# STCs and procedure codes
Source: https://www.stedi.com/docs/providers/providers-stc-procedure-codes

***

title: STCs and procedure codes
sidebarTitle: "STCs and procedure codes"
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You're likely running an eligibility check to determine the patient's coverage and financial responsibility for particular medical or dental services, such as chiropractic or hospice care.

You can retrieve specific types of benefits information from the payer by including either a service type code (STC) or a procedure code and qualifier in your request.

However, it's not always clear which STC or procedure code to use for best results. This page explains how to choose the right STC or procedure code for your eligibility check, how to test whether a payer supports a specific STC, and how to map procedure codes to STCs when necessary.

## Should I use STCs or procedure codes?

It depends on the type of benefits information you want to retrieve.

### Medical benefits

You'll almost always need to submit an STC because most medical payers don't support procedure codes (CPT/HCPCS/CDT). Refer to our guidance for [choosing STCs](#choose-the-right-stc).

### Dental benefits

Many (but not all) dental payers support procedure codes. However, we recommend:

1. First try STC `35` - especially if you need information about general dental benefits. Many payers only return comprehensive dental-specific benefits for STC `35`.
2. Try the relevant CDT code if you still need more benefits information for a specific service.
3. If the CDT code still doesn't return what you need, try the STC mapped to that CDT code. Refer to our list of [common mappings](#dental) for dental benefits.

## Choose the right STC

A Service Type Code (STC) is a two-character code that groups similar healthcare services into standard categories, such as `47` (Hospital) and `UC` (Urgent Care). STC support varies by payer:

* Not all payers support all STCs.
* Some payers only respond to the first STC you send and ignore the rest.
* Some payers completely ignore the STCs in the request and always return a default response for STC `30` (Health Benefit Plan Coverage).
* Some payers don't support multiple STCs in a single request.
* Some payers do support multiple STCs, but only a limited number per request.

When choosing an STC, we recommend:

* Send the most specific STC you can for the services you're targeting. You should [test the STCs](#test-payer-stc-support) that seem most appropriate to determine which ones yield the most benefits information. Refer to our list of [STCs for common services](#stcs-for-common-services).
* If no specific STC seems appropriate or if the payer doesn't support it, fall back to a [general benefit check](#general-benefit-checks).
* Include only one STC per request, unless you've tested the payer and confirmed they support multiple STCs in a single request *and* that the response contains better benefits information when you include more than one.

If after testing, no STC produces the benefits information you need, you may need to call the payer or visit the payer portal.

### General benefit checks

Use STC `30` for general medical benefits or `35` for general dental benefits. These STCs are supported by all payers and are a good fall back when a payer doesn't support a more specific STC.

When you send STC `30` in an eligibility check, all payers must return benefits information for the following STCs when the patient's plan covers them:

* `1` (Medical Care)
* `33` (Chiropractic)
* `47` (Hospital)
* `86` (Emergency Services)
* `88` (Pharmacy)
* `98` (Professional Physician Visit - Office)
* `AL` (Vision - Optometry)
* `MH` (Mental Health)
* `UC` (Urgent Care)

<Tip>
  [CAQH CORE-certified payers](#required-stcs-for-core-certified-payers) are
  required to support a broader set of STCs.
</Tip>

### STCs for common services

Try the following STCs in the order shown - from the most specific to more general alternatives. We recommend sending only one STC at a time, unless you've [tested the payer](#test-payer-stc-support) and confirmed they support multiple in a single request.

We've also included the mapping to specific procedure codes where possible, to make it easier to determine the right STC for your use case.

#### Medical

Ranges of applicable codes are represented as `rangeStart - rangeEnd`.

