Status Last Reviewed: 11/1/2024
| Num. | Date | Requested Description | Type | Code | Status |
|---|---|---|---|---|---|
| 46 | 5/15/2024 | Naturopathy involves using natural remedies to assist the body's self-healing process, administered by a naturopathic physician. | New | Pending |
Service Type Codes
958
These codes identify business groupings for health care services or benefits.
NOTE
This code list is not applicable to the 005010 version. Reference the Service Type Code listing within the 005010X279 Health Care Eligibility Benefit Inquiry and Response (270/271) implementation guide for a list of compliant Service Type Code values allowed in the 005010 version.
This code list is not applicable to the 005010 version. Reference the Service Type Code listing within the 005010X279 Health Care Eligibility Benefit Inquiry and Response (270/271) implementation guide for a list of compliant Service Type Code values allowed in the 005010 version.
Maintenance Request Status
The list below shows the status of change requests which are in process.
Each request will be in one of the following statuses:
- Received
The request has been submitted but is not yet under review. - Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present. - In Process
The CMG has initiated their decision process. - On Hold
The CMG has initiated their decision process but cannot complete it at this time. - CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version. - CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
1/1/2024
| 1 | Medical Care Medical services to diagnose and/or treat a medical condition, illness, or injury Start: 09/20/2009 |
| 2 | Surgical Surgical services provided by a healthcare provider Start: 09/20/2009 |
| 3 | Consultation Counseling and/or coordination of care with other Physicians, other qualified Healthcare Providers or agencies Start: 09/20/2009 |
| 4 | Diagnostic X-Ray Diagnostic x-ray provided by a healthcare provider Start: 09/20/2009 |
| 5 | Diagnostic Lab Diagnostic lab provided by a healthcare provider Start: 09/20/2009 |
| 6 | Radiation Therapy Radiation therapy provided by a healthcare provider Start: 09/20/2009 |
| 7 | Anesthesia Anesthesia services provided by a healthcare provider Start: 09/20/2009 |
| 8 | Surgical Assistance Assistant surgeon/surgical assistance provided by a healthcare provider if required because of the complexity of the surgical procedures Start: 09/20/2009 |
| 9 | Hearing Aid Small electronic device that is worn in or above the ear. Start: 09/01/2023 |
| 10 | Blood The allotment of whole blood, blood plasma, or blood derivatives Start: 09/20/2009 |
| 11 | Durable Medical Equipment Used Used equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home. Start: 09/20/2009 |
| 12 | Durable Medical Equipment Purchased Purchased equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home. Start: 09/20/2009 |
| 13 | Hearing Aid Power Source Batteries or other type of device used to charge a hearing aid Start: 09/01/2023 |
| 14 | Renal Supplies Supplies to support treatment of kidneys, or bladder functions. (Example: Dialysis Supplies and/or catheters) Start: 09/20/2009 |
| 15 | Sleep Study Start: 01/01/2024 |
| 17 | Pre-Admission Testing Services related to the preparation for admission to establish the patients current health status. Start: 09/20/2009 |
| 18 | Durable Medical Equipment Rental Rental equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home. Start: 09/20/2009 |
| 19 | Pneumonia Vaccine Services provided by a physician or other healthcare provider related to administration of Pneumococcal Pneumonia vaccination. Start: 09/20/2009 |
| 20 | Second Surgical Opinion Second professional opinion sought to verify or confirm the necessity for surgical procedures Start: 09/20/2009 |
| 21 | Third Surgical Opinion Third professional opinion sought to verify or confirm the necessity for surgical procedures Start: 09/20/2009 |
| 22 | Social Work Services related to a systematic way of helping individuals and groups towards better adaptation to society Start: 09/20/2009 |
| 23 | Diagnostic Dental The translation of data gathered by clinical and radiographic examination into an organized, classified definition of conditions present. Start: 09/20/2009 |
| 24 | Periodontics The art and science of examination, diagnosis, and treatment of diseases affecting the periodontium; a study of the supporting structures of the teeth, normal anatomy and physiology and the deviations. Start: 09/20/2009 |
