Document
T-MSIS Valid Value List (VVL) - Changes Between Versions 4.0.0 and 4.1.1 Redline
ICR 202610-0938-005 · OMB 0938-0345 · Object 173982800.
Document Viewer [pdf]
Status: Original and derived artifacts are available for this document.
Download: pdf
Loading document viewer…
Document Metadata
| File Type | application/pdf |
|---|---|
| File Title | T-MSIS Valid Value List (VVL) - Changes Between Versions 4.0.0 and 4.1.1 Redline |
| Subject | T-MSIS Valid Value List (VVL) - Changes Between Versions 4.0.0 and 4.1.1 Redline |
| Author | CMS |
| Last Modified By | Microsoft® Word for Microsoft 365 |
| File Modified | 2026-05-29 |
| File Created | 2026-05-29 |
| Conversion State | complete |
Extracted Text
Centers for Medicaid and CHIP Services (CMCS)
T-MSIS Valid Value Lists (VVLs) - Changes Between Versions 4.0.0 and 4.1.1 Redline
Last Modified: 2026-05-29
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 Medicai d 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 pers ons 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 0938 -0345 (Expires: 11/30/2027. The time required to complete this information collection is estimated to average 1 1.25 hours per response, including
the time to review instructions, search existing data resources, gather the data needed, and complete and review the informat ion 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.
Color Coding Key:
Black indicates no change.
Red indicates content has been added or changed
Red with strike-out indicates content has been removed.
1
VVL Field
VVL Name
VVL Code
VVL Code Description
Effective
Start Date
Effective
End Date
1115A-DEMONSTRATION-IND
1115A-DEMONSTRATION-IND
1115A Demonstration Indicator List
1115A Demonstration Indicator List
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
0
1
2
3
Not a 1115A
1115A
Inpatient Hospital
Inpatient Mental Health
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
4
5
Nursing Care Services
Physician/Surgical
01/01/0001
01/01/0001
12/31/9999
12/31/9999
6
7
Outpatient Hospital
Outpatient Mental Health
01/01/0001
01/01/0001
12/31/9999
12/31/9999
8
9
Prescribed Drugs
Dental Services
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
10
11
Vision Services
Other Practitioners
01/01/0001
01/01/0001
12/31/9999
12/31/9999
21.P-FORM
21.P-FORM
21.P Form List
21.P Form List
21.P-FORM
21.P-FORM
21.P Form List
21.P Form List
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
12
13
14
15
16
17
18
19
20
21
22
23
Clinic Services
Therapy Services
Laboratory/Radiological
Medical Equipment
Family Planning
Abortions
Screening Services
Home Health
Health Services Initiatives
Home and Community
Hospice
Medical Transportation
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
24
Case Management
01/01/0001
12/31/9999
2
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
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
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
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
21BASE-FORM
21BASE Form List
21BASE Form List
25
26
31
32
33
34
35
1A
1B
1C
1D
32A
32B
35A
35B
8A
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
2
3
4
5
6
7
8
9
10
11
12
13
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
3
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-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
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
21BASE-FORM
21BASE-FORM
21BASE Form List
21BASE Form List
21BASE-FORM
21BASE-FORM
21BASE Form List
21BASE Form List
21BASE-FORM
21BASE-FORM
21BASE-FORM
21BASE-FORM
64.10BASE-FORM
21BASE Form List
21BASE Form List
21BASE Form List
21BASE Form List
64.10BASE Form List
14
15
16
17
18
19
20
21
22
23
24
25
26
31
32
33
Laboratory/Radiological
Medical Equipment
Family Planning
Abortions
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
34
35
1A
1B
1C
1D
32A
32B
35A
35B
8A
29
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
4
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
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
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
64.21U-FORM
64.21U Form List
64.21U Form List
64.21U-FORM
64.21U-FORM
64.21U Form List
64.21U Form List
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
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Inpatient Hospital Services - Reg. Payments
Inpatient Mental Health - Reg. Payment
Nursing Care Services
Physician/Surgical
Outpatient Hospital Services
Outpatient Mental Health
Prescribed Drugs
Dental Services
Vision Services
Other Practitioners
Clinic Services
Therapy Services
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
18
19
20
21
22
23
24
26
31
1A
1B
1C
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
5
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
64.21U-FORM
64.21U-FORM
64.21U-FORM
64.21U-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
64.21U Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP-FORM
64.21UP-FORM
64.21UP Form List
64.21UP Form List
64.21UP-FORM
64.21UP-FORM
64.21UP Form List
64.21UP Form List
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
1D
21A
2A
3A
3B
8A1
8A2
8A3
8A4
8A5
8A6
8A7
2
3
4
5
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
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
6
7
8
9
10
11
12
13
14
15
16
17
Outpatient Hospital
Outpatient Mental Health
Prescribed Drugs
Dental Services
Vision Services
Other Practitioners
Clinic services
Therapy Services
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
6
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-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
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP-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
64.21UP-FORM
64.21UP-FORM
64.21UP-FORM
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP Form List
64.21UP-FORM
64.21UP-FORM
64.21UP Form List
64.21UP Form List
64.21UP-FORM
64.21UP-FORM
64.21UP Form List
64.21UP Form List
64.21UP-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.21UP Form List
64.9A Form List
64.9A Form List
64.9A Form List
64.9A Form List
18
19
20
21
22
23
24
26
31
1A
1B
1C
1D
21A
2A
3A
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
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
3B
8A1
8A2
8A3
8A4
8A5
8A6
8A7
A1A
A1B1
A1B2
A1C
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
7
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
64.9A-FORM
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
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9A Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
A1C1
A1C2
A1C3
A1C4
A2
B1
B2
B3
7
8
11
12
13
14
15
16
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
Sterilizations
Abortions
EPSDT Screening
Rural 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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
22
25
26
27
28
30
31
32
33
34
35
36
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
38
39
40
41
42
43
44
45
46
47
48
49
69
10A
10B
17A
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
Medicare - Part 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
17B
17C1
17D
18A
18A1
18A2
18A3
18A4
18A5
18A6
18B1
18B1a
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
9
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
18B1b
18B1c
18B1d
18B1e
18B1f
18B2
18B2a
18B2b
18B2c
18B2d
18B2e
18B2f
18C
18D
18E
19A
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
19B
19C
19D
1A
1B
1C
1D
23A
23B
24A
24B
29A
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
10
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
29B
2A
2B
2C
34A
37A
37B
37C
3A
3B
46A1
46A2
46A3
46A4
46A5
46A6
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%
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
46B
4A
OUD Medicaid Assisted Treatment Services
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Public Providers
01/01/0001
01/01/0001
12/31/9999
12/31/9999
4B
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Private Providers
01/01/0001
12/31/9999
4C
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Supplemental
Payments
01/01/0001
12/31/9999
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
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
11
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE Form List
64.9BASE-FORM
64.9BASE-FORM
64.9BASE-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9BASE Form List
64.9BASE Form List
64.9BASE 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
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
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
6B
7A1
7A2
7A3
7A4
7A5
7A6
7A7
9A
9B
7
8
11
12
13
14
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
15
16
22
25
26
27
28
30
31
32
33
34
EPSDT Screen
Rural Health Clinic
Programs/All-Inclusive
Primary Care Case Manage
Hospice
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
35
36
38
39
40
41
42
43
44
45
46
47
48
49
69
10A
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
10B
17A
17B
17C1
17D
18A
18A1
18A2
18A3
18A4
18A5
18A6
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
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
13
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
18B1
18B1a
18B1b
18B1c
18B1d
18B1e
18B1f
18B2
18B2a
18B2b
18B2c
18B2d
18B2e
18B2f
18C
18D
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
18E
19A
19B
19C
19D
1A
1B
1C
1D
23A
23B
24A
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
Personal Care Services - SDS 1915(j)
Targeted Case Management Services - Com. Case-Man.
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
14
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
24B
29A
29B
2A
2B
2C
34A
37A
37B
37C
3A
3B
46A1
46A2
46A3
46A4
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
46A5
46A6
46B
4A
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
64.9P-FORM
64.9P Form List
4B
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Private Providers
01/01/0001
12/31/9999
64.9P-FORM
64.9P Form List
4C
Intermediate Care Facility Services - Ind. with Intellectual Disabilities: Supplemental
Payments
01/01/0001
12/31/9999
64.9P-FORM
64.9P-FORM
64.9P-FORM
64.9P Form List
64.9P Form List
64.9P Form List
5A
5B
5C
Physician & Surgical Services - Reg. Payments
Physician & Surgical Services - Sup. Payments
Physician & Surgical Services - Evaluation and Management
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
15
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
ACCEPTING-NEW-PATIENTS-IND
ACCEPTING-NEW-PATIENTS-IND
ACCEPTING-NEW-PATIENTS-IND
ACCREDITATION-ORGANIZATION
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
Accepting New Patients Indicator List
Accepting New Patients Indicator List
Accepting New Patients Indicator List
Accreditation Organization List
5D
6A
6B
7A1
7A2
7A3
7A4
7A5
7A6
7A7
9A
9B
0
1
8
01
Physician & Surgical Services - Vaccine codes
Outpatient Hospital Services - Reg. Payments
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
No
Yes
N/A - The individual only practices as a member of a group.
National committee for quality assurance - excellent
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
ACCREDITATION-ORGANIZATION
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
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
Accreditation Organization List
02
03
05
06
07
08
11
12
13
14
15
16
National committee for quality assurance - commendable
National committee for quality assurance - provisional
URAC - full
URAC - conditional
URAC - provisional
Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) - 3 years
Not accredited
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)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
16
ACCREDITATION-ORGANIZATION
Accreditation Organization List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://www.ncqa.org/programs/health-plans/healthplan-accreditation-hpa/ and https://www.aaahc.org/accreditation/accreditationgeneral-information/terms-of-accreditation/
ADDR-BORDER-STATE-IND
ADDR-BORDER-STATE-IND
ADDR-BORDER-STATE-IND
ADJUSTMENT-IND
Address Border State Indicator List
Address Border State Indicator List
Address Border State Indicator List
Adjustment Indicator List
0
1
8
0
No
Yes
N/A - State does not distinguish "border state providers".
Original Claim/Encounter/Payment/Financial Transaction - Indicates that this is the first
(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).
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
ADJUSTMENT-IND
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/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
17
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
ADJUSTMENT-IND
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/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.
01/01/0001
12/31/9999
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.
01/01/0001
12/31/9999
18
ADJUSTMENT-REASON-CODE
Adjustment Reason Code List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://x12.org/codes/claim-adjustment-reason-codes
ADMISSION-TYPE
ADMISSION-TYPE
Admission Type List
Admission Type List
1
2
EMERGENCY
URGENT
01/01/0001
01/01/0001
12/31/9999
12/31/9999
ADMISSION-TYPE
ADMISSION-TYPE
Admission Type List
Admission Type List
3
4
ELECTIVE
NEWBORN
01/01/0001
01/01/0001
12/31/9999
12/31/9999
ADMISSION-TYPE
ADMISSION-TYPE
Admission Type List
Admission Type List
5
9
TRAUMA
UNKNOWN
01/01/0001
01/01/0001
12/31/9999
12/31/9999
ADMISSION-TYPE
Admission Type List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://www.nubc.org/license
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
2
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.
01/01/0001
12/31/9999
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
3
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.
