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pdfCenters for Medicaid and CHIP Services (CMCS)
T-MSIS Valid Value List (VVL) - Changes Between Versions 2.4.0 and 4.0.0
PRA Disclosure Statement: The Transformed Medicaid Statistical Information System (T-MSIS) is used to assist the Centers for Medicare & Medicaid Services (CMS) with monitoring and oversight of Medicaid and CHIP programs, to enable
evaluation of demonstrations under section 1115 of the Social Security Act and to calculate quality measures and other metrics, including those reported through the new Medicaid and CHIP Scoreboard. Section 4735 of the Balanced
Budget Act of 1997 included a statutory requirement for states to submit claims data, enrollee encounter data, and supporting information. Section 6504 of the Affordable Care Act strengthened this provision by requiring states to include
data elements the Secretary determines necessary for program integrity, program oversight, and administration. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 09380345 (Expires: 03/31/2026. The time required to complete this information collection is estimated to average 10 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance
Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
VVL
Order
VVL Code Descrip?on
Effec?ve
Start Date
Effec?ve
End Date
VVL Field
VVL Name
VVL Code
1
2
3
4
5
6
1115A-DEMONSTRATION-IND
1115A-DEMONSTRATION-IND
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
1115A Demonstration Indicator List
1115A Demonstration Indicator List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
0
1
2
3
4
5
NoNot a 1115A
Yes1115A
Inpatient Hospital
Inpatient Mental Health
Nursing Care Services
Physician/Surgical
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Outpatient Hospital
Outpatient Mental Health
Prescribed Drugs
Dental Services
Vision Services
Other Practitioners
Clinic Services
Therapy Services
Laboratory/Radiological
Medical Equipment
Family Planning
Abortions
Screening Services
Home Health
Health Services Initiatives
Home and Community
Hospice
Medical Transportation
Case Management
Translation and Interpretation
ARP Section 9821 COVID Vaccine/Vaccine Administration
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21.P-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21.P Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
31
32
33
34
35
1A
1B
1C
1D
32A
32B
35A
35B
8A
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Other Services
Outreach
Administration
PERM Administration
Citizenship Verification Technology-CHIPRA
Premiums: Up To 150% - Gross Premiums Paid
Premiums: Up To 150% - Cost Sharing Offset
Premiums: Over 150% - Gross Premiums Paid
Premiums: Over 150% - Cost Sharing Offset
Increased Outreach and Enrollment of Indians
Increase Outreach and Enrollment of children through premium subsidies
CVT Development
CVT Operation
Drug Rebate
Inpatient Hospital
Inpatient Mental Health
Nursing Care
Physician/Surgical
Outpatient Hospital
Outpatient Mental Health
Prescribed Drugs
Dental Services
Vision Services
Other Practitioners
Clinic Services
Therapy
Laboratory/Radiological
Medical Equipment
Family Planning
Abortions
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
64.10BASE-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
64.10BASE Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
18
19
20
21
22
23
24
25
26
31
32
33
34
35
1A
1B
1C
1D
32A
32B
35A
35B
8A
29
2
3
4
5
6
7
Screening Services
Home Health
Health Services Initiatives
Home And Community-Based Services
Hospice
Medical Transportation
Case Management
Translation and Interpretation
ARP Section 9821 COVID Vaccine/Vaccine Administration
Other Services
Outreach
Administration
PERM Administration
Citizenship Verification Technology-CHIPRA
Premiums - Up To 150%: Gross Premiums Paid
Premiums - Up To 150%: Cost Sharing Offset
Premiums - Over 150%: Gross Premiums Paid
Premiums - Over 150%: Cost Sharing Offset
Increased Outreach and Enrollment of Indians
Increase Outreach and Enrollment of children through premium subsidies
CVT Development
CVT Operation
Drug Rebate
Non-Emergency Medical Transportation
Inpatient Hospital Services - Reg. Payments
Inpatient Mental Health - Reg. Payment
Nursing Care Services
Physician/Surgical
Outpatient Hospital Services
Outpatient Mental Health
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
26
31
1A
1B
1C
1D
21A
2A
3A
3B
8A1
8A2
8A3
Prescribed Drugs
Dental Services
Vision Services
Other Practitioners
Clinic Services
Therapy Services
Laboratory/Radiological
Medical Equipment
Family Planning
Abortions
Screening Services
Home Health
Medicare Payments
Home And Community
Hospice
Medical Transport
Case Management
ARP Section 9821 COVID Vaccine/Vaccine Administration
Other Services
Premiums: Up To 150% - Gross Premiums Paid
Premiums: Up To 150% - Cost Sharing Offset
Premiums: Over 150% - Gross Premiums Paid
Premiums: Over 150% - Cost Sharing Offset
Home and Community-Based Services - Regular Payment (WAIVER)
Inpatient Hospital Services - DSH
Inpatient Mental Health - DSH
Certified Community Behavior Health Clinic Payments
Drug Rebate - National
Drug Rebate - State
MCO - National Agreement
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21U Form List
64.21U Form List
64.21U Form List
64.21U Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
8A4
8A5
8A6
8A7
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
26
31
1A
MCO - State Sidebar Agreement
Increased ACA OFFSET - Fee for Service - 100%
Increased ACA OFFSET - MCO - 100%
Drug Rebate Offset - Value Based Purchasing
Inpatient Hospital - Reg. Payments
Inpatient Mental Health - Reg. Payments
Nursing
Physician/Surgical
Outpatient Hospital
Outpatient Mental Health
Prescribed Drugs
Dental Services
Vision Services
Other Practitioners
Clinic services
Therapy Services
Laboratory/Radiological
Medical Equipment
Family Planning
Abortions
Screening
Home Health
Medicare Payments
Home And Community
Hospice
Medical Transport
Case Management
ARP Section 9821 COVID Vaccine/Vaccine Administration
Other Services
Premiums Up To 150% - Gross Premiums Paid
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
1B
1C
1D
21A
2A
3A
3B
8A1
8A2
8A3
8A4
8A5
8A6
8A7
A1A
A1B1
A1B2
A1C
A1C1
A1C2
A1C3
A1C4
A2
B1
B2
B3
7
8
11
12
Premiums Up To 150% - Cost Sharing Offset
Premiums Over 150% - Gross Premiums Paid
Premiums Over 150% - Cost Sharing Offset
Home and Community-Based Services - Regular Payment (WAIVER)
Inpatient Hospital - DSH
Inpatient Mental Health - DSH
Certified Community Behavior Health Clinic Payments
Drug Rebate - National
Drug Rebate - State
MCO - National Agreement
MCO - State Sidebar Agreement
Increased ACA OFFSET - Fee for Service - 100%
Increased ACA OFFSET - MCO - 100%
Drug Rebate Offset - Value Based Purchasing
Medicare Collections
Other Collection - Health Insurance
Other Collections - Casualty Insurance
Total Collections - Cooperative Agreements & Assign of Rights
Less: Excess Paid to Individuals
Net Collections To Reimburse State Title XIX Medical Payments
Less 15% Incentive Actually Paid Under Section 1903(p)(1)
Net Federal Share
Total TPL Collections
Medicare Title XVIII
Health Insurance
Other Cost Avoidance
Prescribed Drugs
Dental Services
Laboratory/Radiological
Home Health Services
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
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13
14
15
16
22
25
26
27
28
30
31
32
33
34
35
36
38
39
40
41
42
43
44
45
46
47
48
49
69
10A
Sterilizations
Abortions
EPSDT Screening
Rural Health
All-Inclusive Care Elderly
Primary Care Case Management
Hospice Benefits
Emergency Services for Undocumented Aliens
Federally-Qualified Health Center
Physical Therapy
Occupational Therapy
Services for Speech, Hearing & Language
Prosthetic Devices, Dentures, Eyeglasses
Diagnostic Screening & Preventive Services
Nurse Mid-Wife
Emergency Hospital Services
Nurse Practitioner Services
School Based Services
Rehabilitative Services (non-school-based)
Private Duty Nursing
Freestanding Birth Center
Health Home for Enrollees w Chronic Conditions
Tobacco Cessation for Pregnant Women
Health Home for Enrollees w Substance-Use-Disorder
OUD Medicaid Assisted Treatment – Drugs
ARP Section 9811 COVID Vaccine/Vaccine Administration
ARP Section 9813 Qualified Community Based Mobile Crisis Intervention – 85%
Health Homes for Children with Medically Complex Conditions
Other Care Services
Clinic Services - Reg. Payments
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
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10B
17A
17B
17C1
17D
18A
18A1
18A2
18A3
18A4
18A5
18A6
18B1
18B1a
18B1b
18B1c
18B1d
18B1e
18B1f
18B2
18B2a
18B2b
18B2c
18B2d
18B2e
18B2f
18C
18D
18E
19A
Clinic Services - Sup. Payments
Medicare - Part A
Medicare - Part B
120% - 134% Of Poverty
Coinsurance
Medicaid - MCO
Medicaid MCO - Evaluation and Management
Medicaid MCO - Vaccine codes
Medicaid MCO - Community First Choice
Medicaid MCO - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Medicaid MCO - Certified Community Behavior Health Clinic Payments
Medicaid MCO - Services Subject to Electronic Visit Verification Requirements
Prepaid Ambulatory Health Plan
MCO PAHP - Evaluation and Management
MCO PAHP - Vaccine codes
MCO PAHP - Community First Choice
MCO PAHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Medicaid PAHP - Certified Community Behavior Health Clinic Payments
MCO PAHP - Services Subject to Electronic Visit Verification Requirements
Prepaid Inpatient Health Plan
MCO PIHP - Evaluation and Management
MCO PIHP - Vaccine codes
MCO PIHP - Community First Choice
MCO PIHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Medicaid PIHP - Certified Community Behavior Health Clinic Payments
MCO PIHP - Services Subject to Electronic Visit Verification Requirements
Medicaid - Group Health
Medicaid - Coinsurance
Medicaid - Other
Home & Community-Based Services - Regular Payment (1915(c) Waiver)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
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19B
19C
19D
1A
1B
1C
1D
23A
23B
24A
24B
29A
29B
2A
2B
2C
34A
37A
37B
37C
3A
3B
46A1
46A2
46A3
46A4
46A5
46A6
46B
4A
Home & Community-Based Services - St. Plan 1915(i) Only Pay.
Home & Community-Based Services - St. Plan 1915(j) Only Pay.
Home & Community Based Services State Plan 1915(k) Community First Choice
Inpatient Hospital - Reg. Payments
Inpatient Hospital - DSH
Inpatient Hospital - Sup. Payments
Inpatient Hospital - GME Sup Payments
Personal Care Services - Reg. Payments
Personal Care Services - SDS 1915(j)
Targeted Case Management Services - Com. Case-Man.
Case Management - State Wide
Non-Emergency Medical Transportation - Reg. Payments
Non-Emergency Medical Transportation - Sup. Payments
Mental Health Facility Services - Reg. Payments
Mental Health Facility - DSH
Certified Community Behavior Health Clinic Payments
Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Critical Access Hospitals - Reg. Payments
Critical Access Hospitals Inpatient - Sup. Payments
Critical Access Hospitals Outpatient - Sup. Payments
Nursing Facility Services - Reg. Payments
Nursing Facility Services - Sup. Payments
OUD MAT DRUG REBATE/National Agreement
OUD MAT DRUG REBATE/State Sidebar
OUD MAT DRUG REBATE MCO /National Agreement
OUD MAT DRUG REBATE MCO /State Sidebar
OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%
OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%
OUD Medicaid Assisted Treatment Services
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Public Providers
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
268
269
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4B
4C
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Private Providers
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Supplemental
Payments
01/01/0001
01/01/0001
12/31/9999
12/31/9999
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
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5A
5B
5C
5D
6A
6B
7A1
7A2
7A3
7A4
7A5
7A6
7A7
9A
9B
7
8
11
12
13
14
15
16
22
25
26
27
Physician & Surgical Services - Reg. Payments
Physician & Surgical Services - Sup. Payments
Physician & Surgical Services - Evaluation and Management
Physician & Surgical Services - Vaccine codes
Outpatient Hospital Services - Reg. Payments
Outpatient Hospital Services - Sup. Payments
Drug Rebate Offset - National
Drug Rebate Offset - State Sidebar Agreement
MCO - National Agreement
MCO - State Sidebar Agreement
Increased ACA OFFSET - Fee for Service - 100%
Increased ACA OFFSET - MCO - 100%
Drug Rebate Offset - Value Based Purchasing
Other Practitioners Services - Reg. Payments
Other Practitioners Services - Sup. Payments
Prescribed Drugs
Dental Services
Laboratory/Radiological
Home Health
Sterilizations
Abortions
EPSDT Screen
Rural Health Clinic
Programs/All-Inclusive
Primary Care Case Manage
Hospice
Emergency Services for Undocumented Aliens
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
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28
30
31
32
33
34
35
36
38
39
40
41
42
43
44
45
46
47
48
49
69
10A
10B
17A
17B
17C1
17D
18A
18A1
18A2
Federally-Qualified Health Center
Physical Therapy
Occupational Therapy
Services for Speech, Hearing & Language
Prosthetic Devices, Dentures, Eyeglasses
Diagnostic Screening & Preventive Services
Nurse Mid-Wife
Emergency Hospital Services
Nurse Practitioner Services
School Based Services
Rehabilitative Services (non-school-based)
Private Duty Nursing
Freestanding Birth Center
Health Home for Enrollees w Chronic Conditions
Tobacco Cessation for Pregnant Women
Health Home for Enrollees w Substance-Use-Disorder
OUD Medicaid Assisted Treatment – Drugs
ARP Section 9811 COVID Vaccine/Vaccine Administration
ARP Section 9813 Qualified Community Based Mobile Crisis Intervention – 85%
Health Homes for Children with Medically Complex Conditions
Other Care Services
Clinic Services - Reg. Payments
Clinic Services - Sup. Payments
MHIP - Part A
MHIP - Part B
MHIP - Qual. Ind. 120-134
MHIP - Coinsurance
MHIP - MCO
Medicaid MCO - Evaluation and Management
Medicaid MCO - Vaccine codes
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
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18A3
18A4
18A5
18A6
18B1
18B1a
18B1b
18B1c
18B1d
18B1e
18B1f
18B2
18B2a
18B2b
18B2c
18B2d
18B2e
18B2f
18C
18D
18E
19A
19B
19C
19D
1A
1B
1C
1D
23A
Medicaid MCO - Community First Choice
Medicaid MCO - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Medicaid MCO - Certified Community Behavior Health Clinic Payments
Medicaid MCO - Services Subject to Electronic Visit Verification Requirements
Prepaid Ambulatory Health Plan
MCO PAHP - Evaluation and Management
MCO PAHP - Vaccine codes
MCO PAHP - Community First Choice
MCO PAHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Medicaid PAHP - Certified Community Behavior Health Clinic Payments
MCO PAHP - Services Subject to Electronic Visit Verification Requirements
Prepaid Inpatient Health Plan
MCO PIHP - Evaluation and Management
MCO PIHP - Vaccine codes
MCO PIHP - Community First Choice
MCO PIHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Medicaid PIHP - Certified Community Behavior Health Clinic Payments
MCO PIHP - Services Subject to Electronic Visit Verification Requirements
MHIP - Group Health Plan
MHIP - Coinsurance and Deductibles
MHIP - Other
Home & Community-Based Services - Regular Payment (1915(c) Waiver)
Home & Community-Based Services - St. Plan 1915(i) Only Pay.
Home & Community-Based Services - St. Plan 1915(j) Only Pay.
Home & Community Based Services State Plan 1915(k) Community First Choice
Inpat. Hos. Serv. - Reg. Payments
Inpat. Hos. Serv. - DSH
Inpatient Hospital - Sup. Payments
Inpatient Hospital - GME Sup Payments
Personal Care Services - Reg. Payments
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
23B
24A
24B
29A
29B
2A
2B
2C
34A
37A
37B
37C
3A
3B
46A1
46A2
46A3
46A4
46A5
46A6
46B
4A
4B
4C
Personal Care Services - SDS 1915(j)
Targeted Case Management Services - Com. Case-Man.
Case Management - State Wide
Non-Emergency Medical Transportation - Reg. Payments
Non-Emergency Medical Transportation - Sup. Payments
Men. Health Fac. Serv. - Reg. Payments
Men. Health Fac. Serv. - DSH Adjustment Payments
Certified Community Behavior Health Clinic Payments
Preventive Services Grade A OR B, ACIP Vaccines and their Admin
Critical Access Hospitals - Reg. Payments
Critical Access Hospitals Inpatient - Sup. Payments
Critical Access Hospitals Outpatient - Sup. Payments
Nursing Facility Services - Reg. Payments
Nursing Facility Services - Sup. Payments
OUD MAT DRUG REBATE/National Agreement
OUD MAT DRUG REBATE/State Sidebar
OUD MAT DRUG REBATE MCO /National Agreement
OUD MAT DRUG REBATE MCO /State Sidebar
OUD MAT DRUG REBATE/Increased ACA Offset Fee for Service - 100%
OUD MAT DRUG REBATE/Increased ACA Offset MCO – 100%
OUD Medicaid Assisted Treatment Services
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Public Providers
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Private Providers
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Supplemental
Payments
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
381
382
383
384
385
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
5A
5B
5C
5D
6A
Physician & Surgical Services - Reg. Payments
Physician & Surgical Services - Sup. Payments
Physician & Surgical Services - Evaluation and Management
Physician & Surgical Services - Vaccine codes
Outpatient Hospital Services - Reg. Payments
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
386
387
388
389
390
391
392
393
394
395
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
396
ACCEPTING-NEW-PATIENTS-IND
Accepting New Patients Indicator
List
0
397
ACCEPTING-NEW-PATIENTS-IND
Accepting New Patients Indicator
List
398
ACCEPTING-NEW-PATIENTS-IND
399
400
401
402
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
64.9P Form List
6B
7A1
7A2
7A3
7A4
7A5
7A6
7A7
9A
9B
Outpatient Hospital Services - Sup. Payments
Drug Rebate - National
Drug Rebate - State
MCO - National Agreement
MCO - State Sidebar Agreement
Increased ACA OFFSET - Fee for Service - 100%
Increased ACA OFFSET - MCO - 100%
Drug Rebate Offset - Value Based Purchasing
Other Practitioners Services - Reg. Payments
Other Practitioners Services - Sup. Payments
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
No
01/01/0001
12/31/9999
1
Yes
01/01/0001
12/31/9999
Accepting New Patients Indicator
List
8
N/A - The individual only practices as a member of a group.
01/01/0001
12/31/9999
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
01
02
03
04
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
403
404
405
406
407
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
05
06
07
08
09
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
408
ACCREDITATION-ORGANIZATION
Accreditation Organization List
10
409
ACCREDITATION-ORGANIZATION
Accreditation Organization List
11
National committee for quality assurance - excellent
National committee for quality assurance - commendable
National committee for quality assurance - provisional
National committee for quality assurance - new plan no longer a valid accreditation
level
URAC - full
URAC - conditional
URAC - provisional
Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) - 3 years
Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) - 1 year - no longer
valid accreditation level
Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) - 6 months - no
longer valid accreditation level
Not accredited
01/01/0001
12/31/9999
410
411
412
413
414
415
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
12
13
14
15
16
See
"VVL_Code_Description"
field
Other
National committee for quality assurance-- accredited
National committee for quality assurance - interim
National committee for quality assurance - denied
JCAHO (Joint Commission on Accreditation of Healthcare Organizations)
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code
sets. The CSMO is the system of record for those specific valid value code sets. While TMSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ncqa.org/programs/healthplans/health-plan-accreditation-hpa/ and
https://www.aaahc.org/accreditation/accreditation-general-information/terms-ofaccreditation/
416
417
418
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ADDR-BORDER-STATE-IND
419
ADDR-BORDER-STATE-IND
420
ADDR-BORDER-STATE-IND
421
ADDR-COUNTY / ELIGIBLECOUNTY-CODE / MANAGEDCARE-COUNTY
ADDR-COUNTY / ELIGIBLECOUNTY-CODE / MANAGEDCARE-COUNTY
ADDR-COUNTY / ELIGIBLECOUNTY-CODE / MANAGEDCARE-COUNTY
422
423
Accreditation Organization List
Accreditation Organization List
Address Border State Indicator
List
Address Border State Indicator
List
Address Border State Indicator
List
US County Code List
Not Applicable
Not Applicable
0
Accreditation Organization List
Accreditation Organization List 2
No
01/01/0001
12/31/9999
1
Yes
01/01/0001
12/31/9999
8
N/A - State does not distinguish "border state providers.".
01/01/0001
12/31/9999
Not Applicable
This URL will take the reader to the American National Standards Institute (ANSI)
Website for the various geographical code sets:
US County Code List
Not Applicable
US County Code List
US County Code List
Not Applicable
Once at the Website, the reader should scroll down to the section entitled "State and
State Equivalents" for the state codes, "FIPS Codes for Outlying Areas of the United
States and the Freely Associated States" for the territory codes and "County
Subdivision" for the county codes.
424
ADDR-TYPE
Eligible Address Type List
01
425
426
427
428
429
430
431
432
433
434
ADDR-TYPE
ADDR-TYPE
ADDR-TYPE
ADDR-TYPE
ADDR-TYPE
ADDR-TYPE
ADDR-TYPE
ADDR-TYPE
ADDR-TYPE
ADJUSTMENT-IND
Provider Address Type List
Eligible Address Type List
Provider Address Type List
Eligible Address Type List
Provider Address Type List
Eligible Address Type List
Provider Address Type List
Eligible Address Type List
Eligible Address Type List
Adjustment Indicator List
1
02
2
03
3
04
4
05
06
0
435
ADJUSTMENT-IND
Adjustment Indicator List
1
Primary home address and contact information, used for the eligibility determination
process
Provider Billing
Primary work address and contact information
Provider Mailing
Secondary residence and contact information
Provider Practice
Secondary work address and contact information
Provider Service Location
Other category of address and contact information
Eligible persons official mailing address
Original Claim/Encounter/Payment/Financial Transaction - Indicates that this is the first 01/01/0001
(and, when applicable, only) fully adjudicated transaction in a
claim/encounter/payment/financial transaction family (one or more claims with the
related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s)
also).
Void/Reversal/Cancel of a prior submission - Use this code to convey that the purpose
of the transaction is to void/reverse/cancel a previously paid/approved
claim/encounter/payment/financial transaction where the
claim/encounter/payment/financial transaction is not being replaced by a new
paid/approved version of the claim/encounter/payment/financial transaction.
Typically, this would be the last claim/encounter/payment/financial transaction that
would ever be associated with a given claim/encounter/payment/financial transaction
family. These records must have the same ICN-ORIG or ICN-ADJ as the
claim/encounter/financial transaction being voided. CMS expects a void transaction to
also have the same MSIS ID and provider ID(s) as the
claim/encounter/payment/financial transaction being voided/reversed/cancelled.
01/01/0001
12/31/9999
12/31/9999
436
ADJUSTMENT-IND
Adjustment Indicator List
4
Replacement/Resubmission of a previously paid/approved
claim/encounter/payment/financial transaction - Use when the purpose of the
transaction is to replace a previously paid/approved
claim/encounter/payment/financial transaction with a new paid/approved version of
the claim/encounter/payment/financial transaction. These records must have the
same ICN-ORIG or ICN-ADJ as the claim/encounter/payment/financial transaction
being replaced. CMS expects a replacement transaction to also have the same MSIS ID
and provider ID(s) as the claim/encounter/payment/financial transaction being
replaced/resubmitted.
01/01/0001
12/31/9999
437
ADJUSTMENT-IND
Adjustment Indicator List
5
Credit Gross Adjustment - Use this code to indicate an aggregate provider-level
01/01/0001
recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on
these claims should be expressed as negative numbers. If a credit gross adjustment is
reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or
debit) then CMS will interpret this to mean that the credit gross adjustment with the
more recent adjudication/transaction date should completely replace the preceding
related gross adjustment. If the ICNs of a credit gross adjustment are not related to any
other gross adjustments (credit or debit) then the credit gross adjustment will always
be treated as a distinct financial transaction.
12/31/9999
438
ADJUSTMENT-IND
Adjustment Indicator List
6
Debit Gross Adjustment - Use this code to indicate an aggregate provider-level
payment to a provider (e.g., not attributable to a single beneficiary). Amounts on
these claims should be expressed as positive numbers. If a debit gross adjustment is
reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or
debit) then CMS will interpret this to mean that the credit gross adjustment with the
more recent adjudication/transaction date should completely replace the preceding
related gross adjustment. If the ICNs of a debit gross adjustment are not related to any
other gross adjustments (credit or debit) then the debit gross adjustment will always
be treated as a distinct financial transaction.
12/31/9999
439
ADJUSTMENT-IND / LINEADJUSTMENT-IND
Adjustment Indicator List
0
440
ADJUSTMENT-IND / LINEADJUSTMENT-IND
Adjustment Indicator List
1
Original Claim/Encounter/Payment - Indicates that this is the first (and, when
applicable, only) fully adjudicated transaction in a claim family (one or more claims
with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider
ID(s) also).
Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose
of the transaction is to void/reverse/cancel a previously paid/approved
01/01/0001
441
ADJUSTMENT-IND / LINEADJUSTMENT-IND
Adjustment Indicator List
4
442
ADJUSTMENT-IND / LINEADJUSTMENT-IND
Adjustment Indicator List
5
443
ADJUSTMENT-IND / LINEADJUSTMENT-IND
Adjustment Indicator List
6
claim/encounter/payment where the claim/encounter/payment is not being replaced
by a new paid/approved version of the claim/encounter/payment. Typically, this
would be the last claim/encounter/payment that would ever be associated with a
given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the
claim/encounter being voided. CMS expects a void transaction to also have the same
MSIS ID and provider ID(s) as the claim/encounter/payment being
voided/reversed/cancelled.
Replacement/Resubmission of a previously paid/approved claim/encounter/payment Use when the purpose of the transaction is to replace a previously paid/approved
claim/encounter/payment with a new paid/approved version of the
claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as
the claim/encounter being replaced. CMS expects a replacement transaction to also
have the same MSIS ID and provider ID(s) as the claim/encounter/payment being
replaced/resubmitted.
Credit Gross Adjustment - Use this code to indicate an aggregate provider-level
recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on
these claims should be expressed as negative numbers. If a credit gross adjustment is
reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or
debit) then CMS will interpret this to mean that the credit gross adjustment with the
more recent adjudication date should completely replace the preceding related gross
adjustment. If the ICNs of a credit gross adjustment are not related to any other gross
adjustments (credit or debit) then the credit gross adjustment will always be treated as
a distinct financial transaction.
Debit Gross Adjustment - Use this code to indicate an aggregate provider-level
payment to a provider (e.g., not attributable to a single beneficiary). Amounts on
these claims should be expressed as positive numbers. If a debit gross adjustment is
reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or
debit) then CMS will interpret this to mean that the credit gross adjustment with the
more recent adjudication date should completely replace the preceding related gross
adjustment. If the ICNs of a debit gross adjustment are not related to any other gross
adjustments (credit or debit) then the debit gross adjustment will always be treated as
a distinct financial transaction.
444
445
446
447
448
449
450
451
452
453
454
455
456
457
ADJUSTMENT-REASON-CODE
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
Adjustment Reason Code List
Not ApplicableSee
Adjustment Reason Code List This data element's valid value code set is maintained by
"VVL_Code_Description" a Code Set Maintenance Organization (CSMO), the official licensing organization for
field
specific valid value code sets. The CSMO is the system of record for those specific valid
value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor
delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's
latest version.
Hour List
00
For background and context, see https://x12.org/codes/claim-adjustment-reasoncodes
0:00-0:59
Hour List
01
1:00-1:59
Hour List
02
2:00-2:59
Hour List
03
3:00-3:59
Hour List
04
4:00-4:59
Hour List
05
5:00-5:59
Hour List
06
6:00-6:59
Hour List
07
7:00-7:59
Hour List
08
8:00-8:59
Hour List
09
9:00-9:59
Hour List
10
10:00-10:59
Hour List
11
11:00-11:59
Hour List
12
12:00-12:59
N/A
N/A
458
469
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-HOUR DISCHARGEHOUR
ADMISSION-TYPE
Hour List
13
13:00-13:59
Hour List
14
14:00-14:59
Hour List
15
15:00-15:59
Hour List
16
16:00-16:59
Hour List
17
17:00-17:59
Hour List
18
18:00-18:59
Hour List
19
19:00-19:59
Hour List
20
20:00-20:59
Hour List
21
21:00-21:59
Hour List
22
22:00-22:59
Hour List
23
23:00-23:59
Admission Type List
1
ADMISSION-TYPE
Admission Type List
2
471
ADMISSION-TYPE
Admission Type List
3
472
ADMISSION-TYPE
Admission Type List
4
473
ADMISSION-TYPE
Admission Type List
5
EMERGENCY The patient requires immediate medical intervention as a result of severe,
life threatening or potentially disabling conditions. Generally, the patient is admitted
through the emergency room.EMERGENCY
URGENT The patient requires immediate attention for the care and treatment of a
physical or mental disorder. Generally, the patient is admitted to the first available and
suitable accommodation.URGENT
ELECTIVE The patients condition permits adequate time to schedule the availability of a
suitable accommodation.ELECTIVE
NEWBORN The patient is a newborn delivered either inside the admitting hospital
(UB04 FL 15 value 5 [A baby born inside the admitting hospital] or outside of the
hospital (UB04 FL 15 value 6 [A baby born outside the admitting hospital]).NEWBORN
TRAUMA The patient visits a trauma center (A trauma center means a facility licensed
or designated by the State or local government authority authorized to do so, or as
470
459
460
461
462
463
464
465
466
467
468
01/01/0001
12/31/9999
01/01/0001
12/31/9999
01/01/0001
12/31/9999
01/01/0001
12/31/9999
01/01/0001
12/31/9999
474
475
ADMISSION-TYPE
ADMISSION-TYPE
Admission Type List
Admission Type List
verified by the American College of surgeons and involving a trauma
activation.)TRAUMA
9
UNKNOWN Information not available.
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code
field
sets. The CSMO is the system of record for those specific valid value code sets. While TMSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
N/A
12/31/9999
N/A
For background and context, see https://www.nubc.org/license
476
478
ADMITTING-DIAGNOSIS-CODE /
DIAGNOSIS-CODE 1 thru
DIAGNOSIS-CODE-12
ADMITTING-DIAGNOSIS-CODE /
DIAGNOSIS-CODE 1 thru
DIAGNOSIS-CODE-12
AFFILIATED-PROGRAM-TYPE
Diagnosis Code List
Not Applicable
Admitting Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes)
Diagnosis Code List
Not Applicable
Admitting Diagnosis Code List (ICD-10)
Affiliated Program Type List
2
01/01/0001
12/31/9999
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
3
Health Plan (state-assigned health plan ID) - The value in the AFFILIATED-PROGRAM-ID
data element contains the state-assigned health plan Identifier of health plan in which
the provider is enrolled to provide services including through the state plan and a
waiver.
Waiver - The value in the AFFILIATED-PROGRAM-ID data element contains an identifier
for the waiver in which a provider is allowed to deliver services to eligible beneficiaries.
479
01/01/0001
12/31/9999
480
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
4
Health Home Entity - The value in the AFFILIATED-PROGRAM-ID data element contains
the name of the health home in which a provider is participating. The health home
entity is responsible for providing health home services to the patient in conformance
with the Health Home SPA. This is the name that the state uses to uniquely identify
the health home team. This entity can be a designated provider (e.g., physician, clinic,
behavioral health organization), a health team which links to a designated provider, or
a health team (physicians, nurses, behavioral health professionals).
