Revenue Center Label
Home Health services paid under PPS submitted as TOB 32X and 33X, effective 10/00. This code may appear multiple times on a claim to identify different HIPPS/Home Health Resource Groups (HRG).
All inclusive rate-room and board plus ancillary
Private medical or general-general classification
Semi-private 2 bed (medical or general) general classification
Semi-private 2 bed (medical or general) medical/surgical/GYN
Semi-private 2 bed (medical or general)-OB
Semi-private 2 bed (medical or general)-psychiatric
Semi-private 2 bed (medical or general)-oncology
Semi-private 2 bed (medical or general)-rehabilitation
Semi-private 2 bed (medical or general)-other
Semi-private 3 and 4 beds-general classification
Semi-private 3 and 4 beds-medical/surgical/GYN
Room&Board ward (medical or general)-general classification
Room&Board ward (medical or general)-medical/surgical/GYN
Room&Board ward (medical or general)-psychiatric
Room&Board ward (medical or general)-hospice
Room&Board ward (medical or general)-detoxification
Room&Board ward (medical or general)-rehabilitation
Room&Board ward (medical or general)-other
Other Room & Board-general classification
Nursery-premature newborn-level II (continuing care)
Nursery-newborn-level III (intermediate care) (eff 10/96)
Nursery-newborn-level IV (intensive care) (eff 10/96)
Leave of absence-patient convenience charges billable
Subacute care - general classification (eff. 10/97)
Intensive care-post ICU; redefined as intermediate ICU (eff 10/96)
Coronary care-post CCU; redefined as intermediate CCU (eff 10/96)
Incremental nursing charge rate-general classification
Incremental nursing charge rate-ICU (include transitional care)
All inclusive ancillary-other inclusive ancillary
Pharmacy-drugs incident to other diagnostic service-subject to payment limit
Pharmacy-drugs incident to radiology-subject to payment limit
IV therapy-pharmacy services (eff 10/94)
IV therapy-drug supply/delivery (eff 10/94)
Medical/surgical supplies-general classification (also see 062X)
DME (other than renal)-general classification
DME (other than renal)-purchase of new DME
DME (other than renal)-purchase of used DME
DME (other than renal)-related to and listed as DME
Nuclear Medicine - Diagnostic radiopharmaceuticals
Nuclear Medicine - Therapuetic radiopharmaceuticals
Computed tomographic (CT) scan-general classification
Operating room services-organ transplant, other than kidney
Operating room services-other operating room services
Anesthesia-incident to RAD and subject to the payment limit
Anesthesia-incident to other diagnostic service and subject to the payment limit
Blood storage and processing-general classification
Blood storage and processing-blood administration
Other imaging services-screening mammography (eff 1/1/91)
Other imaging services-positron emission tomography (eff 10/94)
Occupational therapy-other (may include restorative therapy)
Speech language pathology-evaluation or re-evaluation
Emergency room-emtala emergency medical screening services (eff 10/96)
Emergency room-ER beyond emtala screening (eff 10/96)
Outpatient services-general classification (deleted 9/93)
Clinic-family practice clinic (eff 10/96)
Free-standing clinic-Clinic visit by a member to RHC/FQHC (eff. 7/1/06). Prior to 7/1/06 - Rural Health-Clinic
Free-standing clinic-Home visit by RHC/FQHC practitioner (eff. 7/1/06). Prior to 7/1/06 - Rural Health-Home
Free-standing clinic - visit by RHC/FQHC practitioner to a member in a covered Part A stay at the SNF. (eff. 7/1/06)
Free-standing clinic - visit by RHC/FQHC practitioner to a member in a SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility. (eff. 7/1/06)
Free-standing clinic-urgent care (eff 10/96)
Free-standing clinic-RHC/FQHC visiting nurse service(s) to a member's home when in a home health shortage area. (eff. 7/1/06)
Free-standing clinic-visit by RHC/FQHC practitioner to other non RHC/FQHC site (e.g. scene of accident). (eff. 7/1/06)
Home health aid (home health)-general classification
Home health aid (home health)-visit charge
Home health aid (home health)-hourly charge
Other visits (home health)-general classification (under HHPPS, not allowed as covered charges)
Other visits (home health)-visit charge (under HHPPS, not allowed as covered charges)
Other visits (home health)-hourly charge (under HHPPS, not allowed as covered charges)
Other visits (home health)-other (under HHPPS, not allowed as covered charges)
Units of service (home health)-general classification (under HHPPS, not allowed as covered charges)
Oxygen/Home Health-stat or port equip/supply or count
Magnetic resonance technology (MRT)-general classification
Medical/surgical supplies-incident to radiology-subject to the payment limit - extension of 027X
Medical/surgical supplies-incident to other diagnostic service-subject to the payment limit - extension of 027X
Medical/surgical supplies-surgical dressings (eff 1/95) - extension of 027X
Medical/surgical supplies-medical investigational devices and procedures with FDA approved IDE's (eff 10/96) - extension of 027X
Drugs requiring specific identification-single drug source (eff 9/93)
Drugs requiring specific identification-multiple drug source (eff 9/93)
Drugs requiring specific identification-restrictive prescription (eff 9/93)
Drugs requiring specific identification-EPO under 10,000 units
Drugs requiring specific identification-EPO 10,000 units or more
Drugs requiring specific identification-detailed coding (eff 3/92)
Self-administered drugs administered in an emergency situation - not requiring detailed coding
Home IV therapy-general classification (eff 10/94)
Home IV therapy-nonroutine nursing (eff 10/94)
Home IV therapy-IV site care, central line (eff 10/94)