01/01/0001
12/31/9999
19
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
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
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
AFFILIATED-PROGRAM-TYPE
Affiliated Program Type List
7
Fee-For-Service - (This value is used to identify providers that are affiliated directly with
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.)
01/01/0001
12/31/9999
AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR
American Indian Alaska Native Indicator
List
0
Individual does not meet the definition of an American Indian/Alaska Native
01/01/0001
12/31/9999
AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR
American Indian Alaska Native Indicator
List
1
Individual meets the definition of an American Indian/Alaska Native
01/01/0001
12/31/9999
AMERICAN-INDIAN-ALASKA-NATIVE-INDICATOR
American Indian Alaska Native Indicator
List
2
Yes, Individual does have CDIB
01/01/0001
02/14/2020
ATYPICAL-PROV-IND
ATYPICAL-PROV-IND
Atypical Provider Indicator List
Atypical Provider Indicator List
0
1
No, the State does not consider this to be an atypical provider
Yes, the State considers this to be an atypical provider
01/01/0001
01/01/0001
12/31/9999
12/31/9999
20
BED-TYPE-CODE
Bed Type Code List
1
Intermediate Care Facility for the Intellectually Disabled bed not in an Institution for
Mental Disease
01/01/0001
12/31/9999
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
BED-TYPE-CODE
BED-TYPE-CODE
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BILLING-UNIT
BORDER-STATE-IND
BORDER-STATE-IND
BRAND-GENERIC-IND
BRAND-GENERIC-IND
BRAND-GENERIC-IND
CATEGORY-FOR-FEDERAL-REIMBURSEMENT
CATEGORY-FOR-FEDERAL-REIMBURSEMENT
CATEGORY-FOR-FEDERAL-REIMBURSEMENT
CATEGORY-FOR-FEDERAL-REIMBURSEMENT
CHIP-CODE
CHIP-CODE
Bed Type Code List
Bed 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
Border State Indicator List
Brand Generic Indicator List
Brand Generic Indicator List
Brand Generic Indicator List
Category for Federal Reimbursement List
Category for Federal Reimbursement List
Category for Federal Reimbursement List
Category for Federal Reimbursement List
CHIP Code List
CHIP Code List
6
7
01
02
03
04
05
06
07
0
1
0
1
2
01
02
03
04
0
1
Inpatient bed in an Institution for Mental Disease
Nursing Facility bed in an Institution for Mental Disease
Per Day
Per Hour
Per Case
Per Encounter
Per Week
Per Month
Other Arrangements
No
Yes
Non-Drug
Generic
Brand
Federal funding under Title XIX
Federal funding under Title XXI
Federal funding under ACA
Federal funding under other legislation
Individual was not Medicaid eligible and not eligible for separate CHIP for the month
Individual was Medicaid eligible, but was not included in either Medicaid-Expansion
CHIP or a separate title XXI CHIP) program for the month
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
09/30/2020
12/31/9999
02/14/2020
12/31/9999
21
CHIP-CODE
CHIP Code List
2
Individual was included in the Medicaid-Expansion CHIP program and subject to
enhanced Federal matching for the month
01/01/0001
12/31/9999
CHIP-CODE
CHIP Code List
3
Individual was not Medicaid-Expansion CHIP eligible, but was included in a separate
title XXI CHIP program for the month.
01/01/0001
12/31/9999
CITIZENSHIP-IND
CITIZENSHIP-IND
Citizenship Indicator List
Citizenship Indicator List
0
1
Non-citizen
U.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
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
CITIZENSHIP-VERIFICATION-FLAG
CITIZENSHIP-VERIFICATION-FLAG
CLAIM-DENIED-INDICATOR
CLAIM-DENIED-INDICATOR
CLAIM-PYMT-REM-CODE
Citizenship Verification Flag List
Citizenship Verification Flag List
Claim Denied Indicator List
Claim Denied Indicator List
Claim Payment Remittance Code List
0
1
0
1
See
"VVL_Code_Description"
field
Citizenship Verified
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 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
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
For background and context, see https://x12.org/codes/remittance-advice-remarkcodes
22
CLAIM-STATUS
Claim Status Code List
See
"VVL_Code_Description"
field
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.
N/A
N/A
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
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
For background and context, see https://x12.org/codes/claim-status-codes and
https://x12.org/codes/claim-status-codes
CLAIM-STATUS-CATEGORY
Claim Status Category List
See
"VVL_Code_Description"
field
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 http://www.wpcedi.com/reference/codelists/healthcare/claim-status-category-codes/
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 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
01
02
03
04
05
06
07
10
11
12
13
14
Capsule
Ointment
Cream
Suppository
Powder
Emulsion
Liquid
Tablet
Solution
Suspension
Lotion
Shampoo
23
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
COMPOUND-DOSAGE-FORM
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
Compound Dosage Form List
15
16
17
18
See
"VVL_Code_Description"
field
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 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
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ncpdp.org/
COMPOUND-DRUG-IND
COMPOUND-DRUG-IND
CONCEPTION-TO-BIRTH-IND
CONCEPTION-TO-BIRTH-IND
CONTINUOUS-ELIGIBILITY-CODE
Compound Drug Indicator List
Compound Drug Indicator List
Conception to Birth Indicator List
Conception to Birth Indicator List
Continuous Eligibility Code List
0
1
0
1
001
Not Compound
Compound
No
Yes
Continuous eligibility for children (optional per SSA 1902(e)(12) or 2105(a)(4)(A))
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
12/31/99
CONTINUOUS-ELIGIBILITY-CODE
CONTINUOUS-ELIGIBILITY-CODE
COPAY-WAIVED-IND
COPAY-WAIVED-IND
CORE-BASED-STATISTICAL-AREA-CODE
Continuous Eligibility Code List
Continuous Eligibility Code List
Copay Waived Indicator List
Copay Waived Indicator List
Core Based Statistical Area Code List
002
995
0
1
1
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
12/31/99
12/31/99
12/31/9999
12/31/9999
12/31/9999
CORE-BASED-STATISTICAL-AREA-CODE
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
CORE-BASED-STATISTICAL-AREA-CODE
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
24
COUNTY
US County Code List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://www.census.gov/library/reference/codelists/ansi.html#cou
COVERAGE-TYPE
COVERAGE-TYPE
Coverage Type List
Coverage Type List
01
02
Drug
Professional (Physician) Visit - Office
01/01/0001
01/01/0001
12/31/9999
12/31/9999
COVERAGE-TYPE
COVERAGE-TYPE
Coverage Type List
Coverage Type List
03
04
Dental Care
Inpatient Hospital
01/01/0001
01/01/0001
12/31/9999
12/31/9999
COVERAGE-TYPE
COVERAGE-TYPE
Coverage Type List
Coverage Type List
05
06
Outpatient Hospital
Nursing Home
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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 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
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Vision
Durable Med Equip (rent)
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
25
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
DIAGNOSIS-CODE
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
Diagnosis Code List
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
See
"VVL_Code_Description"
field
PT/OT/ST
Hospice
Transportation
Other
Not Crossover Claim
Crossover 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 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
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
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
For background and context, see
https://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/codes
DIAGNOSIS-CODE-FLAG
DIAGNOSIS-CODE-FLAG
DIAGNOSIS-POA-FLAG
DIAGNOSIS-POA-FLAG
Diagnosis Code Flag List
Diagnosis Code Flag List
Diagnosis POA Flag List
Diagnosis POA Flag List
1
2
1
N
ICD-9
ICD-10
Unreported/Not used. Exempt from POA reporting.
Diagnosis was not present at time of inpatient admission
26
DIAGNOSIS-POA-FLAG
Diagnosis POA Flag List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://www.nubc.org/license
DIAGNOSIS-POA-FLAG
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
DIAGNOSIS-POA-FLAG
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
DIAGNOSIS-POA-FLAG
DIAGNOSIS-TYPE
DIAGNOSIS-TYPE
Diagnosis POA Flag List
Diagnosis Type List
Diagnosis Type List
Y
A
D
Diagnosis was present at time of inpatient admission
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
01/01/0001
12/31/9999
12/31/99
12/31/99
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
12/31/99
12/31/99
12/31/99
12/31/99
12/31/9999
12/31/9999
12/31/9999
DISABILITY-TYPE-CODE
Disability Type Code List
04
Individual has serious difficulty walking or climbing stairs. (Applicable only to people
who are 5 years old or older.)
