BILL TYPES PAGE 1 OF 8 UPDATED: 9/13

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I

NPATIENT

H

OSPITAL

111 R

EGULAR

I

NPATIENT

112 F

IRST

P

ORTION

:

CONTINUOUS STAY INPATIENT CLAIM

113 S

UBSEQUENT

P

ORTION

:

CONTINUOUS STAY INPATIENT CLAIM

114 F

INAL

P

ORTION

:

CONTINUOUS STAY INPATIENT CLAIM

115 I

NPATIENT

:

LATE CHARGE

(

S

)

ONLY CLAIM

116 I

NPATIENT

:

ADJUSTMENT OR PRIOR CLAIM NEEDED

117 I

NPATIENT

:

REPLACEMENT OF PRIOR CLAIM

118 I

NPATIENT

:

VOID

/

CANCEL OF PRIOR CLAIM

H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

)

121 H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

):

ADMIT THROUGH DISCHARGE

122 H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

):

INTERIM

,

FIRST CLAIM

123 H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

):

INTERIM

,

CONTINUING CLAIM

124 H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

):

INTERIM

,

FINAL CLAIM

125 H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

):

LATE CHARGE

(

S

)

ONLY CLAIM

127 H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

):

REPLACEMENT OF PRIOR CLAIM

128 H

OSPITAL

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

):

VOID

/

CANCEL OF PRIOR CLAIM

O

UTPATIENT

H

OSPITAL

131 R

EGULAR

O

UTPATIENT

132 F

IRST

I

NTERIM

:

C

ONTINUING OUTPATIENT CLAIM

133 S

UBSEQUENT INTERIM

:

CONTINUING OUTPATIENT CLAIM

134 F

INAL

I

NTERIM

:

OUTPATIENT CLAIM

135 O

UTPATIENT

:

LATE CHARGE

(

S

)

ONLY CLAIM

136 O

UTPATIENT

:

ADJUSTMENT OF PRIOR CLAIM

137 O

UTPATIENT

:

REPLACEMENT OF PRIOR CLAIM

138 O

UTPATIENT

:

VOID

/

CANCEL OF PRIOR CLAIMS

O

UTPATIENT

D

IAGNOSTIC

(N

ON

T

REATMENT

P

LAN

)

141 O

UTPATIENT

D

IAGNOSTIC

:

ADMIT THROUGH DISCHARGE

142 O

UTPATIENT

D

IAGNOSTIC

:

INTERIM

,

FIRST CLAIM

143 O

UTPATIENT

D

IAGNOSTIC

:

INTERIM

,

CONTINUING CLAIM

144 O

UTPATIENT

D

IAGNOSTIC

:

INTERIM

,

FINAL CLAIM

145 O

UTPATIENT

D

IAGNOSTIC

:

LATE CHARGE

(

S

)

ONLY CLAIM

146 O

UTPATIENT

D

IAGNOSTIC

:

ADJUSTMENT OF PRIOR CLAIM

147 O

UTPATIENT

D

IAGNOSTIC

:

REPLACEMENT OF PRIOR CLAIM

148 O

UTPATIENT

D

IAGNOSTIC

:

VOID

/

CANCEL OF PRIOR CLAIM

H

OSPITAL

S

WING

B

EDS

181 H

OSPITAL

S

WING

B

EDS

:

ADMIT THROUGH DISCHARGE

182 H

OSPITAL

S

WING

B

EDS

:

INTERIM

,

FIRST CLAIM

183 H

OSPITAL

S

WING

B

EDS

:

INTERIM

,

CONTINUING CLAIM

(2)

185 H

OSPITAL

S

WING

B

EDS

:

LATE CHARGE

(

S

)

ONLY CLAIM

187 H

OSPITAL

S

WING

B

EDS

:

REPLACEMENT OF PRIOR CLAIM

188 H

OSPITAL

S

WING

B

EDS

:

VOID

/

CANCEL OF PRIOR CLAIM

S

KILLED

N

URSING

211 S

KILLED

N

URSING

:

