Appendix B - Code Listings

Table of Contents

  1. Procedure Code Table
  2. B.2 EI HIPAA Procedure Code Table
  3. B.3 Procedure Results Code Table
  4. B.4 Service Code Table

Procedure Code Table

Procedure Code Description
009 ILL-DEFINED INTESTINAL INFECTI
010 PRIMARY TUBERCULOSIS INFECTION
033 WHOOPING COUGH
034 STREP SORE THROAT AND SCARLET
042 HUMAN IMMUNODEFICIENCY VIRUS D
052 CHICKENPOX
055 MEASLES
056 RUBELLA
071 RABIES
072 MUMPS
191 MALIGNANT NEOPLASM OF BRAIN
225 BENIGN NEOPLASM OF BRAIN
315 SPECIFIC DELAYS IN DEVELOPMENT
343 INFANTILE CEREBRAL PALSY
372 DISORDERS OF CONJUNCTIVA
373 INFLAMMATION OF EYELIDS
381 NONSUPPURATIVE OTITIS MEDIA
382 SUPPURATIVE/UNSPEC OTITIS MEDI
00400 GENERAL ANESTHESIA
431 INTRACEREBRAL HEMORRHAGE
436 ACUTE ILL DEFINED CV DISEASE
460 ACUTE NASOPHARYNGITIS
463 ACUTE TONSILLITIS
465 ACUTE URI MULTIPLE SITES
466 ACUTE BRONCHITIS AND BRONCHIOL
477 ALLERGIC RHINITIS
480 VIRAL PNEUMONIA
481 PNEUMOCOCCAL PNEUMONIA
487 INFLUENZA
493 ASTHMA
520 DISORDERS TOOTH DEVELOPMENT
590 INFECTIONS OF KIDNEY
630 HYDATIDIFORM MOLE
631 OT ABNORMAL PRODUCT CONCEPTION
632 MISSED ABORTION
633 ECTOPIC PREGNANCY
634 SPONTANEOUS ABORTION
635 LEGALLY INDUCED ABORTION
637 UNSPECIFIED ABORTION
638 FAILED ATTEMPTED ABORTION
639 COMPLICATIONS FOLLOWING ABORTI
640 HEMORRHAGE IN EARLY PREGNANCY
641 ANTEPART HEMORRHAGE/PLACENTA P
642 ESSEN HYPERTENSION IN PREGNANC
643 EXCESSIVE VOMITING IN PREGNANC
644 EARLY OR THREATENED LABOR
645 LATE PREGNANCY
646 OTHER COMPLICATION PREGNANCY
647 INFECTIOUS DISEASE COMPL PREGN
648 OT CONDITION COMPL PREGNANCY
650 NORMAL DELIVERY
651 MULTIPLE GESTATION
652 MALPOSITION/MALPRESENTATION FE
653 DISPROPORTION IN PREGNANCY
654 ABNORMAL PELVIC ORGAN IN PREGN
655 FETAL ABNORMALITY AFFECT MOTHE
656 OT FETAL/PLACEN PROBLEM MOTHER
657 POLYHYDRAMNIOS
658 OTHER AMNIOTIC PROBLEM
659 OTHER CARE IN LABOR/DELIVERY
660 OBSTRUCTED LABOR
663 CORD COMPLICATION LABOR/DELIVE
664 TRAUMA TO VULVA/PERINEUM DELIV
665 OTHER OBSTETRICAL TRAUMA
666 POSTPARTUM HEMORRHAGE
667 RETAINED PRODUCTS OF CONCEPTIO
668 ANESTHESIA COMPLIC LABOR/DELIV
669 OTHER COMPLIC LABOR/DELIVERY
670 MAJOR PUERPERAL INFECTION
671 VENOUS COMPLICATIONS IN PREGNA
672 PUERPERAL PYREXIA
673 OBSTETRICAL PULMONARY EMBOLISM
674 OT/UNSPEC COMPLIC PUERPERIUM
675 INFECTION BREAST ASSOC CHILDBI
676 OT BREAST DIS ASSOC W CHILDBRT
684 IMPETIGO
692 CONTACT DERMATITIS
740 ANENCEPHALUS AND SIMILAR ANOMA
741 SPINA BIFIDA
742 OT CONGITAL ANOMALY NERVOUS SY
743 CONGENITAL ANOMALIES OF EYE
744 CONGENITAL ANOMALY EAR/FACE/NE
745 BULBUS CORDIS ANOMALIES
746 OTHER CONGENITAL ANOMAL HEART
747 CONGENITAL ANOMALY CIRCULATORY
748 CONGENITAL ANOMALY RESPIRATORY
749 CLEFT PALATE AND CLEFT LIP
750 OTH ANOMALY UP ALIMENTARY TRAC
751 CONGENITAL ANOMALY DIGESTIVE S
752 CONGENITAL ANOMALY GENITAL ORG
753 CONGENITAL ANOMALIES URINARY S
754 OT CONG MUSCULOSKELETAL DEFORM
755 OTHER CONGENITAL ANOMALIES LIM
756 OT CONGENITAL MUSCULOSKEL ANOM
757 CONGENITAL ANOMALIES INTEGUMEN
758 CHROMOSOMAL ANOMALIES
759 OT/UNSPECIF CONGENITAL ANOMALI
765 DISORDERS SHORT GEST/LOW BIRTH
766 LONG GESTATION/HIGH BIRTHWEIGH
767 BIRTH TRAUMA
768 INTRAUTERINE HYPOXIA/BIRTH ASP
769 RESPIRATORY DISTRESS SYNDROME
770 OT RESPIR CONDITION FETUS/NEWB
771 INFECTION PERINATAL PERIOD
772 FETAL AND NEONATAL HEMORRHAGE
773 HEMOLYTIC DISEASE FETUS/NEWBOR
774 OTHER PERINATAL JAUNDICE
775 INTEGUMENT CONDITIONS OF FETUS
776 HEMATOLOGIC CONDITIONS OF FETU
777 PERINATAL DISORDERS DIGESTIVE
778 INTEGUMENT CONDITIONS OF FETUS
779 OT CONDITION ORIG IN PERINAT P
851 CEREBRAL LACERATION AND CONTUS
852 SUBARACH HEMORRHAGE INJURY
853 BRAIN HEMORRHAGE INJURY
854 INTRACRANIAL INJURY
2702 DISTURBANCE AROMATIC AMINO ACI
2708 OT DISORDERS AMINO ACID METABO
2779 UNS DISORDER METABOLISM
2990 INFANTILE AUTISM
3152 OTHER LEARNING DIFFICULTIES
3153 DEVELOPMENTAL SPEECH DISORDER
3154 COORDINATION DISORDER
3155 MIXED DEVELOPMENT DISORDER
3158 OTHER DELAYS IN DEVELOPMENT
3159 UNS DELAY IN DEVELOPMENT
3229 UNS MENINGITIS
3308 OTHER CEREBRAL DEGENER CHILDHO
3314 OBSTRUCTIVE HYDROCEPHALUS
3350 WERDNIG HOFFMANN DISEASE
3430 DIPLEGIC INFANTILE CER PALSY
3431 HEMIPLEGIC INFANTILE CER PALSY
3432 QUADRIPLEGIC INFANTILE CER PAL
3433 MONOPLEGIC INFANTILE CER PALSY
3434 INFANTILE HEMIPLEGIA
3438 OTHER INFANTILE CER PALSY
3439 UNS INFANTILE CER PALSY
3456 INFANTILE SPASMS
3480 CEREBRAL CYSTS
3483 ENCEPHALOPATHY NOT CLASSIFIED
3590 CONGENITAL HEREDITARY MUSCULAR
3591 HEREDITARY PROGRESSIVE MUSCULA
3592 MYOTONIC DISORDERS
3671 MYOPIA
3680 AMBLYOPIA EX ANOPSIA
3690 PROFOUND VISION IMPARIMENT BOT
3691 MODERATE/PROFOUND VISION
3692 MODERATE/MODERATE VISION
3693 UNQUALIFIED VISUAL LOSS BOTH E
3694 LEGAL BLINDNESS AS DEFINED IN
3696 PROFOUND VISION IMPAIR ONE EYE
3697 MODERATE VISION IMPAIR ONE EYE
3698 UNQUALIFIED VISUAL LOSS ONE EY
3699 UNSPEC VISUAL LOS
7369 ACQUIRED DEFORMITY LIMB SITE U
7410 SPINA BIFIDA WITH HYDROCEPHALU
7416 Td BOOSTER 2
7419 SPINA BIFIDA WO HYDROCEPHALUS
7420 ENCEPHALOCELE
7421 MICROCEPHALUS
