Code list identifiers table
This table lists the unique code list identifiers used by the Pack for Healthcare along with their associated external code source, or sources. The table also provides information about the contents of the code list.
The code lists that default to PM (pattern match) do not have corresponding *.json load files. These codes are not shipped because of the following reasons:
- Due to licensing/legal requirements, code lists are not redistributed.
- Lists are available, but prohibitively large, and it is expected that customers would maintain either the full list or a subset of the list that is applicable for their implementation.
If a customer is providing their own data for a table that is not shipped, the corresponding rules that are only set as PM can be updated to CV by including the rules in hipaa_rules_to_change.json and updating the ValidationSubType field.
The rules that use the ICD-10 code sets are set to PM by default, and can be switched to CV, but only the full lists of procedure (T5_896_P) and diagnosis (T5_897_A) codes are included in the pack. There are no specific guidelines that indicate which subset is allowed for T5_896_R Principal Procedure Codes or T5_897_C Admitting Diagnosis Codes, and business/medical conditions beyond the scope of data validation could dictate which are allowed. Customers can optionally provide their own subset of codes to use for T5_896_R and T5_897_C, or update the rules using them to reference T5_896_P and T5_897_A using the hipaa_rules_change.json file.
Note: The Pack for Healthcare provides
the maps to transform the source code lists to the
xml/json format needed for
the Type 5 load and these can be referenced as a
model for implementations by the customers to create
their own code lists for Type 5 checking.
| External Code Source | Code List ID | Code List Contents | On/Off Default | Default Method | Code List Import Name |
|---|---|---|---|---|---|
| 4 | T5_004 | Federal Reserve Routing Codes or ABA Transit Routing Number | On | PM | |
| 5 | T5_005_A | ISO 3166 Part 1 Country Codes | On | PM | |
| T5_005_B | ISO 3166 Part 2 Country Subdivision Codes | On | PM | ||
| T5_005_C | ISO 4217 Currency or Fund Codes | On | PM | ||
| 16 | T5_016_A | Dun & Bradstreet D-U-N-S Numbers | On | PM | |
| T5_016_B | Dun & Bradstreet D-U-N-S+4 Numbers | On | PM | ||
| 22 | T5_022 | US and MX States and CA Provinces | On | CV | T5_022_States_and_Provinces |
| T5_022_A | US States and Outlying Areas | On | CV | T5_022_A_US_States | |
| T5_022_AB | US States and CA Provinces | On | CV | T5_022_AB_US_States_and_CA_Provs | |
| T5_022_B | Canadian Provinces | On | CV | T5_022_B_CA_Provinces | |
| T5_022_C | Mexican States | On | CV | T5_022_C_MX_States | |
| 41 | T5_041 | Universal Product Codes | Off | PM | |
| T5_041_A | EAN/UCC-8 | On | PM | ||
| T5_041_B | UCC-12 | On | PM | ||
| T5_041_C | EAN/UCC-13 | On | PM | ||
| T5_041_D | GTIN 14-digit Data Structure | On | PM | ||
| 51 | T5_051 | US ZIP, ZIP Plus 4 and CA Postal Codes | On | PM | |
| T5_051_A | US ZIP Codes (5 digits) | On | PM | ||
| T5_051_B | US ZIP Plus 4 Codes (9 digits) | On | PM | ||
| T5_051_BC | US ZIP+4 (9 digits only) and CA Postal Codes | On | PM | ||
| T5_051_C | CA Postal Codes | On | PM | ||
| 60 | T5_060 | Depository Financial Institution (DFI) Identification Numbers | Off | PM | |
| 91 | T5_091 | CPA Canadian Financial Institution Branch and Institution Numbers | On | PM | |
| 94 | T5_094 | Equivalents to ISO 8601 Time Zone Codes | Off | PM | |