Home IV therapy-IV start/change peripheral line (eff 10/94)
Home IV therapy-nonroutine nursing, peripheral line (eff 10/94)
Home IV therapy-train disabled patient, central line (eff 10/94)
Home IV therapy-train patient/caregiver, peripheral line (eff 10/94)
Home IV therapy-train disabled patient, peripheral line (eff 10/94)
Home IV therapy-other IV therapy services (eff 10/94)
Hospice services-general inpatient care (non-respite)
Respite care (HHA)-hourly charge/skilled nursing (eff 9/93)
OP special residence charges - general classification
OP special residence charges - hospital based
OP special residence charges - contracted
EKG/ECG-telemetry (include fetal monitering until 9/93)
Treatment or observation room-general classification
Treatment or observation room-treatment room (eff 9/93)
Treatment or observation room-observation room (eff 9/93)
Preventative care services-general classification (eff 10/94)
Preventative care services-vaccine administration (eff 10/94)
Preventative care services-other (eff 10/94)
Telemedicine - general classification (eff 10/97)
Inpatient renal dialysis-inpatient peritoneal (non-CAPD)
Inpatient renal dialysis-other inpatient dialysis
Organ acquisition-living donor (eff 10/94); prior to 10/94, defined as living donor kidney
Organ acquisition-cadaver donor (eff 10/94); prior to 10/94, defined as cadaver donor kidney
Organ acquisition-unknown donor (eff 10/94); prior to 10/94, defined as unknown donor kidney
Organ acquisition - unsuccessful organ search-donor bank charges (eff 10/94); prior to 10/94, defined as other kidney acquisition
Organ acquisition-cadaver donor-heart (obsolete, eff 10/94)
Organ acquisition-other donor (eff 10/94); prior to 10/94, defined as other
Hemodialysis OP or home dialysis-general classification
Hemodialysis OP or home dialysis-hemodialysis-composite or other rate
Hemodialysis OP or home dialysis-home supplies
Hemodialysis OP or home dialysis-home equipment
Hemodialysis OP or home dialysis-maintenance/100%
Hemodialysis OP or home dialysis-support services
Peritoneal dialysis OP or home-general classification
Peritoneal dialysis OP or home-peritoneal-composite or other rate
Peritoneal dialysis OP or home-home supplies
Peritoneal dialysis OP or home-support services
CAPD outpatient-CAPD/composite or other rate
CCPD outpatient-CCPD/composite or other rate
Miscellaneous dialysis-home dialysis aide visit (eff 9/93)
Other donor bank-bone; changed to reserved for national assignment (eff 4/94)
Other donor bank-skin; changed to reserved for national assignment (eff 4/94)
Behavior Health Treatment/Services - general classification (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments-general classification
Behavior Health Treatment/Services - electroshock treatment (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments-electroshock treatment
Behavior Health Treatment/Services - milieu therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments-milieu therapy
Behavior Health Treatment/Services - play therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments-play therapy
Behavior Health Treatment/Services - activity therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments-activity therapy
Behavior Health Treatment/Services - intensive outpatient services-psychiatric (eff. 10/2004)
Behavior Health Treatment/Services - intensive outpatient services-chemical dependency (eff. 10/2004)
Behavior Health Treatment/Services - community behavioral health program-day treatment (eff. 10/2004)
Reserved for National Use (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological treatments-other
Behavioral Health Treatment/Services-Reserved for National Assignment (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-general classification
Behavioral Health Treatment/Services-rehabilitation (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-rehabilitation
Behavioral Health Treatment/Services-partial hospitalization-less intensive (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-less intensive
Behavioral Health Treatment/Services-partial hospitalization-intensive (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-intensive
Behavioral Health Treatment/Services-individual therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-individual therapy
Behavioral Health Treatment/Services-group therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-group therapy
Behavioral Health Treatment/Services-family therapy (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-family therapy
Behavioral Health Treatment/Services-biofeedback (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-biofeedback
Behavioral Health Treatment/Services-testing (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-testing
Behavioral Health Treatment/Services-other (eff. 10/2004); prior to 10/2004 defined as Psychiatric/psychological services-other
Other diagnostic services-peripheral vascular lab
Other therapeutic services-education/training (include diabetes diet training)
Other therapeutic services-routine complex medical equipment
Other therapeutic services-ancillary complex medical equipment (eff 3/92)
Professional Fees-athletic training (extension of 094X)
Professional Fees-kinesiotherapy (extension of 094X)
Professional fees-other NOTE: 097X is an extension of 096X
Professional fees-speech pathology NOTE: 098X is an extension of 096X & 097X
Patient convenience items-private linen service
Patient convenience items-nonpatient room rentals
Patient convenience items-late discharge charge
Behavioral Health Accomodations - General
Reduced physical functions-RUGS PB2/ADL index of 6-8
High rehabilitation-RUGS RHC/ADL index of 12-14
Very high rehabilitation-RUGS RVA/ADL index of 4-7