Category
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
Hospital and DTC Clinic Ambulatory Care/Outpatient Rate Codes
Rate Code Rate Cd Desc
2961
AIDS CLINIC, THERAPEUTIC VISIT
2983
HIV COUNSELING AND TESTING VISIT
3111
POST-TEST HIV COUNSELING VISIT-POS RESULT
3109
HIV COUNSELING VISIT (NO TESTING)
3107
MONTHLY DIALYSIS SVCS - MEDICARE CROSSOVER
2887
CHILD REHABILITATION
1604
MOMS HEALTH SUPPORTIVE SERVICES
3138
NEWBORN HEARING SCRNG SVC - 1ST/INITIAL STAGE
3139
NEWBORN HEARING SCRNG SVC - 2ND/FOLLOWUP STAGE
4011
FQHC GROUP PSYCHOTHERAPY
4012
FQHC OFF-SITE SERVICES
4013
FQHC INDIVIDUAL THRESHOLD VISIT
2888
COMPREHENSIVE PHYSICAL EXAM (SCHOOL HEALTH PROJECT)
2889
ROUTINE VISIT (SCHOOL HEALTH PROJECT)
1616
CHC,WCC,PEDIATRIC
1617
FAMILY PLANNING
1620
DENTAL
1641
HEMODIALYSIS FACILITY SESSION
2870
OUTPATIENT DEPT
2875
FAMILY MEDICINE
2879
GENERAL - ER
2880
PART-TIME CLINIC SERVICES
2883
RENAL OR HEMODIALYSIS
2910
HEMODIALYSIS FACILITY SESSION
2911
HOME HEMODIALYSIS CAPD/CCPD WEEKLY
2912
HOME HEMODIALYSIS CAPD/CCPD DAILY
2914
HOME HEMODIALYSIS EXTENDED PERITONEAL 20-29 HOURS
2940
AIDS CLINIC, INITIAL VISIT
2941
AIDS CLINIC, FOLLOW-UP VISIT, EXTENDED
2942
AIDS CLINIC, FOLLOW-UP VISIT (ROUTINE)
2944
AIDS CLINIC, INFUSION THERAPY (CHEMOTHERAPY)
2945
AIDS CLINIC, SUBSEQUENT COMPREHENSVE VISIT
2984
POST-TEST HIV COUNSELING VISIT-NEG RESULT
2985
INITIAL COMP HIV MEDICAL EVAL VISIT
2986
DRUG/IMMUNOTHERAPY VST-HIV IFECTED PT.
2987
MONITORING VST-ASYMPTOMATIC HIV DISEASE
2988
AIDS DENTAL CLINIC VISIT
2989
OB HIV COUNSLG/TESTING-UNREGISTERED PTS
3001
PAS 1 - NERVE REPAIR
3002
PAS 2 - EYE THERAPEUTIC
3003
PAS 3 - EYE REPAIR
3004
PAS 4 - LENS REMOVE/REPLACE
3005
PAS 5 - EYE LASER THERAPEUTIC
3006
PAS 6 - EYE MUSCLE REPAIR
3007
PAS 7 - EAR REPAIR
3008
PAS 8 - EAR THERAPEUTIC
3009
PAS 9 - NASAL/PARANASAL THERAPEUTIC
3010
PAS 10 - RHINO/SEPTO PLASTY
3011
PAS 11 - TONSIL/ADENOID THERAPEUTIC
3012
PAS 12 - NASAL/TRACHEAL ENDOSCOPE
3013
PAS 13 - THORACIC DIAGNOSTIC/THERAPEUTIC
3014
PAS 14 - VASCULAR DIAGNOSTIC II
3015
PAS 15 - VASCULAR REPAIR
3016
PAS 16 - VASCULAR DIAGNOSTIC/THERAPEUTIC
3017
PAS 17 - UPPER G.I. DIAGNOSTIC/THERAPEUTIC
3018
PAS 18 - LOWER G.I. DIAGNOSTIC/THERAPEUTIC
3019
PAS 19 - RECTAL DIAGNOSTIC/THERAPEUTIC
3020
PAS 20 - HEPATIC DIAGNOSTIC/THERAPEUTIC
3021
PAS 21 - HEPATIC ENDOSCOPY
3022
PAS 22 - HERNIA REPAIR
3023
PAS 23 - CYSTOSCOPE
3024
PAS 24 - UROLOGICAL THERAPEUTIC
3025
PAS 25 - LITHOTRIPSY
3026
PAS 26 - MALE GENITAL DIAGNOSTIC
3027