01/01/0001
12/31/9999
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
27
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
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 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
N/A
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ncpdp.org/
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
AD
439-E4: Additional Drug Needed
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
AN
439-E4: Prescription Authentication
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
AR
439-E4: Adverse Drug Reaction
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
AT
439-E4: Additive Toxicity
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
CD
439-E4: Chronic Disease Management
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
CH
439-E4: Call Help Desk
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
CS
439-E4: Patient Complaint/Symptom
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DA
439-E4: Drug-Allergy
01/01/0001
12/31/9999
28
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DC
439-E4: Drug-Disease (Inferred)
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DD
439-E4: Drug-Drug Interaction
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DF
439-E4: Drug-Food interaction
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DI
439-E4: Drug Incompatibility
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DL
439-E4: Drug-Lab Conflict
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DM
439-E4: Apparent Drug Misuse
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
DS
439-E4: Tobacco Use
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
ED
439-E4: Patient Education/Instruction
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
ER
439-E4: Overuse
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
EX
439-E4: Excessive Quantity
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
HD
439-E4: High Dose
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
IC
439-E4: Iatrogenic Condition
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
ID
439-E4: Ingredient Duplication
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
LD
439-E4: Low Dose
01/01/0001
12/31/9999
29
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
LK
439-E4: Lock In Recipient
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
LR
439-E4: Underuse
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
MC
439-E4: Drug-Disease (Reported)
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
MN
439-E4: Insufficient Duration
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
MS
439-E4: Missing Information/Clarification
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
MX
439-E4: Excessive Duration
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
NA
439-E4: Drug Not Available
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
NC
439-E4: Non-covered Drug Purchase
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
ND
439-E4: New Disease/Diagnosis
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
NF
439-E4: Non-Formulary Drug
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
NN
439-E4: Unnecessary Drug
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
NP
439-E4: New Patient Processing
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
NR
439-E4: Lactation/Nursing Interaction
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
NS
439-E4: Insufficient Quantity
01/01/0001
12/31/9999
30
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
OH
439-E4: Alcohol Conflict
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PA
439-E4: Drug-Age
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PC
439-E4: Patient Question/Concern
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PG
439-E4: Drug-Pregnancy
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PH
439-E4: Preventive Health Care
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PN
439-E4: Prescriber Consultation
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PP
439-E4: Plan Protocol
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PR
439-E4: Prior Adverse Reaction
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
PS
439-E4: Product Selection Opportunity
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
RE
439-E4: Suspected Environmental Risk
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
RF
439-E4: Health Provider Referral
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
SC
439-E4: Suboptimal Compliance
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
SD
439-E4: Suboptimal Drug/Indication
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
SE
439-E4: Side Effect
01/01/0001
12/31/9999
31
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
SF
439-E4: Suboptimal Dosage Form
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
SR
439-E4: Suboptimal Regimen
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
SX
439-E4: Drug-Gender
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
TD
439-E4: Therapeutic
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
TN
439-E4: Laboratory Test Needed
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E4
Drug Utilization Reason for Service Code
List
TP
439-E4: Payer/Processor Question
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code 00
List
440-E5: No intervention
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code AS
List
440-E5: Patient assessment
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code CC
List
440-E5: Coordination of care
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code DE
List
440-E5: Dosing evaluation/determination
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code FE
List
440-E5: Formulary enforcement
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code GP
List
440-E5: Generic product selection
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code M0
List
440-E5: Prescriber consulted
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code MA
List
440-E5: Medication administration
01/01/0001
12/31/9999
32
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code MR
List
440-E5: Medication review
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code P0
List
440-E5: Patient consulted
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code PE
List
440-E5: Patient education/instruction
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code PH
List
440-E5: Patient medication history
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code PM
List
440-E5: Patient monitoring
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code PT
List
440-E5: Perform laboratory test
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code R0
List
440-E5: Pharmacist consulted other source
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code RT
List
440-E5: Recommend laboratory test
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code SC
List
440-E5: Self-care consultation
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code SW
List
440-E5: Literature search/review
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code TC
List
440-E5: Payer/processor consulted
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E5
Drug Utilization Professional Service Code TH
List
440-E5: Therapeutic product interchange
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
00
441-E6: Not Specified
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1A
441-E6: Filled As Is
01/01/0001
12/31/9999
33
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1B
441-E6: Filled Prescription As Is
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1C
441-E6: Filled
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1D
441-E6: Filled
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1E
441-E6: Filled
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1F
441-E6: Filled
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1G
441-E6: Filled
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1H
441-E6: Brand-to-Generic Change
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
1J
441-E6: Rx-to-OTC Change
01/01/0001
12/31/9999
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
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
2A
441-E6: Prescription Not Filled
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
2B
441-E6: Not Filled
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3A
441-E6: Recommendation Accepted
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3B
441-E6: Recommendation Not Accepted
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3C
441-E6: Discontinued Drug
01/01/0001
12/31/9999
34
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3D
441-E6: Regimen Changed
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3E
441-E6: Therapy Changed
01/01/0001
12/31/9999
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
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3G
441-E6: Drug Therapy Unchanged
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3H
441-E6: Follow-Up/Report
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3J
441-E6: Patient Referral
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3K
441-E6: Instructions Understood
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3M
441-E6: Compliance Aid Provided
01/01/0001
12/31/9999
DRUG-UTILIZATION-CODE-E6
Drug Utilization Result of Service Code
List
3N
441-E6: Medication Administered
01/01/0001
12/31/9999
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
00
01
02
03
04
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
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
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
05
06
08
09
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
35
DUAL-ELIGIBLE-CODE
ELG-IDENTIFIER-TYPE
ELG-IDENTIFIER-TYPE
ELIGIBILITY-EXTENSION-CODE
Dual Eligible Code List
Eligible Identifier Type List
Eligible Identifier Type List
Eligibility Extension Code List
10
1
2
001
Separate CHIP Eligible is entitled to Medicare
Medicaid Card ID
Old MSIS Identification Number
60-day extended postpartum coverage (mandatory per SSA 1902(e)(5) and
2112(d)(2)(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
ELIGIBILITY-EXTENSION-CODE
Eligibility Extension Code List
002
12-month extended postpartum coverage (optional per SSA 1902(e)(16) or
2107(e)(1)(J))
01/01/0001
12/31/9999
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-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
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
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
Eligibility Group List
003
995
01
02
03
04
05
06
07
08
09
11
12
13
14
15
16
17
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 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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
36
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
19
20
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
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
21
22
23
24
25
Working Disabled under 1619(b)
Disabled Adult Children
Qualified Medicare Beneficiaries
Qualified Disabled and Working Individuals
Specified Low Income Medicare Beneficiaries
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
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
26
27
Qualifying Individuals
Optional Coverage of Parents and Other Caretaker Relatives
01/01/0001
01/01/0001
12/31/9999
12/31/9999
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
28
29
Reasonable Classifications of Individuals under Age 21
Children with Non-IV-E Adoption Assistance
01/01/0001
01/01/0001
12/31/9999
12/31/9999
ELIGIBILITY-GROUP
ELIGIBILITY-GROUP
Eligibility Group List
Eligibility Group List
30
31
Independent Foster Care Adolescents
Optional Targeted Low Income Children
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
32
33
34
35
36
37
38
39
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
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
ELIGIBILITY-GROUP
Eligibility Group List
40
Optional State Supplement Recipients - 1634 States, and SSI Criteria States with 1616
Agreements
01/01/0001
12/31/9999
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
ELIGIBILITY-GROUP
Eligibility Group List
42
Institutionalized Individuals Eligible under a Special Income Level
01/01/0001
12/31/9999
37
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
43
44
45
46
47
48
49
50
51
52
53
54
55
56
59
60
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
Medically Needy Aged, Blind or Disabled
Medically Needy Blind or Disabled Individuals Eligible in 1973
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
61
62
63
64
65
66
67
68
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
01/01/0001
01/01/0001
01/01/0001
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
69
70
71
38
ELIGIBILITY-GROUP
Eligibility Group List
ELIGIBILITY-GROUP
Eligibility Group List
ELIGIBILITY-GROUP
Eligibility Group List
ELIGIBILITY-GROUP
Eligibility Group List
01/01/0001
12/31/9999
72
Adult Group - Individuals at or below 133% FPL Age 19 through 64 - newly eligible for all
states
01/01/0001
12/31/9999
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
74
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
01/01/0001
12/31/9999
Uninsured Individual eligible for COVID-19 testing
03/18/2020
12/31/9999
ELIGIBILITY-GROUP
Eligibility Group List
75
76
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
01
02
Income Requirement not met - do not use for changes in household composition
Asset requirement not met - do not use for changes in household composition
01/01/0001
01/01/0001
12/31/9999
12/31/9999
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
03
04
Income reduced - (do not use - typically not a reason for termination)
Aged out of program
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
Eligibility Termination Reason List
Eligibility Termination Reason List
Eligibility Termination Reason List
Eligibility Termination Reason List
Eligibility Termination Reason List
Eligibility Termination Reason List
06
07
08
09
10
11
12
13
Death
No longer disabled
No longer institutionalized
No longer in need of long-term care services
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
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
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
14
15
Failure to pay premium or enrollment fees
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
01/01/0001
12/31/9999
12/31/9999
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
16
Voluntary request for termination
01/01/0001
12/31/9999
39
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
17
Do not use after 06/30/2027 - Lack of verifications (e.g., unable to successfully verify
citizenship status, immigration status, income, or other information from an
application; if unverifiable due to non-response, document as "Failure to respond)
01/01/0001
12/31/9999
06/30/2027
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
18
19
Fraud
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
01/01/0001
12/31/9999
12/31/9999
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
20
Disqualification for residence in an Institution for Mental Disease (IMD) - use when the
state is able to distinguish a more granular reason than just residency requirement not
met
01/01/0001
12/31/9999
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
Eligibility Termination Reason List
21
22
23
Suspension/Termination with reason unknown
Other
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
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
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
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
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
26
27
No longer meets categorical eligibility requirements.
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
01/01/0001
12/31/9999
12/31/9999
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
28
Time limited eligibility expired (e.g., Transitional Medical Assistance (TMA)
01/01/0001
12/31/9999
ELIGIBILITY-TERMINATION-REASON
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
Eligibility Termination Reason List
29
30
Closed as duplicate
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
01/01/0001
12/31/9999
12/31/9999
40
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
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 re-determined eligible for at least the same program had the program not been
terminated)
01/01/0001
12/31/9999
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
32
Beneficiary income could not be verified (if unable to verify due to non-response,
report with "failure to respond" using valid value '13')
01/01/0001
12/31/9999
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
33
The individual's immigration status or citizenship status could not be verified - or - the
individual's immigration status is verified and their status is not satisfactory for full
benefits (i.e., IMMIGRATION-STATUS does not equal 2 [CHIPRA 214] or 4 [eligible
noncitizen])
01/01/0001
12/31/9999
01/01/0001
12/31/9999
If unable to verify due to non-response, report with "failure to respond" using valid
value '13'
Unable to verify other information from a beneficiary's case file (if unable to verify due
to non-response, report with "failure to respond" using valid value '13')
ELIGIBILITY-TERMINATION-REASON
Eligibility Termination Reason List
36
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
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
ELIGIBLE-ADDR-TYPE
Eligible Address Type List
Eligible Address Type List
Eligible Address Type List
Eligible Address Type List
Eligible Address Type List
02
03
04
05
06
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
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
ENGL-PROF-CODE
ENGL-PROF-CODE
ENGL-PROF-CODE
ENGL-PROF-CODE
ENROLLMENT-TYPE
Engl Prof List
Engl Prof List
Engl Prof List
Engl Prof List
Enrollment Type List
0
1
2
3
1
Very Well
Well
Not well
No spoken proficiency
Medicaid
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
41
ENROLLMENT-TYPE
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
ETHNICITY-CODE
EXPENDITURE-AUTHORITY-TYPE
EXPENDITURE-AUTHORITY-TYPE
FACILITY-GROUP-INDIVIDUAL-CODE
Enrollment Type List
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
Ethnicity Code List
Expenditure Authority Type List
Expenditure Authority Type List
Facility Group Individual Code List
2
0
1
2
3
4
5
6
01
95
01
CHIP
Not of Hispanic or, Latino/a, or Spanish origin
Mexican, Mexican American, Chicano/a
Puerto Rican
Cuban
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
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
FACILITY-GROUP-INDIVIDUAL-CODE
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
FACILITY-GROUP-INDIVIDUAL-CODE
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
FILE-ENCODING-SPECIFICATION
FILE-ENCODING-SPECIFICATION
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
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
FLF
PSV
CLAIM-IP
CLAIM-LT
CLAIM-OT
CLAIM-RX
ELIGIBLE
The file follows a fixed length format.
The file follows a pipe-delimited format.
