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kxzk/x12_status_codes_all.csv

Created May 13, 2024 20:03
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x12_status_codes_all.csv
status_code status_label
0 Cannot provide further status electronically.
1 For more detailed information, see remittance advice.
2 More detailed information in letter.
3 Claim has been adjudicated and is awaiting payment cycle.
4 This is a subsequent request for information from the original request.
5 This is a final request for information.
6 Balance due from the subscriber.
7 Claim may be reconsidered at a future date.
8 No payment due to contract/plan provisions.
9 No payment will be made for this claim.
10 All originally submitted procedure codes have been combined.
11 Some originally submitted procedure codes have been combined.
12 One or more originally submitted procedure codes have been combined.
13 All originally submitted procedure codes have been modified.
14 Some all originally submitted procedure codes have been modified.
15 One or more originally submitted procedure code have been modified.
16 Claim/encounter has been forwarded to entity. Usage: This code requires use of an Entity Code.
17 Claim/encounter has been forwarded by third party entity to entity. Usage: This code requires use of an Entity Code.
18 Entity received claim/encounter, but returned invalid status. Usage: This code requires use of an Entity Code.
19 Entity acknowledges receipt of claim/encounter. Usage: This code requires use of an Entity Code.
20 Accepted for processing.
21 Missing or invalid information. Usage: At least one other status code is required to identify the missing or invalid information.
22 ... before entering the adjudication system.
23 Returned to Entity. Usage: This code requires use of an Entity Code.
24 Entity not approved as an electronic submitter. Usage: This code requires use of an Entity Code.
25 Entity not approved. Usage: This code requires use of an Entity Code.
26 Entity not found. Usage: This code requires use of an Entity Code.
27 Policy canceled.
28 Claim submitted to wrong payer.
29 Subscriber and policy number/contract number mismatched.
30 Subscriber and subscriber id mismatched.
31 Subscriber and policyholder name mismatched.
32 Subscriber and policy number/contract number not found.
33 Subscriber and subscriber id not found.
34 Subscriber and policyholder name not found.
35 Claim/encounter not found.
37 Predetermination is on file, awaiting completion of services.
38 Awaiting next periodic adjudication cycle.
39 Charges for pregnancy deferred until delivery.
40 Waiting for final approval.
41 Special handling required at payer site.
42 Awaiting related charges.
44 Charges pending provider audit.
45 Awaiting benefit determination.
46 Internal review/audit.
47 Internal review/audit - partial payment made.
48 Referral/authorization.
49 Pending provider accreditation review.
50 Claim waiting for internal provider verification.
51 Investigating occupational illness/accident.
52 Investigating existence of other insurance coverage.
53 Claim being researched for Insured ID/Group Policy Number error.
54 Duplicate of a previously processed claim/line.
55 Claim assigned to an approver/analyst.
56 Awaiting eligibility determination.
57 Pending COBRA information requested.
59 Information was requested by a non-electronic method. Usage: At least one other status code is required to identify the requested information.
60 Information was requested by an electronic method. Usage: At least one other status code is required to identify the requested information.
61 Eligibility for extended benefits.
64 Re-pricing information.
65 Claim/line has been paid.
66 Payment reflects usual and customary charges.
67 Payment made in full.
68 Partial payment made for this claim.
69 Payment reflects plan provisions.
70 Payment reflects contract provisions.
71 Periodic installment released.
72 Claim contains split payment.
73 Payment made to entity, assignment of benefits not on file. Usage: This code requires use of an Entity Code.
78 Duplicate of an existing claim/line, awaiting processing.
81 Contract/plan does not cover pre-existing conditions.
83 No coverage for newborns.
84 Service not authorized.
85 Entity not primary. Usage: This code requires use of an Entity Code.
86 Diagnosis and patient gender mismatch.
87 Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code)
88 Entity not eligible for benefits for submitted dates of service. Usage: This code requires use of an Entity Code.
89 Entity not eligible for dental benefits for submitted dates of service. Usage: This code requires use of an Entity Code.
90 Entity not eligible for medical benefits for submitted dates of service. Usage: This code requires use of an Entity Code.