01/01/0001
12/31/9999
481
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
5
Other - The value in the AFFILIATED-PROGRAM-ID data element contains an identifier
for something other than a health plan, waiver, or health home entity.
01/01/0001
12/31/9999
477
482
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
6
Sub-capitated Network provider – The value in the AFFILIATED-PROGRAM-ID data
element contains the state-assigned health plan identifier with which the network
provider has a sub-capitated contract to provide services for managed care plan
enrollees.
01/01/0001
12/31/9999
483
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
7
Fee-For-Service - (This value is used to identify providers that are affiliated directly with 01/01/0001
the state’s Medicaid or CHIP agency (or their fiscal intermediary) and reimbursed by
the Medicaid or CHIP agency on a FFS basis. The value in the AFFILIATED-PROGRAM-ID
data element contains the ANSI state code of the state in which the provider is
enrolled to provide services including through the state plan and a waiver.)
12/31/9999
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
ALLOWED-CHARGE-SRC
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
Allowed Charge Source List
1
2
4
5
7
A
B
C
D
E
F
G
H
I
J
K
L
M
O
P
R
U
V
Priced using QMB Pricing
Lab panel bundled
Priced using RBRVS
Anesthesia pricing
APC priced
Manually priced
By report
Maximum fee
Percent of charges
Reimbursement Rate
Lower level screening fee
Billed Charges
Denied
Medicare Coins and deductible
Daily Per Diem Rate
Medicare allowed amount
First 20 days stay
Medicare prevailing
APRDRG pricing
DRG
DRG w/cost outlier
DRG priced by proration
Mid-level priced
507
508
ALLOWED-CHARGE-SRC
AMERICAN-INDIAN-ALASKANNATIVE-INDICATOR
Allowed Charge Source List
American Indian Alaskan Native
Indicator List
Z
0
ATP Bundled
Individual does not meet the definition of an American Indian/Alaskan Native.
01/01/0001
12/31/9999
509
AMERICAN-INDIAN-ALASKANNATIVE-INDICATOR
American Indian Alaskan Native
Indicator List
1
Individual meets the definition of an American Indian/Alaskan Native.
01/01/0001
12/31/9999
510
AMERICAN-INDIAN-ALASKANATIVE-INDICATOR
American Indian Alaska Native
Indicator List
2
Yes, Individual does have CDIB
01/01/0001
02/14/2020
511
512
513
ATYPICAL-PROV-IND
ATYPICAL-PROV-IND
BED-TYPE-CODE
Atypical Provider Indicator List
Atypical Provider Indicator List
Bed Type Code List
0
1
1
No, the State does not consider this to be an atypical provider
Yes, the State considers this to be an atypical provider
Intermediate Care Facility for the Intellectually Disabled bed not in an Institution for
Mental Disease
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
514
515
516
517
BED-TYPE-CODE
BED-TYPE-CODE
BED-TYPE-CODE
BED-TYPE-CODE
Bed Type Code List
Bed Type Code List
Bed Type Code List
Bed Type Code List
2
3
4
5
Inpatient bed not in an Institution for Mental Disease
Nursing Facility bed not in an Institution for Mental Disease
Title 18 Skilled Nursing Facility (T18 SNF) bed not in an Institution for Mental Disease
Intermediate Care Facility for the Intellectually Disabled bed in an Institution for
Mental Disease
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
518
519
BED-TYPE-CODE
BED-TYPE-CODE
Bed Type Code List
Bed Type Code List
6
7
Inpatient bed in an Institution for Mental Disease
Nursing Facility bed in an Institution for Mental Disease
01/01/0001
01/01/0001
12/31/9999
12/31/9999
520
521
522
523
524
525
526
527
528
529
530
531
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
001
002
003
004
005
006
007
008
009
010
011
012
Inpatient Hospital Services
Outpatient Hospital Services
Rural health clinic services
FQHC services
Other Laboratory and X-Ray Services
Nursing Facility Services for 21 and over
EPSDT
Family Planning Services
Mandatory tobacco cessation counseling for pregnant women under 1905(a)(4)(D)
Physicians' Services
Medical and Surgical Services Furnished by a Dentist
Nurse-midwife services
532
533
534
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
013
014
015
535
536
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
016
017
537
BENEFIT-TYPE
Benefit Type Code List
018
538
BENEFIT-TYPE
Benefit Type Code List
019
539
BENEFIT-TYPE
Benefit Type Code List
020
540
BENEFIT-TYPE
Benefit Type Code List
021
541
BENEFIT-TYPE
Benefit Type Code List
022
542
543
544
545
546
547
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
023
024
025
026
027
028
548
549
550
551
552
553
554
555
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
029
030
031
032
033
034
035
036
556
BENEFIT-TYPE
Benefit Type Code List
037
Certified pediatric or family nurse practitioners' services
Free Standing Birth Center Services
Home Health Services - Intermittent or part-time nursing services provided by a home
health agency
Home Health Services - Home Health Aide Services Provided by a Home Health Agency
Home Health Services - Medical supplies, equipment, and appliances suitable for use in
the home
Medical care and any type of remedial care recognized under State law - Podiatrists'
Services
Medical care and any type of remedial care recognized under State law - Optometrists'
Services
Medical care and any type of remedial care recognized under State law - Chiropractors'
Services
Medical care and any type of remedial care recognized under State law - Other
Practitioners' Services within scope of practice as defined by State law
Home Health Services - Physical therapy; occupational therapy; speech pathology;
audiology provided by a home health agency
Private Duty Nursing
Clinic Services
Dental Services
Physical Therapy and Related Services - Physical Therapy
Physical Therapy and Related Services - Occupational Therapy
Physical Therapy and Related Services - Services for individuals with speech, hearing and
language disorders
Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Prescribed Drugs
Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Dentures
Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Prosthetic Devices
Prescription drugs, dentures, and prosthetic devices; and eyeglasses - Eyeglasses
Other diagnostic, screening, preventive, and rehabilitative services - Diagnostic Services
Other diagnostic, screening, preventive, and rehabilitative services - Screening Services
Other diagnostic, screening, preventive, and rehabilitative services - Preventive Services
Other diagnostic, screening, preventive, and rehabilitative services - Rehabilitative
Services
Services for individuals over age 65 in IMDs - Inpatient hospital services
557
558
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
038
039
559
560
561
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
040
041
042
562
BENEFIT-TYPE
Benefit Type Code List
043
563
564
565
566
567
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
044
045
046
047
048
568
BENEFIT-TYPE
Benefit Type Code List
049
569
BENEFIT-TYPE
Benefit Type Code List
050
570
BENEFIT-TYPE
Benefit Type Code List
051
571
BENEFIT-TYPE
Benefit Type Code List
052
572
BENEFIT-TYPE
Benefit Type Code List
053
573
574
575
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
054
055
056
576
BENEFIT-TYPE
Benefit Type Code List
057
577
578
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
058
059
Services for individuals over age 65 in IMDs - Nursing facility services
Intermediate Care Facility Services for individuals with intellectual disabilities or persons
with related conditions
Inpatient psychiatric facility services for under 21
Hospice Care
Case Management Services and TB related services - Case management services as
defined in the State Plan in accordance with section 1905(a)(19) or 1915(g)
Case Management Services and TB related services - Special TB related services under
section 1902(z)(2)
Respiratory care services under 1902(e)9)(A) through (C)
Personal care services
Primary care case management services
Special sickle-cell anemia-related services
Any other medical care and any other type of remedial care recognized under State law,
specified by the Secretary - Transportation
Any other medical care and any other type of remedial care recognized under State law,
specified by the Secretary - Services provided in religious non-medical health care
facilities
Any other medical care and any other type of remedial care recognized under State law,
specified by the Secretary - Nursing facility services for patients under 21
Any other medical care and any other type of remedial care recognized under State law,
specified by the Secretary - Emergency hospital services
Any other medical care and any other type of remedial care recognized under State law,
specified by the Secretary - Critical Access Hospitals
Extended services for pregnant women - Additional Services for any other medical
conditions that may complicate pregnancy
Community First Choice
Health Home Services
Limited Pregnancy-Related Services for Pregnant Women with Income Above the
Applicable Income Limit
Ambulatory prenatal care for pregnant women furnished during a presumptive eligibility
period
Benefits for Families Receiving Transitional Medical Assistance
Standards for Coverage of Transplant Services
579
580
581
582
583
584
585
586
587
588
589
590
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
060
061
062
063
064
065
066
067
068
069
070
071
591
BENEFIT-TYPE
Benefit Type Code List
072
592
593
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
073
074
594
595
596
597
598
599
600
601
602
603
604
605
606
607
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
075
076
077
078
079
080
081
082
083
084
085
086
087
088
School-Based Services Payment Methodologies
Indian Health Services and Tribal Health Facilities
Methods and Standards to Assure High Quality Care
Medicare Premium Payments
Medicare Coinsurance and Deductibles
Other Medical Insurance Premium Payments
Programs for Distribution of Pediatric Vaccines
Laboratory and x-ray services
Home Health Services - Home health aide services provided by a home health agency
Private duty nursing services
Physical Therapy and Related Services - Audiology services
Extended services for pregnant women - Additional Pregnancy-related and postpartum
services for a 60-day period after the pregnancy ends and any remaining days in the
month in which the 60th day falls.
Home and Community Care for Functionally Disabled Elderly individuals as defined and
described in the State Plan
Emergency services for certain legalized aliens and undocumented aliens
Licensed or Otherwise State-Approved Free-Standing Birthing Center and other
ambulatory services that are offered by a freestanding birth center
Homemaker
Home Health Aide
Adult Day Health services
Habilitation
Habilitation: Residential Habilitation
Habilitation: Supported Employment
Habilitation: Education (non IDEA available)
Habilitation: Day Habilitation
Habilitation: Pre-Vocational
Habilitation: Other Habilitative Services
Respite
Day Treatment (mental health service)
Psychosocial rehabilitation
Environmental Modifications (Home Accessibility Adaptations)
608
609
610
611
612
613
614
615
616
617
618
619
620
621
622
623
624
625
626
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
BENEFIT-TYPE
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
Benefit Type Code List
089
090
091
092
093
094
095
096
097
098
099
100
101
102
103
104
105
106
107
627
628
629
630
631
632
633
634
635
BENEFIT-TYPE
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BORDER-STATE-IND
Benefit Type Code List
Billing Unit List
Billing Unit List
Billing Unit List
Billing Unit List
Billing Unit List
Billing Unit List
Billing Unit List
Border State Indicator List
108
01
02
03
04
05
06
07
0
Vehicle Modifications
Non-Medical Transportation
Special Medical Equipment (minor assistive Devices)
Home Delivered meals
Assistive Technology (i.e., communication devices)
Personal Emergency Response (PERS)
Nursing Services
Community Transition Services
Adult Foster Care
Day Supports (non-habilitative)
Supported Employment
Supported Living Arrangements
Supports for Consumer Direction (Supports Facilitation)
Participant Directed Goods and Services
Senior Companion (Adult Companion Services)
Assisted Living
Program for All-inclusive Care for the Elderly (PACE) Services
Self-directed Personal Assistance Services under 1915(j)
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARSCoV2 or the diagnosis of the virus that
causes COVID19, and the administration of such in vitro diagnostic products
COVID19 testing-related services
Per Day
Per Hour
Per Case
Per Encounter
Per Week
Per Month
Other Arrangements
No
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
636
637
638
639
640
BORDER-STATE-IND
BRAND-GENERIC-IND
BRAND-GENERIC-IND
BRAND-GENERIC-IND
CATEGORY-FOR-FEDERALREIMBURSEMENT
Border State Indicator List
Brand Generic Indicator List
Brand Generic Indicator List
Brand Generic Indicator List
Category for Federal
Reimbursement List
1
0
1
2
01
Yes
Not a Non-Drug
Generic
Brand
Federal funding under Title XIX
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
641
CATEGORY-FOR-FEDERALREIMBURSEMENT
Category for Federal
Reimbursement List
02
Federal funding under Title XXI
01/01/0001
12/31/9999
642
CATEGORY-FOR-FEDERALREIMBURSEMENT
Category for Federal
Reimbursement List
03
Federal funding under ACA
01/01/0001
09/30/2020
643
CATEGORY-FOR-FEDERALREIMBURSEMENT
Category for Federal
Reimbursement List
04
Federal funding under other legislation
01/01/0001
12/31/9999
644
CHIP-CODE
CHIP Code List
0
01/01/0001
02/14/2020
645
CHIP-CODE
CHIP Code List
1
01/01/0001
12/31/9999
646
CHIP-CODE
CHIP Code List
2
01/01/0001
12/31/9999
647
CHIP-CODE
CHIP Code List
3
01/01/0001
12/31/9999
648
649
CITIZENSHIP-IND
CITIZENSHIP-IND
Citizenship Indicator List
Citizenship Indicator List
0
1
Individual was not Medicaid eligible and not eligible for separate CHIP for the month
*End Dated 20200214
Individual was Medicaid eligible, but was not included in either Medicaid-Expansion CHIP
or a separate title XXI CHIP) program for the month. These include blind and disabled
people and low-income families with dependent children.
Individual was included in the Medicaid-Expansion CHIP program and subject to
enhanced Federal matching for the month. States with Medicaid-Expansion programs
have built upon existing Medicaid programs to include low-income children whose
family incomes are above Medicaid income eligibility thresholds.
Individual was not Medicaid-Expansion CHIP eligible, but was included in a separate title
XXI CHIP program for the month. States using Separate CHIP have used CHIP funds to
create separate programs outside of their Medicaid programs.
NoNon-citizen
YesU.S. Citizen (If the state’s eligibility determination system does not distinguish
between U.S. citizens and U.S. nationals who are not U.S. citizens, then use this value for
all U.S. citizens and U.S. nationals (see 42 CFR 435 and 436.).)
01/01/0001
01/01/0001
12/31/9999
12/31/9999
650
CITIZENSHIP-IND
Citizenship Indicator List
2
U.S. National (If the state’s eligibility determination system does distinguish between
U.S. citizens and U.S. nationals who are not U.S. citizens, then use this value for U.S.
nationals who are not U.S. citizens (see 42 CFR 435 and 436.).)
01/01/0001
12/31/9999
651
CITIZENSHIP-VERIFICATION-FLAG Citizenship Verification Flag List
0
Citizenship Verified
01/01/0001
12/31/9999
652
653
654
655
CITIZENSHIP-VERIFICATION-FLAG
CLAIM-DENIED-INDICATOR
CLAIM-DENIED-INDICATOR
CLAIM-PYMT-REM-CODE
Citizenship Verification Flag List
Claim Denied Indicator List
Claim Denied Indicator List
Claim Payment Remittance Code
List
1
0
1
See
"VVL_Code_Description"
field
Enrolled in Medicaid pending citizenship verification
Denied: The payment of claim in its entirety was denied by the state.
Not Denied: The state paid some or all of the claim.
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code sets.
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
N/A
N/A
N/A
N/A
N/A
For background and context, see https://x12.org/codes/remittance-advice-remark-codes
656
657
CLAIM-LINE-STATUS / CLAIMSTATUS
CLAIM-STATUS
Claim Status List
Not Applicable
Link to Claim Status List
Claim Status Code List
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code sets.
field
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
For background and context, see https://x12.org/codes/claim-status-codes and
https://x12.org/codes/claim-status-codes
658
659
CLAIM-PYMT-REM-CODE-1 to
CLAIM-PYMT-REM-CODE-4
CLAIM-STATUS-CATEGORY
Claim Payment Remittance
Code List
Claim Status Category List
Not Applicable
Claim Payment Remittance Code List
Not ApplicableSee
Link to Claim Status Category ListThis data element's valid value code set is maintained
"VVL_Code_Description" by a Code Set Maintenance Organization (CSMO), the official licensing organization for
field
specific valid value code sets. The CSMO is the system of record for those specific valid
value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor
delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's
latest version.
For background and context, see http://www.wpcedi.com/reference/codelists/healthcare/claim-status-category-codes/
660
CMS-64-CATEGORY-FORFEDERAL-REIMBURSEMENT
CMS 64 Category for Federal
Reimbursement List
01
Federal funding under Title XIX
661
662
663
664
665
666
667
668
669
670
671
672
673
674
675
676
677
678
679
680
CMS-64-CATEGORY-FORFEDERAL-REIMBURSEMENT
CMS-64-CATEGORY-FORFEDERAL-REIMBURSEMENT
CMS-64-CATEGORY-FORFEDERAL-REIMBURSEMENT
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
CMS 64 Category for Federal
Reimbursement List
CMS 64 Category for Federal
Reimbursement List
CMS 64 Category for Federal
Reimbursement List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
02
Federal funding under Title XXI
03
Federal funding under ACA *Code end dated 20200920
04
Federal funding under other legislation
01
02
03
04
05
06
07
10
11
12
13
14
15
16
17
18
See
"VVL_Code_Description"
field
Capsule
Ointment
Cream
Suppository
Powder
Emulsion
Liquid
Tablet
Solution
Suspension
Lotion
Shampoo
Elixir
Syrup
Lozenge
Enema
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code sets.
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
01/01/0001
01/01/0001
12/31/9999
12/31/9999
For background and context, see https://www.ncpdp.org/
681
682
COMPOUND-DRUG-IND
COMPOUND-DRUG-IND
Compound Drug Indicator List
Compound Drug Indicator List
0
1
Not Compound
Compound
683
CONCEPTION-TO-BIRTH-IND
684
CONCEPTION-TO-BIRTH-IND
685
686
687
688
689
690
0
No
01/01/0001
12/31/9999
1
Yes
01/01/0001
12/31/9999
CONTINUOUS-ELIGIBILITY-CODE
CONTINUOUS-ELIGIBILITY-CODE
CONTINUOUS-ELIGIBILITY-CODE
COPAY-WAIVED-IND
COPAY-WAIVED-IND
CORE-BASED-STATISTICAL-AREACODE
Conception to Birth Indicator
List
Conception to Birth Indicator
List
Continuous Eligibility Code List
Continuous Eligibility Code List
Continuous Eligibility Code List
Copay Waived Indicator List
Copay Waived Indicator List
Core Based Statistical Area Code
List
001
002
995
0
1
1
Continuous eligibility for children (optional per SSA 1902(e)(12) or 2105(a)(4)(A))
1115 waiver for continuous eligibility
Other
Not Waived: The provider did not waive the beneficiary's copayment,.
Waived: The provider waived the beneficiary's copayment.
The MCOs service area falls partially or entirely inside one or more metropolitan areas.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
2958465
2958465
2958465
12/31/9999
12/31/9999
12/31/9999
691
CORE-BASED-STATISTICAL-AREACODE
Core Based Statistical Area Code
List
2
The MCOs service area falls partially or entirely inside one or more micropolitan areas,
but not within any metropolitan areas.
01/01/0001
12/31/9999
692
CORE-BASED-STATISTICAL-AREACODE
Core Based Statistical Area Code
List
3
The MCOs service area falls entirely outside of all metropolitan and micropolitan areas.
01/01/0001
12/31/9999
693
COUNTY
US County Code List
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code sets.
field
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
N/A
N/A
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
For background and context, see https://www.census.gov/library/reference/codelists/ansi.html#cou
694
695
696
697
698
699
700
701
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
01
02
03
04
05
06
07
08
Drug
Professional (Physician) Visit - Office
Dental Care
Inpatient Hospital
Outpatient Hospital
Nursing Home
Vision
Durable Med Equip (rent)
702
703
704
705
706
707
708
709
710
711
712
713
714
715
716
717
718
719
720
721
722
723
724
725
726
727
728
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
COVERAGE-TYPE
CROSSOVER-INDICATOR
CROSSOVER-INDICATOR
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
DATA-DICTIONARY-VERSION
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Coverage Type List
Crossover Indicator List
Crossover Indicator List
Data Dictionary Version List
Data Dictionary Version List
Data Dictionary Version List
Data Dictionary Version List
Data Dictionary Version List
Data Dictionary Version List
Data Dictionary Version List
Data Dictionary Version List
Data Dictionary Version List
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
98
0
1
DEC13V2.3
NOV07V2.1
NOV13V1.1
NOV15V2.0
NOV17V2.1
NOV23V2.2
v2.4.0
v3.0.0
v4.0.0
Durable Med Equip (purchase)
Home Health
Mental health - outpatient
Mental health - inpatient
Psychiatric care- outpatient
Psychiatric care- inpatient
Rehabilitation
Cancer
Emergency Services
Chiropractic
Surgical
Diagnostic Medical, including X-ray and Lab Services
PT/OT/ST
Hospice
Transportation
Other
Not Crossover Claim
Crossover Claim
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
06/27/2022
02/14/2025
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
729
DIAGNOSIS-CODE
Diagnosis Code List
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code sets.
field
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
N/A
N/A
For background and context, see
https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes
730
731
732
733
734
735
736
DIAGNOSIS-CODE-FLAG-1 to
DIAGNOSIS-CODE-FLAG-12 /
ADMITTING-DIAGNOSIS-CODEFLAG
DIAGNOSIS-CODE-FLAG-1 to
DIAGNOSIS-CODE-FLAG-12 /
ADMITTING-DIAGNOSIS-CODEFLAG
DIAGNOSIS-CODE-FLAG
DIAGNOSIS-CODE-FLAG
DIAGNOSIS-POA-FLAG-1 to
DIAGNOSIS-POA-FLAG-12
DIAGNOSIS-POA-FLAG-1 to
DIAGNOSIS-POA-FLAG-12
DIAGNOSIS-POA-FLAG
Diagnosis Code Flag List
1
ICD-9
Diagnosis Code Flag List
2
ICD-10
Diagnosis Code Flag List
Diagnosis Code Flag List
Diagnosis POA Flag List
1
2
1
ICD-9
ICD-10
Unreported/Not used. Exempt from POA reporting.
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
Diagnosis POA Flag List
N
Diagnosis was not present at time of inpatient admission
01/01/0001
12/31/9999
Diagnosis POA Flag List
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code sets.
field
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
N/A
N/A
For background and context, see https://www.nubc.org/license
737
DIAGNOSIS-POA-FLAG-1 to
DIAGNOSIS-POA-FLAG-12
Diagnosis POA Flag List
U
Documentation insufficient to determine if condition was present at the time of
inpatient admission
01/01/0001
12/31/9999
738
DIAGNOSIS-POA-FLAG-1 to
DIAGNOSIS-POA-FLAG-12
Diagnosis POA Flag List
W
Clinically undetermined. Provider unable to clinically determine whether the condition
was present at the time of inpatient admission.
01/01/0001
12/31/9999
739
Diagnosis POA Flag List
Y
Diagnosis was present at time of inpatient admission
01/01/0001
740
741
DIAGNOSIS-POA-FLAG-1 to
DIAGNOSIS-POA-FLAG-12
DIAGNOSIS-TYPE
DIAGNOSIS-TYPE
Diagnosis Type List
Diagnosis Type List
A
D
Admitting (from 837I or UB-04 claim for IP and LT)
Diagnosis Code #1-5 (from NCPDP claim for RX) or #1-12 (from 837P, CMS-1500, 837D,
or ADA claim for OT)
01/01/0001
01/01/0001
2958465
2958465
742
743
744
745
746
747
748
DIAGNOSIS-TYPE
DIAGNOSIS-TYPE
DIAGNOSIS-TYPE
DIAGNOSIS-TYPE
DISABILITY-TYPE-CODE
DISABILITY-TYPE-CODE
DISABILITY-TYPE-CODE
Diagnosis Type List
Diagnosis Type List
Diagnosis Type List
Diagnosis Type List
Disability Type Code List
Disability Type Code List
Disability Type Code List
E
O
P
R
01
02
03
External Cause of Injury #1-12 (from 837I claim for IP, LT, and OT)
Other Diagnosis #1-24 (for IP, LT) or #1-12 (from 837I or UB-04 claim for OT)
Principal (from 837I or UB-04 claim for IP, LT, and OT)
Reason for Visit #1-3 (from 837I claim for OT)
Individual is deaf or has serious difficulty hearing.
Individual is blind or has serious difficulty seeing, even when wearing glasses.
Individual has serious difficulty concentrating, remembering, or making decisions
because of a physical, mental, or emotional condition. (Applicable only to people who
are 5 years old or older.)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
2958465
2958465
2958465
2958465
12/31/9999
12/31/9999
12/31/9999
749
DISABILITY-TYPE-CODE
Disability Type Code List
04
Individual has serious difficulty walking or climbing stairs. (Applicable only to people who 01/01/0001
are 5 years old or older.)
12/31/9999
750
DISABILITY-TYPE-CODE
Disability Type Code List
05
Individual has difficulty dressing or bathing. (Applicable only to people who are 5 years
old or older.)
01/01/0001
12/31/9999
751
DISABILITY-TYPE-CODE
Disability Type Code List
06
Individual has difficulty doing errands alone such as visiting a doctor's office or shopping
because of a physical, mental, or emotional condition. (Applicable only to people who
are 15 years old or older.)
01/01/0001
12/31/9999
752
753
754
DISABILITY-TYPE-CODE
DISABILITY-TYPE-CODE
DRUG-UTILIZATION-CODE
Disability Type Code List
Disability Type Code List
Drug Utilization Code List
07
08
See
"VVL_Code_Description"
field
Other
None
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code sets.