| 25 | Restorative Broad term applied to any restorations to the tooth/teeth structure(s). Anterior teeth include up to five surface classifications - Mesial, Distal, Incisal, Lingual and Labial. Posterior teeth include up to five surface classifications: Mesial, Distal, Occlusal, Lingual and Buccal. Start: 09/20/2009 |
| 26 | Endodontics The branch of dentistry that is concerned with the morphology, physiology and pathology of the dental pulp and periradicular (gum) tissues. Start: 09/20/2009 |
| 27 | Maxillofacial Prosthetics The branch of prosthetics is concerned with the restoration of stomatognathic and associated facial structure that have been affected by disease, injury, surgery, or congenital defect. Start: 09/20/2009 |
| 28 | Adjunctive Dental Services Typically these services involve a drug such as anesthesia or other substances that serve as a supplemental purpose in dental therapy. Start: 09/20/2009 |
| 30 | Plan Coverage and General Benefits Plan coverage and general benefits for the member's policy or contract. Start: 09/20/2009 | Last Modified: 11/01/2019 |
| 32 | Plan Waiting Period Start: 09/20/2009 |
| 33 | Chiropractic Manipulations and modalities provided by a healthcare provider Start: 09/20/2009 |
| 34 | Chiropractic Modality Start: 09/20/2009 | Stop: 07/01/2016 |
| 35 | Dental Care The treatment of the teeth and their supporting structures. Start: 09/20/2009 |
| 36 | Dental Crowns An artificial replacement for the natural crown of the tooth covering all five surfaces (Anterior teeth surface classifications - Mesial, Distal, Incisal, Lingual and Labial. Posterior teeth surface classifications: Mesial, Distal, Occlusal, Lingual and Buccal. Start: 09/20/2009 |
| 37 | Dental Accident Supplies or appliances for care of teeth due to accidental injury provided by healthcare provider Start: 09/20/2009 |
| 38 | Orthodontics The area of dentistry concerned with the supervision, guidance, and correction of the growing and mature orofacial structures. This includes conditions that require movement of the teeth or correction of the malrelationships and malformations of related structures by the adjustment of relationships between and among teeth and facial bones by the application of forces or the stimulation and redirection of functional forces within the craniofacial complex. Start: 09/20/2009 |
| 39 | Prosthodontics The part of dentistry pertaining to the restoration and maintenance of oral function, comfort, appearance and health of the patient by replacement of missing teeth and contiguous tissues with artificial substitutes. It has three main branches: removable prosthodontics, fixed prosthodontics and maxillofacial prosthetics. Start: 09/20/2009 |
| 40 | Oral Surgery Diagnosis and treatment of disorders of the mouth, teeth, jaws and facial structure provided by a healthcare provider Start: 09/20/2009 |
| 41 | Preventive Dental The dental procedures in dental practice and health programs that prevent the occurrence of oral diseases. Start: 09/20/2009 | Last Modified: 01/24/2010 |
| 42 | Home Health Care Healthcare services rendered in the home by a healthcare provider Start: 09/20/2009 |
| 43 | Home Health Prescriptions Start: 09/20/2009 |
| 45 | Hospice An integrated set of services and supplies to provide palliative and supportive care to terminally ill patients. Start: 09/20/2009 |
| 46 | Respite Care Services related to temporary care of a dependent elderly, ill, or handicapped person, providing relief for their usual caregivers Start: 09/20/2009 |
| 47 | Hospitalization Hospital Inpatient and Outpatient services and supplies for a patient who may or may not have been admitted to a hospital, for the purpose of receiving medical care or other health services. Start: 09/20/2009 |
| 49 | Hospital - Room and Board Start: 09/20/2009 |
| 54 | Long Term Care Care provided for an individual when they cannot care for themselves within the home or in a facility Start: 09/20/2009 |
| 55 | Major Medical Start: 09/20/2009 |
| 56 | Medically Related Transportation Ambulance, Ambulate or other Medical transport services Start: 09/20/2009 |
| 60 | Plan Coverage Indicates whether a patient has active or inactive coverage for the service date requested. Start: 09/20/2009 | Last Modified: 11/01/2019 |
