# Claims code lists
Source: https://www.stedi.com/docs/healthcare/claims-code-lists

***

title: Claims code lists
sidebarTitle: "Code lists"
--------------------------

This page contains code lists that are too long to represent clearly within the [API reference documentation](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-claims). You can find code lists for:

* [837 claims](#837-claim-code-lists) (professional, dental, and institutional)
* [277CA claim acknowledgments](#277ca-code-lists)
* [835 Electronic Remittance Advice (ERAs)](#era-code-lists)
* [276/277 claim status checks](#claim-status-code-lists)

## 837 claim code lists

You may need to reference the following code lists when submitting professional, dental, and institutional claims.

### Ambulance Certification Condition Codes

Used in the professional claims `claimInformation.ambulanceCertification.conditionCodes` property.

<Accordion title="Ambulance Certification Condition Codes">
  * `01` - Patient was admitted to a hospital
  * `04` - Patient was moved by stretcher
  * `05` - Patient was unconscious or in shock
  * `06` - Patient was transported in an emergency situation
  * `07` - Patient had to be physically restrained
  * `08` - Patient had visible hemorrhaging
  * `09` - Ambulance service was medically necessary
  * `12` - Patient is confined to a bed or chair; use to indicate that the patient was bedridden during transport
</Accordion>

### Ambulance Transport Reason Codes

Used in the professional claims `claimInformation.ambulanceTransportInformation.ambulanceTransportReasonCode` property.

<Accordion title="Ambulance Transport Reason Codes">
  * `A` - Patient was transported to nearest facility for care of symptoms, complaints, or both
  * `B` - Patient was transported for the benefit of a preferred physician
  * `C` - Patient was transported for the nearness of family members
  * `D` - Patient was transported for the care of a specialist or for availability of specialized equipment
  * `E` - Patient Transferred to Rehabilitation Facility
</Accordion>

### Attachment Report Type Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.serviceLines.serviceLineSupplementalInformation.attachmentReportTypeCode` property
* Institutional claims `claimInformation.claimSupplementalInformation.reportInformation.attachmentReportTypeCode` property
* Dental claims `claimInformation.claimSupplementalInformation.reportInformation.attachmentReportTypeCode` property. A subset of the codes are supported for [dental claims](#dental).

<Accordion title="Attachment Report Type Codes">
  - `03` - Report Justifying Treatment Beyond Utilization Guidelines
  - `04` - Drugs Administered
  - `05` - Treatment Diagnosis
  - `06` - Initial Assessment
  - `07` - Functional Goals
  - `08` - Plan of Treatment
  - `09` - Progress Report
  - `10` - Continued Treatment
  - `11` - Chemical Analysis
  - `13` - Certified Test Report
  - `15` - Justification for Admission
  - `21` - Recovery Plan
  - `A3` - Allergies/Sensitivities Document
  - `A4` - Autopsy Report
  - `AM` - Ambulance Certification
  - `AS` - Admission Summary
  - `B2` - Prescription
  - `B3` - Physician Order
  - `B4` - Referral Form
  - `BR` - Benchmark Testing Results
  - `BS` - Baseline
  - `BT` - Blanket Test Results
  - `CB` - Chiropractic Justification
  - `CK` - Consent Form(s)
  - `CT` - Certification
  - `D2` - Drug Profile Document
  - `DA` - Dental Models
  - `DB` - Durable Medical Equipment Prescription
  - `DG` - Diagnostic Report
  - `DJ` - Discharge Monitoring Report
  - `DS` - Discharge Summary
  - `EB` - Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payor)
  - `HC` - Health Certificate
  - `HR` - Health Clinic Records
  - `I5` - Immunization Record
  - `IR` - State School Immunization Records
  - `LA` - Laboratory Results
  - `M1` - Medical Record Attachment
  - `MT` - Models
  - `NN` - Nursing Notes
  - `OB` - Operative Note
  - `OC` - Oxygen Content Averaging Report
  - `OD` - Orders and Treatments Document
  - `OE` - Objective Physical Examination (including vital signs) Document
  - `OX` - Oxygen Therapy Certification
  - `OZ` - Support Data for Claim
  - `P4` - Pathology Report
  - `P5` - Patient Medical History Document
  - `PE` - Parenteral or Enteral Certification
  - `PN` - Physical Therapy Notes
  - `PO` - Prosthetics or Orthotic Certification
  - `PQ` - Paramedical Results
  - `PY` - Physician's Report
  - `PZ` - Physical Therapy Certification
  - `RB` - Radiology Films
  - `RR` - Radiology Reports
  - `RT` - Report of Tests and Analysis Report
  - `RX` - Renewable Oxygen Content Averaging Report
  - `SG` - Symptoms Document
  - `V5` - Death Notification
  - `XP` - Photographs
</Accordion>

#### Dental

For dental claims, only the following attachment report type codes are supported:

<Accordion title="Dental Attachment Report Type Codes">
  * `B4` - Referral Form
  * `DA` - Dental Models
  * `DG` - Diagnostic Report
  * `EB` - Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payor)
  * `OZ` - Support Data for Claim
  * `P6` - Periodontal Charts
  * `RB` - Radiology Films
  * `RR` - Radiology Reports
</Accordion>

### Attachment Transmission Codes

Used in the professional claims `claimInformation.serviceLines.durableMedicalEquipmentCertificateOfMedicalNecessity.attachmentTransmissionCode` property.

<Accordion title="Attachment Transmission Codes">
  * `AB` - Previously Submitted to Payer
  * `AD` - Certification Included in this Claim
  * `AF` - Narrative Segment Included in this Claim
  * `AG` - No Documentation is Required
  * `NS` - Not Specified; Paperwork is available on request at the provider's site. This means that the paperwork is not being sent with the claim at this time. Instead, it is available to the payer (or appropriate entity) at their request.
</Accordion>

### Claim Filing Indicator Codes

Used in the following APIs and properties:

* Professional Claims `claimInformation.claimFilingCode` and `claimInformation.otherSubscriberInformation.claimFilingIndicatorCode` properties.
* Institutional Claims `claimInformation.claimFilingCode` and `claimInformation.otherSubscriberInformation.claimFilingIndicatorCode` properties.
* Dental Claims `claimInformation.claimFilingCode` and `claimInformation.otherSubscriberInformation.claimFilingIndicatorCode` properties.

<Accordion title="Claim Filing Indicator Codes">
  - `11` - Other Non-Federal Programs
  - `12` - Preferred Provider Organization (PPO)
  - `13` - Point of Service (POS)
  - `14` - Exclusive Provider Organization (EPO)
  - `15` - Indemnity Insurance
  - `16` - Health Maintenance Organization (HMO) Medicare Risk
  - `17` - Dental Maintenance Organization
  - `AM` - Automobile Medical
  - `BL` - Blue Cross/Blue Shield
  - `CH` - Champus
  - `CI` - Commercial Insurance Co.
  - `DS` - Disability
  - `FI` - Federal Employees Program
  - `HM` - Health Maintenance Organization
  - `LM` - Liability Medical
  - `MA` - Medicare Part A
  - `MB` - Medicare Part B
  - `MC` - Medicaid
  - `OF` - Other Federal Program; Use when submitting Medicare Part D claims
  - `TV` - Title V
  - `VA` - Veterans Affairs Plan
  - `WC` - Workers' Compensation Health Claim
  - `ZZ` - Mutually Defined; Use when Type of Insurance is not known
</Accordion>

#### Choosing the right code

For some payers, the value for `claimInformation.claimFilingCode` is relatively obvious. For example, if you're submitting a claim to Medicaid California Medi-Cal, then it makes sense to default to populating `claimInformation.claimFilingCode` with `MC` (Medicaid).

