REVENUE CODE LIST REQUIRING CPT/HCPCS CODES FOR OUTPATIENT FACILITY CLAIMS

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REVENUE CODE LIST REQUIRING CPT/HCPCS CODES FOR OUTPATIENT FACILITY CLAIMS For Providers Effective July 15, 2018 Revenue Code Description 240 All inclusive ancillary, general 250 Pharmacy 251 Drugs, generic 252 Drugs, non-generic 253 Drugs, take home 254 Drugs, incidental to other diagnostic services 255 Drugs, incidental radiology 256 Drugs, experimental 257 Drugs, non-prescription 258 Intravenous (IV) solutions 259 Drugs, other 260 Intravenous (IV) therapy 261 Intravenous (IV) therapy, infusion pump 262 Intravenous (IV) therapy, pharmacy services 263 Intravenous (IV) therapeutic drug, supply and delivery 264 Intravenous (IV) therapy, supplies 269 Intravenous (IV) therapy, other 274 Medical/surgical supplies and devices, prosthetic/orthotic devices 280 Oncology 290 Durable medical equipment, general 291 Durable medical equipment, rental 292 Durable medical equipment, purchase of new 294 Durable medical equipment, supplies and drugs 299 Durable medical equipment, other 300 Laboratory, general classification 301 Laboratory, chemistry 302 Laboratory, immunology 303 Laboratory, renal patient (home) 304 Laboratory, dialysis 305 Laboratory, hematology 306 Laboratory, bacteriology and microbiology 307 Laboratory, urology 308 Reserved laboratory

309 Laboratory, other 310 Laboratory, pathology general classification 311 Laboratory pathology cytology 312 Laboratory pathology histology 313 Reserved laboratory pathology 314 Laboratory, pathology biopsy 315 Reserved laboratory, pathology 316 Reserved laboratory, pathology 317 Reserved laboratory, pathology 318 Reserved laboratory, pathology 319 Laboratory, pathology other 320 Radiology, diagnostic general classification 321 Radiology, diagnostic angiocardiology 322 Radiology, diagnostic arthrography 323 Radiology, diagnostic arteriography 324 Radiology, diagnostic chest X-ray 325 Reserved radiology, diagnostic 326 Reserved radiology, diagnostic 327 Reserved radiology, diagnostic 328 Reserved radiology, diagnostic 329 Radiology, diagnostic other 330 Radiology, therapeutic chemotherapy general classification 331 Radiology, therapeutic chemotherapy, chemotherapy administration injected 332 Radiology, therapeutic chemotherapy, chemotherapy administration oral 333 Radiology, therapeutic chemotherapy, radiation therapy 334 Reserved radiology, therapeutic chemotherapy 335 Radiology, therapeutic chemotherapy, administration intravenous (IV) 336 Reserved radiology, therapeutic chemotherapy 337 Reserved radiology, therapeutic chemotherapy 338 Reserved radiology, therapeutic chemotherapy 339 Radiology, therapeutic chemotherapy other 340 Nuclear medicine, general classification 341 Nuclear medicine, diagnostic 342 Nuclear medicine, therapeutic 343 Nuclear medicine, diagnostic radiopharmaceuticals 344 Nuclear medicine, therapeutic radiopharmaceuticals 349 Nuclear medicine, other 350 Computerized axial tomography (CAT), general 351 Computerized axial tomography (CAT), head 352 Computerized axial tomography (CAT), body