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ncpdp.org/
12/31/9999
755
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
AD
439-E4: Additional Drug Needed
01/01/0001
12/31/9999
756
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
AN
439-E4: Prescription Authentication
01/01/0001
12/31/9999
757
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
AR
439-E4: Adverse Drug Reaction
01/01/0001
12/31/9999
758
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
AT
439-E4: Additive Toxicity
01/01/0001
12/31/9999
759
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
CD
439-E4: Chronic Disease Management
01/01/0001
12/31/9999
760
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
CH
439-E4: Call Help Desk
01/01/0001
12/31/9999
761
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
CS
439-E4: Patient Complaint/Symptom
01/01/0001
12/31/9999
762
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DA
439-E4: Drug-Allergy
01/01/0001
12/31/9999
763
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DC
439-E4: Drug-Disease (Inferred)
01/01/0001
12/31/9999
764
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DD
439-E4: Drug-Drug Interaction
01/01/0001
12/31/9999
765
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DF
439-E4: Drug-Food interaction
01/01/0001
12/31/9999
766
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DI
439-E4: Drug Incompatibility
01/01/0001
12/31/9999
767
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DL
439-E4: Drug-Lab Conflict
01/01/0001
12/31/9999
768
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DM
439-E4: Apparent Drug Misuse
01/01/0001
12/31/9999
769
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
DS
439-E4: Tobacco Use
01/01/0001
12/31/9999
770
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
ED
439-E4: Patient Education/Instruction
01/01/0001
12/31/9999
771
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
ER
439-E4: Overuse
01/01/0001
12/31/9999
772
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
EX
439-E4: Excessive Quantity
01/01/0001
12/31/9999
773
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
HD
439-E4: High Dose
01/01/0001
12/31/9999
774
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
IC
439-E4: Iatrogenic Condition
01/01/0001
12/31/9999
775
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
ID
439-E4: Ingredient Duplication
01/01/0001
12/31/9999
776
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
LD
439-E4: Low Dose
01/01/0001
12/31/9999
777
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
LK
439-E4: Lock In Recipient
01/01/0001
12/31/9999
778
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
LR
439-E4: Underuse
01/01/0001
12/31/9999
779
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
MC
439-E4: Drug-Disease (Reported)
01/01/0001
12/31/9999
780
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
MN
439-E4: Insufficient Duration
01/01/0001
12/31/9999
781
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
MS
439-E4: Missing Information/Clarification
01/01/0001
12/31/9999
782
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
MX
439-E4: Excessive Duration
01/01/0001
12/31/9999
783
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
NA
439-E4: Drug Not Available
01/01/0001
12/31/9999
784
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
NC
439-E4: Non-covered Drug Purchase
01/01/0001
12/31/9999
785
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
ND
439-E4: New Disease/Diagnosis
01/01/0001
12/31/9999
786
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
NF
439-E4: Non-Formulary Drug
01/01/0001
12/31/9999
787
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
NN
439-E4: Unnecessary Drug
01/01/0001
12/31/9999
788
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
NP
439-E4: New Patient Processing
01/01/0001
12/31/9999
789
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
NR
439-E4: Lactation/Nursing Interaction
01/01/0001
12/31/9999
790
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
NS
439-E4: Insufficient Quantity
01/01/0001
12/31/9999
791
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
OH
439-E4: Alcohol Conflict
01/01/0001
12/31/9999
792
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PA
439-E4: Drug-Age
01/01/0001
12/31/9999
793
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PC
439-E4: Patient Question/Concern
01/01/0001
12/31/9999
794
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PG
439-E4: Drug-Pregnancy
01/01/0001
12/31/9999
795
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PH
439-E4: Preventive Health Care
01/01/0001
12/31/9999
796
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PN
439-E4: Prescriber Consultation
01/01/0001
12/31/9999
797
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PP
439-E4: Plan Protocol
01/01/0001
12/31/9999
798
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PR
439-E4: Prior Adverse Reaction
01/01/0001
12/31/9999
799
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
PS
439-E4: Product Selection Opportunity
01/01/0001
12/31/9999
800
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
RE
439-E4: Suspected Environmental Risk
01/01/0001
12/31/9999
801
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
RF
439-E4: Health Provider Referral
01/01/0001
12/31/9999
802
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for
Service Code List
SC
439-E4: Suboptimal Compliance
01/01/0001
12/31/9999
803
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for
Service Code List
SD
439-E4: Suboptimal Drug/Indication
01/01/0001
12/31/9999
804
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for
Service Code List
SE
439-E4: Side Effect
01/01/0001
12/31/9999
805
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for
Service Code List
SF
439-E4: Suboptimal Dosage Form
01/01/0001
12/31/9999
806
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
SR
439-E4: Suboptimal Regimen
01/01/0001
12/31/9999
807
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for
Service Code List
SX
439-E4: Drug-Gender
01/01/0001
12/31/9999
808
DRUG-UTILIZATION-CODE (439E4, Reason for Service Code)
Drug Utilization Reason for
Service Code List
TD
439-E4: Therapeutic
01/01/0001
12/31/9999
809
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for
Service Code List
TN
439-E4: Laboratory Test Needed
01/01/0001
12/31/9999
810
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for
Service Code List
TP
439-E4: Payer/Processor Question
01/01/0001
12/31/9999
811
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)-E5
Drug Utilization Result
ofProfessional Service Code List
00
Not Specified440-E5: No intervention
01/01/0001
12/31/9999
812
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
1A
Filled As Is, False Positive
1B
Filled Prescription As Is
1C
Filled, With Different Dose
813
814
815
816
817
818
819
820
821
822
823
824
825
826
827
828
829
830
831
832
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
1D
Filled, With Different Directions
1E
Filled, With Different Drug
1F
Filled, With Different Quantity
1G
Filled, With Prescriber Approval
1H
Brand-to-Generic Change
1J
Rx-to-OTC Change
1K
Filled with Different Dosage Form
2A
Prescription Not Filled
2B
Not Filled, Directions Clarified
3A
Recommendation Accepted
3B
Recommendation Not Accepted
3C
Discontinued Drug
3D
Regimen Changed
3E
Therapy Changed
3F
Therapy Changed-cost increased acknowledged
3G
Drug Therapy Unchanged
3H
Follow-Up/Report
3J
Patient Referral
833
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (441-E6,
Result of Service Code)
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Result of Service
Code List
Drug Utilization Professional
Service Code List
Drug Utilization Professional
Service Code List
3K
Instructions Understood
3M
Compliance Aid Provided
3N
Medication Administered
00
No intervention
AS
440-E5: Patient assessment
01/01/0001
12/31/9999
838
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
CC
440-E5: Coordination of care
01/01/0001
12/31/9999
839
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
DE
440-E5: Dosing evaluation/determination
01/01/0001
12/31/9999
840
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
FE
440-E5: Formulary enforcement
01/01/0001
12/31/9999
841
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
GP
440-E5: Generic product selection
01/01/0001
12/31/9999
842
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
M0
440-E5: Prescriber consulted
01/01/0001
12/31/9999
843
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
MA
440-E5: Medication administration
01/01/0001
12/31/9999
844
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
MR
440-E5: Medication review
01/01/0001
12/31/9999
845
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
P0
440-E5: Patient consulted
01/01/0001
12/31/9999
846
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
PE
440-E5: Patient education/instruction
01/01/0001
12/31/9999
847
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
PH
440-E5: Patient medication history
01/01/0001
12/31/9999
848
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
PM
440-E5: Patient monitoring
01/01/0001
12/31/9999
834
835
836
837
849
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
PT
440-E5: Perform laboratory test
01/01/0001
12/31/9999
850
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
R0
440-E5: Pharmacist consulted other source
01/01/0001
12/31/9999
851
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
RT
440-E5: Recommend laboratory test
01/01/0001
12/31/9999
852
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
SC
440-E5: Self-care consultation
01/01/0001
12/31/9999
853
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
SW
440-E5: Literature search/review
01/01/0001
12/31/9999
854
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
TC
440-E5: Payer/processor consulted
01/01/0001
12/31/9999
855
DRUG-UTILIZATION-CODE (44Ø-E5,
Professional Service Code)
Drug Utilization Professional
Service Code List
TH
440-E5: Therapeutic product interchange
01/01/0001
12/31/9999
856
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
00
441-E6: Not Specified
01/01/0001
12/31/9999
857
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1A
441-E6: Filled As Is
01/01/0001
12/31/9999
858
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1B
441-E6: Filled Prescription As Is
01/01/0001
12/31/9999
859
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1C
441-E6: Filled
01/01/0001
12/31/9999
860
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1D
441-E6: Filled
01/01/0001
12/31/9999
861
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1E
441-E6: Filled
01/01/0001
12/31/9999
862
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1F
441-E6: Filled
01/01/0001
12/31/9999
863
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1G
441-E6: Filled
01/01/0001
12/31/9999
864
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1H
441-E6: Brand-to-Generic Change
01/01/0001
12/31/9999
865
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1J
441-E6: Rx-to-OTC Change
01/01/0001
12/31/9999
866
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
1K
441-E6: Filled with Different Dosage Form
01/01/0001
12/31/9999
867
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
2A
441-E6: Prescription Not Filled
01/01/0001
12/31/9999
868
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
2B
441-E6: Not Filled
01/01/0001
12/31/9999
869
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3A
441-E6: Recommendation Accepted
01/01/0001
12/31/9999
870
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3B
441-E6: Recommendation Not Accepted
01/01/0001
12/31/9999
871
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3C
441-E6: Discontinued Drug
01/01/0001
12/31/9999
872
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3D
441-E6: Regimen Changed
01/01/0001
12/31/9999
873
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3E
441-E6: Therapy Changed
01/01/0001
12/31/9999
874
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3F
441-E6: Therapy Changed-cost increased acknowledged
01/01/0001
12/31/9999
875
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3G
441-E6: Drug Therapy Unchanged
01/01/0001
12/31/9999
876
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3H
441-E6: Follow-Up/Report
01/01/0001
12/31/9999
877
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3J
441-E6: Patient Referral
01/01/0001
12/31/9999
878
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3K
441-E6: Instructions Understood
01/01/0001
12/31/9999
879
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3M
441-E6: Compliance Aid Provided
01/01/0001
12/31/9999
880
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service
Code List
3N
441-E6: Medication Administered
01/01/0001
12/31/9999
881
882
883
884
885
886
887
888
889
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
DUAL-ELIGIBLE-CODE
Dual Eligible Code List
Dual Eligible Code List
Dual Eligible Code List
Dual Eligible Code List
Dual Eligible Code List
Dual Eligible Code List
Dual Eligible Code List
Dual Eligible Code List
Dual Eligible Code List
00
01
02
03
04
05
06
08
09
Eligible is not a Medicare beneficiary
Eligible is entitled to Medicare- QMB only
Eligible is entitled to Medicare- QMB AND Medicaid coverage
Eligible is entitled to Medicare- SLMB only
Eligible is entitled to Medicare- SLMB AND Medicaid coverage
Eligible is entitled to Medicare- QDWI
Eligible is entitled to Medicare- Qualifying individuals
Eligible is entitled to Medicare- Other Dual Eligibles (Non QMB, SLMB, QDWI or QI)
Eligible is entitled to Medicare - Other (This code is to be used only with specific CMS
approval.)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
890
891
892
893
894
895
896
897
898
899
900
901
902
903
904
905
906
DUAL-ELIGIBLE-CODE
ELG-IDENTIFIER-TYPE
ELG-IDENTIFIER-TYPE
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
Dual Eligible Code List
Eligible Identifier Type List
Eligible Identifier Type List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
10
1
2
01
02
03
04
05
06
07
08
09
10
11
12
13
14
Separate CHIP Eligible is entitled to Medicare
Medicaid Card ID (State MMIS)
Old MSIS Identification Number (State MMIS)
Excess income
Excess assets
Income reduced
Aged out of program
No longer in the foster care system
Death
No longer disabled
No longer institutionalized
No longer in need of long-term care services resides
Obtained employer sponsored insurance (ESI)
Gained access to public employees health plan
Obtained other coverage (not ESI or public employees health plan)
Failure to respond
Failure to pay premium or enrollment fees
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
907
908
909
910
911
912
913
914
915
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-CHANGE-REASON
ELIGIBILITY-EXTENSION-CODE
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Change Reason List
Eligibility Extension Code List
15
16
17
18
19
20
21
22
001
Moved to a different state
Voluntary request for termination
Lack of verifications
Fraud
Suspension due to incarceration
Residence in an Institution for Mental Disease (IMD)
Suspension/Termination with reason unknown
Other
60-day extended postpartum coverage (mandatory per SSA 1902(e)(5) and 2112(d)(2)(A))
916
917
918
919
920
921
922
923
924
925
926
927
928
ELIGIBILITY-EXTENSION-CODE
ELIGIBILITY-EXTENSION-CODE
ELIGIBILITY-EXTENSION-CODE
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Extension Code List
Eligibility Extension Code List
Eligibility Extension Code List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
002
003
995
01
02
03
04
05
06
07
08
09
10
929
930
931
932
933
934
935
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
11
12
13
14
15
16
17
12-month extended postpartum coverage (optional per SSA 1902(e)(16) or 2107(e)(1)(J))
1115 waiver for extended postpartum coverage
Other
Parents and Other Caretaker Relatives
Transitional Medical Assistance
Extended Medicaid due to Earnings
Extended Medicaid due to Spousal Support Collections
Pregnant Women
Deemed Newborns
Infants and Children under Age 19
Children with Title IV-E Adoption Assistance, Foster Care or Guardianship Care
Former Foster Care Children
Individuals at or below 133% FPL Age 19 through 64|Non-pregnant individuals aged 19
through 64, not otherwise mandatorily eligible, with income at or below 133% FPL
Individuals Receiving SSI
Aged, Blind and Disabled Individuals in 209(b) States
Individuals Receiving Mandatory State Supplements
Individuals Who Are Essential Spouses
Institutionalized Individuals Continuously Eligible Since 1973
Blind or Disabled Individuals Eligible in 1973
Individuals Who Lost Eligibility for SSI/SSP Due to an Increase in OASDI Benefits in 1972
01/01/0001
12/31/9999
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
936
ELIGIBILITY-GROUP
Eligibility Group List
18
Individuals Who Would be Eligible for SSI/SSP but for OASDI COLA increases since April,
1977
01/01/0001
12/31/9999
937
938
939
940
941
942
943
944
945
946
947
948
949
950
951
952
953
954
955
956
957
958
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Disabled Widows and Widowers Ineligible for SSI due to Increase in OASDI
Disabled Widows and Widowers Ineligible for SSI due to Early Receipt of Social Security
Working Disabled under 1619(b)
Disabled Adult Children
Qualified Medicare Beneficiaries
Qualified Disabled and Working Individuals
Specified Low Income Medicare Beneficiaries
Qualifying Individuals
Optional Coverage of Parents and Other Caretaker Relatives
Reasonable Classifications of Individuals under Age 21
Children with Non-IV-E Adoption Assistance
Independent Foster Care Adolescents
Optional Targeted Low Income Children
Individuals Electing COBRA Continuation Coverage
Individuals above 133% FPL under Age 65
Certain Individuals Needing Treatment for Breast or Cervical Cancer
Individuals Eligible for Family Planning Services
Individuals with Tuberculosis
Aged, Blind or Disabled Individuals Eligible for but Not Receiving Cash Assistance
Individuals Eligible for Cash Assistance except for Institutionalization
Individuals Receiving Home and Community Based Services under Institutional Rules
Optional State Supplement Recipients - 1634 States, and SSI Criteria States with 1616
Agreements
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
959
ELIGIBILITY-GROUP
Eligibility Group List
41
Optional State Supplement Recipients - 209(b) States, and SSI Criteria States without 1616
Agreements
01/01/0001
12/31/9999
960
961
962
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
Eligibility Group List
42
43
44
Institutionalized Individuals Eligible under a Special Income Level
Individuals participating in a PACE Program under Institutional Rules
Individuals Receiving Hospice Care
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
963
964
965
966
967
968
969
970
971
972
973
974
975
976
977
978
979
980
981
982
983
984
985
986
987
988
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
45
46
47
48
49
50
51
52
53
54
55
56
59
60
61
62
63
64
65
66
67
68
69
70
71
72
Qualified Disabled Children under Age 19
Poverty Level Aged or Disabled
Work Incentives Eligibility Group
Ticket to Work Basic Group
Ticket to Work Medical Improvements Group
Family Opportunity Act Children with Disabilities
Individuals Eligible for Home and Community-Based Services
Individuals Eligible for Home and Community-Based Services - Special Income Level
Medically Needy Pregnant Women
Medically Needy Children under Age 18
Medically Needy Children Age 18 through 20
Medically Needy Parents and Other Caretakers
Medically Needy Aged, Blind or Disabled
Medically Needy Blind or Disabled Individuals Eligible in 1973
Targeted Low-Income Children
Deemed Newborn
Children Ineligible for Medicaid Due to Loss of Income Disregards
Coverage from Conception to Birth
Children with Access to Public Employee Coverage
Children Eligible for Dental Only Supplemental Coverage
Targeted Low-Income Pregnant Women
Pregnant Women with Access to Public Employee Coverage
Individuals with Mental Health Conditions (expansion group)
Family Planning Participants (expansion group)
Other expansion group
Adult Group - Individuals at or below 133% FPL Age 19 through 64 - newly eligible for all
states
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
989
ELIGIBILITY-GROUP
Eligibility Group List
73
Adult Group - Individuals at or below 133% FPL Age 19 through 64 -- not newly eligible for
non 1905z(3) states
01/01/0001
12/31/9999
990
ELIGIBILITY-GROUP
Eligibility Group List
74
Adult Group - Individuals at or below 133% FPL Age 19 through 64 - not newly eligible
parent/ caretaker-relative(s) in 1905z(3) states
01/01/0001
12/31/9999
991
ELIGIBILITY-GROUP
Eligibility Group List
75
Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible nonparent/ caretaker-relative(s) in 1905z(3) states
01/01/0001
12/31/9999
992
993
ELIGIBILITY-GROUP
ELIGIBILITY-TERMINATION-REASON
Eligibility Group List
Eligibility Termination Reason List
76
01
Uninsured Individual eligible for COVID-19 testing
Income Requirement not met - do not use for changes in household composition
03/18/2020
01/01/0001
12/31/9999
12/31/9999
994
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
02
Asset requirement not met - do not use for changes in household composition
01/01/0001
12/31/9999
995
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
03
Income reduced - (do not use - typically not a reason for termination)
01/01/0001
12/31/9999
996
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
04
Aged out of program
01/01/0001
12/31/9999
997
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
05
No longer in the foster care system - (do not use - typically not a reason for termination)
01/01/0001
12/31/9999
998
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
06
Death
01/01/0001
12/31/9999
999
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
07
No longer disabled
01/01/0001
12/31/9999
1000
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
08
No longer institutionalized
01/01/0001
12/31/9999
1001
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
09
No longer in need of long-term care services
01/01/0001
12/31/9999
1002
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
10
Obtained employer sponsored insurance (ESI)
01/01/0001
12/31/9999
1003
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
11
Gained access to public employees health plan
01/01/0001
12/31/9999
1004
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
12
Obtained other coverage (not ESI or public employees health plan)
01/01/0001
12/31/9999
1005
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
13
Failure to respond
01/01/0001
12/31/9999
1006
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
14
Failure to pay premium or enrollment fees
01/01/0001
12/31/9999
1007
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
15
Residency requirement not met (e.g., individual moved to a different state, individual has
entered or been discharged from an otherwise unspecified facility or institution)
01/01/0001
12/31/9999
1008
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
16
Voluntary request for termination
01/01/0001
12/31/9999
1009
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
17
Lack of verifications (e.g., unable to successfully verify citizenship status, immigration
status, income, or other information from an application; if unverifiable due to nonresponse, document as "Failure to respond)
01/01/0001
12/31/9999
1010
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
18
Fraud
01/01/0001
12/31/9999
1011
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
19
Suspension/termination due to incarceration - use when the state is able to distinguish a
more granular reason than just residency requirement not met
01/01/0001
12/31/9999
1012
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
20
Disqualification for residence in an Institution for Mental Disease (IMD) - use when the
01/01/0001
state is able to distinguish a more granular reason than just residency requirement not met
12/31/9999
1013
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
21
Suspension/Termination with reason unknown
01/01/0001
12/31/9999
1014
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
22
Other
01/01/0001
12/31/9999
1015
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
23
Terminated due to Incorrect Granting of Eligibility (e.g., someone is given eligibility in error
and then eligibility has to be retracted/terminated)
01/01/0001
12/31/9999
1016
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
24
Household or family composition criteria not met (e.g., someone was incorrectly included
or excluded from the household or family composition) - do not use for changes in income
01/01/0001
12/31/9999
1017
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
25
Non-financial program requirements not met (e.g. child support not paid, failure of drug
tests, failure to apply for SSN, etc.)
01/01/0001
12/31/9999
1018
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
26
No longer meets categorical eligibility requirements.
01/01/0001
12/31/9999
1019
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
27
End of pregnancy/postpartum coverage period - should only be used if the beneficiary did
not obtain coverage through another coverage group like parent/caretaker relative
01/01/0001
12/31/9999
1020
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
28
Time limited eligibility expired (e.g., Transitional Medical Assistance (TMA)
01/01/0001
12/31/9999
1021
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
29
Closed as duplicate
01/01/0001
12/31/9999
1022
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
30
Medical/health status or condition or level of care requirements no longer met - for
reasons other than no longer being institutionalized or no longer meeting disability
requirements (e.g., completed breast and/or cervical cancer treatment, incarcerated
individual no longer requires temporary inpatient level of care)
01/01/0001
12/31/9999
1023
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
31
Change in federal or state law or policy (e.g., a state or federal program is completely
01/01/0001
discontinued and not replaced by an equivalent or transitional program; unwinding of the
Families First Coronavirus Response Act coverage of COVID testing for otherwise uninsured
individuals who would have otherwise continued to be eligible if they had been redetermined eligible for at least the same program had the program not been terminated)
12/31/9999
1024
ELIGIBLE-ADDR-TYPE
Eligible Address Type List
01
Primary home address and contact information, used for the eligibility determination
process
01/01/0001
12/31/9999
1025
1026
1027
1028
1029
1030
1031
1032
1033
1034
1035
1036
1037
1038
1039
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
ENGL-PROF-CODE
ENGL-PROF-CODE
ENGL-PROF-CODE
ENGL-PROF-CODE
ENROLLMENT-TYPE
ENROLLMENT-TYPE
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
Eligible Address Type List
Eligible Address Type List
Eligible Address Type List
Eligible Address Type List
Eligible Address Type List
Engl Prof List
Engl Prof List
Engl Prof List
Engl Prof List
Enrollment Type List
Enrollment Type List
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
02
03
04
05
06
0
1
2
3
1
2
0
1
2
3
Primary work address and contact information
Secondary residence and contact information
Secondary work address and contact information
Other category of address and contact information
Eligible person's official mailing address
Very Well
Well
Not well
No spoken proficiency
Medicaid or Medicaid Expansion CHIP
Separate Title XXI CHIP
Not of Hispanic or, Latino/a, or Spanish origin
Mexican, Mexican American, Chicano/a
Puerto Rican
Cuban
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1040
1041
1042
1043
1044
1045
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
EXPENDITURE-AUTHORITY-TYPE
EXPENDITURE-AUTHORITY-TYPE
FACILITY-GROUP-INDIVIDUALCODE
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
Expenditure Authority Type List
Expenditure Authority Type List
Facility Group Individual Code List
4
5
6
01
95
01
Another Hispanic, Latino, or Spanish origin
Hispanic or Latino Unknown
Ethnicity Unspecified
1115
Other
Facility - The entity identified by the associated SUBMITTING-STATE-PROV-ID is a facility.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1046
FACILITY-GROUP-INDIVIDUALCODE
Facility Group Individual Code List
02
Group - The entity identified by the associated SUBMITTING-STATE-PROV-ID is a group of
individual practitioners.
01/01/0001
12/31/9999
1047
FACILITY-GROUP-INDIVIDUALCODE
Facility Group Individual Code List
03
Individual - The entity identified by the associated SUBMITTING-STATE-PROV-ID is an
individual practitioner.
01/01/0001
12/31/9999
1048
1049
1050
1051
1052
1053
1054
1055
1056
1057
1058
1059
1060
1061
1062
1063
1064
1065
1066
FILE-ENCODING-SPECIFICATION
FILE-ENCODING-SPECIFICATION
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-STATUS-INDICATOR
FILE-STATUS-INDICATOR
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FIXED-PAYMENT-IND
File Encoding Specification List
File Encoding Specification List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
File Status Indicator List
File Status Indicator List
File Submission Method List
File Submission Method List
File Submission Method List
File Submission Method List
File Submission Method List
Fixed Payment Indicator List
FLF
PSV
CLAIM-IP
CLAIM-LT
CLAIM-OT
CLAIM-RX
ELIGIBLE
FINTRANS
MNGDCARE
PROVIDER
TPL-FILE
P
T
01
02
03
04
05
0
The file follows a fixed length format.
The file follows a pipe-delimited format.
Inpatient claims fileClaim/Encounters File
Long term care claims fileTerm Care Claims/Encounters File
Other claims fileClaims/Encounters File
Prescription claims filePharmacy Claims/Encounters File
Eligible fFile
Financial Transaction File
Managed care organization fileCare Plan Information File
Provider fFile
Third-party liability file Party Liability File
Production fFile
Test fFile
True Full File Refresh (TFFR)
Rolling History File Refresh (RHFR)
Incremental Timespan (IT) - One month incremental Create files
Change-Segment Only (CSO)
Incremental Timespan (IT) - Multi-month incremental Create files
Not Fixed Payment
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2958465
2958465
2958465
2958465
2958465
12/31/9999
1067
1068
1069
1070
1071
1072
1073
1074
1075
1076
1077
1078
1079
FIXED-PAYMENT-IND
FORCED-CLAIM-IND
FORCED-CLAIM-IND
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-SOURCE-NONFEDERALSHARE
Fixed Payment Indicator List
Forced Claim Indicator List
Forced Claim Indicator List
Funding Code List
Funding Code List
Funding Code List
Funding Code List
Funding Code List
Funding Code List
Funding Code List
Funding Code List
Funding Code List
Funding Source Non-Federal Share
List
1
0
1
A
B
C
D
E
F
G
H
I
01
FFS Fixed Payment
No
Yes
Medicaid Agency
CHIP Agency
Mental Health Service Agency
Education Agency
Child and Family Services Agency
County
City
Providers
Other
State appropriations to the Medicaid agency
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1080
FUNDING-SOURCE-NONFEDERALSHARE
Funding Source Non-Federal Share
List
02
Intergovernmental transfers (IGT)
01/01/0001
12/31/9999
1081
FUNDING-SOURCE-NONFEDERALSHARE
Funding Source Non-Federal Share
List
03
Certified public expenditures (CPE)
01/01/0001
12/31/9999
1082
FUNDING-SOURCE-NONFEDERALSHARE
Funding Source Non-Federal Share
List
04
Provider taxes
01/01/0001
12/31/9999
1083
FUNDING-SOURCE-NONFEDERALSHARE
Funding Source Non-Federal Share
List
05
Donations
01/01/0001
12/31/9999
1084
FUNDING-SOURCE-NONFEDERALSHARE
Funding Source Non-Federal Share
List
06
State appropriations to the CHIP agency
01/01/0001
12/31/9999
1085
1086
1087
1088
1089
1090
1091
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
Gender Identity List
Gender Identity List
Gender Identity List
Gender Identity List
Gender Identity List
Gender Identity List
Gender Identity List
1
2
3
4
5
6
7
Female
Male
Transgender female
Transgender male
Not sure
Prefer not to answer
Other
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1092
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
001
Aged
01/01/0001
12/31/9999
1093
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
002
Physical Disabilities
01/01/0001
12/31/9999
1094
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
003
Intellectual Disabilities
01/01/0001
12/31/9999
1095
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
004
Autism Spectrum Disorder
01/01/0001
12/31/9999
1096
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
005
Developmental Disabilities
01/01/0001
12/31/9999
1097
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
006
Mental Illness and/or Serious Emotional Disturbance
01/01/0001
12/31/9999
1098
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
007
Brain Injury
01/01/0001
12/31/9999
1099
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
008
HIV/AIDSs
01/01/0001
12/31/9999
1100
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
009
Technology Dependent or Medically Fragile
01/01/0001
12/31/9999
1101
HCBS-CHRONIC-CONDITION-NONHEALTH-HOME-CODE
HCBS Chronic Condition Non
Health Home Code List
010
Disabled (other)
01/01/0001
12/31/9999
1102
1103
1104
1105
1106
1107
HCBS-SERVICE-CODE
HCBS-SERVICE-CODE
HCBS-SERVICE-CODE
HCBS-SERVICE-CODE
HCBS-SERVICE-CODE
HCBS-SERVICE-CODE
HCBS Service Code List
HCBS Service Code List
HCBS Service Code List
HCBS Service Code List
HCBS Service Code List
HCBS Service Code List
1
2
3
4
5
6
The HCBS service was provided under 1915(i)
The HCBS service was provided under 1915(j)
The HCBS service was provided under 1915(k)
The HCBS service was provided under a 1915(c) HCBS Waiver
The HCBS service was provided under an 1115 waiver
The HCBS service was not provided under the statutes identified above and was of an
acute care nature
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1108
HCBS-SERVICE-CODE
HCBS Service Code List
7
The HCBS service was not provided under the statutes identified above and was of a long
term care nature
01/01/0001
12/31/9999
1109
1110
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS Taxonomy Code List
HCBS Taxonomy Code List
01010
02011
Case Management
Group Living, Residential Habilitation
01/01/0001
01/01/0001
12/31/9999
12/31/9999
1111
1112
1113
1114
1115
1116
1117
1118
1119
1120
1121
1122
1123
1124
1125
1126
1127
1128
1129
1130
1131
1132
1133
1134
1135
1136
1137
1138
1139
1140
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
02012
02013
02021
02022
02023
02031
02032
02033
03010
03021
03022
03030
04010
04020
04030
04040
04050
04060
04070
04080
05010
05020
06010
07010
08010
08020
08030
08040
08050
08060
Group Living, Mental Health Services
Group Living, Other
Shared Living, Residential Habilitation
Shared Living, Mental Health Services
Shared Living, Other
In-e Residential Habilitation
In-Home Round-The-Clock Mental Health Services
In-Home Round-The-Clock Services, Other
Job Development
Ongoing Supported Employment, Individual
Ongoing Supported Employment, Group
Career Planning
Prevocational Services
Day Habilitation
Education Services
Day Treatment/Partial Hospitalization
Adult Day Health
Adult Day Services (Social Model)
Community Integration
Medical Day Care for Children
Private Duty Nursing
Skilled Nursing
Home Delivered Meals
Rent and Food Expenses For Live-In Caregiver
Home-Based Habilitation
Home Health Aide
Personal Care
Companion
Homemaker
Chore
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1141
1142
1143
1144
1145
1146
1147
1148
1149
1150
1151
1152
1153
1154
1155
1156
1157
1158
1159
1160
1161
1162
1163
1164
1165
1166
1167
1168
1169
1170
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
09011
09012
09020
10010
10020
10030
10040
10050
10060
10070
10080
10090
11010
11020
11030
11040
11050
11060
11070
11080
11090
11100
11110
11120
11130
12010
12020
13010
14010
14020
Respite, Out-Of-Home
Respite, In-Home
Caregiver Counseling and/or Training
Mental Health Assessment
Assertive Community Treatment
Crisis Intervention
Behavior Support
Peer Specialist
Counseling
Psychosocial Rehabilitation
Clinic Services
Other Mental Health and Behavioral Services
Health Monitoring
Health Assessment
Medication Assessment and/or Management
Nutrition Consultation
Physician Services
Prescription Drugs
Dental Services
Occupational Therapy
Physical Therapy
Speech, Hearing, And Language Therapy
Respiratory Therapy
Cognitive Rehabilitative Therapy
Other Therapies
Financial Management Services In Support Of Participant Direction
Information and Assistance In Support Of Participant Direction
Participant Training
Personal Emergency Response System (Pers)
Home and/or Vehicle Accessibility Adaptations
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1171
1172
1173
1174
1175
1176
1177
1178
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
1179
1180
HCPCS-RATE
HEALTH-CARE-ACQUIREDCONDITION-IND
HCPCS Rate List
Healthcare Acquired Condition
Indicator List
Not Applicable
0
1181
HEALTH-CARE-ACQUIREDCONDITION-IND
Healthcare Acquired Condition
Indicator List
1182
HEALTH-HOME-CHRONICCONDITION
1183
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
14031
14032
15010
16010
17010
17020
17030
17990
Equipment and Technology
Supplies
Non-Medical Transportation
Community Transition Services
Goods and Services
Interpreter
Housing Consultation
Other
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
HCPCS Codes
No
01/01/0001
12/31/9999
1
Yes
01/01/0001
12/31/9999
Health Home Chronic Condition
List
A
Mental health
01/01/0001
12/31/9999
HEALTH-HOME-CHRONICCONDITION
Health Home Chronic Condition
List
B
Substance abuse
01/01/0001
12/31/9999
1184
HEALTH-HOME-CHRONICCONDITION
Health Home Chronic Condition
List
C
Asthma
01/01/0001
12/31/9999
1185
HEALTH-HOME-CHRONICCONDITION
Health Home Chronic Condition
List
D
Diabetes
01/01/0001
12/31/9999
1186
HEALTH-HOME-CHRONICCONDITION
Health Home Chronic Condition
List
E
Heart disease
01/01/0001
12/31/9999
1187
HEALTH-HOME-CHRONICCONDITION
Health Home Chronic Condition
List
F
Overweight (BMI of >25)
01/01/0001
12/31/9999
1188
HEALTH-HOME-CHRONICCONDITION
Health Home Chronic Condition
List
G
HIV/AIDS
01/01/0001
12/31/9999
1189
HEALTH-HOME-CHRONICCONDITION
Health Home Chronic Condition
List
H
Other
01/01/0001
12/31/9999
1190
HEALTH-HOME-PROV-IND
1191
HEALTH-HOME-PROV-IND
1192
1193
1194
1195
1196
1197
1198
1199
1200
1201
1202
1203
1204
1205
1206
1207
1208
1209
1210
1211
1212
1213
1214
1215
1216
1217
1218
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
Health Home Provider Indicator
List
Health Home Provider Indicator
List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Household Size List
Household Size List
Household Size List
0
No
01/01/0001
12/31/9999
1
Yes
01/01/0001
12/31/9999
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
01
02
03
0:00-0:59
1:00-1:59
2:00-2:59
3:00-3:59
4:00-4:59
5:00-5:59
6:00-6:59
7:00-7:59
8:00-8:59
9:00-9:59
10:00-10:59
11:00-11:59
12:00-12:59
13:00-13:59
14:00-14:59
15:00-15:59
16:00-16:59
17:00-17:59
18:00-18:59
19:00-19:59
20:00-20:59
21:00-21:59
22:00-22:59
23:00-23:59
1 person
2 people
3 people
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1219
1220
1221
1222
1223
1224
1225
1226
1227
1228
1229
1230
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
IHS-SERVICE-IND
IHS-SERVICE-IND
IMMIGRATION-STATUS
IMMIGRATION-STATUS
IMMIGRATION-STATUS
IMMIGRATION-STATUS
IMMIGRATION-VERIFICATIONFLAG
Household Size List
Household Size List
Household Size List
Household Size List
Household Size List
IHS Service Indicator Code List
IHS Service Indicator Code List
Immigration Status List
Immigration Status List
Immigration Status List
Immigration Status List
Immigration Verification Flag List
04
05
06
07
08
0
1
1
2
3
8
0
4 people
5 people
6 people
7 people
8 or more people
No
Yes
Qualified non-citizen
Lawfully present under CHIPRA 214
Eligible only for payment for emergency services
Not Applicable (U.S. citizen or U.S. national)
Immigration Status Verified
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1231
IMMIGRATION-VERIFICATIONFLAG
Immigration Verification Flag List
1
Enrolled in Medicaid pending immigration verification
01/01/0001
12/31/9999
1232
1233
1234
1235
1236
1237
1238
1239
1240
1241
1242
1243
1244
1245
1246
1247
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
None
Anthrax
Cervical Cancer)
Diphtheria
Hepatitis A
Hepatitis B
Haemophilus influenza type b (Hib)
Human Papillomavirus (HPV)
H1N1 Flu
Seasonal Flu
Japanese Encephalitis
Lyme Disease
Measles
Meningococcal
Monkey pox
Mumps
1248
1249
1250
1251
1252
1253
1254
1255
1256
1257
1258
1259
1260
1261
1262
1263
1264
1265
1266
1267
1268
1269
1270
1271
1272
1273
1274
1275
1276
1277
1278
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
IMMUNIZATION-TYPE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-STANDARD-CODE
INCOME-STANDARD-CODE
INCOME-STANDARD-CODE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Immunization Type List
Income Code List
Income Code List
Income Code List
Income Code List
Income Code List
Income Code List
Income Code List
Income Code List
Income Standard Code List
Income Standard Code List
Income Standard Code List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
16
17
18
19
20
21
22
23
24
25
26
27
28
29
01
02
03
04
05
06
07
08
01
02
95
01
02
03
04
05
06
Pertussis
Pneumococcal
Poliomyelitis
Rabies
Rotavirus
Rubella
Shingles
Smallpox
Tetanus
Tuberculosis
Typhoid Fever
Varicella
Yellow Fever
Other
Individual's State-defined family income is from 0 to 100% of the FPL
Individual's State-defined family income is from 101 to 133% of the FPL
Individual's State-defined family income is from 134 to 150% of the FPL
Individual's State-defined family income is from 151 to 200% of the FPL
Individual's State-defined family income is from 201 to 255% of the FPL
Individual's State-defined family income is from 256 to 300% of the FPL
Individual's State-defined family income is from 301 to 400% of the FPL
Individual's State-defined family income is over 400% of the FPL
MAGI
Non-MAGI
Other
Medical or comprehensive health insurance plan (e.g. HMO)
Dental health insurance plan
Vision health insurance plan
Prenatal/delivery health insurance plan
Long term care health insurance plan (Long Term PIHP)
Transportation health insurance plan (Transportation PAHP)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2958465
2958465
2958465
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1279
1280
1281
1282
1283
1284
1285
1286
1287
1288
1289
1290
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Insurance Plan Type List
Level of Care Status List
Level of Care Status List
07
08
09
10
11
12
13
14
15
16
001
002
1291
1292
1293
1294
1295
1296
1297
1298
1299
1300
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
LICENSE-TYPE
LICENSE-TYPE
LICENSE-TYPE
LICENSE-TYPE
LICENSE-TYPE
LINE-ADJUSTMENT-IND
Level of Care Status List
Level of Care Status List
Level of Care Status List
Level of Care Status List
License Type List
License Type List
License Type List
License Type List
License Type List
Line Adjustment Indicator List
003
004
005
888
1
2
3
4
5
0
A managed care plan
Disease management health insurance plan (Disease Management PAHP)
PAHP (Medical only)
Comprehensive health insurance and Long Term Care (hybrid)
Other health insurance plan
Veterans Administration health benefits
Indian Health Service Program health benefits
TRICARE health benefits
Eligible enrolled in private LTC insurance
Fee-for-Service insurance
Hospital as defined in 42 CFR $440.10
Inpatient psychiatric facility for individuals under age 21 as provided in 42 CFR
$440.160
Nursing Facility
ICF/IDD
Other Type of Facility
Not Applicable (Not in LTSS program)
State, county, or municipality professional or business license
DEA license
Professional society accreditation
CLIA accreditation
Other
Original Claim/Encounter/Payment - Indicates that this is the first (and, when
applicable, only) fully adjudicated transaction in a claim family (one or more claims
with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider
ID(s) also).