PAS 27 - GENITO-URINARY REPAIR
3028
PAS 28 - MALE GENITAL THERAPEUTIC
3029
PAS 29 - LAPAROSCOPY
3030
PAS 30 - OVIDUCT DIAGNOSTIC/THERAPEUTIC
3031
PAS 31 - GYN DIAGNOSTIC/THERAPEUTIC
3032
PAS 32 - DILATION AND CURETTAGE
3033
PAS 33 - SOFT TISSUE REPAIR
3034
PAS 34 - BONE THERAPEUTIC
3035
PAS 35 - ARTHROSCOPY
Page 1 of 7
Category
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
Hospital and DTC Clinic Ambulatory Care/Outpatient Rate Codes
Rate Code Rate Cd Desc
3036
PAS 36 - BONE REPAIR
3037
PAS 37 - SOFT TISSUE THERAPY
3038
PAS 38 - BREAST DIAGNOSTIC/THERAPEUTIC
3039
PAS 39 - BREAST REPAIR
3040
PAS 40 - SKIN DIAGNOSTIC/THERAPEUTIC
3041
PAS 41 - SKIN REPAIR
3042
PAS 42 - UROLOGICAL DIAGNOSTIC
3043
ADDITIONAL SURGERY - PAS 1
3044
ADDITIONAL SURGERY - PAS 2
3045
ADDITIONAL SURGERY - PAS 3
3046
ADDITIONAL SURGERY - PAS 4
3047
ADDITIONAL SURGERY - PAS 5
3048
ADDITIONAL SURGERY - PAS 6
3049
ADDITIONAL SURGERY - PAS 7
3050
ADDITIONAL SURGERY - PAS 8
3051
ADDITIONAL SURGERY - PAS 9
3052
ADDITIONAL SURGERY - PAS 10
3053
ADDITIONAL SURGERY - PAS 11
3054
ADDITIONAL SURGERY - PAS 12
3055
ADDITIONAL SURGERY - PAS 13
3056
ADDITIONAL SURGERY - PAS 14
3057
ADDITIONAL SURGERY - PAS 15
3058
ADDITIONAL SURGERY - PAS 16
3059
ADDITIONAL SURGERY - PAS 17
3060
ADDITIONAL SURGERY - PAS 18
3061
ADDITIONAL SURGERY - PAS 19
3062
ADDITIONAL SURGERY - PAS 20
3063
ADDITIONAL SURGERY - PAS 21
3064
ADDITIONAL SURGERY - PAS 22
3065
ADDITIONAL SURGERY - PAS 23
3066
ADDITIONAL SURGERY - PAS 24
3067
ADDITIONAL SURGERY - PAS 25
3068
ADDITIONAL SURGERY - PAS 26
3069
ADDITIONAL SURGERY - PAS 27
3070
ADDITIONAL SURGERY - PAS 28
3071
ADDITIONAL SURGERY - PAS 29
3072
ADDITIONAL SURGERY - PAS 30
3073
ADDITIONAL SURGERY - PAS 31
3074
ADDITIONAL SURGERY - PAS 32
3075
ADDITIONAL SURGERY - PAS 33
3076
ADDITIONAL SURGERY - PAS 34
3077
ADDITIONAL SURGERY - PAS 35
3078
ADDITIONAL SURGERY - PAS 36
3079
ADDITIONAL SURGERY - PAS 37
3080
ADDITIONAL SURGERY - PAS 38
3081
ADDITIONAL SURGERY - PAS 39
3082
ADDITIONAL SURGERY - PAS 40
3083
ADDITIONAL SURGERY - PAS 41
3084
ADDITIONAL SURGERY - PAS 42
3085
PAS 43 - ORAL SURGERY
3086
ADDITIONAL SURGERY - PAS 43
3092
CHEMO CLINIC SERVICE
3093
PAS 44 - STEREOTACTIC RAD THER OF BRAIN
3095
PAS 45 VITRECTOMY WITH THERAPY DRUG IMP
3096
ADDITIONAL SURGERY - PAS 45
3098
HYPERBARIC TREATMENT
3099
HEAD INJURY/TRAUMA CLINIC
3100
ORTHOPEDIC REHAB CLINIC
3101
HOSP-BASED PCAP INITIAL PRENATAL CARE VISIT
3102
HOSP-BASED PCAP FOLLOW-UP PRENATAL VISIT
3103
HOSPITAL-BASED PCAP POST-PARTUM CARE