91 Entity not eligible/not approved for dates of service. Usage: This code requires use of an Entity Code.
92 Entity does not meet dependent or student qualification. Usage: This code requires use of an Entity Code.
93 Entity is not selected primary care provider. Usage: This code requires use of an Entity Code.
94 Entity not referred by selected primary care provider. Usage: This code requires use of an Entity Code.
95 Requested additional information not received.
96 No agreement with entity. Usage: This code requires use of an Entity Code.
97 Patient eligibility not found with entity. Usage: This code requires use of an Entity Code.
98 Charges applied to deductible.
99 Pre-treatment review.
100 Pre-certification penalty taken.
101 Claim was processed as adjustment to previous claim.
102 Newborn's charges processed on mother's claim.
103 Claim combined with other claim(s).
104 Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient)
105 Claim/line is capitated.
106 This amount is not entity's responsibility. Usage: This code requires use of an Entity Code.
107 Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)
108 Coverage has been canceled for this entity. (Use code 27)
109 Entity not eligible. Usage: This code requires use of an Entity Code.
110 Claim requires pricing information.
111 At the policyholder's request these claims cannot be submitted electronically.
112 Policyholder processes their own claims.
113 Cannot process individual insurance policy claims.
114 Claim/service should be processed by entity. Usage: This code requires use of an Entity Code.
115 Cannot process HMO claims
116 Claim submitted to incorrect payer.
117 Claim requires signature-on-file indicator.
118 TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN)
119 TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252)
120 TPO rejected claim/line because claim does not contain enough information. (Use status code 21)
121 Service line number greater than maximum allowable for payer.
122 Missing/invalid data prevents payer from processing claim. (Use CSC Code 21)
123 Additional information requested from entity. Usage: This code requires use of an Entity Code.
124 Entity's name, address, phone and id number. Usage: This code requires use of an Entity Code.
125 Entity's name. Usage: This code requires use of an Entity Code.
126 Entity's address. Usage: This code requires use of an Entity Code.
127 Entity's Communication Number. Usage: This code requires use of an Entity Code.
128 Entity's tax id. Usage: This code requires use of an Entity Code.
129 Entity's Blue Cross provider id. Usage: This code requires use of an Entity Code.
130 Entity's Blue Shield provider id. Usage: This code requires use of an Entity Code.
131 Entity's Medicare provider id. Usage: This code requires use of an Entity Code.
132 Entity's Medicaid provider id. Usage: This code requires use of an Entity Code.
133 Entity's UPIN. Usage: This code requires use of an Entity Code.
134 Entity's TRICARE provider id. Usage: This code requires use of an Entity Code.
135 Entity's commercial provider id. Usage: This code requires use of an Entity Code.
136 Entity's health industry id number. Usage: This code requires use of an Entity Code.
137 Entity's plan network id. Usage: This code requires use of an Entity Code.
138 Entity's site id . Usage: This code requires use of an Entity Code.
139 Entity's health maintenance provider id (HMO). Usage: This code requires use of an Entity Code.
140 Entity's preferred provider organization id (PPO). Usage: This code requires use of an Entity Code.
141 Entity's administrative services organization id (ASO). Usage: This code requires use of an Entity Code.
142 Entity's license/certification number. Usage: This code requires use of an Entity Code.
143 Entity's state license number. Usage: This code requires use of an Entity Code.
144 Entity's specialty license number. Usage: This code requires use of an Entity Code.
145 Entity's specialty/taxonomy code. Usage: This code requires use of an Entity Code.
146 Entity's anesthesia license number. Usage: This code requires use of an Entity Code.
147 Entity's qualification degree/designation (e.g. RN,PhD,MD). Usage: This code requires use of an Entity Code.
148 Entity's social security number. Usage: This code requires use of an Entity Code.
149 Entity's employer id. Usage: This code requires use of an Entity Code.
150 Entity's drug enforcement agency (DEA) number. Usage: This code requires use of an Entity Code.
152 Pharmacy processor number.
153 Entity's id number. Usage: This code requires use of an Entity Code.
154 Relationship of surgeon & assistant surgeon.
155 Entity's relationship to patient. Usage: This code requires use of an Entity Code.
156 Patient relationship to subscriber
157 Entity's Gender. Usage: This code requires use of an Entity Code.
158 Entity's date of birth. Usage: This code requires use of an Entity Code.
159 Entity's date of death. Usage: This code requires use of an Entity Code.
160 Entity's marital status. Usage: This code requires use of an Entity Code.
161 Entity's employment status. Usage: This code requires use of an Entity Code.
162 Entity's health insurance claim number (HICN). Usage: This code requires use of an Entity Code.
163 Entity's policy/group number. Usage: This code requires use of an Entity Code.
164 Entity's contract/member number. Usage: This code requires use of an Entity Code.
165 Entity's employer name, address and phone. Usage: This code requires use of an Entity Code.
166 Entity's employer name. Usage: This code requires use of an Entity Code.
167 Entity's employer address. Usage: This code requires use of an Entity Code.
168 Entity's employer phone number. Usage: This code requires use of an Entity Code.
169 Entity's employer id.
170 Entity's employee id. Usage: This code requires use of an Entity Code.
171 Other insurance coverage information (health, liability, auto, etc.).
172 Other employer name, address and telephone number.
173 Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Usage: This code requires use of an Entity Code.