Inpatient Claim/Encounters File
Long Term Care Claims/Encounters File
Other Claims/Encounters File
Pharmacy Claims/Encounters File
Eligible File
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
FILE-NAME
FILE-NAME
FILE-NAME
FILE-NAME
FILE-STATUS-INDICATOR
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
T-MSIS File Type List
File Status Indicator List
FINTRANS
MNGDCARE
PROVIDER
TPL-FILE
P
Financial Transaction File
Managed Care Plan Information File
Provider File
Third Party Liability File
Production File
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
42
FILE-STATUS-INDICATOR
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FILE-SUBMISSION-METHOD
FIXED-PAYMENT-IND
FIXED-PAYMENT-IND
FORCED-CLAIM-IND
FORCED-CLAIM-IND
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
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
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
T
01
02
03
04
05
0
1
0
1
A
B
C
D
E
F
Test File
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
FFS Fixed Payment
No
Yes
Medicaid Agency
CHIP Agency
Mental Health Service Agency
Education Agency
Child and Family Services Agency
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
12/31/9999
12/31/99
12/31/99
12/31/99
12/31/99
12/31/99
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
FUNDING-CODE
FUNDING-CODE
FUNDING-CODE
FUNDING-SOURCE-NONFEDERAL-SHARE
FUNDING-SOURCE-NONFEDERAL-SHARE
FUNDING-SOURCE-NONFEDERAL-SHARE
FUNDING-SOURCE-NONFEDERAL-SHARE
FUNDING-SOURCE-NONFEDERAL-SHARE
FUNDING-SOURCE-NONFEDERAL-SHARE
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
Funding Code List
Funding Code List
Funding Code List
Funding Source Non-Federal Share List
Funding Source Non-Federal Share List
Funding Source Non-Federal Share List
Funding Source Non-Federal Share List
Funding Source Non-Federal Share List
Funding Source Non-Federal Share List
Gender Identity List
Gender Identity List
Gender Identity List
G
H
I
01
02
03
04
05
06
1
2
3
City
Providers
Other
State appropriations to the Medicaid agency
Intergovernmental transfers (IGT)
Certified public expenditures (CPE)
Provider taxes
Donations
State appropriations to the CHIP agency
Female
Male
Transgender female
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
43
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
GENDER-IDENTITY
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
Gender Identity List
Gender Identity List
Gender Identity List
Gender Identity List
HCBS Chronic Condition Non Health
Home Code List
4
5
6
7
001
Transgender male
Not sure
Prefer not to answer
Other
Aged
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
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
002
Physical Disabilities
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
003
Intellectual Disabilities
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
004
Autism Spectrum Disorder
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
005
Developmental Disabilities
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
006
Mental Illness and/or Serious Emotional Disturbance
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
007
Brain Injury
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
008
HIV/AIDs
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
009
Technology Dependent or Medically Fragile
01/01/0001
12/31/9999
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-CODE
HCBS Chronic Condition Non Health
Home Code List
010
Disabled (other)
01/01/0001
12/31/9999
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
1
2
3
4
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
44
HCBS-SERVICE-CODE
HCBS-SERVICE-CODE
HCBS Service Code List
HCBS Service Code List
5
6
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
12/31/9999
12/31/9999
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
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
01010
02011
02012
02013
02021
02022
02023
02031
02032
02033
03010
03021
03022
03030
04010
04020
04030
04040
04050
04060
04070
04080
05010
Case Management
Group Living, Residential Habilitation
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
45
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
05020
06010
07010
08010
08020
08030
08040
08050
08060
09011
09012
09020
10010
10020
10030
10040
Skilled Nursing
Home Delivered Meals
Rent and Food Expenses For Live-In Caregiver
Home-Based Habilitation
Home Health Aide
Personal Care
Companion
Homemaker
Chore
Respite, Out-Of-Home
Respite, In-Home
Caregiver Counseling and/or Training
Mental Health Assessment
Assertive Community Treatment
Crisis Intervention
Behavior Support
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
10050
10060
10070
10080
10090
11010
11020
11030
11040
11050
11060
11070
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
46
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
11080
11090
11100
11110
11120
11130
12010
12020
13010
14010
14020
14031
14032
15010
16010
17010
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
Equipment and Technology
Supplies
Non-Medical Transportation
Community Transition Services
Goods and 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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
HCBS-TAXONOMY
HCBS-TAXONOMY
HCBS-TAXONOMY
HEALTH-CARE-ACQUIRED-CONDITION-IND
HCBS Taxonomy Code List
HCBS Taxonomy Code List
HCBS Taxonomy Code List
Healthcare Acquired Condition Indicator
List
17020
17030
17990
0
Interpreter
Housing Consultation
Other
No
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
HEALTH-CARE-ACQUIRED-CONDITION-IND
Healthcare Acquired Condition Indicator
List
1
Yes
01/01/0001
12/31/9999
HEALTH-HOME-CHRONIC-CONDITION
HEALTH-HOME-CHRONIC-CONDITION
HEALTH-HOME-CHRONIC-CONDITION
HEALTH-HOME-CHRONIC-CONDITION
HEALTH-HOME-CHRONIC-CONDITION
Health Home Chronic Condition List
Health Home Chronic Condition List
Health Home Chronic Condition List
Health Home Chronic Condition List
Health Home Chronic Condition List
A
B
C
D
E
Mental health
Substance abuse
Asthma
Diabetes
Heart disease
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
47
HEALTH-HOME-CHRONIC-CONDITION
HEALTH-HOME-CHRONIC-CONDITION
HEALTH-HOME-CHRONIC-CONDITION
HEALTH-HOME-PROV-IND
HEALTH-HOME-PROV-IND
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
Health Home Chronic Condition List
Health Home Chronic Condition List
Health Home Chronic Condition List
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
F
G
H
0
1
00
01
02
03
04
05
06
07
08
09
10
Overweight (BMI of >25)
HIV/AIDS
Other
No
Yes
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
HOUR
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
Hour List
11
12
13
14
15
16
17
18
19
20
21
22
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
48
HOUR
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
HOUSEHOLD-SIZE
IHS-SERVICE-IND
IHS-SERVICE-IND
IMMIGRATION-STATUS
Hour List
Household Size List
Household Size List
Household Size List
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
23
01
02
03
04
05
06
07
08
0
1
1
23:00-23:59
1 person
2 people
3 people
4 people
5 people
6 people
7 people
8 or more people
No
Yes
Qualified non-citizen alien
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
IMMIGRATION-STATUS
IMMIGRATION-STATUS
IMMIGRATION-STATUS
IMMIGRATION-STATUS
IMMIGRATION-VERIFICATION-FLAG
IMMIGRATION-VERIFICATION-FLAG
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-CODE
INCOME-STANDARD-CODE
Immigration Status List
Immigration Status List
Immigration Status List
Immigration Status List
Immigration Verification Flag List
Immigration Verification Flag 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
2
3
4
8
0
1
01
02
03
04
05
06
07
08
01
Lawfully present under CHIPRA 214
Eligible only for payment for emergency Medicaid services only
Eligible noncitizen
Not Applicable (U.S. citizen or U.S. national)
Immigration Status Verified
Enrolled in Medicaid pending immigration verification
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
01/01/0001
01/01/0001
10/01/2026
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
09/30/2026
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/99
49
INCOME-STANDARD-CODE
INCOME-STANDARD-CODE
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
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
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
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
02
95
01
02
03
04
05
06
07
08
09
10
11
12
13
14
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)
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/99
12/31/99
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
INSURANCE-PLAN-TYPE
INSURANCE-PLAN-TYPE
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
Insurance Plan Type List
Insurance Plan Type List
Level of Care Status List
Level of Care Status List
15
16
001
002
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
LEVEL-OF-CARE-STATUS
LICENSE-TYPE
LICENSE-TYPE
LICENSE-TYPE
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
003
004
005
888
1
2
3
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
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
50
LICENSE-TYPE
LICENSE-TYPE
LINE-ADJUSTMENT-IND
License Type List
License Type List
Line Adjustment Indicator List
4
5
0
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
12/31/9999
12/31/9999
12/31/9999
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
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
51
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
LINE-ADJUSTMENT-IND
Line 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 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.
01/01/0001
12/31/9999
LINE-ADJUSTMENT-REASON-CODE
Line Adjustment Reason Code List
See
"VVL_Code_Description"
field
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.
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://x12.org/codes/claim-adjustment-reason-codes
LTSS-LEVEL-CARE
LTSS-LEVEL-CARE
LTSS-LEVEL-CARE
LTSS Level of Care List
LTSS Level of Care List
LTSS Level of Care List
1
2
3
Skilled Care
Intermediate Care
Custodial Care
52
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
MANAGED-CARE-PLAN-OTHER-ID-TYPE
MANAGED-CARE-PLAN-OTHER-ID-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
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
Managed Care Plan Other ID Type List
Managed Care Plan Other ID 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
1
2
3
4
5
6
7
01
02
01
02
03
04
05
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
Federal Tax ID
State Tax ID
Comprehensive MCO
Traditional PCCM Provider
Enhanced PCCM Provider Entity
HIO
Medical-only PIHP (risk or non-risk/non-comprehensive/with inpatient hospital or
institutional 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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
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
07
08
09
10
11
12
13
14
15
16
17
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
PACE
01/01/0001
01/01/0001
01/01/0001
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
53
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
Managed Care Plan Type List
Managed Care Plan Type List
18
19
Pharmacy PAHP
Individual is enrolled in Long-Term Services & Supports (LTSS) and Mental Health (MH)
PIHP
01/01/0001
01/01/0001
12/31/9999
12/31/9999
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PLAN-TYPE
MANAGED-CARE-PROFIT-STATUS
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
20
60
70
80
01
Other
Accountable Care Organization
Health/Medical Home
Integrated Care For Dual Eligibles
501(C)(3) NON-PROFIT
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
MANAGED-CARE-PROFIT-STATUS
MANAGED-CARE-PROFIT-STATUS
Managed Care Profit Status List
Managed Care Profit Status List
02
03
FOR-PROFIT, CLOSELY HELD
FOR-PROFIT, PUBLICLY TRADED
01/01/0001
01/01/0001
12/31/9999
12/31/9999
MANAGED-CARE-PROFIT-STATUS
MANAGED-CARE-PROGRAM
Managed Care Profit Status List
Managed Care Program List
04
1
OTHER
Medicaid State Plan
01/01/0001
01/01/0001
12/31/9999
12/31/9999
MANAGED-CARE-PROGRAM
MANAGED-CARE-PROGRAM
Managed Care Program List
Managed Care Program List
2
3
CHIP State Plan
Both Medicaid and CHIP
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
MANAGED-CARE-SERVICE-AREA
Managed Care Service Area List
2
County - The managed care entity provides services to beneficiaries in specified
counties.
