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| wdt_ID | Effective | Code type | Code | Brand name | Code description | Vendor | Action |
|---|---|---|---|---|---|---|---|
| 19599 | 2016-12-02 | CPT | 0001U | RED BLOOD CELL ANTIGEN TYPING, DNA, HUMAN ERYTHROCYTE ANTIGEN GENE ANALYSIS OF 35 ANTIGENS FROM 11 BLOOD GROUPS, UTILIZING WHOLE BLOOD, COMMON RBC ALLELES REPORTED | SHP | Prior Authorization Required | |
| 19600 | 2016-12-02 | CPT | 0002U | ONCOLOGY (COLORECTAL), QUANTITATIVE ASSESSMENT OF THREE URINE METABOLITES (ASCORBIC ACID, SUCCINIC ACID AND CARNITINE) BY LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING ACQUISITION, ALGORITHM REPORTED AS | SHP | Prior Authorization Required | |
| 19601 | 2017-01-01 | REV | 0100 | ALL- INCLUSIVE ROOM & BOARD PLUS ANCILLARY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19602 | 2017-01-01 | REV | 0101 | ALL-INCLUSIVE R andB | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19603 | 2017-01-01 | REV | 0110 | PVT - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19604 | 2017-01-01 | REV | 0111 | PVT - MEDICAL/SURGICAL/GYN | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19605 | 2017-01-01 | REV | 0112 | PVT - OB | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19606 | 2017-01-01 | REV | 0113 | PVT - PEDIATRIC | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19607 | 2017-01-01 | REV | 0117 | PVT - ONCOLOGY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19608 | 2017-01-01 | REV | 0119 | PVT - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19609 | 2017-01-01 | REV | 0120 | SEMI - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19610 | 2017-01-01 | REV | 0121 | SEMI - MEDICAL/SURGICAL/GYN | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19611 | 2017-01-01 | REV | 0122 | SEMI - OB | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19612 | 2017-01-01 | REV | 0123 | SEMI - PEDIATRIC | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19613 | 2017-01-01 | REV | 0127 | SEMI - ONCOLOGY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19614 | 2017-01-01 | REV | 0128 | SEMI - REHABILITATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19615 | 2017-01-01 | REV | 0129 | SEMI - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19616 | 2017-01-01 | REV | 0130 | 3 and 4 BED - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19617 | 2017-01-01 | REV | 0131 | 3 and 4 BED - MEDICAL/SURGICAL/GYN | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19618 | 2017-01-01 | REV | 0132 | 3 and 4 BED - OB | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19619 | 2017-01-01 | REV | 0133 | 3 and 4 BED - PEDIATRIC | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19620 | 2017-01-01 | REV | 0137 | 3 and 4 BED - ONCOLOGY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19621 | 2017-01-01 | REV | 0138 | 3 and 4 BED - REHABILITATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19622 | 2017-01-01 | REV | 0139 | 3 and 4 BED - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19623 | 2017-01-01 | REV | 0140 | PVT/DLX - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19624 | 2017-01-01 | REV | 0141 | PVT/DLX - MEDICAL/SURGICAL/GYN | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19625 | 2017-01-01 | REV | 0142 | PVT/DLX - OB | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19626 | 2017-01-01 | REV | 0143 | PVT/DLX - PEDIATRIC | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19627 | 2017-01-01 | REV | 0147 | PVT/DLX - ONCOLOGY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19628 | 2017-01-01 | REV | 0149 | PRIVATE DELUXE - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19629 | 2017-01-01 | REV | 0150 | WARD - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19630 | 2017-01-01 | REV | 0151 | WARD - MEDICAL/SURGICAL/GYN | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19631 | 2017-01-01 | REV | 0152 | WARD - OB | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19632 | 2017-01-01 | REV | 0153 | WARD - PEDIATRIC | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19633 | 2017-01-01 | REV | 0157 | WARD - ONCOLOGY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19634 | 2017-01-01 | REV | 0159 | WARD -OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19635 | 2017-01-01 | REV | 0160 | R and B - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19636 | 2017-01-01 | REV | 0164 | STERILE ENVIRONMENT | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19637 | 2017-01-01 | REV | 0167 | SELF CARE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19638 | 2017-01-01 | REV | 0169 | R and B - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19639 | 2017-01-01 | REV | 0170 | NURSERY - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19640 | 2017-01-01 | REV | 0171 | NEWBORN - LEVEL I | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19641 | 2017-01-01 | REV | 0172 | PREMATURE - LEVEL II | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19642 | 2017-01-01 | REV | 0173 | INTERMEDIATE - LEVEL III | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19643 | 2017-01-01 | REV | 0174 | NEONATAL ICU - LEVEL IV | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19644 | 2017-01-01 | REV | 0175 | NURSERY: NEONATAL ICU | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19645 | 2017-01-01 | REV | 0179 | OTHER NURSERY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19646 | 2017-01-01 | REV | 0180 | IP ANCILLARY -GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19647 | 2017-01-01 | REV | 0182 | PATIENT CONVENIENCE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19648 | 2017-01-01 | REV | 0183 | THERAPEUTIC LEAVE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19649 | 2017-01-01 | REV | 0185 | HOSPITALIZATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19650 | 2017-01-01 | REV | 0189 | OTHER LEAVE OF ABSENCE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19651 | 2017-01-01 | REV | 0190 | SUBACUTE - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19652 | 2017-01-01 | REV | 0191 | SUBACUTE CARE - LEVEL I | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19653 | 2017-01-01 | REV | 0192 | SUBACUTE CARE - LEVEL II | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19654 | 2017-01-01 | REV | 0193 | SUBACUTE CARE - LEVEL III | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19655 | 2017-01-01 | REV | 0194 | SUBACUTE CARE - LEVEL IV | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19656 | 2017-01-01 | REV | 0199 | SUBACUTE/OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19657 | 2017-01-01 | REV | 0200 | ICU - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19658 | 2017-01-01 | REV | 0201 | ICU - SURGICAL | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19659 | 2017-01-01 | REV | 0202 | ICU - MEDICAL | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19660 | 2017-01-01 | REV | 0203 | ICU - PEDIATRIC | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19661 | 2017-01-01 | REV | 0206 | ICU - INTERMEDIATE ICU | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19662 | 2017-01-01 | REV | 0207 | ICU - BURN CARE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19663 | 2017-01-01 | REV | 0208 | ICU - TRAUMA | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19664 | 2017-01-01 | REV | 0209 | ICU - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19665 | 2017-01-01 | REV | 0210 | CCU - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19666 | 2017-01-01 | REV | 0211 | CCU - MYOCARDIAL INFARCTION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19667 | 2017-01-01 | REV | 0212 | CCU - PULMONARY CARE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19668 | 2017-01-01 | REV | 0213 | CCU - HEART TRANSPLANT | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19669 | 2017-01-01 | REV | 0214 | CCU - INTERMEDIATE CCU | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19670 | 2017-01-01 | REV | 0219 | CCU - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19671 | 2017-01-01 | REV | 0220 | SPECIAL CHARGES - GENERAL CLASSIFICATION | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19672 | 2017-01-01 | REV | 0221 | ADMISSION CHARGE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19673 | 2017-01-01 | REV | 0222 | TECHNICAL SUPPORT CHARGE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19674 | 2017-01-01 | REV | 0223 | UR SERVICE CHARGE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19675 | 2017-01-01 | REV | 0224 | LATE DISCHARGE, MEDICALLY NECESSARY | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19676 | 2017-01-01 | REV | 0229 | SPECIAL CHARGES - OTHER | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19677 | 2017-01-01 | REV | 0681 | TRAUMA LEVEL I | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19678 | 2017-01-01 | REV | 0682 | TRAUMA LEVEL II | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19679 | 2017-01-01 | REV | 0683 | TRAUMA LEVEL III | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19680 | 2017-01-01 | REV | 0684 | TRAUMA LEVEL IV | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19681 | 2017-01-01 | REV | 0689 | TRAUMA RESPONSE - OTHER TRAUMA RESPONSE | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19682 | 2017-01-01 | REV | 0801 | INPATIENT HEMODIALYSIS | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19683 | 2017-01-01 | REV | 0802 | INPATIENT PERITONEAL (NON-CAPD) | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19684 | 2017-01-01 | REV | 0803 | INPATIENT PERITONEAL DIALYSIS | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19685 | 2017-01-01 | REV | 0804 | INPATIENT CONTINUOUS CYCLING PERITONEAL DIALYSIS | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19686 | 2017-01-01 | REV | 0809 | RENAL DIALYSIS - OTHER INPATIENT DIALYSIS | SHP | Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274 | |
| 19687 | 2017-01-01 | CPT | 0159T | CAD BREAST MRI | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19688 | 2017-01-01 | CPT | 0291T | INTRAV OPTCL CHERNCE TMGRPHY W/S&I INJ INTL VESL | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19689 | 2017-01-01 | CPT | 0292T | INTRAV OPTCAL COHRNCE TMGRPHY W/S&I ADL VESL | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19690 | 2017-01-01 | CPT | 70336 | MRI, TEMPOROMANDIBULAR JOINTS | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19691 | 2017-01-01 | CPT | 70450 | CT SCAN, HEAD/BRAIN; W/O CONTRAST MATL | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19692 | 2017-01-01 | CPT | 70460 | CT SCAN, HEAD/BRAIN; W/CONTRAST MATL(S) | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19693 | 2017-01-01 | CPT | 70470 | CT SCAN, HEAD/BRAIN; W/O CONTRAST MATL, THEN W/CON | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19694 | 2017-01-01 | CPT | 70480 | CT SCAN, ORBIT/SELLA/POSTERIOR FOSSA/OUTER, MIDDLE | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19695 | 2017-01-01 | CPT | 70481 | CT SCAN, ORBIT/SELLA/POSTERIOR FOSSA/OUTER, MIDDLE | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19696 | 2017-01-01 | CPT | 70482 | CT SCAN, ORBIT/SELLA/POSTERIOR FOSSA/OUTER, MIDDLE | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19697 | 2017-01-01 | CPT | 70486 | CT SCAN, MAXILLOFACIAL AREA; W/O CONTRAST MATL | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| 19698 | 2017-01-01 | CPT | 70487 | CT SCAN, MAXILLOFACIAL AREA; W/CONTRAST MATL(S) | SHP | Billed with one of the following Places of Service or Types of Bill 01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,22,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,6 | |
| Effective | Code type | Code | Brand name | Code description | Vendor | Action |
