2004
536	Claim Indirect Teaching Amount Start: 10/31/2004
537	Claim MSP Pass-through Amount Start: 10/31/2004
538	Claim or Encounter Identifier Start: 10/31/2004
539	Claim PPS Capital Amount Start: 10/31/2004
540	Claim PPS Capital Outlier Amount Start: 10/31/2004
541	Claim Submission Reason Code Start: 10/31/2004
542	Claim Total Denied Charge Amount Start: 10/31/2004
543	Clearinghouse or Value Added Network Trace Start: 10/31/2004
544	Clinical Laboratory Improvement Amendment Start: 10/31/2004
545	Contract Amount Start: 10/31/2004
546	Contract Code Start: 10/31/2004
547	Contract Percentage Start: 10/31/2004
548	Contract Type Code Start: 10/31/2004
549	Contract Version Identifier Start: 10/31/2004
550	Coordination of Benefits Code Start: 10/31/2004
551	Coordination of Benefits Total Submitted Charge Start: 10/31/2004
552	Cost Report Day Count Start: 10/31/2004
553	Covered Amount Start: 10/31/2004
554	Date Claim Paid Start: 10/31/2004
555	Delay Reason Code Start: 10/31/2004
556	Demonstration Project Identifier Start: 10/31/2004
557	Diagnosis Date Start: 10/31/2004
558	Discount Amount Start: 10/31/2004
559	Document Control Identifier Start: 10/31/2004
560	Entity’s Additional/Secondary Identifier. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
561	Entity’s Contact Name. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
562	Entity’s National Provider Identifier (NPI). Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
563	Entity’s Tax Amount. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
564	EPSDT Indicator Start: 10/31/2004
565	Estimated Claim Due Amount Start: 10/31/2004
566	Exception Code Start: 10/31/2004
567	Facility Code Qualifier Start: 10/31/2004
568	Family Planning Indicator Start: 10/31/2004
569	Fixed Format Information Start: 10/31/2004
570	Free Form Message Text Start: 10/31/2004 | Stop: 01/01/2013
571	Frequency Count Start: 10/31/2004
572	Frequency Period Start: 10/31/2004
573	Functional Limitation Code Start: 10/31/2004
574	HCPCS Payable Amount Home Health Start: 10/31/2004
575	Homebound Indicator Start: 10/31/2004
576	Immunization Batch Number Start: 10/31/2004
577	Industry Code Start: 10/31/2004
578	Insurance Type Code Start: 10/31/2004
579	Investigational Device Exemption Identifier Start: 10/31/2004
580	Last Certification Date Start: 10/31/2004
581	Last Worked Date Start: 10/31/2004
582	Lifetime Psychiatric Days Count Start: 10/31/2004
583	Line Item Charge Amount Start: 10/31/2004
584	Line Item Control Number Start: 10/31/2004
585	Denied Charge or Non-covered Charge Start: 10/31/2004 | Last Modified: 07/09/2007
586	Line Note Text Start: 10/31/2004
587	Measurement Reference Identification Code Start: 10/31/2004
588	Medical Record Number Start: 10/31/2004
589	Provider Accept Assignment Code Start: 10/31/2004 | Last Modified: 10/17/2010
590	Medicare Coverage Indicator Start: 10/31/2004
591	Medicare Paid at 100% Amount Start: 10/31/2004
592	Medicare Paid at 80% Amount Start: 10/31/2004
593	Medicare Section 4081 Indicator Start: 10/31/2004
594	Mental Status Code Start: 10/31/2004
595	Monthly Treatment Count Start: 10/31/2004
596	Non-covered Charge Amount Start: 10/31/2004
597	Non-payable Professional Component Amount Start: 10/31/2004
598	Non-payable Professional Component Billed Amount Start: 10/31/2004
599	Note Reference Code Start: 10/31/2004
600	Oxygen Saturation Qty Start: 10/31/2004
601	Oxygen Test Condition Code Start: 10/31/2004
602	Oxygen Test Date Start: 10/31/2004
603	Old Capital Amount Start: 10/31/2004
604	Originator Application Transaction Identifier Start: 10/31/2004