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1301
LINE-ADJUSTMENT-IND
Line Adjustment Indicator List
1
Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose
of the transaction is to void/reverse/cancel a previously paid/approved
claim/encounter/payment where the claim/encounter/payment is not being replaced
by a new paid/approved version of the claim/encounter/payment. Typically, this
would be the last claim/encounter/payment that would ever be associated with a
given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the
claim/encounter being voided. CMS expects a void transaction to also have the same
MSIS ID and provider ID(s) as the claim/encounter/payment being
voided/reversed/cancelled.
01/01/0001
12/31/9999
1302
LINE-ADJUSTMENT-IND
Line Adjustment Indicator List
4
Replacement/Resubmission of a previously paid/approved claim/encounter/payment
- Use when the purpose of the transaction is to replace a previously paid/approved
claim/encounter/payment with a new paid/approved version of the
claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as
the claim/encounter being replaced. CMS expects a replacement transaction to also
have the same MSIS ID and provider ID(s) as the claim/encounter/payment being
replaced/resubmitted.
01/01/0001
12/31/9999
1303
LINE-ADJUSTMENT-IND
Line Adjustment Indicator List
5
Credit Gross Adjustment - Use this code to indicate an aggregate provider-level
recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on
these claims should be expressed as negative numbers. If a credit gross adjustment is
reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or
debit) then CMS will interpret this to mean that the credit gross adjustment with the
more recent adjudication date should completely replace the preceding related gross
adjustment. If the ICNs of a credit gross adjustment are not related to any other gross
adjustments (credit or debit) then the credit gross adjustment will always be treated
as a distinct financial transaction.
01/01/0001
12/31/9999
1304
LINE-ADJUSTMENT-IND
Line Adjustment Indicator List
1305
LINE-ADJUSTMENT-REASONCODE
Line Adjustment Reason Code List Not ApplicableSee
Link to Line Adjustment Reason Code ListThis data element's valid value code set is
"VVL_Code_Description" maintained by a Code Set Maintenance Organization (CSMO), the official licensing
field
organization for specific valid value code sets. The CSMO is the system of record for
those specific valid value code sets. While T-MSIS endeavors to be in-sync with
CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data
submissions using the CSMO's latest version.
1306
1307
1308
1309
1310
1311
1312
1313
1314
1315
1316
1317
1318
1319
1320
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
6
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Debit Gross Adjustment - Use this code to indicate an aggregate provider-level
payment to a provider (e.g., not attributable to a single beneficiary). Amounts on
these claims should be expressed as positive numbers. If a debit gross adjustment is
reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or
debit) then CMS will interpret this to mean that the credit gross adjustment with the
more recent adjudication date should completely replace the preceding related gross
adjustment. If the ICNs of a debit gross adjustment are not related to any other gross
adjustments (credit or debit) then the debit gross adjustment will always be treated as
a distinct financial transaction.
For background and context, see https://x12.org/codes/claim-adjustment-reasoncodes
Physician
Speech Language Pathologist
Oral Surgery (Dentist only)
Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
Anesthesiology Assistant
Chiropractic
Optometry
Certified Nurse Midwife
Certified Registered Nurse Anesthetist (CRNA)
Mammography Center
Independent Diagnostic Testing Facility (IDTF)
Podiatry
Ambulatory Surgical Center
Nurse Practitioner
Medical Supply Company with Orthotist
01/01/0001
12/31/9999
N/A
N/A
1321
1322
1323
1324
1325
1326
1327
1328
1329
1330
1331
1332
1333
1334
1335
1336
1337
1338
1339
1340
1341
1342
1343
1344
1345
1346
1347
1348
1349
1350
1351
1352
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
Medical Supply Company with Prosthetist
Medical Supply Company with Orthotist-Prosthetist
Other Medical Supply Company
Individual Certified Orthotist
Individual Certified Prosthetist
Individual Certified Prosthetist-Orthotist
Medical Supply Company with Pharmacist
Ambulance Service Provider
Public Health or Welfare Agency
Voluntary Health or Charitable Agency
Psychologist, Clinical
Portable X-Ray Supplier
Audiologist
Physical Therapist in Private Practice
Occupational Therapist in Private Practice
Clinical Laboratory
Clinic or Group Practice
Registered Dietitian or Nutrition Professional
Mass Immunizer Roster Biller
Radiation Therapy Center
Slide Preparation Facility
Licensed Clinical Social Worker
Certified Clinical Nurse Specialist
Advance Diagnostic Imaging
Optician
Physician Assistant
Hospital-General
Skilled Nursing Facility
Intermediate Care Nursing Facility
Other Nursing Facility
Home Health Agency
Pharmacy
1353
1354
1355
1356
1357
1358
1359
1360
1361
1362
1363
1364
1365
1366
1367
1368
1369
1370
1371
1372
1373
1374
1375
1376
1377
1378
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LOCKIN-PROV-TYPE
LTSS-LEVEL-CARE
LTSS-LEVEL-CARE
LTSS-LEVEL-CARE
MAINTENANCE-ASSISTANCESTATUS
MAINTENANCE-ASSISTANCESTATUS
MAINTENANCE-ASSISTANCESTATUS
MAINTENANCE-ASSISTANCESTATUS
MAINTENANCE-ASSISTANCESTATUS
MAINTENANCE-ASSISTANCESTATUS
MANAGED-CARE-ADDR-TYPE
MANAGED-CARE-ADDR-TYPE
MANAGED-CARE-ADDR-TYPE
MANAGED-CARE-ADDR-TYPE
MANAGED-CARE-ADDR-TYPE
MANAGED-CARE-ADDR-TYPE
MANAGED-CARE-ADDR-TYPE
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
Lockin Provider Type List
LTSS Level of Care List
LTSS Level of Care List
LTSS Level of Care List
Maintenance Assistance Status
List
Maintenance Assistance Status
List
Maintenance Assistance Status
List
Maintenance Assistance Status
List
Maintenance Assistance Status
List
Maintenance Assistance Status
List
Managed Care Address Type List
Managed Care Address Type List
Managed Care Address Type List
Managed Care Address Type List
Managed Care Address Type List
Managed Care Address Type List
Managed Care Address Type List
48
49
50
51
52
53
54
55
56
57
1
2
3
0
Medical Supply Company with Respiratory Therapist
Department Store
Grocery Store
Indian Health Service facility
Oxygen supplier
Pedorthic personnel
Medical supply company with pedorthic personnel
Rehabilitation Agency
Ocularist
All Other
Skilled Care
Intermediate Care
Custodial Care
Eligible for Separate CHIP only
1
Receiving Cash or eligible under section 1931 of the Act
2
Medically Needy
3
Poverty Related
4
Other
5
1115 - Demonstration expansion eligible
1
2
3
4
5
6
7
MCOs corporate address and contact information
MCOs mailing address
MCOs service location address
MCOs Billing address and contact information
CEO's address and contact information
CFO's address and contact information
Other
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1379
MANAGED-CARE-PLAN-OTHER-ID- Managed Care Plan Other ID Type 01
TYPE
List
Federal Tax ID
01/01/0001
12/31/9999
1380
MANAGED-CARE-PLAN-OTHER-ID- Managed Care Plan Other ID Type 02
TYPE
List
State Tax ID
01/01/0001
12/31/9999
1381
1382
1383
1384
1385
1386
1387
1388
1389
1390
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
01
02
03
04
05
06
07
08
09
10
1391
1392
1393
1394
1395
1396
1397
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
11
12
13
14
15
16
17
1398
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
18
1399
1400
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
Managed Care Plan Pop List
19
20
1401
1402
1403
1404
1405
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
21
22
23
24
25
Parents and Other Caretaker Relatives
Transitional Medical Assistance
Extended Medicaid due to Earnings
Extended Medicaid due to Spousal Support Collections
Pregnant Women
Deemed Newborns
Infants and Children under Age 19
Children with Title IV-E Adoption Assistance, Foster Care or Guardianship Care
Former Foster Care Children
Individuals at or below 133% FPL Age 19 through 64|Non-pregnant individuals aged
19 through 64, not otherwise mandatorily eligible, with income at or below 133% FPL
Individuals Receiving SSI
Aged, Blind and Disabled Individuals in 209(b) States
Individuals Receiving Mandatory State Supplements
Individuals Who Are Essential Spouses
Institutionalized Individuals Continuously Eligible Since 1973
Blind or Disabled Individuals Eligible in 1973
Individuals Who Lost Eligibility for SSI/SSP Due to an Increase in OASDI Benefits in
1972
Individuals Who Would be Eligible for SSI/SSP but for OASDI COLA increases since
April, 1977
Disabled Widows and Widowers Ineligible for SSI due to Increase in OASDI
Disabled Widows and Widowers Ineligible for SSI due to Early Receipt of Social
Security
Working Disabled under 1619(b)
Disabled Adult Children
Qualified Medicare Beneficiaries
Qualified Disabled and Working Individuals
Specified Low Income Medicare Beneficiaries
1406
1407
1408
1409
1410
1411
1412
1413
1414
1415
1416
1417
1418
1419
1420
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
1421
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
41
1422
1423
1424
1425
1426
1427
1428
1429
1430
1431
1432
1433
1434
1435
1436
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
Qualifying Individuals
Optional Coverage of Parents and Other Caretaker Relatives
Reasonable Classifications of Individuals under Age 21
Children with Non-IV-E Adoption Assistance
Independent Foster Care Adolescents
Optional Targeted Low Income Children
Individuals Electing COBRA Continuation Coverage
Individuals above 133% FPL under Age 65
Certain Individuals Needing Treatment for Breast or Cervical Cancer
Individuals Eligible for Family Planning Services
Individuals with Tuberculosis
Aged, Blind or Disabled Individuals Eligible for but Not Receiving Cash Assistance
Individuals Eligible for Cash Assistance except for Institutionalization
Individuals Receiving Home and Community Based Services under Institutional Rules
Optional State Supplement Recipients - 1634 States, and SSI Criteria States with 1616
Agreements
Optional State Supplement Recipients - 209(b) States, and SSI Criteria States without
1616 Agreements
Institutionalized Individuals Eligible under a Special Income Level
Individuals participating in a PACE Program under Institutional Rules
Individuals Receiving Hospice Care
Qualified Disabled Children under Age 19
Poverty Level Aged or Disabled
Work Incentives Eligibility Group
Ticket to Work Basic Group
Ticket to Work Medical Improvements Group
Family Opportunity Act Children with Disabilities
Individuals Eligible for Home and Community-Based Services
Individuals Eligible for Home and Community-Based Services - Special Income Level
Medically Needy Pregnant Women
Medically Needy Children under Age 18
Medically Needy Children Age 18 through 20
Medically Needy Parents and Other Caretakers
1437
1438
1439
1440
1441
1442
1443
1444
1445
1446
1447
1448
1449
1450
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
Managed Care Plan Pop List
59
60
61
62
63
64
65
66
67
68
69
70
71
72
1451
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
72
1452
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
73
1453
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
73
1454
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
74
1455
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
74
1456
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
75
1457
MANAGED-CARE-PLAN-POP
Managed Care Plan Pop List
75
1458
1459
1460
1461
1462
MANAGED-CARE-PLAN-POP
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
Managed Care Plan Pop List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
76
01
02
03
04
Medically Needy Aged, Blind or Disabled
Medically Needy Blind or Disabled Individuals Eligible in 1973
Targeted Low-Income Children
Deemed Newborn
Children Ineligible for Medicaid Due to Loss of Income Disregards
Coverage from Conception to Birth
Children with Access to Public Employee Coverage
Children Eligible for Dental Only Supplemental Coverage
Targeted Low-Income Pregnant Women
Pregnant Women with Access to Public Employee Coverage
Individuals with Mental Health Conditions (expansion group)
Family Planning Participants (expansion group)
Other expansion group
Adult Group - Individuals at or below 133% FPL Age 19 through 64 - newly eligible for
all states
Adult Group - Individuals at or below 133% FPL Age 19 through 64 - newly eligible for
all states
Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible
for non 1905z(3) states
Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible
for non 1905z(3) states
Adult Group - Individuals at or below 133% FPL Age 19 through 64 not newly eligible
parent/ caretaker-relative(s) in 1905z(3) states
Adult Group - Individuals at or below 133% FPL Age 19 through 64 not newly eligible
parent/ caretaker-relative(s) in 1905z(3) states
Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible
non-parent/ caretaker-relative(s) in 1905z(3) states
Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible
non-parent/ caretaker-relative(s) in 1905z(3) states
Uninsured Individual eligible for COVID-19 testing
Comprehensive MCO
Traditional PCCM Provider arrangement
Enhanced PCCM Provider arrangement
Health Insuring Organization (HIO)HIO
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1463
MANAGED-CARE-PLAN-TYPE
Managed Care Plan Type List
05
Medical-only PIHP (risk or non-risk/non-comprehensive/with inpatient hospital or
institutional services)
01/01/0001
12/31/9999
1464
MANAGED-CARE-PLAN-TYPE
Managed Care Plan Type List
06
Medical-only PAHP (risk or non-risk/non-comprehensive/no inpatient hospital or
institutional services)
01/01/0001
12/31/9999
1465
1466
1467
1468
1469
1470
1471
1472
1473
1474
1475
1476
1477
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
07
08
09
10
11
12
13
14
15
16
17
18
19
Long Term Care (LTC) PIHP
Mental Health (MH) PIHP
Mental Health (MH) PAHP
Substance Use Disorders (SUD) PIHP
Substance Use Disorders (SUD) PAHP
Mental Health (MH) and Substance Use Disorders (SUD) PIHP
Mental Health (MH) and Substance Use Disorders (SUD) PAHP
Dental PAHP
Transportation PAHP
Disease Management PAHP
Program for All-Inclusive Care for the Elderly (PACE)PACE
Pharmacy PAHP
Individual is enrolled in Long-Term Services & Supports (LTSS) and Mental Health (MH)
PIHP
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1478
1479
1480
1481
1482
1483
1484
1485
1486
1487
1488
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PROFIT-STATUS
MANAGED-CARE-PROFIT-STATUS
MANAGED-CARE-PROFIT-STATUS
MANAGED-CARE-PROFIT-STATUS
MANAGED-CARE-PROGRAM
MANAGED-CARE-PROGRAM
MANAGED-CARE-PROGRAM
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Plan Type List
Managed Care Profit Status List
Managed Care Profit Status List
Managed Care Profit Status List
Managed Care Profit Status List
Managed Care Program List
Managed Care Program List
Managed Care Program List
20
60
70
80
01
02
03
04
1
2
3
Other
Accountable Care Organization
Health/Medical Home
Integrated Care For Dual Eligibles
501(C)(3) NON-PROFIT
FOR-PROFIT, CLOSELY HELD
FOR-PROFIT, PUBLICLY TRADED
OTHER
Medicaid State Plan
CHIP State Plan
Both Medicaid and CHIP
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
09/30/2020
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1489
MANAGED-CARE-SERVICE-AREA
Managed Care Service Area List
1
Statewide - The managed care entity provides services to beneficiaries throughout the
entire state.
01/01/0001
12/31/9999
1490
MANAGED-CARE-SERVICE-AREA
Managed Care Service Area List
2
01/01/0001
12/31/9999
1491
1492
MANAGED-CARE-SERVICE-AREA
MANAGED-CARE-SERVICE-AREA
Managed Care Service Area List
Managed Care Service Area List
3
4
County - The managed care entity provides services to beneficiaries in specified
counties.
City - The managed care entity provides services to beneficiaries in specified cities.
Region - The managed care entity provides services to beneficiaries in specified
regions, not defined by individual counties within the state (("region" is state-defined).
01/01/0001
01/01/0001
12/31/9999
12/31/9999
1493
MANAGED-CARE-SERVICE-AREA
Managed Care Service Area List
5
Zip Code - The managed care entity program provides services to beneficiaries in
specified zip codes.
01/01/0001
12/31/9999
1494
MANAGED-CARE-SERVICE-AREA
Managed Care Service Area List
6
Other - The managed care entity provides services to beneficiaries in "other" area(s),
not Statewide, County, City, or Region.
01/01/0001
12/31/9999
1495
MANAGED-CARE-SERVICE-AREANAME
Managed Care Service Area
Name List
Not ApplicableSee
This URL will take the reader to the American National Standards Institute (ANSI)
N/A
"VVL_Code_Description" Website for the various geographical code sets:This data element's valid value code set
field
is maintained by a Code Set Maintenance Organization (CSMO), the official licensing
organization for specific valid value code sets. The CSMO is the system of record for
those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's
updates, minor delays may occur but that shouldn't block T-MSIS data submissions
using the CSMO's latest version.
1496
1497
1498
1499
1500
1501
1502
1503
MANAGED-CARE-SERVICE-AREANAME
MANAGED-CARE-SERVICE-AREANAME
Managed Care Service Area
Name List
Managed Care Service Area
Name List
Not Applicable
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
01
02
03
04
05
06
Not Applicable
N/A
For background and context, see https://www.census.gov/library/reference/codelists/ansi.html
Managed Care Service Area Name List
Once at the Website, the reader should scroll down to the section entitled "State and
State Equivalents" for the state codes, "FIPS Codes for Outlying Areas of the United
States and the Freely Associated States" for the territory codes and "County
Subdivision" for the county codes.
Legally Married (to opposite sex), spouse present
Legally Married (to opposite sex), spouse absent
Legally Married (to same sex), spouse present
Legally Married (to same sex), spouse absent
Partnered or in Civil Union (to opposite sex), spouse present
Partnered or in Civil Union (to opposite sex), spouse absent
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1504
1505
1506
1507
1508
1509
1510
1511
1512
1513
1514
1515
1516
1517
1518
1519
1520
1521
1522
1523
1524
1525
1526
1527
1528
1529
1530
1531
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MARITAL-STATUS
MBESCBES-FORM-GROUP
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
Marital Status List
MBESCBES Form Group List
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
1
Partnered or in Civil Union (to same sex), spouse present
Partnered or in Civil Union (to same sex), spouse absent
Legally separated (and not married or partnered)
Divorced (and not currently married or partnered)
Separated (and not currently married or partnered)
Widower/Widow (and not currently married or partnered)
Never married/partnered
Other
Legally Married (to opposite sex)
Legally Married (to same sex)
Legally Married, spouse present
Legally Married, spouse absent
Legally Married
Partnered or in Civil Union (to opposite sex)
Partnered (Registered Domestic Partner) or in Civil Union (to same sex)
Partnered (Registered Domestic Partner) or in Civil Union, spouse present
Partnered (Registered Domestic Partner) or in Civil Union, spouse absent
Partnered (Registered Domestic Partner) or in Civil Union
Partnered (Registered Domestic Partner)
Civil Union
Legally Married, Partnered, or in Civil Union
Legally separated (and still legally married)
Legally separated
Annulled (and not currently married or partnered)
Separated (and currently married or partnered)
Separated
Single, widowed, or divorced
The MBES/CBES form that this expenditure was or will be reported to is a form for
Medicaid (but not Medicaid-expansion CHIP) expenditures or adjustments.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1532
MBESCBES-FORM-GROUP
MBESCBES Form Group List
2
The MBES/CBES form that this expenditure was or will be reported to is a form for
Medicaid-expansion CHIP expenditures or adjustments.
01/01/0001
12/31/9999
1533
MBESCBES-FORM-GROUP
MBESCBES Form Group List
3
The MBES/CBES form that this expenditure was or will be reported to is a form for
separate CHIP expenditures or adjustments.
01/01/0001
12/31/9999
1534
1535
1536
1537
MBESCBES-FORMGP-1
MBESCBES-FORMGP-1
MBESCBES-FORMGP-1
MBESCBES-FORMGP-1
MBESCBES Form Group 1 List
MBESCBES Form Group 1 List
MBESCBES Form Group 1 List
MBESCBES Form Group 1 List
64.10BASE
64.9A
64.9BASE
64.9P
Quarterly Expenditures for State & Local Administration
Third Party Liability Collections and Cost Avoidance
Medical Assistance Expenditures by Type of Service
Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program,
Prior Period Adjustment
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1538
1539
MBESCBES-FORMGP-2
MBESCBES-FORMGP-2
MBESCBES Form Group 2 List
MBESCBES Form Group 2 List
64.21U
64.21UP
Child Health Expenditures by Service
Quarterly Medical Assistance Expenditures by Children’s Health Insurance Program
expenditure categories
01/01/0001
01/01/0001
12/31/9999
12/31/9999
1540
1541
1542
1543
1544
1545
1546
1547
1548
1549
1550
1551
1552
MBESCBES-FORMGP-3
MBESCBES-FORMGP-3
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MEDICAID-BASIS-OF-ELIGIBILITY
MBESCBES Form Group 3 List
MBESCBES Form Group 3 List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
Medicaid Basis of Eligibility List
21BASE
21P
00
01
02
03
04
05
06
07
08
10
11
01/01/0001
01/01/0001
12/31/9999
12/31/9999
1553
MEDICARE-COMB-DED-IND
Medicare Combined Deductible
Indicator List
0
Children's Health Expenditures By Type of Service
Quarterly Children's Health Insurance Program
Eligible for Separate CHIP only
Aged Individual
Blind/Disabled Individual
Not used
Child (not Child of Unemployed Adult, not Foster Care Child)
Adult (not based on unemployed status)
Child of Unemployed Adult (optional)
Unemployed Adult (optional)
Foster Care Child
Refugee Medical Assistance (45 CFR Sub-part G)
Individual covered under the Breast and Cervical Cancer Prevention and Treatment
Act of 2000
Amount not combined with coinsurance amount
01/01/0001
12/31/9999
1554
MEDICARE-COMB-DED-IND
Medicare Combined Deductible
Indicator List
1
Amount combined with coinsurance amount
01/01/0001
12/31/9999
1555
MEDICARE-REIM-TYPE
Medicare Reimbursement Type
List
01
IPPS - Acute Inpatient PPS
01/01/0001
12/31/9999
1556
MEDICARE-REIM-TYPE
1557
MEDICARE-REIM-TYPE
1558
MEDICARE-REIM-TYPE
1559
MEDICARE-REIM-TYPE
1560
MEDICARE-REIM-TYPE
1561
MEDICARE-REIM-TYPE
1562
MEDICARE-REIM-TYPE
1563
MEDICARE-REIM-TYPE
1564
1565
1566
1567
1568
1569
1570
1571
1572
1573
1574
1575
1576
1577
1578
MFP-LIVES-WITH-FAMILY
MFP-LIVES-WITH-FAMILY
MFP-LIVES-WITH-FAMILY
MFP-QUALIFIED-INSTITUTION
MFP-QUALIFIED-INSTITUTION
MFP-QUALIFIED-INSTITUTION
MFP-QUALIFIED-INSTITUTION
MFP-QUALIFIED-INSTITUTION
MFP-QUALIFIED-INSTITUTION
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
Medicare Reimbursement Type
List
Medicare Reimbursement Type
List
Medicare Reimbursement Type
List
Medicare Reimbursement Type
List
Medicare Reimbursement Type
List
Medicare Reimbursement Type
List
Medicare Reimbursement Type
List
Medicare Reimbursement Type
List
02
LTCHPPS - Long-term Care Hospital PPS
01/01/0001
12/31/9999
03
SNFPPS - Skilled Nursing Facility PPS
01/01/0001
12/31/9999
04
HHPPS - Home Health PPS
01/01/0001
12/31/9999
05
IRFPPS - Inpatient Rehabilitation Facility PPS
01/01/0001
12/31/9999
06
IPFPPS - Inpatient Psychiatric Facility PPS
01/01/0001
12/31/9999
07
OPPS - Outpatient PPS
01/01/0001
12/31/9999
08
Fee Schedules (for physicians, DME, ambulance, and clinical lab)
01/01/0001
12/31/9999
09
Part C Hierarchical Condition Category Risk Assessment (CMS-HCC RA) Capitation
Payment Model
01/01/0001
12/31/9999
MFP Lives with Family List
MFP Lives with Family List
MFP Lives with Family List
MFP Qualified Institution List
MFP Qualified Institution List
MFP Qualified Institution List
MFP Qualified Institution List
MFP Qualified Institution List
MFP Qualified Institution List
MFP Qualified Residence List
MFP Qualified Residence List
MFP Qualified Residence List
MFP Qualified Residence List
MFP Qualified Residence List
MFP Qualified Residence List
0
1
2
00
01
02
03
04
05
00
01
02
03
04
05
No
Yes
No MFPNon Participation
Default- No MFPNon Participation
Nursing Facility
ICF/IID (Intermediate Care Facilities for individuals with Intellectual Disabilities)
IMD (Institution for Mental Diseases)
Hospital
Other
Default - No MFPNon Participation
Home owned by participant
Home owned by family member
Apartment leased by participant, not assisted living
Apartment leased by participant, assisted living
Group home of no more than 4 people
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1579
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
00
Default - No MFP Participation
01/01/0001
12/31/9999
1580
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
01
Completed 365 days of participation
01/01/0001
12/31/9999
1581
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
02
Suspended eligibility
01/01/0001
12/31/9999
1582
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
03
Re-institutionalized
01/01/0001
12/31/9999
1583
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
04
Died
01/01/0001
12/31/9999
1584
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
05
Moved
01/01/0001
12/31/9999
1585
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
06
No longer needed services
01/01/0001
12/31/9999
1586
MFP-REASON-PARTICIPATIONENDED
MFP Reason Participation Ended
List
07
Other
01/01/0001
12/31/9999
1587
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
00
Default- No MFPNon Participation
01/01/0001
12/31/9999
1588
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
01
Acute care hospitalization followed by long term rehabilitation
01/01/0001
12/31/9999
1589
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
02
Deterioration in cognitive functioning
01/01/0001
12/31/9999
1590
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
03
Deterioration in health
01/01/0001
12/31/9999
1591
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
04
Deterioration in mental health
01/01/0001
12/31/9999
1592
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
05
Loss of housing
01/01/0001
12/31/9999
1593
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
06
Loss of personal care giver
01/01/0001
12/31/9999
1594
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
07
By request of participant or guardian
01/01/0001
12/31/9999
1595
MFP-REINSTITUTIONALIZEDREASON
MFP Reinstitutionalized Reason
List
08
Lack of sufficient community services
01/01/0001
12/31/9999
1596
NATIONAL-HEALTH-CAREENTITY-ID-TYPE
National Health Care Entity ID
Type List
1
1597
NATIONAL-HEALTH-CAREENTITY-ID-TYPE
National Health Care Entity ID
Type List
2
1598
NATIONAL-HEALTH-CAREENTITY-ID-TYPE
National Health Care Entity ID
Type List
3
1599
NDC-UNIT-OF-MEASURE/UNITOF-MEASURE
NDC-UNIT-OF-MEASURE/UNITOF-MEASURE
NDC-UNIT-OF-MEASURE/UNITOF-MEASURE
NDC-UNIT-OF-MEASURE/UNITOF-MEASURE
NDC-UNIT-OF-MEASURE/UNITOF-MEASURE
NDC-UNIT-OF-MEASURE/UNITOF-MEASURE
NDC Unit of Measure List
EA
Controlling Health Plan (CHP) ID - the national health plan identifier of a health plan
that either controls its own business activities, actions, or policies, or is controlled by
an entity that is not a health plan and exercises sufficient control over the subhealth
plan(s) under it so as to direct its own business activities, actions, or policies, as well as
those of any subhealth plans under it.
Subhealth Plan (SHP) ID - the national health plan identifier of a health plan whose
business activities, actions, or policies are directed by a controlling health plan. All
subhealth HPIDs should be reported.
Other Entity Identifier (OEID) - a national identifier for entities that are not health
plans, health care providers, or individuals (as defined in 45 CFR 160.103), but that
need to be identified in standard transactions (including, for example, third party
administrators, transaction vendors, clearinghouses, and other payers). Other entities
are not required to obtain an OEID, but they could obtain and use one if they need to
be identified in covered transactions.