For other payers, the correct code may be more difficult to determine. For example, if submitting a claim to the Centers for Medicare and Medicaid Services (CMS), you may need to submit `MA` (Medicare Part A) or `MB` (Medicare Part B).

In these cases, you can run a [real-time eligibility check](/healthcare/send-eligibility-checks) and evaluate whether the response contains any information that clearly suggests which claim filing code to use. For example, if the eligibility response contains `"benefitsInformation.insuranceType" : "Commercial"` then you should submit `"claimInformation.claimFilingCode": "CI"`.

One thing to note is that you may not always get back a `benefitsInformation.insuranceType` value in an eligibility response because payers are not required to send it. In these cases, you can just submit `ZZ` as the `claimFilingCode` because the vast majority of payers will accept that value.

Once you use this workflow to determine a best guess for the Claim Filing Indicator Code for each payer, you can try sending a claim.

* **Rejection:** The rejection message will clearly state that the claim filing indicator code was incorrect, and should state which one to send instead.
* **Acceptance:** The claim filing indicator code you submitted was correct.

### Claim Pricing (Institutional Claims)

For properties in the Institutional Claims `claimInformation.claimPricingInformation` object and the `claimInformation.serviceLines.lineAdjudicationInformation` object.

#### Exception Codes

Used in the institutional claims `claimInformation.claimPricingInformation.exceptionCode` property.

<Accordion title="Exception Codes">
  * `1` - Non-Network Professional Provider in Network Hospital
  * `2` - Emergency Care
  * `3` - Services or Specialist not in Network
  * `4` - Out-of-Service Area
  * `5` - State Mandates
  * `6` - Other
</Accordion>

#### Policy Compliance Codes

Used in the institutional claims `claimInformation.claimPricingInformation.policyComplianceCode` and `claimInformation.serviceLines.linePricingInformation.policyComplianceCode` properties.

<Accordion title="Policy Compliance Codes">
  * `1` - Procedure Followed (Compliance)
  * `2` - Not Followed - Call Not Made (Non-Compliance Call Not Made)
  * `3` - Not Medically Necessary (Non-Compliance Non-Medically Necessary)
  * `4` - Not Followed Other (Non-Compliance Other)
  * `5` - Emergency Admit to Non-Network Hospital
</Accordion>

#### Pricing Methodology Codes

Used in the institutional claims `claimInformation.claimPricingInformation.pricingMethodologyCode` and `claimInformation.serviceLines.lineRepricingInformation.pricingMethodologyCode` properties.

<Accordion title="Pricing Methodology Codes">
  * `00` - Zero Pricing (Not Covered Under Contract)
  * `01` - Priced as Billed at 100%
  * `02` - Priced at the Standard Fee Schedule
  * `03` - Priced at a Contractual Percentage
  * `04` - Bundled Pricing
  * `05` - Peer Review Pricing
  * `06` - Per Diem Pricing
  * `07` - Flat Rate Pricing
  * `08` - Combination Pricing
  * `09` - Maternity Pricing
  * `10` - Other Pricing
  * `11` - Lower of Cost
  * `12` - Ratio of Cost
  * `13` - Cost Reimbursed
  * `14` - Adjustment Pricing
</Accordion>

#### Product or Service ID Qualifier Codes

Used in the institutional claims properties:

* `claimInformation.claimPricingInformation.productOrServiceIDQualifier`
* `claimInformation.serviceLines.lineAdjudicationInformation.productOrServiceIDQualifier`
* `claimInformation.serviceLines.institutionalService.procedureIdentifier`
* `claimInformation.serviceLines.lineRepricingInformation.productOrServiceIDQualifier`

<Accordion title="Product or Service ID Qualifier Codes">
  - `ER` - Jurisdiction Specific Procedure and Supply Codes; Not allowed for use under HIPAA. You can only use this code if a new rule names the Jurisdiction Specific Procedure and Supply Codes as an allowable code set under HIPAA, OR the Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR for claims not covered by HIPAA.
  - `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes; Because the AMA's CPT codes are also level 1 HCPCS codes, they are reported under HC.
  - `HP` - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code
  - `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code; Not allowed for use under HIPAA. You can only use this qualifier if a new rule names the Home Infusion EDI Coalition (HIEC) Product/Service Codes as an allowable code set under HIPAA, OR the Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR for claims not covered by HIPAA.
  - `WK` - Advanced Billing Concepts (ABC) Codes; Approved by the Secretary of HHS as a pilot project allowed under HIPAA law. Only parties registered in the pilot project and their trading partners can use this qualifier in transactions covered by HIPAA. Otherwise, you can only use this code if a new rule names the Complementary, Alternative, or Holistic Procedure Codes as an allowable code set under HIPAA OR for claims not covered by HIPAA.
</Accordion>

#### Reject Reason Codes

Used in the institutional claims `claimInformation.claimPricingInformation.rejectReasonCode` and `claimInformation.serviceLines.lineRepricingInformation.rejectReasonCode` properties.

<Accordion title="Reject Reason Codes">
  * `T1` - Cannot Identify Provider as TPO (Third Party Organization) Participant
  * `T2` - Cannot Identify Payer as TPO (Third Party Organization) Participant
  * `T3` - Cannot Identify Insured as TPO (Third Party Organization) Participant
  * `T4` - Payer Name or Identifier Missing
  * `T5` - Certification Information Missing
  * `T6` - Claim does not contain enough information for re-pricing
</Accordion>

### Composite Medical Procedure - Product or Service ID Qualifier Codes

Used in the professional claims `claimInformation.serviceLines.lineAdjudicationInformation.serviceIdQualifier` and `claimInformation.serviceLines.professionalService.procedureIdentifier` properties.

<Accordion title="Composite Medical Procedure - Product or Service ID Qualifier Codes">
  * `ER` - Jurisdiction Specific Procedure and Supply Codes; Not allowed for use under HIPAA. You can only use this code if a new rule names the Jurisdiction Specific Procedure and Supply Codes as an allowable code set under HIPAA, OR the Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR for claims not covered by HIPAA.
  * `HC` - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes; Because the AMA's CPT codes are also level 1 HCPCS codes, they are reported under HC.
  * `IV` - Home Infusion EDI Coalition (HIEC) Product/Service Code; Not allowed for use under HIPAA. You can only use this qualifier if a new rule names the Home Infusion EDI Coalition (HIEC) Product/Service Codes as an allowable code set under HIPAA, OR the Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR for claims not covered by HIPAA.
  * `WK` - Advanced Billing Concepts (ABC) Codes; Approved by the Secretary of HHS as a pilot project allowed under HIPAA law. Only parties registered in the pilot project and their trading partners can use this qualifier in transactions covered by HIPAA. Otherwise, you can only use this code if a new rule names the Complementary, Alternative, or Holistic Procedure Codes as an allowable code set under HIPAA OR for claims not covered by HIPAA.
</Accordion>

### Delay Reason Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.delayReasonCode` property.
* Institutional claims `claimInformation.delayReasonCode` property.
* Dental claims `claimInformation.delayReasonCode` property.