353 Reserved computerized axial tomography (CAT) 354 Reserved computerized axial tomography (CAT) 355 Reserved computerized axial tomography (CAT) 356 Reserved computerized axial tomography (CAT) 357 Reserved computerized axial tomography (CAT) 358 Reserved computerized axial tomography (CAT) 359 Computerized axial tomography (CAT), other 360 Operating room services, general 361 Operating room services, minor surgery 362 Operating services, organ transplant other than kidney 363 Reserved operating room services 364 Reserved operating room services 365 Reserved operating room services 366 Reserved operating room services 367 Operating room services, kidney transplant 368 Reserved operating room services 369 Operating room services 380 Blood and blood products, general 381 Blood and blood products, packed red cells 382 Blood and blood products, whole blood products 383 Blood and blood products, plasma 384 Blood and blood products, platelets 385 Blood and blood products, leukocytes 386 Blood and blood products, other components 387 Blood and blood products, other derivatives (cryoprecipitate) 388 Blood and blood products, reserved components 389 Blood and blood products, other 390 Blood administration process, storage general 391 Blood administration process, storage administration 399 Blood, other storage 400 Imaging services, general 401 Imaging services, diagnostic mammography 402 Imaging services, ultrasound 403 Imaging services, screening mammography 404 Imaging services, positron emission tomography 405 Reserved imaging services 406 Reserved imaging services 407 Reserved imaging services

408 Reserved imaging services 409 Imaging services, other 410 Respiratory services, general 411 Reserved respiratory services 412 Respiratory services, inhalation 413 Respiratory services, hyperbaric oxygen therapy 414 Reserved respiratory services 415 Reserved respiratory services 416 Reserved respiratory services 417 Reserved respiratory services 418 Reserved respiratory services 419 Respiratory services, other 420 Physical therapy, general 421 Physical therapy, visit 422 Physical therapy, hourly 423 Physical therapy, group 424 Physical therapy, evaluation or reevaluation 425 Reserved physical therapy 426 Reserved physical therapy 427 Reserved physical therapy 428 Reserved physical therapy 429 Physical therapy, other 430 Occupational therapy, general 431 Occupational therapy, visit 432 Occupational therapy, hourly 433 Occupational therapy, group 434 Occupational therapy, evaluation or reevaluation 435 Reserved occupational therapy 436 Reserved occupational therapy 437 Reserved occupational therapy 438 Reserved occupational therapy 439 Occupational therapy, other 440 Speech therapy, general 441 Speech therapy, visit 442 Speech therapy, hourly 443 Speech therapy, group 444 Speech therapy, evaluation or reevaluation 445 Reserved speech therapy 446 Reserved speech therapy 447 Reserved speech therapy 448 Reserved speech therapy 449 Speech therapy, other

450 Emergency room, general 451 Emergency room, EMTALA emergency medical screening 452 Emergency room, beyond EMTALA screening 453 Reserved emergency room 454 Reserved emergency room 455 Reserved emergency room 456 Emergency room, urgent care 457 Reserved emergency room 458 Reserved emergency room 459 Emergency room, other 460 Pulmonary function, general 461 Reserved pulmonary function 462 Reserved pulmonary function 463 Reserved pulmonary function 464 Reserved pulmonary function 465 Reserved pulmonary function 466 Reserved pulmonary function 467 Reserved pulmonary function 468 Reserved pulmonary function 469 Pulmonary function, other 470 Audiology, general 471 Audiology, diagnostic 472 Audiology, treatment 473 Reserved audiology 474 Reserved audiology 475 Reserved audiology 476 Reserved audiology 477 Reserved audiology 478 Reserved audiology 479 Audiology, other 480 Cardiology, general 481 Cardiology, cardiac catheterization laboratory 482 Cardiology, stress test 483 Cardiology, echocardiology 484 Reserved cardiology 485 Reserved cardiology 486 Reserved cardiology 487 Reserved cardiology 488 Reserved cardiology 489 Cardiology, other