7422 REDUCTION DEFORMITIES BRAIN
7423 CONGENITAL HYDROCEPHALUS
7424 OTHER ANOMALIES BRAIN
7425 OT CONGITAL ANOMALY SPINAL COR
7433 CONGENITAL CATARACT/LENS ANOMA
7469 UNS ANOMALY HEART
7554 REDUCTION DEFORMITIES UNS LIMB
7580 DOWN'S SYNDROME
7581 PATAU'S SYNDROME
7582 EDWARDS' SYNDROME
7583 AUTOSOMAL DELETION SYNDROMES
7585 OTH CONDITIONS AUTOSOMAL ANOMA
7597 MULTIPLE CONGENITAL ANOMALIES
7598 OTHER CONGENITAL ANOMALIES
7650 EXTREME IMMATURITY DISORDERS
7676 BIRTH INJURY TO BRACHIAL PLEXU
7685 SEVERE BIRTH ASPHYXIA
7710 CONGENITAL RUBELLA
7711 CONGENITAL CYTOMEGALOVIRUS INF
7712 OTH CONGENITAL INFECTIONS
7790 CONVULSIONS IN NEWBORN
9529 SPINAL CORD INJURY UNS SITE
10021 FNA WITHOUT IMAGING GUIDANCE
10022 FNA WITH IMAGING GUIDANCE
19000 PUNCTURE ASPIRATION OF BREAST
19001 PUNCTURE ASPIRATION OF BREAST
19100 PERCUTANEOUS NEEDLE CORE BREAS
19101 OPEN INCISIONAL BREAST BIOPSY
19102 PERCUTANEOUS NEEDLE CORE BREAS
19103 BREAST BX W/ MAMMATOME DEVICE
19120 EXCISION OF CYST, LESION, OTHE
19125 EXCISION OF BREAST LESION, PRE
19126 EXCISION OF BREAST LESION, X-R
19290 PREOP PLACEMENT OF NEEDLE LOCA
19291 PREOP PLACEMENT OF NEEDLE WIRE
19295 IMAGE GUIDED PLACEMENT OF CLIP
31531 DEVELOPMENTAL LANGUAGE DISORDE
31532 RECEPTIVE LANGUAGE DISORDER
31539 OTH DEVELOPMENTAL SPEECH DISOR
36221 RETROLENTAL FIBROPLASIA
36415 VENIPUNCTURE
38910 UNS SENSORINEURAL HEARING LOSS
57452 COLPOSCOPY OF CERVIX INCLUDING
57454 COLPOSCOPY WITH BIOPSY AND END
57455 COLPOSCOPY WITH BIOPSY
57456 COLPOSCOPY WITH ENDOCERVICAL C
57460 ENDOSCOPY WITH LOOP ELECTRODE
57461 ENDOSCOPY WITH LOOP ELECTRODE
57500 BIOPSIES/LOCAL EXCISION OF CER
57505 ENDOCERVICAL CURETTAGE (ECC)
57511 CRYOCAUTERY OF THE CERVIX
57520 CONIZATION OF CERVIX
57522 LOOP ELECTRODE EXCISION PROCED
58100 EmBx WITH OR W/O ENDOCERVICAL
58110 ENDOMETRIAL BX WITH COLPOSCOPY
58150 HYSTER/ANY TYPE (NOT PAID)
58558 HYSTEROSCOPY W ENDOMETRIAL BX
59020 FETAL STRESS TS
59025 FTL NON STRESS
59409 VAGINAL DELIVRY
59410 VAGINAL DELIVRY
59420 PRENATAL VISIT
59425 PRENATAL VISIT
59426 PRENATAL VISIT
59430 POST-PARTUM VST
59500 C-SEC DELIVERY
59514 C-SEC DELIVERY
59515 C-SEC DELIVERY
71010 CHEST XRAY, 1 VIEW
71020 CHEST XRAY, 2 VIEWS
75489 OTHER NONTERATOGENIC ANOMALIES
75560 UNS ANOMALY LOWER LIMB
75613 ABSENCE VERTEBRA CONGENITAL
75651 OSTEOGENESIS IMPERFECTA
75889 OTH CONDITIONS CHROMOSOME ANOM
75981 PRADER-WILLI SYNDROME
75983 FRAGILE X SYNDROME
75989 OTHER ANOMALIES
76071 MATERNAL ALCOHOL AFFECT NEWBOR
76098 RADIOLOGICAL EXAM SURGICAL SPE
76645 ULTRASOUND, BILATERAL OR UNILA
76805 SONOGRAM
76810 SONOGRAM
76815 SONOGRAM
76816 SONOGRAM
76856 ULTRASOUND, PELVIC
76942 US GUIDE NEEDLE Bx
77031 STEREO LOCAL BREAST Bx PER LES
77032 PREOP NEEDLE WIRE X-RAY S & I
77053 MAMMARY DUCTOGRAM SINGLE DUCT
77054 MAMMARY DUCTOGRAM MULTIPLE DUC
77055 DIAGNOSTIC MAMMOGRAM, UNILATER
77056 DIAGNOSTIC MAMMOGRAM, BILATERA
77057 SCREENING MAMMOGRAM, BILATERAL
77058 BREAST MRI, UNILATERAL (NOT PA
77059 BREAST MRI, BILATERAL (NOT PAI
80048 BASIC METABOLIC PANEL
80053 COMPREHENSIVE METABOLIC PANEL
80055 OBSTETRIC PAN
80061 FASTING LIPID PANEL
81001 URINALYSIS
81025 PREGNANCY TEST
82465 TOTAL CHOLESTEROL
82947 GLUCOSE, QUANTITATIVE
82951 GLUCOSE, TOLERANCE TEST
83036 HEMOGLOBIN
83718 HDL CHOLESTEROL
85014 HEMATOCRIT
85018 HEMOGLOBIN
85025 CBC WITH DIFFERENTIAL WBC COUN
85027 CBC WITHOUT DIFFERENTIAL
86279 RUBELLA
86280 HEMAGGLUTINATIN
86311 HIV TESTING
86592 SYPHILIS TEST
86593 SYPHILIS TEST
86631 CHLAMYDIA
86632 CHLAMYDIA IgM
86687 HTLV I
86688 HTLV II
86689 HIV CONFRM TEST
86701 HIV-1 TESTING
86702 HIV-2 TESTING
86703 HIV-1 & -2 TEST
86762 RUBELLA
87081 GONORRHEA
87179 MICROBIAL ID
87621 HPV TESTING
88141 PAP TEST, REPORTED IN TBS, REQ
88142 PAP TEST, LIQUID BASED, THIN P
88164 PAP TEST, REPORTED IN THE BETH
88172 EVALUATION OF FNA
88173 INTERPRETATION AND REPORT OF F
88305 SURGICAL PATHOLOGY-BREAST OR C
88307 SURG PATHOLOGY, BREAST (EVAL S
88331 FROZEN SECTION, FIRST TISSUE B
88332 FROZEN SECTION, EACH ADDITIONA
93000 EKG
99070 SURGICAL SUPPLIES
99144 CONSCIOUS SEDATION
99201 OV NEW PT - BREAST EXAM ONLY(1
99202 OV NEW PT - PELVIC EXAM ONLY(2
99203 OV NEW PT - BREAST & PELVIC (3
99204 OFFICE VISIT
99205 OFFICE VISIT
99211 OFFICE VISIT
99212 OV EST PATIENT - BREAST OR PEL
99213 OV EST PT - BREAST & PELVIC
99215 OFFICE VISIT
99241 CONSULTATION VISIT/REPEAT CBE
99242 CONSULTATION VISIT, 30 MINUTES
99243 CONSULTATION VISIT, 40 MINUTES
99401 IOV WITHOUT RRC
C1000 SWITCH ACTIVATED DEVICE
C1010 SWITCH, BATTERY ADAPTER
C1020 COMPUTER ACCESS, SOFTWARE
C1500 ADAPTIVE, UTENSIL, FEEDING
C1510 ADAPTIVE, CUP, NOSEY
C1599 ADL/ADAPTIVE, MISCELLANEOUS
C2000 HEARING AID,PEDIATRIC CARE KIT
C2010 HEARING AID, ALLIGATOR CLIP
C3000 THERAPY BALL, ANY SIZE
C3010 ROLL, BOLSTER, ANY SIZE
C3020 WEIGHTED VEST, ANY TYPE
C3030 WEIGHTED BLANKET, ANY SIZE
C3050 WEIGHTS, MISCELLANEOUS
E0130 WALKER, RIGID, PICKUP
E0135 WALKER, FOLDING, PICKUP
E0141 WALKER, RIGID, WHEELED
E0143 WALKER,FOLDING,WHEELED
E0155 WLKR, WHL ATCH FOR PK-UP, PAIR
E0158 WLKR, LEG EXTNSNS,PER SET OF 4