<Accordion title="Delay Reason Codes">
  - `1` - Proof of Eligibility Unknown or Unavailable
  - `2` - Litigation
  - `3` - Authorization Delays
  - `4` - Delay in Certifying Provider
  - `5` - Delay in Supplying Billing Forms
  - `6` - Delay in Delivery of Custom-made Appliances
  - `7` - Third Party Processing Delay
  - `8` - Delay in Eligibility Determination
  - `9` - Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules
  - `10` - Administration Delay in the Prior Approval Process
  - `11` - Other
  - `15` - Natural Disaster
</Accordion>

### Drug Identification Product or Service ID Qualifier Codes

Used in the professional claims `claimInformation.serviceLines.drugIdentification.serviceIdQualifier` property.

<Accordion title="Drug Identification Product or Service ID Qualifier Codes">
  * `EN` - EAN/UCC - 13
  * `EO` - EAN/UCC - 8
  * `HI` - HIBC (Health Care Industry Bar Code) Supplier Labeling Standard Primary Data Message
  * `N4` - National Drug Code in 5-4-2 Format
  * `ON` - Customer Order Number
  * `UK` - GTIN 14-digit Data Structure
  * `UP` - UCC - 12
</Accordion>

### Individual Relationship Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.otherSubscriberInformation.individualRelationshipCode` property.
* Institutional claims `claimInformation.otherSubscriberInformation.individualRelationshipCode` property.
* Dental claims `claimInformation.otherSubscriberInformation.individualRelationshipCode` property.

<Accordion title="Individual Relationship Codes">
  - `01` - Spouse
  - `18` - Self
  - `19` - Child
  - `20` - Employee
  - `21` - Unknown
  - `39` - Organ Donor
  - `40` - Cadaver Donor
  - `53` - Life Partner
  - `G8` - Other Relationship
</Accordion>

### Insurance Type Codes

Used in the following APIs and properties:

* Professional claims `subscriber.insuranceTypeCode` and `claimInformation.otherSubscriberInformation.insuranceTypeCode` properties.
* Dental claims `subscriber.insuranceTypeCode` and `claimInformation.otherSubscriberInformation.insuranceTypeCode` properties.

<Accordion title="Insurance Type Codes">
  - `12` - Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
  - `13` - Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
  - `14` - Medicare Secondary, No-fault Insurance including Auto is Primary
  - `15` - Medicare Secondary Worker's Compensation
  - `16` - Medicare Secondary Public Health Service (PHS)or Other Federal Agency
  - `41` - Medicare Secondary Black Lung
  - `42` - Medicare Secondary Veteran's Administration
  - `43` - Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
  - `47` - Medicare Secondary, Other Liability Insurance is Primary
</Accordion>

### Payment Responsibility Sequence Number Codes

Used in the following APIs and properties:

* Professional claims `subscriber.paymentResponsibilityLevelCode` and `claimInformation.otherSubscriberInformation.paymentResponsibilityLevelCode` properties.
* Institutional claims `subscriber.paymentResponsibilityLevelCode` and `claimInformation.otherSubscriberInformation.paymentResponsibilityLevelCode` properties.
* Dental claims `subscriber.paymentResponsibilityLevelCode` and `claimInformation.otherSubscriberInformation.paymentResponsibilityLevelCode` properties.

<Accordion title="Payment Responsibility Sequence Number Codes">
  - `A` - Payer Responsibility Four
  - `B` - Payer Responsibility Five
  - `C` - Payer Responsibility Six
  - `D` - Payer Responsibility Seven
  - `E` - Payer Responsibility Eight
  - `F` - Payer Responsibility Nine
  - `G` - Payer Responsibility Ten
  - `H` - Payer Responsibility Eleven
  - `P` - Primary
  - `S` - Secondary
  - `T` - Tertiary
  - `U` - Unknown; This code may only be used in payer to payer COB claims when the original payer determined the presence of this coverage from eligibility files received from this payer or when the original claim did not provide the responsibility sequence for this payer.
</Accordion>

### Pricing/Repricing (Professional and Dental Claims)

Used in the professional claims and dental claims APIs.

#### Exception Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.claimPricingRepricingInformation.exceptionCode` and `claimInformation.serviceLines.linePricingRepricingInformation.exceptionCode` properties.
* Dental claims `claimInformation.claimPricingRepricingInformation.exceptionCode` and `claimInformation.serviceLines.linePricingRepricingInformation.exceptionCode` properties.

<Accordion title="Exception Codes (Professional and Dental)">
  - `1` - Non-Network Professional Provider in Network Hospital
  - `2` - Emergency Care
  - `3` - Services or Specialist not in Network
  - `4` - Out-of-Service Area
  - `5` - State Mandates
  - `6` - Other
</Accordion>

#### Policy Compliance Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.claimPricingRepricingInformation.policyComplianceCode` and `claimInformation.serviceLines.linePricingRepricingInformation.policyComplianceCode` properties.
* Dental claims `claimInformation.claimPricingRepricingInformation.policyComplianceCode` and `claimInformation.serviceLines.linePricingRepricingInformation.policyComplianceCode` properties.

<Accordion title="Policy Compliance Codes (Professional and Dental)">
  - `1` - Procedure Followed (Compliance)
  - `2` - Not Followed - Call Not Made (Non-Compliance Call Not Made)
  - `3` - Not Medically Necessary (Non-Compliance Non-Medically Necessary)
  - `4` - Not Followed Other (Non-Compliance Other)
  - `5` - Emergency Admit to Non-Network Hospital
</Accordion>

#### Pricing Methodology Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.claimPricingRepricingInformation.pricingMethodologyCode` and `claimInformation.serviceLines.linePricingRepricingInformation.pricingMethodologyCode` properties.
* Dental claims `claimInformation.claimPricingRepricingInformation.pricingMethodologyCode` and `claimInformation.serviceLines.linePricingRepricingInformation.pricingMethodologyCode` properties.

<Accordion title="Pricing Methodology Codes (Professional and Dental)">
  - `00` - Zero Pricing (Not Covered Under Contract)
  - `01` - Priced as Billed at 100%
  - `02` - Priced at the Standard Fee Schedule
  - `03` - Priced at a Contractual Percentage
  - `04` - Bundled Pricing
  - `05` - Peer Review Pricing
  - `07` - Flat Rate Pricing
  - `08` - Combination Pricing
  - `09` - Maternity Pricing
  - `10` - Other Pricing
  - `11` - Lower of Cost
  - `12` - Ratio of Cost
  - `13` - Cost Reimbursed
  - `14` - Adjustment Pricing
</Accordion>

#### Reject Reason Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.claimPricingRepricingInformation.rejectReasonCode` and `claimInformation.serviceLines.linePricingRepricingInformation.rejectReasonCode` properties.
* Dental claims `claimInformation.claimPricingRepricingInformation.rejectReasonCode` and `claimInformation.serviceLines.linePricingRepricingInformation.rejectReasonCode` properties.