01/01/0001
12/31/9999
MANAGED-CARE-SERVICE-AREA
MANAGED-CARE-SERVICE-AREA
Managed Care Service Area List
Managed Care Service Area List
3
4
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
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
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
54
MANAGED-CARE-SERVICE-AREA-NAME
Managed Care Service Area Name List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://www.census.gov/library/reference/codelists/ansi.html
MARITAL-STATUS
MARITAL-STATUS
Marital Status List
Marital Status List
01
02
Legally Married (to opposite sex), spouse present
Legally Married (to opposite sex), spouse absent
01/01/0001
01/01/0001
12/31/9999
12/31/9999
MARITAL-STATUS
MARITAL-STATUS
Marital Status List
Marital Status List
03
04
Legally Married (to same sex), spouse present
Legally Married (to same sex), spouse absent
01/01/0001
01/01/0001
12/31/9999
12/31/9999
MARITAL-STATUS
MARITAL-STATUS
Marital Status List
Marital Status List
05
06
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
12/31/9999
12/31/9999
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 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
07
08
09
10
11
12
13
14
15
16
17
18
19
20
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)
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
55
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
MBESCBES Form Group List
21
22
23
24
25
26
27
28
29
30
31
32
33
1
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
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
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
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
MBESCBES-FORMGP-3
MBESCBES Form Group 3 List
21BASE
Children's Health Expenditures By Type of Service
01/01/0001
12/31/9999
56
MBESCBES-FORMGP-3
MEDICARE-COMB-DED-IND
MBESCBES Form Group 3 List
Medicare Combined Deductible Indicator
List
21P
0
Quarterly Children's Health Insurance Program
Amount not combined with coinsurance amount
01/01/0001
01/01/0001
12/31/9999
12/31/9999
MEDICARE-COMB-DED-IND
Medicare Combined Deductible Indicator
List
1
Amount combined with coinsurance amount
01/01/0001
12/31/9999
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
MEDICARE-REIM-TYPE
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
Medicare Reimbursement Type List
01
02
IPPS - Acute Inpatient PPS
LTCHPPS - Long-term Care Hospital PPS
SNFPPS - Skilled Nursing Facility PPS
HHPPS - Home Health PPS
IRFPPS - Inpatient Rehabilitation Facility PPS
IPFPPS - Inpatient Psychiatric Facility PPS
OPPS - Outpatient PPS
Fee Schedules (for physicians, DME, ambulance, and clinical lab)
Part C Hierarchical Condition Category Risk Assessment (CMS-HCC RA) Capitation
Payment Model
01/01/0001
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
No
Yes
Non Participation
Default- Non Participation
Nursing Facility
ICF/IID (Intermediate Care Facilities for individuals with Intellectual Disabilities)
IMD (Institution for Mental Diseases)
Hospital
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
Other
Default - Non Participation
Home owned by participant
Home owned by family member
Apartment leased by participant, not assisted living
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
03
04
05
06
07
08
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 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
09
0
1
2
00
01
02
03
04
MFP-QUALIFIED-INSTITUTION
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP Qualified Institution List
MFP Qualified Residence List
MFP Qualified Residence List
MFP Qualified Residence List
MFP Qualified Residence List
05
00
01
02
03
57
MFP-QUALIFIED-RESIDENCE
MFP-QUALIFIED-RESIDENCE
MFP-REASON-PARTICIPATION-ENDED
MFP-REASON-PARTICIPATION-ENDED
MFP-REASON-PARTICIPATION-ENDED
MFP-REASON-PARTICIPATION-ENDED
MFP-REASON-PARTICIPATION-ENDED
MFP-REASON-PARTICIPATION-ENDED
MFP-REASON-PARTICIPATION-ENDED
MFP-REASON-PARTICIPATION-ENDED
MFP-REINSTITUTIONALIZED-REASON
MFP-REINSTITUTIONALIZED-REASON
MFP-REINSTITUTIONALIZED-REASON
MFP-REINSTITUTIONALIZED-REASON
MFP-REINSTITUTIONALIZED-REASON
MFP-REINSTITUTIONALIZED-REASON
MFP Qualified Residence List
MFP Qualified Residence List
MFP Reason Participation Ended List
MFP Reason Participation Ended List
MFP Reason Participation Ended List
MFP Reason Participation Ended List
MFP Reason Participation Ended List
MFP Reason Participation Ended List
MFP Reason Participation Ended List
MFP Reason Participation Ended List
MFP Reinstitutionalized Reason List
MFP Reinstitutionalized Reason List
MFP Reinstitutionalized Reason List
MFP Reinstitutionalized Reason List
MFP Reinstitutionalized Reason List
MFP Reinstitutionalized Reason List
04
05
00
01
02
03
04
05
06
07
00
01
02
03
04
05
Apartment leased by participant, assisted living
Group home of no more than 4 people
Default - No Participation
Completed 365 days of participation
Suspended eligibility
Re-institutionalized
Died
Moved
No longer needed services
Other
Default- Non Participation
Acute care hospitalization followed by long term rehabilitation
Deterioration in cognitive functioning
Deterioration in health
Deterioration in mental health
Loss of housing
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
MFP-REINSTITUTIONALIZED-REASON
MFP-REINSTITUTIONALIZED-REASON
MFP-REINSTITUTIONALIZED-REASON
NDC-UNIT-OF-MEASURE
NDC-UNIT-OF-MEASURE
NDC-UNIT-OF-MEASURE
NDC-UNIT-OF-MEASURE
MFP Reinstitutionalized Reason List
MFP Reinstitutionalized Reason List
MFP Reinstitutionalized Reason List
NDC Unit of Measure List
NDC Unit of Measure List
NDC Unit of Measure List
NDC Unit of Measure List
06
07
08
F2
GR
ME
ML
Loss of personal care giver
By request of participant or guardian
Lack of sufficient community services
International Unit
Gram
Milligram
Milliliter
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
58
NDC-UNIT-OF-MEASURE
NDC Unit of Measure List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://www.x12.org/
NDC-UNIT-OF-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
NDC Unit of Measure 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
UN
00
01
02
03
04
05
06
07
Unit
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)
01/01/0001
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
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
08
09
10
11
12
13
14
15
16
17
18
19
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
59
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
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
36
37
38
39
40
41
42
43
44
45
46
47
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
60
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
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
64
65
66
67
68
69
70
71
72
73
74
75
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
61
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
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
92
93
94
95
96
97
98
99
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
62
OCCURRENCE-CODE
Occurrence Code List
See
"VVL_Code_Description"
field
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.
N/A
N/A
For background and context, see https://www.nubc.org/license or
https://med.noridianmedicare.com/web/jea/topics/claim-submission/occurrencecodes
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
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
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
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
63
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
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
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
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
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
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
OPERATING-AUTHORITY
Operating Authority List
11
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
01/01/0001
12/31/9999
OPERATING-AUTHORITY
Operating Authority List
12
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
OPERATING-AUTHORITY
Operating Authority List
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
64
OPERATING-AUTHORITY
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
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
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
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
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
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
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
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
OTHER-INSURANCE-IND
OTHER-INSURANCE-IND
OTHER-TPL-COLLECTION
Other Insurance Indicator List
Other Insurance Indicator List
Other TPL Collection List
0
1
000
No
Yes
Not Applicable
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
OTHER-TPL-COLLECTION
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
Other TPL Collection List
001
002
003
004
005
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
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
65
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
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
006
007
00
01
02
06
07
08
09
10
01
02
03
04
05
06
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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 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
07
08
09
10
11
12
13
14
15
16
17
18
Proprietary - Other
Proprietary - multiple owners
Government - Federal
Government - State
Government - City
Government - County
Government - City-County
Government - Hospital District
Government - State and City/County
Government - other multiple owners
Voluntary /Proprietary
Proprietary/Government
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
66
OWNERSHIP-CODE
OWNERSHIP-CODE
PATIENT-STATUS
Ownership Code List
Ownership Code List
Patient Status List
19
88
See
"VVL_Code_Description"
field
Voluntary/Government
N/A - The individual only practices as part of a group, e.g., as an employee
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
N/A
12/31/9999
12/31/9999
N/A
For background and context, see https://www.nubc.org/license
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
PAYEE-ID-TYPE
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
01
02
03
04
05
06
07
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
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
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
PAYER-ID-TYPE
PAYER-ID-TYPE
PAYER-ID-TYPE
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
Payer ID Type List
Payer ID Type List
Payer ID Type List
08
09
95
01
02
03
04
95
01
02
03
04
Beneficiary
Non-Medicaid eligible guardian
Other
SSN
EIN
ITIN
State Tax ID
Other
State
Capitated plan ID
Sub-capitated entity ID
Sub-capitated network provider ID
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
67
PAYER-ID-TYPE
PAYMENT-LEVEL-IND
Payer ID Type List
Payment Level Indicator List
95
1
Other
Payment/allowed amount is not determined at the individual line level (e.g., DRG or
outpatient PPS)
01/01/0001
01/01/0001
12/31/9999
12/31/9999
PAYMENT-LEVEL-IND
Payment Level Indicator List
2
Payment/allowed amount is determined at the individual line 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
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
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
PLACE-OF-SERVICE
Place of Service Code List
See
"VVL_Code_Description"
field
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.
N/A
N/A
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
For background and context, see https://www.cms.gov/Medicare/Coding/place-ofservice-codes/Place_of_Service_Code_Set
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
01
02
03
04
05
Self
Spouse
Custodial Parent
Noncustodial Parent (Child Support Enforcement in effect)
Noncustodial Parent without child support enforcement in effect
68
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
POLICY-OWNER-CODE
PREFERRED-LANGUAGE-CODE
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Policy Owner Code List
Preferred Language Code List
06
07
08
09
See
"VVL_Code_Description"
field
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.
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://en.wikipedia.org/wiki/List_of_ISO_6392_codes
PREGNANCY-IND
PREGNANCY-IND
Pregnancy Indicator List
Pregnancy Indicator List
0
1
No
Yes
01/01/0001
01/01/0001
12/31/9999
12/31/9999
PRESCRIPTION-ORIGIN-CODE
Prescription Origin Code List
See
"VVL_Code_Description"
field
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.
N/A
N/A
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
For background and context, see https://www.ncpdp.org/ or
https://www.ncpdp.org/NCPDP/media/pdf/VersionD-Questions.pdf
PRIMARY-ELIGIBILITY-GROUP-IND
PRIMARY-ELIGIBILITY-GROUP-IND
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
PROCEDURE-CODE-FLAG
Primary Eligibility Group Indicator List
Primary Eligibility Group Indicator List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
Procedure Code Flag List
0
1
01
02
06
07
NO
YES
CPT 4
ICD-9 CM
HCPCS Level II and CDT
ICD-10 - PCS (Will be implemented on 10/1/2014)
69
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
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
26
27
28
29
30
31
32
33
34
35
36
37
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
70
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
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
54
55
56
57
58
59
60
61
62
63
64
65
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
71
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
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
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
82
83
84
85
86
87
00
01
02
03
04
05
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
72
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
PROGRAM-TYPE
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
07
08
10
11
12
13
14
15
16
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
PROGRAM-TYPE
PROV-ADDR-TYPE
Program Type List
Provider Address Type List
17
1
COVID-19 Testing Services (1905(a)(3) and 2103(c))
Provider Billing
03/18/2020
01/01/0001
12/31/9999
12/31/9999
PROV-ADDR-TYPE
PROV-ADDR-TYPE
Provider Address Type List
Provider Address Type List
2
3
Provider Mailing
Provider Practice
01/01/0001
01/01/0001
12/31/9999
12/31/9999
PROV-ADDR-TYPE
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Address Type List
Provider Authorized Category of Service
Code List
4
001
Provider Service Location
Inpatient hospital services, other than services in an institution for mental diseases
01/01/0001
01/01/0001
12/31/9999
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
002
Outpatient hospital services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
003
Rural health clinic services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
004
Other ambulatory services furnished by a rural health clinic
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
005
Professional laboratory services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
006
Technical laboratory services
01/01/0001
12/31/9999
73
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
007
Professional radiological services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
008
Technical radiological services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
010
Early and periodic screening and diagnosis and treatment (EPSDT) services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
012
Physicians' services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
013
Medical and surgical services of a dentist
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
014
Outpatient substance abuse treatment services.
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
016
Home health services - Nursing services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
017
Home health services - Home health aide services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
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
74
PROV-CLASSIFICATION-CODE-TYPE-4
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-CODE-TYPE-4
Provider Authorized Category of Service
Code List
022
Private duty nursing services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
023
Advanced practice nurse services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
024
Pediatric nurse
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
025
Nurse-midwife service
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
026
Nurse practitioner services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
027
Respiratory care for ventilator-dependent individuals
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
028
Clinic services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
029
Dental services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
030
Physical therapy services (when not provided under home health services)
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
031
Occupational therapy services (when not provided under home health services)
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
033
Prescribed drugs
01/01/0001
12/31/9999
75
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
034
Over-the-counter medications.