E0188 PAD,SHEEPSKIN,SYNTHETIC,ANY SZ
E0189 PAD,SHEEPSKIN,LAMBS WOOL,ANY S
E1399 DURABLE MEDICAL EQUIPMENT, NEC
EITR1 USE TRANSPORT CODES AS REQD
G0202 DIGITAL SCREENING MAMMOGRAM BI
G0204 DIGITAL DIAGNOSTIC MAMMOGRAM B
G0206 DIGITAL DIAGNOSTIC MAMMOGRAM U
L1500 THKAO, MOBILITY FRAME
L1510 THKAO, STANDING FRAME
L1902 AFO, ANKLE GUANTLET
L1904 AFO, ANKLE GAUNTLET, MOLDED
L1920 AFO,SNGL UPRGHT WTH ST/AD STOP
L1930 AFO, PLASTIC
L1940 AFO, PLASTIC,MOLDED TO PATIENT
L1950 AFO,PLAST,MOLD TO PTNT,SPIRAL
L1960 AFO,PLAST,MOLD T/P,POST SOL AN
L1970 AFO,PLAST,MOLD T/P,W/ANK JOINT
L1980 AFO,SG/UPR,PLN/DRF,SOL/STR,CLF
L1990 AFO,DB/UPR,PLN/DRF,SOL/STR,CLF
L2040 HKAFO,TORS/CTRL,BILTR/ROT STRA
L2050 HKAFO,T/C,B/T CBL,HIP JNT STRP
L2070 HKAFO,TOR/CTR,UNILAT ROT STRAP
L2080 HKAFO,T/CTR,UNILAT,CBL HIP JNT
L2200 LE ADD,LMT ANK MOTION,EACH,JNT
L2210 LE ADD,DRF,PLAN/FLX ASS,EAC JN
L2220 LE ADD,DRF,PL/FLX AS/RESIST,EA
L2230 LE ADD,SPLT/FLT/CPR STIR,PLATE
L2240 LE ADD,ROUND CALIPER/PLATE ATT
L2250 LE ADD,FOOT PLATE,MOLD,STIRRUP
L2270 LE ADD,VAR/VAL T-STRAP,MLL/PAD
L2275 LE ADD,VAR/VAL CORRECT,PLASTIC
L2820 LE ADD,SOFT INTRFC F/MOLD PLAS
L2999 LOWER EXT ORTH,N/OTHRWS CLASSI
L3000 FT INS REM,UCB TP,BERK SH,MOLD
L3001 FT INS REMVBL,SPENCO,MOLDED EA
L3010 FT INS REM,LONGIT ARCH SUP,MOL
L3020 FT INS REM,LON/METAT SUPPT,MOL
L3030 FT INS REM,FORMED TO PATN FOOT
L3040 FT ARCH SUP,REM,PREMOLD LONGIT
L3140 FT ABDCTION ROT BAR,INCL SHOES
L3150 FT ABDCTION ROTAT BAR,NO SHOES
L3170 FOOT, PLASTIC HEEL STABILIZER
L3201 ORT SHOE,OXF W/SPTR/PNTR,INFAN
L3202 ORT SHOE,OXF W/SPTR/PNTR,CHILD
L3204 ORT SHOE,HTOP W/SPTR/PNTR,INFA
L3206 ORT SHOE,HTOP W/SPTR/PNTR,CHLD
L3350 HEEL WEDGE
L3800 WHFO, SHORT OPPONENS,NO ATTACH
L3805 WHFO, LONG OPPONENS,NO ATTACH
RTAA REFERRAL TO TREAT ACT APPROVED
RTAD REFERRAL TO TREAT ACT DENIED
V19 FAMILY HX OF OTHER CONDITIONS
V461 DEPENDENCE ON RESPIRATOR
V550 ATTENTION TO TRACHEOSTOMY
W7018 HK SCREENING
W7020 HEARING SCRNING
W7087 VISION SCRNING
W7114 MCCARTHY
W7115 EARLY SCRNING
W7116 DEVL PROFILE II
W7117 MINNEAPOLIS
W7118 VINELAND
W7121 HEARING AID,DISPENSING FEE,BIN
W7130 HEAR AID,DISPENS FEE,MONAURAL
W7133 AFO, PREFABRICATED
W7170 BENIK KNEE SUPPORT
W7171 BENIK HAND SPLINT
W7173 BENIK VEST
W7184 PDITRC/YTH,POS,ACT,FLOOR CHAIR
W7186 WEDGE, FLOOR THERAPY
W7265 AFO,ADDTH,FOOT/CALF STRAP,EACH
W7273 PROJECT MEMPHIS
W7318 HEARING AID, STETHESCOPE
W7355 SMO
W7359 PRENATAL RISK
W7360 RISK ASSMT
W7361 RISK ASSESSMENT
W7362 RISK ASSESSMENT
W7363 RISK ASSESSMENT
W7364 EARLY SCN-AGS
W7367 CHICAGO EARLY
W7375 LEAD SCREENING
W7376 VINELAND
W7401 EPIDEMIOLOGICAL
W7402 DPT 3
W7403 DTP 1
W7404 DPT 2
W7405 DPT B1
W7406 DPT B2
W7407 OPV 1
W7408 OPV 2
W7409 OPV 3
W7410 OPV B1
W7411 OPV B2
W7412 Td 1
W7413 Td 2
W7415 Td BOOSTER 1
W7416 Td BOOSTER 2
W7430 DENVER DST
W7494 PT EVAL/ASSESS - ONSITE
W7495 PT EVAL/ASSESS - OFFSITE
W7496 SLT EVAL/ASSESS - ONSITE
W7497 SLT EVAL/ASSESS - OFFSITE
W7498 OT EVAL/ASSESS - ONSITE
W7499 OT EVAL/ASSESS - OFFSITE
W7500 NURSING EVAL/ASSESS - ONSITE
W7501 NURSING EVAL/ASSESS - OFFSITE
W7509 SLP/AU A/R ASSESS - ONSITE
W7510 A/R ASSESSMENT - ONSITE
W7511 A/R IFSP DEVELOPMENT
W7512 SLP/AU A/R SERVICES - ONSITE
W7513 A/R SERVICES - ONSITE
W7514 SLP/AU A/R ASSESS - OFFSITE
W7515 A/R ASSESSMENT - OFFSITE
W7516 A/R IFSP MEETING OFFSITE
W7517 SLP/AU A/R SERVICES - OFFSITE
W7518 A/R SERVICES - OFFSITE
W7519 SLP/AU GROUP A/R SERVICES
W7520 GROUP A/R SERVICES
W7521 VISION GROUP SERVICES
W7522 FTS IFSP DEVELOPMENT
W7523 FMLY TRAINING\SUPPORT-ONSITE
W7524 IFSP MEETING OFFSITE
W7525 FMLY TRAINING\SUPPORT-OFFSITE
W7526 GRP FMLY TRAINING\SUPPORT
W7528 HEALTH/PHYSICIAN TO PROVIDER
W7529 HEALTH/PHYSICIAN TO FAMILY
W7531 GROUP NURSING SERVICES
W7532 GROUP NUTRITION SERVICES
W7533 SCHOOL S/L EVAL/ASSESS-ONSITE
W7534 SCHOOL S/L INDIV. THERAPY-ON
W7535 SCHOOL S/L EVAL/ASSESS-OFFSITE
W7536 SCHOOL S/L INDIV. THERAPY-OFF
W7537 SCHOOL S/L GROUP THERAPY
W7580 MEASLES
W7581 RUBELLA
W7582 MUMPS
W7583 MMR
W7584 MEASLES,RUBELLA
W7585 HIB
W7588 MAKE UP VISIT
W7589 HEPATITIS B
W7590 DTP/Hib
W7615 COMM SYST,LABOR F/CUSTOM DISPL
W7695 BATTELLE DEV IN
W7696 BAYLEY
W7697 PIERS-HARRIS
W7698 OTIS-LENON
W7952 BENCH, TRANSFER, UNPADDED
W8158 HEAR AID,BATT,ZINC AIR,ANY SIZ
W8178 HEAR AID,BATT,SILVER,ANY SIZE
W8183 HEARING AID, EAR MOLD, EACH
W8184 HEAR AID,REPAIRS,< THAT $100
W8185 HEARING AID REPAIRS OVER $100
W8186 HEARING AID,REPLACEMENT CORD
W8187 HEARING AID, BINAURAL
W8188 HEARING AID, MONAURAL
W8192 HEAR AID,MONRL CREATING BINRL
W8665 BATH CHAIR
W8666 PEDIATRIC FLOOR SITTER/FEEDER
W8667 STANDER, ANY TYP, W OR W/O WHE
W8716 EXAMINATION BY AN AUDIOLOGIST
W8717 HEARING AID ASSESSMENT
W8725 OT INDIVIDUAL THERAPY - ONSITE
W8726 OT INDIVIDUAL THERAPY-OFFSITE
W8727 OT GROUP THERAPY
W8728 DT EVAL/ASSESS - ONSITE
W8729 DT EVAL/ASSESS - OFFSITE
W8732 DT IFSP DEVELOPMENT
W8733 IFSP MEETING OFFSITE
W8734 PT INDIVIDUAL THERAPY-ONSITE
W8735 PT INDIVIDUAL THERAPY-OFFSITE
W8736 PT GROUP THERAPY
W8737 SW EVAL/ASSESS - ONSITE