<Accordion title="Reject Reason Codes (Professional and Dental)">
  - `T1` - Cannot Identify Provider as TPO (Third Party Organization) Participant
  - `T2` - Cannot Identify Payer as TPO (Third Party Organization) Participant
  - `T3` - Cannot Identify Insured as TPO (Third Party Organization) Participant
  - `T4` - Payer Name or Identifier Missing
  - `T5` - Certification Information Missing
  - `T6` - Claim does not contain enough information for re-pricing
</Accordion>

### Service Authorization Exception Codes

Used in the following APIs and properties:

* Professional claims `claimInformation.claimSupplementalInformation.serviceAuthorizationExceptionCode` property
* Institutional claims `claimInformation.claimSupplementalInformation.serviceAuthorizationExceptionCode` property.
* Dental claims `claimInformation.claimSupplementalInformation.serviceAuthorizationExceptionCode` property

<Accordion title="Service Authorization Exception Codes">
  - `1` - Immediate/Urgent Care
  - `2` - Services Rendered in a Retroactive Period
  - `3` - Emergency Care
  - `4` - Client has Temporary Medicaid
  - `5` - Request from County for Second Opinion to Determine if Recipient Can Work
  - `6` - Request for Override Pending
  - `7` - Special Handling
</Accordion>

### Vision Condition Codes

Used in the professional claims `claimInformation.patientConditionInformationVision.conditionCodes` property.

<Accordion title="Vision Condition Codes">
  * `L1` - General Standard of 20 Degree or .5 Diopter Sphere or Cylinder Change Met
  * `L2` - Replacement Due to Loss or Theft
  * `L3` - Replacement Due to Breakage or Damage
  * `L4` - Replacement Due to Patient Preference
  * `L5` - Replacement Due to Medical Reason
</Accordion>

## 277CA code lists

You may need to refer to the following code lists while evaluating the 277CA claim acknowledgment.

### Claim Status Category Code

A claim's status is reported using a category code, which is returned in multiple locations within the 277CA. For each instance, Stedi returns two properties:

* `healthCareClaimStatusCategoryCode`: The code, such as `A1`, `P2`, or `F1`.
* `healthCareClaimStatusCategoryCodeValue`: The description associated with that code.

These values indicate the status of a claim or encounter.

<Accordion title="Claim Status Category Codes">
  * `A0` - Acknowledgement/Forwarded - The claim/encounter has been forwarded to another entity.
  * `A1` - Acknowledgement/Receipt - The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication.
  * `A2` - Acknowledgement/Acceptance into adjudication system - The claim/encounter has been accepted into the adjudication system.
  * `A3` - Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the adjudication system.
  * `A4` - Acknowledgement/Not Found - The claim/encounter can not be found in the adjudication system.
  * `A5` - Acknowledgement/Split Claim - The claim/encounter has been split upon acceptance into the adjudication system.
  * `A6` - Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.
  * `A7` - Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.
  * `A8` - Acknowledgement/Rejected for relational field in error.
  * `DR01` - Acknowledgement/Receipt - The claim/encounter has been received. This does not mean the claim has been accepted into the data reporting/processing system.
  * `DR02` - Acknowledgement/Acceptance into the data reporting/processing system - The claim/encounter has been accepted into the data reporting/processing system.
  * `DR03` - Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the data reporting/processing system.
  * `DR04` - Acknowledgement/Not Found - The claim/encounter can not be found in the data reporting/processing system.
  * `DR05` - Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected.
  * `DR06` - Acknowledgment/Rejected for invalid information - The claim/encounter has invalid information as specified in the Status details and has been rejected.
  * `DR07` - Acknowledgement/Rejected for relational field in error.
  * `DR08` - Acknowledgement/Warning - The claim/encounter has been accepted into the data reporting/processing system but has received a warning as specified in the Status details.
  * `P0` - Pending: Adjudication/Details - This is a generic message about a pended claim. A pended claim is one for which no remittance advice has been issued,or only part of the claim has been paid.
  * `P1` - Pending/In Process - The claim or encounter is in the adjudication system.
  * `P2` - Pending/Payer Review - The claim/encounter is suspended and is pending review (e.g. medical review,repricing,Third Party Administrator processing).
  * `P3` - Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider.
  * `P4` - Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient.
  * `P5` - Pending/Payer Administrative/System hold
  * `F0` - Finalized - The claim/encounter has completed the adjudication cycle and no more action will be taken.
  * `F1` - Finalized/Payment - The claim/line has been paid.
  * `F2` - Finalized/Denial - The claim/line has been denied.
  * `F3` - Finalized/Revised - Adjudication information has been changed
  * `F3F` - Finalized/Forwarded - The claim/encounter processing has been completed. Any applicable payment has been made and the claim/encounter has been forwarded to a subsequent entity as identified on the original claim or in this payer's records.
  * `F3N` - Finalized/Not Forwarded - The claim/encounter processing has been completed. Any applicable payment has been made. The claim/encounter has NOT been forwarded to any subsequent entity identified on the original claim.
  * `F4` - Finalized/Adjudication Complete - No payment forthcoming - The claim/encounter has been adjudicated and no further payment is forthcoming.
  * `R0` - Requests for additional Information/General Requests - Requests that don't fall into other R - type categories.
  * `R1` - Requests for additional Information/Entity Requests - Requests for information about specific entities (subscribers,patients,various providers).
  * `R3` - Requests for additional Information/Claim/Line - Requests for information that could normally be submitted on a claim.
  * `R4` - Requests for additional Information/Documentation - Requests for additional supporting documentation. Examples: certification,x - ray,notes.
  * `R5` - Request for additional information/more specific detail - Additional information as a follow up to a previous request is needed. The original information was received but is inadequate. More specific/detailed information is requested.
  * `R6` - Requests for additional information – Regulatory requirements
  * `R7` - Requests for additional information – Confirm care is consistent with Health Plan policy coverage
  * `R8` - Requests for additional information – Confirm care is consistent with health plan coverage exceptions
  * `R9` - Requests for additional information – Determination of medical necessity
  * `R10` - Requests for additional information – Support a filed grievance or appeal
  * `R11` - Requests for additional information – Pre - payment review of claims
  * `R12` - Requests for additional information – Clarification or justification of use for specified procedure code
  * `R13` - Requests for additional information – Original documents submitted are not readable. Used only for subsequent request(s).
  * `R14` - Requests for additional information – Original documents received are not what was requested. Used only for subsequent request(s).
  * `R15` - Requests for additional information – Workers Compensation coverage determination.
  * `R16` - Requests for additional information – Eligibility determination
  * `R17` - Replacement of a Prior Request. Used to indicate that the current attachment request replaces a prior attachment request.
  * `E0` - Response not possible - error on submitted request data
  * `E1` - Response not possible - System Status
  * `E2` - Information Holder is not responding; resubmit at a later time.
  * `E3` - Correction required - relational fields in error.
  * `E4` - Trading partner agreement specific requirement not met: Data correction required.
  * `D0` - Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria.
</Accordion>

## ERA code lists

You may need to refer to the following code lists while evaluating the 835 Electronic Remittance Advice (ERA).