Each
NDC Unit of Measure List
F2
International Unit
01/01/0001
12/31/9999
NDC Unit of Measure List
GM
Grams
NDC Unit of Measure List
GR
Gram
01/01/0001
12/31/9999
NDC Unit of Measure List
ME
Milligram
01/01/0001
12/31/9999
NDC Unit of Measure List
ML
Milliliter
01/01/0001
12/31/9999
1600
1601
1602
1603
1604
1605
NDC-UNIT-OF-MEASURE
NDC Unit of Measure List
See
This data element's valid value code set is maintained by a Code Set Maintenance
N/A
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code
field
sets. The CSMO is the system of record for those specific valid value code sets. While TMSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
N/A
For background and context, see https://www.x12.org/
1606
1607
1608
1609
1610
1611
1612
1613
1614
1615
1616
1617
1618
1619
1620
1621
1622
1623
1624
1625
1626
1627
1628
NDC-UNIT-OF-MEASURE/UNITOF-MEASURE
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NDC Unit of Measure List
UN
Unit
01/01/0001
12/31/9999
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
00
01-99
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
New Prescription
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
01/01/0001
12/31/9999
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1629
1630
1631
1632
1633
1634
1635
1636
1637
1638
1639
1640
1641
1642
1643
1644
1645
1646
1647
1648
1649
1650
1651
1652
1653
1654
1655
1656
1657
1658
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
21
22
23
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
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1659
1660
1661
1662
1663
1664
1665
1666
1667
1668
1669
1670
1671
1672
1673
1674
1675
1676
1677
1678
1679
1680
1681
1682
1683
1684
1685
1686
1687
1688
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1689
1690
1691
1692
1693
1694
1695
1696
1697
1698
1699
1700
1701
1702
1703
1704
1705
1706
1707
1708
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
NEW-REFILL-IND
OCCURRENCE-CODE
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
New Refill Indicator List
Occurrence Code List
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
See
"VVL_Code_Description"
field
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
Number of Refill(s)
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code
sets. The CSMO is the system of record for those specific valid value code sets. While TMSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
For background and context, see https://www.nubc.org/license or
https://med.noridianmedicare.com/web/jea/topics/claim-submission/occurrencecodes
1709
1710
OCCURRENCE-CODE-01 to
OCCURRENCE-CODE-10
OCCURRENCE-CODE-01 to
OCCURRENCE-CODE-10
Occurrence Code List
Not Applicable
Occurrence Code List
Not Applicable
Occurrence Codes
Occurrence Span Codes
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
1711
1712
1713
1714
OFFSET-TRANS-TYPE
OFFSET-TRANS-TYPE
OFFSET-TRANS-TYPE
OPERATING-AUTHORITY
Offset Transaction Type List
Offset Transaction Type List
Offset Transaction Type List
Operating Authority List
1
2
3
01
Capitation
Individual Premium
Group Premium
1115 demonstration waiver program - demonstration projects under which most
provisions of Section 1902 of the Social Security Act are waived and/or expenditures
that would not otherwise be eligible for FFP are authorized. States use these to expand
eligibility, restructure Medicaid coverage and secure programmatic flexibility.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1715
OPERATING-AUTHORITY
Operating Authority List
02
1915(b) waiver program - waivers of most provisions of Section 1902 of the Social
Security Act in order to limit beneficiaries' freedom of choice of provider; selectively
contract with providers; or provide additional services to beneficiaries (State may
include BBA special populations)
01/01/0001
12/31/9999
1716
OPERATING-AUTHORITY
Operating Authority List
03
1932(a) state plan option to use managed care for MCO and PCCM programs mandatory managed care programs implemented through the state plan (State must
exclude or permit voluntary enrollment of specific populations)
01/01/0001
12/31/9999
1717
OPERATING-AUTHORITY
Operating Authority List
04
1915(a) voluntary managed care program - an MCO managed care program in which
enrollment is voluntary and therefore does not require a waiver.
01/01/0001
12/31/9999
1718
OPERATING-AUTHORITY
Operating Authority List
05
Concurrent 1915(b)/1915(c) waivers- programs, or portions thereof, operating under
both 1915(b) managed care and 1915(c) home and community-based services waivers.
01/01/0001
12/31/9999
1719
OPERATING-AUTHORITY
Operating Authority List
06
Concurrent 1915(a)/1915(c) waivers- programs, or portions thereof, operating under
both 1915(a) voluntary managed care and 1915(c) home and community-based
services waiver
01/01/0001
12/31/9999
1720
OPERATING-AUTHORITY
Operating Authority List
07
Concurrent 1932(a)/1915(c) waivers - programs, or portions thereof, operating under
both 1932(a) managed care and 1915(c) home and community-based services waiver.
01/01/0001
12/31/9999
1721
OPERATING-AUTHORITY
Operating Authority List
08
PACE - program that provides pre-paid, capitated comprehensive, health care services
to the frail elderly.
01/01/0001
12/31/9999
1722
OPERATING-AUTHORITY
Operating Authority List
09
1905(t) voluntary PCCM program - A PCCM managed care program in which
enrollment is voluntary and therefore does not require a waiver.
01/01/0001
12/31/9999
1723
OPERATING-AUTHORITY
Operating Authority List
10
1937benchmark benefit program - -programs to provide benefits that differ from
Medicaid state plan benefits using managed care and implemented through the state
plan.
01/01/0001
12/31/9999
1724
OPERATING-AUTHORITY
Operating Authority List
11
1725
OPERATING-AUTHORITY
Operating Authority List
12
1726
OPERATING-AUTHORITY
Operating Authority List
1727
OPERATING-AUTHORITY
1728
1729
1902(a)(70) non-emergency medical transportation program -non-emergency medical
transportation brokerage programs implemented through the state plan which can
vary scope of services, operate on a less-than-statewide basis, and limit freedom of
choice
Concurrent 1915(b)/1915(i) HCBS state plan services - the optional 1915(i) state plan
Home and Community-Based Services (HCBS) benefit operated in conjunction with a
1915(b) managed care waiver program.
01/01/0001
12/31/9999
01/01/0001
12/31/9999
13
Concurrent 1915(a)/ 1915(i) HCBS state plan services - the optional 1915(i) state plan
Home and Community-Based Services (HCBS) benefit operated in conjunction with a
1915(a) voluntary managed care program.
01/01/0001
12/31/9999
Operating Authority List
14
Concurrent 1932(a)/ 1915(i) HCBS state plan services - the optional 1915(i) state plan
Home and Community-Based Services (HCBS) benefit operated in conjunction with a
1932(a) managed care state plan option.
01/01/0001
12/31/9999
OPERATING-AUTHORITY
OPERATING-AUTHORITY
Operating Authority List
Operating Authority List
15
16
1945 Health Homes.
Concurrent 1915(a)/1915(j) - programs, or portions thereof, operating under both
1915(a) and 1915(j) authorities
01/01/0001
01/01/0001
12/31/9999
12/31/9999
1730
OPERATING-AUTHORITY
Operating Authority List
17
Concurrent 1932(a)/1915(j) - programs, or portions thereof, operating under both
1932(a) and 1915(j) authorities
01/01/0001
12/31/9999
1731
OPERATING-AUTHORITY
Operating Authority List
18
Concurrent 1915(b)/1915(j) - programs, or portions thereof, operating under both
1915(b) and 1915(j) authorities
01/01/0001
12/31/9999
1732
OPERATING-AUTHORITY
Operating Authority List
19
Concurrent 1115/1915(j) - programs, or portions thereof, operating under both 1115
and 1915(j) authorities
01/01/0001
12/31/9999
1733
OPERATING-AUTHORITY
Operating Authority List
20
Concurrent 1915(a)/1915(k) - programs, or portions thereof, operating under both
1915(a) and 1915(k) authorities
01/01/0001
12/31/9999
1734
OPERATING-AUTHORITY
Operating Authority List
21
Concurrent 1932(a)/1915(k) - programs, or portions thereof, operating under both
1932(a) and 1915(k) authorities
01/01/0001
12/31/9999
1735
OPERATING-AUTHORITY
Operating Authority List
22
Concurrent 1915(b)/1915(k) - programs, or portions thereof, operating under both
1915(b) and 1915(k) authorities
01/01/0001
12/31/9999
1736
OPERATING-AUTHORITY
Operating Authority List
23
Concurrent 1115/1915(k) - programs, or portions thereof, operating under both 1115
and 1915(k) authorities
01/01/0001
12/31/9999
1737
OTHER-INSURANCE-IND
Other Insurance Indicator List
0
No
01/01/0001
12/31/9999
1738
1739
1740
1741
1742
1743
1744
1745
1746
1747
1748
1749
1750
1751
1752
1753
1754
1755
1756
1757
1758
1759
1760
1761
1762
1763
1764
1765
1766
1767
OTHER-INSURANCE-IND
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OUTLIER-CODE
OUTLIER-CODE
OUTLIER-CODE
OUTLIER-CODE
OUTLIER-CODE
OUTLIER-CODE
OUTLIER-CODE
OUTLIER-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
Other Insurance Indicator List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Outlier Code List
Outlier Code List
Outlier Code List
Outlier Code List
Outlier Code List
Outlier Code List
Outlier Code List
Outlier Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
1
000
001
002
003
004
005
006
007
00
01
02
06
07
08
09
10
01
02
03
04
05
06
07
08
09
10
11
12
13
Yes
Not Applicable
Third Party Resource is Casualty/Tort
Third Party Resource is Estate
Third Party Resource is Lien (TEFRA)
Third Party Resource is Lien (Other)
Third Party Resource is Worker's Compensation
Third Party Resource is Medical Malpractice
Third Party Resource is Other
No Outlier
Day Outlier
Cost Outlier
Valid DRG Received from the intermediary
CMS Developed DRG
CMS Developed DRG Using Patient Status Code
Not Group able
Composite of cost outliers
Voluntary - Non-Profit - Religious Organizations
Voluntary - Non-Profit - Other
Voluntary - multiple owners
Proprietary - Individual
Proprietary - Corporation
Proprietary - Partnership
Proprietary - Other
Proprietary - multiple owners
Government - Federal
Government - State
Government - City
Government - County
Government - City-County
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1768
1769
1770
1771
1772
1773
1774
1775
1776
1777
1778
1779
1780
1781
1782
1783
1784
1785
1786
1787
1788
1789
1790
1791
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
OWNERSHIP-CODE
PATIENT-STATUS
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-TAX-ID-TYPE
PAYEE-TAX-ID-TYPE
PAYEE-TAX-ID-TYPE
PAYEE-TAX-ID-TYPE
PAYEE-TAX-ID-TYPE
PAYER-ID-TYPE
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Ownership Code List
Patient Status List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee ID Type List
Payee Tax ID Type List
Payee Tax ID Type List
Payee Tax ID Type List
Payee Tax ID Type List
Payee Tax ID Type List
Payer ID Type List
14
15
16
17
18
19
88
Not ApplicableSee
"VVL_Code_Description"
field
01
02
03
04
05
06
07
08
09
95
01
02
03
04
95
01
Government - Hospital District
Government - State and City/County
Government - other multiple owners
Voluntary /Proprietary
Proprietary/Government
Voluntary/Government
N/A - The individual only practices as part of a group, e.g., as an employee
A valid list of Patient Status codes can be purchased at
https://www.nubc.org/licenseThis data element's valid value code set is maintained by
a Code Set Maintenance Organization (CSMO), the official licensing organization for
specific valid value code sets. The CSMO is the system of record for those specific valid
value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor
delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's
latest version.
For background and context, see https://www.nubc.org/license
State
Capitated plan ID
Sub-capitated plan ID
Sub-capitated network provider ID
State contracted FFS provider ID assigned by state
State contracted FFS provider NPI
Insurance carrier
Beneficiary
Non-Medicaid eligible guardian
Other
SSN
EIN
ITIN
State Tax ID
Other
State
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1792
1793
1794
1795
1796
PAYER-ID-TYPE
PAYER-ID-TYPE
PAYER-ID-TYPE
PAYER-ID-TYPE
PAYMENT-LEVEL-IND
Payer ID Type List
Payer ID Type List
Payer ID Type List
Payer ID Type List
Payment Level Indicator List
02
03
04
95
1
Capitated plan ID
Sub-capitated entity ID
Sub-capitated network provider ID
Other
Claim paymentPayment/allowed amount is not determined at the headerindividual
line level (e.g., DRG or outpatient PPS)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1797
PAYMENT-LEVEL-IND
Payment Level Indicator List
2
Claim paymentPayment/allowed amount is determined at the individual linesline level
(e.g., RBRVS) and when applicable, cost-sharing and/or coordination of benefits were
deducted from one or more specific line-level payment/allowed amount(s)
01/01/0001
12/31/9999
1798
PAYMENT-LEVEL-IND
Payment Level Indicator List
3
Payment/allowed amount is determined for each individual line (e.g., RBRVS) but then
cost sharing or coordination of benefits was deducted from the total paid/allowed
amount at the header only
01/01/0001
12/31/9999
1799
1800
1801
1802
1803
1804
PAYMENT-PERIOD-TYPE
PAYMENT-PERIOD-TYPE
PAYMENT-PERIOD-TYPE
PAYMENT-PERIOD-TYPE
PAYMENT-PERIOD-TYPE
PAYMENT-PERIOD-TYPE
Payment Period Type List
Payment Period Type List
Payment Period Type List
Payment Period Type List
Payment Period Type List
Payment Period Type List
01
02
03
04
05
95
Bene coverage period
Service coverage period
Provider coverage period
Fiscal period
Episode of care
Other
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1805
PLACE-OF-SERVICE
Place of Service Code List
Not ApplicableSee
Place of Service Code ListThis data element's valid value code set is maintained by a
"VVL_Code_Description" Code Set Maintenance Organization (CSMO), the official licensing organization for
field
specific valid value code sets. The CSMO is the system of record for those specific valid
value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor
delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's
latest version.
N/A
N/A
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
For background and context, see https://www.cms.gov/Medicare/Coding/place-ofservice-codes/Place_of_Service_Code_Set
1806
1807
1808
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
01
02
03
Self
Spouse
Custodial Parent
1809
1810
1811
1812
1813
1814
1815
1816
1817
1818
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
PREFERRED-LANGUAGE-CODE
PREGNANCY-IND
PREGNANCY-IND
PRESCRIPTION-ORIGIN-CODE
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Preferred Language Code List
Pregnancy Indicator List
Pregnancy Indicator List
Prescription Origin Code List
04
05
06
07
08
09
See
"VVL_Code_Description"
field
Noncustodial Parent (Child Support Enforcement in effect)
Noncustodial Parent without child support enforcement in effect
Grandparent
Guardian
Domestic Partner
Other
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code
sets. The CSMO is the system of record for those specific valid value code sets. While TMSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
For background and context, see https://en.wikipedia.org/wiki/List_of_ISO_6392_codes
0
No
1
Yes
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code
field
sets. The CSMO is the system of record for those specific valid value code sets. While TMSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ncpdp.org/ or
https://www.ncpdp.org/NCPDP/media/pdf/VersionD-Questions.pdf
1819
PRIMARY-ELIGIBILITY-GROUP-IND Primary Eligibility Group
Indicator List
0
NoNO
01/01/0001
12/31/9999
1820
PRIMARY-ELIGIBILITY-GROUP-IND Primary Eligibility Group
Indicator List
1
YesYES
01/01/0001
12/31/9999
1821
PRIMARY-LANGUAGE-CODE
Primary Language Code List
Not Applicable
1822
PRIMARY-LANGUAGE-CODE
Primary Language Code List
Not Applicable
See language codes in the Data Dictionary Appendix G: ISO 639-2 Language Codes
Reference for a list of all valid language codes
Language Codes List
1823
1824
1825
1826
1827
1828
1829
1830
1831
1832
1833
1834
1835
1836
1837
1838
1839
1840
1841
1842
1843
1844
PRIMARY-LANGUAGE-ENGLPROF-CODE
PRIMARY-LANGUAGE-ENGLPROF-CODE
PRIMARY-LANGUAGE-ENGLPROF-CODE
PRIMARY-LANGUAGE-ENGLPROF-CODE
PROCEDURE-CODE-1 thru
PROCEDURE-CODE-6
PROCEDURE-CODE-1 thru
PROCEDURE-CODE-6
PROCEDURE-CODE-1 thru
PROCEDURE-CODE-6
PROCEDURE-CODE-FLAG 1 thru
PROCEDURE-CODE-FLAG 6
PROCEDURE-CODE-FLAG 1 thru
PROCEDURE-CODE-FLAG 6
PROCEDURE-CODE-FLAG 1 thru
PROCEDURE-CODE-FLAG 6
PROCEDURE-CODE-FLAG 1 thru
PROCEDURE-CODE-FLAG 6
PROCEDURE-CODE-FLAG 1 thru
PROCEDURE-CODE-FLAG 6
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
Primary Language Engl Prof List
0
Very Well
Primary Language Engl Prof List
1
Well
Primary Language Engl Prof List
2
Not well
Primary Language Engl Prof List
3
No spoken proficiency
Procedure Code List
Not Applicable
Procedure Code List
Procedure Code List
Not Applicable
Procedure Code List 2
Procedure Code List
Not Applicable
Procedure Code List 3
Procedure Code Flag List
01
CPT 4
01/01/0001
12/31/9999
Procedure Code Flag List
02
ICD-9 CM
01/01/0001
12/31/9999
Procedure Code Flag List
06
HCPCS (Both NationalLevel II and Regional HCPCS)CDT
01/01/0001
12/31/9999
Procedure Code Flag List
07
ICD-10 - CM PCS (Will be implemented on 10/1/2014)
01/01/0001
12/31/9999
Procedure Code Flag List
10-87
Other Systems
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
10
11
12
13
14
15
16
17
18
19
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1845
1846
1847
1848
1849
1850
1851
1852
1853
1854
1855
1856
1857
1858
1859
1860
1861
1862
1863
1864
1865
1866
1867
1868
1869
1870
1871
1872
1873
1874
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
20
21
22
23
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
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1875
1876
1877
1878
1879
1880
1881
1882
1883
1884
1885
1886
1887
1888
1889
1890
1891
1892
1893
1894
1895
1896
1897
1898
1899
1900
1901
1902
1903
1904
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
Program Type List
80
81
82
83
84
85
86
87
00
01
02
03
04
05
07
08
10
11
12
13
14
15
16
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
Other Systems
No Special Program
EPSDT
Family Planning
Rural Health Clinic
Federally Qualified Health Centers (FQHC)
Indian Health Services
Home and Community Based Care Waiver Services
Money Follows the Person (MFP)
BIP - Balancing Incentive Payment
Community First Choice (1915(k))
Medicaid Emergency Psychiatric Demonstration
Home and Community Based Services (HCBS) State Plan Option (1915(i))
State Plan CHIP
Psychiatric Residential Treatment Facilities Demonstration Grant Program (PRTF)
1915(j) (Self- directed personal assistance services/personal care under State Plan or
1915(c) waiver)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1928
1929
1930
1931
1932
1933
1934
PROGRAM-TYPE
PROV-ADDR-TYPE
PROV-ADDR-TYPE
PROV-ADDR-TYPE
PROV-ADDR-TYPE
PROV-CLASSIFICATION-TYPE
PROV-CLASSIFICATION-TYPE
Program Type List
Provider Address Type List
Provider Address Type List
Provider Address Type List
Provider Address Type List
Provider Classification Type List
Provider Classification Type List
17
1
2
3
4
1
2
COVID-19 Testing and Testing-Related Services (1905(a)(3) and 2103(c))
Provider Billing
Provider Mailing
Provider Practice
Provider Service Location
Taxonomy code
Provider specialty code
03/18/2020
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
PROV-CLASSIFICATION-TYPE
PROV-CLASSIFICATION-TYPE
PROV-CLASSIFICATION-TYPE = 1
(Provider Taxonomy)
PROV-CLASSIFICATION-TYPE = 1
(Provider Taxonomy)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
Provider Classification Type List
Provider Classification Type List
Provider Taxonomy List
3
4
Not Applicable
Provider Taxonomy List
Not Applicable
Provider type code
Authorized category of service code
The key values pairs for this list is incorporated by reference and can be found at the
following URL:
Link to Provider Taxonomy Code List
Provider Specialty List
01
General Practice
Provider Specialty List
02
General Surgery
Provider Specialty List
03
Allergy/Immunology
Provider Specialty List
04
Otolaryngology
Provider Specialty List
05
Anesthesiology C
Provider Specialty List
06
Cardiology
Provider Specialty List
07
Dermatology
Provider Specialty List
08
Family Practice
Provider Specialty List
09
Interventional Pain Management
Provider Specialty List
10
Gastroenterology
Provider Specialty List
11
Internal Medicine
Provider Specialty List
12
Osteopathic Manipulative Therapy
Provider Specialty List
13
Neurology
Provider Specialty List
14
Neurosurgery
Provider Specialty List
15
Speech Language Pathologist
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
Provider Specialty List
16
Obstetrics/Gynecology
Provider Specialty List
17
Hospice and Palliative Care
Provider Specialty List
18
Ophthalmology
Provider Specialty List
19
Oral Surgery (dentists only)
Provider Specialty List
20
Orthopedic Surgery
Provider Specialty List
21
Cardiac Electrophysiology
Provider Specialty List
22
Pathology
Provider Specialty List
23
Sports Medicine
Provider Specialty List
24
Plastic and Reconstructive Surgery
Provider Specialty List
25
Physical Medicine and Rehabilitation
Provider Specialty List
26
Psychiatry
Provider Specialty List
27
Geriatric Psychiatry
Provider Specialty List
28
Colorectal Surgery (formerly proctology)
Provider Specialty List
29
Pulmonary Disease
Provider Specialty List
30
Diagnostic Radiology
Provider Specialty List
31
Cardiac Rehabilitation & Intensive Cardiac Rehabilitation
Provider Specialty List
32
Anesthesiologist Assistant
Provider Specialty List
33
Thoracic Surgery
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
Provider Specialty List
34
Urology
Provider Specialty List
35
Chiropractic
Provider Specialty List
36
Nuclear Medicine
Provider Specialty List
37
Pediatric Medicine
Provider Specialty List
38
Geriatric Medicine
Provider Specialty List
39
Nephrology
Provider Specialty List
40
Hand Surgery
Provider Specialty List
41
Optometry
Provider Specialty List
42
Certified Nurse Midwife
Provider Specialty List
43
Certified Registered Nurse Anesthetist (CRNA)
Provider Specialty List
44
Infectious Disease
Provider Specialty List
45
Mammography Center
Provider Specialty List
46
Endocrinology
Provider Specialty List
47
Independent Diagnostic Testing Facility (IDTF)
Provider Specialty List
48
Podiatry
Provider Specialty List
49
Ambulatory Surgical Center
Provider Specialty List
50
Nurse Practitioner
Provider Specialty List
51
Medical Supply Company with Orthotist
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
Provider Specialty List
52
Medical Supply Company with Prosthetist
Provider Specialty List
53
Medical Supply Company with Orthotist-Prosthetist
Provider Specialty List
54
Other Medical Supply Company
Provider Specialty List
55
Individual Certified Orthotist
Provider Specialty List
56
Individual Certified Prosthetist
Provider Specialty List
57
Individual Certified Orthotist-Prosthetist
Provider Specialty List
58
Medical Supply Company with Pharmacist
Provider Specialty List
59
Ambulance Service Provider
Provider Specialty List
60
Public Health or Welfare Agency
Provider Specialty List
61
Voluntary Health or Charitable Agency
Provider Specialty List
62
Psychologist (Billing Independently)
Provider Specialty List
63
Portable X-Ray Supplier
Provider Specialty List
64
Audiologist
Provider Specialty List
65
Physical Therapist in Private Practice
Provider Specialty List
66
Rheumatology
Provider Specialty List
67
Occupational Therapist in Private Practice
Provider Specialty List
68
Clinical Psychologist
Provider Specialty List
69
Clinical Laboratory
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
Provider Specialty List
70
Single or Multispecialty Clinic or Group Practice
Provider Specialty List
71
Registered Dietitian or Nutrition Professional
Provider Specialty List
72
Pain Management
Provider Specialty List
73
Mass Immunization Roster Biller
Provider Specialty List
74
Radiation Therapy Center
Provider Specialty List
75
Slide Preparation Facility
Provider Specialty List
76
Peripheral Vascular Disease
Provider Specialty List
77
Vascular Surgery
Provider Specialty List
78
Cardiac Surgery
Provider Specialty List
79
Addiction Medicine
Provider Specialty List
80
Licensed Clinical Social Worker
Provider Specialty List
81
Critical Care (Intensivists)
Provider Specialty List
82
Hematology
Provider Specialty List
83
Hematology/Oncology
Provider Specialty List
84
Preventive Medicine
Provider Specialty List
85
Maxillofacial Surgery
Provider Specialty List
86
Neuropsychiatry
Provider Specialty List
87
All Other Suppliers
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
Provider Specialty List
88
Unknown Supplier/Provider Specialty
Provider Specialty List
89
Certified Clinical Nurse Specialist
Provider Specialty List
90
Medical Oncology
Provider Specialty List
91
Surgical Oncology
Provider Specialty List
92
Radiation Oncology
Provider Specialty List
93
Emergency Medicine
Provider Specialty List
94
Interventional Radiology
Provider Specialty List
95
Advance Diagnostic Imaging
Provider Specialty List
96
Optician
Provider Specialty List
97
Physician Assistant
Provider Specialty List
98
Gynecological/Oncology
Provider Specialty List
99
Undefined physician type (provider is an MD)
Provider Specialty List
A0
Hospital-General
Provider Specialty List
A1
Skilled Nursing Facility
Provider Specialty List
A2
Intermediate Care Nursing Facility
Provider Specialty List
A3
Other Nursing Facility
Provider Specialty List
A4
Home Health Agency
Provider Specialty List
A5
Pharmacy
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
2059
2060
2061
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 2
(Provider Specialty Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
Provider Specialty List
A6
Medical Supply Company with Respiratory Therapist
Provider Specialty List
A7
Department Store
Provider Specialty List
A8
Grocery Store
Provider Specialty List
A9
Indian Health Service facility
Provider Specialty List
B1
Oxygen supplier
Provider Specialty List
B2
Pedorthic personnel
Provider Specialty List
B3
Medical supply company with pedorthic personnel
Provider Specialty List
B4
Rehabilitation Agency
Provider Specialty List
B5
Ocularist
Provider Type Code List
01
Physician
Provider Type Code List
02
Speech Language Pathologist
Provider Type Code List
03
Oral Surgery (Dentist only)
Provider Type Code List
04
Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
Provider Type Code List
05
Anesthesiology Assistant
Provider Type Code List
06
Chiropractic
Provider Type Code List
07
Optometry
Provider Type Code List
08
Certified Nurse Midwife
Provider Type Code List
09
Certified Registered Nurse Anesthetist (CRNA)
2062
2063
2064
2065
2066
2067
2068
2069
2070
2071
2072
2073
2074
2075
2076
2077
2078
2079
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
Provider Type Code List
10
Mammography Center
Provider Type Code List
11
Independent Diagnostic Testing Facility (IDTF)
Provider Type Code List
12
Podiatry
Provider Type Code List
13
Ambulatory Surgical Center
Provider Type Code List
14
Nurse Practitioner
Provider Type Code List
15
Medical Supply Company with Orthotist
Provider Type Code List
16
Medical Supply Company with Prosthetist
Provider Type Code List
17
Medical Supply Company with Orthotist-Prosthetist
Provider Type Code List
18
Other Medical Supply Company
Provider Type Code List
19
Individual Certified Orthotist
Provider Type Code List
20
Individual Certified Prosthetist
Provider Type Code List
21
Individual Certified Prosthetist-Orthotist
Provider Type Code List
22
Medical Supply Company with Pharmacist
Provider Type Code List
23
Ambulance Service Provider
Provider Type Code List
24
Public Health or Welfare Agency
Provider Type Code List
25
Voluntary Health or Charitable Agency
Provider Type Code List
26
Psychologist, Clinical
Provider Type Code List
27
Portable X-Ray Supplier
2080
2081
2082
2083
2084
2085
2086
2087
2088
2089
2090
2091
2092
2093
2094
2095
2096
2097
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
Provider Type Code List
28
Audiologist
Provider Type Code List
29
Physical Therapist in Private Practice
Provider Type Code List
30
Occupational Therapist in Private Practice
Provider Type Code List
31
Clinical Laboratory
Provider Type Code List
32
Clinic or Group Practice
Provider Type Code List
33
Registered Dietitian or Nutrition Professional
Provider Type Code List
34
Mass Immunizer Roster Biller
Provider Type Code List
35
Radiation Therapy Center
Provider Type Code List
36
Slide Preparation Facility
Provider Type Code List
37
Licensed Clinical Social Worker
Provider Type Code List
38
Certified Clinical Nurse Specialist
Provider Type Code List
39
Advance Diagnostic Imaging
Provider Type Code List
40
Optician
Provider Type Code List
41
Physician Assistant
Provider Type Code List
42
Hospital-General
Provider Type Code List
43
Skilled Nursing Facility
Provider Type Code List
44
Intermediate Care Nursing Facility
Provider Type Code List
45
Other Nursing Facility
2098
2099
2100
2101
2102
2103
2104
2105
2106
2107
2108
2109
2110
2111
2112
2113
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-TYPE = 3
(Provider Type Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Type Code List
46
Home Health Agency
Provider Type Code List
47
Pharmacy
Provider Type Code List
48
Medical Supply Company with Respiratory Therapist
Provider Type Code List
49
Department Store
Provider Type Code List
50
Grocery Store
Provider Type Code List
51
Indian Health Service facility
Provider Type Code List
52
Oxygen supplier
Provider Type Code List
53
Pedorthic personnel
Provider Type Code List
54
Medical supply company with pedorthic personnel
Provider Type Code List
55
Rehabilitation Agency
Provider Type Code List
56
Ocularist
Provider Type Code List
57
All Other
Provider Authorized Category of
Service Code List
001
Inpatient hospital services, other than services in an institution for mental diseases
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
002
Outpatient hospital services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
003
Rural health clinic services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
004
Other ambulatory services furnished by a rural health clinic
01/01/0001
12/31/9999
2114
2115
2116
2117
2118
2119
2120
2121
2122
2123
2124
2125
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
005
Professional laboratory services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
006
Technical laboratory services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
007
Professional radiological services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
008
Technical radiological services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
009
Nursing facility services for individuals age 21 or older (other than services in an
institution for mental disease)
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
010
Early and periodic screening and diagnosis and treatment (EPSDT) services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
011
Family planning services and supplies for individuals of child-bearing age
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
012
Physicians' services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
013
Medical and surgical services of a dentist
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
014
Outpatient substance abuse treatment services.
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
015
Medical or other remedial care or services, other than physicians' services, provided by
licensed practitioners within the scope of practice as defined under State law
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
016
Home health services - Nursing services
01/01/0001
12/31/9999
2126
2127
2128
2129
2130
2131
2132
2133
2134
2135
2136
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
017
Home health services - Home health aide services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
018
Home health services - Medical supplies, equipment, and appliances suitable for use in
the home
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
019
Home health services - Physical therapy provided by a home health agency or by a
facility licensed by the State to provide medical rehabilitation services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
020
Home health services - Occupational therapy provided by a home health agency or by a
facility licensed by the State to provide medical rehabilitation services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
021
Home health services - Speech pathology and audiology services provided by a home
health agency or by a facility licensed by the State to provide medical rehabilitation
services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
022
Private duty nursing services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
023
Advanced practice nurse services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
024
Pediatric nurse
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
025
Nurse-midwife service
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
026
Nurse practitioner services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
027
Respiratory care for ventilator-dependent individuals
01/01/0001
12/31/9999
2137
2138
2139
2140
2141
2142
2143
2144
2145
2146
2147
2148
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
028
Clinic services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
029
Dental services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
030
Physical therapy services (when not provided under home health services)
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
031
Occupational therapy services (when not provided under home health services)
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
032
Speech, hearing, and language disorders services (when not provided under home
health services)
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
033
Prescribed drugs
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
034
Over-the-counter medications.
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
035
Dentures
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
036
Prosthetic devices
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
037
Eyeglasses
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
038
Hearing Aids
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
039
Diagnostic services
01/01/0001
12/31/9999
2149
2150
2151
2152
2153
2154
2155
2156
2157
2158
2159
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
040
Screening services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
041
Preventive services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
042
Well-baby and well-child care services as defined by the State.
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
043
Rehabilitative services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
044
Inpatient hospital services for individuals age 65 or older in institutions for mental
diseases
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
045
Nursing facility services for individuals age 65 or older in institutions for mental
diseases
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
046
Intermediate care facility (ICF/IIDICF/IID) services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
047
Nursing facility services, other than in institutions for mental diseases
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
048
Inpatient psychiatric services for individuals under age 21
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
049
Outpatient mental health services, other than Outpatient substance abuse treatment
services. This TOS includes services furnished in a State-operated mental hospital and
including community-based services.