W8738 SW EVAL/ASSESS - OFFSITE
W8741 SW IFSP DEVELOPMENT
W8742 IFSP MEETING OFFSITE
W8743 INDIVIDUAL DT - ONSITE
W8744 INDIVIDUAL DT - OFFSITE
W8745 GROUP DT
W8746 PSY EVAL/ASSESS - ONSITE
W8747 PSY EVAL/ASSESS - OFFSITE
W8750 PSY IFSP DEVELOPMENT
W8751 IFSP MEETING OFFSITE
W8752 NURSING SERVICES - ONSITE
W8753 NURSING SERVICES - OFFSITE
W8756 PT IFSP DEVELOPMENT
W8757 IFSP MEETING OFFSITE
W8760 SLT/SCHOOL S/L IFSP DEVELOPMNT
W8761 NUTRITION SERVICES - ONSITE
W8762 NUTRITION SERVICES - OFFSITE
W8763 IFSP MEETING OFFSITE
W8766 OT IFSP DEVELOPMENT
W8767 IFSP MEETING OFFSITE
W8770 NURSING IFSP DEVELOPMENT
W8771 IFSP MEETING OFFSITE
W8772 NUTR ASSESSMENT - ONSITE
W8773 NUTR ASSESSMENT - OFFSITE
W8774 NUTR IFSP DEVELOPMENT
W8775 IFSP MEETING OFFSITE
W8776 VISION ASSESSMENT - ONSITE
W8777 VISION ASSESSMENT - OFFSITE
W8778 VISION IFSP DEVELOPMENT
W8779 IFSP MEETING OFFSITE
W8780 SW INDIVIDUAL TREATMENT-ONSITE
W8781 SW INDIV. TREATMENT-OFFSITE
W8782 SW GROUP TREATMENT
W8789 SLT INDIV. THERAPY - ONSITE
W8790 SLT INDIV. THERAPY - OFFSITE
W8791 SLT GROUP THERAPY
W8798 PSY INDIV. TREATMENT-ONSITE
W8799 PSY INDIV. TREATMENT-OFFSITE
W8836 PSY GROUP TREATMENT
W8838 PRIVATE AUTO MILEAGE
W8840 OPTOMETRIC EXAMINATION
W8841 DISPENSING FEE
W8842 VISION SERVICE - ONSITE
W8844 VISION SERVICE - OFFSITE
W8846 PAIR OF LENSES (SAME RX)
W8847 RIGHT LENS (DIFFERENT RX)
W8848 LEFT LENS (DIFFERENT RX)
W8851 TAXI, BASE RATE
W8852 TAXI, RETURN
W8853 TAXI, MILEAGE
W8854 SERVICE CAR, BASE RATE
W8855 SERVICE CAR, RETURN
W8856 SERVICE CAR, MILEAGE
W8861 MEDICAL DIAGNOSTIC EVALUATION
W8862 FRAME
W8863 COMM SYST,N/LOW TECH,$499 OR <
W8864 COMM SYST,MID RANGE,$500-$1499
W8865 COMM SYST,HIGH TEC,$1500 OR >
W8866 COMM ACCESS,INTRFCING OR MODIF
W8962 WALKER,PELVIC STABLZER ATTACHM
W8964 GAIT TRAINER, ANY TYPE
W8965 WALKER,FOREARM SUPPORT,ATTACHM
WWVE OV EST PT WITH COUNSELING
WWVN OV NEW PT WITH COUNSELING

B.2 EI HIPAA Procedure Code Table

Proc HIPAA Code Mod1 Mod2 Mod3 Mod4 Description
90802 SOC WRK/OTHER EVAL/ASSESS
92015 OPTOMETRIC EXAMINATION
92340 DISPENSING FEE
92506 TL AURAL REHAB EVAL/ASSESS
92506 SPEECH THERAPY EVAL/ASSESS
92507 TL AURAL REHAB DIRECT SERVICES
92507 SPEECH THERAPY SERVICES
92508 TL AURAL REHAB GROUP SERVICES
92508 SPEECH THERAPY GROUP SERVICES
92626 AURAL REHAB EVAL/ASSESS
96111 DEV THERAPY EVAL/ASSESS
96150 PSYCH/OTHER COUNS EVAL/ASSESS
96152 PSYCH/OTHER COUNS SERVICES
96153 PSYCH/OTHER COUNS GROUP SERV
97001 PT EVAL/ASSESSMENT
97003 OT EVAL/ASSESSMENT
97110 PT SERVICES
97150 SC OT GROUP SERVICES
97150 SE PT GROUP SERVICES
97150 OT GROUP SERVICES
97530 OT SERVICES
97802 NUTRITION EVAL/ASSESSMENT
97803 NUTRITION SERVICES
97804 NUTRITION GROUP SERVICES
99173 VISION EVAL/ASSESSMENT
99199 VISION EVAL/ASSESSMENT
99245 MEDICAL DIAGNOSTIC EVALUATION
99271 TL AURAL REHAB IFSP MTG/DEV
99271 SC OT IFSP MTG/DEV
99271 SE PT IFSP MTG/DEV
99271 SPEECH IFSP MTG/DEV
99272 NURSING IFSP MTG/DEV
99273 PSYCH/OTHER COUNS IFSP MTG/DEV
99274 MEDICAL DIAGNOSTIC EVALUATION
99275 SOC WRK/OTHER IFSP MTG/DEV
99371 HEALTH CONSULT/MD TO PROVIDER
99372 HEALTH CONSULT/MD TO FAMILY
99499 GN SPEECH IFSP MTG/DEV
99499 GO OT IFSP MTG/DEV
99499 GP PT IFSP MTG/DEV
99499 SC AURAL REHAB IFSP MTG/DEV
99499 TD NURSING IFSP MTG/DEV
99499 UK PSYCH/OTHER COUNS IFSP MTG/DEV
99499 SE SOC WRK/OTHER IFSP MTG/DEV
99499 HA NUTRITION IFSP MTG/DEV
99499 VISION IFSP MTG/DEV
99499 TL DEV THERAPY IFSP MEG/DEV
99499 HT FAM TRNG/SUPPORT IFSP MTG/DEV
A0090 Transportation Private Auto
A0100 Transportation/Taxi Rate
A0120 Transportation/Service Car Rat
A0425 Transportation Mileage
A4636 REPLACEMENT HANDGRIP EA
A4637 REPLACEMENT TIP EA
A9300 EXERCISE EQUIPMENT
A9900 MISC DME SUPP/ACC/SERV
C1000 SWITCH ACTIVATED DEVICE
C1010 SWITCH, BATTERY ADAPTER
C1020 COMPUTER ACCESS, SOFTWARE
C1500 ADAPTIVE, UTENSIL, FEEDING
C1510 ADAPTIVE, CUP, NOSEY
C1599 ADL/ADAPTIVE, MISCELLANEOUS
C2000 HEARING AID,PEDIATRIC CARE KIT
C2010 HEARING AID, ALLIGATOR CLIP
C3000 THERAPY BALL, ANY SIZE
C3010 ROLL, BOLSTER, ANY SIZE
C3020 WEIGHTED VEST, ANY TYPE
C3030 WEIGHTED BLANKET, ANY SIZE
C3050 WEIGHTS, MISCELLANEOUS
D5130 IMMEDIATE UPPER
E0110 CRUTCH, FOREARM ADJ/FIXED PR
E0111 CRUTCH, FOREARM ADJ/FIXED EA
E0130 WALKER, RIGID P/U ADJ/FIXED EA
E0135 WALKER, FOLD P/U ADJ/FIXED HT
E0141 WALKER, RIGID WHEELED W/O SEAT
E0143 WALKER, FOLD WHEELED W/O SEAT
E0144 WALKER, FOLD ENCL WHL W PST ST
E0146 WALKER, FOLD WHEEL W SEAT
E0153 PLATFORM ATT FOREARM CRUTCH EA
E0154 PLATFORM ATT WALKER EA
E0155 WHEEL ATT RIGID P/U WALKER PR
E0158 LEG EXT WALKER SET FOUR (4)
E0162 SITZ BATH CHAIR
E0188 PAD SHEEPSKIN SYNTHETIC ANY SZ
E0189 PAD SHEEPSKIN LAMBS WOL ANY SZ
E0245 TUB STOOL OR BENCH
E0638 STND FRME ANY SZ W/ W/O WHEELS
E0641 STND FRME SYS MULTI POS ANY SZ
E0642 STND FRME SYS, MOBILE, ANY SZ
E1399 DURABLE MEDICAL EQUIP NEC
E1802 DYN ADJ FA PRO/SUP W SOFT INTF
E1902
E1902 COM BD, NON-EL AUG/ALT COM DEV
E2500 DIGIT PRE-RECORD < 8 MIN
E2502 DIGIT PRE-RECORD > 8 < 20 MIN
E2504 DIGIT PRE-RECORD >20 < 40 MIN
E2506 DIGIT PRE-RECORD > 40 MIN
