| Value |
Description |
German Interpretation |
Comment |
Chapter |
| 01 |
Most common semi-private rate |
|
|
|
| 02 |
Hospital has no semi-private rooms |
|
|
|
| 04 |
Inpatient professional component charges which are combined billed |
|
|
|
| 05 |
Professional component included in charges and also billed separate to carrier |
|
|
|
| 06 |
Medicare blood deductible |
|
|
|
| 08 |
Medicare life time reserve amount in the first calendar year |
|
|
|
| 09 |
Medicare co-insurance amount in the first calendar year |
|
|
|
| 10 |
Lifetime reserve amount in the second calendar year |
|
|
|
| 11 |
Co-insurance amount in the second calendar year |
|
|
|
| 12 |
Working aged beneficiary/spouse with employer group health plan |
|
|
|
| 13 |
ESRD beneficiary in a Medicare coordination period with an employer group health plan |
|
|
|
| 14 |
No Fault including auto/other |
|
|
|
| 15 |
Worker’s Compensation |
|
|
|
| 16 |
PHS, or other federal agency |
|
|
|
| 17 |
Payer code |
|
|
|
| 21 |
Catastrophic |
|
|
|
| 22 |
Surplus |
|
|
|
| 23 |
Recurring monthly incode |
|
|
|
| 24 |
Medicaid rate code |
|
|
|
| 30 |
Pre-admission testing |
|
|
|
| 31 |
Patient liability amount |
|
|
|
| 37 |
Pints of blood furnished |
|
|
|
| 38 |
Blood deductible pints |
|
|
|
| 39 |
Pints of blood replaced |
|
|
|
| 40 |
New coverage not implemented by HMO (for inpatient service only) |
|
|
|
| 41 |
Black lung |
|
|
|
| 42 |
VA |
|
|
|
| 43 |
Disabled beneficiary under age 64 with LGHP |
|
|
|
| 44 |
Amount provider agreed to accept from primary payer when this amount is less than charges but higher than payment received,, then a Medicare secondary payment is due |
|
|
|
| 45 |
Accident hour |
|
|
|
| 46 |
Number of grace days |
|
|
|
| 47 |
Any liability insurance |
|
|
|
| 48 |
Hemoglobin reading |
|
|
|
| 49 |
Hematocrit reading |
|
|
|
| 50 |
Physical therapy visits |
|
|
|
| 51 |
Occupational therapy visits |
|
|
|
| 52 |
Speech therapy visits |
|
|
|
| 53 |
Cardiac rehab visits |
|
|
|
| 56 |
Skilled nurse - home visit hours |
|
|
|
| 57 |
Home health aide - home visit hours |
|
|
|
| 58 |
Arterial blood gas |
|
|
|
| 59 |
Oxygen saturation |
|
|
|
| 60 |
HHA branch MSA |
|
|
|
| 67 |
Peritoneal dialysis |
|
|
|
| 68 |
EPO-drug |
|
|
|
| 70 |
Payer codes |
|
|
|
| 72 |
Payer codes |
|
|
|
| 70 ... 72 |
Payer codes |
|
|
|
| 71 |
Payer codes |
|
|
|
| 75 |
Payer codes |
|
|
|
| 75 ... 79 |
Payer codes |
|
|
|
| 76 |
Payer codes |
|
|
|
| 77 |
Payer codes |
|
|
|
| 78 |
Payer codes |
|
|
|
| 79 |
Payer codes |
|
|
|
| 80 |
Psychiatric visits |
|
|
|
| 81 |
Visits subject to co-payment |
|
|
|
| A1 |
Deductible payer A |
|
|
|
| A2 |
Coinsurance payer A |
|
|
|
| A3 |
Estimated responsibility payer A |
|
|
|
| X0 |
Service excluded on primary policy |
|
|
|
| X4 |
Supplemental coverage |
|
|
|