3104
HEMO, EPO ADD-ON UP TO 10,000 UNITS
3105
HEMO, EPO ADD-ON 10,000 UNITS OR MORE
3106
HEMO, EPO ADD-ON PER 1,000 UNIT
3110
CHAP SCREENING EXAMINATION
3112
AIDS CLINIC, INFUS. THERAPY-1 UNIT BLOOD
3113
AIDS CLINIC, INFUS. THERAPY-2 UNITS BLOOD
3114
AIDS CLINIC, INFUS. THERAPY-3 UNITS BLOOD
3115
AIDS CLINIC, INFUS. THERAPY-4 UNITS BLOOD
3140
HYPERBARIC THERAPY - 1/2 HOUR
6501
PAC 1 DIAGNOSTIC INVESTIGATION EXAMS NEC
6502
PAC 2 DIAGNOSTIC INVEST WITH NUCL IMAGING
6503
PAC 3 DIAGNOSTIC INVEST WITH CAT IMAGING
Page 2 of 7
Category
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
Hospital and DTC Clinic Ambulatory Care/Outpatient Rate Codes
Rate Code Rate Cd Desc
6504
PAC 4 DIAGNOSTIC INVEST WITH MRI
6505
PAC 5 MANAGEMENT EXAM NEC
6506
PAC 6 MEDICATION ADMINISTRATION
6507
PAC 7 PEDITRC ANUAL WELCARE EXAM (AGE 3-17)
6508
PAC 8 ADULT ANUAL WELL CARE EXAM (AGE >17)
6509
PAC 9 FIRST PRENATAL - ROUTINE
6510
PAC 10 FIRST PRENATAL - COMPLICATED
6511
PAC 11 PRENATAL MGMNT REVISIT - COMPLICATED
6512
PAC 12 POST PARTUM MGMNT - COMPLICATED
6513
PAC 13 PRENATAL REVISIT WELL CARE - NORMAL
6514
PAC 14 POST PARTUM MGMNT - NORMAL
6515
PAC 15 NEONATAL & CONGENITAL DIAG INVEST
6516
PAC 16 MGMNT OF NEONATAL & CONGENITL PROB
6517
PAC 17 PEDIATRIC WELL CARE EXAM (AGE <3)
6518
PAC 18 FEMALE REPRODUCTIVE DIAG INVEST
6519
PAC 19 MGMNT OF FEMALE REPRODUCTIVE PROB
6520
PAC 20 ANNUAL GYNECOLOGICAL EXAM
6521
PAC 21 CONTRACEPTIVE WELL CARE EXAM
6522
PAC 22 ENT DIAG INVEST-ADULT (AGE >17)
6523
PAC 23 ENT DIAG INVEST-PEDIA (AGE 0-17)
6524
PAC 24 MGMNT OF ENT PROB-ADULT (AGE >17)
6525
PAC 25 MGMNT OF ENT PROB-PEDIA (AGE 0-17)
6526
PAC 26 OPHTHALMOLOGICAL SERVICES
6527
PAC 27 RESPRATRY DIAG INVEST-ADLT (AGE>17)
6528
PAC 28 RESP DIAG INVEST-PEDIA (AGE 0-17)
6529
PAC 29 MGMNT OF RESP PROB-ADULT (AGE>17)
6530
PAC 30 MGMNT OF RESP PROB-PEDIA (AGE 0-17)
6531
PAC 31 SYSTEMIC INFECTION DIAG INVEST
6532
PAC 32 MGMNT OF SYSTEMIC INFECTIONS
6533
PAC 33 GASTROINTESTINAL DIAG INVEST
6534
PAC 34 MGMT GSTRONTSTNL PROB-ADLT (AGE >17)
6535
PAC 35 MGMT GSTRONTSTNL PROB-PED (AGE 0-17)
6536
PAC 36 HEPATOBILIARY DIAG INVESTIGATION
6537
PAC 37 MGMNT OF HEPATOBILIARY PROB
6538
PAC 38 GENITO-UROLOGICAL DIAG INVEST
6539
PAC 39 MGMNT OF GENITO-UROLOGICAL PROB
6540
PAC 40 CARDIAC DIAG INVESTIGATION
6541
PAC 41 MANAGEMENT OF CARDIAC PROB
6542
PAC 42 ENDOCRINAL DIAG INVESTIGATION
6543
PAC 43 MGMNT OF OTHER ENDOCRINAL PROB
6544
PAC 44 MGMT OF DIABETES-PEDIATRC (AGE 0-17)
6545
PAC 45 MGMNT OF DIABETES-ADULT (AGE >17)