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODEProvider Authorized Category of
TYPE = -4 (Authorized Category of Service Code List
Service Code)
050
Inpatient substance abuse treatment services and residential substance abuse
treatment services.
01/01/0001
12/31/9999
2160
2161
2162
2163
2164
2165
2166
2167
2168
2169
2170
2171
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
051
Personal care services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
052
Primary care case management services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
053
Targeted case management services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
054
Case Management services other than those that meet the definition of primary care
case management services or targeted case management services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
055
Care coordination services.
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
056
Transportation services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
057
Enabling services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
058
Services furnished in a religious nonmedical health care institution
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
059
Skilled nursing facility services for individuals under age 21
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
060
Emergency hospital services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
061
Critical access hospital services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
062
HCBS - Case management services
01/01/0001
12/31/9999
2172
2173
2174
2175
2176
2177
2178
2179
2180
2181
2182
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
063
HCBS - Homemaker services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
064
HCBS - Home health aide services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
065
HCBS - Personal care services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
066
HCBS - Adult day health services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
067
HCBS - Habilitation services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
068
HCBS - Respite care services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
069
HCBS - Day treatment or other partial hospitalization services, psychosocial
rehabilitation services and clinic services (whether or not furnished in a facility) for
individuals with chronic mental illness
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
070
HCBS - Day Care
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
071
HCBS - Training for family members
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
072
HCBS - Minor modification to the home
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
073
HCBS - Other services requested by the agency and approved by CMS as cost effective
and necessary to avoid institutionalization
01/01/0001
12/31/9999
2183
2184
2185
2186
2187
2188
2189
2190
2191
2192
2193
2194
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
Provider Authorized Category of
Service Code List
074
HCBS - Expanded habilitation services - Prevocational services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
075
HCBS - Expanded habilitation services - Educational services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
076
HCBS - Expanded habilitation services - Supported employment services, which
facilitate paid employment
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
077
HCBS-65-plus - Case management services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
078
HCBS-65-plus - Homemaker services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
079
HCBS-65-plus - Home health aide services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
080
HCBS-65-plus - Personal care services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
081
HCBS-65-plus - Adult day health services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
082
HCBS-65-plus - Respite care services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
083
HCBS-65-plus - Other medical and social services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
084
Sterilizations
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
085
Prenatal care and pre-pregnancy family planning services and supplies.
01/01/0001
12/31/9999
2195
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
086
Other Pregnancy-related Procedures
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
087
Hospice services
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
088
Any other health care services or items specified by the Secretary and not excluded
under regulations.
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
089
Disposable medical supplies.
01/01/0001
12/31/9999
2199
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
090
Critical access hospital services - IP
01/01/0001
12/31/9999
2200
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
091
Skilled care - hospital residing
01/01/0001
12/31/9999
2201
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
092
Exceptional care - hospital residing
01/01/0001
12/31/9999
2202
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
093
Non-acute care - hospital residing
01/01/0001
12/31/9999
2203
PROV-CLASSIFICATION-CODETYPE = -4 (Authorized Category of
Service Code)
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
115
Residential care
01/01/0001
12/31/9999
Provider Authorized Category of
Service Code List
120
Capitated payments for primary care case management (PCCM)
01/01/0001
12/31/9999
2205
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
123
Disproportionate share hospital (DSH) payments
01/01/0001
12/31/9999
2206
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
127
Indian Health Service (IHS) - Family Plan
01/01/0001
12/31/9999
2207
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
132
Supplemental payment - inpatient
01/01/0001
12/31/9999
2208
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
133
Supplemental payment - nursing
01/01/0001
12/31/9999
2196
2197
2198
2204
2209
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
134
Supplemental payment - outpatient
01/01/0001
12/31/9999
2210
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
135
EHR payments to provider
01/01/0001
12/31/9999
2211
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
136
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that
causes COVID–19, and the administration of such in vitro diagnostic products
03/18/2020
12/31/9999
2212
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
137
COVID–19 testing-related services
03/18/2020
12/31/9999
2213
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
138
Per member per month (PMPM) payments for health home services
01/01/0001
12/31/9999
2214
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
143
Per member per month (PMPM) payments for other payments
01/01/0001
12/31/9999
2215
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
144
Payments to individuals for personal assistance services under 1915(j)
01/01/0001
12/31/9999
2216
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
145
Medication Assisted Treatment (MAT) services and drugs for evidenced-based
treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the
Social Security Act
10/01/2020
12/31/9999
2217
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
146
Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who
receive services in an institution for mental disease (IMD)
01/01/0001
12/31/9999
2218
PROV-CLASSIFICATION-CODETYPE-4
Provider Authorized Category of
Service Code List
147
Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items
and services for which medical assistance is available under the State plan to infants
with the diagnosis of neonatal abstinence syndrome without any other significant
medical risk factors.
01/01/0001
12/31/9999
2219
2220
2221
2222
PROV-CLASSIFICATION-TYPE
PROV-CLASSIFICATION-TYPE
PROV-CLASSIFICATION-TYPE
PROV-CLASSIFICATION-TYPE
Provider Classification Type List
Provider Classification Type List
Provider Classification Type List
Provider Classification Type List
1
2
3
4
Taxonomy code
Provider specialty code
Provider type code
Authorized category of service code
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2223
PROV-ENROLLMENT-METHOD
Provider Enrollment Method
1
Enrolled through use of Medicare enrollment system (State did not require that
provider submit application. Rather Provider is active Medicare provider and state
Medicaid program accepted these credentials as sufficient to participate as state
Medicaid provider.)
01/01/0001
12/31/9999
2224
2225
2226
2227
2228
2229
2230
2231
2232
2233
2234
2235
2236
2237
2238
2239
PROV-ENROLLMENT-METHOD
PROV-ENROLLMENT-METHOD
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
Provider Enrollment Method
Provider Enrollment Method
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
2
3
100000000
170000000
250000000
260000000
270000000
280000000
290000000
300000000
310000000
320000000
330000000
340000000
380000000
Not ApplicableSee
"VVL_Code_Description"
field
Enrolled through use of state-based provider application
Other ?
Individuals or Groups (of Individuals)
Non-Individual - Other Service Providers
Non-Individual - Agencies
Non-Individual - Ambulatory Health Care Facilities
Non-Individual - Hospital Units
Non-Individual - Hospitals
Non-Individual - Laboratories
Non-Individual - Managed Care Organizations
Non-Individual - Nursing & Custodial Care Facilities
Non-Individual - Residential Treatment Facilities
Non-Individual - Suppliers
Non-Individual - Transportation Services
Non-Individual - Respite Care Facility
Note: Appendix L takes the WPC taxonomy codes and relates each one to its provider
facility type codeThis data element's valid value code set is maintained by a Code Set
Maintenance Organization (CSMO), the official licensing organization for specific valid
value code sets. The CSMO is the system of record for those specific valid value code
sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may
occur but that shouldn't block T-MSIS data submissions using the CSMO's latest
version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
2240
2241
2242
2243
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
Provider Identifier Type List
Provider Identifier Type List
Provider Identifier Type List
Provider Identifier Type List
1
2
3
4
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
For background and context, see https://x12.org/codes/provider-taxonomy-codes
State-specific Medicaid Provider ID
NPI
Medicare ID
NCPDP ID
2244
2245
2246
2247
2248
2249
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Identifier Type List
Provider Identifier Type List
Provider Identifier Type List
Provider Identifier Type List
Provider Identifier Type List
Provider Medicaid Enrollment
Status Code List
5
6
7
8
9
01
Federal Tax ID
State Tax ID
SSN
Other
Old State Provider ID
Active - Active Do Not Pay
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2250
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
02
Active - Active Reinstated
01/01/0001
12/31/9999
2251
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
03
Active - Active
01/01/0001
12/31/9999
2252
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
04
Active - Eligibility Verification
01/01/0001
12/31/9999
2253
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
05
Active - Encounter Only
01/01/0001
12/31/9999
2254
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
06
Active - Financial Trans Only
01/01/0001
12/31/9999
2255
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
20
Denied - Denied Two Provider Numbers
01/01/0001
12/31/9999
2256
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
21
Denied - For Other Reasons
01/01/0001
12/31/9999
2257
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
22
Denied - Invalid License
01/01/0001
12/31/9999
2258
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
23
Denied - Not Eligible
01/01/0001
12/31/9999
2259
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
24
Denied - Same Number Assigned
01/01/0001
12/31/9999
2260
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
40
Pending - Enrollment
01/01/0001
12/31/9999
2261
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
41
Pending - License/Cert Verification
01/01/0001
12/31/9999
2262
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
42
Pending - Missing Documentation
01/01/0001
12/31/9999
2263
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
43
Pending - No License/Temp License
01/01/0001
12/31/9999
2264
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
44
Pending - NPI Invalid
01/01/0001
12/31/9999
2265
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
45
Pending - Rate Determination
01/01/0001
12/31/9999
2266
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
46
Pending - Signed Agreement
01/01/0001
12/31/9999
2267
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
47
Pending - Status Approval
01/01/0001
12/31/9999
2268
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
48
Pending - W9 Missing or Incomplete
01/01/0001
12/31/9999
2269
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
60
Term - Abuse of billing privileges
01/01/0001
12/31/9999
2270
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
61
Term - Action Taken by Medicaid/CHIP
01/01/0001
12/31/9999
2271
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
62
Term - Action Taken by Medicare
01/01/0001
12/31/9999
2272
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
63
Term - Change of Ownership
01/01/0001
12/31/9999
2273
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
64
Term - Failure to report a change of address/ownership
01/01/0001
12/31/9999
2274
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
65
Term - False or misleading information
01/01/0001
12/31/9999
2275
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
66
Term - Federal exclusion/ debarment, etc.
01/01/0001
12/31/9999
2276
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
67
Term - Felony conviction
01/01/0001
12/31/9999
2277
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
68
Term - Involuntary Termination
01/01/0001
12/31/9999
2278
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
69
Term - License Expired
01/01/0001
12/31/9999
2279
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
70
Term - License Revoked
01/01/0001
12/31/9999
2280
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
71
Term - Loss of license or other State action
01/01/0001
12/31/9999
2281
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
72
Term - Medicare/Medicaid Exclusion
01/01/0001
12/31/9999
2282
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
73
Term - Medicaid Authority
01/01/0001
12/31/9999
2283
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
74
Term - Medicare Termination
01/01/0001
12/31/9999
2284
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
75
Term - Misuse of billing number
01/01/0001
12/31/9999
2285
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
76
Term - No Claims Activity
01/01/0001
12/31/9999
2286
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
77
Term - Non-Compliance
01/01/0001
12/31/9999
2287
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
78
Term - Onsite review/ Provider is no longer operational
01/01/0001
12/31/9999
2288
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
79
Term - Other
01/01/0001
12/31/9999
2289
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
80
Term - Provider Deceased
01/01/0001
12/31/9999
2290
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
81
Term - State exclusion/ debarment, etc.
01/01/0001
12/31/9999
2291
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
82
Term - Unknown
01/01/0001
12/31/9999
2292
PROV-MEDICAID-ENROLLMENTSTATUS-CODE
Provider Medicaid Enrollment
Status Code List
83
Term - Voluntary Termination
01/01/0001
12/31/9999
2293
2294
2295
2296
2297
2298
2299
2300
2301
2302
2303
2304
2305
2306
2307
2308
2309
2310
2311
2312
2313
2314
2315
2316
2317
2318
2319
2320
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
Provider Profit Status List
Provider Profit Status List
Provider Profit Status List
Provider Profit Status List
Provider Profit Status List
Provider Profit Status List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
01
02
03
04
88
99
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
501(C)(3) NON-PROFIT
FOR-PROFIT, CLOSELY HELD
FOR-PROFIT, PUBLICLY TRADED
OTHER
N/A - The individual only practices as part of a group
Unknown
General Practice
General Surgery
Allergy/Immunology
Otolaryngology
Anesthesiology
Cardiology
Dermatology
Family Practice
Interventional Pain Management
Gastroenterology
Internal Medicine
Osteopathic Manipulative Therapy
Neurology
Neurosurgery
Speech Language Pathologist
Obstetrics/Gynecology
Hospice and Palliative Care
Ophthalmology
Oral Surgery (dentists only)
Orthopedic Surgery
Cardiac Electrophysiology
Pathology
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2321
2322
2323
2324
2325
2326
2327
2328
2329
2330
2331
2332
2333
2334
2335
2336
2337
2338
2339
2340
2341
2342
2343
2344
2345
2346
2347
2348
2349
2350
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
23
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
Sports Medicine
Plastic and Reconstructive Surgery
Physical Medicine and Rehabilitation
Psychiatry
Geriatric Psychiatry
Colorectal Surgery (formerly proctology)
Pulmonary Disease
Diagnostic Radiology
Cardiac Rehabilitation & Intensive Cardiac Rehabilitation
Anesthesiologist Assistant
Thoracic Surgery
Urology
Chiropractic
Nuclear Medicine
Pediatric Medicine
Geriatric Medicine
Nephrology
Hand Surgery
Optometry
Certified Nurse Midwife
Certified Registered Nurse Anesthetist (CRNA)
Infectious Disease
Mammography Center
Endocrinology
Independent Diagnostic Testing Facility (IDTF)
Podiatry
Ambulatory Surgical Center
Nurse Practitioner
Medical Supply Company with Orthotist
Medical Supply Company with Prosthetist
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2351
2352
2353
2354
2355
2356
2357
2358
2359
2360
2361
2362
2363
2364
2365
2366
2367
2368
2369
2370
2371
2372
2373
2374
2375
2376
2377
2378
2379
2380
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
Medical Supply Company with Orthotist-Prosthetist
Other Medical Supply Company
Individual Certified Orthotist
Individual Certified Prosthetist
Individual Certified Orthotist-Prosthetist
Medical Supply Company with Pharmacist
Ambulance Service Provider
Public Health or Welfare Agency
Voluntary Health or Charitable Agency
Psychologist (Billing Independently)
Portable X-Ray Supplier
Audiologist
Physical Therapist in Private Practice
Rheumatology
Occupational Therapist in Private Practice
Clinical Psychologist
Clinical Laboratory
Single or Multispecialty Clinic or Group Practice
Registered Dietitian or Nutrition Professional
Pain Management
Mass Immunization Roster Biller
Radiation Therapy Center
Slide Preparation Facility
Peripheral Vascular Disease
Vascular Surgery
Cardiac Surgery
Addiction Medicine
Licensed Clinical Social Worker
Critical Care (Intensivists)
Hematology
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2381
2382
2383
2384
2385
2386
2387
2388
2389
2390
2391
2392
2393
2394
2395
2396
2397
2398
2399
2400
2401
2402
2403
2404
2405
2406
2407
2408
2409
2410
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
A0
A1
A2
A3
A4
A5
A6
A7
A8
A9
B1
B2
B3
Hematology/Oncology
Preventive Medicine
Maxillofacial Surgery
Neuropsychiatry
All Other Suppliers
Unknown Supplier/Provider Specialty
Certified Clinical Nurse Specialist
Medical Oncology
Surgical Oncology
Radiation Oncology
Emergency Medicine
Interventional Radiology
Advance Diagnostic Imaging
Optician
Physician Assistant
Gynecological/Oncology
Undefined physician type (provider is an MD)
Hospital-General
Skilled Nursing Facility
Intermediate Care Nursing Facility
Other Nursing Facility
Home Health Agency
Pharmacy
Medical Supply Company with Respiratory Therapist
Department Store
Grocery Store
Indian Health Service facility
Oxygen supplier
Pedorthic personnel
Medical supply company with pedorthic personnel
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2411
2412
2413
2414
2415
2416
2417
2418
2419
2420
2421
2422
2423
2424
2425
2426
2427
2428
2429
2430
2431
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-SPECIALTY
PROV-TAXONOMY
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Specialty List
Provider Taxonomy List
B4
B5
C0
C1
C2
C3
C4
C5
C6
C7
C8
C9
D1
D2
D3
D4
D5
D6
D7
D8
See
"VVL_Code_Description"
field
Rehabilitation Agency
Ocularist
Sleep Medicine
Centralized Flu
Indirect Payment Procedure
Interventional Cardiology
Restricted Use
Dentist
Hospitalist
Advanced Heart Failure and Transplant Cardiology
Medical Toxicology
Hematopoietic Cell Transplantation and Cellular Therapy
Medicare Diabetes Preventive Program
Restricted Use
Medical Genetics and Genomics
Undersea and Hyperbaric Medicine
Opioid Treatment Program
Home Infusion Therapy Services
Micrographic Dermatologic Surgery
Adult Congenital Heart Disease
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code
sets. The CSMO is the system of record for those specific valid value code sets. While
T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but
that shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
For background and context, see https://x12.org/codes/provider-taxonomy-codes
2432
2433
2434
2435
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
01
02
03
04
Physician
Speech Language Pathologist
Oral Surgery (Dentist only)
Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
2436
2437
2438
2439
2440
2441
2442
2443
2444
2445
2446
2447
2448
2449
2450
2451
2452
2453
2454
2455
2456
2457
2458
2459
2460
2461
2462
2463
2464
2465
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Anesthesiology Assistant
Chiropractic
Optometry
Certified Nurse Midwife
Certified Registered Nurse Anesthetist (CRNA)
Mammography Center
Independent Diagnostic Testing Facility (IDTF)
Podiatry
Ambulatory Surgical Center
Nurse Practitioner
Medical Supply Company with Orthotist
Medical Supply Company with Prosthetist
Medical Supply Company with Orthotist-Prosthetist
Other Medical Supply Company
Individual Certified Orthotist
Individual Certified Prosthetist
Individual Certified Prosthetist-Orthotist
Medical Supply Company with Pharmacist
Ambulance Service Provider
Public Health or Welfare Agency
Voluntary Health or Charitable Agency
Psychologist, Clinical
Portable X-Ray Supplier
Audiologist
Physical Therapist in Private Practice
Occupational Therapist in Private Practice
Clinical Laboratory
Clinic or Group Practice
Registered Dietitian or Nutrition Professional
Mass Immunizer Roster Biller
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2466
2467
2468
2469
2470
2471
2472
2473
2474
2475
2476
2477
2478
2479
2480
2481
2482
2483
2484
2485
2486
2487
2488
2489
2490
2491
2492
2493
2494
2495
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROV-TYPE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Type Code List
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
01
02
03
11
12
13
Radiation Therapy Center
Slide Preparation Facility
Licensed Clinical Social Worker
Certified Clinical Nurse Specialist
Advance Diagnostic Imaging
Optician
Physician Assistant
Hospital-General
Skilled Nursing Facility
Intermediate Care Nursing Facility
Other Nursing Facility
Home Health Agency
Pharmacy
Medical Supply Company with Respiratory Therapist
Department Store
Grocery Store
Indian Health Service facility
Oxygen supplier
Pedorthic personnel
Medical supply company with pedorthic personnel
Rehabilitation Agency
Ocularist
All Other
Institutions for Mental Disease
Institutional claim - any (837I format or UB-04 form)
Institutional claim - electronic (837I format)
Institutional claim (UB-04 form)
Professional claim - any (837P format or CMS-1500 form)
Professional claim - electronic (837P format)
Professional claim - paper (CMS-1500 form)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2496
2497
2498
2499
2500
2501
2502
2503
2504
2505
2506
2507
2508
2509
2510
2511
2512
2513
2514
2515
2516
2517
2518
2519
2520
2521
2522
2523
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
REASON-FOR-CHANGE
REASON-FOR-CHANGE
REASON-FOR-CHANGE
REASON-FOR-CHANGE
REBATE-ELIGIBLE-INDICATOR
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Race List
Reason for Change List
Reason for Change List
Reason for Change List
Reason for Change List
Rebate Eligible Indicator List
21
22
23
31
95
001
002
003
004
005
006
007
008
009
010
011
012
013
014
015
016
017
018
LSE
MERGE
TCAM
UNMERGE
0
Dental claim - any (837D format or ADA Dental Claim Form)
Dental claim - electronic (837D format)
Dental claim - paper (ADA Dental Claim Form)
Pharmacy claim (NCPDP format)
Other claim form or format not listed above
White
Black or African American
American Indian or Alaskan Native
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Asian Unknown
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Native Hawaiian or Other Pacific Islander Unknown
Unspecified
Other
Large System Enhancement
Merge Beneficiaries
Transition between CHIP and Medicaid
Unmerge Beneficiaries
NDC is not eligible for drug rebate program. (Manufacturer does not have a rebate
agreement.)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2524
REBATE-ELIGIBLE-INDICATOR
Rebate Eligible Indicator List
1
NDC is eligible for drug rebate program
01/01/0001
12/31/9999
2525
2526
2527
2528
2529
2530
2531
2532
2533
2534
2535
2536
2537
2538
2539
2540
2541
2542
2543
2544
2545
2546
2547
2548
2549
2550
2551
2552
2553
2554
REBATE-ELIGIBLE-INDICATOR
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
Rebate Eligible Indicator List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
2
CIP00001
CIP00002
CIP00003
CIP00004
CLT00001
CLT00002
CLT00003
CLT00004
COT00001
COT00002
COT00003
COT00004
CRX00001
CRX00002
CRX00003
CRX00004
ELG00001
ELG00002
ELG00003
ELG00004
ELG00005
ELG00006
ELG00007
ELG00008
ELG00009
ELG00010
ELG00011
ELG00012
ELG00013
NDC is exempt from the drug rebate program (biological and medical devices)
FILE-HEADER-RECORD-IP
CLAIM-HEADER-RECORD-IP
CLAIM-LINE-RECORD-IP
CLAIM-DX-IP
FILE-HEADER-RECORD-LT
CLAIM-HEADER-RECORD-LT
CLAIM-LINE-RECORD-LT
CLAIM-DX-LT
FILE-HEADER-RECORD-OT
CLAIM-HEADER-RECORD-OT
CLAIM-LINE-RECORD-OT
CLAIM-DX-OT
FILE-HEADER-RECORD-RX
CLAIM-HEADER-RECORD-RX
CLAIM-LINE-RECORD-RX
CLAIM-DX-RX
FILE-HEADER-RECORD-ELIGIBILITY
PRIMARY-DEMOGRAPHICS-ELIGIBILITY
VARIABLE-DEMOGRAPHICS-ELIGIBILITY
ELIGIBLE-CONTACT-INFORMATION
ELIGIBILITY-DETERMINANTS
HEALTH-HOME-SPA-PARTICIPATION-INFORMATION
HEALTH-HOME-SPA-PROVIDERS
HEALTH-HOME-CHRONIC-CONDITIONS
LOCK-IN-INFORMATION
MFP-INFORMATION
STATE-PLAN-OPTION-PARTICIPATION
WAIVER-PARTICIPATION
LTSS-PARTICIPATION
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2555
2556
2557
2558
2559
2560
2561
2562
2563
2564
2565
2566
2567
2568
2569
2570
2571
2572
2573
2574
2575
2576
2577
2578
2579
2580
2581
2582
2583
2584
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
ELG00014
ELG00015
ELG00016
ELG00017
ELG00018
ELG00020
ELG00021
ELG00022
ELG00023
FTX00001
FTX00002
FTX00003
FTX00004
FTX00005
FTX00006
FTX00007
FTX00008
FTX00009
FTX00095
MCR00001
MCR00002
MCR00003
MCR00004
MCR00005
MCR00006
MCR00007
MCR00008
MCR00009
MCR00010
PRV00001
MANAGED-CARE-PARTICIPATION
ETHNICITY-INFORMATION
RACE-INFORMATION
DISABILITY-INFORMATION
1115A-DEMONSTRATION-INFORMATION
HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME
ENROLLMENT-TIME-SPAN
ELG-IDENTIFIERS
SOGI
FILE-HEADER-RECORD-FTX
INDIVIDUAL-CAPITATION-PMPM
INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
GROUP-INSURANCE-PREMIUM-PAYMENT
COST-SHARING-OFFSET
VALUE-BASED-PAYMENT
STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
COST-SETTLEMENT-PAYMENT
FQHC-WRAP-PAYMENT
MISCELLANEOUS-PAYMENT
FILE-HEADER-RECORD-MANAGED-CARE
MANAGED-CARE-MAIN
MANAGED-CARE-LOCATION-AND-CONTACT-INFO
MANAGED-CARE-SERVICE-AREA
MANAGED-CARE-OPERATING-AUTHORITY
MANAGED-CARE-PLAN-POPULATION-ENROLLED
MANAGED-CARE-ACCREDITATION-ORGANIZATION
NATIONAL-HEALTH-CARE-ENTITY-ID-INFO
CHPID-SHPID-RELATIONSHIP
MANAGED-CARE-ID
FILE-HEADER-RECORD-PROVIDER
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2585
2586
2587
2588
2589
2590
2591
2592
2593
2594
2595
2596
2597
2598
2599
2600
2601
2602
2603
2604
2605
2606
2607
2608
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
RECORD-ID
REIMBURSEMENTARRANGEMENT
REIMBURSEMENTARRANGEMENT
REIMBURSEMENTARRANGEMENT
REIMBURSEMENTARRANGEMENT
REIMBURSEMENTARRANGEMENT
REIMBURSEMENTARRANGEMENT
REIMBURSEMENTARRANGEMENT
REIMBURSEMENTARRANGEMENT
RESTRICTED-BENEFITS-CODE
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Record ID List
Reimbursement Arrangement List
PRV00002
PRV00003
PRV00004
PRV00005
PRV00006
PRV00007
PRV00008
PRV00009
PRV00010
TPL00001
TPL00002
TPL00003
TPL00004
TPL00005
TPL00006
01
PROV-ATTRIBUTES-MAIN
PROV-LOCATION-AND-CONTACT-INFO
PROV-LICENSING-INFO
PROV-IDENTIFIERS
PROV-TAXONOMY-CLASSIFICATION
PROV-MEDICAID-ENROLLMENT
PROV-AFFILIATED-GROUPS
PROV-AFFILIATED-PROGRAMS
PROV-BED-TYPE-INFO
FILE-HEADER-RECORD-TPL
TPL-MEDICAID-ELIGIBLE-PERSON-MAIN
TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO
TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES
TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION
TPL-ENTITY-CONTACT-INFORMATION
Risk-based Capitation, no incentives or risk-sharing
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Reimbursement Arrangement List
02
Risk-based Capitation with Incentive Arrangements
01/01/0001
12/31/9999
Reimbursement Arrangement List
03
Risk-based Capitation with other risk-sharing Arrangements
01/01/0001
12/31/9999
Reimbursement Arrangement List
04
Non-Risk Capitation
01/01/0001
12/31/9999
Reimbursement Arrangement List
05
Fee-For-Service
01/01/0001
12/31/9999
Reimbursement Arrangement List
06
Primary Care Case Management Payment
01/01/0001
12/31/9999
Reimbursement Arrangement List
07
Other
01/01/0001
12/31/9999
Reimbursement Arrangement List
08
Primary Care Case Management Payment plus Fee-For-Service
01/01/0001
12/31/9999
Restricted Benefits Code List
0
Individual is not eligible for Medicaid or CHIP during the month.
01/01/0001
12/31/9999
2609
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
1
Individual is eligible for Medicaid or CHIP and entitled to the full scope of Medicaid or
CHIP benefits.
01/01/0001
12/31/9999
2610
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
2
Individual is eligible for Medicaid or Medicaid-Expansion CHIP, but only entitled to
restricted benefits based on alien status.
01/01/0001
12/31/9999
2611
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
3
Individual is eligible for Medicaid but only entitled to restricted benefits based on
Medicare dual-eligibility status (e.g., QMB, SLMB, QDWI, QI).
01/01/0001
12/31/9999
2612
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
4
Individual is eligible for Medicaid or CHIP but is only entitled to restricted benefits for
pregnancy-related services, including services that do and those that do not meet the
Minimum Essential Coverage standard.
01/01/0001
12/31/9999
2613
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
5
Individual is eligible for Medicaid or Medicaid-Expansion CHIP, but for reasons other
than alien, dual-eligibility, or pregnancy-related status, is only entitled to restricted
benefits (e.g., restricted benefits based upon substance abuse, medically needy, or
other criteria) that meet the standard for Minimum Essential Coverage.
01/01/0001
12/31/9999
2614
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
6
Individual is eligible for Medicaid or Medicaid-Expansion CHIP but only entitled to
restricted benefits for family planning services.
01/01/0001
12/31/9999
2615
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
7
Individual is eligible for Medicaid and entitled to Medicaid benefits under an
alternative package of benchmark-equivalent coverage, as enacted by the Deficit
Reduction Act of 2005.
01/01/0001
12/31/9999
2616
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
A
Individual is eligible for Medicaid and entitled to benefits under the Psychiatric
Residential Treatment Facilities Demonstration Grant Program (PRTF), as enacted by
the Deficit Reduction Act of 2005.
01/01/0001
12/31/9999
2617
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
B
Individual is eligible for Medicaid and entitled to Medicaid benefits using a Health
Opportunity Account (HOA)).
01/01/0001
12/31/9999
2618
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
C
Individual is eligible for S-separate CHIP dental coverage (supplemental dental
wraparound benefit to employer-sponsored insurance)).
01/01/0001
12/31/9999
2619
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
D
Individual is eligible for Medicaid and entitled to benefits under a ""Money Follows
the Person"" (MFP) rebalancing demonstration, as enacted by the Deficit Reduction
Act of 2005, to allow States to develop community based long term care
opportunities.
01/01/0001
12/31/9999
2620
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
E
Individual is eligible for Medicaid or Medicaid-Expansion CHIP, but for reasons other
than alien, dual-eligibility, or pregnancy-related status, is only entitled to restricted
benefits (e.g., restricted benefits based on substance abuse, medically needy, or other
criteria) that do not meet the standard for Minimum Essential Coverage.
01/01/0001
12/31/9999
2621
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
F
Individual is eligible for Medicaid but is only entitled to restricted benefits for medical
assistance for COVID-19 diagnostic products and any visit described as a COVID-–19
testing-related service for which payment may be made under the State plan during
any portion of the public health emergency period, beginning March 18, 2020, as
described in Sections 1902(a)(10)(A)(ii)(XXIII), 1902(ss) and clause XVIII in the matter
following 1902(a)(10)(G) of the Social Security Act.
03/18/2020
12/31/9999
2622
RESTRICTED-BENEFITS-CODE
Restricted Benefits Code List
G
Individual is eligible for Medicaid but only entitled to restricted benefits based on
Medicare dual-eligibility status Medicare Part B-ID ESRD Benefit.
01/01/2023
12/31/9999
2623
REVENUE-CODE
N/A
N/A
Revenue Code List
Not ApplicableSee
Revenue Code ListThis data element's valid value code set is maintained by a Code Set
"VVL_Code_Description" Maintenance Organization (CSMO), the official licensing organization for specific valid
field
value code sets. The CSMO is the system of record for those specific valid value code sets.
While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but
that shouldn't block T-MSIS data submissions using the CSMO's latest version.