| 61 | In-vitro Fertilization Services to treat infertility Start: 09/20/2009 |
| 62 | MRI Scan Diagnostic MRI (Magnetic Resonance Imaging) services. Start: 09/20/2009 |
| 63 | Donor Procedures Services related to the collection of tissues, organs, or fluids for use in the treatment for another person Start: 09/20/2009 |
| 64 | Acupuncture A system of alternative treatment that involves pricking the skin or tissues with needles Start: 09/20/2009 |
| 65 | Newborn Care Management of the infant during the transition to extra uterine life and subsequent period of stabilization Start: 09/20/2009 |
| 66 | Pathology Creation of slides from tissues and its interpretation provided by a healthcare provider Start: 09/20/2009 |
| 67 | Smoking Cessation Treatment to assist in the discontinuation of the use of nicotine Start: 09/20/2009 |
| 68 | Well Baby Care Medical services and physician visits which are recommended by the American Pediatric Association as appropriate and routine care for a child to a specific age limit. Start: 09/20/2009 |
| 69 | Maternity Services related to maternity care including related conditions resulting in childbirth when provided, or ordered and billed by a physician or nurse midwife Start: 09/20/2009 |
| 70 | Transplants Services related to the transfer of living organs or tissue from one body to another. Start: 09/20/2009 |
| 71 | Audiology Services related to hearing disorders, including evaluation of hearing function and rehabilitation of patients with hearing impairment Start: 09/20/2009 |
| 72 | Inhalation Therapy Services related to the use of inhaled agents to treat respiratory diseases and conditions Start: 09/20/2009 |
| 73 | Diagnostic Medical Services required to determine the diagnose to treat a medical condition, illness, or injury Start: 09/20/2009 |
| 74 | Private Duty Nursing A nurse who is hired to provide focused care to an individual patient in a hospital, clinic, nursing home or patient's home Start: 09/20/2009 |
| 75 | Prosthetics A device that is used to replace a part of the body that is missing. Start: 09/20/2009 | Last Modified: 07/01/2016 |
| 76 | Dialysis The process by which uric acid and urea are removed from circulating blood by means of a dialyzer Start: 09/20/2009 |
| 77 | Otology Services related to diagnosis and treatment of the ear and related structures Start: 09/20/2009 |
| 78 | Chemotherapy The treatment of disease by means of chemicals that have a specific toxic effect upon the disease-producing microorganisms or that selectively destroy cancerous tissue. Start: 09/20/2009 |
| 79 | Allergy Testing A skin or blood test to determine what substance, or allergen, may trigger an allergic response in a person Start: 09/20/2009 |
| 80 | Immunizations The introduction of a vaccine with the goal of producing immunity Start: 09/20/2009 |
| 81 | Routine Physical A physical examination performed on asymptomatic patients for medical screening purposes. Start: 09/20/2009 |
| 82 | Family Planning Educational services that assists individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. Start: 09/20/2009 |
| 83 | Infertility Services to diagnose and/or treat infertility. Covered services may include assisted reproductive technology procedures. Start: 09/20/2009 |
| 84 | Abortion Services related to the elective termination of a pregnancy Start: 09/20/2009 |
| 85 | HIV - AIDS Treatment Services related to diagnosis and treatment of HIV - AIDS Start: 09/20/2009 |
| 86 | Emergency Services Services provided by healthcare providers for the treatment of a sudden and unexpected medical condition or injury which requires immediate medical attention Start: 09/20/2009 |
| 87 | Cancer Treatment Services related to diagnosis and treatment of cancer not performed by an Oncologist Start: 09/20/2009 |
| 88 | Retail/Independent Pharmacy A licensed entity that dispenses prescription drugs and provides professional pharmacy services, such as clinical pharmacy consulting respective to the dispensing function. The entity may be a retail/chain or independent pharmacy or any other entity which dispenses prescription drugs. Start: 09/20/2009 | Last Modified: 05/01/2017 |
| 89 | Free Standing Prescription Drug Members have separate cost sharing for prescription drugs and medical coverage. Start: 09/20/2009 |
| 90 | Mail Order Pharmacy A mail order pharmacy delivers medications directly to patients through the mail. Start: 09/20/2009 | Last Modified: 05/01/2017 |