605	Orthodontic Treatment Months Count Start: 10/31/2004
606	Paid From Part A Medicare Trust Fund Amount Start: 10/31/2004
607	Paid From Part B Medicare Trust Fund Amount Start: 10/31/2004
608	Paid Service Unit Count Start: 10/31/2004
609	Participation Agreement Start: 10/31/2004
610	Patient Discharge Facility Type Code Start: 10/31/2004
611	Peer Review Authorization Number Start: 10/31/2004
612	Per Day Limit Amount Start: 10/31/2004
613	Physician Contact Date Start: 10/31/2004
614	Physician Order Date Start: 10/31/2004
615	Policy Compliance Code Start: 10/31/2004
616	Policy Name Start: 10/31/2004
617	Postage Claimed Amount Start: 10/31/2004
618	PPS-Capital DSH DRG Amount Start: 10/31/2004
619	PPS-Capital Exception Amount Start: 10/31/2004
620	PPS-Capital FSP DRG Amount Start: 10/31/2004
621	PPS-Capital HSP DRG Amount Start: 10/31/2004
622	PPS-Capital IME Amount Start: 10/31/2004
623	PPS-Operating Federal Specific DRG Amount Start: 10/31/2004
624	PPS-Operating Hospital Specific DRG Amount Start: 10/31/2004
625	Predetermination of Benefits Identifier Start: 10/31/2004
626	Pregnancy Indicator Start: 10/31/2004
627	Pre-Tax Claim Amount Start: 10/31/2004
628	Pricing Methodology Start: 10/31/2004
629	Property Casualty Claim Number Start: 10/31/2004
630	Referring CLIA Number Start: 10/31/2004
631	Reimbursement Rate Start: 10/31/2004
632	Reject Reason Code Start: 10/31/2004
633	Related Causes Code (Accident, auto accident, employment) Start: 10/31/2004 | Last Modified: 10/17/2010
634	Remark Code Start: 10/31/2004
635	Repriced Ambulatory Patient Group Code Start: 10/31/2004
636	Repriced Line Item Reference Number Start: 10/31/2004
637	Repriced Saving Amount Start: 10/31/2004
638	Repricing Per Diem or Flat Rate Amount Start: 10/31/2004
639	Responsibility Amount Start: 10/31/2004
640	Sales Tax Amount Start: 10/31/2004
641	Service Adjudication or Payment Date. Note: Use code 516. Start: 10/31/2004 | Last Modified: 09/20/2009 | Stop: 10/01/2010
642	Service Authorization Exception Code Start: 10/31/2004
643	Service Line Paid Amount Start: 10/31/2004
644	Service Line Rate Start: 10/31/2004
645	Service Tax Amount Start: 10/31/2004
646	Ship, Delivery or Calendar Pattern Code Start: 10/31/2004
647	Shipped Date Start: 10/31/2004
648	Similar Illness or Symptom Date Start: 10/31/2004
649	Skilled Nursing Facility Indicator Start: 10/31/2004
650	Special Program Indicator Start: 10/31/2004
651	State Industrial Accident Provider Number Start: 10/31/2004
652	Terms Discount Percentage Start: 10/31/2004
653	Test Performed Date Start: 10/31/2004
654	Total Denied Charge Amount Start: 10/31/2004
655	Total Medicare Paid Amount Start: 10/31/2004
656	Total Visits Projected This Certification Count Start: 10/31/2004
657	Total Visits Rendered Count Start: 10/31/2004
658	Treatment Code Start: 10/31/2004
659	Unit or Basis for Measurement Code Start: 10/31/2004
660	Universal Product Number Start: 10/31/2004
661	Visits Prior to Recertification Date Count CR702 Start: 10/31/2004
662	X-ray Availability Indicator Start: 10/31/2004
663	Entity’s Group Name. Note: This code requires use of an Entity Code. Start: 10/31/2004 | Last Modified: 02/11/2010
664	Orthodontic Banding Date Start: 10/31/2004
665	Surgery Date Start: 10/31/2004
666	Surgical Procedure Code Start: 10/31/2004
667	Real-Time requests not supported by the information holder, do not resubmit Start: 02/28/2005
668	Missing Endodontics treatment history and prognosis Start: 06/30/2005
669	Dental service narrative needed. Start: 10/31/2005
670	Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 | Last Modified: 02/28/2007