174 Entity's student status. Usage: This code requires use of an Entity Code.
175 Entity's school name. Usage: This code requires use of an Entity Code.
176 Entity's school address. Usage: This code requires use of an Entity Code.
177 Transplant recipient's name, date of birth, gender, relationship to insured.
178 Submitted charges.
179 Outside lab charges.
180 Hospital s semi-private room rate.
181 Hospital s room rate.
182 Allowable/paid from other entities coverage Usage: This code requires the use of an entity code.
183 Amount entity has paid. Usage: This code requires use of an Entity Code.
184 Purchase price for the rented durable medical equipment.
185 Rental price for durable medical equipment.
186 Purchase and rental price of durable medical equipment.
187 Date(s) of service.
188 Statement from-through dates.
189 Facility admission date
190 Facility discharge date
191 Date of Last Menstrual Period (LMP)
192 Date of first service for current series/symptom/illness.
193 First consultation/evaluation date.
194 Confinement dates.
195 Unable to work dates/Disability Dates.
196 Return to work dates.
197 Effective coverage date(s).
198 Medicare effective date.
199 Date of conception and expected date of delivery.
200 Date of equipment return.
201 Date of dental appliance prior placement.
202 Date of dental prior replacement/reason for replacement.
203 Date of dental appliance placed.
204 Date dental canal(s) opened and date service completed.
205 Date(s) dental root canal therapy previously performed.
206 Most recent date of curettage, root planing, or periodontal surgery.
207 Dental impression and seating date.
208 Most recent date pacemaker was implanted.
209 Most recent pacemaker battery change date.
210 Date of the last x-ray.
211 Date(s) of dialysis training provided to patient.
212 Date of last routine dialysis.
213 Date of first routine dialysis.
214 Original date of prescription/orders/referral.
215 Date of tooth extraction/evolution.
216 Drug information.
217 Drug name, strength and dosage form.
218 NDC number.
219 Prescription number.
220 Drug product id number. (Use code 218)
221 Drug days supply and dosage.
222 Drug dispensing units and average wholesale price (AWP).
223 Route of drug/myelogram administration.
224 Anatomical location for joint injection.
225 Anatomical location.
226 Joint injection site.
227 Hospital information.
228 Type of bill for UB claim
229 Hospital admission source.
230 Hospital admission hour.
231 Hospital admission type.
232 Admitting diagnosis.
233 Hospital discharge hour.
234 Patient discharge status.
235 Units of blood furnished.
236 Units of blood replaced.
237 Units of deductible blood.
238 Separate claim for mother/baby charges.
239 Dental information.
240 Tooth surface(s) involved.
241 List of all missing teeth (upper and lower).
242 Tooth numbers, surfaces, and/or quadrants involved.
243 Months of dental treatment remaining.
244 Tooth number or letter.
245 Dental quadrant/arch.
246 Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
247 Line information.
248 Accident date, state, description and cause.
249 Place of service.
250 Type of service.
251 Total anesthesia minutes.
252 Entity's prior authorization/certification number. Usage: This code requires the use of an Entity Code.
253 Procedure/revenue code for service(s) rendered. Use codes 454 or 455.
254 Principal diagnosis code.
255 Diagnosis code.
256 DRG code(s).
257 ADSM-III-R code for services rendered.
258 Days/units for procedure/revenue code.
259 Frequency of service.
260 Length of medical necessity, including begin date.
261 Obesity measurements.
262 Type of surgery/service for which anesthesia was administered.
263 Length of time for services rendered.
264 Number of liters/minute & total hours/day for respiratory support.
265 Number of lesions excised.
266 Facility point of origin and destination - ambulance.
267 Number of miles patient was transported.
268 Location of durable medical equipment use.
269 Length/size of laceration/tumor.
270 Subluxation location.
271 Number of spine segments.
272 Oxygen contents for oxygen system rental.
273 Weight.
274 Height.
275 Claim.
276 UB04/HCFA-1450/1500 claim form
277 Paper claim.
278 Signed claim form.
279 Claim/service must be itemized
280 Itemized claim by provider.
281 Related confinement claim.
282 Copy of prescription.
283 Medicare entitlement information is required to determine primary coverage
284 Copy of Medicare ID card.
285 Vouchers/explanation of benefits (EOB).
286 Other payer's Explanation of Benefits/payment information.
287 Medical necessity for service.
288 Hospital late charges
289 Reason for late discharge.
290 Pre-existing information.
291 Reason for termination of pregnancy.
292 Purpose of family conference/therapy.
293 Reason for physical therapy.
294 Supporting documentation. Usage: At least one other status code is required to identify the supporting documentation.