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
035
Dentures
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
036
Prosthetic devices
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
037
Eyeglasses
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
038
Hearing Aids
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
039
Diagnostic services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
040
Screening services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
041
Preventive services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
043
Rehabilitative services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
046
Intermediate care facility (ICF/IID) services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
047
Nursing facility services, other than in institutions for mental diseases
01/01/0001
12/31/9999
76
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
048
Inpatient psychiatric services for individuals under age 21
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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-CODE-TYPE-4
Provider Authorized Category of Service
Code List
050
Inpatient substance abuse treatment services and residential substance abuse
treatment services.
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
051
Personal care services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
052
Primary care case management services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
053
Targeted case management services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
055
Care coordination services.
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
056
Transportation services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
057
Enabling services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
058
Services furnished in a religious nonmedical health care institution
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
059
Skilled nursing facility services for individuals under age 21
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
060
Emergency hospital services
01/01/0001
12/31/9999
77
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
061
Critical access hospital services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
062
HCBS - Case management services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
063
HCBS - Homemaker services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
064
HCBS - Home health aide services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
065
HCBS - Personal care services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
066
HCBS - Adult day health services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
067
HCBS - Habilitation services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
068
HCBS - Respite care services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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-CODE-TYPE-4
Provider Authorized Category of Service
Code List
070
HCBS - Day Care
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
071
HCBS - Training for family members
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
072
HCBS - Minor modification to the home
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
78
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
074
HCBS - Expanded habilitation services - Prevocational services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
075
HCBS - Expanded habilitation services - Educational services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
077
HCBS-65-plus - Case management services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
078
HCBS-65-plus - Homemaker services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
079
HCBS-65-plus - Home health aide services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
080
HCBS-65-plus - Personal care services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
081
HCBS-65-plus - Adult day health services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
082
HCBS-65-plus - Respite care services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
083
HCBS-65-plus - Other medical and social services
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
084
Sterilizations
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
085
Prenatal care and pre-pregnancy family planning services and supplies.
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
086
Other Pregnancy-related Procedures
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
087
Hospice services
01/01/0001
12/31/9999
79
PROV-CLASSIFICATION-CODE-TYPE-4
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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
089
Disposable medical supplies.
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
090
Critical access hospital services - IP
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
091
Skilled care - hospital residing
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
092
Exceptional care - hospital residing
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
093
Non-acute care - hospital residing
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
115
Residential care
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
120
Capitated payments for primary care case management (PCCM)
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
123
Disproportionate share hospital (DSH) payments
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
127
Indian Health Service (IHS) - Family Plan
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
132
Supplemental payment - inpatient
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
133
Supplemental payment - nursing
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
134
Supplemental payment - outpatient
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
135
EHR payments to provider
01/01/0001
12/31/9999
80
PROV-CLASSIFICATION-CODE-TYPE-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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
137
COVID–19 testing-related services
03/18/2020
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-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
PROV-CLASSIFICATION-CODE-TYPE-4
Provider Authorized Category of Service
Code List
143
Per member per month (PMPM) payments for other payments
01/01/0001
12/31/9999
PROV-CLASSIFICATION-CODE-TYPE-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
PROV-CLASSIFICATION-CODE-TYPE-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
PROV-CLASSIFICATION-CODE-TYPE-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
PROV-CLASSIFICATION-CODE-TYPE-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
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
81
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
PROV-ENROLLMENT-METHOD
PROV-ENROLLMENT-METHOD
PROV-FACILITY-TYPE
Provider Enrollment Method
Provider Enrollment Method
Provider Facility Type
2
3
100000000
Enrolled through use of state-based provider application
Other?
Individuals or Groups (of Individuals)
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
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 Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
170000000
250000000
260000000
270000000
280000000
290000000
300000000
310000000
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
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
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
PROV-FACILITY-TYPE
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
Provider Facility Type
320000000
330000000
340000000
380000000
See
"VVL_Code_Description"
field
Non-Individual - Residential Treatment Facilities
Non-Individual - Suppliers
Non-Individual - Transportation Services
Non-Individual - Respite Care Facility
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
N/A
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://x12.org/codes/provider-taxonomy-codes
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
Provider Identifier Type List
Provider Identifier Type List
1
2
State-specific Medicaid Provider ID
NPI
82
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-IDENTIFIER-TYPE
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Identifier Type List
Provider Identifier Type List
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
3
4
5
6
7
8
9
01
Medicare ID
NCPDP ID
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
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
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
02
Active - Active Reinstated
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
03
Active - Active
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
04
Active - Eligibility Verification
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
05
Active - Encounter Only
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
06
Active - Financial Trans Only
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
20
Denied - Denied Two Provider Numbers
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
21
Denied - For Other Reasons
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
22
Denied - Invalid License
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
23
Denied - Not Eligible
01/01/0001
12/31/9999
83
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
24
Denied - Same Number Assigned
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
40
Pending - Enrollment
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
41
Pending - License/Cert Verification
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
42
Pending - Missing Documentation
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
43
Pending - No License/Temp License
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
44
Pending - NPI Invalid
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
45
Pending - Rate Determination
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
46
Pending - Signed Agreement
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
47
Pending - Status Approval
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
48
Pending - W9 Missing or Incomplete
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
60
Term - Abuse of billing privileges
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
61
Term - Action Taken by Medicaid/CHIP
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
62
Term - Action Taken by Medicare
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
63
Term - Change of Ownership
01/01/0001
12/31/9999
84
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
64
Term - Failure to report a change of address/ownership
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
65
Term - False or misleading information
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
66
Term - Federal exclusion/ debarment, etc.
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
67
Term - Felony conviction
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
68
Term - Involuntary Termination
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
69
Term - License Expired
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
70
Term - License Revoked
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
71
Term - Loss of license or other State action
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
72
Term - Medicare/Medicaid Exclusion
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
73
Term - Medicaid Authority
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
74
Term - Medicare Termination
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
75
Term - Misuse of billing number
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
76
Term - No Claims Activity
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
77
Term - Non-Compliance
01/01/0001
12/31/9999
85
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
78
Term - Onsite review/ Provider is no longer operational
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
79
Term - Other
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
80
Term - Provider Deceased
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
81
Term - State exclusion/ debarment, etc.
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
82
Term - Unknown
01/01/0001
12/31/9999
PROV-MEDICAID-ENROLLMENT-STATUS-CODE
Provider Medicaid Enrollment Status
Code List
83
Term - Voluntary Termination
01/01/0001
12/31/9999
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
PROV-PROFIT-STATUS
Provider Profit Status List
Provider Profit Status List
Provider Profit Status List
Provider Profit Status List
01
02
03
04
501(C)(3) NON-PROFIT
FOR-PROFIT, CLOSELY HELD
FOR-PROFIT, PUBLICLY TRADED
OTHER
01/01/0001
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
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
88
99
01
02
03
04
05
06
07
08
09
10
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
86
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
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
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
Sports Medicine
Plastic and Reconstructive Surgery
Physical Medicine and Rehabilitation
Psychiatry
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
27
28
29
30
31
32
33
34
35
36
37
38
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
87
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
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
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
Medical Supply Company with Orthotist-Prosthetist
Other Medical Supply Company
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
55
56
57
58
59
60
61
62
63
64
65
66
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
88
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
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
83
84
85
86
87
88
89
90
91
92
93
94
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
89
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
95
96
97
98
99
A0
A1
A2
A3
A4
A5
A6
A7
A8
A9
B1
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
B2
B3
B4
B5
C0
C1
C2
C3
C4
C5
C6
C7
Pedorthic personnel
Medical supply company with pedorthic personnel
Rehabilitation Agency
Ocularist
Sleep Medicine
Centralized Flu
Indirect Payment Procedure
Interventional Cardiology
Restricted Use
Dentist
Hospitalist
Advanced Heart Failure and Transplant Cardiology
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
90
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 Taxonomy List
C8
C9
D1
D2
D3
D4
D5
D6
D7
D8
See
"VVL_Code_Description"
field
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 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
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
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
12/31/9999
12/31/9999
12/31/9999
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://x12.org/codes/provider-taxonomy-codes
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
01
02
03
04
05
06
07
08
09
10
11
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)
91
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
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
28
29
30
31
32
33
34
35
36
37
38
39
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
92
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
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
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
Provider Claim Form Code List
Provider Claim Form Code List
Provider Claim Form Code List
56
57
58
01
02
03
11
12
13
21
22
23
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)
Dental claim - any (837D format or ADA Dental Claim Form)
Dental claim - electronic (837D format)
Dental claim - paper (ADA Dental Claim 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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
93
PROVIDER-CLAIM-FORM-CODE
PROVIDER-CLAIM-FORM-CODE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
RACE
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
31
95
001
002
003
004
005
006
007
008
009
010
011
012
013
014
Pharmacy claim (NCPDP format)
Other claim form or format not listed above
White
Black or African American
American Indian or Alaska Native
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Asian Unknown
Native Hawaiian
Guamanian or Chamorro
Samoan
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
RACE
RACE
RACE
RACE
REASON-FOR-CHANGE
REASON-FOR-CHANGE
REASON-FOR-CHANGE
REASON-FOR-CHANGE
REBATE-ELIGIBLE-INDICATOR
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
015
016
017
018
LSE
MERGE
TCAM
UNMERGE
0
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
REBATE-ELIGIBLE-INDICATOR
REBATE-ELIGIBLE-INDICATOR
Rebate Eligible Indicator List
Rebate Eligible Indicator List
1
2
NDC is eligible for drug rebate program
NDC is exempt from the drug rebate program (biological and medical devices)
01/01/0001
01/01/0001
12/31/9999
12/31/9999
94
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
CIP00001
CIP00002
CIP00003
CIP00004
CLT00001
CLT00002
CLT00003
CLT00004
COT00001
COT00002
COT00003
COT00004
CRX00001
CRX00002
CRX00003
CRX00004
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
ELG00001
ELG00002
ELG00003
ELG00004
ELG00005
ELG00006
ELG00007
ELG00008
ELG00009
ELG00010
ELG00011
ELG00012
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
95
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
ELG00013
ELG00014
ELG00015
ELG00016
ELG00017
ELG00018
ELG00020
ELG00021
ELG00022
ELG00023
FTX00001
FTX00002
FTX00003
FTX00004
FTX00005
FTX00006
LTSS-PARTICIPATION
LTSS-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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
FTX00007
FTX00008
FTX00009
FTX00095
MCR00001
MCR00002
MCR00003
MCR00004
MCR00005
MCR00006
MCR00007
MCR00008
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
96
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
MCR00009
MCR00010
PRV00001
PRV00002
PRV00003
PRV00004
PRV00005
PRV00006
PRV00007
PRV00008
PRV00009
PRV00010
TPL00001
TPL00002
TPL00003
TPL00004
CHPID-SHPID-RELATIONSHIP
MANAGED-CARE-ID
FILE-HEADER-RECORD-PROVIDER
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
RECORD-ID
RECORD-ID
REIMBURSEMENT-ARRANGEMENT
REIMBURSEMENT-ARRANGEMENT
REIMBURSEMENT-ARRANGEMENT
REIMBURSEMENT-ARRANGEMENT
REIMBURSEMENT-ARRANGEMENT
REIMBURSEMENT-ARRANGEMENT
REIMBURSEMENT-ARRANGEMENT
REIMBURSEMENT-ARRANGEMENT
RESTRICTED-BENEFITS-CODE
Record ID List
Record ID List
Reimbursement Arrangement List
Reimbursement Arrangement List
Reimbursement Arrangement List
Reimbursement Arrangement List
Reimbursement Arrangement List
Reimbursement Arrangement List
Reimbursement Arrangement List
Reimbursement Arrangement List
Restricted Benefits Code List
TPL00005
TPL00006
01
02
03
04
05
06
07
08
0
TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION
TPL-ENTITY-CONTACT-INFORMATION
Risk-based Capitation, no incentives or risk-sharing
Risk-based Capitation with Incentive Arrangements
Risk-based Capitation with other risk-sharing Arrangements
Non-Risk Capitation
Fee-For-Service
Primary Care Case Management Payment
Other
Primary Care Case Management Payment plus Fee-For-Service
Individual is not eligible for Medicaid or CHIP during the month.