{/* prettier-ignore-start */}

\| Procedure codes | Type of care | STCs to try |
\| ----------|--------------|-------------|
\| `97151 - 97157` | ABA Therapy | `BD`, `MH` |
\| `97810`, `97811 - 97814` | Acupuncture | `64`, `1` |
\| `96401 - 96549` | Chemotherapy | `ON`, `78`, `87`, `91`, `92` |
\| `96493` | Chemotherapy, IV push | `78`, `87`, `91`, `92` |
\| `96494` | Chemotherapy, additional infusion | `78`, `87`, `91`, `92` |
\| `99490`, `99439`, `99491`, `99437`, `99487` | Chronic Care Management (CCM) services | `A4`, `MH`, `98`, `1` |
\| too many to list | Dermatology | `3`, `98` |
\| `E1399` | Durable Medical Equipment | `DM`, `11`, `12`, `18` |
\| `96375` | IV push | `92` |
\| `96360`, `96365`, `96366` | IV Therapy/Infusion | `92`, `98` |
\| too many to list | Maternity (professional) | `BT`, `BU`, `BV`, `69` |
\| `97802` | Medical nutrition therapy | `98`, `MH`, `BZ`, `1` |
\| `97803` | Medical nutrition follow-up | `98`, `MH`, `BZ`, `1` |
\| too many to list | Mental health | `MH`, `96`, `98`, `A4`, `BD`, `CF` |
\| `95700 - 96020` | Neurology | `98` |
\| `99460`, `99463` | Newborn/facility | `65`, `BI` |
\| `97165 - 97168` and `97110`, `97530`, `97112`, `97140`, `97535`, `97116`, `97129` | Occupational therapy | `AD`, `98` |
\| `97110`, `97112`, `97116`, `97350`, and several others | Physical therapy | `PT`, `AE` |
\| too many to list | Podiatry | `93`, `98` |
\| too many to list | Primary care | `96`, `98`, `A4`, `A3`, `99`, `A0`, `A1`, `A2`, `98` |
\| `99214` | Psychiatry visits | `A4`, `MH` |
\| `96130` | Psychological testing evaluation | `A4`, `MH` |
\| `90832`, `90834`, `90837`, `90833`, `90836`, `90838`, `90839`, `90846`, `90847`, `90849` | Psychotherapy | `96`, `98`, `A4`, `BD`, `CF` |
\| too many to list | Rehabilitation | `A9`, `AA`, `AB`, `AC` |
\| `98975`, `98976`, `98977`, `98980`, `98981` | Remote Therapeutic Monitoring (RTM) services | `A4`, `98`, `MH`, `92`, `DM`, `1` |
\| `99304-99318` | Skilled Nursing | `AG`, `AH` |
\| `92507`, `92508`, `92521`, `92522`, `92523`, `92526`, `92607`, `92609`, `92605`, `92618` | Speech Therapy | `AF`, `98` |
\| `90791`, `90832`, `90834`, `90837`, `90853`, `99408`, `99409`, and `H0017-H0019` | Substance Abuse/Addiction | `AI`, `AJ`, `AK`, `MH` |
\| `99202-99215`, `99421-99423`, `99441-99443`, `G2010` and `G2012` | Telehealth | `9`, `98` |
\| `90867` | Transcranial magnetic stimulation | `A4`, `MH` |

{/* prettier-ignore-end */}

#### Dental

Procedure codes are listed in ranges. For example, `D0xxx` represents CDT codes from `D0000` to `D0999`.

{/* prettier-ignore-start */}

\| Procedure | Type of care | STCs to try |
\|---------------------|--------------------------------------|--------------|
\| `D0xxx` | Diagnostic (such as evaluations and radiographs) | `23` |\
\| `D1xxx` | Preventive (such as prophylaxis, fluoride, and sealants) | `41` |\
\| `D2xxx` | Restorative (fillings and crowns not tied to implants) | `25` |\
\| `D3xxx` | Endodontics (such as root canals) | `26` |\
\| `D4xxx` | Periodontics (such as SRP and perio maintenance) | `24` |\
\| `D59xx` | Maxillofacial prosthetics (specifically for `D5900–D5999`, all other `D5xxx` use `39` instead) | `27` |\
\| `D5xxx/D6xxx`, except `D59xx` | Prosthodontics (removable and fixed, such as dentures and bridges) | `39` |\
\| `D7xxx` | Oral & maxillofacial surgery (such as extractions and osseous surgery) | `40` |
\| `D9xxx` | Adjunctive general services (such as palliative, occlusal guards, and anesthesia) | `28` |

{/* prettier-ignore-end */}

### Full STC list

You can include the following STCs in an eligibility check. Not all payers support all STCs, so you should always [test each payer](#test-payer-stc-support) to ensure they support the STCs you plan to use.

* The word physician in service type codes refers to any healthcare provider, including physician assistants, nurse practitioners, and other types of healthcare professionals.
* **Don't send STCs that aren't in this list.** This list is specific to X12 version 005010, the mandated version for eligibility checks. It's different from the [X12 Service Type Codes](https://x12.org/codes/service-type-codes) list, which applies to X12 versions later than 005010. Payers shouldn't accept or send STCs not explicitly listed in version 005010.