671	Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 | Last Modified: 02/28/2007
672	Other Payer’s payment information is out of balance Start: 10/31/2006
673	Patient Reason for Visit Start: 10/31/2006
674	Authorization exceeded Start: 10/31/2006
675	Facility admission through discharge dates Start: 10/31/2006
676	Entity possibly compensated by facility. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
677	Entity not affiliated. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
678	Revenue code and patient gender mismatch Start: 10/31/2006
679	Submit newborn services on mother’s claim Start: 10/31/2006
680	Entity’s Country. Note: This code requires use of an Entity Code. Start: 10/31/2006 | Last Modified: 02/11/2010
681	Claim currency not supported Start: 10/31/2006
682	Cosmetic procedure Start: 02/28/2007
683	Awaiting Associated Hospital Claims Start: 02/28/2007
684	Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Note: Only for use to reject claims or status requests in transactions that were ‘accepted with errors’ on a 997 or 999 Acknowledgement.) Start: 11/05/2007
685	Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit. Start: 01/27/2008
686	The claim/ encounter has completed the adjudication cycle and the entire claim has been voided Start: 01/27/2008
687	Claim estimation can not be completed in real time. Do not resubmit. Start: 01/27/2008
688	Present on Admission Indicator for reported diagnosis code(s). Start: 01/27/2008
689	Entity was unable to respond within the expected time frame. Note: This code requires use of an Entity Code. Start: 06/01/2008 | Last Modified: 02/11/2010
690	Multiple claims or estimate requests cannot be processed in real time. Start: 06/01/2008
691	Multiple claim status requests cannot be processed in real time. Start: 06/01/2008
692	Contracted funding agreement-Subscriber is employed by the provider of services Start: 09/21/2008
693	Amount must be greater than or equal to zero. Note: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009
694	Amount must not be equal to zero. Note: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009
695	Entity’s Country Subdivision Code. Note: This code requires use of an Entity Code. Start: 01/25/2009 | Last Modified: 02/11/2010
696	Claim Adjustment Group Code. Start: 01/25/2009
697	Invalid Decimal Precision. Note: At least one other status code is required to identify the data element in error. Start: 07/01/2009
698	Form Type Identification Start: 07/01/2009
699	Question/Response from Supporting Documentation Form Start: 07/01/2009
700	ICD10. Note: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 07/01/2009
701	Initial Treatment Date Start: 07/01/2009
702	Repriced Claim Reference Number Start: 11/01/2009
703	Advanced Billing Concepts (ABC) code Start: 01/24/2010
704	Claim Note Text Start: 01/24/2010
705	Repriced Allowed Amount Start: 01/24/2010
706	Repriced Approved Amount Start: 01/24/2010
707	Repriced Approved Ambulatory Patient Group Amount Start: 01/24/2010
708	Repriced Approved Revenue Code Start: 01/24/2010
709	Repriced Approved Service Unit Count Start: 01/24/2010
710	Line Adjudication Information. Note: At least one other status code is required to identify the data element in error. Start: 01/24/2010
711	Stretcher purpose Start: 01/24/2010
712	Obstetric Additional Units Start: 01/24/2010
713	Patient Condition Description Start: 01/24/2010
714	Care Plan Oversight Number Start: 01/24/2010
715	Acute Manifestation Date Start: 01/24/2010
716	Repriced Approved DRG Code Start: 01/24/2010