| 91 | Brand Name Prescription Drug The original formulation of a prescription drug, approved by the FDA for distribution. Start: 09/20/2009 |
| 92 | Generic Prescription Drug Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. Start: 09/20/2009 |
| 93 | Podiatry Professional services of a physician or other healthcare provider for the care or treatment of conditions of the foot. Start: 09/20/2009 |
| 94 | Dental and prediagnostic tests and examinations Refer to the American Dental Association Code on Dental Procedures and Nomenclature (CDT Code). Start: 03/01/2019 |
| 95 | Periodontal Surgical Services Refer to the American Dental Association Code on Dental Procedures and Nomenclature (CDT Code). Start: 03/01/2019 |
| 96 | Adjustment to dentures/repairs to complete dentures, denture rebase procedures, and denture reline procedures Refer to the American Dental Association Code on Dental Procedures and Nomenclature (CDT Code). Start: 03/01/2019 |
| 97 | Dental, non-surgical extractions Refer to the American Dental Association Code on Dental Procedures and Nomenclature (CDT Code). Start: 03/01/2019 |
| 98 | Prescription Drug Start: 03/01/2019 |
| 99 | Bariatric services - Services that deal with the causes, education, prevention and treatment of obesity. Start: 07/01/2019 |
| A4 | Psychiatric Services related to the diagnosis or treatment of mental health. Start: 09/20/2009 |
| A6 | Psychotherapy Professional services, including individual or group therapy by providers such as psychiatrists, psychologists, clinical social workers, or psychiatric nurses. Start: 09/20/2009 |
| A7 | Psychiatric - Inpatient Start: 09/20/2009 |
| A8 | Psychiatric - Outpatient Start: 09/20/2009 |
| A9 | Rehabilitation Services related to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible Start: 09/20/2009 |
| AB | Rehabilitation - Inpatient Start: 09/20/2009 |
| AC | Rehabilitation - Outpatient Start: 09/20/2009 |
| AD | Occupational Therapy Professional and facility occupational therapy services performed by an occupational therapist, physician or other healthcare provider at a hospital, office or other covered facility. Start: 09/20/2009 |
| AE | Physical Medicine Services related to the diagnosis, evaluation, and management of persons of all ages with physical and/or cognitive impairment and disability. Start: 09/20/2009 |
| AF | Speech Therapy Professional and facility speech therapy services performed by a speech therapist, physician or other healthcare provider at a hospital, office or other covered facility. Start: 09/20/2009 |
| AG | Skilled Nursing Care Services for a patient in a skilled nursing facility for the purpose of receiving medical care or other health services. Start: 09/20/2009 |
| AI | Substance Abuse Services provided at a hospital, office or other covered facility as they are related to the diagnosis and treatment of Substance Abuse. Start: 09/20/2009 |
| AJ | Alcoholism Treatment Services related to the management of Alcohol dependencies or addiction Start: 09/20/2009 |
| AK | Drug Addiction Services related to the management of Drug dependencies or addiction, excluding Alcohol Start: 09/20/2009 |
| AL | Optometry Routine vision services furnished by an optometrist. May include coverage for eyeglasses, contact lenses, routine eye exams, and/or vision testing for the prescribing or fitting of eyeglasses or contact lenses. Start: 09/20/2009 |
| AM | Frames The framework for a pair of eyeglasses Start: 09/20/2009 |
| AO | Lenses A piece of transparent substance having two opposite surfaces either both curved or one curved and one plane, used in an optical device in correcting defects of vision. Start: 09/20/2009 |
| AP | Routine Eye Exam A series of tests to evaluate an individual's vision and check for eye diseases. Start: 09/20/2009 |
| AQ | Nonmedically Necessary Physical (These physicals are required by other entities e.g., insurance application, pilot license, employment or school) A physical examination performed on asymptomatic patients for medical screening purposes. Start: 09/20/2009 |
| AR | Experimental Drug Therapy Treatment of a physical or mental condition using non-generally accepted drugs, such as not FDA approved, Clinical Trial. Start: 09/20/2009 |
| B1 | Burn Care Services related to the treatment of Burns Start: 09/20/2009 |