490 Ambulatory surgery 499 Other, ambulatory surgery 500 Outpatient services 510 Clinic, other 511 Clinic, chronic pain center 512 Clinic, dental 513 Clinic, psychiatric 514 Clinic, obstetrics/gynecology (OB/GYN) 515 Clinic, pediatric 516 Clinic, urgent care 517 Clinic, family practice 518 Reserved clinic 519 Clinic, other 521 Rural clinic 526 Urgent care clinic 529 Other 530 Osteopathic services, general 531 Osteopathic services, therapy 532 Reserved osteopathic services 533 Reserved osteopathic services 534 Reserved osteopathic services 535 Reserved osteopathic services 536 Reserved osteopathic services 537 Reserved osteopathic services 538 Reserved osteopathic services 539 Osteopathic services, other 540 Ambulance, general 541 Ambulance, supplies 542 Ambulance, medical transport 543 Ambulance, heart mobile 544 Ambulance, oxygen 545 Ambulance, air 546 Ambulance, neonatal services 547 Ambulance, pharmacy 548 Ambulance, electrocardiogram (EKG) transmission 549 Ambulance, other 550 Skilled nursing 551 Skilled nursing, visit 561 Home health medical, social services, general 571 Aide/home health visit

601 Home health, oxygen, general 610 Magnetic resonance technology, general 611 Magnetic resonance technology, brain/brain stem 612 Magnetic resonance technology, spinal cord/spine 613 Magnetic resonance technology reserved 614 Magnetic resonance technology, other magnetic resonance imaging (MRI) 615 Magnetic resonance technology, head and neck 616 Magnetic resonance technology, lower extremities 617 Magnetic resonance technology reserved 618 Magnetic resonance technology, other 619 Magnetic resonance technology, other 621 Medical surgical supplies incidentals, radiology 622 Medical surgical supplies incidental to other diagnostic services 624 U.S. Food and Drug Administration (FDA) investigational devices 631 Drug, single 632 Drug, multi 634 Pharmacy, extension of 025X erythropoietin (EPO) less than 10,000 units 635 Pharmacy extension of 025X erythropoietin (EPO) 10,000 or more units 636 Pharmacy 025x extension drugs requiring detailed coding 637 Drugs, self-administered 650 Hospice 651 Hospice, routine home care 652 Hospice, continuous home care 656 Hospice, general inpatient care (non-respite) 722 Labor room delivery, delivery room 723 Labor room delivery, circumcision 724 Labor room delivery birthing center 729 Labor room delivery, other 730 Electrocardiogram (EKG), electroencephalogram (EEG) 731 Electrocardiogram (EKG), electroencephalogram (EEG), Holter monitor 732 Telemetry 739 Electrocardiogram (EKG), electroencephalogram (EEG), other 740 Electroencephalogram (EEG), general 741 Reserved electroencephalogram (EEG) 742 Reserved electroencephalogram (EEG) 743 Reserved electroencephalogram (EEG)

744 Reserved electroencephalogram (EEG) 745 Reserved electroencephalogram (EEG) 746 Reserved electroencephalogram (EEG) 747 Reserved electroencephalogram (EEG) 748 Reserved electroencephalogram (EEG) 749 Reserved electroencephalogram (EEG) 750 Gastrointestinal (GI) services general 751 Reserved gastrointestinal (GI) services 752 Reserved gastrointestinal (GI) services 753 Reserved gastrointestinal (GI) services 754 Reserved gastrointestinal (GI) services 755 Reserved gastrointestinal (GI) services 756 Reserved gastrointestinal (GI) services 757 Reserved gastrointestinal (GI) services 758 Reserved gastrointestinal (GI) services 759 Reserved gastrointestinal (GI) services 760 Specialty room, general 761 Specialty room, treatment room 769 Specialty room, other rooms 770 Preventive care services, general 771 Preventive care services, vaccine administration 772 Reserved preventive care services 773 Reserved preventive care services 774 Reserved preventive care services 775 Reserved preventive care services 776 Reserved preventive care services 777 Reserved preventive care services 778 Reserved preventive care services 779 Reserved preventive care services 780 Telemedicine, general 781 Reserved telemedicine 782 Reserved telemedicine 783 Reserved telemedicine 784 Reserved telemedicine 785 Reserved telemedicine 786 Reserved telemedicine 787 Reserved telemedicine 788 Reserved telemedicine 789 Reserved telemedicine 790 Extra-corporeal shock wave therapy, general 791 Reserved extra-corporeal shock wave therapy