6546
PAC 46 SKIN & SOFT TISSUE DIAG INVEST
6547
PAC 47 INFLAMMATORY MUSC/SKEL DIAG INVEST
6548
PAC 48 OTHER MUSC/SKEL DIAG INVESTIGATION
6549
PAC 49 REHABILITATION THERAPY
6550
PAC 50 MGMNT OF SKIN & SOFT TISSUE PROB
6551
PAC 51 MANAGEMENT OF POISONING
6552
PAC 52 MGMNT OF INFLAMM MUSC/SKEL PROB
6553
PAC 53 MGMNT OF OTHER MUSC/SKEL PROB
6554
PAC 54 ONCOLOGICAL DIAG INVESTIGATION
6555
PAC 55 AIDS DIAG INVESTIGATION
6556
PAC 56 OTHER HEMATOLOGICAL DIAG INVEST
6557
PAC 57 THERAPEUTIC IV PUSH & CHEMO INJECT
6558
PAC 58 THERAPEUTIC INFUSIONS
6559
PAC 59 THERAPEUTIC RADIOTHERAPY
6560
PAC 60 ONCOLOGICAL MANAGEMENT
6561
PAC 61 MGMT OF ANEMIAS-PEDIATRC (AGE 0-17)
6562
PAC 62 MGMT OF ANEMIAS-ADULT (AGE >17)
6563
PAC 63 MGMT OF AIDS-PEDIATRIC (AGE 0-17)
6564
PAC 64 MGMT OF AIDS-ADULT (AGE>17)
6565
PAC 65 MGMNT OF OTHER HEMATOLOGICAL PROB
6566
PAC 66 NEURO & PSYCHO/SOCIAL DIAG INVEST
6567
PAC 67 SPEECH & HEARNG SVCS-ADULT (AGE >17)
6568
PAC 68 SPECH & HEARNGSVCS-PEDIA (AGE 0-17)
6569
PAC 69 NEUROLOGICAL & PSYCHO/SOCIAL MGMNT
6570
PAC 70 COUNSELING
6571
PAC 71 DIAG INVEST OF VASCULAR SYSTEMS
7501
PAC 1 MEDICARE CLAIM
7502
PAC 2 MEDICARE CLAIM
7503
PAC 3 MEDICARE CLAIM
7504
PAC 4 MEDICARE CLAIM
7505
PAC 5 MEDICARE CLAIM
Page 3 of 7
Category
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
HOSPITALS - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
Hospital and DTC Clinic Ambulatory Care/Outpatient Rate Codes
Rate Code Rate Cd Desc
7506
PAC 6 MEDICARE CLAIM
7508
PAC 8 MEDICARE CLAIM
7509
PAC 9 MEDICARE CLAIM
7510
PAC 10 MEDICARE CLAIM
7511
PAC 11 MEDICARE CLAIM
7512
PAC 12 MEDICARE CLAIM
7513
PAC 13 MEDICARE CLAIM
7514
PAC 14 MEDICARE CLAIM
7515
PAC 15 MEDICARE CLAIM
7516
PAC 16 MEDICARE CLAIM
7517
PAC 17 MEDICARE CLAIM
7518
PAC 18 MEDICARE CLAIM
7519
PAC 19 MEDICARE CLAIM
7520
PAC 20 MEDICARE CLAIM
7521
PAC 21 MEDICARE CLAIM
7522
PAC 22 MEDICARE CLAIM
7524
PAC 24 MEDICARE CLAIM
7525
PAC 25 MEDICARE CLAIM
7526
PAC 26 MEDICARE CLAIM
7527
PAC 27 MEDICARE CLAIM
7529
PAC 29 MEDICARE CLAIM
7530
PAC 30 MEDICARE CLAIM
7531
PAC 31 MEDICARE CLAIM
7532
PAC 32 MEDICARE CLAIM
7533
PAC 33 MEDICARE CLAIM
7534
PAC 34 MEDICARE CLAIM
7535
PAC 35 MEDICARE CLAIM
7536
PAC 36 MEDICARE CLAIM
7537
PAC 37 MEDICARE CLAIM
7538
PAC 38 MEDICARE CLAIM
7539
PAC 39 MEDICARE CLAIM
7540
PAC 40 MEDICARE CLAIM
7541
PAC 41 MEDICARE CLAIM
7542
PAC 42 MEDICARE CLAIM
7543
PAC 43 MEDICARE CLAIM
7544
PAC 44 MEDICARE CLAIM
7545
PAC 45 MEDICARE CLAIM
7546
PAC 46 MEDICARE CLAIM
7547