| B2 | Brand Name Prescription Drug - Formulary Lists of brand name drugs covered and published by the health plan/payer/processor/PBM to help physicians reach clinically and economically appropriate prescribing decisions for patients. Start: 09/20/2009 |
| B3 | Brand Name Prescription Drug - Non-Formulary A brand name drug that is not listed on the covered and published list of the health plan/payer/processor/PBM. Start: 09/20/2009 |
| BA | Independent Medical Evaluation Services when a doctor/physical therapist/chiropractor/psychologist/neuropsychologist who has not previously been involved in a person's care examines an individual. There is no doctor/therapist-patient relationship. Start: 09/20/2009 |
| BB | Psychiatric Treatment Partial Hospitalization Start: 09/20/2009 | Last Modified: 03/01/2023 |
| BC | Day Care (Psychiatric) Start: 09/20/2009 | Last Modified: 03/01/2023 |
| BD | Cognitive Therapy A type of psychotherapy in which negative patterns of thought, are challenged in order to alter unwanted behavior patterns or treat mood disorders. Start: 09/20/2009 |
| BE | Massage Therapy The manipulation of muscles and other soft tissues of the body by a therapist for the treatment of health conditions such as pain, cancer, fibromyalgia, HIV/AIDS, depression. Start: 09/20/2009 |
| BF | Pulmonary Rehabilitation Services and instructional guidance administered to an individual suffering from respiratory disease in an attempt to improve the quality of life for the patient. Start: 09/20/2009 |
| BG | Cardiac Rehabilitation Services and instructional guidance rendered by a physician or other healthcare provider in a hospital or covered facility that are designed to help an individual recover from a cardiovascular event Start: 09/20/2009 |
| BH | Pediatric Treatment or care related to infants, children, and adolescents Start: 09/20/2009 |
| BI | Nursery Room and Board Treatment or care related to newborns Start: 09/20/2009 |
| BK | Orthopedic Services related to the correction or prevention of deformities, disorders, or injuries of the skeleton and associated structures. Start: 09/20/2009 |
| BL | Cardiac Services of or relating to the heart Start: 09/20/2009 |
| BM | Lymphatic Services related to a lymph, lymph node, or a lymphatic vessel Start: 09/20/2009 |
| BN | Gastrointestinal Services to treat disorders of the stomach and intestines, and related systems Start: 09/20/2009 |
| BP | Endocrine Services related to the systems that secrete hormones Start: 09/20/2009 |
| BQ | Neurology Services related to the treatment of the nerves or nervous system. Start: 09/20/2009 |
| BT | Gynecological Medical care and management of the female reproductive system and associated disorders provided by a physician or other healthcare provider. Start: 09/20/2009 |
| BU | Obstetrical Medical care and management related to the care of a woman prior, during and after pregnancy, provided by a physician or other healthcare provider. Start: 09/20/2009 |
| BV | Obstetrical/Gynecological Start: 09/20/2009 |
| BW | Mail Order Prescription Drug: Brand Name Start: 09/20/2009 | Stop: 07/01/2016 |
| BX | Mail Order Prescription Drug: Generic Start: 09/20/2009 | Stop: 07/01/2016 |
| BY | Physician Visit - Sick Professional services rendered by a physician or other healthcare provider during a non-routine visit related to a illness. Start: 09/20/2009 |
| BZ | Physician Visit - Well Professional services rendered by a physician or other healthcare provider during a routine or preventative care visit. Start: 09/20/2009 |
| C1 | Coronary Care Treatment of diseases of the arteries of the heart Start: 09/20/2009 |
| CK | Screening X-ray X-ray services provided by a physician or other healthcare provider for the purpose of preventative care. Start: 09/20/2009 |
| CL | Screening laboratory Laboratory services provided by a physician or other healthcare provider for the purpose of preventative care. Start: 09/20/2009 |
| CM | Mammogram, High Risk Patient Mammography services for patients that have been identified with a greater than normal risk for breast cancers and related diseases. Start: 09/20/2009 |
| CN | Mammogram, Low Risk Patient Mammography services for patients that have been identified with a normal risk for breast cancers and related diseases. Start: 09/20/2009 |
| CO | Flu Vaccination Services provided by a physician or other healthcare provider related to the administration of influenza virus vaccination. Start: 09/20/2009 |