For background and context, see https://www.nubc.org/
2624
SDP-IND
State Directed Payment
Indicator List
0
No, not an SDP
01/01/0001
12/31/9999
2625
SDP-IND
State Directed Payment
Indicator List
1
Yes, SDP
01/01/0001
12/31/9999
2626
2627
2628
2629
2630
2631
2632
SELF-DIRECTION-TYPE
SELF-DIRECTION-TYPE
SELF-DIRECTION-TYPE
SELF-DIRECTION-TYPE
SERVICE-TRACKING-TYPE
SERVICE-TRACKING-TYPE
SERVICE-TRACKING-TYPE
Self Direction Type List
Self Direction Type List
Self Direction Type List
Self Direction Type List
Service Tracking Type List
Service Tracking Type List
Service Tracking Type List
000
001
002
003
00
01
02
Not Applicable
Hiring Authority
Budget Authority
Hiring and Budget Authority
Not a Service Tracking Claim
Drug Rebate
DSH Payment
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2633
2634
2635
2636
2637
2638
2639
2640
2641
2642
2643
2644
2645
2646
2647
2648
2649
2650
2651
2652
2653
2654
2655
2656
2657
2658
2659
2660
2661
2662
2663
SERVICE-TRACKING-TYPE
SERVICE-TRACKING-TYPE
SERVICE-TRACKING-TYPE
SERVICE-TRACKING-TYPE
SEX
SEX
SEX
SEX-ASSIGNED-AT-BIRTH
SEX-ASSIGNED-AT-BIRTH
SEX-ASSIGNED-AT-BIRTH
SEX-ASSIGNED-AT-BIRTH
SEX-ASSIGNED-AT-BIRTH
SEXUAL-ORIENTATION
SEXUAL-ORIENTATION
SEXUAL-ORIENTATION
SEXUAL-ORIENTATION
SEXUAL-ORIENTATION
SEXUAL-ORIENTATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
SOURCE-LOCATION
Service Tracking Type List
Service Tracking Type List
Service Tracking Type List
Service Tracking Type List
Sex List
Sex List
Sex List
Sex Assigned at Birth List
Sex Assigned at Birth List
Sex Assigned at Birth List
Sex Assigned at Birth List
Sex Assigned at Birth List
Sexual Orientation List
Sexual Orientation List
Sexual Orientation List
Sexual Orientation List
Sexual Orientation List
Sexual Orientation List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
Source Location List
03
04
05
06
F
M
U
1
2
3
4
5
1
2
3
4
5
6
01
02
03
04
05
06
07
08
09
10
20
22
23
Lump Sum Payment
Cost Settlement
Supplemental
Other
Female
Male
Unknown
Female
Male
Not sure
Prefer not to answer
Other
Lesbian or gay
Straight
Bisexual
Not sure
Prefer not to answer
Other
MMIS
Non-MMIS CHIP Payment System
Pharmacy Benefits Manager (PBM) Vendor
Dental Benefits Manager Vendor
Transportation Provider System
Mental Health Claims Payment System
Financial Transaction/Accounting System
Other State Agency Claims Payment System
County/Local Government Claims Payment System
Other Vendor/Other Claims Payment System
Managed Care Organization (MCO)
Sub-contracted entity
Sub-capitated network provider
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2664
2665
2666
2667
2668
2669
2670
SPLIT-CLAIM-IND
SPLIT-CLAIM-IND
SSDI-IND
SSDI-IND
SSI-IND
SSI-IND
SSI-STATE-SUPPLEMENTSTATUS-CODE
Split Claim Indicator List
Split Claim Indicator List
SSDI Indicator List
SSDI Indicator List
SSI Indicator List
SSI Indicator List
SSI State Supplement Code List
0
1
0
1
0
1
000
No
Yes
No
Yes
No
Yes
Not Applicable
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2671
SSI-STATE-SUPPLEMENTSTATUS-CODE
SSI State Supplement Code List
001
Mandatory
01/01/0001
12/31/9999
2672
SSI-STATE-SUPPLEMENTSTATUS-CODE
SSI State Supplement Code List
002
Optional
01/01/0001
12/31/9999
2673
2674
2675
2676
2677
2678
2679
2680
2681
2682
2683
2684
2685
2686
2687
2688
2689
2690
SSI-STATUS
SSI-STATUS
SSI-STATUS
SSI-STATUS
SSN-INDICATOR
SSN-INDICATOR
SSN-VERIFICATION-FLAG
SSN-VERIFICATION-FLAG
SSN-VERIFICATION-FLAG
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
SSI Status List
SSI Status List
SSI Status List
SSI Status List
SSN Indicator List
SSN Indicator List
SSN Verification Flag List
SSN Verification Flag List
SSN Verification Flag List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
000
001
002
003
0
1
0
1
2
01
02
04
05
06
08
09
10
11
Not Applicable
SSI
SSI Eligible Spouse
SSI Pending a Final Determination of Disposal of Resources Exceeding SSI Dollar Limits
State does not use SSN as MSIS-IDENTIFICATION-NUMBER
State uses SSN as MSIS-IDENTIFICATION-NUMBER
SSN not verified
SSN successfully verified by SSA
SSN is pending SSA verification
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2691
2692
2693
2694
2695
2696
2697
2698
2699
2700
2701
2702
2703
2704
2705
2706
2707
2708
2709
2710
2711
2712
2713
2714
2715
2716
2717
2718
2719
2720
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
12
13
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa (Medicaid)
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2721
2722
2723
2724
2725
2726
2727
2728
2729
2730
2731
2732
2733
2734
2735
2736
2737
2738
2739
2740
2741
2742
2743
2744
2745
2746
2747
2748
2749
2750
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
44
45
46
47
48
49
50
51
53
54
55
56
60
64
66
67
68
69
70
71
72
74
76
78
79
81
84
86
89
93
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Johnston Atoll
Marshall Islands
Commonwealth of the Northern Mariana Islands
Palau
Midway Islands
Puerto Rico
U.S. Minor Outlying Islands
Navassa Island
U.S. Virgin Islands
Wake Island
Baker Island
Howland Island
Jarvis Island
Kingman Reef
WYOMING CHIP
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2751
2752
2753
2754
2755
2756
STATE
STATE
STATE
STATE
STATE
STATE
State Code List
State Code List
State Code List
State Code List
State Code List
State Code List
94
95
96
97
99
See
"VVL_Code_Description"
field
MONTANA TPA
Palmyra Atoll
Iowa (CHIP) - I4
Pennsylvania (CHIP) - P1
Test State
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code sets.
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't
block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
For background and context, see https://www.census.gov/library/reference/codelists/ansi.html#par_textimage_3
2757
2758
2759
2760
2761
2762
2763
2764
2765
2766
2767
2768
2769
2770
STATE-PLAN-ENROLLMENT
STATE-PLAN-ENROLLMENT
STATE-PLAN-ENROLLMENT
STATE-PLAN-ENROLLMENT
STATE-PLAN-OPTION-TYPE
STATE-PLAN-OPTION-TYPE
STATE-PLAN-OPTION-TYPE
STATE-PLAN-OPTION-TYPE
STATE-PLAN-OPTION-TYPE
STATE-PLAN-OPTION-TYPE
STATE-PLAN-OPTION-TYPE
SUBCAPITATION-IND
SUBCAPITATION-IND
SUBMISSION-TRANSACTIONTYPE
State Plan Enrollment List
State Plan Enrollment List
State Plan Enrollment List
State Plan Enrollment List
State Plan Option Type List
State Plan Option Type List
State Plan Option Type List
State Plan Option Type List
State Plan Option Type List
State Plan Option Type List
State Plan Option Type List
Subcapitation Indicator List
Subcapitation Indicator List
Submission Transaction Type
List
1
2
3
4
00
01
02
03
04
05
06
1
2
C
Medicaid
CHIP
Both Medicaid and CHIP
Not state plan affiliated
Not Applicable
Community First Choice
1915(i)
1915(j)
1932(a)
1915(a)
1937 (Alternative Benefit Plans)
No, transaction is not a sub-capitation payment or recoupment
Yes, transaction is a sub-capitation or recoupment
Create File - -a file that contains a complete set of transactions/changes processed since
the last Create file submission. States may submit only one valid Create file per reporting
period and data file type.
2771
SUBMISSION-TRANSACTIONTYPE
Submission Transaction Type
List
R
Replacement File - -a Replacement submission is a replacement of the month's data. It
will completely replace the immediate prior submission. If a later replacement entry is
received, it will overwrite the previous replacement, as well as a prior Create or Update
submission for the same data type and reporting period.
01/01/0001
12/31/9999
2772
SUBMISSION-TRANSACTIONTYPE
Submission Transaction Type
List
U
Update File - -a file that contains T-MSIS record segments created in response to business 01/01/0001
rule rejects. Note: The records in an Update file are not generated as a result of a change
processed in the state's Medicaid or Medicaid-related systems during the current
reporting month. These Update file record segments may be unchanged from the ones
submitted previously for various reasons (for example, the state may be unable to process
a change record in their Medicaid / Medicaid-related systems to correct the issue because
the state is simply passing through to T-MSIS data that originated outside of the state's
systems).[1] Conversely, the records may be different from those previously submitted,
but the change is the result of a fix whose root cause problem was an issue in the T-MSIS
file-creation or replacement process at CMS. Regardless, the record was not generated
from a change that occurred in the state's source data.
12/31/9999
2773
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
01
Alabama
State Code List
02
Alaska
State Code List
04
Arizona
2774
2775
2776
2777
2778
2779
2780
2781
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
05
Arkansas
State Code List
06
California
State Code List
08
Colorado
State Code List
09
Connecticut
State Code List
10
Delaware
State Code List
11
District of Columbia
2782
2783
2784
2785
2786
2787
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
12
Florida
State Code List
13
Georgia
State Code List
15
Hawaii
State Code List
16
Idaho
State Code List
17
Illinois
State Code List
18
Indiana
2788
2789
2790
2791
2792
2793
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
19
Iowa
State Code List
20
Kansas
State Code List
21
Kentucky
State Code List
22
Louisiana
State Code List
23
Maine
State Code List
24
Maryland
2794
2795
2796
2797
2798
2799
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
25
Massachusetts
State Code List
26
Michigan
State Code List
27
Minnesota
State Code List
28
Mississippi
State Code List
29
Missouri
State Code List
30
Montana
2800
2801
2802
2803
2804
2805
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
31
Nebraska
State Code List
32
Nevada
State Code List
33
New Hampshire
State Code List
34
New Jersey
State Code List
35
New Mexico
State Code List
36
New York
2806
2807
2808
2809
2810
2811
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
37
North Carolina
State Code List
38
North Dakota
State Code List
39
Ohio
State Code List
40
Oklahoma
State Code List
41
Oregon
State Code List
42
Pennsylvania
2812
2813
2814
2815
2816
2817
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
44
Rhode Island
State Code List
45
South Carolina
State Code List
46
South Dakota
State Code List
47
Tennessee
State Code List
48
Texas
State Code List
49
Utah
2818
2819
2820
2821
2822
2823
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
50
Vermont
State Code List
51
Virginia
State Code List
53
Washington
State Code List
54
West Virginia
State Code List
55
Wisconsin
State Code List
56
Wyoming
2824
2825
2826
2827
2828
2829
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
State Code List
60
American Samoa
State Code List
66
Guam
State Code List
72
Puerto Rico
State Code List
78
U.S. Virgin Islands
State Code List
93
Wyoming (CHIP) - W4
State Code List
94
Montana (TPA) - M8
2830
2831
2832
2833
2834
2835
2836
2837
SUBMITTING-STATE /
State Code List
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
State Code List
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
State Code List
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
State Code List
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
SUBMITTING-STATE /
State Code List
MANAGED-CARE-STATE / ADDRSTATE / ELIGIBLE-STATE /
INSURANCE-CARRIER-STATE /
ORIGINATION-STATE /
DESTINATION-STATE
TANF-CASH-CODE
TANF Cash Code List
TANF-CASH-CODE
TANF Cash Code List
TANF-CASH-CODE
TANF Cash Code List
96
Iowa (CHIP) - I4
97
Pennsylvania (CHIP) - P1
Not Applicable
This URL will take the reader to the American National Standards Institute (ANSI) Website
for the various geographical code sets:
Not Applicable
State Code List
Not Applicable
The list is based on ANSI state codes but in some cases have been modified to meet TMSIS needs.
0
1
2
Individual was not eligible for mMedicaid.
Individual did not receive TANF benefits
Individual did receive TANF benefits (States should only use this value if they can
accurately separate eligible receiving TANF benefits from other 1931 eligible) reported
into MAS 1)
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
2838
2839
2840
2841
2842
2843
2844
2845
2846
2847
2848
2849
2850
2851
2852
2853
2854
2855
2856
2857
2858
2859
2860
2861
2862
2863
2864
2865
2866
2867
TEACHING-IND
TEACHING-IND
TOOTH-DESIGNATION-SYSTEM
TOOTH-DESIGNATION-SYSTEM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
Teaching Indicator List
Teaching Indicator List
Tooth Designation System List
Tooth Designation System List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
0
1
JO
JP
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
No
Yes
ANSI/ADA/ISO Specification No. 3950
ADA's Universal/National Tooth Designation system
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2868
2869
2870
2871
2872
2873
2874
2875
2876
2877
2878
2879
2880
2881
2882
2883
2884
2885
2886
2887
2888
2889
2890
2891
2892
2893
2894
2895
2896
2897
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
27
28
29
30
31
32
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2898
2899
2900
2901
2902
2903
2904
2905
2906
2907
2908
2909
2910
2911
2912
2913
2914
2915
2916
2917
2918
2919
2920
2921
2922
2923
2924
2925
2926
2927
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
75
76
77
78
79
80
81
82
A
AS
B
BS
C
CS
D
DS
E
ES
F
FS
G
GS
H
HS
I
IS
J
JS
K
KS
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Upper Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2928
2929
2930
2931
2932
2933
2934
2935
2936
2937
2938
2939
2940
2941
2942
2943
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Number List
L
LS
M
MS
N
NS
O
OS
P
PS
Q
QS
R
RS
S
See
"VVL_Code_Description"
field
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code sets.
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't
block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
For background and context, see https://www.ada.org/-/media/project/adaorganization/ada/ada-org/files/publications/cdt/ada_utds_value_set_v1_2022_aug.pdf
2944
2945
2946
2947
2948
2949
2950
2951
TOOTH-NUM
TOOTH-NUM
TOOTH-NUM
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
Tooth Number List
Tooth Number List
Tooth Number List
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
SS
T
TS
00
01
02
03
04
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Lower Arch, (commencing in the Upper right quadrant and rotating counterclockwise)
Entire Oral Cavity
Maxillary Area
Mandibular Area
Upper Right Sextant
Upper Anterior Sextant
2952
2953
2954
2955
2956
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
05
06
07
08
09
Upper Left Sextant
Lower Left Sextant
Lower Anterior Sextant
Lower Right Sextant
Other Area of Oral Cavity (An area specified in an annexed document or further
explanation available.)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2957
2958
2959
2960
2961
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
TOOTH-QUAD-CODE
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
Tooth Quad Code List
10
20
30
40
See
"VVL_Code_Description"
field
Upper Right Quadrant (Right Refers to the oral and skeletal structures on the right side.)
Upper Left Quadrant (Left Refers to the oral and skeletal structures on the left side.)
Lower Left Quadrant
Lower Right Quadrant
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code sets.
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't
block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ada.org/-/media/project/adaorganization/ada/adaorg/files/publications/cdt/areaoftheoralcavityandtoothanatomybycdtcode_2022jan.pdf
2962
2963
TOOTH-SURFACE-CODE
TOOTH-SURFACE-CODE
Tooth Surface Code List
Tooth Surface Code List
B
D
Buccal - The surface of the tooth which is closest to the cheek.
Distal - The surface of the tooth facing away from an invisible line drawn vertically
through the center of the face.
01/01/0001
01/01/0001
12/31/9999
12/31/9999
2964
2965
2966
2967
TOOTH-SURFACE-CODE
TOOTH-SURFACE-CODE
TOOTH-SURFACE-CODE
TOOTH-SURFACE-CODE
Tooth Surface Code List
Tooth Surface Code List
Tooth Surface Code List
Tooth Surface Code List
F
I
L
M
Facial - The surface of a tooth that is directed towards the face.
Incisal - The cutting edges of the anterior teeth.
Lingual - The surface of the tooth that is directed towards the tongue.
Mesial - The surface of a tooth which faces toward an invisible line drawn vertically
through the center of the face.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2968
TOOTH-SURFACE-CODE
Tooth Surface Code List
O
Occlusal - The surfaces of the posterior (back) teeth which provides the chewing function.
01/01/0001
12/31/9999
2969
TOOTH-SURFACE-CODE
Tooth Surface Code List
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code sets.
field
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't
block T-MSIS data submissions using the CSMO's latest version.
N/A
N/A
For background and context, see https://www.ada.org/-/media/project/adaorganization/ada/ada-org/files/publications/cdt/ada_utds_value_set_v1_2022_aug.pdf
2970
2971
2972
2973
2974
2975
2976
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-HEALTH-INSURANCECOVERAGE-IND
TPL Entity Address Type List
TPL Entity Address Type List
TPL Entity Address Type List
TPL Entity Address Type List
TPL Entity Address Type List
TPL Entity Address Type List
TPL Health Insurance Coverage
Indicator List
06
07
08
09
10
11
0
TPL-Entity Corporate Location
TPL-Entity Mailing
TPL-Entity Satellite Location
TPL-Entity Billing
TPL-Entity Correspondence
TPL-Other
Medicaid/CHIP eligibleEligible individual has no TPL insurance coverage.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2977
TPL-HEALTH-INSURANCECOVERAGE-IND
TPL Health Insurance Coverage
Indicator List
1
Medicaid/CHIP eligibleEligible individual does have TPL insurance coverage.
01/01/0001
12/31/9999
2978
TPL-OTHER-COVERAGE-IND
0
Medicaid/CHIP eligibleEligible individual has no other TPL funding available.
01/01/0001
12/31/9999
2979
TPL-OTHER-COVERAGE-IND
1
Medicaid/CHIP eligibleEligible individual does have other TPL funding available.
01/01/0001
12/31/9999
2980
2981
2982
2983
2984
TRANSACTION-TYPE
TRANSACTION-TYPE
TRANSACTION-TYPE
TRANSACTION-TYPE
TRANSACTION-TYPE
TPL Other Coverage Indicator
List
TPL Other Coverage Indicator
List
Transaction Type List
Transaction Type List
Transaction Type List
Transaction Type List
Transaction Type List
01
02
03
04
95
Kick payment
Provider retainer payment
Direct reimbursement to Bene for retroactive period cost (e.g. 42 CFR 447.25)
Direct reimbursement to Bene for non-emergency transportation
Other
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
2985
TYPE-OF-BILL
Type of Bill List
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code sets.
field
The CSMO is the system of record for those specific valid value code sets. While T-MSIS
endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't
block T-MSIS data submissions using the CSMO's latest version.
For background and context, see https://www.nubc.org/license
2986
2987
2988
2989
2990
2991
2992
2993
2994
2995
2996
2997
2998
2999
3000
3001
3002
3003
3004
3005
3006
3007
3008
3009
3010
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
0
1
1
1
1
1
Nonpayment/Zero Claims
Hospital
Inpatient
Rural Health Clinic (RHC)
Hospice (Nonhospital Based)
Admit Through Discharge Claim
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
2
2
2
2
2
3
3
3
3
3
4
4
4
4
4
5
5
5
Skilled Nursing
Inpatient
Hospital Based or Independent Renal Dialysis Facility
Hospice (Hospital Based)
Interim-First Claim
Home Health
Outpatient
Free Standing Provider-Based Federally Qualified Health Center (FQHC)
Ambulatory Surgical Center Services to Hospital Outpatients
Interim-Continuing Claims (Not valid for PPS Bills)
Religious Nonmedical (Hospital)
Other
Other Rehabilitation Facility (ORF)
Free Standing Birthing Center
Interim-Last Claim (Not valid for PPS Bills)
Reserved for national assignment (discontinued effective 10/1/05).
Intermediate Care - Level I
Comprehensive Outpatient Rehabilitation Facility (CORF)
N/A
N/A
3011
3012
3013
3014
3015
3016
3017
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
5
5
6
6
6
6
7
3018
3019
3020
3021
3022
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
7
7
7
7
8
3023
TYPE-OF-BILL
Type of Bill List
8
3024
3025
3026
3027
3028
3029
3030
3031
3032
3033
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
8
8
8
9
9
9
9
9
A
B
3034
3035
TYPE-OF-BILL
TYPE-OF-BILL
Type of Bill List
Type of Bill List
C
D
3036
3037
3038
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
Type of Bill List
Type of Bill List
Type of Bill List
E
F
G
Critical Access Hospital
Late Charge Only
Intermediate Care
Intermediate Care - Level II
Community Mental Health Center (CMHC)
Residential Facility
Clinic or Hospital Based Renal Dialysis Facility (requires special information in second digit
below).
Reserved for national assignment (discontinued effective 10/1/05).
Reserved for national assignment (discontinued effective 10/1/05)
Freestanding Non-residential Opioid Treatment Program (Effective 1/1/21)
Replacement of Prior Claim
Special facility or hospital ASC surgery (requires special information in second digit
below).
Swing Bed (may be used to indicate billing for SNF level of care in a hospital with an
approved swing bed agreement).
Licensed Freestanding Emergency Medical Facility (Effective 4/1/12)
Reserved for National Assignment
Void/Cancel of a Prior Claim
Reserved for National Assignment
Reserved for National Assignment
OTHER
OTHER
Final Claim for a Home Health PPS Episode
Admission/Election Notice
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Termination/Revocation Notice
Hospice Change of Provider Notice
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Void/Cancel
Hospice Change of Ownership
Beneficiary Initiated Adjustment Claim
CWF Initiated Adjustment Claim
3039
3040
3041
3042
3043
3044
3045
3046
3047
3048
3049
3050
3051
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List
Type of Bill List (2nd position;
Facility Type)
H
I
J
K
M
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
Not Applicable
P
1
CMS Initiated Adjustment Claim
FI Adjustment Claim (Other than QIO or Provider
Initiated Adjustment Claim-Other
OIG Initiated Adjustment Claim
MSP Initiated Adjustment Claim
1st Digit must always be a zero ('0')
2nd Digit-Type of Facility
3rd Digit-Bill Classification (Except Clinics and Special Facilities)
3rd Digit-Classification (Clinics Only)
3rd Digit-Classification (Special Facilities Only)
4th Digit-Frequency
QIO Adjustment Claim
Hospital
01/01/0001
12/31/9999
3052
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
2
Skilled Nursing
01/01/0001
12/31/9999
3053
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
3
Home Health
01/01/0001
12/31/9999
3054
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
4
Religious Nonmedical (Hospital)
01/01/0001
12/31/9999
3055
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
5
Reserved for national assignment (discontinued effective 10/1/05).
01/01/0001
10/01/2005
3056
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
6
Intermediate Care
01/01/0001
12/31/9999
3057
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
7
Clinic or Hospital Based Renal Dialysis Facility (requires special information in second digit
below).
01/01/0001
12/31/9999
3058
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
8
Special facility or hospital ASC surgery (requires special information in second digit below). 01/01/0001
12/31/9999
3059
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position;
Facility Type)
9
Reserved for National Assignment
12/31/9999
01/01/0001
3060
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3061
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3062
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3063
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3064
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3065
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3066
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3067
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3068
TYPE-OF-BILL-3-BILLCLASSIFICATION-CLINICS
3069
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
3070
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Clinics; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
1
Rural Health Clinic (RHC)
01/01/0001
12/31/9999
2
Hospital Based or Independent Renal Dialysis Facility
01/01/0001
12/31/9999
3
Free Standing Provider-Based Federally Qualified Health Center (FQHC)
01/01/0001
12/31/9999
4
Other Rehabilitation Facility (ORF)
01/01/0001
12/31/9999
5
Comprehensive Outpatient Rehabilitation Facility (CORF)
01/01/0001
12/31/9999
6
Community Mental Health Center (CMHC)
01/01/0001
12/31/9999
7
Federally Qualified Health Center (FQHC) (Effective 4/1/10)
04/01/2010
12/31/9999
8
Licensed Freestanding Emergency Medical Facility (Effective 4/1/12)
04/01/2012
12/31/9999
9
OTHER
01/01/0001
12/31/9999
1
Hospice (Nonhospital Based)
01/01/0001
12/31/9999
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
2
Hospice (Hospital Based)
01/01/0001
12/31/9999
3071
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
3
Ambulatory Surgical Center Services to Hospital Outpatients
01/01/0001
12/31/9999
3072
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
4
Free Standing Birthing Center
01/01/0001
12/31/9999
3073
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
5
Critical Access Hospital
01/01/0001
12/31/9999
3074
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
6
Residential Facility
01/01/0001
12/31/9999
3075
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
7
Freestanding Non-residential Opioid Treatment Program (Effective 1/1/21)
01/01/2021
12/31/9999
3076
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
8
Reserved for National Assignment
01/01/0001
12/31/9999
3077
TYPE-OF-BILL-3-BILLCLASSIFICATION-FACILITY
Type of Bill List (3rd position;
Facility Type: Facilities; Type of
Care)
9
OTHER
01/01/0001
12/31/9999
3078
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
1
Inpatient
01/01/0001
12/31/9999
3079
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
2
Inpatient
01/01/0001
12/31/9999
3080
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
3
Outpatient
01/01/0001
12/31/9999
3081
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
4
Other
01/01/0001
12/31/9999
3082
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
3083
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
3084
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
3085
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
3086
TYPE-OF-BILL-3-BILLCLASSIFICATION-OTHER
3087
TYPE-OF-BILL-4-FREQUENCY
3088
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill List (3rd position;
Facility Type: Other; Type of
Care)
Type of Bill list (4th position;
Frequency)
5
Intermediate Care - Level I
01/01/0001
12/31/9999
6
Intermediate Care - Level II
01/01/0001
12/31/9999
7
Reserved for national assignment (discontinued effective 10/1/05).
01/01/0001
10/01/2005
8
Swing Bed (may be used to indicate billing for SNF level of care in a hospital with an
approved swing bed agreement).
01/01/0001
12/31/9999
9
Reserved for National Assignment
01/01/0001
12/31/9999
0
Nonpayment/Zero Claims
01/01/0001
12/31/9999
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
1
Admit Through Discharge Claim
01/01/0001
12/31/9999
3089
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
2
Interim-First Claim
01/01/0001
12/31/9999
3090
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
3
Interim-Continuing Claims (Not valid for PPS Bills)
01/01/0001
12/31/9999
3091
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
A
Admission/Election Notice
01/01/0001
12/31/9999
3092
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
B
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Termination/Revocation Notice
01/01/0001
12/31/9999
3093
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
C
Hospice Change of Provider Notice
01/01/0001
12/31/9999
3094
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
D
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Void/Cancel
01/01/0001
12/31/9999
3095
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
E
Hospice Change of Ownership
01/01/0001
12/31/9999
3096
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
F
Beneficiary Initiated Adjustment Claim
01/01/0001
12/31/9999
3097
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
G
CWF Initiated Adjustment Claim
01/01/0001
12/31/9999
3098
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
H
CMS Initiated Adjustment Claim
01/01/0001
12/31/9999
3099
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
I
FI Adjustment Claim (Other than QIO or Provider
01/01/0001
12/31/9999
3100
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
J
Initiated Adjustment Claim-Other
01/01/0001
12/31/9999
3101
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
K
OIG Initiated Adjustment Claim
01/01/0001
12/31/9999
3102
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
M
MSP Initiated Adjustment Claim
01/01/0001
12/31/9999
3103
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position;
Frequency)
P
QIO Adjustment Claim
01/01/0001
12/31/9999
3104
3105
3106
3107
TYPE-OF-CLAIM
Type of Claim List
1
A Fee-For-Service Medicaid or Medicaid-expansion CHIP Claim
01/01/0001
12/31/9999
TYPE-OF-CLAIM
TYPE-OF-CLAIM
Type of Claim List
Type of Claim List
2
3
Medicaid or Medicaid-expansion CHIP Capitated Payment
Medicaid or Medicaid-expansion CHIP Managed Care Encounter (a.k.a. ""Dummy"")
record that simulates a bill for a service rendered to a patient covered under some form
of Capitation Plan. This includes billing records submitted by providers to non-state
entities (e.g., MCOs, health plans) for which the State has no financial liability since the at
risk entity has already received a capitated payment from the State.
01/01/0001
12/31/9999
3108
3109
TYPE-OF-CLAIM
TYPE-OF-CLAIM
Type of Claim List
Type of Claim List
4
5
3110
3111
TYPE-OF-CLAIM
TYPE-OF-CLAIM
Type of Claim List
Type of Claim List
A
B
Medicaid or Medicaid-expansion CHIP Service Tracking Claim
Medicaid or Medicaid-expansion CHIP Supplemental Payment (above capitation fee or
above negotiated rate) (e.g., FQHC additional reimbursement)
Separate CHIP (Title XXI) claim: A Fee-for-Service Claim
Separate CHIP (Title XXI) claim: Capitated Payment
01/01/0001
12/31/9999
3112
TYPE-OF-CLAIM
Type of Claim List
C
Separate CHIP (Title XXI) managed care encounter record that simulates a bill for a service
or items rendered to a patient covered under some form of Capitation Plan. This includes
billing records submitted by providers to non-State entities (e.g., MCOs, health plans) for
which a state has no financial liability as the at-risk entity has already received a capitated
payment from the state
3113
3114
TYPE-OF-CLAIM
TYPE-OF-CLAIM
Type of Claim List
Type of Claim List
D
E
3115
3116
3117
3118
3119
3120
TYPE-OF-CLAIM
TYPE-OF-CLAIM
TYPE-OF-CLAIM
TYPE-OF-CLAIM
TYPE-OF-CLAIM
TYPE-OF-CLAIM
Type of Claim List
Type of Claim List
Type of Claim List
Type of Claim List
Type of Claim List
Type of Claim List
U
V
W
X
Y
Z
Separate CHIP (Title XXI) Service Tracking Claim
Separate CHIP (Title XXI) claim for a supplemental payment (above capitation fee or
above negotiated rate) (e.g., FQHC additional reimbursement)
Other FFS claim
Other Capitated Payment
Other Managed Care Encounter
Non-Medicaid/CHIP service tracking claims
Other Supplemental Payment
Denied claims
3121
3122
3123
3124
3125
3126
3127
3128
3129
3130
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-OTHER-THIRD-PARTYLIABILITY
Type of Hospital List
Type of Hospital List
Type of Hospital List
Type of Hospital List
Type of Hospital List
Type of Hospital List
Type of Hospital List
Type of Hospital List
Type of Hospital List
Type of Other Third-Party Liability
List
3131
TYPE-OF-OTHER-THIRD-PARTYLIABILITY
3132
TYPE-OF-OTHER-THIRD-PARTYLIABILITY
01/01/0001
12/31/9999
01/01/0001
12/31/9999
01/01/0001
12/31/9999
01/01/0001
06/30/2020
Not a hospital
Inpatient Hospital
Outpatient Hospital
Critical Access Hospital
Swing Bed Hospital
Inpatient Psychiatric Hospital
IHS Hospital
Children's Hospital
Other
Tort/Casualty Claim
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
Type of Other Third-Party Liability 2
List
Medical Malpractice
01/01/0001
12/31/9999
Type of Other Third-Party Liability 3
List
Estate (an estate, annuity or designated trust)
01/01/0001
12/31/9999
00
01
02
03
04
05
06
07
08
1
3133
TYPE-OF-OTHER-THIRD-PARTYLIABILITY
Type of Other Third-Party Liability 4
List
Liens
01/01/0001
12/31/9999
3134
TYPE-OF-OTHER-THIRD-PARTYLIABILITY
Type of Other Third-Party Liability 5
List
Worker's Compensation
01/01/0001
12/31/9999
3135
TYPE-OF-OTHER-THIRD-PARTYLIABILITY
Type of Other Third-Party Liability 6
List
Payments from an individual or group who has either voluntarily or been assigned
legal responsibility for the health care of one or more Medicaid recipients; fraternal
groups; unions
01/01/0001
12/31/9999
3136
TYPE-OF-OTHER-THIRD-PARTYLIABILITY
Type of Other Third-Party Liability 7
List
Other - unidentified
01/01/0001
12/31/9999
3137
TYPE-OF-SERVICE
001
Inpatient hospital services, other than services in an institution for mental diseases
3138
3139
3140
3141
3142
3143
3144
3145
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
002
003
004
005
006
007
008
009
3146
3147
3148
3149
3150
3151
3152
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Inpatient Claim)
List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Long Term
Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (RX Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
3153
3154
3155
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
016
017
018
Outpatient hospital services
Rural health clinic services
Other ambulatory services furnished by a rural health clinic
Professional laboratory services, Technical laboratory services
Technical laboratory services
Professional radiological services
Technical radiological services
Nursing facility services for individuals age 21 or older (other than services in an
institution for mental disease)
Early and periodic screening and diagnosis and treatment (EPSDT) services
Family planning services and supplies for individuals of child-bearing age
Family planning services and supplies for individuals of child-bearing age
Physicians' services
Medical and surgical services of a dentist
Outpatient substance abuse treatment services.