E2510 SPEECH GENERATED DEVICE
E2511 SPCH SFTWR PRGM FOR PERS COMP
E2512 SPCH ACCSSRY MOUNTING SYSTEM
E2599 SPCH ACCSSRY NOT OTHWSE CLSSFD
E8000 GAIT TRNR PED POST SUP W/ACCSS
E8001 GAIT TRNR PED UPRGHT SUP ACCSS
E8002 GAIT TRNR PED ANT SUP W/ ACCSS
EIAE AUDIOLOGY EVALUATION
EIHC HEALTH CONSULTATION
EITR1 TRANSPORTATION SERVICES
EIVC1 USE EYEGLASS CODES AS REQRS
H0004 SOC WRK/OTHER COUNS SERVICES
H0004 HQ SOC WRK/OTHER GROUP SERVICES
K0113 TRUNK SUPP DEV, VEST PREFAB
K0541 SPCH GEN, DIG SP PREREC==8 MIN
K0542 SPCH GEN, DIG SP PREREC > 8MIN
K0544 SPCH GEN, SYN SP MULT FORM/ACC
K0546 ACCESS SPCH GEN, MOUNT SYST
K0547 ACCESS SPEECH GEN NOC
L0110 HELMET,CERVICAL CRAN, NON-MOLD
L0120 COLLAR, FLEX NONADJ FOAM
L0130 COLLAR, CERVICAL, MOLDED
L0140 CERVICAL COLLAR
L0150 COLLAR, CERVICAL, ADJ CHIN CUP
L0160 COLLAR - CERVICAL
L0172 COLLAR - CERVICAL, TWO PIECE
L0174 HENSINGER HEAD SUPPORT
L0220 ABDOMINAL BINDER/RIB BELT
L0450 BENIK VEST
L0452 TLSO FLEX,CUSTOM
L0625 ABDOMINAL BINDER, LUMBAR ORTHOSIS, FLEXIBLE POST
L0626 ABDOMINAL BINDER, LUMBAR ORTHOSIS, PAD STAYS STRAPS
L0628 ABDOMINAL BINDER, FLEXIBLE SACRO
L0976 ABDOMINAL BINDER
L0984 SPINAL ORTH, PROT BODY SOCK
L0999 SPINAL ORTHOSIS NOT SPECIFIED
L1200 TLSO INCL FURNISH ORTHOSIS
L1499 SPINAL ORTHOSIS, NOT SPECIFIED
L1500 THKAO, MOBILITY FRAME
L1510 THKAO, STAND FR W/W/O TRAY/ACC
L1520 THKAO, SWIVEL WALKER
L1600 HO, L1600 COV ONLY PREFAB F&A
L1610 HO, L1600 COV ONLY PREFAB F&A
L1620 HO, ABD SEMI-FLEX PREFAB F&A
L1630 HO, ABD SEMI-FLEX CUST FAB
L1640 HO, ABD STAT BAND/BAR CUST FAB
L1650 HO, ABD STAT ADJ PREFAB F&A
L1660 HO, ABD STAT PLASTC PRFAB F&A
L1680 HO, RANCHO TYPE, CUST FAB
L1690 SWASH PREFAB F&A
L1730 HIP ORTHOSIS
L1800 KO, ELAST STAYS PREFAB F&A
L1810 KO, ELAST JNTS PREFAB F&A
L1830 KO IMMOB CANV LONG PREFAB F&A
L1832 ADJUSTABLE KNEE BRACE
L1846 KNEE ORTHOSIS
L1850 KNEE ORTHOTIC
L1860 KO, MOD PROST SOCKET CUST FAB
L1901 AO, ELAST PREFAB F&A
L1902 AFO, ANKLE GAUNT PREFAB F&A
L1904 AFO, MOLD ANKLE GUANT CUSFAB
L1907 SUPERMALLEOLAR ORTHOTICS
L1920 AFO, SGL STAT/ADJ STOP CUSFAB
L1930 AFO, PLASTIC/OTHER PREFAB F&A
L1940 AFO, PLASTIC/OTHER CUSFAB
L1945 AFO, MOLD PLASTIC CUSFAB
L1950 AFO, SPIRAL PLASTIC CUSFAB
L1960 AFO, POST SOLID PLASTIC CUSFAB
L1970 AFO, PLASTIC W JNT CUSFAB
L1980 AFO, SGL BAR BK ORTH CUSFAB
L1990 AFO, DBL BAR BK ORTH CUSFAB
L2000 KAFO, SGL UPRT FR KNEE/ANKLE
L2010 KAFO, SGL UPRT FR ANK W/O KNJT
L2020 KAFO, DBL UPRT FR KNEE/ANKLE
L2030 KAFO, DBL UPRT FR ANK W/O KNJT
L2035 KAFO, PLASTIC STATIC PREFAB
L2036 KAFO, PLASTIC DBL UPRT CUSFAB
L2037 KAFO, PLASTIC SGL UPRT CUSFAB
L2038 KAFO, PLASTIC W/O KN JT CUSFAB
L2040 HKAFO, BIL STRAP CUSFAB
L2050 HKAFO, BIL CABLES CUSFAB
L2060 HKAFO, BIL BALL BRG JT CUSFAB
L2070 HKAFO, UNILAT STRAP CUSFAB
L2080 HKAFO, UNILAT CABLE CUSFAB
L2090 HKAFO, UNIL BALL BRG JT CUSFAB
L2184 LIMITED MOTION KNEE JOINT
L2200 ADD LE, LIM ANKLE MOT EA JT
L2210 ADD LE, DORSIFLEX ASST EA JT
L2220 ADD LE, DORSI/PLANT FLEX EA JT
L2230 ADD LE, SPLIT FLAT ATTACH
L2240 ADD LE, ROUND ATTCH
L2250 ADD LE, FOOT PL MOLD STIR ATT
L2260 ADD LE, REINF SOL STIRRUP
L2265 ADD LE, LONG TONGUE STIRRUP
L2270 ADD LE, VAR/VAL T OR MALL PAD
L2275 ADD LE, VAR/VAL PLASTIC
L2280 ADD LE, MOLD INNER BOOT
L2300 ADD LE, ABD BAR JT ADJ
L2310 ADD LE, ABD BAR, STRT
L2320 ADD LE, NONMOLD LACER
L2330 ADD LE, LACER MOLDED
L2335 ADD LE, ANT SWING BAND
L2340 ADD LE, PRETIB SHELL, MOLD
L2350 ADD LE, BK SOCKET, MOLD
L2360 ADD LE, EXT STEEL SHANK
L2370 ADD LE, PATTEN BOTTOM
L2375 ADD LE, TORSION CONT ANK JT ST
L2380 ADD LE, TORSION CONT, ST KN JT
L2405 ADD KNEE JT DROP LOCK EA
L2415 ADD KN LOCK W INT REL MECH JT
L2425 ADD KNEE JT, DISC/DIAL ADJ EA
L2430 ADD KNEE JT, RATCHET EA JT
L2435 ADD KNEE JOINT, POLYCENT JT EA
L2580 ADD LE, PELVIC SLING
L2600 ADD LE, PELV CONT JT THRUST EA
L2622 ADD LE, PELV CONT ADJ FLEX EA
L2624 ADD LE, ADJ FLEX/EXT/ABD EA
L2627 ADD LE, PELV PLASTIC MOLD RECP
L2628 ADD LE, PELV METAL RECP
L2630 ADD LE, PELV BAND/BELT UNILAT
L2640 ADD LE, PELV BAND/BELT BIL
L2650 ADD LE, PELV/THOR GLUT PAD EA
L2660 ADD LE, THOR CONT BAND
L2670 ADD LE, THOR PARASPINAL UPRT
L2680 ALL LE, THOR LAT SUPP UPRT
L2760 ADD LE, PER EXT PER BAR
L2768 ORTH SIDE BAR DISC DEV PER BAR
L2770 ADD LE, ANY MAT PER BAR/JT
L2785 ADD LE, DROP LOCK, EA
L2795 ADD LE, FULL KNEECAP
L2800 ADD LE, KNEECAP MED/LAT PULL
L2810 ADD LE, CONDYLAR PAD
L2820 ADD LE, SOFT INTERFACE BK
L2830 ADD LE, SOFT INTERFACE AK
L2840 TIBIAL LENGTH SOCK
L2860 ADD LE, CONC ADJ TORS EA
L2999 LE ORTHOSIS, NOS
L3000 FOOT INSERT, REM MOLD UCB EA
L3001 FOOT INS, REM MOLD SPENCO EA
L3002 FOOT INS, REM MOLD PLASTA EA
L3003 FOOT INS, REM MOLD SILICONE EA
L3010 FT INS, REM MOLD LONGARCH EA
L3020 FT INS, REM MOLD LONG/META EA
L3030 FOOT INSERT, REM FORMED EA
L3040 FOOT, ARCH SUP REM MOLD LONG
L3050 FOOT, ARCH SUP REM MOLD META
L3060 FT, ARCH REM MOLD LONG/META
L3070 FT, ARCH NONREM ATTACH LONG
L3080 FT, ARCH NONREM ATTACH META
L3090 FT, ARCH NOREM ATT LONG/META
L3140 FOOT, ABD BAR INCL SHOES
L3150 FOOT, ABD ROT BAR W/O SHOES