ADMIT THROUGH DISCHARGE

212 S

KILLED

N

URSING

:

INTERIM

,

FIRST CLAIM

213 S

KILLED

N

URSING

:

INTERIM

,

CONTINUING CLAIM

214

S

KILLED

N

URSING

:

FINAL CLAIM

215 S

KILLED

N

URSING

:

LATE CHARGE

(

S

)

ONLY CLAIM

217 S

KILLED

N

URSING

:

REPLACEMENT OF PRIOR CLAIM

218 S

KILLED

N

URSING

:

VOID

/

CANCEL OF PRIOR CLAIM

S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

)

221 S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

):

ADMIT THROUGH DISCHARGE

222 S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

):

INTERIM

,

FIRST CLAIM

223 S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

):

INTERIM

,

CONTINUING CLAIM

224

S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

):

FINAL CLAIM

225 S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

):

LATE CHARGE

(

S

)

ONLY CLAIM

227 S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

):

REPLACEMENT OF PRIOR CLAIM

228 S

KILLED

N

URSING

(M

EDICARE

P

ART

B

ONLY

):

VOID

/

CANCEL OF PRIOR CLAIM

S

KILLED

N

URSING

O

UTPATIENT

231 S

KILLED

N

URSING

O

UTPATIENT

:

ADMIT THROUGH DISCHARGE

232 S

KILLED

N

URSING

O

UTPATIENT

:

INTERIM

,

FIRST CLAIM

233 S

KILLED

N

URSING

O

UTPATIENT

:

INTERIM

,

CONTINUING CLAIM

234

S

KILLED

N

URSING

O

UTPATIENT

:

FINAL CLAIM

235 S

KILLED

N

URSING

O

UTPATIENT

:

LATE CHARGE

(

S

)

ONLY CLAIM

237 S

KILLED

N

URSING

O

UTPATIENT

:

REPLACEMENT OF PRIOR CLAIM

238 S

KILLED

N

URSING

O

UTPATIENT

:

VOID

/

CANCEL OF PRIOR CLAIM

H

OME

H

EALTH

I

NPATIENT

(

NOT UNDER A

P

LAN OF

T

REATMENT

)

TION CHANGE

321 H

OME

H

EALTH

I

NPATIENT

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

ADMIT THROUGH DISCHARGE

DESCRIP

322 H

OME

H

EALTH

I

NPATIENT

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

INTERIM

,

FIRST CLAIM

323 H

OME

H

EALTH

I

NPATIENT

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

INTERIM

,

CONTINUING CLAIM

324 H

OME

H

EALTH

I

NPATIENT

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

INTERIM

,

FINAL CLAIM

325 H

OME

H

EALTH

I

NPATIENT

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

LATE CHARGE

(

S

)

ONLY CLAIM

(3)

PRIOR CLAIM

C

OORDINATED

H

OME

C

ARE

(M

EDICARE

A

T

REATMENT

P

LAN

I

NCLUDING

DME)

D

ISCONTINUED AS OF

O

CTOBER

1,

2013

331 C

OORDINATED

H

OME

C

ARE

:

ADMIT THROUGH DISCHARGE

332 C

OORDINATED

H

OME

C

ARE

:

INTERIM

,

FIRST CLAIM

333 C

OORDINATED

H

OME

C

ARE

:

INTERIM

,

CONTINUING CLAIM

334 C

OORDINATED

H

OME

C

ARE

:

INTERIM

,

FINAL CLAIM

335 C

OORDINATED

H

OME

C

ARE

:

LATE CHARGE

(

S

)

ONLY CLAIM

337 C

OORDINATED

H

OME

C

ARE

:

REPLACEMENT OF PRIOR CLAIM

338 C

OORDINATED

H

OME

C

ARE

:

VOID

/

CANCEL OF PRIOR CLAIM

H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

)

RIPTION CHANGE

341 H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

ADMIT THROUGH DISCHARGE

DESC

342 H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

INTERIM

,

FIRST CLAIM

343 H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

INTERIM

,

CONTINUING CLAIM

344 H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

INTERIM

,

FINAL CLAIM

345 H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

LATE CHARGE

(

S

)

