HIPAA Code Sets

Making the transition to HIPAA compliance can be a difficult and painstaking process. For many, just finding the implementation details is a burden. In order to help you make this transition, Ingenix has compiled a list of many of the HIPAA "Code Sets" that you will need to use when making your system(s) compliant.

Code Code Set Available From Status Update Freq
4 ABA Routing Number Thomson Financial Publishing Available for Purchase Semi-annually Jan & Jul
5 Countries -ISO 3166 American National Standards Institute (ANSI) - ISO 3166 Available for Purchase Every 5 years or as required
    Countries -ISO 3166 ISO 3166 Maintenance Agency Copyrighted;Unrestricted Access
    Currencies and Funds - ISO 4217 American National Standards Institute (ANSI) ISO 4217 Available for Purchase Every 5 years or as required
    Currencies and Funds - ISO 4217 BSI Currency Code Service Unrestricted Access
16 D-U-N-S Number Dun & Bradstreet Available for Purchase
22 States and Outlying Areas of the U.S. U.S. Postal Service Unrestricted Access As required/Published annually
41 Universal Product Code Uniform Code Council, Inc. Unrestricted Access
43 FIPS-55 US Geological Survey Unrestricted Access As required/Published occasionally
51 ZIP Code U.S. Postal Service Unrestricted Access As required/Published annually
60 DFI Identification Number Thomson Financial Publishing Available for Purchase Published in Jun & Dec
77 X12.3 Data Element Dictionary/X12.22 Segment Directory Data Interchange Standards Association, Inc. (DISA) Available for Purchase Yearly releases (Dec) & sub releases
91 Canadian Financial Institution Branch and Institution Number Bowne of Canada,Ltd Available for Purchase
94 International Organization for Standardization (Date and Time) American National Standards Institute (ANSI) - ISO 8601 Available for Purchase As required/ad hoc
102 Languages American National Standards Institute (ANSI) - ISO 639 Available for Purchase As required/ad hoc
121 Health Industry Identification Number Health Industry Business Communications Council Restricted Access Updated weekly
130 HCPCS CMS Unrestricted Access Annually (Oct)
131 ICD-9-CM U.S. National Center for Health Statistics Unrestricted Access/Available for Purchase Annually (Oct)
    ICD-10-CM U.S. National Center for Health Statistics Available for Purchase Annually (Oct)
132 National Uniform Billing Committee (NUBC) Codes National Uniform Billing Committee Available for Purchase Quarterly
133 CPT Codes Order Department (AMA) Available for Purchase Yearly (Jan)
134 National Drug Code U.S. Food and Drug Administration (FDA) Unrestricted Access Monthly
135 American Dental Association Codes (CDT-4) American Dental Association Available for Purchase Systematic Review every 2 to 3 years/3-5 years
139 Claim Adjustment Reason Codes Washington Publishing Company Unrestricted Access 3 times a year Feb, Jun, Oct
158 Health Care Financing Administration (HCFA) - Code Lists CMS Unrestricted Access HCPCS updated quarterly
229 Diagnosis Related Group Number (DRG) Superintendant of Documents - US Government Printing Office Unrestricted Access/Available for Purchase Annual Oct 1
230 Admission Source Code National Uniform Billing Committee Available for Purchase As required/Quarterly
231 Admission Type Code National Uniform Billing Committee Available for Purchase As required/Quarterly
235 Claim Frequency code National Uniform Billing Committee Unrestricted Access As required/Quarterly
236 Uniform Billing Claim Form Bill Type National Uniform Billing Committee Available for Purchase As required/Quarterly
237 Place of Service CMS Unrestricted Access As required
239 Patient Status Code National Uniform Billing Committee Available for Purchase As required
240 National Drug Code by Format Federal Drug Listing Branch HFN-315 Unrestricted Access As required/Monthly Full refresh/Quarterly Mar, Jun, Sep, Dec
245 National Association of Insurance Commissioners (NAIC) Code National Association of Insurance Commissioners Available for Purchase 2 times a year Jun, Dec
307 National Association of Boards of Pharmacy Number National Council for Prescription Drug Programs Available for Purchase Quarterly
359 Treatment Codes CMS Unrestricted Access As required
411 Remittance Remark Codes Washington Publishing Company Unrestricted Access 3 times a year Mar, Jul, Nov
457 NISO Z39.53 Language Code List National Information Standards Organization Press Unrestricted Access As required
507 Health Care Claim Status Category Code Washington Publishing Company Unrestricted Access 3x/year Feb, Jun, Oct
508 Health Care Claim Status Code Washington Publishing Company Unrestricted Access 3x/year Feb, Jun, Oct
513 Home Infusion EDI Coalition (HEIC) Code List Home Infusion EDI Coalition Unrestricted Access As required
530 National Council for Prescripton Drug Programs Reject/Payment Codes NCPDP Available for Purchase for Non Members/Unrestricted Access for M Quarterly
537 Health Care Financing Administration National Provider Identifier CMS Unrestricted Access
540 Health Care Financing Administration National PlanID CMS Unrestricted Access
    HCFA Public Use Files CMS Unrestricted Access
    Canadian Province Abbreviations Canadian Postal Service Unrestricted Access/Available for Purchase As required
    CLIA Number CMS Unrestricted Access
    NUBC Condition Codes National Uniform Billing Committee Available for Purchase As required/Quarterly
    NUBC Occurrence Codes National Uniform Billing Committee Available for Purchase As required/Quarterly
    NUBC Occurrence Span Codes National Uniform Billing Committee Available for Purchase As required/Quarterly
    NUBC Value Codes National Uniform Billing Committee Available for Purchase As required/Quarterly
    UB92 Bill Type Code National Uniform Billing Committee Available for Purchase As required/Quarterly
    UB92 Facility Type Code (2 digits) National Uniform Billing Committee Available for Purchase As required/Quarterly
    UB92 Revenue Codes National Uniform Billing Committee Available for Purchase As required/Quarterly
    IHS/CHS Tribal Residency Codes Indian Health Service Unrestricted Access
    Provider Taxonomy Codes Washington Publishing Company Unrestricted Access 2x/year (Jan/July)
    CMS Carrier Numbers CMS Unrestricted Access
    Listing of HHRGs, HIPPS Codes and Weights CMS Unrestricted Access As required
    Health Industry Labeler Identification Code HIBCC Available for Purchase
    DOD1 - Military Rank and Health Care Services Region Tricare Unrestricted Access As required
    EDI Formats WPC Unrestricted Access As needed
    Social Security Number Social Security Administration Unrestricted Access
    Logical Observation Identifier Names and Codes (LOINC) Regenstrief Institute for Healthcare Unrestricted Access


  

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