L3170 FOOT, PLASTIC HEEL STABILIZER
L3201 ORTHO SHOE, OXFORD INFANT
L3202 ORTHO SHOE, OXFORD CHILD
L3204 ORTHO SHOE, HIGHTOP INFANT
L3206 ORTHO SHOE, HIGHTOP CHILD
L3209 HIGH TOP ORTHOPEDIC SHOE
L3212 BENESCH BOOT, PAIR INFANT
L3213 BENESCH BOOT, PAIR CHILD
L3257 ORTHO FTWR, ADD CHG SPLIT SZ
L3300 LIFT ELEV HEEL TAP META PER IN
L3310 LIFT, ELEV HEEL/SOLE NEOP/IN
L3320 LIFT, ELEV HEEL/SOLE CORK/IN
L3332 LIFT, ELEV INS SHOE TAP 11/2IN
L3334 HEEL LIFT
L3350 HEEL WEDGE
L3370 WEDGE/SOLE
L3390 WEDGE/OUTFLARE
L3380 CLUBFOOT WEDGE
L3580 ORTHO SHOE ADD, CONVERT VELCRO
L3649 ANSWER 2 SHOES (PAIR)
L3700 EO, ELASTIC STAYS PREFAB F&A
L3701 EO, ELASTIC PREFAB F&A
L3710 EO, ELAST METAL JT PREFAB F&A
L3720 EO, DBL UPRT FREE MOT CUSFAB
L3730 EO, DBL UPRT EXT/FLEX CUSFAB
L3740 EO, DBL UPRT FR MOT CUSFAB
L3760 EO, LOCK JT PREFAB ANY TYPE
L3762 EO, RIG W/O JT PREFAB F&A
L3805 WHFO, LG OPPON NO ATT CUSFAB
L3807 WHFO, W/O JT PREFAB F&A ANY
L3808 HAND SPLINT
L3890 ADD UE, CONC ADJ TORSION EA
L3906 WHO, WRIST GAUNT MOLD
L3907 WHFO, THUMB SPICA MOLDED
L3908 WHO, COCKUP NONMOLD PREFAB F&A
L3909 WO, ELAST PREFAB F&A
L3911 WHFO, ELASTIC PREFAB F&A
L3912 HFO, FLEX GL FING CONT PREFAB
L3916 WRIST EXTENSION SPLINT
L3923 HFO, W/O FT PREFAB F&A
L3936 WHFO, PALMER PREFAB
L3938 WHFO, DORSAL WRIST PREFAB
L3946 HFO, COMP ELAST PREFAB
L3954 HFO, SPREADING HAND
L3956 ADD JT TO UE, ANY PER JT
L3960 SHOULDER ORTHOSIS
L3999 UPPER LIMB ORTHOSIS, NOS
L4210 REP ORTH DEV, REP/REPL MIN PT
L4350 PNEUMATIC WALKING SPLINT
L4392 REPL SOFT INTERFACE, STAT AFO
L4396 ANKLE CONTRACTURE SUPPORT
L9999 SALES TAX
Q4051
S5199 PERS CARE ITEM, NOS, EACH
T1001 NURSING EVAL/ASSESSMENT
T1002 NURSING SERVICES
T1002 HQ NURSING SERVICES GROUP
T1013 INTERPRETATION SERVICES
T1013 HQ INTERPRETATION GROUP SERVICES
T1013 HQ HT INT DEAF GROUP SERVICES
T1013 HT INT DEAF INDIVIDUAL SERVICES
T1013 TL TRANSLATION SERVICES
T1017 Service Coordinated/Targeted C
T1023 NUTRITION IFSP MTG/DEV
T1024 DEV THERAPY IFSP MEG/DEV
T1024 TL FAM TRNG/SUPPORT IFSP MTG/DEV
T1024 SE VISION IFSP MTG/DEV
T1027 DEV THERAPY SERVICES
T1027 HQ DEV THERAPY GROUP
T1027 TL FAM TRNG/SUPPORT SERVICES
T1027 HQ TL FAM TRNG/SUPPORT GRP SERVICES
V2020 Vision Eyeglasses Frames
V2025 Vision Eyeglass Deluxe Frames
V2799 VISION SERVICES
V2799 HQ VISION SERVICES GROUP
V5010 HEARING AID ASSESSMENT
V5011 HEARING AID FITTING
V5014 REP/MOD HEARING AID
V5060 HEARING AID, MONAURAL BTE
V5090 DISPENSING FEE
V5100 HEARING AID, BILATERAL
V5130 BINAURAL, IN THE EAR
V5140 HEARING AID, BINAURAL BTE
V5150 HEARING AID, BINAURAL GLASSES
V5160 HEARING AID DISP FEE, BINA
V5241 HEARING AID DISP FEE, MONA
V5264 HEAR AID, EARMOLD NOT DISP ANY
V5266 BATTERY FOR USE IN HEARING AID
V5267 HEARING AID SUPP/ACCESS
V5299 MISC HEARING SERVICE
V5336 REP/MOD AUG COMM DEVICE
W7121 HEARING AID,DISPENSING FEE,BIN
W7130 HEAR AID,DISPENS FEE,MONAURAL
W7133 AFO, PREFABRICATED
W7170 BENIK KNEE SUPPORT
W7171 BENIK HAND SPLINT
W7173 BENIK VEST
W7184 PDITRC/YTH,POS,ACT,FLOOR CHAIR
W7186 WEDGE, FLOOR THERAPY
W7265 AFO,ADDTH,FOOT/CALF STRAP,EACH
W7318 HEARING AID, STETHESCOPE
W7355 SMO
W7615 COMM SYST,LABOR F/CUSTOM DISPL
W7952 BENCH, TRANSFER, UNPADDED
W8158 HEAR AID,BATT,ZINC AIR,ANY SIZ
W8178 HEAR AID,BATT,SILVER,ANY SIZE
W8183 HEARING AID, EAR MOLD, EACH
W8184 HEAR AID,REPAIRS,< THAT $100
W8185 HEARING AID REPAIRS OVER $100
W8186 HEARING AID,REPLACEMENT CORD
W8187 HEARING AID, BINAURAL
W8188 HEARING AID, MONAURAL
W8192 HEAR AID,MONRL CREATING BINRL
W8665 BATH CHAIR
W8666 PEDIATRIC FLOOR SITTER/FEEDER
W8667 STANDER, ANY TYP, W OR W/O WHE
W8863 COMM SYST,N/LOW TECH,$499 OR <
W8864 COMM SYST,MID RANGE,$500-$1499
W8865 COMM SYST,HIGH TEC,$1500 OR >
W8866 COMM ACCESS,INTRFCING OR MODIF
W8962 WALKER,PELVIC STABLZER ATTACHM
W8964 GAIT TRAINER, ANY TYPE
W8965 WALKER,FOREARM SUPPORT,ATTACHM

B.3 Procedure Results Code Table

Procedure Results Code Description
1 NORMAL/NEGATIVE
2 BENIGN FINDING
5 NOT TRACKED BY IBCCP
7 FLUID OR TISSUE THICKNESS PRES
8 UNSATISFACTORY
9 OTHER OR UNKNOWN REASON
15 1991 UNSATISFACTORY
B1 NORMAL EXAM
B10 DISCRETE PALPABLE MASS
B11 BIOPSY RECOMMENDED
B12 FNA RECOMMENDED
B13 SHORT TERM FOLLOW-UP
B14 PARTICIPANT REFUSED
B2 BENIGN FINDING
B21 HYPERPLASIA
B22 CYSTIC
B23 INDETERMINATE
B24 SOLID
B3 DISCRETE PALPABLE MASS
B31 NEGATIVE/BENIGN
B32 ATYPICAL
B33 SUSPICIOUS FOR MALIGNANCY
B34 INSUFFICIENT SAMPLE
B35 NO FLUID OR TISSUE OBTAINED
B36 NON-SUSPICIOUS FOR MALIGNANCY
B37 OTHER BENIGN CHANGES
B4 BLOODY/SEROUS NIPPLE DISCHARGE
B5 NIPPLE OR AREOLAR SCALINESS
B6 SKIN DIMPLING OR RETRACTION
B62 BENIGN/ATYPICAL
B63 CANCER, IN SITU
B64 CANCER, INVASIVE
B65 CANCER IN SITU, DUCTAL
B66 CANCER IN SITU, LOBULAR
B7 PREVIOUS NORMAL CBE-PAST 12 MO
B8 CBE NOT DONE TODAY
B9 CBE REFUSED
C1 NORMAL/BENIGN REACTION/INFLAMM
C11 BIOPSY RECOMMENDED
C12 FNA RECOMMENDED
C13 FOLLOW-UP, PREVIOUS ABNORMAL
C14 PARTICIPANT REFUSED
C2 ABNORMAL BUT PROBABLY BENIGN
C21 HIGH RISK HPV DETECTED
C22 HIGH RISK HPV NOT DETECTED
C3 ABNORMAL NEEDS FURTHER EVAL.