792 Reserved extra-corporeal shock wave therapy 793 Reserved extra-corporeal shock wave therapy 794 Reserved extra-corporeal shock wave therapy 795 Reserved extra-corporeal shock wave therapy 796 Reserved extra-corporeal shock wave therapy 797 Reserved extra-corporeal shock wave therapy 798 Reserved extra-corporeal shock wave therapy 799 Reserved extra-corporeal shock wave therapy 811 Acquisition of body components, living donor 812 Acquisition of body components, cadaver donor 813 Acquisition of body components, unknown donor 814 Acquisition of body components unsuccessful organ search, donor bank charges 819 Other, donor 820 Hemodialysis, outpatient or home general 821 Hemodialysis, composite or other rate 829 Hemodialysis, other 831 Peritoneal dialysis, outpatient or home composite or other rate 851 Continuous cycling peritoneal dialysis, outpatient or home composite or other rate 880 Dialysis, miscellaneous 900 Behavioral health treatment services, general 901 Behavioral health treatment services, electroshock 902 Behavioral health treatment services, milieu therapy 903 Behavioral health treatment services, play therapy 904 Behavioral health treatment services, activity Therapy 905 Behavioral health treatment services, intensive outpatient psychiatric 906 Behavioral health treatment services, intensive outpatient chemical dependency 907 Behavioral health treatment services, community behavioral health program 908 Reserved behavioral health treatment services 909 Reserved behavioral health treatment services 910 Reserved behavioral health treatment services, 090X extension 911 Behavioral health treatment services, 090X extension: rehabilitation 912 Behavioral health treatment services, 090X extension: partial hospitalization, less intensive 913 Behavioral health treatment services, 090X extension: partial hospitalization, intensive

914 Behavioral health treatment services, 090X extension: individual therapy 915 Behavioral health treatment, services 090X extension: group therapy 916 Behavioral health treatment, services 090X extension: family therapy 917 Behavioral health treatment, services 090X extension: bio feedback 918 Behavioral health treatment, services 090X extension: testing 919 Behavioral health treatment, services 090X extension: other 920 Other diagnostic services, general 921 Other diagnostic services, peripheral vascular laboratory 922 Other diagnostic services, electromyelgram 923 Other diagnostic services, pap smear 924 Other diagnostic services, allergy test 925 Other diagnostic services, pregnancy test 926 Reserved other, diagnostic services 927 Reserved other, diagnostic services 928 Reserved other, diagnostic services 929 Other diagnostic services, other 940 Other therapeutic services, general 941 Other therapeutic services, recreational therapy 942 Education, training 943 Cardiac rehabilitation 944 Other therapeutic services, drug rehabilitation 945 Other therapeutic services, alcohol rehabilitation 946 Other therapeutic services, complex medical equipment routine 947 Other therapeutic services, complex medical equipment, ancillary 948 Pulmonary rehabilitation 949 Other therapeutic services, other 950 Reserved other therapeutic services, extension: 951 Other therapeutic services, extension: athletic training 952 Other therapeutic services, extension: kinesiotherapy 953 Reserved other therapeutic services, extension of

954 Reserved other therapeutic services, extension of 955 Reserved other therapeutic services, extension of 956 Reserved other therapeutic services, extension of 957 Reserved other, therapeutic services, extension of 958 Reserved other, therapeutic services, extension of 959 Reserved other, therapeutic services, extension of 960 Professional fee 961 Professional fee, psychology 962 Professional fee, eye 963 Professional fee, anesthesiologist Medical Doctor 964 Professional fee, anesthesiologist, certified registered nurse anesthetist (CRNA) 969 Other, professional fee 971 Professional fee, laboratory 972 Professional fee, radiology, diagnostic 975 Professional fee, operating room 981 Professional fee, emergency room 982 Professional fee, outpatient 983 Professional fee, clinic 984 Professional fee, social services 985 Professional fee, electrocardiogram (EKG) 986 Professional fee, electroencephalography (EEG) 987 Professional fee, house visit 988 Professional fee, consultation

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