PAC 47 MEDICARE CLAIM
7548
PAC 48 MEDICARE CLAIM
7549
PAC 49 MEDICARE CLAIM
7550
PAC 50 MEDICARE CLAIM
7551
PAC 51 MEDICARE CLAIM
7552
PAC 52 MEDICARE CLAIM
7553
PAC 53 MEDICARE CLAIM
7554
PAC 54 MEDICARE CLAIM
7555
PAC 55 MEDICARE CLAIM
7556
PAC 56 MEDICARE CLAIM
7557
PAC 57 MEDICARE CLAIM
7558
PAC 58 MEDICARE CLAIM
7559
PAC 59 MEDICARE CLAIM
7560
PAC 60 MEDICARE CLAIM
7561
PAC 61 MEDICARE CLAIM
7562
PAC 62 MEDICARE CLAIM
7564
PAC 64 MEDICARE CLAIM
7565
PAC 65 MEDICARE CLAIM
7566
PAC 66 MEDICARE CLAIM
7567
PAC 67 MEDICARE CLAIM
7568
PAC 68 MEDICARE CLAIM
7569
PAC 69 MEDICARE CLAIM
7570
PAC 70 MEDICARE CLAIM
7571
PAC 71 MEDICARE CLAIM
1813
TB/HIV COUNSELING W/O TESTING - MC CLIENT
1814
STD/HIV COUNSELING W/O TESTING - MC CLIENT
1815
TB/HIV COUNSELING & TESTING - MC CLIENT
1816
STD/HIV COUNSELING & TESTING - MC CLIENT
1817
TB/HIV POST TEST NEGATIVE - MC CLIENT
1818
STD/HIV POST TEST NEGATIVE - MC CLIENT
1819
TB/HIV POST TEST POSITIVE - MC CLIENT
1820
STD/HIV POST TEST POSITIVE - MC CLIENT
1850
(HIV) DAY HEALTHCARE SERVICE
3142
D & T CS/MMIS TC INTAKE EXAM MANAGED CARE
Page 4 of 7
Category
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
DTC's - Subsumed
Hospital and DTC Clinic Ambulatory Care/Outpatient Rate Codes
Rate Code Rate Cd Desc
5312
TB/DIRECTLY OBSERVED THERAPY - DNST LVL 1
5313
TB/DIRECTLY OBSERVED THERAPY - DNST LVL 2
5317
TB/DIRECTLY OBSERVED THERAPY - UPST LVL 1
5318
TB/DIRECTLY OBSERVED THERAPY - UPST LVL 2
3141
SCREENING FOR ORTHODONTIC TREATMENT
1226
FITTING OF SPECTACLES, MONOFOCAL, BIFOCAL, MULTIFOCAL
1227
FITTING OF SPECTACLES & EYEGLASS MATERIALS
5301
MEDICAL EVALUATION SSHSP
5388
PRESCHOOL SUPPORTIVE HEALTH PROGRAM - IEP
5389
SCHOOL-AGE SUPPORTIVE HEALTH PROGRAM - IEP
FQHC INDIVIDUAL THRESHOLD VISIT[1]
4013
1601
D&T PCAP INITIAL PRENATAL CARE VISIT
1602
D&T PCAP FOLLOW-UP PRENATAL CARE VISIT
1603
D&T PCAP POST-PARTUM CARE
1610
ALL INCLUSIVE
1611
ABORTION
1612
HOME TRANSFUSION
1622
INITIAL VISIT (CLINIC)
1623
ANTEPARTUM VISIT
1624
LABOR
1625
DELIVERY & AFTERCARE
1626
POSTPARTUM HOME AND OFFICE VISITS
1627
COMP PHYS EXAM (SCHOOL HEALTH PROJECT)
1628
ROUTINE VISIT (SCHOOL HEALTH PROJ)
1629
PART-TIME CLINIC SERVICES
1638
TB CLINIC, CLS III PT DESIGNATION, INC PHYS
1640
TB CLINIC, CLS II PT DESIGNATION
1642
HOME HEMODIALYSIS CAPD/CCPD WEEKLY
1643
HOME HEMODIALYSIS CAPD/CCPD DAILY
1696
POST-TEST HIV COUNSELING VISIT - NEGATIVE RESULTS
1697
INITIAL COMP HIV MEDICAL EVALUATION VISIT
1698
DRUG/IMMUNOTHERAPY VISIT - HIV INFECTED PT.