| CP | Eyewear Accessories Services related to Eyewear and Eyewear Accessories Start: 09/20/2009 |
| CQ | Case Management Services that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's health and human service needs Start: 09/20/2009 |
| DG | Dermatology Services provided by a physician or other healthcare provider involving the skin and its diseases. Start: 09/20/2009 |
| DM | Durable Medical Equipment Durable medical equipment that can withstand repeated use and is primarily and customarily used to serve a medical purpose and generally is not useful to a person in the absence of an illness or injury. Start: 09/20/2009 |
| DS | Diabetic Supplies Blood sugar (glucose) test strips, monitors, insulin, lancet devices and lancets, glucose control solutions used to monitor and assist in the treatment of diabetes. Start: 09/20/2009 |
| E0 | Applied Behavioral Analysis Therapy Services related to the assessment and treatment of learning and/or developmental disabilities to include techniques and principles to bring about meaningful and positive changes in behavior, improve attention, focus, memory, academics and/or increase language, communication and social skills. Start: 09/20/2009 | Last Modified: 07/01/2017 |
| E1 | Non-Medical Equipment (non DME) Durable equipment that can withstand repeated use and serves to augment or replace impaired functionality, environmental control and facilitate a patient's independent living. Start: 09/20/2009 |
| E2 | Psychiatric Emergency Emergency services related to the diagnosis or treatment of mental disease. Start: 09/20/2009 |
| E3 | Step Down Unit A hospital unit providing a level of care between intensive and routine. Start: 09/20/2009 |
| E4 | Skilled Nursing Facility Head Level of Care Services directly related to care associated with severe brain injuries requiring a skilled level of care. Start: 09/20/2009 |
| E5 | Skilled Nursing Facility Ventilator Level of Care Services directly related to care associated with ventilator dependent respiratory conditions requiring a skilled level of care. Start: 09/20/2009 |
| E6 | Level of Care 1 Skilled Care - Skilled Nursing Care in a regular hospital bed Start: 09/20/2009 |
| E7 | Level of Care 2 Comprehensive Care - Skilled Nursing Care Level II includes attributes of prior level plus services such as Wound Care (Stage 3), Tracheotomy Care, etc. Start: 09/20/2009 |
| E8 | Level of Care 3 Complex Care - Skilled Nursing Care Level III include attributes of prior levels plus services such as Ventilator Care, Specialty Beds, Peritoneal Dialysis, etc. Start: 09/20/2009 |
| E9 | Level of Care 4 Start: 09/20/2009 |
| E10 | Radiographs An image or picture produced on a radiation-sensitive film emulsion by exposure to ionizing radiation direct through an area, region, or substance of interest, followed by chemical processing of the film Start: 01/24/2010 |
| E11 | Diagnostic Imaging The use of radiographic, sonographic, and other technologies to create a graphic depiction of the body parts in question. Start: 01/24/2010 |
| E12 | Basic Restorative - Dental Start: 01/24/2010 | Stop: 07/01/2017 |
| E13 | Major Restorative - Dental Start: 01/24/2010 | Stop: 07/01/2017 |
| E14 | Fixed Prosthodontics The branch of prosthodontics concerned with the replacement or restoration of teeth by artificial substitutes that are not readily removable such as fixed partial dentures, pontics and abutments. Start: 01/24/2010 |
| E15 | Removable Prosthodontics The branch of prosthodontics concerned with the replacement or restoration of teeth by artificial substitutes that are readily removable such as a denture, partial denture and interim prosthesis. Start: 01/24/2010 |
| E16 | Intraoral Images - Complete Series Complete set of images using radiographic, sonographic, and other technologies representing an image or set of images within the oral cavity. Start: 01/24/2010 |
| E17 | Oral Evaluation The art and science of evaluation to make a clinical judgment or appraisal of a patient's dental health or condition. Start: 01/24/2010 |
| E18 | Dental Prophylaxis A series of procedures where plaque, calculus, and stain are removed from the teeth often referred to as "prophy" or teeth cleaning. Start: 01/24/2010 |