ONLY CLAIM

347 H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

REPLACEMENT OF PRIOR CLAIM

348 H

OME

H

EALTH

S

ERVICES

(

NOT UNDER A

P

LAN OF

T

REATMENT

):

VOID

/

CANCEL OF PRIOR CLAIM

R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTION

H

OSPITAL

I

NPATIENT

411 R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

-

H

OSPITAL

I

NPATIENT

:

ADMIT THROUGH DISCHARGE

412 R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

-

H

OSPITAL

I

NPATIENT

:

INTERIM FIRST CLAIM

413 R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

-

H

OSPITAL

I

NPATIENT

:

INTERIM

,

CONTINUING CLAIM

414 R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

-

H

OSPITAL

I

NPATIENT

:

INTERIM

,

FINAL CLAIM

415 R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

-

H

OSPITAL

I

NPATIENT

:

LATE CHARGE

(

S

)

ONLY CLAIM

417 R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

-

H

OSPITAL

I

NPATIENT

:

REPLACEMENT OF PRIOR CLAIM

418 R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

-

H

OSPITAL

I

NPATIENT

:

(4)

R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

O

UTPATIENT

S

ERVICES

43X R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

O

UTPATIENT

S

ERVICES

I

NTERMEDIATE

C

ARE

L

EVEL

I

65X R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

O

UTPATIENT

S

ERVICES

I

NTERMEDIATE

C

ARE

L

EVEL

II

66X R

ELIGIOUS

N

ON

-M

EDICAL

H

EALTH

C

ARE

I

NSTITUTIONS

O

UTPATIENT

S

ERVICES

C

LINIC

R

URAL

H

EALTH

711 C

LINIC

R

URAL

H

EALTH

:

ADMIT THROUGH DISCHARGE

712 C

LINIC

R

URAL

H

EALTH

:

INTERIM

,

FIRST CLAIM

713 C

LINIC

R

URAL

H

EALTH

:

INTERIM

,

CONTINUING CLAIM

714 C

LINIC

R

URAL

H

EALTH

:

INTERIM

,

FINAL CLAIM

715 C

LINIC

R

URAL

H

EALTH

:

LATE CHARGE

(

S

)

ONLY CLAIM

717 C

LINIC

R

URAL

H

EALTH

:

REPLACEMENT OF PRIOR CLAIM

H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

721 H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

:

ADMIT THROUGH DISCHARGE

722 H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

:

INTERIM

,

FIRST CLAIM

723 H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

:

INTERIM

,

CONTINUING CLAIM

724 H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

:

INTERIM

,

FINAL CLAIM

725 H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

:

LATE CHARGE

(

S

)

ONLY CLAIM

727 H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

:

REPLACEMENT OF PRIOR CLAIM

728 H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

:

VOID

/

CANCEL OF PRIOR CLAIM

F

REE

S

TANDING

C

LINIC

73X F

REE

S

TANDING

C

LINIC

C

LINIC

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(ORF)

741 C

LINIC

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(ORF):

ADMIT THROUGH DISCHARGE

742 C

LINIC

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(ORF):

INTERIM

,

FIRST CLAIM

743 C

LINIC

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(ORF):

INTERIM

,

CONTINUING CLAIM

744 C

LINIC

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(ORF):

INTERIM

,

FINAL CLAIM

745 C

LINIC

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(ORF):

LATE CHARGE

(

S

)

ONLY

(5)

C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF)

751 C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF):

ADMIT THROUGH DISCHARGE

752 C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF):

INTERIM

,

FIRST CLAIM

753 C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF):

INTERIM

,

CONTINUING CLAIM

754 C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF):

INTERIM

,

FINAL CLAIM

755 C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF):

LATE CHARGE

(

S

)

ONLY CLAIM

757 C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF):

REPLACEMENT OF PRIOR CLAIM

758 C

LINIC

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(CORF):