295 Attending physician report.
296 Nurse's notes.
297 Medical notes/report.
298 Operative report.
299 Emergency room notes/report.
300 Lab/test report/notes/results.
301 MRI report.
302 Refer to codes 300 for lab notes and 311 for pathology notes
303 Physical therapy notes. Use code 297:6O (6 'OH' - not zero)
304 Reports for service.
305 Radiology/x-ray reports and/or interpretation
306 Detailed description of service.
307 Narrative with pocket depth chart.
308 Discharge summary.
309 Code was duplicate of code 299
310 Progress notes for the six months prior to statement date.
311 Pathology notes/report.
312 Dental charting.
313 Bridgework information.
314 Dental records for this service.
315 Past perio treatment history.
316 Complete medical history.
317 Patient's medical records.
318 X-rays/radiology films
319 Pre/post-operative x-rays/photographs.
320 Study models.
321 Radiographs or models. (Use codes 318 and/or 320)
322 Recent Full Mouth X-rays
323 Study models, x-rays, and/or narrative.
324 Recent x-ray of treatment area and/or narrative.
325 Recent fm x-rays and/or narrative.
326 Copy of transplant acquisition invoice.
327 Periodontal case type diagnosis and recent pocket depth chart with narrative.
328 Speech therapy notes. Use code 297:6R
329 Exercise notes.
330 Occupational notes.
331 History and physical.
332 Authorization/certification (include period covered). (Use code 252)
333 Patient release of information authorization.
334 Oxygen certification.
335 Durable medical equipment certification.
336 Chiropractic certification.
337 Ambulance certification/documentation.
338 Home health certification. Use code 332:4Y
339 Enteral/parenteral certification.
340 Pacemaker certification.
341 Private duty nursing certification.
342 Podiatric certification.
343 Documentation that facility is state licensed and Medicare approved as a surgical facility.
344 Documentation that provider of physical therapy is Medicare Part B approved.
345 Treatment plan for service/diagnosis
346 Proposed treatment plan for next 6 months.
347 Refer to code 345 for treatment plan and code 282 for prescription
348 Chiropractic treatment plan. (Use 345:QL)
349 Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P
350 Speech pathology treatment plan. Use code 345:6R
351 Physical/occupational therapy treatment plan. Use codes 345:6O (6 'OH' - not zero), 6N
352 Duration of treatment plan.
353 Orthodontics treatment plan.
354 Treatment plan for replacement of remaining missing teeth.
355 Has claim been paid?
356 Was blood furnished?
357 Has or will blood be replaced?
358 Does provider accept assignment of benefits? (Use code 589)
359 Is there a release of information signature on file? (Use code 333)
360 Benefits Assignment Certification Indicator
361 Is there other insurance?
362 Is the dental patient covered by medical insurance?
363 Possible Workers' Compensation
364 Is accident/illness/condition employment related?
365 Is service the result of an accident?
366 Is injury due to auto accident?
367 Is service performed for a recurring condition or new condition?
368 Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility?
369 Does patient condition preclude use of ordinary bed?
370 Can patient operate controls of bed?
371 Is patient confined to room?
372 Is patient confined to bed?
373 Is patient an insulin diabetic?
374 Is prescribed lenses a result of cataract surgery?
375 Was refraction performed?
376 Was charge for ambulance for a round-trip?
377 Was durable medical equipment purchased new or used?
378 Is pacemaker temporary or permanent?
379 Were services performed supervised by a physician?
380 CRNA supervision/medical direction.
381 Is drug generic?
382 Did provider authorize generic or brand name dispensing?
383 Nerve block use (surgery vs. pain management)
384 Is prosthesis/crown/inlay placement an initial placement or a replacement?
385 Is appliance upper or lower arch & is appliance fixed or removable?
386 Orthodontic Treatment/Purpose Indicator
387 Date patient last examined by entity. Usage: This code requires use of an Entity Code.
388 Date post-operative care assumed
389 Date post-operative care relinquished
390 Date of most recent medical event necessitating service(s)
391 Date(s) dialysis conducted
392 Date(s) of blood transfusion(s)
393 Date of previous pacemaker check
394 Date(s) of most recent hospitalization related to service
395 Date entity signed certification/recertification Usage: This code requires use of an Entity Code.
396 Date home dialysis began
397 Date of onset/exacerbation of illness/condition
398 Visual field test results
399 Report of prior testing related to this service, including dates
400 Claim is out of balance
401 Source of payment is not valid
402 Amount must be greater than zero. Usage: At least one other status code is required to identify which amount element is in error.
403 Entity referral notes/orders/prescription. Effective 05/01/2018: Entity referral notes/orders/prescription. Usage: this code requires use of an entity code.