| E19 | Panoramic Images A tomogram of the jaws, taken with a specialized machine designed to present a panoramic view of the full circumferential length of the jaws on a single film. Start: 01/24/2010 |
| E20 | Sealants A resinous material designed for application to the occlusal surfaces of posterior teeth to seal the surface irregularities and prevent the carious process. Start: 01/24/2010 |
| E21 | Fluoride Treatments A separate process from dental prophylaxis of applying prescription strength fluoride product designed to prevent caries. Start: 01/24/2010 |
| E22 | Dental Implants A device, usually alloplastic, that is surgically inserted into or onto the oral tissue. To be used as a prosthodontic abutment, it should remain quiescent and purely secondary to local tissue physiology. Start: 01/24/2010 |
| E23 | Temporomandibular Joint Dysfunction Services related to the Impaired function of the temporomandibular articulation of the jaw. Start: 01/24/2010 |
| E24 | Retail Pharmacy Prescription Drug Dispenses prescription drugs and provides professional pharmacy services, such as clinical pharmacy consulting respective to the dispensing function. The entity may be a retail/chain or independent pharmacy or any other entity which dispenses prescription drugs. Start: 06/06/2010 | Last Modified: 11/01/2017 | Stop: 11/01/2017 |
| E25 | Long Term Care Pharmacy Long term care pharmacy serve the residents of nursing homes, assisted care facilities, extended care facilities, retirement homes, or post acute care. These are considered "closed door pharmacies" Start: 06/06/2010 |
| E26 | Comprehensive Medication Therapy Management Review A holistic review of medical care provided by pharmacists whose aim is to optimize drug therapy and improve therapeutic outcomes for patients Start: 06/05/2011 |
| E27 | Targeted Medication Therapy Management Review A targeted medication therapy management (MTM) review is consultation with a patient about their medication therapy related to a specific diagnosis, disease state or medication Start: 06/05/2011 |
| E28 | Dietary/Nutritional Services Nutrition and diet counseling such as: weight management, eating disorders, pregnancy, pediatric, food allergy, diabetes, celiac disease Start: 01/29/2012 |
| E29 | Technical Cardiac Rehabilitation Services Component Start: 09/30/2012 | Stop: 07/01/2016 |
| E30 | Professional Cardiac Rehabilitation Services Component Start: 09/30/2012 | Stop: 07/01/2016 |
| E31 | Professional Intensive Cardiac Rehabilitation Services Component Start: 09/30/2012 | Stop: 07/01/2016 |
| E32 | Intensive Cardiac Rehabilitation - Technical Component Start: 06/02/2013 | Last Modified: 11/01/2016 | Stop: 05/01/2017 |
| E33 | Intensive Cardiac Rehabilitation A group of physical activities designed to help a patient recover from a cardiovascular event Start: 06/02/2013 |
| E34 | Pulmonary Rehabilitation - Technical Component Start: 06/02/2013 | Last Modified: 11/01/2016 | Stop: 05/01/2017 |
| E35 | Pulmonary Rehabilitation - Professional Component Start: 06/02/2013 | Last Modified: 11/01/2016 | Stop: 05/01/2017 |
| E36 | Convenience Care A category of walk-in clinic located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses Start: 06/02/2013 |
| E37 | Telemedicine Services provided via telecommunication and/or information technology venues to provide clinical health services. Start: 07/01/2015 Technical Note: Services performed that are related to telemedicine; not a place of service. |
| E38 | Pharmacist Services Clinical services provided by a pharmacist Start: 07/01/2015 |
| E39 | Diabetic Education Patient educational program designed to bring awareness of diabetes, what it takes to treat it, and the necessary changes that should be made to improve their lifestyle. Start: 03/01/2016 |
| E40 | Early Intervention Services related to treatment for babies or toddlers with developmental delays or disabilities. Start: 11/01/2016 |
| EA | Preventive Services Preventive services such as check-ups, patient counseling and screenings to prevent illness, disease and other health-related problems. Start: 09/20/2009 |
| EB | Specialty Pharmacy Specialty pharmacies are designed to efficiently deliver medications with specialized handling, storage, and distribution requirements. Specialty pharmacies are also designed to improve clinical and economic outcomes for patients with complex, often chronic and rare conditions, with close contact and management by clinicians. Start: 09/20/2009 |