1699
MONITORING VISIT - ASYMPTOMATIC HIV DISEASE
1701
PAS 1 - NERVE REPAIR
1702
PAS 2 - EYE THERAPEUTIC
1703
PAS 3 - EYE REPAIR
1704
PAS 4 - LENS REMOVE/REPLACE
1705
PAS 5 - EYE LASER THERAPEUTIC
1706
PAS 6 - EYE MUSCLE REPAIR
1707
PAS 7 - EYE REPAIR
1708
PAS 8 - EAR THERAPEUTIC
1709
PAS 9 - NASAL/PARANASAL THERAPEUTIC
1710
PAS 10 - RHINO/SEPTO PLASTY
1711
PAS 11 - TONSIL/ADENOID THERAPEUTIC
1712
PAS 12 - NASAL/TRACHEAL ENDOSCOPE
1713
PAS 13 - THORACIC DIAGNOSTIC/THERAPEUTIC
1714
PAS 14 - VASCULAR DIAGNOSTIC II
1715
PAS 15 - VASCULAR REPAIR
1716
PAS 16 - VASCULAR DIAGNOSTIC/THERAPEUTIC
1717
PAS 17 - UPPER G.I. DIAGNOSTIC/THERAPEUTIC
1718
PAS 18 - LOWER G.I. DIAGNOSTIC/THERAPEUTIC
1719
PAS 19 - RECTAL DIAGNOSTIC/THERAPEUTIC
1720
PAS 20 - HEPATIC DIAGNOSTIC/THERAPEUTIC
1721
PAS 21 - HEPATIC ENDOSCOPY
1722
PAS 22 - HERNIA REPAIR
1723
PAS 23 - CYSTOSCOPE
1724
PAS 24 - UROLOGICAL THERAPEUTIC
1725
PAS 25 - LITHOTRIPSY
1726
PAS 26 - MALE GENITAL DIAGNOSTIC
1727
PAS 27 - GENITO-URINARY REPAIR
1728
PAS 28 - MALE GENITAL THERAPEUTIC
1729
PAS 29 - LAPAROSCOPY
1730
PAS 30 - OVIDUCT DIAGNOSTIC/THERAPEUTIC
1731
PAS 31 - GYN DIAGNOSTIC/THERAPEUTIC
1732
PAS 32 - DILATION AND CURETTAGE
1733
PAS 33 - SOFT TISSUE REPAIR
1734
PAS 34 - BONE THERAPEUTIC
1735
PAS 35 - ARTHROSCOPY
1736
PAS 36 - BONE REPAIR
1737
PAS 37 - SOFT TISSUE THERAPY
1738
PAS 38 - BREAST DIAGNOSTIC/THERAPEUTIC
1739
PAS 39 - BREAST REPAIR
1740
PAS 40 - SKIN DIAGNOSTIC/THERAPEUTIC
Page 5 of 7
Hospital and DTC Clinic Ambulatory Care/Outpatient Rate Codes
Category
Rate Code Rate Cd Desc
DTC's - Subsumed
1741
PAS 41 - SKIN REPAIR
DTC's - Subsumed
1742
PAS 42 - UROLOGICAL DIAGNOSTIC
DTC's - Subsumed
1743
ADDITIONAL SURGERY - PAS 1
DTC's - Subsumed
1744
ADDITIONAL SURGERY - PAS 2
DTC's - Subsumed
1745
ADDITIONAL SURGERY - PAS 3
DTC's - Subsumed
1746
ADDITIONAL SURGERY - PAS 4
DTC's - Subsumed
1747
ADDITIONAL SURGERY - PAS 5
DTC's - Subsumed
1748
ADDITIONAL SURGERY - PAS 6
DTC's - Subsumed
1749
ADDITIONAL SURGERY - PAS 7
DTC's - Subsumed
1750
ADDITIONAL SURGERY - PAS 8
DTC's - Subsumed
1751
ADDITIONAL SURGERY - PAS 9
DTC's - Subsumed
1752
ADDITIONAL SURGERY - PAS 10
DTC's - Subsumed
1753
ADDITIONAL SURGERY - PAS 11
DTC's - Subsumed
1754
ADDITIONAL SURGERY - PAS 12
DTC's - Subsumed
1755
ADDITIONAL SURGERY - PAS 13
DTC's - Subsumed
1756
ADDITIONAL SURGERY - PAS 14
DTC's - Subsumed
1757
ADDITIONAL SURGERY - PAS 15
DTC's - Subsumed
1758
ADDITIONAL SURGERY - PAS 16
DTC's - Subsumed
1759
ADDITIONAL SURGERY - PAS 17
DTC's - Subsumed
1760
ADDITIONAL SURGERY - PAS 18
DTC's - Subsumed
1761
ADDITIONAL SURGERY - PAS 19
DTC's - Subsumed
1762
ADDITIONAL SURGERY - PAS 20
DTC's - Subsumed
1763
ADDITIONAL SURGERY - PAS 21
DTC's - Subsumed
1764
ADDITIONAL SURGERY - PAS 22
DTC's - Subsumed
1765
ADDITIONAL SURGERY - PAS 23
DTC's - Subsumed
1766
ADDITIONAL SURGERY - PAS 24
DTC's - Subsumed
1767
ADDITIONAL SURGERY - PAS 25
DTC's - Subsumed
1768
ADDITIONAL SURGERY - PAS 26
DTC's - Subsumed
1769
ADDITIONAL SURGERY - PAS 27
DTC's - Subsumed
1770
ADDITIONAL SURGERY - PAS 28
DTC's - Subsumed
1771
ADDITIONAL SURGERY - PAS 29
DTC's - Subsumed
1772
ADDITIONAL SURGERY - PAS 30
DTC's - Subsumed
1773