<Accordion title="Service Type Codes">
  - `1` Medical Care
  - `2` Surgical
  - `3` Consultation
  - `4` Diagnostic X-Ray
  - `5` Diagnostic Lab
  - `6` Radiation Therapy
  - `7` Anesthesia
  - `8` Surgical Assistance
  - `9` Other Medical
  - `10` Blood Charges
  - `11` Used Durable Medical Equipment
  - `12` Durable Medical Equipment Purchase
  - `13` Ambulatory Service Center Facility
  - `14` Renal Supplies in the Home
  - `15` Alternate Method Dialysis
  - `16` Chronic Renal Disease (CRD) Equipment
  - `17` Pre-Admission Testing
  - `18` Durable Medical Equipment Rental
  - `19` Pneumonia Vaccine
  - `20` Second Surgical Opinion
  - `21` Third Surgical Opinion
  - `22` Social Work
  - `23` Diagnostic Dental
  - `24` Periodontics
  - `25` Restorative
  - `26` Endodontics
  - `27` Maxillofacial Prosthetics
  - `28` Adjunctive Dental Services
  - `30` Health Benefit Plan Coverage - **supported by all payers**
  - `32` Plan Waiting Period
  - `33` Chiropractic
  - `34` Chiropractic Office Visits
  - `35` Dental Care
  - `36` Dental Crowns
  - `37` Dental Accident
  - `38` Orthodontics
  - `39` Prosthodontics
  - `40` Oral Surgery
  - `41` Routine (Preventive) Dental
  - `42` Home Health Care
  - `43` Home Health Prescriptions
  - `44` Home Health Visits
  - `45` Hospice
  - `46` Respite Care
  - `47` Hospital
  - `48` Hospital - Inpatient
  - `49` Hospital - Room and Board
  - `50` Hospital - Outpatient
  - `51` Hospital - Emergency Accident
  - `52` Hospital - Emergency Medical
  - `53` Hospital - Ambulatory Surgical
  - `54` Long Term Care
  - `55` Major Medical
  - `56` Medically Related Transportation
  - `57` Air Transportation
  - `58` Cabulance
  - `59` Licensed Ambulance
  - `60` General Benefits
  - `61` In-vitro Fertilization
  - `62` MRI/CAT Scan
  - `63` Donor Procedures
  - `64` Acupuncture
  - `65` Newborn Care
  - `66` Pathology
  - `67` Smoking Cessation
  - `68` Well Baby Care
  - `69` Maternity
  - `70` Transplants
  - `71` Audiology Exam
  - `72` Inhalation Therapy
  - `73` Diagnostic Medical
  - `74` Private Duty Nursing
  - `75` Prosthetic Device
  - `76` Dialysis
  - `77` Otological Exam
  - `78` Chemotherapy
  - `79` Allergy Testing
  - `80` Immunizations
  - `81` Routine Physical
  - `82` Family Planning
  - `83` Infertility
  - `84` Abortion
  - `85` AIDS
  - `86` Emergency Services
  - `87` Cancer
  - `88` Pharmacy
  - `89` Free Standing Prescription Drug
  - `90` Mail Order Prescription Drug
  - `91` Brand Name Prescription Drug
  - `92` Generic Prescription Drug
  - `93` Podiatry
  - `94` Podiatry - Office Visits
  - `95` Podiatry - Nursing Home Visits
  - `96` Professional (Physician)
  - `97` Anesthesiologist
  - `98` Professional (Physician) Visit - Office
  - `99` Professional (Physician) Visit - Inpatient
  - `A0` Professional (Physician) Visit - Outpatient