01/01/0001
01/01/0001
01/01/0001
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
97
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
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
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
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
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
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
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
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
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
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
98
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
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
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
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
REVENUE-CODE
Revenue Code List
See
"VVL_Code_Description"
field
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.
N/A
N/A
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
For background and context, see https://www.nubc.org/
SDP-IND
SDP-IND
SELF-DIRECTION-TYPE
SELF-DIRECTION-TYPE
SELF-DIRECTION-TYPE
State Directed Payment Indicator List
State Directed Payment Indicator List
Self Direction Type List
Self Direction Type List
Self Direction Type List
0
1
000
001
002
No, not an SDP
Yes, SDP
Not Applicable
Hiring Authority
Budget Authority
99
SELF-DIRECTION-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
Self Direction 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
003
F
M
U
1
2
3
4
5
1
2
3
4
5
6
01
Hiring and Budget Authority
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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 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
02
03
04
05
06
07
08
09
10
20
22
23
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
100
SPLIT-CLAIM-IND
SPLIT-CLAIM-IND
SSDI-IND
SSDI-IND
SSI-IND
SSI-IND
SSI-STATE-SUPPLEMENT-STATUS-CODE
SSI-STATE-SUPPLEMENT-STATUS-CODE
SSI-STATE-SUPPLEMENT-STATUS-CODE
SSI-STATUS
SSI-STATUS
SSI-STATUS
SSI-STATUS
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
SSI State Supplement Code List
SSI State Supplement Code List
SSI Status List
SSI Status List
SSI Status List
SSI Status List
0
1
0
1
0
1
000
001
002
000
001
002
003
No
Yes
No
Yes
No
Yes
Not Applicable
Mandatory
Optional
Not Applicable
SSI
SSI Eligible Spouse
SSI Pending a Final Determination of Disposal of Resources Exceeding SSI Dollar Limits
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
SSN-INDICATOR
SSN-INDICATOR
SSN-VERIFICATION-FLAG
SSN-VERIFICATION-FLAG
SSN-VERIFICATION-FLAG
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
STATE
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
0
1
0
1
2
01
02
04
05
06
08
09
10
11
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
101
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
12
13
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa (Medicaid)
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
29
30
31
32
33
34
35
36
37
38
39
40
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
102
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
41
42
44
45
46
47
48
49
50
51
53
54
55
56
60
64
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
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
66
67
68
69
70
71
72
74
76
78
79
81
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
01/01/0001
01/01/0001
01/01/0001
01/01/0001
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
103
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
84
86
89
93
94
95
96
97
99
See
"VVL_Code_Description"
field
Howland Island
Jarvis Island
Kingman Reef
WYOMING CHIP
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 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
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
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
12/31/9999
12/31/9999
12/31/9999
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
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
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
1
2
3
4
00
01
02
03
04
05
06
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)
104
SUBCAPITATION-IND
SUBCAPITATION-IND
SUBMISSION-TRANSACTION-TYPE
Subcapitation Indicator List
Subcapitation Indicator List
Submission Transaction Type List
1
2
C
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.
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
SUBMISSION-TRANSACTION-TYPE
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
SUBMISSION-TRANSACTION-TYPE
Submission Transaction Type List
U
Update File-a file that contains T-MSIS record segments created in response to business
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.
01/01/0001
12/31/9999
TANF-CASH-CODE
TANF-CASH-CODE
TANF Cash Code List
TANF Cash Code List
0
1
Individual was not eligible for Medicaid.
Individual did not receive TANF benefits
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TANF-CASH-CODE
TANF Cash Code List
2
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
12/31/9999
TEACHING-IND
TEACHING-IND
Teaching Indicator List
Teaching Indicator List
0
1
No
Yes
01/01/0001
01/01/0001
12/31/9999
12/31/9999
105
TOOTH-DESIGNATION-SYSTEM
TOOTH-DESIGNATION-SYSTEM
TOOTH-NUM
Tooth Designation System List
Tooth Designation System List
Tooth Number List
JO
JP
1
ANSI/ADA/ISO Specification No. 3950
ADA's Universal/National Tooth Designation system
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
TOOTH-NUM
Tooth Number List
2
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
3
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
4
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
5
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
6
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
7
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
8
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
9
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
10
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
11
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
12
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
13
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
106
TOOTH-NUM
Tooth Number List
14
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
15
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
16
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
17
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
18
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
19
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
20
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
21
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
22
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
23
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
24
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
25
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
26
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
27
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
107
TOOTH-NUM
Tooth Number List
28
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
29
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
30
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
31
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
32
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
51
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
52
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
53
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
54
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
55
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
56
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
57
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
58
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
59
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
108
TOOTH-NUM
Tooth Number List
60
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
61
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
62
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
63
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
64
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
65
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
66
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
67
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
68
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
69
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
70
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
71
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
72
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
73
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
109
TOOTH-NUM
Tooth Number List
74
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
75
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
76
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
77
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
78
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
79
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
80
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
81
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
82
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
A
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
AS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
B
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
BS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
C
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
110
TOOTH-NUM
Tooth Number List
CS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
D
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
DS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
E
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
ES
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
F
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
FS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
G
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
GS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
H
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
HS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
I
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
IS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
J
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
111
TOOTH-NUM
Tooth Number List
JS
Upper Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
K
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
KS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
L
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
LS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
M
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
MS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
N
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
NS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
O
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
OS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
P
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
PS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
Q
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
112
TOOTH-NUM
Tooth Number List
QS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
R
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
RS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
S
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
See
"VVL_Code_Description"
field
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.
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
TOOTH-NUM
Tooth Number List
SS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
T
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
TOOTH-NUM
Tooth Number List
TS
Lower Arch (commencing in the Upper right quadrant and rotating counterclockwise)
01/01/0001
12/31/9999
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
00
01
02
03
04
Entire Oral Cavity
Maxillary Area
Mandibular Area
Upper Right Sextant
Upper Anterior Sextant
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
113
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
TOOTH-QUAD-CODE
Tooth Quad Code List
10
Upper Right Quadrant (Right Refers to the oral and skeletal structures on the right
side.)
01/01/0001
12/31/9999
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
20
30
40
See
"VVL_Code_Description"
field
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 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
N/A
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
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
TOOTH-SURFACE-CODE
TOOTH-SURFACE-CODE
TOOTH-SURFACE-CODE
Tooth Surface Code List
Tooth Surface Code List
Tooth Surface Code List
F
I
L
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.
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
114
TOOTH-SURFACE-CODE
Tooth Surface Code List
M
Mesial - The surface of a tooth which faces toward an invisible line drawn vertically
through the center of the face.
01/01/0001
12/31/9999
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
TOOTH-SURFACE-CODE
Tooth Surface Code List
See
"VVL_Code_Description"
field
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.
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
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL Entity Address Type List
TPL Entity Address Type List
06
07
TPL-Entity Corporate Location
TPL-Entity Mailing
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-ENTITY-ADDR-TYPE
TPL-HEALTH-INSURANCE-COVERAGE-IND
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
08
09
10
11
0
TPL-Entity Satellite Location
TPL-Entity Billing
TPL-Entity Correspondence
TPL-Other
Eligible individual has no TPL insurance coverage.
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
TPL-HEALTH-INSURANCE-COVERAGE-IND
TPL Health Insurance Coverage Indicator
List
1
Eligible individual does have TPL insurance coverage.
01/01/0001
12/31/9999
TPL-OTHER-COVERAGE-IND
TPL-OTHER-COVERAGE-IND
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
0
1
01
02
03
Eligible individual has no other TPL funding available.
Eligible individual does have other TPL funding available.
Kick payment
Provider retainer payment
Direct reimbursement to Bene beneficiaries for retroactive period cost (e.g. 42 CFR
447.25)
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
115
TRANSACTION-TYPE
TRANSACTION-TYPE
TRANSACTION-TYPE
TYPE-OF-BILL
Transaction Type List
Transaction Type List
Transaction Type List
Type of Bill List
04
05
95
See
"VVL_Code_Description"
field
Direct reimbursement to Bene beneficiaries for non-emergency transportation
PMPM Health Home Service Payment
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.
01/01/0001
01/01/0001
01/01/0001
N/A
12/31/9999
12/31/9999
12/31/9999
N/A
For background and context, see https://www.nubc.org/license
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position; Facility
Type)
1
Hospital
01/01/0001
12/31/9999
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position; Facility
Type)
2
Skilled Nursing
01/01/0001
12/31/9999
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position; Facility
Type)
3
Home Health
01/01/0001
12/31/9999
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position; Facility
Type)
4
Religious Nonmedical (Hospital)
01/01/0001
12/31/9999
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
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position; Facility
Type)
6
Intermediate Care
01/01/0001
12/31/9999
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
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
TYPE-OF-BILL-2-FACILITY-TYPE
Type of Bill List (2nd position; Facility
Type)
9
Reserved for National Assignment
01/01/0001
12/31/9999
116
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
1
Rural Health Clinic (RHC)
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
2
Hospital Based or Independent Renal Dialysis Facility
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
3
Free Standing Provider-Based Federally Qualified Health Center (FQHC)
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
4
Other Rehabilitation Facility (ORF)
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
5
Comprehensive Outpatient Rehabilitation Facility (CORF)
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
6
Community Mental Health Center (CMHC)
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
7
Federally Qualified Health Center (FQHC) (Effective 4/1/10)
04/01/2010
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
8
Licensed Freestanding Emergency Medical Facility (Effective 4/1/12)
04/01/2012
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS
Type of Bill List (3rd position; Facility
Type: Clinics; Type of Care)
9
OTHER
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY
Type of Bill List (3rd position; Facility
Type: Facilities; Type of Care)
1
Hospice (Nonhospital Based)
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY
Type of Bill List (3rd position; Facility
Type: Facilities; Type of Care)
2
Hospice (Hospital Based)
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-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
TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY
Type of Bill List (3rd position; Facility
Type: Facilities; Type of Care)
4
Free Standing Birthing Center
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY
Type of Bill List (3rd position; Facility
Type: Facilities; Type of Care)
5
Critical Access Hospital
01/01/0001
12/31/9999
117
TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY
Type of Bill List (3rd position; Facility
Type: Facilities; Type of Care)
6
Residential Facility
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-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
TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY
Type of Bill List (3rd position; Facility
Type: Facilities; Type of Care)
8
Reserved for National Assignment
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY
Type of Bill List (3rd position; Facility
Type: Facilities; Type of Care)
9
OTHER
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
1
Inpatient
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
2
Inpatient
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
3
Outpatient
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
4
Other
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
5
Intermediate Care - Level I
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
6
Intermediate Care - Level II
01/01/0001
12/31/9999
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
7
Reserved for national assignment (discontinued effective 10/1/05).
