Taxonomy Display Names
Display Names Added to Taxonomy Code Set Look-up Tool
September 17, 2020
The Health Care Provider Taxonomy look-up tool has recently been updated to format that is easier to navigate. The left-hand side of the page is an expandable list that includes an introduction and help page. The codes are presented within the hierarchical three Levels and the list can be expanded or collapsed. Clicking on a code brings up its details on the right-hand side of the page, including the new display name, definition, and effective date. The display name has been added to give a more consumer-friendly, but still accurate, name for the code.
The new display names will be added to the CSV file in the January 2021 release of the code set.
Updates to V11.0 7/23 1500 Instruction Manual
Updates to the 11.0 7/23 1500 Instruction Manual
February 14, 2024
The NUCC has released updates to its Version 11.0 7/23 1500 Health Insurance Claim Form Reference Instruction Manual. The updates include a minor revision to the property and casualty instructions in Item Number 1a and a minor revision to the examples in Item Numbers 32 and 33.
The changes go into effect immediately and will be incorporated into the next released version of the 1500 instruction manual. The complete list of changes is available under the 1500 Claim Form tab.
Codes for COVID-19 Professional Claims
Codes for COVID-19 Professional Claims
Condition Codes and Modifier
The following Condition Codes and Modifier are available for use on the paper 1500 Claim Form and in the electronic 837 Professional:
• Condition Code DR - Disaster related (effective March 24, 2020)
• Modifier CR - Catastrophe/disaster related (effective March 24, 2020)
• Condition Code 90 - Service provided as part of an Expanded Access (EA) approval (effective January 19, 2021)
• Condition Code 91 - Service provided as part of an Emergency Use Authorization (EUA) (effective January 19, 2021)
The Centers for Medicare & Medicaid Services' (CMS) MLN Matters SE20011 provides more information on the use of Condition Code DR and Modifier CR for COVID-19 related Medicare claims. For Medicare, Condition Code DR is reported only in the institutional claim (electronic 837I or paper UB-04). The NUCC has approved the use of Condition Code DR in the professional claim due to the business need by other payers to identify COVID-19 related claims. Separately, CMS MLN Matters MM12049 provides additional information on the use of Condition Codes 90 and 91.
The complete list of Condition Codes available for use in the professional claim is available on the Condition Codes page under the Code Sets tab.
Provider Characteristics Codes
The NUCC has released the following new Health Care Provider Characteristics codes related to COVID-19:
• 6J - This provider offers testing for COVID-19 (effective April 1, 2020)
• 6K - This provider offers a vaccine for COVID-19 (effective January 1, 2021)
The complete list of Provider Characteristics codes is available under the Code Set tab.
Resources for Implementing the 02/12 1500 Claim Form
Resources for Implementing the 02/12 1500 Claim Form
Payers may begin accepting the 02/12 1500 Claim Form as of January 6, 2014. The following resources will assist your organization in implementing the revised form:
• Understanding the Changes to the 0212 1500 Claim Form presentation
• Updating to the 0212 1500 Claim Form
Submitters of the form should follow up with their specific payer(s) regarding their transition timeline information.
January 2024 Taxonomy Code Set Update Released
January 2024 Taxonomy Code Set Update
January 2, 2024
The NUCC has released the semi-annual update to the Health Care Provider Taxonomy code set, which will go into effect on April 1, 2024. The complete code set is available under the "Code Sets" tab. Changes to the code set are listed in the "Modifications" tabs under in the Code Sets and Provider Taxonomy menu tabs.