| 102 | T5_102 | ISO 639 Language Codes | On | PM | |
| 121 | T5_121 | HIBCC Health Industry Numbers (HIN) | On | PM | |
| 130/133 | T5_130_and_133_P | HCPCS Level I & II Procedure/Service Codes | On | PM | |
| T5_130_and_133_Q | HCPCS Level I & II Procedure/Service Modifier Codes | On | PM | ||
| T5_130_and_133_R | HCPCS Level I & II Procedure/Service Codes (Principal) | On | PM | ||
| 130 | T5_130_P | HCPCS Level II Ancillary Service/Procedure Codes | On | CV | T5_130_P_HCPCS_II_Proc_Codes |
| T5_130_Q | HCPCS Level II Ancillary Service/Procedure Modifier Codes | On | CV | T5_130_Q_HCPCS_II_Modifier_Codes | |
| T5_130_R | HCPCS Level II Ancillary Service/Procedure Codes (Principal) | On | PM | ||
| 131 | T5_131_A | ICD-9 Diagnosis Codes | On | PM | T5_131_A_ICD9_Diagnosis_Codes |
| T5_131_B | ICD-9 Diagnosis Codes (Principal) | On | PM | ||
| T5_131_C | ICD-9 Diagnosis Codes (Admitting) | On | PM | ||
| T5_131_D | ICD-9 Diagnosis Codes (Patient Reason for Visit) | On | PM | ||
| T5_131_E | ICD-9 Diagnosis Codes (E-Codes) | On | PM | T5_131_E_ICD9_Ext_Causes_Codes | |
| T5_131_P | ICD-9 In-Patient Hospital Procedure Codes | On | PM | T5_131_P_ICD9_Procedure_Codes | |
| T5_131_R | ICD-9 In-Patient Hospital Procedure Codes (Principal) | On | PM | ||
| 132 | T5_132_P | NUBC Procedure Codes | Off | PM | |
| T5_132_Q | NUBC Procedure Modifier Codes | Off | PM | ||
| T5_132_R | NUBC Revenue Codes | On | PM | ||
| T5_132_S | NUBC Condition Codes | On | PM | ||
| T5_132_T | NUBC Occurrence Codes | On | PM | ||
| T5_132_U | NUBC Occurrence Span Codes | On | PM | ||
| T5_132_V | NUBC Value Codes | On | PM | ||
| 132/641 | T5_132_S_and_641 | NUBC Condition Codes and D & B Condition Code List | Off | PM | |
| 133 | T5_133_P | CPT-4 Procedure Codes | On | PM | |
| T5_133_Q | CPT-4 Procedure Modifier Codes | Off | PM | ||
| 135 | T5_135_A | ADA Systemized Nomenclature of Dentistry Diagnosis Codes | Off | PM | |
| T5_135_B | ADA Systemized Nomenclature of Dentistry Diagnosis Codes (Principal) | Off | PM | ||
| T5_135_P | ADA CDT-4 Procedure Codes | On | PM | ||
| T5_135_Q | ADA CDT-4 Procedure Modifier Codes | Off | PM | ||
| T5_135_T | ADA Universal National Tooth Designation System | On | PM | ||
| T5_135_U | ADA Code on Dental Procedures and Nomenclature Oral Cavity Codes | On | PM | ||
| 139 | T5_139 | Claim Adjustment Reason Codes (CARC) | On | CV | T5_139_Claim_Adjust_Reason_Codes |
| 229 | T5_229 | Diagnosis Related Group (DRG) Codes | On | CV | T5_229_Dx_Related_Group_Codes |
| 230 | T5_230 | NUBC Point of Origin for Admission or Visit (Admission Source Code) | On | PM | |
| 231 | T5_231 | NUBC Priority of Admission or Visit (Admission Type Code) | On | PM | |
| 235 | T5_235 | NUBC Claim Frequency Type Codes | On | PM | |
| 236 | T5_236 | NUBC Uniform Billing Claim Form Bill Type Codes | On | PM | |
| 237 | T5_237 | CMS Place of Service Codes for Professional Claims | On | CV | T5_237_Place_of_Service_Codes |
| 239 | T5_239 | NUBC Patient Status Codes | On | PM | |
| 240 | T5_240_A | NDC National Drug Codes in 5-4-2 Format | On | PM | |
| T5_240_B | NDC National Health Related Item Codes in 4-6 Format | Off | PM | ||
| 244 | T5_244 | Codes identifying the nature of insurance coverage | On | CV | T5_244_Line_of_Business_Codes |
| 245 | T5_245 | NAIC Insurance Company Identifiers | On | PM | |
| 284 | T5_284 | NCCI Nature of Injury Codes | Off | PM | |
| 307 | T5_307 | National Council for Prescription Drug Programs Pharmacy Numbers | On | PM | |
