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Searches healthcare codes sets, such as ICD-10, HCPCS, NDC and many others and returns JSON or CSV with codes and descriptions.
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Fetches code's details, including the code's edits and categories
| code required | string |
| type | string (TypeEnum) Enum: "CLAIM_ADJUSTMENT_REASON_CODE" "CLAIM_STATUS_CATEGORY_CODE" "CLAIM_STATUS_CODE" "DIAGNOSIS" "DRG" "DRUG" "FACILITY_TYPE" "FREQUENCY_CODE" "MODIFIER" "PROCEDURE" "PROVIDER_ADJUSTMENT_REASON_CODE" "PROVIDER_TAXONOMY" "RBCS_TAXONOMY" "REMITTANCE_ADVICE_REMARK_CODE" "UB04_CONDITION_CODE" "UB04_OCCURRENCE_CODE" "UB04_OCCURRENCE_SPAN_CODE" "UB04_REVENUE_CODE" "UB04_TYPE_OF_BILL" "UB04_VALUE_CODE" "UB_CODE" "X12_AMOUNT_QUALIFIER_CODE" "X12_DATE_TIME_QUALIFIER_CODE" "X12_ENTITY_IDENTIFIER_CODE" "X12_IDENTIFICATION_CODE" "X12_QUANTITY_QUALIFIER_CODE" "X12_REFERENCE_IDENTIFICATION_QUALIFIER_CODE" Example: type=PROCEDURE Has to be supplied if the code may not be unique across all code sets. E.g., some codes could be used for both procedures and diagnoses |
| code | string Healthcare code |
| desc | string Code description |
{- "type": "PROCEDURE",
- "subType": "CPT",
- "code": "36425",
- "desc": "Venipuncture, cutdown; age 1 or over",
- "fullDesc": "Venipuncture, cutdown; age 1 or over",
- "shortDesc": "VENIPUNCTURE CUTDOWN 1 YR/>",
- "startDate": "1993-01-01",
- "categories": [
- {
- "type": "RBCS_TAXONOMY",
- "subType": "RBCS_CATEGORY",
- "code": "P",
- "desc": "Procedure"
}, - {
- "type": "RBCS_TAXONOMY",
- "subType": "RBCS_SUB_CATEGORY",
- "code": "PV",
- "desc": "Vascular"
}
], - "edits": {
- "mueLimits": [
- {
- "claimType": "HOSPITAL",
- "maxUnits": 2,
- "rationale": "Clinical: CMS Workgroup"
}, - {
- "claimType": "PRACTITIONER",
- "maxUnits": 2,
- "rationale": "Clinical: CMS Workgroup"
}
], - "minAge": 1,
- "maxAge": 124,
- "checkTypes": [
- "MUE",
- "MIN_AGE",
- "MAX_AGE",
- "PTP"
], - "disallowedCodes": [
- {
- "code": "0543T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0544T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0545T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0548T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0553T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0563T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0565T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0566T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0567T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0568T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0569T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0570T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0571T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0572T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0573T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0574T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0580T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0581T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0582T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "0655T",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "15772",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "15774",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20560",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20561",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20700",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20701",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20702",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20703",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20704",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "20705",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "21602",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "21603",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "33017",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "33018",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "33019",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "33858",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "33859",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "33871",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "34717",
- "rationale": "CPT Manual or CMS manual coding instructions",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "34718",
- "rationale": "CPT Manual or CMS manual coding instructions",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "35702",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "35703",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "36410",
- "rationale": "CPT \"separate procedure\" definition",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "36420",
- "rationale": "Mutually exclusive procedures",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "37202",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "49013",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "49014",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "62318",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "62319",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64415",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64416",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64417",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64450",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64470",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64475",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64490",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "64493",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "66987",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "66988",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "69990",