404 Specific findings, complaints, or symptoms necessitating service
405 Summary of services
406 Brief medical history as related to service(s)
407 Complications/mitigating circumstances
408 Initial certification
409 Medication logs/records (including medication therapy)
410 Explain differences between treatment plan and patient's condition
411 Medical necessity for non-routine service(s)
412 Medical records to substantiate decision of non-coverage
413 Explain/justify differences between treatment plan and services rendered.
414 Necessity for concurrent care (more than one physician treating the patient)
415 Justify services outside composite rate
416 Verification of patient's ability to retain and use information
417 Prior testing, including result(s) and date(s) as related to service(s)
418 Indicating why medications cannot be taken orally
419 Individual test(s) comprising the panel and the charges for each test
420 Name, dosage and medical justification of contrast material used for radiology procedure
421 Medical review attachment/information for service(s)
422 Homebound status
423 Prognosis
424 Statement of non-coverage including itemized bill
425 Itemize non-covered services
426 All current diagnoses
427 Emergency care provided during transport
428 Reason for transport by ambulance
429 Loaded miles and charges for transport to nearest facility with appropriate services
430 Nearest appropriate facility
431 Patient's condition/functional status at time of service.
432 Date benefits exhausted
433 Copy of patient revocation of hospice benefits
434 Reasons for more than one transfer per entitlement period
435 Notice of Admission
436 Short term goals
437 Long term goals
438 Number of patients attending session
439 Size, depth, amount, and type of drainage wounds
440 why non-skilled caregiver has not been taught procedure
441 Entity professional qualification for service(s)
442 Modalities of service
443 Initial evaluation report
444 Method used to obtain test sample
445 Explain why hearing loss not correctable by hearing aid
446 Documentation from prior claim(s) related to service(s)
447 Plan of teaching
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.
449 Projected date to discontinue service(s)
450 Awaiting spend down determination
451 Preoperative and post-operative diagnosis
452 Total visits in total number of hours/day and total number of hours/week
453 Procedure Code Modifier(s) for Service(s) Rendered
454 Procedure code for services rendered.
455 Revenue code for services rendered.
456 Covered Day(s)
457 Non-Covered Day(s)
458 Coinsurance Day(s)
459 Lifetime Reserve Day(s)
460 NUBC Condition Code(s)
461 NUBC Occurrence Code(s) and Date(s)
462 NUBC Occurrence Span Code(s) and Date(s)
463 NUBC Value Code(s) and/or Amount(s)
464 Payer Assigned Claim Control Number
465 Principal Procedure Code for Service(s) Rendered
466 Entity's Original Signature. Usage: This code requires use of an Entity Code.
467 Entity Signature Date. Usage: This code requires use of an Entity Code.
468 Patient Signature Source
469 Purchase Service Charge
470 Was service purchased from another entity? Usage: This code requires use of an Entity Code.
471 Were services related to an emergency?
472 Ambulance Run Sheet
473 Missing or invalid lab indicator
474 Procedure code and patient gender mismatch
475 Procedure code not valid for patient age
476 Missing or invalid units of service
477 Diagnosis code pointer is missing or invalid
478 Claim submitter's identifier
479 Other Carrier payer ID is missing or invalid
480 Entity's claim filing indicator. Usage: This code requires use of an Entity Code.
481 Claim/submission format is invalid.
482 Date Error, Century Missing
483 Maximum coverage amount met or exceeded for benefit period.
484 Business Application Currently Not Available
485 More information available than can be returned in real time mode. Narrow your current search criteria. This change effective September 1, 2017: More information available than can be returned in real-time mode. Narrow your current search criteria.
486 Principal Procedure Date
487 Claim not found, claim should have been submitted to/through 'entity'. Usage: This code requires use of an Entity Code.
488 Diagnosis code(s) for the services rendered.
489 Attachment Control Number
490 Other Procedure Code for Service(s) Rendered
491 Entity not eligible for encounter submission. Usage: This code requires use of an Entity Code.
492 Other Procedure Date
493 Version/Release/Industry ID code not currently supported by information holder
494 Real-Time requests not supported by the information holder, resubmit as batch request This change effective September 1, 2017: Real-time requests not supported by the information holder, resubmit as batch request
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.
496 Submitter not approved for electronic claim submissions on behalf of this entity. Usage: This code requires use of an Entity Code.
497 Sales tax not paid
498 Maximum leave days exhausted
499 No rate on file with the payer for this service for this entity Usage: This code requires use of an Entity Code.
500 Entity's Postal/Zip Code. Usage: This code requires use of an Entity Code.
501 Entity's State/Province. Usage: This code requires use of an Entity Code.
502 Entity's City. Usage: This code requires use of an Entity Code.
503 Entity's Street Address. Usage: This code requires use of an Entity Code.
504 Entity's Last Name. Usage: This code requires use of an Entity Code.
505 Entity's First Name. Usage: This code requires use of an Entity Code.
506 Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Usage: This code requires use of an Entity Code.