| 327 | T5_327 | SWIFT BICs (8 or 11 characters) | On | PM | |
| 359 | T5_359 | CMS Home Health Treatment Codes | Off | PM | |
| 407 | T5_407 | Nature of Injury Code from Occupational Injury and Illness Manual | Off | PM | |
| 411 | T5_411 | CMS Claim Payment or Remittance Advice Remark Codes (RARC) | On | CV | T5_411_Remittance_Advice_Codes |
| 457 | T5_457 | NISO Z39.53 Language Codes | On | PM | |
| 468 | T5_468 | CMS Ambulatory Patient Classification Codes | Off | PM | |
| 507 | T5_507 | Health Care Claim Status Category Codes | On | CV | T5_507_Claim_Status_Cat_Codes |
| T5_507_A | Health Care Claim Status Category D0 or E Codes | On | CV | T5_507_A_Claim_Stat_Cat_D0_or_E | |
| T5_507_B | Health Care Claim Status Category R Codes | On | CV | T5_507_B_Claim_Stat_Cat_R_Codes | |
| T5_507_C | Health Care Claim Status Category Not R Codes | On | CV | T5_507_C_Claim_Stat_Cat_Not_R | |
| 508 | T5_508 | Claim Status Codes | On | CV | T5_508_Claim_Status_Codes |
| 513 | T5_513_P | Home Infusion EDI Coalition (HIEC) Product/Service Code | Off | PM | |
| T5_513_Q | Home Infusion EDI Coalition (HIEC) Product/Service Code (Modifier) | Off | PM | ||
| 530 | T5_530 | NCPDP Claim Reject/Payment Codes | Off | PM | |
| 537 | T5_537 | CMS National Provider Identifiers (NPI) | On | PM | |
| 540 | T5_540 | CMS Health Care Plan Identifiers (HPID) | Off | PM | |
| 576 | T5_576_P | Workers Compensation (IAIABC) Procedure/Supply Codes | Off | PM | |
| T5_576_Q | Workers Compensation (IAIABC) Procedure/Supply Modifier Codes | Off | PM | ||
| 582 | T5_582 | DMERC (Certificate of Medical Necessity) CMN Form Identifiers | Off | PM | |
| 656 | T5_656 | ACORD Form Type Codes | Off | PM | |
| 663 | T5_663_P | Logical Observation Identifier Names and Codes (LOINC) | On | PM | |
| T5_663_Q | Logical Observation Identifier Names and Codes (LOINC) Modifiers | On | PM | ||
| 682 | T5_682 | Health Care Provider Taxonomy Codes | On | CV | T5_682_Provider_Taxonomy_Codes |
| 716 | T5_716_P | HIPPS Skilled Nursing Facility Rate Codes | On | CV | T5_716_P_HIPPS_Fac_Rate_Codes |
| T5_716_Q | HIPPS Skilled Nursing Facility Rate Modifier Codes | Off | PM | ||
| 843 | T5_843_P | Advanced Billing Concepts (ABC) Procedure Codes | Off | PM | |
| T5_843_Q | Advanced Billing Concepts (ABC) Procedure Modifier Codes | Off | PM | ||
| T5_843_R | Advanced Billing Concepts (ABC) Procedure Codes (Principal) | Off | PM | ||
| 844 | T5_844 | DOD Dependent Eligibility Category | Off | PM | |
| 859 | T5_859 | CDC Classification of Race or Ethnicity Codes | Off | PM | |
| 860 | T5_860 | CDC Race or Ethnicity Collection Codes | Off | PM | |
| 886 | T5_886 | Health Care Service Review Decision Reason Codes | On | CV | T5_886_Decision_Reason_Codes |
| 896 | T5_896_P | ICD-10-PCS In-Patient Hospital Procedure Codes | On | PM | |
| T5_896_R | ICD-10-PCS In-patient Hospital Procedure Codes (Principal) | On | PM | ||
| 897 | T5_897_A | ICD-10-CM Diagnosis Codes | On | PM | |
| T5_897_B | ICD-10-CM Diagnosis Codes (Principal) | On | PM | ||
| T5_897_C | ICD-10-CM Diagnosis Codes (Admitting) | On | PM | ||
| T5_897_D | ICD-10-CM Diagnosis Codes (Patient Reason for Visit) | On | PM | ||
| T5_897_E | ICD-10-CM Diagnosis Codes (E-Code) | On | PM | ||
| 932 | T5_932 | UPU Universal Postal Codes | Off | PM | |
| 932/51 | T5_932_and_051 | US ZIP, ZIP Plus 4, CA and UPU Postal Codes | Off | PM | |
| T5_932_and_051_BC | US ZIP+4 (9 digits only), CA and UPU Postal Codes | Off | PM | ||
| DOD1 | T5_DOD1 | DOD Health Service Region | On | PM |