  - `A1` Professional (Physician) Visit - Nursing Home
  - `A2` Professional (Physician) Visit - Skilled Nursing Facility
  - `A3` Professional (Physician) Visit - Home
  - `A4` Psychiatric - `A5` Psychiatric - Room and Board
  - `A6` Psychotherapy
  - `A7` Psychiatric - Inpatient
  - `A8` Psychiatric - Outpatient
  - `A9` Rehabilitation
  - `AA` Rehabilitation - Room and Board
  - `AB` Rehabilitation - Inpatient
  - `AC` Rehabilitation - Outpatient
  - `AD` Occupational Therapy
  - `AE` Physical Medicine
  - `AF` Speech Therapy
  - `AG` Skilled Nursing Care
  - `AH` Skilled Nursing Care - Room and Board
  - `AI` Substance Abuse
  - `AJ` Alcoholism
  - `AK` Drug Addiction
  - `AL` Vision (Optometry)
  - `AM` Frames
  - `AN` Routine Exam - Use for Routine Vision Exam only
  - `AO` Lenses
  - `AQ` Nonmedically Necessary Physical
  - `AR` Experimental Drug Therapy
  - `B1` Burn Care
  - `B2` Brand Name Prescription Drug - Formulary
  - `B3` Brand Name Prescription Drug - Non-Formulary
  - `BA` Independent Medical Evaluation
  - `BB` Partial Hospitalization (Psychiatric)
  - `BC` Day Care (Psychiatric)
  - `BD` Cognitive Therapy
  - `BE` Massage Therapy
  - `BF` Pulmonary Rehabilitation
  - `BG` Cardiac Rehabilitation
  - `BH` Pediatric
  - `BI` Nursery
  - `BJ` Skin
  - `BK` Orthopedic
  - `BL` Cardiac
  - `BM` Lymphatic
  - `BN` Gastrointestinal
  - `BP` Endocrine
  - `BQ` Neurology
  - `BR` Eye
  - `BS` Invasive Procedures
  - `BT` Gynecological
  - `BU` Obstetrical
  - `BV` Obstetrical/Gynecological
  - `BW` Mail Order Prescription Drug - Brand Name
  - `BX` Mail Order Prescription Drug - Generic
  - `BY` Physician Visit - Office: Sick
  - `BZ` Physician Visit - Office: Well
  - `C1` Coronary Care
  - `CA` Private Duty Nursing - Inpatient
  - `CB` Private Duty Nursing - Home
  - `CC` Surgical Benefits - Professional (Physician)
  - `CD` Surgical Benefits - Facility
  - `CE` Mental Health Provider - Inpatient
  - `CF` Mental Health Provider - Outpatient
  - `CG` Mental Health Facility - Inpatient
  - `CH` Mental Health Facility - Outpatient
  - `CI` Substance Abuse Facility - Inpatient
  - `CJ` Substance Abuse Facility - Outpatient
  - `CK` Screening X-ray - `CL` Screening Laboratory
  - `CM` Mammogram, High Risk Patient
  - `CN` Mammogram, Low Risk Patient
  - `CO` Flu Vaccination
  - `CP` Eyewear and Eyewear Accessories
  - `CQ` Case Management
  - `DG` Dermatology
  - `DM` Durable Medical Equipment
  - `DS` Diabetic Supplies
  - `GF` Generic Prescription Drug - Formulary
  - `GN` Generic Prescription Drug - Non-Formulary
  - `GY` Allergy
  - `IC` Intensive Care
  - `MH` Mental Health
  - `NI` Neonatal Intensive Care
  - `ON` Oncology
  - `PT` Physical Therapy
  - `PU` Pulmonary
  - `RN` Renal
  - `RT` Residential Psychiatric Treatment
  - `TC` Transitional Care
  - `TN` Transitional Nursery Care
  - `UC` Urgent Care
</Accordion>