### Claim Adjustment Group Code

This code is returned in the [`transactions.detailInfo.paymentInfo.claimAdjustments.claimAdjustmentGroupCode` property](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.claimAdjustments.claimAdjustmentGroupCode). It categorizes the adjustment reason codes returned in the `claimAdjustments` object.

<Accordion title="Claim Adjustment Group Codes">
  * `CO` - Contractual Obligations | The payer uses this code when a joint payer/payee contractual agreement or a regulatory requirement resulted in an adjustment. An example of a contractual obligation might be a Participating Provider Agreement.
  * `OA` - Other adjustments | The payer uses this code when the adjustment doesn't fall within the other categories.
  * `PI` - Payor Initiated Reductions | The payer uses this code when, in their opinion, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer (i.e., medical review or professional review organization adjustments).
  * `PR` - Patient Responsibility | The payer uses this code when the adjustment amount is the responsibility of the patient.
</Accordion>

### Claim Adjustment Reason Code (CARC)

This code is returned in the following properties:

* [`transactions[].detailInfo[].paymentInfo[].claimAdjustments[].adjustmentReasonCode`](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.claimAdjustments.adjustmentReasonCode1) (1-6)
* [`transactions[].detailInfo[].paymentInfo[].serviceLines[].serviceAdjustments[].adjustmentReasonCode`](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.serviceLines.serviceAdjustments.adjustmentReasonCode1) (1-6)

CARCs identify the reason for an adjustment. Visit [Claim Adjustment Reason Codes](https://x12.org/codes/claim-adjustment-reason-codes) in the X12 documentation for a complete list.

### Claim Filing Indicator Code

This code is returned in the [`transactions.detailInfo.paymentInfo.claimPaymentInfo.claimFilingIndicatorCode` property](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.claimPaymentInfo.claimFilingIndicatorCode). It identifies the type of claim submitted.

<Accordion title="Claim Filing Indicator Codes (ERA)">
  * `12` - Preferred Provider Organization (PPO) | This code is also used for Blue Cross/Blue Shield participating provider arrangements.
  * `13` - Point of Service (POS)
  * `14` - Exclusive Provider Organization (EPO)
  * `15` - Indemnity Insurance | This code is also used for Blue Cross/Blue Shield non-participating provider arrangements.
  * `16` - Health Maintenance Organization (HMO) Medicare Risk
  * `17` - Dental Maintenance Organization
  * `AM` - Automobile Medical
  * `CH` - Champus
  * `DS` - Disability
  * `HM` - Health Maintenance Organization
  * `LM` - Liability Medical
  * `MA` - Medicare Part A
  * `MB` - Medicare Part B
  * `MC` - Medicaid
  * `OF` - Other Federal Program | This code is used for the Black Lung Program.
  * `TV` - Title V
  * `VA` - Veterans Affairs Plan
  * `WC` - Workers' Compensation Health Claim
  * `ZZ` - Mutually Defined
</Accordion>

### Claim Status Code

This code is returned in the [`transactions.detailInfo.paymentInfo.claimPaymentInfo.claimStatusCode` property](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.claimPaymentInfo.claimStatusCode). It identifies the status of an entire claim as assigned by the payer, claim review organization, or repricing organization.

Codes `19`, `20`, and `21` indicate that the claim is a [crossover claim](/healthcare/receive-claim-responses#crossover-claims) that has been forwarded to an additional payer for processing. This practice is common in coordination of benefits (COB) scenarios. You may need to enroll the provider with the additional payer before they can process the claim.

<Accordion title="Claim Status Codes">
  * `1` - Processed as Primary | The payer uses this code when the claim was adjudicated by the current payer as primary regardless of whether any part of the claim was paid.
  * `2` - Processed as Secondary | The payer uses this code when the claim was adjudicated by the current payer as secondary regardless of whether any part of the claim was paid.
  * `3` - Processed as Tertiary | The payer uses this code when the claim was adjudicated by the current payer as tertiary (or subsequent) regardless of whether any part of the claim was paid.
  * `4` - Denied | The payer uses this code when the Patient/Subscriber is not recognized, and the claim was not forwarded to another payer.
  * `19` - Processed as Primary, Forwarded to Additional Payer(s)
  * `20` - Processed as Secondary, Forwarded to Additional Payer(s)
  * `21` - Processed as Tertiary, Forwarded to Additional Payer(s)
  * `22` - Reversal of Previous Payment
  * `23` - Not Our Claim, Forwarded to Additional Payer(s) | The payer sends this code when the patient/subscriber is not recognized or the claim was not adjudicated by the payer, but other payers are known and the claim has been forwarded to another payer.
  * `25` - Predetermination Pricing Only - No Payment
</Accordion>

### Credit or Debit Flag Code

This code is returned in the [`transactions.financialInformation.creditOrDebitFlagCode` property](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.financialInformation.creditOrDebitFlagCode). It indicates whether the payment is a credit or a debit.

<Accordion title="Credit or Debit Flag Codes">
  * `C` - Credit | The payer uses this code to indicate a credit to the provider's account and a debit to the payer's account, initiated by the payer. In the case of an EFT, no additional action is required of the provider. The payer also uses this code when a check is issued for the payment.
  * `D` - Debit | The payer uses this code to indicate a debit to the payer's account and a credit to the provider's account, initiated by the provider at the instruction of the payer.
</Accordion>

### Payment Method Code

This code is returned in the [`transactions.financialInformation.paymentMethodCode` property](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.financialInformation.paymentMethodCode). It identifies the payment format. Note that the remaining properties in the `financialInformation` object contain additional requirements and information about the payment.

<Accordion title="Payment Method Codes">
  * `ACH` - Automated Clearing House (ACH) | The payer uses this code to move money electronically through the ACH, or to notify the provider that an ACH transfer was requested.
  * `BOP` - Financial Institution Option | The payer uses this code to indicate that the third-party processor will choose the method of payment based upon endpoint requests or capabilities.
  * `CHK` - Check | The payer uses this code to indicate that a check has been issued for payment.
  * `FWT` - Federal Reserve Funds/Wire Transfer - Nonrepetitive | The payer uses this code to indicate that the funds were sent through the wire system.
  * `NON` - Non-Payment Data | The payer uses this code when the `transactions.financialInformation.transactionHandlingCode` is `H`, indicating that this is information only and no dollars are to be moved.
</Accordion>

### Provider Adjustment Reason Code

This code is returned in the [transactions\[\].providerAdjustments\[\].adjustments\[\].adjustmentReasonCode](https://www.stedi.com/docs/healthcare/api-reference/get-healthcare-reports-835#response.transactions.providerAdjustments\[].adjustments\[].adjustmentReasonCode) property.

This code identifies the reason for an adjustment made to the provider's account outside of the claim-level and service-line-level adjustments. The valid codes for X12 release 5010, which Stedi uses for ERAs, differ from the Provider Adjustment Reason Codes list on the X12 website. Use the following code list for ERAs you receive through Stedi.