ADDITIONAL SURGERY - PAS 31
DTC's - Subsumed
1774
ADDITIONAL SURGERY - PAS 32
DTC's - Subsumed
1775
ADDITIONAL SURGERY - PAS 33
DTC's - Subsumed
1776
ADDITIONAL SURGERY - PAS 34
DTC's - Subsumed
1777
ADDITIONAL SURGERY - PAS 35
DTC's - Subsumed
1778
ADDITIONAL SURGERY - PAS 36
DTC's - Subsumed
1779
ADDITIONAL SURGERY - PAS 37
DTC's - Subsumed
1780
ADDITIONAL SURGERY - PAS 38
DTC's - Subsumed
1781
ADDITIONAL SURGERY - PAS 39
DTC's - Subsumed
1782
ADDITIONAL SURGERY - PAS 40
DTC's - Subsumed
1783
ADDITIONAL SURGERY - PAS 41
DTC's - Subsumed
1784
ADDITIONAL SURGERY - PAS 42
DTC's - Subsumed
1806
HEMO, EPO ADD-ON PER 1,000 UNITS
APG Rate Codes for DTCs and Hospitals 1401
HOSPITAL AMBULATORY SURGERY APG
APG Rate Codes for DTCs and Hospitals 1404
HOSPITAL AMBULATORY SURGERY APG - CAPTIAL ADD-ON
APG Rate Codes for DTCs and Hospitals 1408
D & T AMBULATORY SURGERY APG
APG Rate Codes for DTCs and Hospitals 1410
D & T AMBULATORY SURGERY APG - CAPITAL ADD-ON
APG Rate Codes for DTCs and Hospitals 1412
D & T AMBULATORY SURGERY APG - EXIST RATE BLEND
APG Rate Codes for DTCs and Hospitals 1416
HOSPITAL AMB SURG APG OUT OF STATE
APG Rate Codes for DTCs and Hospitals 1418
HOSPITAL AMB SURG APG OUT OF STATE - CAPITAL ADD
APG Rate Codes for DTCs and Hospitals 1400
HOSPITAL OUTPATIENT APG
APG Rate Codes for DTCs and Hospitals 1403
HOSPITAL OUTPATIENT APG - CAPTIAL ADD-ON
APG Rate Codes for DTCs and Hospitals 1406
HOSPITAL OUTPATIENT APG - EXISTING RATE FOR BLEND
APG Rate Codes for DTCs and Hospitals 1407
D & T CLINIC APG
APG Rate Codes for DTCs and Hospitals 1409
D & T CLINIC APG - CAPITAL ADD-ON
APG Rate Codes for DTCs and Hospitals 1411
D & T CLINIC APG - EXISTING RATE FOR BLEND
APG Rate Codes for DTCs and Hospitals 1413
HOSPITAL OP APG OUT OF STATE
APG Rate Codes for DTCs and Hospitals 1414
HOSPITAL OP APG OUT OF STATE - EXISTING RATE BLEND
APG Rate Codes for DTCs and Hospitals 1415
HOSPITAL OP APG OUT OF STATE - CAPITOL ADD-ON
APG Rate Codes for DTCs and Hospitals 1422
DTC GENERAL CLINIC- APG EPISODE BASE RATE
APG Rate Codes for DTCs and Hospitals 1423
DTC GENERAL CLINIC- APG EPISODE BLEND PAYMENT
APG Rate Codes for DTCs and Hospitals 1424
DTC GENERAL CLINIC- APG EPISODE CAPITOL ADD-ON
APG Rate Codes for DTCs and Hospitals 1432
HOSPITAL CLINIC - APG EPISODE BASE RATE
APG Rate Codes for DTCs and Hospitals 1433
HOSPITAL CLINIC - APG EPISODE BLEND PAYMENT
APG Rate Codes for DTCs and Hospitals 1434
HOSPITAL CLINIC - APG EPISODE CAPITOL ADD-ON
APG Rate Codes for DTCs and Hospitals 1441
HOSPITAL OUT OF STATE CLINIC - EPISODE PAYMENT
APG Rate Codes for DTCs and Hospitals 1442
HOSPITAL OUT OF STATE CLINIC - EPISODE EXISTG RATE
APG Rate Codes for DTCs and Hospitals 1443
HOSPITAL OUT OF STATE CLINIC - EPISODE CAPL ADD-ON
APG Rate Codes for DTCs and Hospitals 1428
D&T CLINIC APG - DENTAL CLINIC
APG Rate Codes for DTCs and Hospitals 1430
D&T CLINIC APG - EXIST RATE BLEND - DENTAL CLINIC
APG Rate Codes for DTCs and Hospitals 1431
D&T CLINIC APG - CAPITAL ADD-ON - DENTAL CLINIC
Page 6 of 7
Hospital and DTC Clinic Ambulatory Care/Outpatient Rate Codes
Category
Rate Code Rate Cd Desc
APG Rate Codes for DTCs and Hospitals 1459
D&T CLINIC APG - DENTAL (EPISODE)