### Test payer STC support

We recommend testing each payer to determine which STC(s) they support and which STC(s) return the most benefits information for the services you care about.

To test whether a payer supports a specific STC:

1. Send a baseline request with just STC `30` for general medical benefits or `35` for general dental benefits.
2. Send a request with the specific STC that best matches the benefit type you want to check. For example, to check mental health benefits, you might send a request with STC `MH` (Mental Health). Use our list of [STCs for common services](#stcs-for-common-services) as a starting point.
3. Compare the baseline response with the response to the specific STC. If they're different, the payer likely supports the specific STC.

You may also want to test whether the payer supports multiple STCs in a single request:

1. Send a baseline request with just STC `30` for general medical benefits or `35` for general dental benefits.
2. Send a request with multiple STCs matching the benefit types you want to check.
3. Compare the responses. If they change based on the number of STCs, the payer likely supports multiple STCs in a single request. If not, the payer may be ignoring or only partially supporting STCs - for example, they may only be returning information for the first STC.

<Tip>
  **Developers:** We recommend scripting your requests to speed up the testing process. Specifically, you should loop through candidate STCs and compare the responses against the baseline STC `30` or `35` response for the same patient. You can also save the `benefitsInformation` array for each STC and diff them.
</Tip>

## Map procedure codes to STCs

It can be hard to map procedure codes to the right STC. For example, if a provider offers medical nutrition therapy and bills using CPT code 97802, should they use service type code `1` - Medical Care, `3` - Consultation, `MH` - Mental Health, or another option?

Unfortunately, there's no standardized mapping between procedure codes and STCs. In fact, payers themselves often don't have an explicit mapping for their own health plans. Their eligibility check systems aren't necessarily directly integrated with their claims processing systems, so when you ask them which STC to use, they may not always be able to provide a good answer.

Review our list of [STCs for common services](#stcs-for-common-services), which contains mappings to the associated procedure codes. If you don't find the procedure code you're looking for, use the following approaches to determine the best STC for your use case:

* Review the payers' documentation for eligibility checks. Some payers provide a list of STCs they support and their mappings to procedure codes.
* If you can't find the information in the payer's documentation, contact the payer directly or reach out to [Stedi support](https://www.stedi.com/contact), and we'll contact the payer for you.
* For dental payers that don't support specific CDT codes, you can use either of these sources to map CDT codes to service type codes. You can either purchase a copy of these documents or contact Stedi support for recommendations about specific mappings:
  * NDEDIC's [Companion to ASC X12 270/271](https://ndedic.org/Sys/Store/Products/1016)
  * Table 6 in the American Dental Association's [Technical Report No. 1102](https://engage.ada.org/p/eg/ada-technical-report-no-1102-electronic-dental-benefits-eligibility-verification-e-book-1390?itm_source=pp-1316\&itm_component=p-related).
* If none of the above methods work, you can ask a medical coder with [AAPC certification](https://www.aapc.com/certifications) for guidance. Their familiarity with billable codes will help them make good recommendations about service type code mappings.

Once you determine the right STC code(s), we recommend maintaining an internal document that contains the mappings for the health plans you most frequently bill.

## Required STCs for CORE-Certified payers

CAQH CORE creates operating rules and frameworks that improve interoperability in healthcare data exchange. CORE requires certified payers to support a broader set of STC codes than those mandated for [general benefits inquiries](#general-benefit-checks).

If the plan covers the service, certified payers must return benefit information for the following STCs. Visit CAQH CORE's website for a complete list of [CORE-Certified Health Plans](https://www.caqh.org/core/core-certified-organizations-pending-and-current).

<Accordion title="Required STCs for CORE-Certified Health Plans">
  * `4` Diagnostic X-Ray
  * `5` Diagnostic Lab
  * `6` Radiation Therapy
  * `7` Anesthesia
  * `8` Surgical Assistance
  * `12` DME Purchase
  * `13` Ambulatory Surgery Facility
  * `18` DME Rental
  * `20` Second Surgical Opinion
  * `30` Health Benefit Plan Coverage
  * `33` Chiropractic
  * `62` MRI/CAT Scan
  * `65` Newborn Care
  * `68` Well Baby Care
  * `78` Chemotherapy
  * `80` Immunizations
  * `81` Routine Physical
  * `82` Family Planning
  * `86` Emergency Services
  * `93` Podiatry
  * `98` Physician Visit - Office
  * `99` Physician Visit - Inpatient
  * `A0` Physician Visit - Outpatient
  * `A3` Physician Visit - Home
  * `AD` Occupational Therapy
  * `AE` Physical Medicine
  * `AF` Speech Therapy
  * `AG` Skilled Nursing Care
  * `BG` Cardiac Rehabilitation
  * `BH` Pediatric
</Accordion>

## STCs in the eligibility response

To determine whether the payer is returning the benefits information you need, you must check the [**Benefits tab** of a completed eligibility check](/providers/providers-review-patient-benefits#benefits-tab). Each benefit listed in the table may be associated with one or more STCs or procedure codes.

![Benefits table overview](/images/providers/benefits-table-overview.png)

The payer may send benefits information for additional STCs you didn't request - this is expected. It can also mean that the payer is ignoring the STC you sent, which is why we recommend [testing payers](#test-payer-stc-support) to determine their support for specific STCs.

To learn more about interpreting the eligibility response, visit [Review patient benefits](/providers/providers-review-patient-benefits).