Institutional:
Code Description
0A Intern/Residency Hospital Plan
0B Intern/Residency Uniform Pre-Payment (U.P.P.) 0C Freestanding Dialysis
0D Coordinated Home Care 0E Plan Hospital
0F Uniform Pre-Payment (U.P.P.) Hospital 0G Freestanding Surgicenter
0H State Hospital
0I Foreign Hospital (outside of U.S.A) 0J Christian Science Sanitarium
0K Freestanding Physical Therapy Center
0L Freestanding Alcohol & Substance Abuse Treatment Center 0M Alcohol & Substance Abuse - Outpatient Only
0N Non-Plan Provider 0O Extended Care Facility 0P Out-of-State Plan Hospital
0Q Medicare Approved Extended Care Facility (ECF) 0R Ambulance
0S Hospice (Plan)
0T Medicare Approved Home Heath Service (Coordinated Home Care) 0U Medicare Approved Freestanding Dialysis Center
0V State Licensed Ambulatory Surgicenter 0W JCAH Approved Extended Care Facility (ECF)
0X JCAH Approved Alcohol Rehabilitation (Inpatient & Outpatient) 0Y Nursing Home
0Z Contracted Provider Affiliation FE Free Standing ER
FR Free Standing Rehab IH Inpatient Hospital Psych LT Long Term Acute Care OF Occupational Therapy Facility PF Physical Therapy Facility
RH Rural Health Provider SF Skilled Nursing Facility ST Speech Therapy Facility TH Birthing Center
TI Psychiatric/Partial Day Hospital TJ Rehabilitation Hospital
T1 Non-Member Hospital T2 Government Hospital
T5 Renal Dialysis – Non-Contracting
Professional:
Code Description
Medical Initials
A0 Chiropractor D.C.
A1 Regular Medical Doctor, Medical Genetics (Ind) M.D.
A2 Podiatrist D.P.M., D.S.C.
A3 Dentist D.D.S., D.M.D.
A4 Radiology Technician, Laboratory Technician, Bacteriologist/Microbiologist -- A5 Group Medical Practice, Clinic or Mixed Therapy Group, Medical Genetics (Grp) --
A6 Osteopath, Medical Genetics (Ind) D.O.
A7 Physical Therapist R.P.T
A8 Clinical Psychologist or Neuropsychologist Ph.D.
A9 Registered Nurse R.N.
AB Hospital Based Physician, Medical Genetics (Ind) --
AC Ambulance Service --
AD Prosthetic-Orthotic Devices --
AE Durable Medical Equipment --
AF Optometrist O.D.
AG Optician --
AH Hearing Aid Supplier --
AI Audiologist --
AJ Christian Science Healer --
AK Paramedic --
AL Clinical Social Worker or Licensed Clinical Social Worker C.S.W, L.C.S.W
AM Pharmacist --
AN Home Health Agency H.H.A.
AP Pastoral Counselor --
AQ Registered Dietician --
AR Licensed Physician Assistant L.P.A.
AS Occupational Therapist O.T, O.T.R.
AT Speech Therapist S.T., R.S.T., S.L.P., S.P.T.
Code Description
Medical Initials
AV Podiatry Group --
AW Clinical Psychiatry Group or Neuropsychologist Group --
AX Registered Nurse Group R.N.
AY Chiropractic Group D.C.
AZ Osteopath Group D.O.
B0 Naprapath Individual D.N.
B1 License Clinical Professional Counselor L.C.P.C.
B2 Acupuncturist (Individual) L.Ac.
B3 Home Infusion Therapist Group --
B4 Massage Therapist --
B5 License Clinical Professional Counselor Group L.C.P.C.
B6 Licensed Clinical Social Worker Group L.C.S.W.
B7 Physical Therapy Group P.T., R.P.T., L.P.T.
B8 Rural Health Clinic --
B9 Advanced/Registered Nurse Practitioner R.N.P.
BA Licensed Marriage & Family Therapist L.M.F.T.