- "rationale": "Misuse of column two code with column one code",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": false
}, - {
- "code": "90772",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "90774",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "90775",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "96372",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "96374",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "96375",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "96376",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "C8952",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER",
- "HOSPITAL"
], - "modifierAllowed": true
}, - {
- "code": "36591",
- "rationale": "CPT Manual or CMS manual coding instructions",
- "claimTypes": [
- "PRACTITIONER"
], - "modifierAllowed": false
}, - {
- "code": "36592",
- "rationale": "CPT Manual or CMS manual coding instructions",
- "claimTypes": [
- "PRACTITIONER"
], - "modifierAllowed": false
}, - {
- "code": "96523",
- "rationale": "CPT Manual or CMS manual coding instructions",
- "claimTypes": [
- "PRACTITIONER"
], - "modifierAllowed": false
}, - {
- "code": "G0351",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER"
], - "modifierAllowed": true
}, - {
- "code": "G0353",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER"
], - "modifierAllowed": true
}, - {
- "code": "G0354",
- "rationale": "Standards of medical / surgical practice",
- "claimTypes": [
- "PRACTITIONER"
], - "modifierAllowed": true
}
]
}
}Searches healthcare code sets using provided search terms. The terms can include codes or any word from a code's description or definition
| query required | string Example: query=0080,0LRQ07Z,knee replacement Search query |
| type | string (TypeEnum) Enum: "CLAIM_ADJUSTMENT_REASON_CODE" "CLAIM_STATUS_CATEGORY_CODE" "CLAIM_STATUS_CODE" "DIAGNOSIS" "DRG" "DRUG" "FACILITY_TYPE" "FREQUENCY_CODE" "MODIFIER" "PROCEDURE" "PROVIDER_ADJUSTMENT_REASON_CODE" "PROVIDER_TAXONOMY" "RBCS_TAXONOMY" "REMITTANCE_ADVICE_REMARK_CODE" "UB04_CONDITION_CODE" "UB04_OCCURRENCE_CODE" "UB04_OCCURRENCE_SPAN_CODE" "UB04_REVENUE_CODE" "UB04_TYPE_OF_BILL" "UB04_VALUE_CODE" "UB_CODE" "X12_AMOUNT_QUALIFIER_CODE" "X12_DATE_TIME_QUALIFIER_CODE" "X12_ENTITY_IDENTIFIER_CODE" "X12_IDENTIFICATION_CODE" "X12_QUANTITY_QUALIFIER_CODE" "X12_REFERENCE_IDENTIFICATION_QUALIFIER_CODE" Example: type=diagnosis Type of the code set to search |
| afterStartDate | string <date> Example: afterStartDate=2020-12-10 Find codes with the start (effective) date after the parameter's value |
| afterEndDate | string <date> Example: afterEndDate=2020-12-10 Find codes with the end (deactivation) date after the parameter's value |
| code | string Healthcare code |
| desc | string Code description |
# Simple search curl -H "X-Api-Key: 123456" $API_URL/code/search?query=0LBQ4 # By words in the description curl -H "X-Api-Key: 123456" -G $API_URL/code/search?type=procedure --data-urlencode 'query=endo right knee' # Multiple codes curl -H "X-Api-Key: 123456" -G $API_URL/code/search?type=procedure --data-urlencode 'query=0LBQ4, 0Y3F4ZZ' # Initial code letter + description curl -H "X-Api-Key: 123456" -G $API_URL/code/search?type=procedure --data-urlencode 'query=code:j adrenalin'
[- {
- "type": "DIAGNOSIS",
- "subType": "ICD_10",
- "code": "A049",
- "desc": "Bacterial intestinal infection, unspecified",
- "formattedCode": "A04.9"
}, - {
- "type": "DRUG",
- "subType": "NDC",
- "code": "0002-1243",
- "desc": "MOUNJARO (tirzepatide)",
- "fullDesc": "MOUNJARO (tirzepatide); Form: Injection, solution; Route: Subcutaneous; Labeler: Eli Lilly and Company",
- "startDate": "2023-07-28",
- "endDate": "2024-12-31"
}, - {
- "type": "PROCEDURE",
- "subType": "CPT",
- "code": "0001A",
- "desc": "Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose",
- "fullDesc": "Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose",
- "shortDesc": "ADM SARSCOV2 30MCG/0.3ML 1ST",
- "startDate": "2020-12-11",
- "endDate": "2023-10-31"
}
]Exports codes that matched the query in the CSV format
| query | string |
| fileName | string |
| howMany | integer <int32> |
| type | string (TypeEnum) Enum: "CLAIM_ADJUSTMENT_REASON_CODE" "CLAIM_STATUS_CATEGORY_CODE" "CLAIM_STATUS_CODE" "DIAGNOSIS" "DRG" "DRUG" "FACILITY_TYPE" "FREQUENCY_CODE" "MODIFIER" "PROCEDURE" "PROVIDER_ADJUSTMENT_REASON_CODE" "PROVIDER_TAXONOMY" "RBCS_TAXONOMY" "REMITTANCE_ADVICE_REMARK_CODE" "UB04_CONDITION_CODE" "UB04_OCCURRENCE_CODE" "UB04_OCCURRENCE_SPAN_CODE" "UB04_REVENUE_CODE" "UB04_TYPE_OF_BILL" "UB04_VALUE_CODE" "UB_CODE" "X12_AMOUNT_QUALIFIER_CODE" "X12_DATE_TIME_QUALIFIER_CODE" "X12_ENTITY_IDENTIFIER_CODE" "X12_IDENTIFICATION_CODE" "X12_QUANTITY_QUALIFIER_CODE" "X12_REFERENCE_IDENTIFICATION_QUALIFIER_CODE" Type of the code set to export See this guide for more details. |
| code | string Healthcare code |
| formattedCode | string Formatted code, e.g., a diagnosis code with a dot |
| desc | string Code description |
| shortDesc | string Short description |
| type | string Code type, e.g., PROCEDURE |
| subType | string Code subtype, e.g., CPT |
| enumName | string Enum constant for X12 codes |
| startDate | string <date> |
| endDate | string <date> |