C33 SUSPICIOUS FOR MALIGNANCY
C4 SUSPICIOUS FOR MALIGNANCY
C5 CERVIX/PARTIAL CERVIC PRESENT
C51 CIN 1/MILD DYSPLASIA
C52 CIN 2/MODERATE DYSPLASIA
C53 CIN 3/SEVERE DYSPLASIA
C6 HPV/CONDYLONMATA/ATYPIA
C71 CANCER, IN SITU
C72 CANCER, INVASIVE
C8 NORMAL/BENIGN/INFLAMMATION
C81 BENIGN/ATYPICAL
C82 CYSTIC
C83 INDETERMINATE
C84 LOW GRADE SIL
C85 HIGH GRADE SIL
M1 NEGATIVE (BI-RADS 1)
M11 RESULT UNKNOWN, MAM FROM N ON-
M13 FILM COMPARISON REQUIRED (BI-R
M2 BENIGN FINDING (BI-RADS 2)
M3 PRBLY BENIGN/NEED F/U(BI-RADS3
M4 SUSP ABNORMALITY-BIOPSY(BI-RA4
M5 HIGHLY SUGGESTIVE MALIGNANCY
M6 ASSESSMENT INCOMPLETE (BI-RA0
M7 UNSATISFACTORY
P2 1991 INFECTION/INFLAM/REACTIVE
P3 ATYPICAL SQUAMOUS CELLS/UN SIG
P4 LOW GRADE SIL
P5 HIGH GRADE SIL
P6 SQUAMOUS CELL CANCER
P7 FLUID OR TISSUE THICKNESS PRES
P8 2001 ASC-H
P9 2001 ABNORMAL GLANDULAR CELLS
PT1 NEGATIVE FOR INTRA LESION/NIL
PT12 RESULT UNKNOWN / NON-PGM SRCE
PT2 ATYPICAL SQUAMOUS CELLS/ASC-US
PT3 LOW GRADE SIL
PT4 ATYPICAL SQUAMOUS CELLS/ASC-H
PT5 HIGH GRADE SIL
PT6 SQUAMOUS CELL CARCINOMA
PT7 ABNORMAL GLANDULAR CELLS
PT8 OTHER
PU33 SUSPICIOUS FOR MALIGNANCY
PU8 UNSATISFACTORY
PU81 BENIGN/ATYPICAL
PU83 INDETERMINATE
R01 participant REFERRED TO TREAT ACT
R02 participant NOT REF TO TREAT ACT
U UNKNOWN
US1 BI-RADS 1 (NEGATIVE)
US2 BI-RADS 2 (CYSTIC/BENIGN/ATYP)
US3 BI-RADS 3 (SHORT TERM F/U)
US4 BI-RADS 4 (SUSPICIOUS ABNORM)
US5 BI-RADS 5 (HIGHLY SUGGESTIVE)
V1 NO INTERVENTION AT THIS TIME
V2 SHORT TERM FOLLOW-UP
V3 BIOPSY/FNA RECOMMENDED
W01 ABNORMAL VALUE(S)
W02 ALERT VALUE(S)
W03 INTEGRATED VISIT/RRC
W04 INTEGRATED VISIT/NO RRC
W10 ABNORMAL-REFERRED
W11 ALERT-REFERRED
W12 ABNORMAL-NOT REFERRED
W13 ALERT-NOT REFERRED
W14 INCLUDE IN INTERVENTION
W15 EXCLUDE FROM INTERVENTION
W16 MEDICATION RECOMMENDED
W17 NO MEDICATION RECOMMENDED
W18 FOLLOW-UP RECOMMENDED
W19 REFERRAL TO OTHER PROVIDER
W20 ALTERNATIVE THERAPY
W21 NORMAL BLOOD PRESSURE
W22 ABNORMAL BLOOD PRESSURE
W23 ALERT BLOOD PRESSURE
W24 OTHER
W25 UNKNOWN
W26 NORMAL TOTAL CHOLESTEROL
W27 ABNORMAL TOTAL CHOLESTEROL
W28 ALERT TOTAL CHOLESTEROL
W29 NORMAL HDL CHOLESTEROL
W30 ABNORMAL HDL CHOLESTEROL
W31 NORMAL TRIGLYCERIDES
W32 ABNORMAL TRIGLYCERIDES
W33 NORMAL BLOOD GLUCOSE
W34 ABNORMAL BLOOD GLUCOSE
W35 ALERT BLOOD GLUCOSE
W36 LAB TEST ADMINISTERED
W37 VENIPUNCTURE NOT ADMINISTERED
W38 CM GIVEN TO ALERT PARTICIPANT
W40 FOLLOW-UP TO ABNORMAL PART
W41 INTERVENTION ADMINISTERED
W42 NORMAL PANEL RESULTS
W43 ABNORMAL PANEL RESULTS
W44 MULTIPLE ABNORMAL PANEL RSLTS
W45 NORMAL LDL CHOLESTEROL
W46 ABNORMAL LDL CHOLESTEROL
W47 MULTIPLE ABNORMAL RESULTS
W48 NORMAL SCREENING

B.4 Service Code Table

Service Type Program Description
0001 INFORMED CONSENT FORM SIGNED
0002 RECORD INITIAL REFERRAL FORM
0003 TPS: VERIFY ALL KIDS < 200%
600 IDCP REFERRAL TO MD/DO
601 IDCP REFERRAL TO RD
602 IDCP REFERRAL TO RPh
603 IDCP REFERRAL TO RN/CDE
604 IDCP INDIVIDUAL DM EDUCATION
606 IDCP SMBG TRAINING
607 IDCP HgbA1C EDUCATION
608 IDCP HgbA1C ASSESSMENT
609 IDCP BP ASSESSMENT
610 IDCP TRAINING IN BP MONITORING
611 IDCP LIPID PROFILE ASSESSMENT
612 IDCP DILATED EYE EXAM
613 IDCP FOOT CARE ASSESSMENT/EDUCATION
614 IDCP SKIN CARE ASSESSMENT/EDUCATION
615 IDCP ADULT IMMUNIZATION EDUCATION
616 IDCP ADULT IMMUNIZATION
617 IDCP REFERRAL FOR REHAB SERVICES
618 IDCP REFERRAL TO PODIATRIST
619 IDCP EXERCISE/PHYSICAL ACTIVITY
620 IDCP INFANT FEED/BF EDUCATION
700 GENERAL ASSESSMENT
701 OTHER SERVICE BARRIERS ASSMNT
702 BONDING AND PARENTING ASSMNT
703 PSYCHOSOCIAL STRESS ASSMNT
704 ALCOHOL/SUBSTANCE ABUSE ASSMNT
705 VIOLENCE ASSESSMENT
706 HOME ASSESSMENT
707 PRENATAL CARE ASSESSMENT
708 PEDIATRIC CARE ASSESSMENT
709 HIV RISK ASSESSMENT
710 MALE RESPONSIBILITY
711 HIV TESTING
712 ENGLISH 2ND LANG
713 INTERPRETATION SRV
800 ANY MEDICAID COVERED SERVICE
801 PREGNANCY TESTING & COUNSELING
802 PRENATAL CARE
803 PRENATAL EDUCATION
804 FAMILY PLANNING
805 GENERAL ADULT MEDICAL
806 WELL CHILD/EPSDT/HEALTHY KIDS
807 PEDIATRIC HEALTH EDUCATION
808 LEAD SCREENING
809 MEDICAL TREATMENT FOR LEAD
810 NUTR COUNSELING FOR LEAD
811 EPIDEMIOLOGIC SURVEY FOR LEAD
812 MEDICAID DETERMINATION
813 MEDICALLY NECESSARY TRANSPTN
814 0-3 EARLY INTERVENTION
815 PUBLIC HEALTH NURSE
816 MENTAL HEALTH COUNSELING
817 SUBSTANCE ABUSE TREATMENT
818 INDIVID & FAMILY COUNSELING
819 WIC/MAC/CSFP
820 POST-PARTUM FOLLOW-UP
821 IMMUNIZATION
822 SPECIALTY MEDICAL CARE
823 SICK CHILD CARE
824 DEVELOPMENTAL SCREENING
825 PERINATAL DEPRESSION SCREENING
826 SOCIAL/EMOTIONAL SCREEN CHILD
827 DENTAL SERVICES
828 VISION SERVICES
829 HEARING SERVICES
833 INTERCONCEPTIONAL CARE
900 ANY SERV NOT COV BY MEDICAID
901 GENETIC COUNSELING
903 HOUSING
904 FAMILY SUPPORT
905 DAYCARE
906 DCFS REFERRAL
907 APORS FOLLOW UP
908 SIDS - FOLLOW UP
909 FAMILY VIOLENCE
910 SUPPORT GROUPS
911 SUBSTANCE PREVENTION
912 GED/HIGH SCHOOL/TECH TRAINING
913 JOB TRAINING/EMPLOYMENT COUNSL
914 ENVIRONMENTAL/INJURY PREVENT
915 REPRODUCTIVE HEALTH EDUCATION
916 FAMILY LIFE EDUCATION
917 INJURY PREVENTION EDUCATION
918 PARENTING SKILLS EDUCATION
919 HIV/STD EDUCATION
920 CAR SAFETY EDUCATION
921 RISK BEHAVIOR EDUCATION
922 PREPARED CHILDBIRTH EDUCATION