<Accordion title="Provider Adjustment Reason Codes">
  * `50` - Late Charge | This is the Late Claim Filing Penalty or Medicare Late Cost Report Penalty
  * `51` - Interest Penalty Charge | This is the interest assessment for late filing.
  * `72` - Authorized Return | This is the provider refund adjustment. This adjustment acknowledges a refund received from a provider for previous overpayment. The payer should provide an identifying number in the `providerAdjustmentIdentifier` property. The adjustment amount is always a negative value.
  * `90` - Early Payment Allowance
  * `AH` - Origination Fee | This is the claim transmission fee. This is used for transmission fees that aren't specific to or dependent upon individual claims.
  * `AM` - Applied to Borrower's Account | This identifies a loan repayment amount. This is capitation specific.
  * `AP` - Acceleration of Benefits | This is the accelerated payment amount or withholding. A positive value for the adjustment represents a withholding. A negative value represents a payment.
  * `B2` - Rebate | The provider has remitted an overpayment to the health plan in excess of the amount requested. The excess amount is being returned to the provider. The amount accepted by the health plan is reported using code `72` (Authorized Return) and is offset by the amount with code `WO` (Overpayment Recovery). This code reports the excess amount (represented as a negative adjustment amount) returned to the provider.
  * `B3` - Recovery Allowance | This represents the check the payer received from the provider for overpayments from other payers. This is different from the provider refund adjustment represented by code `72` (Authorized Return). This adjustment should always be offset by another adjustment referring to the original refund request or reason.
  * `BD` - Bad Debt Adjustment | This is the bad debt passthrough.
  * `BN` - Bonus | This is capitation specific.
  * `C5` - Temporary Allowance | This is the tentative adjustment.
  * `CR` - Capitation Interest | This is capitation specific.
  * `CS` - Adjustment
  * `CT` - Capitation Payment | This is capitation specific.
  * `CV` - Capital Passthru
  * `CW` - Certified Registered Nurse Anesthetist Passthru
  * `DM` - Direct Medical Education Passthru
  * `E3` - Withholding
  * `FB` - Forwarding Balance | This is the balance forward. A negative adjustment value represents a balance moving forward to a future ERA. A positive value represents a balance being applied from a previous ERA. The payer should provide a reference number for tracking purposes in the `providerAdjustmentIdentifier` property.
  * `FC` - Fund Allocation | This is capitation specific.
  * `GO` - Graduate Medical Education Passthru
  * `HM` - Hemophilia Clotting Factor Supplement
  * `IP` - Inceptive Premium Payment | This is capitation specific.
  * `IR` - Internal Revenue Service Withholding
  * `IS` - Interim Settlement | This is the interim rate lump sum adjustment.
  * `J1` - Nonreimbursable | This offsets the claim or service level data that reflects what could be paid if not for demonstration program or other limitation that prevents issuance of payment.
  * `L3` - Penalty | This is the capitation-related penalty. Withholding or release is identified by the sign of the adjustment amount.
  * `L6` - Interest Owed | This is the interest paid on claims in this ERA.
  * `LE` - Levy | IRS levy.
  * `LS` - Lump Sum | This is the disproportionate share adjustment, indirect medical education passthrough, non-physician passthrough, passthrough lump sum adjustment, or other passthrough amount. The payer should identify the specific type of lump sum adjustment in the `providerAdjustmentIdentifier` property.
  * `OA` - Organ Acquisition Passthru
  * `OB` - Offset for Affiliated Providers | The payer should identify the affiliated providers in the `providerAdjustmentIdentifier` property.
  * `PI` - Periodic Interim Payment | This is the periodic interim lump sum payments and reductions (PIP). The payments are made to a provider at the beginning of some period in advance of claims. These payments are advances on the expected claims for the period. The reductions are the recovery of actual claims payments during the period. For example, when a provider has a PIP payment, claims within this ERA covered by that payment are offset using this code to remove the claim payment from the current check. The sign of the adjustment amount determines whether this is a payment (negative) or reduction (positive). This payment and recoupment is effectively a loan to the provider and loan repayment.
  * `PL` - Payment Final | This is the final settlement.
  * `RA` - Retro-activity Adjustment | This is capitation specific.
  * `RE` - Return on Equity
  * `SL` - Student Loan Repayment
  * `TL` - Third Party Liability | This is capitation specific.
  * `WO` - Overpayment Recovery | This is the recovery of previous overpayment. The payer should provide an identifying number in the `providerAdjustmentIdentifier` property.
  * `WU` - Unspecified Recovery | Medicare is currently using this code to represent penalty collections withheld for the IRS (an outside source).
</Accordion>

### Remittance Advice Remark Code (RARC)

This code is returned in the following properties:

* [`transactions[].detailInfo[].paymentInfo[].inpatientAdjudication.claimPaymentRemarkCode`](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.inpatientAdjudication.claimPaymentRemarkCode1) (1-6)
* [`transactions[].detailInfo[].paymentInfo[].outpatientAdjudication.claimPaymentRemarkCode`](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.outpatientAdjudication.claimPaymentRemarkCode1) (1-6)
* [`transactions[].detailInfo[].paymentInfo[].serviceLines[].healthCareCheckRemarkCodes[].remarkCode`](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.detailInfo.paymentInfo.serviceLines.healthCareCheckRemarkCodes.remarkCode) - this property can either be a RARC or a National Council for Prescription Drug Programs Reject/Payment Code

RARCs provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or convey information about remittance processing.

Visit [Remittance Advice Remark Codes](https://x12.org/codes/remittance-advice-remark-codes) in the X12 documentation for a complete list.

### Transaction Handling Code

This code is returned in the [`transactions.financialInformation.transactionHandlingCode` property](/healthcare/api-reference/get-healthcare-reports-835#response.transactions.financialInformation.transactionHandlingCode). It indicates the actions taken by both the sender and the receiver.

<Accordion title="Transaction Handling Codes">
  * `C` - Payment Accompanies Remittance Advice | The payer uses this code to instruct the third-party processor to move funds and remittance details together through the banking system.
  * `D` - Make Payment Only | The payer uses this code to instruct the third-party processor to move only funds through the banking system and to ignore any remittance information.
  * `H` - Notification Only | The payer uses this code when the actual provider payment (listed in the `transactions.financialInformation.totalActualProviderPaymentAmount` property) is zero, and the transaction is not being used for Prenotification of Future Transfers. This indicates remittance information without any associated payment.
  * `I` - Remittance Information Only | The payer uses this code to indicate to the payee that the remittance detail is moving separately from the payment.
  * `P` - Prenotification of Future Transfers | This code is used only by the payer and the banking system to initially validate account numbers before beginning an EFT relationship.
  * `U` - Split Payment and Remittance | The payer uses this code to instruct the third-party processor to split the payment and remittance details and send each on a separate path.
  * `X` - Handling Party's Option to Split Payment and Remittance | The payer uses this code to instruct the third-party processor to move the payment and remittance detail, together or separately, based upon endpoint requests or capabilities.
</Accordion>

## Claim status code lists

You may need to reference the following code lists when working with the 276/277 claim status request or response.

### Claim status

Used in the [`claims.claimStatus.statusCode`](/healthcare/api-reference/post-healthcare-claim-status#response.claims.claimStatus.statusCode) property. This is the status code used to identify the status of an entire claim or a service line. For example, code `20` means `Accepted for Processing`.

This is either a Health Care Claim Status Code or a National Council for Prescription Drug Programs (NCPDP) Reject/Payment Code, when the status is related to pharmacy claims.