# All procedures curl -G $API_URL/code/csv?type=procedure # Procedures for the search query curl -G $API_URL/code/csv?type=procedure --data-urlencode 'query=0LBQ4, 0Y3F4ZZ'
code,formattedCode,desc,shortDesc,type,subType,enumName,startDate,endDate 1,,"Deductible Amount",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 10,,"The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 100,,"Payment made to patient/insured/responsible party.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 101,,"Predetermination: anticipated payment upon completion of services or claim adjudication.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 102,,"Major Medical Adjustment.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 103,,"Provider promotional discount (e.g., Senior citizen discount).",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 104,,"Managed care withholding.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 105,,"Tax withholding.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 106,,"Patient payment option/election not in effect.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 107,,"The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 108,,"Rent/purchase guidelines were not met. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 109,,"Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 11,,"The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 110,,"Billing date predates service date.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 111,,"Not covered unless the provider accepts assignment.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 112,,"Service not furnished directly to the patient and/or not documented.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 113,,"Payment denied because service/procedure was provided outside the United States or as a result of war. Notes: Use Codes 157, 158 or 159.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01,2007-06-30 114,,"Procedure/product not approved by the Food and Drug Administration.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 115,,"Procedure postponed, canceled, or delayed.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 116,,"The advance indemnification notice signed by the patient did not comply with requirements.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 117,,"Transportation is only covered to the closest facility that can provide the necessary care.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 118,,"ESRD network support adjustment.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 119,,"Benefit maximum for this time period or occurrence has been reached.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 12,,"The diagnosis is inconsistent with the provider type. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 120,,"Patient is covered by a managed care plan. Notes: Use code 24.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01,2007-06-30 121,,"Indemnification adjustment - compensation for outstanding member responsibility.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 122,,"Psychiatric reduction.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 123,,"Payer refund due to overpayment. Notes: Refer to implementation guide for proper handling of reversals.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01,2007-06-30 124,,"Payer refund amount - not our patient. Notes: Refer to implementation guide for proper handling of reversals.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01,2007-06-30 125,,"Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01,2013-11-01 126,,"Deductible -- Major Medical Notes: Use Group Code PR and code 1.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1997-02-28,2008-04-01 127,,"Coinsurance -- Major Medical Notes: Use Group Code PR and code 2.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1997-02-28,2008-04-01 128,,"Newborn's services are covered in the mother's Allowance.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1997-02-28, 129,,"Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1997-02-28, 13,,"The date of death precedes the date of service.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 130,,"Claim submission fee.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1997-02-28, 131,,"Claim specific negotiated discount.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1997-02-28, 132,,"Prearranged demonstration project adjustment.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1997-02-28, 133,,"The disposition of this service line is pending further review. (Use only with Group Code OA). Usage: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837).",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2014-07-01, 134,,"Technical fees removed from charges.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1998-10-31, 135,,"Interim bills cannot be processed.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1998-10-31, 136,,"Failure to follow prior payer's coverage rules. (Use only with Group Code OA)",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1998-10-31, 137,,"Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1999-02-28, 138,,"Appeal procedures not followed or time limits not met.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1999-06-30,2018-05-01 139,,"Contracted funding agreement - Subscriber is employed by the provider of services. Use only with Group Code CO.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1999-06-30, 14,,"The date of birth follows the date of service.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 140,,"Patient/Insured health identification number and name do not match.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1999-06-30, 141,,"Claim spans eligible and ineligible periods of coverage.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1999-06-30,2012-07-01 142,,"Monthly Medicaid patient liability amount.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2000-06-30, 143,,"Portion of payment deferred.