BB Hospital Based Physician Group, Medical Genetics (Grp) --
BC Registered Nurse First Assistant --
BD Prosthetic – Orthotic Group --
BE Surgical Assistant --
BF Optometrist Group O.D.
BG Optician Group --
BI Audiologist Group --
BL Certified Registered Nurse Anesthetist C.R.N.A.
BM Skilled Nurse/Home Health Aide/Durable Medical Equipment (DME) Therapy Group --
BN Skilled Nurse Therapist Group --
BP Specialty Pharmacy --
BQ Nutritionist/Dietician Group --
BR Licensed Physician Assistant Group L.P.A.
BS Occupational Therapist Group O.T., R.O.T., O.T.R.
BT Speech Therapist Group S.T., R.S.T., S.L.P.
BU Mixed Therapy – Occupational Physical Speech
BV Certified Diabetes Educator --
BW Licensed Midwife --
BX Certified Nurse Specialist/Individual C.N.S.
BY Naprapath Group D.N.
CA Licensed Marriage & Family Therapist Group L.M.F.T. CB Imaging Center
CC Registered Nurse First Assistant Group --
CD Certified Nurse Practitioner/Individual C.N.P.
CE Surgical Assistant Group --
CH Doctor of Oriental Medicine Group --
CI Early Intervention Specialist Individual CG Early Intervention Specialist Group
CP Certified Nurse Practitioner C.N.P.
Code Description
Medical Initials
CW Licensed Midwife Group --
CX Certified Nurse Specialist/Group C.N.S.
C0 Licensed Clinical Social Worker Group, Licensed Clinical Professional Counselor Group L.C.S.W., L.C.P.C.
C2 Acupuncture Group --
C4 Massage Therapist Group --
C9 Advance/Registered Nurse Practitioner Group R.N.P.
DA License Genetic Counselor (Individual)
DD Certified Nurse Practitioner Group C.N.P.
DP Certified Nurse Practitioner Group C.N.P.
DW Certified Nurse Midwife Individual C.N.M
D4 License Genetic Counselor Group D6 Behavioral Health Mixed Specialty Group D7 Telemedicine Group
D8 Licensed Social Worker Individual D9 Dietitian Individual
E1 Lactation Consultant Individual E2 Lactation Consultation Group
E3 Physical Therapy Assistant - Individual PTA
E4 Occupational Therapy Assistant - Individual OTA
E5 Speech Therapy Assistant - Individual SLPA
EW Certified Nurse Midwife Group C.N.M
F1 Federally Qualified Health Center (FQHC) F2 Family Planning
F4 Immunization Clinic Pharmacy
FW Licensed Practical Nurse L.P.N
IC Immunization Clinic
ID Independent Diagnostic Testing Facility IR Immediate Care Centers
IS Ambulatory Infusion Suites
HA Board Certified Behavioral Analyst Individual HB Assistant Behavioral Analyst Group
HC Doctorial Behavioral Analyst Group HD Doctorial Behavioral Analyst Individual HG Board Certified Behavioral Analyst Group HP Hospitalist Individual
HS Assistant Behavioral Analyst Individual PD Cardio Pulmonary Diagnostic Testing PH Pharmacist
RT Respiratory Therapist Individual SI Free Standing Imaging Center SL Sleep Lab
SS Home Sleep Study
TA Advanced Nurse Practitioner R.N.P.
TB Licensed Practical Nurse Group L.P.N
TC Licensed Professional Counselor L.P.C.
Code Description
Medical Initials
TE Home Infusion Therapist --
TF Licensed Chemical & Dependency Counselor --
TG Athletic Trainers Group TK Athletic Trainer (Individual)
T4 Licensed Marriage & Family Therapist L.M.F.T.
T6 Disease Management/Education --
T7 Licensed Psychological Associates --
T8 Certified Registered Nurse Anesthetist C.R.N.A.
T9 Certified Registered Nurse Anesthetist Group C.R.N.A. WS Wellness Screening
YZ Foreign Provider (Outside U.S.A.) --