* Visit [Claim Status Codes](https://x12.org/codes/claim-status-codes) in the official X12 documentation for a complete list of Health Care Claim Status Codes.
* Visit the [National Council for Prescription Drug Programs website](https://www.ncpdp.org/) for access to the Reject/Payment Code list.

### Claim status category

A code that provides more detail about the claim status. For example, code `F1` means `Finalized/Revised - Adjudication information has been changed`.

It's returned in the following properties:

* [`claims.claimStatus.statusCategoryCode`](https://www.stedi.com/docs/healthcare/api-reference/post-healthcare-claim-status#response.claims.claimStatus.statusCategoryCode)
* [`claims.serviceDetails.status.statusCategoryCode`](/healthcare/api-reference/post-healthcare-claim-status#response.claims.serviceDetails.status.statusCategoryCode)

Visit [Claim Status Category Codes](https://x12.org/codes/claim-status-category-codes) in the official X12 documentation for a complete list.

### Entity identifier

A code identifying the organizational entity, physical location, property, or individual associated with the `claims.claimStatus.statusCode`. For example, code `1G` means `Oncology Center`.

It's returned in the following properties:

* [`claims.claimStatus.entityCode`](/healthcare/api-reference/post-healthcare-claim-status#response.claims.claimStatus.entityCode)
* [`claims.serviceDetails.status.entityCode`](/healthcare/api-reference/post-healthcare-claim-status#response.claims.serviceDetails.status.entityCode)

<Accordion title="Entity Identifier Codes">
  - `1E` - Health Maintenance Organization (HMO)
  - `1G` - Oncology Center
  - `1H` - Kidney Dialysis Unit
  - `1I` - Preferred Provider Organization (PPO)
  - `1O` - Acute Care Hospital
  - `1P` - Provider
  - `1Q` - Military Facility
  - `1R` - University, College or School
  - `1S` - Outpatient Surgicenter
  - `1T` - Physician, Clinic or Group Practice
  - `1U` - Long Term Care Facility
  - `1V` - Extended Care Facility
  - `1W` - Psychiatric Health Facility
  - `1X` - Laboratory
  - `1Y` - Retail Pharmacy
  - `1Z` - Home Health Care
  - `2A` - Federal, State, County or City Facility
  - `2B` - Third-Party Administrator
  - `2D` - Miscellaneous Health Care Facility
  - `2E` - Non-Health Care Miscellaneous Facility
  - `2I` - Church Operated Facility
  - `2K` - Partnership
  - `2P` - Public Health Service Facility
  - `2Q` - Veterans Administration Facility
  - `2S` - Public Health Service Indian Service Facility
  - `2Z` - Hospital Unit of an Institution (prison hospital, college infirmary, etc.)
  - `03` - Dependent
  - `3A` - Hospital Unit Within an Institution for the Mentally Retarded
  - `3C` - Tuberculosis and Other Respiratory Diseases Facility
  - `3D` - Obstetrics and Gynecology Facility
  - `3E` - Eye, Ear, Nose and Throat Facility
  - `3F` - Rehabilitation Facility
  - `3G` - Orthopedic Facility
  - `3H` - Chronic Disease Facility
  - `3I` - Other Specialty Facility
  - `3J` - Children's General Facility
  - `3K` - Children's Hospital Unit of an Institution
  - `3L` - Children's Psychiatric Facility
  - `3M` - Children's Tuberculosis and Other Respiratory Diseases Facility
  - `3N` - Children's Eye, Ear, Nose and Throat Facility
  - `3O` - Children's Rehabilitation Facility
  - `3P` - Children's Orthopedic Facility
  - `3Q` - Children's Chronic Disease Facility
  - `3R` - Children's Other Specialty Facility
  - `3S` - Institution for Mental Retardation
  - `3T` - Alcoholism and Other Chemical Dependency Facility
  - `3U` - General Inpatient Care for AIDS/ARC Facility
  - `3V` - AIDS/ARC Unit
  - `3W` - Specialized Outpatient Program for AIDS/ARC
  - `3X` - Alcohol/Drug Abuse or Dependency Inpatient Unit
  - `3Y` - Alcohol/Drug Abuse or Dependency Outpatient Services
  - `3Z` - Arthritis Treatment Center
  - `4A` - Birthing Room/LDRP Room
  - `4B` - Burn Care Unit
  - `4C` - Cardiac Catherization Laboratory
  - `4D` - Open-Heart Surgery Facility
  - `4E` - Cardiac Intensive Care Unit
  - `4F` - Angioplasty Facility
  - `4G` - Chronic Obstructive Pulmonary Disease Service Facility
  - `4H` - Emergency Department
  - `4I` - Trauma Center (Certified)
  - `4J` - Extracorporeal Shock-Wave Lithotripter (ESWL) Unit
  - `4L` - Genetic Counseling/Screening Services
  - `4M` - Adult Day Care Program Facility
  - `4N` - Alzheimer's Diagnostic/Assessment Services
  - `4O` - Comprehensive Geriatric Assessment Facility
  - `4P` - Emergency Response (Geriatric) Unit
  - `4Q` - Geriatric Acute Care Unit
  - `4R` - Geriatric Clinics
  - `4S` - Respite Care Facility
  - `4U` - Patient Education Unit
  - `4V` - Community Health Promotion Facility
  - `4W` - Worksite Health Promotion Facility
  - `4X` - Hemodialysis Facility
  - `4Y` - Home Health Services
  - `4Z` - Hospice
  - `5A` - Medical Surgical or Other Intensive Care Unit
  - `5B` - Histopathology Laboratory
  - `5C` - Blood Bank
  - `5D` - Neonatal Intensive Care Unit
  - `5E` - Obstetrics Unit
  - `5F` - Occupational Health Services
  - `5G` - Organized Outpatient Services
  - `5H` - Pediatric Acute Inpatient Unit
  - `5I` - Psychiatric Child/Adolescent Services
  - `5J` - Psychiatric Consultation-Liaison Services
  - `5K` - Psychiatric Education Services
  - `5L` - Psychiatric Emergency Services
  - `5M` - Psychiatric Geriatric Services
  - `5N` - Psychiatric Inpatient Unit
  - `5O` - Psychiatric Outpatient Services
  - `5P` - Psychiatric Partial Hospitalization Program
  - `5Q` - Megavoltage Radiation Therapy Unit
  - `5R` - Radioactive Implants Unit
  - `5S` - Therapeutic Radioisotope Facility
  - `5T` - X-Ray Radiation Therapy Unit
  - `5U` - CT Scanner Unit
  - `5V` - Diagnostic Radioisotope Facility
  - `5W` - Magnetic Resonance Imaging (MRI) Facility
  - `5X` - Ultrasound Unit
  - `5Y` - Rehabilitation Inpatient Unit
  - `5Z` - Rehabilitation Outpatient Services
  - `6A` - Reproductive Health Services
  - `6B` - Skilled Nursing or Other Long-Term Care Unit
  - `6C` - Single Photon Emission Computerized Tomography (SPECT) Unit
  - `6D` - Organized Social Work Service Facility
  - `6E` - Outpatient Social Work Services
  - `6F` - Emergency Department Social Work Services
  - `6G` - Sports Medicine Clinic/Services
  - `6H` - Hospital Auxiliary Unit
  - `6I` - Patient Representative Services
  - `6J` - Volunteer Services Department
  - `6K` - Outpatient Surgery Services
  - `6L` - Organ/Tissue Transplant Unit
  - `6M` - Orthopedic Surgery Facility
  - `6N` - Occupational Therapy Services
  - `6O` - Physical Therapy Services
  - `6P` - Recreational Therapy Services
  - `6Q` - Respiratory Therapy Services
  - `6R` - Speech Therapy Services
  - `6S` - Women's Health Center/Services
  - `6U` - Cardiac Rehabilitation Program Facility
  - `6V` - Non-Invasive Cardiac Assessment Services
  - `6W` - Emergency Medical Technician
  - `6X` - Disciplinary Contact
  - `6Y` - Case Manager
  - `7C` - Place of Occurrence
  - `13` - Contracted Service Provider
  - `17` - Consultant's Office
  - `28` - Subcontractor
  - `30` - Service Supplier
  - `36` - Employer
  - `40` - Receiver
  - `43` - Claimant Authorized Representative
  - `44` - Data Processing Service Bureau
  - `61` - Performed At
  - `71` - Attending Physician
  - `72` - Operating Physician
  - `73` - Other Physician
  - `74` - Corrected Insured
  - `77` - Service Location
  - `80` - Hospital
  - `82` - Rendering Provider
  - `84` - Subscriber's Employer
  - `85` - Billing Provider
  - `87` - Pay-to Provider
  - `95` - Research Institute
  - `CK` - Pharmacist
  - `CZ` - Admitting Surgeon
  - `D2` - Commercial Insurer
  - `DD` - Assistant Surgeon
  - `DJ` - Consulting Physician
  - `DK` - Ordering Physician
  - `DN` - Referring Provider
  - `DO` - Dependent Name
  - `DQ` - Supervising Physician
  - `E1` - Person or Other Entity Legally Responsible for a Child
  - `E2` - Person or Other Entity With Whom a Child Resides
  - `E7` - Previous Employer
  - `E9` - Participating Laboratory
  - `FA` - Facility
  - `FD` - Physical Address
  - `FE` - Mail Address
  - `G0` - Dependent Insured
  - `G3` - Clinic
  - `GB` - Other Insured
  - `GD` - Guardian
  - `GI` - Paramedic
  - `GJ` - Paramedical Company
  - `GK` - Previous Insured
  - `GM` - Spouse Insured
  - `GY` - Treatment Facility
  - `HF` - Healthcare Professional Shortage Area (HPSA) Facility
  - `HH` - Home Health Agency
  - `I3` - Independent Physicians Association (IPA)
  - `IJ` - Injection Point
  - `IL` - Insured or Subscriber
  - `IN` - Insurer
  - `LI` - Independent Lab
  - `LR` - Legal Representative
  - `MR` - Medical Insurance Carrier
  - `MSC` - Mammography Screening Center
  - `OB` - Ordered By
  - `OD` - Doctor of Optometry
  - `OX` - Oxygen Therapy Facility
  - `P0` - Patient Facility
  - `P2` - Primary Insured or Subscriber
  - `P3` - Primary Care Provider
  - `P4` - Prior Insurance Carrier
  - `P6` - Third Party Reviewing Preferred Provider Organization (PPO)
  - `P7` - Third Party Repricing Preferred Provider Organization (PPO)
  - `PRP` - Primary Payer
  - `PT` - Party to Receive Test Report
  - `PV` - Party performing certification
  - `PW` - Pickup Address
  - `QA` - Pharmacy
  - `QB` - Purchase Service Provider
  - `QC` - Patient
  - `QD` - Responsible Party
  - `QE` - Policyholder
  - `QH` - Physician
  - `QK` - Managed Care
  - `QL` - Chiropractor
  - `QN` - Dentist
  - `QO` - Doctor of Osteopathy
  - `QS` - Podiatrist
  - `QV` - Group Practice
  - `QY` - Medical Doctor
  - `RC` - Receiving Location
  - `RW` - Rural Health Clinic
  - `S4` - Skilled Nursing Facility
  - `SEP` - Secondary Payer
  - `SJ` - Service Provider
  - `SU` - Supplier/Manufacturer
  - `T4` - Transfer Point | Used to identify the geographic location where a patient is transferred or diverted.
  - `TL` - Testing Laboratory
  - `TQ` - Third Party Reviewing Organization (TPO)
  - `TT` - Transfer To
  - `TTP` - Tertiary Payer
  - `TU` - Third Party Repricing Organization (TPO)
  - `UH` - Nursing Home
  - `X3` - Utilization Management Organization
  - `X4` - Spouse
  - `X5` - Durable Medical Equipment Supplier
  - `ZZ` - Mutually Defined
</Accordion>