VOID

/

CANCEL OF PRIOR CLAIM

C

LINIC

C

OMMUNITY

M

ENTAL

H

EALTH

C

ENTER

76X C

LINIC

C

OMMUNITY

M

ENTAL

H

EALTH

C

ENTER

C

LINIC

F

EDERALLY

Q

UALIFIED

H

EALTH

C

ENTER

77X C

LINIC

F

EDERALLY

Q

UALIFIED

H

EALTH

C

ENTER

L

ICENSED

F

REE

S

TANDING

E

MERGENCY

M

EDICAL

F

ACILITY

78X L

ICENSED

F

REE

S

TANDING

E

MERGENCY

M

EDICAL

F

ACILITY

C

LINIC

-

OTHER

79X C

LINIC

-

OTHER

S

PECIALTY

F

ACILITY

H

OSPICE

(N

ON

-H

OSPITAL

B

ASED

)

811 S

PECIALTY

F

ACILITY

H

OSPICE

(N

ON

-H

OSPITAL

B

ASED

):

ADMIT THROUGH DISCHARGE

812 S

PECIALTY

F

ACILITY

H

OSPICE

(N

ON

-H

OSPITAL

B

ASED

):

INTERIM

,

FIRST CLAIM

813 S

PECIALTY

F

ACILITY

H

OSPICE

(N

ON

-H

OSPITAL

B

ASED

):

INTERIM

,

CONTINUING CLAIM

814 S

PECIALTY

F

ACILITY

H

OSPICE

(N

ON

-H

OSPITAL

B

ASED

):

INTERIM

,

FINAL CLAIM

815 S

PECIALTY

F

ACILITY

H

OSPICE

(N

ON

-H

OSPITAL

B

ASED

):

LATE CHARGE

(

S

)

ONLY

817 S

PECIALTY

F

ACILITY

H

OSPICE

(N

ON

-H

OSPITAL

B

ASED

):

REPLACEMENT OF PRIOR CLAIM

(6)

S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

)

821 S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

):

ADMIT THROUGH DISCHARGE

822 S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

):

INTERIM

,

FIRST CLAIM

823 S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

):

INTERIM

,

CONTINUING CLAIM

824 S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

):

INTERIM

,

FINAL CLAIM

825 S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

):

LATE CHARGE

(

S

)

ONLY

827 S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

):

REPLACEMENT OF PRIOR CLAIM

828 S

PECIALTY

F

ACILITY

H

OSPICE

(H

OSPITAL

B

ASED

):

VOID

/

CANCEL OF PRIOR CLAIM

S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

831 S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

:

ADMIT THROUGH DISCHARGE

832 S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

:

INTERIM

,

FIRST CLAIM

833 S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

:

INTERIM

,

CONTINUING CLAIM

834 S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

:

INTERIM

,

FINAL CLAIM

835 S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

:

LATE CHARGE

(

S

)

ONLY CLAIM

837 S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

:

REPLACEMENT OF PRIOR CLAIM

838 S

PECIALTY

F

ACILITY

A

MBULATORY

S

URGERY

:

VOID

/

CANCEL OF PRIOR CLAIM

S

PECIALTY

F

ACILITY

F

REE

S

TANDING

B

IRTHING

C

ENTER ASSIFIED TO OUTPATIENT ONLY

84X S

PECIALTY

F

ACILITY

F

REE

S

TANDING

B

IRTHING

C

ENTER

RECL

S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

851 S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

:

ADMIT THROUGH DISCHARGE

852 S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

:

INTERIM

,

FIRST CLAIM

853 S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

:

INTERIM

,

CONTINUING CLAIM

854 S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

:

INTERIM

,

FINAL CLAIM

855 S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

:

LATE CHARGE

(

S

)

ONLY CLAIM

857 S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

:

REPLACEMENT OF PRIOR CLAIM

838 S

PECIALTY

F

ACILITY

C

RITICAL

A

CCESS

H

OSPITAL

:

VOID

/

CANCEL OF PRIOR CLAIM

S

PECIALTY

F

ACILITY

R

ESIDENTIAL

F

ACILITY

86X S

PECIALTY

F

ACILITY

R

ESIDENTIAL

F

ACILITY

S

PECIALTY

F

ACILITY

O

THER CLASSIFIED TO OUTPATIENT ONLY

89X S

PECIALTY

F

ACILITY

O

THER

RE

(7)

T

O DETERMINE ALL OTHER

T

YPE OF

B

ILLS

,

USE THE FOLLOWING

:

1ST

DIGIT

=

TYPE

OF

FACILITY

2ND

DIGIT

=

BILL

CLASSIFICATION

(3

DIFFERENT

CATEGORIES)

FACILITIES

EXCLUDING

CLINICS

&SPECIAL

FACILITIES

CLINICS

ONLY

SPECIAL

FACILITIES

ONLY

3RD

DIGIT

=

FREQUENCY

TYPE

OF

FACILITY

1ST

DIGIT:

H

OSPITAL

1

S

KILLED

N

URSING

2

H

OME

H

EALTH

3

C

HRISTIAN

S

CIENCE

(H

OSPITAL

) 4

C

HRISTIAN

S

CIENCE

(E

XTENDED

C

ARE

) 5

I

NTERMEDIATE

C

ARE

6

C

LINIC

7

S

PECIALTY

F

ACILITY

8

R

ESERVED FOR

N

ATIONAL

U

SE

9

BILL

CLASSIFICATION

(EXCEPT

CLINICS

AND

SPECIAL

FACILITIES)

2ND

DIGIT:

I

NPATIENT

(

INCLUDING

M

EDICARE

P

ART

A) 1

I

NPATIENT

(M

EDICARE

P

ART

B

ONLY

) 2

O

UTPATIENT

3

O

THER

(

FOR

H

OSPITAL

R

EFERENCED

D

IAGNOSTIC

S

ERVICES

,

OR

H

OME

H

EALTH NOT UNDER PLAN OF TREATMENT

)

4

I

NTERMEDIATE

C

ARE

-L

EVEL

I 5

I

NTERMEDIATE

C

ARE

-L

EVEL

II 6

S

UBACUTE

I

NPATIENT

(R

EVUE CODE

19X

REQUIRED

)

7

S

WING

B

EDS

8

R

ESERVED FOR

N

ATIONAL

U

SE

9

BILL

CLASSIFICATION

(CLINICS

ONLY)

2ND

DIGIT:

R

URAL

H

EALTH

1

H

OSPITAL

B

ASED OR

I

NDEPENDENT

R

ENAL

D

IALYSIS

C

ENTER

2

F

REE

S

TANDING

3

O

UTPATIENT

R

EHABILITATION

F

ACILITY

(ORF)

4

C

OMPREHENSIVE

O

UTPATIENT

R

EHABILITATION

F

ACILITIES

(CORFS)

(8)

R

ESERVED FOR

N

ATIONAL

U

SE

7-8

O

THER

9

BILL

CLASSIFICATION

(SPECIAL

FACILITIES

ONLY)

2ND

DIGIT:

H

OSPICE

(N

ON

-H

OSPITAL BASED

)

1

H

OSPICE

(H

OSPITAL BASED

) 2

A

MBULATORY

S

URGERY

C

ENTER

3

F

REE

S

TANDING

B

IRTHING

C

ENTER

4

R

URAL

P

RIMARY

C

ARE

H

OSPITAL

5

R

ESERVED FOR

N

ATIONAL

U

SE

6-8

O

THER

9

FREQUENCY

3RD

DIGIT:

N

ON

-P

AYMENT

/Z

ERO

C

LAIM

0

A

DMIT THROUGH DISCHARGE

1

I

NTERIM

,

FIRST CLAIM

2

I

NTERIM

,

CONTINUING CLAIM

3

I

NTERIM

,

LAST CLAIM

4

L

ATE

C

HARGE

(

S

)

ONLY CLAIM

5

R

EPLACEMENT OF PRIOR CLAIM

7

V

OID

/C

ANCEL OF PRIOR CLAIM

8

R

ESERVED FOR

N

ATIONAL

A

SSIGNMENT

9

Figure

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References

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