507 HCPCS
508 ICD9 Usage: At least one other status code is required to identify the related procedure code or diagnosis code.
509 External Cause of Injury Code.
510 Future date. Usage: At least one other status code is required to identify the data element in error.
511 Invalid character. Usage: At least one other status code is required to identify the data element in error.
512 Length invalid for receiver's application system. Usage: At least one other status code is required to identify the data element in error.
513 HIPPS Rate Code for services Rendered
514 Entity's Middle Name Usage: This code requires use of an Entity Code.
515 Managed Care review
516 Other Entity's Adjudication or Payment/Remittance Date. Usage: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary.
517 Adjusted Repriced Claim Reference Number
518 Adjusted Repriced Line item Reference Number
519 Adjustment Amount
520 Adjustment Quantity
521 Adjustment Reason Code
522 Anesthesia Modifying Units
523 Anesthesia Unit Count
524 Arterial Blood Gas Quantity
525 Begin Therapy Date
526 Bundled or Unbundled Line Number
527 Certification Condition Indicator
528 Certification Period Projected Visit Count
529 Certification Revision Date
530 Claim Adjustment Indicator
531 Claim Disproportinate Share Amount
532 Claim DRG Amount
533 Claim DRG Outlier Amount
534 Claim ESRD Payment Amount
535 Claim Frequency Code
536 Claim Indirect Teaching Amount
537 Claim MSP Pass-through Amount
538 Claim or Encounter Identifier
539 Claim PPS Capital Amount
540 Claim PPS Capital Outlier Amount
541 Claim Submission Reason Code
542 Claim Total Denied Charge Amount
543 Clearinghouse or Value Added Network Trace
544 Clinical Laboratory Improvement Amendment (CLIA) Number
545 Contract Amount
546 Contract Code
547 Contract Percentage
548 Contract Type Code
549 Contract Version Identifier
550 Coordination of Benefits Code
551 Coordination of Benefits Total Submitted Charge
552 Cost Report Day Count
553 Covered Amount
554 Date Claim Paid
555 Delay Reason Code
556 Demonstration Project Identifier
557 Diagnosis Date
558 Discount Amount
559 Document Control Identifier
560 Entity's Additional/Secondary Identifier. Usage: This code requires use of an Entity Code.
561 Entity's Contact Name. Usage: This code requires use of an Entity Code.
562 Entity's National Provider Identifier (NPI). Usage: This code requires use of an Entity Code.
563 Entity's Tax Amount. Usage: This code requires use of an Entity Code.
564 EPSDT Indicator
565 Estimated Claim Due Amount
566 Exception Code
567 Facility Code Qualifier
568 Family Planning Indicator
569 Fixed Format Information
570 Free Form Message Text
571 Frequency Count
572 Frequency Period
573 Functional Limitation Code
574 HCPCS Payable Amount Home Health
575 Homebound Indicator
576 Immunization Batch Number
577 Industry Code
578 Insurance Type Code
579 Investigational Device Exemption Identifier
580 Last Certification Date
581 Last Worked Date
582 Lifetime Psychiatric Days Count
583 Line Item Charge Amount
584 Line Item Control Number
585 Denied Charge or Non-covered Charge
586 Line Note Text
587 Measurement Reference Identification Code
588 Medical Record Number
589 Provider Accept Assignment Code
590 Medicare Coverage Indicator
591 Medicare Paid at 100% Amount
592 Medicare Paid at 80% Amount
593 Medicare Section 4081 Indicator
594 Mental Status Code
595 Monthly Treatment Count
596 Non-covered Charge Amount
597 Non-payable Professional Component Amount
598 Non-payable Professional Component Billed Amount
599 Note Reference Code
600 Oxygen Saturation Qty
601 Oxygen Test Condition Code
602 Oxygen Test Date
603 Old Capital Amount
604 Originator Application Transaction Identifier
605 Orthodontic Treatment Months Count
606 Paid From Part A Medicare Trust Fund Amount
607 Paid From Part B Medicare Trust Fund Amount
608 Paid Service Unit Count
609 Participation Agreement
610 Patient Discharge Facility Type Code
611 Peer Review Authorization Number
612 Per Day Limit Amount
613 Physician Contact Date
614 Physician Order Date
615 Policy Compliance Code
616 Policy Name
617 Postage Claimed Amount
618 PPS-Capital DSH DRG Amount
619 PPS-Capital Exception Amount
620 PPS-Capital FSP DRG Amount
621 PPS-Capital HSP DRG Amount
622 PPS-Capital IME Amount
623 PPS-Operating Federal Specific DRG Amount
624 PPS-Operating Hospital Specific DRG Amount
625 Predetermination of Benefits Identifier
626 Pregnancy Indicator
627 Pre-Tax Claim Amount
628 Pricing Methodology
629 Property Casualty Claim Number
630 Referring CLIA Number
631 Reimbursement Rate
632 Reject Reason Code