APG Rate Codes for DTCs and Hospitals 1460
D&T CLINIC APG - DENTAL BLEND AMOUNT (EPISODE)
APG Rate Codes for DTCs and Hospitals 1461
D&T CLINIC APG -DENTAL CAPITAL ADD-ON (EPISODE)
APG Rate Codes for DTCs and Hospitals 1402
HOSPITAL EMERGENCY ROOM APG
APG Rate Codes for DTCs and Hospitals 1405
HOSPITAL EMERGENCY ROOM APG - CAPITAL ADD-ON
APG Rate Codes for DTCs and Hospitals 1419
HOSPITAL ER APG OUT OF STATE[1]
APG Rate Codes for DTCs and Hospitals 1421
HOSPITAL ER APG OUT OF STATE - CAPITOL ADD-ON[1]
APG Rate Codes for DTCs and Hospitals 1425
DTC CLINIC MR/DD/TBI - APG EPISODE BASE RATE
APG Rate Codes for DTCs and Hospitals 1426
DTC CLINIC MR/DD/TBI - APG EPISODE BLEND PAYMENT
APG Rate Codes for DTCs and Hospitals 1427
DTC CLINIC MR/DD/TBI - APG EPISODE CAPITOL ADD-ON
APG Rate Codes for DTCs and Hospitals 1435
D&T CLINIC APG - GEN CLINIC (MR/DD/TBI PATIENT)
APG Rate Codes for DTCs and Hospitals 1436
D&T CLIN APG - EXIST BLND - GEN CL (MR/DD/TBI PAT)
APG Rate Codes for DTCs and Hospitals 1437
D&T CLINIC APG - CAP ADD-ON - GEN CLIN (MR/DD/TBI)
APG Rate Codes for DTCs and Hospitals 1489
HOSPITAL OP APG - MR/DD/TBI PATIENT (EPISODE)
APG Rate Codes for DTCs and Hospitals 1490
HOSPITAL OP APG BLEND PAYMENT - MR/DD/TBI (EPISODE)
APG Rate Codes for DTCs and Hospitals 1491
HOSPITAL OP APG CAPITAL ADD-ON - MR/DD/TBI (EPISODE)
APG Rate Codes for DTCs and Hospitals 1501
OPD - MR/DD/TBI PATIENT
APG Rate Codes for DTCs and Hospitals 1502
OPD - MR/DD/TBI PATIENT
APG Rate Codes for DTCs and Hospitals 1503
OPD - MR/DD/TBI PATIENT
APG Rate Codes for DTCs and Hospitals 1438
D&T CLINIC APG - RENAL CLINIC
APG Rate Codes for DTCs and Hospitals 1439
D&T CLINIC APG - EXIST RATE BLEND - RENAL CLINIC
APG Rate Codes for DTCs and Hospitals 1440
D&T CLINIC APG - CAPITAL ADD-ON - RENAL CLINIC
APG Rate Codes for DTCs and Hospitals 1456
D&T CLINIC APG - RENAL (EPISODE)
APG Rate Codes for DTCs and Hospitals 1457
D&T CLINIC APG - RENAL BLEND AMOUNT (EPISODE)
APG Rate Codes for DTCs and Hospitals 1458
D&T CLINIC APG - RENAL CAPITAL ADD-ON (EPISODE)
APG Rate Codes for DTCs and Hospitals 1444
HOSPITAL OUTPATIENT APG - SCHOOL BASED HEALTH PRO
APG Rate Codes for DTCs and Hospitals 1445
HOSPITAL OUTPATIENT APG - EXISTING RATE FOR BLEND
APG Rate Codes for DTCs and Hospitals 1446
HOSPITAL OUTPATIENT APG - CAPITAL ADD-ON -SCHOOL
APG Rate Codes for DTCs and Hospitals 1447
D & T CLINIC APG - SCHOOL BASED HEALTH PROJECT
APG Rate Codes for DTCs and Hospitals 1448
D & T CLINIC APG - EXISTING RATE FOR BLEND - SCHO
APG Rate Codes for DTCs and Hospitals 1449
D & T CLINIC APG - CAPITOL ADD-ON - SCHOOL BASED H
APG Rate Codes for DTCs and Hospitals 1450
HOSPITAL APG - SCHOOL BASED HEALTH CLINIC (EPISODE)
APG Rate Codes for DTCs and Hospitals 1451
HOSPITAL APG - SBHC BLEND AMOUNT (EPISODE)
APG Rate Codes for DTCs and Hospitals 1452
HOSPITAL APG - SBHC CAPITAL ADD-ON (EPISODE)
APG Rate Codes for DTCs and Hospitals 1453
D&T CLINIC APG - SCHOOL BASED HEALTH (EPISODE)
APG Rate Codes for DTCs and Hospitals 1454
D&T CLINIC APG - SBHC BLEND AMOUNT (EPISODE)
APG Rate Codes for DTCs and Hospitals 1455
D&T CLINIC APG - SBHC CAPITAL ADD-ON (EPISODE)
Page 7 of 7