Medical or other remedial care or services, other than physicians' services, provided
by licensed practitioners within the scope of practice as defined under State law
Home health services - Nursing services
Home health services - Home health aide services
Home health services - Medical supplies, equipment, and appliances suitable for use
in the home
010
011
011
012
013
014
015
3156
TYPE-OF-SERVICE
Type of Service (RX Claim) List
018
3157
TYPE-OF-SERVICE
Type of Service (Other Claim) List
019
3158
TYPE-OF-SERVICE
Type of Service (Other Claim) List
020
3159
TYPE-OF-SERVICE
Type of Service (Other Claim) List
021
3160
3161
3162
3163
3164
3165
3166
3167
3168
3169
3170
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
022
023
024
025
026
027
028
029
030
031
032
3171
3172
3173
3174
3175
3176
3177
3178
3179
3180
3181
3182
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (RX Claim) List
Type of Service (RX Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (RX Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
033
034
035
036
036
037
038
039
040
041
042
043
Home health services - Medical supplies, equipment, and appliances suitable for use
in the home
Home health services - Physical therapy provided by a home health agency or by a
facility licensed by the State to provide medical rehabilitation services
Home health services - Occupational therapy provided by a home health agency or by
a facility licensed by the State to provide medical rehabilitation services
Home health services - Speech pathology and audiology services provided by a home
health agency or by a facility licensed by the State to provide medical rehabilitation
services
Private duty nursing services
Advanced practice nurse services
Pediatric nurse
Nurse-midwife service
Nurse practitioner services
Respiratory care for ventilator-dependent individuals
Clinic services
Dental services
Physical therapy services (when not provided under home health services)
Occupational therapy services (when not provided under home health services)
Speech, hearing, and language disorders services (when not provided under home
health services)
Prescribed drugs
Over-the-counter medications.
Dentures
Medical equipment/prosthetic devices
Medical equipment/prosthetic devices
Eyeglasses
Hearing Aids
Diagnostic services
Screening services
Preventive services
Well-baby and well-child care services as defined by the State.
Rehabilitative services
3183
TYPE-OF-SERVICE
3184
TYPE-OF-SERVICE
3185
TYPE-OF-SERVICE
3186
TYPE-OF-SERVICE
3187
TYPE-OF-SERVICE
3188
TYPE-OF-SERVICE
3189
TYPE-OF-SERVICE
3190
Type of Service (Long Term
Claim) List
Type of Service (Long Term
Claim) List
Type of Service (Long Term
Claim) List
Type of Service (Long Term
Claim) List
Type of Service (Long Term
Claim) List
Type of Service (Other Claim) List
044
046
Inpatient hospital services for individuals age 65 or older in institutions for mental
diseases
Nursing facility services for individuals age 65 or older in institutions for mental
diseases
Intermediate care facility (ICF/IID) services
047
Nursing facility services, other than in institutions for mental diseases
048
Inpatient psychiatric services for individuals under age 21
049
055
056
057
058
Outpatient mental health services, other than Outpatient substance abuse treatment
services. This TOS includes services furnished in a State-operated mental hospital and
including community-based services.
Inpatient substance abuse treatment services and residential substance abuse
treatment services.
Inpatient substance abuse treatment services and residential substance abuse
treatment services.
Personal care services
Primary care case management services
Targeted case management services
Case Management services other than those that meet the definition of primary care
case management services or targeted case management services
Care coordination services
Transportation services
Enabling services
Services furnished in a religious nonmedical health care institution
050
TYPE-OF-SERVICE
Type of Service (Long Term
Claim) List
Type of Service (Other Claim) List
3191
3192
3193
3194
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
051
052
053
054
3195
3196
3197
3198
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
3199
TYPE-OF-SERVICE
3200
TYPE-OF-SERVICE
3201
3202
3203
3204
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Long Term
Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
059
Skilled nursing facility services for individuals under age 21
060
Emergency hospital services
060
061
062
063
Emergency hospital services
Critical access hospital services - OT
HCBS - Case management services
HCBS - Homemaker services
045
050
3205
3206
3207
3208
3209
3210
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
064
065
066
067
068
069
3211
3212
3213
3214
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
070
071
072
073
3215
3216
3217
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
074
075
076
3218
3219
3220
3221
3222
3223
3224
3225
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
077
078
079
080
081
082
083
084
3226
3227
3228
3229
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
084
085
085
086
Sterilizations
Prenatal care and pre-pregnancy family planning services and supplies.
Prenatal care and pre-pregnancy family planning services and supplies.
Other Pregnancy-related Procedures
3230
3231
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (RX Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
HCBS - Home health aide services
HCBS - Personal care services
HCBS - Adult day health services
HCBS - Habilitation services
HCBS - Respite care services
HCBS - Day treatment or other partial hospitalization services, psychosocial
rehabilitation services and clinic services (whether or not furnished in a facility) for
individuals with chronic mental illness
HCBS - Day Care
HCBS - Training for family members
HCBS - Minor modification to the home
HCBS - Other services requested by the agency and approved by CMS as cost effective
and necessary to avoid institutionalization
HCBS - Expanded habilitation services - Prevocational services
HCBS - Expanded habilitation services - Educational services
HCBS - Expanded habilitation services - Supported employment services, which
facilitate paid employment
HCBS-65-plus - Case management services
HCBS-65-plus - Homemaker services
HCBS-65-plus - Home health aide services
HCBS-65-plus - Personal care services
HCBS-65-plus - Adult day health services
HCBS-65-plus - Respite care services
HCBS-65-plus - Other medical and social services
Sterilizations
086
087
Other Pregnancy-related Procedures
Hospice services
3232
TYPE-OF-SERVICE
Type of Service (Other Claim) List
088
3233
3234
3235
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
089
089
090
3236
TYPE-OF-SERVICE
091
Skilled care - hospital residing
3237
TYPE-OF-SERVICE
092
Exceptional care - hospital residing
3238
TYPE-OF-SERVICE
093
Non-acute care - hospital residing
3239
3240
3241
3242
3243
3244
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
115
119
120
121
122
123
Residential care
Capitated payments to HMOs, HIOs, or PACE plans
Capitated payments for primary care case management (PCCM)
Premium payments for private health insurance
Capitated payments to prepaid health plans (PHPs)
Disproportionate share hospital (DSH) payments
3245
3246
3247
3248
3249
3250
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
123
127
127
131
131
132
Disproportionate share hospital (DSH) payments
Indian Health Service (IHS) - Family Plan
Indian Health Service (IHS) - Family Plan
Drug Rebates
Drug Rebates
Supplemental payment - inpatient
3251
TYPE-OF-SERVICE
133
Supplemental payment - nursing
3252
3253
TYPE-OF-SERVICE
TYPE-OF-SERVICE
134
135
Supplemental payment outpatient
EHR payments to provider
3254
3255
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (RX Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Inpatient Claim)
List
Type of Service (Inpatient Claim)
List
Type of Service (Inpatient Claim)
List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (RX Claim) List
Type of Service (Other Claim) List
Type of Service (RX Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Long Term
Claim) List
Type of Service (Other Claim) List
Type of Service (Inpatient Claim)
List
Type of Service (Other Claim) List
Type of Service (Inpatient Claim)
List
Any other health care services or items specified by the Secretary and not excluded
under regulations.
Disposable medical supplies.
Disposable medical supplies.
Critical access hospital services - IP
135
136
EHR payments to provider
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
3256
TYPE-OF-SERVICE
Type of Service (Long Term
Claim) List
136
3257
TYPE-OF-SERVICE
Type of Service (Other Claim) List
136
3258
TYPE-OF-SERVICE
Type of Service (RX Claim) List
136
3259
TYPE-OF-SERVICE
137
3260
TYPE-OF-SERVICE
137
COVID-19 testing-related services
3261
3262
3263
3264
3265
3266
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Inpatient Claim)
List
Type of Service (Long Term
Claim) List
Type of Service (Other Claim) List
Type of Service (RX Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARSCoV2 or the diagnosis of the virus that
causes COVID-19, and the administration of such in vitro diagnostic products
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARS-CoV-2 or the diagnosis of the virus that
causes COVID-19, and the administration of such in vitro diagnostic products
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARSCoV2 or the diagnosis of the virus that
causes COVID19, and the administration of such in vitro diagnostic products
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARS-CoV-2 or the diagnosis of the virus that
causes COVID-19, and the administration of such in vitro diagnostic products
COVID-19 testing-related services
137
137
138
139
140
141
3267
3268
3269
3270
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
TYPE-OF-SERVICE
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
Type of Service (Other Claim) List
142
143
144
145
COVID-19 testing-related services
COVID-19 testing-related services
Per member per month (PMPM) payments for health home services
Per member per month (PMPM) payments for Medicare Part A premiums
Per member per month (PMPM) payments for Medicare Part B premiums
Per member per month (PMPM) payments for Medicare Advantage Dual Special
Needs Plans (D-SNP) Medicare Part C
Per member per month (PMPM) payments for Medicare Part D premiums
Per member per month (PMPM) payments for other payments
Payments to individuals for personal assistance services under 1915(j)
Medication Assisted Treatment (MAT) services and drugs for evidenced-based
treatment of Opioid Use Disorder (OUD)
3271
TYPE-OF-SERVICE
Type of Service (RX Claim) List
145
3272
3273
3274
3275
3276
3277
3278
3279
3280
3281
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
Type of Service IP List
Type of Service IP List
Type of Service IP List
Type of Service IP List
Type of Service IP List
Type of Service IP List
Type of Service IP List
Type of Service IP List
Type of Service IP List
Type of Service IP List
001
058
060
084
086
090
091
092
093
136
3282
3283
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-LT
Type of Service IP List
Type of Service LT List
137
009
3284
TYPE-OF-SERVICE-LT
Type of Service LT List
3285
TYPE-OF-SERVICE-LT
3286
3287
3288
3289
3290
Medication Assisted Treatment (MAT) services and drugs for evidenced-based
treatment of Opioid Use Disorder (OUD)
Inpatient hospital services, other than services in an institution for mental diseases
Services furnished in a religious nonmedical health care institution
Emergency hospital services
Sterilizations
Other Pregnancy-related Procedures
Critical access hospital services - IP
Skilled care - hospital residing
Exceptional care - hospital residing
Non-acute care - hospital residing
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that
causes COVID–19, and the administration of such in vitro diagnostic products
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
03/18/2020
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
COVID–19 testing-related services
Nursing facility services for individuals age 21 or older (other than services in an
institution for mental disease)
03/18/2020
01/01/0001
12/31/9999
12/31/9999
044
Inpatient hospital services for individuals age 65 or older in institutions for mental
diseases
01/01/0001
12/31/9999
Type of Service LT List
045
01/01/0001
12/31/9999
TYPE-OF-SERVICE-LT
TYPE-OF-SERVICE-LT
TYPE-OF-SERVICE-LT
TYPE-OF-SERVICE-LT
Type of Service LT List
Type of Service LT List
Type of Service LT List
Type of Service LT List
046
047
048
050
Nursing facility services for individuals age 65 or older in institutions for mental
diseases
ICF/IID (Intermediate Care Facilities for individuals with Intellectual Disabilities)
Nursing facility services, other than in institutions for mental diseases
Inpatient psychiatric services for individuals under age 21
Inpatient substance abuse treatment services and residential substance abuse
treatment services.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
TYPE-OF-SERVICE-LT
Type of Service LT List
059
Skilled nursing facility services for individuals under age 21
01/01/0001
12/31/9999
3291
TYPE-OF-SERVICE-LT
Type of Service LT List
136
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that
causes COVID–19, and the administration of such in vitro diagnostic products
03/18/2020
12/31/9999
3292
3293
TYPE-OF-SERVICE-LT
TYPE-OF-SERVICE-LT
Type of Service LT List
Type of Service LT List
137
146
COVID–19 testing-related services
Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who
receive services in an institution for mental disease (IMD)
03/18/2020
01/01/0001
12/31/9999
12/31/9999
3294
TYPE-OF-SERVICE-LT
Type of Service LT List
147
Residential Pediatric Recovery Center (RPRC): A center or facility that furnishes items
and services for which medical assistance is available under the State plan to infants
with the diagnosis of neonatal abstinence syndrome without any other significant
medical risk factors.
01/01/0001
12/31/9999
3295
3296
3297
3298
3299
3300
3301
3302
3303
3304
3305
3306
3307
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
002
003
004
005
006
007
008
010
011
012
013
014
015
Outpatient hospital services
Rural health clinic services
Other ambulatory services furnished by a rural health clinic
Professional laboratory services, Technical laboratory services
Technical laboratory services
Professional radiological services
Technical radiological services
Early and periodic screening and diagnosis and treatment (EPSDT) services
Family planning services and supplies for individuals of child-bearing age
Physicians' services
Medical and surgical services of a dentist
Outpatient substance abuse treatment services.
Medical or other remedial care or services, other than physicians' services, provided
by licensed practitioners within the scope of practice as defined under State law
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3308
3309
3310
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
016
017
018
Home health services - Nursing services
Home health services - Home health aide services
Home health services - Medical supplies, equipment, and appliances suitable for use in
the home
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
3311
TYPE-OF-SERVICE-OT
Type of Service OT List
019
Home health services - Physical therapy provided by a home health agency or by a
facility licensed by the State to provide medical rehabilitation services
01/01/0001
12/31/9999
3312
TYPE-OF-SERVICE-OT
Type of Service OT List
020
Home health services - Occupational therapy provided by a home health agency or by
a facility licensed by the State to provide medical rehabilitation services
01/01/0001
12/31/9999
3313
TYPE-OF-SERVICE-OT
Type of Service OT List
021
Home health services - Speech pathology and audiology services provided by a home
health agency or by a facility licensed by the State to provide medical rehabilitation
services
01/01/0001
12/31/9999
3314
3315
3316
3317
3318
3319
3320
3321
3322
3323
3324
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
022
023
024
025
026
027
028
029
030
031
032
Private duty nursing services
Advanced practice nurse services
Pediatric nurse
Nurse-midwife service
Nurse practitioner services
Respiratory care for ventilator-dependent individuals
Clinic services
Dental services
Physical therapy services (when not provided under home health services)
Occupational therapy services (when not provided under home health services)
Speech, hearing, and language disorders services (when not provided under home
health services)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3325
3326
3327
3328
3329
3330
3331
3332
3333
3334
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
035
036
037
038
039
040
041
042
043
049
Dentures
Medical equipment/prosthetic devices
Eyeglasses
Hearing Aids
Diagnostic services
Screening services
Preventive services
Well-baby and well-child care services as defined by the State.
Rehabilitative services
Outpatient mental health services, other than Outpatient substance abuse treatment
services. This TOS includes services furnished in a State-operated mental hospital and
including community-based services.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3335
TYPE-OF-SERVICE-OT
Type of Service OT List
050
Inpatient substance abuse treatment services and residential substance abuse
treatment services.
01/01/0001
12/31/9999
3336
3337
3338
3339
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
051
052
053
054
Personal care services
Primary care case management services
Targeted case management services
Case Management services other than those that meet the definition of primary care
case management services or targeted case management services
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3340
3341
3342
3343
3344
3345
3346
3347
3348
3349
3350
3351
3352
3353
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
055
056
057
058
060
061
062
063
064
065
066
067
068
069
Care coordination services
Transportation services
Enabling services
Services furnished in a religious nonmedical health care institution
Emergency hospital services
Critical access hospital services - OT
HCBS - Case management services
HCBS - Homemaker services
HCBS - Home health aide services
HCBS - Personal care services
HCBS - Adult day health services
HCBS - Habilitation services
HCBS - Respite care services
HCBS - Day treatment or other partial hospitalization services, psychosocial
rehabilitation services and clinic services (whether or not furnished in a facility) for
individuals with chronic mental illness
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3354
3355
3356
3357
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
070
071
072
073
HCBS - Day Care
HCBS - Training for family members
HCBS - Minor modification to the home
HCBS - Other services requested by the agency and approved by CMS as cost effective
and necessary to avoid institutionalization
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3358
3359
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
074
075
HCBS - Expanded habilitation services - Prevocational services
HCBS - Expanded habilitation services - Educational services
01/01/0001
01/01/0001
12/31/9999
12/31/9999
3360
TYPE-OF-SERVICE-OT
Type of Service OT List
076
HCBS - Expanded habilitation services - Supported employment services, which
facilitate paid employment
01/01/0001
12/31/9999
3361
3362
3363
3364
3365
3366
3367
3368
3369
3370
3371
3372
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
077
078
079
080
081
082
083
084
085
086
087
088
HCBS-65-plus - Case management services
HCBS-65-plus - Homemaker services
HCBS-65-plus - Home health aide services
HCBS-65-plus - Personal care services
HCBS-65-plus - Adult day health services
HCBS-65-plus - Respite care services
HCBS-65-plus - Other medical and social services
Sterilizations
Prenatal care and pre-pregnancy family planning services and supplies.
Other Pregnancy-related Procedures
Hospice services
Any other health care services or items specified by the Secretary and not excluded
under regulations.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3373
3374
3375
3376
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
Type of Service OT List
Type of Service OT List
089
115
127
136
Disposable medical supplies.
Residential care
Indian Health Service (IHS) - Family Plan
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that
causes COVID–19, and the administration of such in vitro diagnostic products
01/01/0001
01/01/0001
01/01/0001
03/18/2020
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3377
3378
3379
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
Type of Service OT List
Type of Service RX List
Type of Service RX List
137
011
018
COVID–19 testing-related services
Family planning services and supplies for individuals of child-bearing age
Home health services - Medical supplies, equipment, and appliances suitable for use in
the home
03/18/2020
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
3380
3381
3382
3383
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
Type of Service RX List
Type of Service RX List
Type of Service RX List
Type of Service RX List
033
034
036
085
Prescribed drugs
Over-the-counter medications.
Medical equipment/prosthetic devices
Prenatal care and pre-pregnancy family planning services and supplies.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3384
3385
3386
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
Type of Service RX List
Type of Service RX List
Type of Service RX List
089
127
136
Disposable medical supplies.
Indian Health Service (IHS) - Family Plan
In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal
Regulations) administered during any portion of the emergency period defined in
paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of
this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that
causes COVID–19, and the administration of such in vitro diagnostic products
01/01/0001
01/01/0001
03/18/2020
12/31/9999
12/31/9999
12/31/9999
3387
3388
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
Type of Service RX List
Type of Service RX List
137
145
COVID–19 testing-related services
Medication Assisted Treatment (MAT) services and drugs for evidenced-based
treatment of Opioid Use Disorder (OUD) in accordance with section 1905(a)(29) of the
Social Security Act
03/18/2020
10/01/2020
12/31/9999
12/31/9999
3389
3390
3391
3392
3393
3394
3395
UNIT-OF-MEASURE
UNIT-OF-MEASURE
UNIT-OF-MEASURE
UNIT-OF-MEASURE
UNIT-OF-MEASURE
UNIT-OF-MEASURE
UNIT-OF-MEASURE
Unit of Measure List
Unit of Measure List
Unit of Measure List
Unit of Measure List
Unit of Measure List
Unit of Measure List
Unit of Measure List
EA
F2
GM
GR
ME
ML
See
"VVL_Code_Description"
field
Each
International Unit
Grams
Gram
Milligram
Milliliter
This data element's valid value code set is maintained by a Code Set Maintenance
Organization (CSMO), the official licensing organization for specific valid value code
sets. The CSMO is the system of record for those specific valid value code sets. While
T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ncpdp.org/
3396
3397
UNIT-OF-MEASURE
VALUE-BASED-PAYMENT-MODELTYPE
NDC Unit of Measure List
Value Based Payment Model
Type List
UN
2A
Unit
FFS/Q&V Foundational payments for infrastructure and operations
01/01/0001
01/01/0001
12/31/9999
12/31/9999
3398
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
2B
FFS/Q&V Pay for reporting
01/01/0001
12/31/9999
3399
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
2C
FFS/Q&V Pay for performance
01/01/0001
12/31/9999
3400
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
3A
APM/FFS APMs with Shared savings
01/01/0001
12/31/9999
3401
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
3B
APM/FFS APMs with shared savings and downside risk
01/01/0001
12/31/9999
3402
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
3N
APM/FFS Risk based payments NOT linked to quality
01/01/0001
12/31/9999
3403
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
4A
POP/PAY Condition-specific population-based payment
01/01/0001
12/31/9999
3404
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
4B
POP/PAY Comprehensive population-based payment
01/01/0001
12/31/9999
3405
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
4C
POP/PAY Integrated finance and delivery system
01/01/0001
12/31/9999
3406
VALUE-BASED-PAYMENT-MODELTYPE
Value Based Payment Model
Type List
4N
POP/PAY Capitated payments NOT linked to quality
01/01/0001
12/31/9999
3407
3408
3409
3410
VETERAN-IND
VETERAN-IND
WAIVER-TYPE
WAIVER-TYPE
Veteran Indicator List
Veteran Indicator List
Waiver Type List
Waiver Type List
0
1
01
02
No
Yes
1115 Other demonstration
1915(b)(1) - These waivers permit freedom-of-choice or mandatory managed care with
some voluntary managed care.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3411
3412
WAIVER-TYPE
WAIVER-TYPE
Waiver Type List
Waiver Type List
03
04
1915(b)(2) - These waivers allow states to use enrollment brokers.
1915(b)(3) - These waivers allow states to use savings to provide additional services
that are not in the State Plan.
01/01/0001
01/01/0001
12/31/9999
12/31/9999
3413
3414
3415
3416
3417
3418
3419
3420
3421
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
05
06
07
08
09
10
11
12
13
1915(b)(4) - These waivers allow fee for service selective contracting.
1915(c) - )-Aged and Disabled
1915(c) - )-Aged
1915(c) - )-Physical Disabilities
1915(c) - )-Intellectual Disabilities
1915(c) - )-Intellectual and Developmental Disabilities
1915(c) - )-Brain Injury
1915(c) - )-HIV/AIDS
1915(c) - )-Technology Dependent or Medically Fragile
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3422
3423
3424
3425
3426
3427
3428
3429
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
14
15
16
17
18
19
20
21
1915(c) - )-Disabled (other)
1915(c) - )-Enrolled in 1915(c) waiver for unspecified or unknown populations
1915(c) - )-Autism/Autism spectrum disorder
1915(c) - )-Developmental Disabilities
1915(c) - )-Mental Illness-Age 18 or Older
1915(c) - )-Mental Illness-Under Age 18
1915(c) waiver concurrent with an 1115 or 1915(b) managed care authority
1115 HIFA Waiver - The associated Waiver-ID is for a HIFA (Health Insurance and
Flexibility and Accountability (HIFA)) waiver. May also be called demonstration waiver
or refer to the eligibility expansion.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
3430
3431
3432
3433
3434
3435
3436
3437
3438
3439
3440
3441
3442
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
22
23
24
25
26
27
28
29
30
31
32
33
7
1115 Pharmacy demonstration
1115 Disaster-related demonstration
1115 Family planning demonstration
1115 Substance use demonstration
1115 Premium Assistance demonstration
1115 Beneficiary engagement demonstration
1115 Former foster care youth from another state
1115 Managed long term services and support
1115 Delivery system reform
1332 Demonstration
1915(b) waiver
1915(c) waiver
Prescribed Drugs
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
8
Dental Services
10
Clinic Services
11
Laboratory/Radiological
12
Home Health Services
3443
3444
3445
3446
3447
3448
3449
3450
3451
3452
3453
3454
3455
3456
3457
3458
3459
3460
3461
3462
3463
3464
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
13
Sterilizations
14
Other Pregnancy-related Procedures
15
EPSDT Screening
16
Rural Health
22
All-Inclusive Care Elderly
25
Primary Care Case Management
26
Hospice Benefits
27
Emergency Services for Undocumented Aliens
28
Federally-Qualified Health Center
29
Non-Emergency Medical Transportation
30
Physical Therapy
31
Occupational Therapy
32
Services for Speech, Hearing & Language
33
Prosthetic Devices, Dentures, Eyeglasses
34
Diagnostic Screening & Preventive Services
35
Nurse Mid-Wife
36
Emergency Hospital Services
37
Critical Access Hospitals
3465
3466
3467
3468
3469
3470
3471
3472
3473
3474
3475
3476
3477
3478
3479
3480
3481
3482
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
38
Nurse Practitioner Services
39
School Based Services
40
Rehabilitative Services (non-school-based)
41
Private Duty Nursing
42
Freestanding Birth Center
43
Health Home for Enrollees w Chronic Conditions
44
Tobacco Cessation for Pregnant Women
45
49
Health Homes for Substance-Use-Disorder Enrollees per section 1006 of the SUPPORT
for Patients and Communities Act
Other Care Services
50
Total
17A
Medicare - Part A
17B
Medicare - Part B
17C1
120% - 134% Of Poverty
17D
Coinsurance
18A
Medicaid - MCO
18A1
Medicaid MCO - Evaluation and Management
18A2
Medicaid MCO - Vaccine codes
18A3
Medicaid MCO - Community First Choice
3483
3484
3485
3486
3487
3488
3489
3490
3491
3492
3493
3494
3495
3496
3497
3498
3499
3500
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
18A4
Medicaid MCO - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
18B1
Prepaid Ambulatory Health Plan
18B1a
MCO PAHP - Evaluation and Management
18B1b
MCO PAHP - Vaccine codes
18B1c
MCO PAHP - Community First Choice
18B1d
MCO PAHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
18B2
Prepaid Inpatient Health Plan
18B2a
MCO PIHP - Evaluation and Management
18B2b
MCO PIHP - Vaccine codes
18B2c
MCO PIHP - Community First Choice
18B2d
MCO PIHP - Preventive Services Grade A OR B, ACIP Vaccines and their Admin
18C
Medicaid - Group Health
18D
Medicaid - Coinsurance
18E
Medicaid - Other
19A
Home & Community-Based Services - Reg. Pay. (Waiv)
19B
Home & Community-Based Services - St. Plan 1915(i) Only Pay.
19C
Home & Community-Based Services - St. Plan 1915(j) Only Pay.
19D
Home & Community Based Services State Plan 1915(k) Community First Choice
3501
3502
3503
3504
3505
3506
3507
3508
3509
3510
3511
3512
3513
3514
3515
3516
3517
3518
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
1A
Inpatient Hospital - Reg. Payments
1B
Inpatient Hospital - DSH
1C
Inpatient Hospital - Sup. Payments
1D
Inpatient Hospital - GME Payments
23A
Personal Care Services - Reg. Payments
23B
Personal Care Services - SDS 1915(j)
24A
Targeted Case Management Services - Com. Case-Man.
24B
Case Management - State Wide
2A
Mental Health Facility Services - Reg. Payments
2B
Mental Health Facility - DSH
34A
Preventive Services Grade A OR B, ACIP Vaccines and their Admin
3A
Nursing Facility Services - Reg. Payments
3B
Nursing Facility Services - Sup. Payments
4A
5A
Intermediate Care Facility Services Individuals with Intellectual Disabilities: Public
Providers
Intermediate Care Facility Services - Individuals with Intellectual Disabilities: Private
Providers
Intermediate Care Facility Services Individuals with Intellectual Disabilities:
Supplemental Payments
Physician & Surgical Services - Reg. Payments
5B
Physician & Surgical Services - Sup. Payments
4B
4C
3519
3520
3521
3522
3523
3524
3525
3526
3527
3528
3529
3530
3531
3532
3533
3534
3535
3536
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XIX-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XIX MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
5C
Physician & Surgical Services - Evaluation and Management
5D
Physician & Surgical Services - Vaccine codes
6A
Outpatient Hospital Services - Reg. Payments
6B
Outpatient Hospital Services - Sup. Payments
7A1
Drug Rebate Offset - National
7A2
Drug Rebate Offset - State Sidebar Agreement
7A3
MCO - National Agreement
7A4
MCO - State Sidebar Agreement
7A5
Increased ACA OFFSET - Fee for Service - 100%
7A6
Increased ACA OFFSET - MCO - 100%
9A
Other Practitioners Services - Reg. Payments
9B
Other Practitioners Services - Sup. Payments
2
Inpatient Hospital
3
Inpatient Mental Health
4
Nursing Care Services
5
Physician/Surgical
6
Outpatient Hospital
7
Outpatient Mental Health
3537
3538
3539
3540
3541
3542
3543
3544
3545
3546
3547
3548
3549
3550
3551
3552
3553
3554
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
8
Prescribed Drugs
9
Dental Services
10
Vision Services
11
Other Practitioners
12
Clinic Services
13
Therapy Services
14
Laboratory/Radiological
15
Medical Equipment
16
Family Planning
17
Other Pregnancy-related Procedures
18
Screening Services
19
Home Health
20
Health Services Initiatives
21
Home and Community
22
Hospice
23
Medical Transportation
24
Case Management
25
Translation and Interpretation
3555
3556
3557
3558
3559
3560
3561
3562
3563
3564
3565
3566
3567
3568
3569
3570
3571
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI-MBESCBES-CATEGORY-OFSERVICE
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
XXI MBESCBES Category of
Service List
31
Other Services
32
Outreach
33
Administration
34
PERM Administration
35
Citizenship Verification Technology CHIPRA
48
Balance
49
Less: Collections
50
Total
1A
Premiums - Up To 150%: Gross Premiums Paid
1B
Premiums - Up To 150%: Cost Sharing Offset
1C
Premiums - Over 150%: Gross Premiums Paid
1D
Premiums - Over 150%: Cost Sharing Offset
32A
Increased Outreach and Enrollment of Indians
32B
Increase outreach and enrollment of children through premium subsidies
35A
CVT Development
35B
CVT Operation
8A
Drug Rebate
3572
ZIP-CODE
Zip Code List
See
This data element's valid value code set is maintained by a Code Set Maintenance
"VVL_Code_Description" Organization (CSMO), the official licensing organization for specific valid value code
field
sets. The CSMO is the system of record for those specific valid value code sets. While
T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that
shouldn't block T-MSIS data submissions using the CSMO's latest version.
For background and context,
https://tools.usps.com/zip-code-lookup.htm?bycitystate
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| File Type | application/pdf |
| File Modified | 2024-07-01 |
| File Created | 2024-07-01 |