633 Related Causes Code (Accident, auto accident, employment)
634 Remark Code
635 Repriced Ambulatory Patient Group Code
636 Repriced Line Item Reference Number
637 Repriced Saving Amount
638 Repricing Per Diem or Flat Rate Amount
639 Responsibility Amount
640 Sales Tax Amount
641 Service Adjudication or Payment Date. Note: Use code 516.
642 Service Authorization Exception Code
643 Service Line Paid Amount
644 Service Line Rate
645 Service Tax Amount
646 Ship, Delivery or Calendar Pattern Code
647 Shipped Date
648 Similar Illness or Symptom Date
649 Skilled Nursing Facility Indicator
650 Special Program Indicator
651 State Industrial Accident Provider Number
652 Terms Discount Percentage
653 Test Performed Date
654 Total Denied Charge Amount
655 Total Medicare Paid Amount
656 Total Visits Projected This Certification Count
657 Total Visits Rendered Count
658 Treatment Code
659 Unit or Basis for Measurement Code
660 Universal Product Number
661 Visits Prior to Recertification Date Count CR702
662 X-ray Availability Indicator
663 Entity's Group Name. Usage: This code requires use of an Entity Code.
664 Orthodontic Banding Date
665 Surgery Date
666 Surgical Procedure Code
667 Real-Time requests not supported by the information holder, do not resubmit This change effective September 1, 2017: Real-time requests not supported by the information holder, do not resubmit
668 Missing Endodontics treatment history and prognosis
669 Dental service narrative needed.
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
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
672 Other Payer's payment information is out of balance
673 Patient Reason for Visit
674 Authorization exceeded
675 Facility admission through discharge dates
676 Entity possibly compensated by facility. Usage: This code requires use of an Entity Code.
677 Entity not affiliated. Usage: This code requires use of an Entity Code.
678 Revenue code and patient gender mismatch
679 Submit newborn services on mother's claim
680 Entity's Country. Usage: This code requires use of an Entity Code.
681 Claim currency not supported
682 Cosmetic procedure
683 Awaiting Associated Hospital Claims
684 Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Usage: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement.)
685 Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit. This change effective September 1, 2017: Claim could not complete adjudication in real-time. Claim will continue processing in a batch mode. Do not resubmit.
686 The claim/ encounter has completed the adjudication cycle and the entire claim has been voided
687 Claim estimation can not be completed in real time. Do not resubmit. This change effective September 1, 2017: Claim predetermination/estimation could not be completed in real-time. Do not resubmit.
688 Present on Admission Indicator for reported diagnosis code(s).
689 Entity was unable to respond within the expected time frame. Usage: This code requires use of an Entity Code.
690 Multiple claims or estimate requests cannot be processed in real time. This change effective September 1, 2017: Multiple claims or estimate requests cannot be processed in real-time.
691 Multiple claim status requests cannot be processed in real time. This change effective September 1, 2017: Multiple claim status requests cannot be processed in real-time.
692 Contracted funding agreement-Subscriber is employed by the provider of services
693 Amount must be greater than or equal to zero. Usage: At least one other status code is required to identify which amount element is in error.
694 Amount must not be equal to zero. Usage: At least one other status code is required to identify which amount element is in error.
695 Entity's Country Subdivision Code. Usage: This code requires use of an Entity Code.
696 Claim Adjustment Group Code.
697 Invalid Decimal Precision. Usage: At least one other status code is required to identify the data element in error.
698 Form Type Identification
699 Question/Response from Supporting Documentation Form
700 ICD10. Usage: At least one other status code is required to identify the related procedure code or diagnosis code.
701 Initial Treatment Date
702 Repriced Claim Reference Number
703 Advanced Billing Concepts (ABC) code
704 Claim Note Text
705 Repriced Allowed Amount
706 Repriced Approved Amount
707 Repriced Approved Ambulatory Patient Group Amount
708 Repriced Approved Revenue Code
709 Repriced Approved Service Unit Count
710 Line Adjudication Information. Usage: At least one other status code is required to identify the data element in error.