| EC | Durable Medical Equipment New New equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home. Start: 09/20/2009 |
| ED | CAT Scan A multi-dimensional diagnostic image of a cross section of the body that is useful in diagnosing disease Start: 09/20/2009 |
| EE | Ophthalmology Services related to diagnosis and treatment of the eye and related structures including surgical services. Start: 09/20/2009 |
| EF | Contact Lenses A thin lens placed directly on the surface of the eye. Contact Lenses are considered medical devices Start: 09/20/2009 |
| EG | Fertility Preservation Start: 11/01/2022 |
| EH | Medically Tailored Meals (MTM) Meals approved by a medical professional or healthcare plan that reflect appropriate dietary therapy for the individual Start: 03/01/2023 |
| EJ | IV Therapy Intravenous (IV) therapy is a medical technique of administering fluids directly into a vein. Start: 03/01/2023 |
| EO | Applied Behavioral Analysis Therapy Start: 03/01/2017 | Stop: 07/01/2017 |
| F1 | Medical Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| F2 | Social Work Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| F3 | Dental Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| F4 | Hearing Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| F5 | Prescription Drug Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| F6 | Vision Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| F7 | Orthodontia Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| F8 | Mental Health Coverage This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry. Start: 11/01/2015 |
| GF | Generic Prescription Drug - Formulary Lists of generic drugs covered and published by the health plan/payer/processor/PBM to help physicians reach clinically and economically appropriate prescribing decisions for patients. Start: 09/20/2009 |
| GN | Generic Prescription Drug - Non-Formulary A generic drug that is not listed on the covered and published list of the health plan/payer/processor/PBM. Start: 09/20/2009 |
| GY | Allergy Services for conditions caused by abnormal hypersensitivity of the immune system to medications, chemical or food substances, and/or environmental factors. Start: 09/20/2009 |
| IC | Intensive Care Continuous and closely monitored health care services provided in a hospital to critically ill patients. Start: 09/20/2009 |
| MH | Mental Health Mental Health services provided by a physician or other healthcare providers who are trained and educated to perform services related to mental health and may be licensed or practice within the scope or licensure or training. Start: 09/20/2009 |
| NI | Neonatal Intensive Care Continuous and closely monitored health care services provided in a hospital to critically ill newborn/neonatal patients. Start: 09/20/2009 |
| ON | Oncology Services related to diagnosis and treatment of cancer provided by an Oncology provider Start: 09/20/2009 |
| PE | Positron Emission Tomography (PET) Scan A nuclear imaging examination which reveals molecular function and activity. Start: 09/20/2009 |
| PT | Physical Therapy Services and care related to evaluation and treatment of injury or disorders Start: 09/20/2009 |
| PU | Pulmonary Services related to the diagnosis and treatment of respiratory conditions. Start: 09/20/2009 |
| RN | Renal Services related to the diagnosis and treatment of kidney conditions. Start: 09/20/2009 |
| RT | Residential Psychiatric Treatment Psychiatry services provided at a live-in facility to a person with emotional disorders who requires continuous medication and/or supervision or relief from environmental stresses Start: 09/20/2009 |
| SMH | Serious Mental Health Services for disorders characterized by severe deficits and pervasive impairment in multiple areas of development. Start: 01/30/2011 |
| TC | Transitional Care Services related to the coordination and continuity of heath care during a movement from one health care setting to another or to home. Start: 09/20/2009 |
| TN | Transitional Nursery Care Services related to the coordination and continuity of heath care for a newborn during a movement from one health care setting to another or to home. Start: 09/20/2009 |
| UC | Urgent Care Medical services and supplies provided by physicians or other healthcare providers for the treatment of an urgent medical condition or injury which requires medical attention. Start: 09/20/2009 |