717	This claim has been split for processing. Start: 01/24/2010
718	Claim/service not submitted within the required timeframe (timely filing). Start: 01/24/2010
719	NUBC Occurrence Code(s) Start: 01/24/2010
720	NUBC Occurrence Code Date(s) Start: 01/24/2010
721	NUBC Occurrence Span Code(s) Start: 01/24/2010
722	NUBC Occurrence Span Code Date(s) Start: 01/24/2010
723	Drug days supply Start: 01/24/2010
724	Drug dosage Start: 01/24/2010
725	NUBC Value Code(s) Start: 01/24/2010
726	NUBC Value Code Amount(s) Start: 01/24/2010
727	Accident date Start: 01/24/2010
728	Accident state Start: 01/24/2010
729	Accident description Start: 01/24/2010
730	Accident cause Start: 01/24/2010
731	Measurement value/test result Start: 01/24/2010
732	Information submitted inconsistent with billing guidelines. Note: At least one other status code is required to identify the inconsistent information. Start: 01/24/2010
733	Prefix for entity’s contract/member number. Start: 01/24/2010
734	Verifying premium payment Start: 06/06/2010
735	This service/claim is included in the allowance for another service or claim. Start: 06/06/2010
736	A related or qualifying service/claim has not been received/adjudicated. Start: 06/06/2010
737	Current Dental Terminology (CDT) Code Start: 06/06/2010
738	Home Infusion EDI Coalition (HEIC) Product/Service Code Start: 06/06/2010
739	Jurisdiction Specific Procedure or Supply Code Start: 06/06/2010
740	Drop-Off Location Start: 06/06/2010
741	Entity must be a person. Note: This code requires use of an Entity Code. Start: 06/06/2010
742	Payer Responsibility Sequence Number Code Start: 06/06/2010
743	Entity’s credential/enrollment information. Note: This code requires use of an Entity Code. Start: 10/17/2010
744	Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. Start: 10/17/2010
745	Identifier Qualifier Note: At least one other status code is required to identify the specific identifier qualifier in error. Start: 10/17/2010
746	Duplicate Submission Note: use only at the information receiver level in the Health Care Claim Acknowledgement transaction. Start: 10/17/2010
747	Hospice Employee Indicator Start: 10/17/2010
748	Corrected Data Note: Requires a second status code to identify the corrected data. Start: 10/17/2010
749	Date of Injury/Illness Start: 10/17/2010
750	Auto Accident State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
751	Ambulance Pick-up State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
752	Ambulance Drop-off State or Province Code Start: 10/17/2010 | Last Modified: 01/30/2011
753	Co-pay status code. Start: 01/30/2011
754	Entity Name Suffix. Note: This code requires the use of an Entity Code. Start: 01/30/2011
755	Entity’s primary identifier. Note: This code requires the use of an Entity Code. Start: 01/30/2011
756	Entity’s Received Date. Note: This code requires the use of an Entity Code. Start: 01/30/2011
757	Last seen date. Start: 01/30/2011
758	Repriced approved HCPCS code. Start: 01/30/2011
759	Round trip purpose description. Start: 01/30/2011
760	Tooth status code. Start: 01/30/2011
761	Entity’s referral number. Note: This code requires the use of an Entity Code. Start: 01/30/2011
762	Locum Tenens Provider Identifier. Code must be used with Entity Code 82 – Rendering Provider Start: 01/20/2013
763	Ambulance Pickup ZipCode Start: 01/20/2013
764	Professional charges are non covered. Start: 06/02/2013
765	Institutional charges are non covered. Start: 06/02/2013
766	Services were performed during a Health Insurance Exchange (HIX) premium payment grace period. Start: 11/01/2013