711 Stretcher purpose
712 Obstetric Additional Units
713 Patient Condition Description
714 Care Plan Oversight Number
715 Acute Manifestation Date
716 Repriced Approved DRG Code
717 This claim has been split for processing.
718 Claim/service not submitted within the required timeframe (timely filing).
719 NUBC Occurrence Code(s)
720 NUBC Occurrence Code Date(s)
721 NUBC Occurrence Span Code(s)
722 NUBC Occurrence Span Code Date(s)
723 Drug days supply
724 Drug dosage. This change effective 5/01/2017: Drug Quantity
725 NUBC Value Code(s)
726 NUBC Value Code Amount(s)
727 Accident date
728 Accident state
729 Accident description
730 Accident cause
731 Measurement value/test result
732 Information submitted inconsistent with billing guidelines. Usage: At least one other status code is required to identify the inconsistent information.
733 Prefix for entity's contract/member number.
734 Verifying premium payment
735 This service/claim is included in the allowance for another service or claim.
736 A related or qualifying service/claim has not been received/adjudicated.
737 Current Dental Terminology (CDT) Code
738 Home Infusion EDI Coalition (HEIC) Product/Service Code
739 Jurisdiction Specific Procedure or Supply Code
740 Drop-Off Location
741 Entity must be a person. Usage: This code requires use of an Entity Code.
742 Payer Responsibility Sequence Number Code
743 Entity's credential/enrollment information. Usage: This code requires use of an Entity Code.
744 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
745 Identifier Qualifier Usage: At least one other status code is required to identify the specific identifier qualifier in error.
746 Duplicate Submission Usage: use only at the information receiver level in the Health Care Claim Acknowledgement transaction.
747 Hospice Employee Indicator
748 Corrected Data Usage: Requires a second status code to identify the corrected data.
749 Date of Injury/Illness
750 Auto Accident State or Province Code
751 Ambulance Pick-up State or Province Code
752 Ambulance Drop-off State or Province Code
753 Co-pay status code.
754 Entity Name Suffix. Usage: This code requires the use of an Entity Code.
755 Entity's primary identifier. Usage: This code requires the use of an Entity Code.
756 Entity's Received Date. Usage: This code requires the use of an Entity Code.
757 Last seen date.
758 Repriced approved HCPCS code.
759 Round trip purpose description.
760 Tooth status code.
761 Entity's referral number. Usage: This code requires the use of an Entity Code.
762 Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider
763 Ambulance Pickup ZipCode
764 Professional charges are non covered.
765 Institutional charges are non covered.
766 Services were performed during a Health Insurance Exchange (HIX) premium payment grace period.
767 Qualifications for emergent/urgent care
768 Service date outside the accidental injury coverage period.
769 DME Repair or Maintenance
770 Duplicate of a claim processed or in process as a crossover/coordination of benefits claim.
771 Claim submitted prematurely. Please resubmit after crossover/payer to payer COB allotted waiting period.
772 The greatest level of diagnosis code specificity is required.
773 One calendar year per claim.
774 Experimental/Investigational
775 Entity Type Qualifier (Person/Non-Person Entity). Usage: this code requires use of an entity code.
776 Pre/Post-operative care
777 Processed based on multiple or concurrent procedure rules.
778 Non-Compensable incident/event. Usage: To be used for Property and Casualty only.
779 Service submitted for the same/similar service within a set timeframe.
780 Lifetime benefit maximum
781 Claim has been identified as a readmission
782 Second surgical opinion
783 Federal sequestration adjustment
784 Electronic Visit Verification criteria do not match.
785 Missing/Invalid Sterilization/Abortion/Hospital Consent Form.
786 Submit claim to the third party property and casualty automobile insurer.
787 Resubmit a new claim, not a replacement claim.
788 Submit these services to the patient's Pharmacy Plan for further consideration. This definition will change on 7/1/2023 to: Submit these services to the Pharmacy plan/processor for further consideration/adjudication.
789 Submit these services to the patient's Medical Plan for further consideration.
790 Submit these services to the patient's Dental Plan for further consideration.
791 Submit these services to the patient's Vision Plan for further consideration.
792 Submit these services to the patient's Behavioral Health Plan for further consideration.
793 Submit these services to the patient's Property and Casualty Plan for further consideration.
794 Claim could not complete adjudication in real time. Resubmit as a batch request.
795 Claim submitted prematurely. Please provide the prior payer's final adjudication.
796 Procedure code not valid for date of service.
797 Entity's TRICARE provider id. Usage: This code requires use of an Entity Code.
798 Claim predetermination/estimation could not be completed in real time. Claim requires manual review upon submission. Do not resubmit.
799 Resubmit a replacement claim, not a new claim.
800 Entity's required reporting has been forwarded to the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only.
801 Entity's required reporting was accepted by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only.
802 Entity's required reporting was rejected by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only.
803 Provider reporting has been rejected due to non-compliance with the jurisdiction's mandated registration. To be used for Property and Casualty only.
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