923 TRANSPORTATION NON-MEDICAID
924 SMOKING CESSATION
925 WOMEN'S SHELTER
926 FOOD AND CLOTHING PROGRAMS
927 SCHOOL BASED PREGNANCY PRGM
928 PRTCPTN IN SUPPORT SERVICES
929 SEXUAL ASSAULT
930 COLLEGE EDUCATION
931 TPS CONTACT
932 BREASTFEEDING EDUC./COUNSELING
933 TB SKIN TEST
934 HEALTHY START/GROW SMART
935 HFI BCH BREASTFEEDING INITIATION
936 GENETICS FOLLOW UP
937 CM DORAL DENTAL
938 CM TRANSPORTATION MEDICAID INFO
939 ENERGY ASSISTANCE PROGRAM
940 POSTPARTUM DEPRESSION BROCHURE
999 UNKNOWN
BCD BCCP BREAST CANCER DIAGNOSTIC
BCD1 BCCP BREAST CANCER DIAGNOSTIC
BCD2 BCCP BREAST CANCER DIAGNOSTIC
BCD3 BCCP BREAST CANCER DIAGNOSTIC
BCD4 BCCP BREAST CANCER DIAGNOSTIC
BCD5 BCCP BREAST CANCER DIAGNOSTIC
BCS BCCP BREAST CANCER SCREENING
BCS1 BCCP BREAST CANCER SCREENING
BCS2 BCCP BREAST CANCER SCREENING
BCS3 BCCP BREAST CANCER SCREENING
BCS4 BCCP BREAST CANCER SCREENING
BCS5 BCCP BREAST CANCER SCREENING
BLOC BLOCK OUT APPOINTMENT TIME
CCD BCCP CERVICAL CANCER DIAGNOSTIC
CCD1 BCCP CERVICAL CANCER DIAGNOSTIC
CCD2 BCCP CERVICAL CANCER DIAGNOSTIC
CCD3 BCCP CERVICAL CANCER DIAGNOSTIC
CCD4 BCCP CERVICAL CANCER DIAGNOSTIC
CCD5 BCCP CERVICAL CANCER DIAGNOSTIC
CCS BCCP CERVICAL CANCER SCREENING
CCS1 BCCP CERVICAL CANCER SCREENING
CCS2 BCCP CERVICAL CANCER SCREENING
CCS3 BCCP CERVICAL CANCER SCREENING
CCS4 BCCP CERVICAL CANCER SCREENING
CCS5 BCCP CERVICAL CANCER SCREENING
CECP ESTABLISH CARE PLAN
DMEA IDCP DM ENROLLMENT ADULT
DMEC IDCP DM ENROLLMENT CHILD
DMUA IDCP DM UPDATE ADULT
DMUC IDCP DM UPDATE CHILD
E01 EI AUDIOLOGY,AURAL REHAB & OTHER
E02 EI ASSISTIVE TECH/DURABLE EQUIPMT
E03 EI DEVELOPMENTAL THERAPY
E04 EI MEDICAL DIAGNOSTIC & EVAL
E05 EI NURSING
E06 EI NUTRITION
E07 EI OCCUPATIONAL THERAPY
E08 EI PSYCHOLOGY & OTHER COUNSELING
E09 EI PHYSICAL THERAPY
E10 EI SERVICE COORDINATION
E11 EI SOCIAL WORK & OTHER COUNSELING
E12 EI SPEECH LANGUAGE THERAPY
E13 EI TRANSPORTATION
E14 EI VISION
E15 EI HEALTH
E16 EI FAMILY TRAINING AND SUPPORT
FSC HFI OFFER HFI SERVICES
ICG IMM IMMUNIZATION CLINIC - GENERAL
IWCV IMM IMMUNIZATION WELL CHILD VISIT
RTTA RTTA REFERRAL TO TREATMENT ACT
WB2N WIC WIC BF TO POSTPARTUM
WCB WIC WIC CERT-BRSTFING
WCBN WIC WIC CERT-BRSTFING NEW
WCC1 WIC WIC CERT-CHILD UP TO AGE 2
WCC2 WIC WIC CERT-CHILD OVER AGE 2
WCI WIC WIC CERT-INFANT
WCIP WIC WIC CERT-INF/PRELIM
WCN WIC WIC CERT-POSTPARTUM
WCNN WIC WIC CERT-POSTPARTUM NEW
WCP WIC WIC CERT-PREGNANT
WCPP WIC WIC CERT-PREGNANT/PRELIM
WEAC WIC WIC NUTR ED-ALL CATEGORIES
WEBB WIC WIC NUTR ED-BF SUPPORT GROUP
WEBC WIC WIC NUTR ED-BF & INF COMBINED
WEBE WIC WIC INTERNET EDUCATION
WEBN WIC WIC NUTR ED-BF NUTR MGMENT
WEC1 WIC WIC NUTR ED-CHILD NUTR 1
WEC2 WIC WIC NUTR ED-CHILD NUTR 2
WEC3 WIC WIC NUTR ED-CHILD NUTR 3
WEC4 WIC WIC NUTR ED-CHILD NUTR 4
WECF WIC WIC NUTR ED-CHILD IRON
WECS WIC WIC NUTR ED-CHLD/SPEC NUTRIENT
WEI1 WIC WIC NUTR ED-INF FD < 6 MONTHS
WEI2 WIC WIC NUTR ED-INF FD > 6 MONTHS
WEIC WIC WIC NUTR ED-INF & MOM COMBINED
WENC WIC WIC NUTR ED-PP & INF COMBINED
WENN WIC WIC NUTR ED-PP NUTRITION
WEPB WIC WIC NUTR ED-PRENATAL BF
WEPF WIC WIC NUTR ED-PRENATAL IRON
WEPN WIC WIC NUTR ED-PRENATAL NUTR
WFIO WIC WIC FI ISSUANCE ONLY
WFMP WIC WIC FARMERS MARKET PROGRAM
WIB WIC WIC IND NUTR ED - BF
WIBP WIC WIC INDIVIDUAL BREAST PUMP
WICH WIC WIC IND NUTR ED - CHILD
WII WIC WIC IND NUTR ED - INFANT
WIN WIC WIC IND NUTR ED - PP
WIP WIC WIC IND NUTR ED - PREGNANT
WKB WIC WIC FOLLOW-UP VST - BF
WKC WIC WIC FOLLOW-UP VST - CHILD
WKI WIC WIC FOLLOW-UP VST - INFANT
WKIP WIC WIC FOLLOW-UP VST - INF/PRELIM
WKN WIC WIC FOLLOW-UP VST - PP
WKP WIC WIC FOLLOW-UP VST - PREGNANT
WKPP WIC WIC FOLLOW-UP VST-PREG/PRELIM
WMFI WIC WIC MISSED FI PICKUP
WMIP WIC WIC MISSED INF/PRELIM
WMPP WIC WIC MISSED PREGNANT/PRELIM
WN2B WIC WIC POSTPARTUM OF BF
WPCA WIC PEER COUNSELOR CONTACT-ASSESSM
WPCA WIC PEER COUNSELOR CONTACT-ASSESSM
WPCH WIC PEER COUNSELOR CONTACT-HOME
WPCH WIC PEER COUNSELOR CONTACT-HOME
WPCI WIC PEER COUNSELOR CONTACT-INDIVID
WPCI WIC PEER COUNSELOR CONTACT-INDIVID
WPCO WIC PEER COUNSELOR - OUTREACH
WPCP WIC PEER COUNSELOR CONTACT-PHONE
WPCP WIC PEER COUNSELOR CONTACT-PHONE
WPCS WIC PEER COUNSELOR - GROUP MEETING
WPCV WIC PEER COUNSELOR-HOSPITAL VISIT
WROS WIC WIC RETURN OUT OF STATE
WSSM WIC WIC SELF-STUDY MODULE
WTE WIC WIC TERMINATION IN ERROR
WTNG WIC WIC TERMINATION NOTICE GIVEN
WUCR WIC WIC UPDATE CLOSEOUT RECORD
WUII WIC WIC UPDATE INFO INFANT
WUIN WIC WIC UPDATE INFOR POSTPARTUM
WUPI WIC WIC UPDATE PROXY INFO
WVOC WIC WIC OUT OF STATE TRANSFER
WWD WW WISEWOMAN DIAGNOSTIC
WWD1 WW WISEWOMAN DIAGNOSTIC
WWD2 WW WISEWOMAN DIAGNOSTIC
WWD3 WW WISEWOMAN DIAGNOSTIC
WWD4 WW WISEWOMAN DIAGNOSTIC
WWD5 WW WISEWOMAN DIAGNOSTIC
WWI1 WW WISEWOMAN INITIAL SCREENING
WWI2 WW WISEWOMAN INITIAL SCREENING
WWI3 WW WISEWOMAN INITIAL SCREENING
WWI4 WW WISEWOMAN INITIAL SCREENING
WWI5 WW WISEWOMAN INITIAL SCREENING
WWIS WW WISEWOMAN INITIAL SCREENING
WWLA WIC WIC WAIT LIST ACTIVE
WWR1 WW WISEWOMAN RE-SCREENING
WWR2 WW WISEWOMAN RE-SCREENING
WWR3 WW WISEWOMAN RE-SCREENING
WWR4 WW WISEWOMAN RE-SCREENING
WWR5 WW WISEWOMAN RE-SCREENING
WWRS WW WISEWOMAN RE-SCREENING
WWS WW WISEWOMAN SCREENING