### Product or service ID qualifier

Used in the [`serviceLineInformation.productOrServiceIDQualifier`](/healthcare/api-reference/post-healthcare-claim-status#body.serviceLineInformation.productOrServiceIDQualifier) request property and returned in the [`claims.serviceDetails.service.serviceIdQualifierCode`](/healthcare/api-reference/post-healthcare-claim-status#response.claims.serviceDetails.service.serviceIdQualifierCode) response property.

It identifies the source of the associated procedure code.

<Accordion title="Product or Service ID Qualifier">
  | Code | Description                                                                            | Usage Notes                                                                                                                                                                                                                                                                                                                                                                                                              |
  | ---- | -------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |
  | `AD` | American Dental Association Codes                                                      | -                                                                                                                                                                                                                                                                                                                                                                                                                        |
  | `ER` | Jurisdiction Specific Procedure and Supply Codes                                       | This code is not allowed for use under HIPAA. The qualifier can only be used when 1) If a new rule names the Jurisdiction Specific Procedure and Supply Codes as an allowable code set under HIPAA, OR 2) The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR 3) For claims that aren't covered under HIPAA.                                                           |
  | `HC` | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes     | Because the CPT codes of the American Medical Association are also level 1 HCPCS codes, the CPT codes are reported under the code HC.                                                                                                                                                                                                                                                                                    |
  | `HP` | Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code | -                                                                                                                                                                                                                                                                                                                                                                                                                        |
  | `IV` | Home Infusion EDI Coalition (HIEC) Product/Service Code                                | This code is not allowed for use under HIPAA. The qualifier can only be used when 1) If a new rule names the Home Infusion EDI Coalition Codes as an allowable code set under HIPAA, OR 2) The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR 3) For claims that aren't covered under HIPAA.                                                                          |
  | `N4` | National Drug Code in 5-4-2 Format                                                     | -                                                                                                                                                                                                                                                                                                                                                                                                                        |
  | `NU` | National Uniform Billing Committee (NUBC) UB92 Codes                                   | This code is the NUBC Revenue Code.                                                                                                                                                                                                                                                                                                                                                                                      |
  | `WK` | Advanced Billing Concepts (ABC) Codes                                                  | This code set has been approved by the Secretary of HHS as a pilot project allowed under HIPAA law. The qualifier may only be used in transactions covered under HIPAA; by parties registered in the pilot project and their trading partners, OR when a new rule names the Complementary, Alternative, or Holistic Procedure Codes as an allowable code set under HIPAA, OR for claims that aren't covered under HIPAA. |
</Accordion>