01/01/0001
10/01/2005
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
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
TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER
Type of Bill List (3rd position; Facility
Type: Other; Type of Care)
9
Reserved for National Assignment
01/01/0001
12/31/9999
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
0
1
Nonpayment/Zero Claims
Admit Through Discharge Claim
01/01/0001
01/01/0001
12/31/9999
12/31/9999
118
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
2
3
A
B
Interim-First Claim
Interim-Continuing Claims (Not valid for PPS Bills)
Admission/Election Notice
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Termination/Revocation Notice
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-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
C
D
Hospice Change of Provider Notice
Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care
Institution Void/Cancel
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-BILL-4-FREQUENCY
TYPE-OF-CLAIM
TYPE-OF-CLAIM
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Bill list (4th position; Frequency)
Type of Claim List
Type of Claim List
E
F
G
H
I
J
K
M
P
1
3
Hospice Change of Ownership
Beneficiary Initiated Adjustment Claim
CWF Initiated Adjustment Claim
CMS Initiated Adjustment Claim
FI Adjustment Claim (Other than QIO or Provider
Initiated Adjustment Claim-Other
OIG Initiated Adjustment Claim
MSP Initiated Adjustment Claim
QIO Adjustment Claim
A Fee-For-Service Medicaid or Medicaid-expansion Claim
Medicaid or Medicaid-expansion 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
01/01/0001
01/01/0001
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
TYPE-OF-CLAIM
Type of Claim List
A
Separate CHIP (Title XXI) claim: A Fee-for-Service Claim
01/01/0001
12/31/9999
119
TYPE-OF-CLAIM
Type of Claim List
C
Separate CHIP (Title XXI) 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
01/01/0001
12/31/9999
TYPE-OF-CLAIM
TYPE-OF-CLAIM
Type of Claim List
Type of Claim List
U
W
Other FFS claim
Other Managed Care Encounter
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TYPE-OF-CLAIM
TYPE-OF-HOSPITAL
Type of Claim List
Type of Hospital List
Z
00
Denied claims
Not a hospital
01/01/0001
01/01/0001
06/30/2020
12/31/9999
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
Type of Hospital List
Type of Hospital List
01
02
Inpatient Hospital
Outpatient Hospital
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
Type of Hospital List
Type of Hospital List
03
04
Critical Access Hospital
Swing Bed Hospital
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
Type of Hospital List
Type of Hospital List
05
06
Inpatient Psychiatric Hospital
IHS Hospital
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TYPE-OF-HOSPITAL
TYPE-OF-HOSPITAL
TYPE-OF-OTHER-THIRD-PARTY-LIABILITY
TYPE-OF-OTHER-THIRD-PARTY-LIABILITY
TYPE-OF-OTHER-THIRD-PARTY-LIABILITY
TYPE-OF-OTHER-THIRD-PARTY-LIABILITY
TYPE-OF-OTHER-THIRD-PARTY-LIABILITY
TYPE-OF-OTHER-THIRD-PARTY-LIABILITY
Type of Hospital List
Type of Hospital List
Type of Other Third-Party Liability List
Type of Other Third-Party Liability List
Type of Other Third-Party Liability List
Type of Other Third-Party Liability List
Type of Other Third-Party Liability List
Type of Other Third-Party Liability List
07
08
1
2
3
4
5
6
Children's Hospital
Other
Tort/Casualty Claim
Medical Malpractice
Estate (an estate, annuity or designated trust)
Liens
Worker's Compensation
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
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
TYPE-OF-OTHER-THIRD-PARTY-LIABILITY
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-IP
Type of Other Third-Party Liability List
Type of Service IP List
Type of Service IP List
7
001
058
Other - unidentified
Inpatient hospital services, other than services in an institution for mental diseases
Services furnished in a religious nonmedical health care institution
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
120
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
060
084
086
090
091
092
093
136
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
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
TYPE-OF-SERVICE-IP
TYPE-OF-SERVICE-LT
Type of Service IP List
Type of Service LT List
137
009
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
TYPE-OF-SERVICE-LT
Type of Service LT List
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
Type of Service LT List
045
Nursing facility services for individuals age 65 or older in institutions for mental
diseases
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
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
121
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
TYPE-OF-SERVICE-LT
Type of Service LT List
137
COVID–19 testing-related services
03/18/2020
12/31/9999
TYPE-OF-SERVICE-LT
Type of Service LT 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
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
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
002
003
Outpatient hospital services
Rural health clinic services
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
004
005
006
007
008
010
011
012
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
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
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
013
014
015
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
12/31/9999
12/31/9999
12/31/9999
TYPE-OF-SERVICE-OT
Type of Service OT List
016
Home health services - Nursing services
01/01/0001
12/31/9999
122
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
017
018
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
12/31/9999
12/31/9999
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
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
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
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
022
023
024
025
026
Private duty nursing services
Advanced practice nurse services
Pediatric nurse
Nurse-midwife service
Nurse practitioner services
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
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
027
028
029
030
031
032
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
035
036
037
038
039
040
Dentures
Medical equipment/prosthetic devices
Eyeglasses
Hearing Aids
Diagnostic services
Screening services
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
123
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
041
042
043
049
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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
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
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
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
055
056
Care coordination services
Transportation services
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
057
058
060
061
062
063
064
065
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
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
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
066
067
068
HCBS - Adult day health services
HCBS - Habilitation services
HCBS - Respite care services
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
124
TYPE-OF-SERVICE-OT
Type of Service OT 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
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
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
074
075
076
HCBS - Expanded habilitation services - Prevocational services
HCBS - Expanded habilitation services - Educational services
HCBS - Expanded habilitation services - Supported employment services, which
facilitate paid employment
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
TYPE-OF-SERVICE-OT
Type of Service OT List
077
HCBS-65-plus - Case management services
01/01/0001
12/31/9999
TYPE-OF-SERVICE-OT
TYPE-OF-SERVICE-OT
Type of Service OT List
Type of Service OT List
078
079
HCBS-65-plus - Homemaker services
HCBS-65-plus - Home health aide services
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
080
081
082
083
084
085
086
087
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
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
TYPE-OF-SERVICE-OT
Type of Service OT List
088
Any other health care services or items specified by the Secretary and not excluded
under regulations.
01/01/0001
12/31/9999
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
089
115
127
Disposable medical supplies.
Residential care
Indian Health Service (IHS) - Family Plan
01/01/0001
01/01/0001
01/01/0001
12/31/9999
12/31/9999
12/31/9999
125
TYPE-OF-SERVICE-OT
Type of Service OT 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
TYPE-OF-SERVICE-OT
Type of Service OT List
137
COVID–19 testing-related services
03/18/2020
12/31/9999
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
Type of Service RX List
Type of Service RX List
011
018
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
01/01/0001
01/01/0001
12/31/9999
12/31/9999
TYPE-OF-SERVICE-RX
TYPE-OF-SERVICE-RX
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
Type of Service RX List
Type of Service RX List
033
034
036
085
089
127
Prescribed drugs
Over-the-counter medications.
Medical equipment/prosthetic devices
Prenatal care and pre-pregnancy family planning services and supplies.
Disposable medical supplies.
Indian Health Service (IHS) - Family Plan
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
TYPE-OF-SERVICE-RX
Type of Service RX 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
TYPE-OF-SERVICE-RX
Type of Service RX List
137
COVID–19 testing-related services
03/18/2020
12/31/9999
TYPE-OF-SERVICE-RX
Type of Service RX 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
UNIT-OF-MEASURE
UNIT-OF-MEASURE
Unit of Measure List
Unit of Measure List
EA
F2
Each
International Unit
01/01/0001
01/01/0001
12/31/9999
12/31/9999
126
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
GM
GR
ME
ML
See
"VVL_Code_Description"
field
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 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
N/A
12/31/9999
12/31/9999
12/31/9999
12/31/9999
N/A
For background and context, see https://www.ncpdp.org/
UNIT-OF-MEASURE
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
NDC Unit of Measure List
Value Based Payment Model Type List
Value Based Payment Model Type List
Value Based Payment Model Type List
Value Based Payment Model Type List
UN
2A
2B
2C
3A
Unit
FFS/Q&V Foundational payments for infrastructure and operations
FFS/Q&V Pay for reporting
FFS/Q&V Pay for performance
APM/FFS APMs with Shared savings
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
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
VALUE-BASED-PAYMENT-MODEL-TYPE
VETERAN-IND
VETERAN-IND
WAIVER-TYPE
WAIVER-TYPE
Value Based Payment Model Type List
Value Based Payment Model Type List
Value Based Payment Model Type List
Value Based Payment Model Type List
Value Based Payment Model Type List
Value Based Payment Model Type List
Veteran Indicator List
Veteran Indicator List
Waiver Type List
Waiver Type List
3B
3N
4A
4B
4C
4N
0
1
01
02
APM/FFS APMs with shared savings and downside risk
APM/FFS Risk based payments NOT linked to quality
POP/PAY Condition-specific population-based payment
POP/PAY Comprehensive population-based payment
POP/PAY Integrated finance and delivery system
POP/PAY Capitated payments NOT linked to quality
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
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
WAIVER-TYPE
Waiver Type List
03
1915(b)(2) - These waivers allow states to use enrollment brokers.
01/01/0001
12/31/9999
127
WAIVER-TYPE
Waiver Type List
04
1915(b)(3) - These waivers allow states to use savings to provide additional services
that are not in the State Plan.
01/01/0001
12/31/9999
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
05
06
07
08
09
10
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
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
WAIVER-TYPE
WAIVER-TYPE
Waiver Type List
Waiver Type List
11
12
1915(c)-Brain Injury
1915(c)-HIV/AIDS
01/01/0001
01/01/0001
12/31/9999
12/31/9999
WAIVER-TYPE
WAIVER-TYPE
Waiver Type List
Waiver Type List
13
14
1915(c)-Technology Dependent or Medically Fragile
1915(c)-Disabled (other)
01/01/0001
01/01/0001
12/31/9999
12/31/9999
WAIVER-TYPE
WAIVER-TYPE
Waiver Type List
Waiver Type List
15
16
1915(c)-Enrolled in 1915(c) waiver for unspecified or unknown populations
1915(c)-Autism/Autism spectrum disorder
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
17
18
19
20
21
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) 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
12/31/9999
12/31/9999
12/31/9999
12/31/9999
12/31/9999
WAIVER-TYPE
WAIVER-TYPE
Waiver Type List
Waiver Type List
22
23
1115 Pharmacy demonstration
1115 Disaster-related demonstration
01/01/0001
01/01/0001
12/31/9999
12/31/9999
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
24
25
26
27
28
1115 Family planning demonstration
1115 Substance use demonstration
1115 Premium Assistance demonstration
1115 Beneficiary engagement demonstration
1115 Former foster care youth from another state
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
128
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
WAIVER-TYPE
ZIP-CODE
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Waiver Type List
Zip Code List
29
30
31
32
33
See
"VVL_Code_Description"
field
1115 Managed long term services and support
1115 Delivery system reform
1332 Demonstration
1915(b) waiver
1915(c) waiver
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,
https://tools.usps.com/zip-code-lookup.htm?bycitystate
129