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2001-02-28, 144,,"Incentive adjustment, e.g. preferred product/service.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2001-06-30, 145,,"Premium payment withholding Notes: Use Group Code CO and code 45.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-06-30,2008-04-01 146,,"Diagnosis was invalid for the date(s) of service reported.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-06-30, 147,,"Provider contracted/negotiated rate expired or not on file.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-06-30, 148,,"Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-06-30, 149,,"Lifetime benefit maximum has been reached for this service/benefit category.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-10-31, 15,,"The authorization number is missing, invalid, or does not apply to the billed services or provider.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01,2018-05-01 150,,"Payer deems the information submitted does not support this level of service.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-10-31, 151,,"Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-10-31, 152,,"Payer deems the information submitted does not support this length of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-10-31, 153,,"Payer deems the information submitted does not support this dosage.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-10-31, 154,,"Payer deems the information submitted does not support this day's supply.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2002-10-31, 155,,"Patient refused the service/procedure.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2003-06-30, 156,,"Flexible spending account payments. Note: Use code 187.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2003-09-30,2009-10-01 157,,"Service/procedure was provided as a result of an act of war.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2003-09-30, 158,,"Service/procedure was provided outside of the United States.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2003-09-30, 159,,"Service/procedure was provided as a result of terrorism.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2003-09-30, 16,,"Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 160,,"Injury/illness was the result of an activity that is a benefit exclusion.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2003-09-30, 161,,"Provider performance bonus",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2004-02-29, 162,,"State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Notes: Use code P1",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2004-02-29,2014-07-01 163,,"Attachment/other documentation referenced on the claim was not received.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2004-06-30, 164,,"Attachment/other documentation referenced on the claim was not received in a timely fashion.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2004-06-30, 165,,"Referral absent or exceeded.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2004-10-31,2018-05-01 166,,"These services were submitted after this payers responsibility for processing claims under this plan ended.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-02-28, 167,,"This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 168,,"Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30,2018-05-01 169,,"Alternate benefit has been provided.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 17,,"Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01,2009-07-01 170,,"Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 171,,"Payment is denied when performed/billed by this type of provider in this type of facility. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 172,,"Payment is adjusted when performed/billed by a provider of this specialty. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 173,,"Service/equipment was not prescribed by a physician.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 174,,"Service was not prescribed prior to delivery.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 175,,"Prescription is incomplete.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 176,,"Prescription is not current.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 177,,"Patient has not met the required eligibility requirements.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 178,,"Patient has not met the required spend down requirements.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 179,,"Patient has not met the required waiting requirements. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 18,,"Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,1995-01-01, 180,,"Patient has not met the required residency requirements.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 181,,"Procedure code was invalid on the date of service.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 182,,"Procedure modifier was invalid on the date of service.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 183,,"The referring provider is not eligible to refer the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 184,,"The prescribing/ordering provider is not eligible to prescribe/order the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 185,,"The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 186,,"Level of care change adjustment.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 187,,"Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30, 188,,"This product/procedure is only covered when used according to FDA recommendations.",,"CLAIM_ADJUSTMENT_REASON_CODE",CARC,,2005-06-30,