January 2022 Provider Taxonomy Code Set Update
December 29, 2021
The NUCC has released the semi-annual update to the Health Care Provider Taxonomy code set, which will go into effect on April 1, 2022. The complete code set is available under the "Code Sets" tab. Changes to the code set are listed in the "New Codes" tab under in the Code Sets and Provider Taxonomy menu tabs.
2021 Updated NUCC 1500 Instruction Manual Released
July 1, 2021
The NUCC has released its annual, updated version of its 1500 Health Insurance Claim Form Reference Instruction Manual. The updated instruction manual, Version 9.0 7/21, goes into effect immediately and is available under the 1500 Claim Form tab.
There were two minor changes to the Version 8.0 7/20 manual. A change log is available on the 1500 Instructions page. Any interim changes, clarifications, or corrections to the instructions following this release will be posted on the NUCC website.
For more information on the 1500 Health Insurance Claim Form Reference Instruction Manual, see the 1500 Claim Form tab.
Do NOT email, fax, or mail completed 1500 Claim Forms to the NUCC. The NUCC does not process claims. Send completed forms to the appropriate payer.
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.
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.
Questions about the DSMO Process?
The Designated Standards Maintenance Organizations (DSMO) have created a presentation "Understanding the HIPAA Processes" to provide information on the HIPAA transactions, code sets, and operating rules processes under HIPAA. The presentation was developed to satisfy an industry need to have in one concise document the process of how to request changes to HIPAA mandated standards.
The presentation is available here: DSMO: Understanding the HIPAA Process
The DSMO includes three American National Standards Institute (ANSI) Accredited standard development organizations ‐ Accredited Standards Committee (ASC) X12, Health Level Seven (HL7) International, and the National Council for Prescription Drug Programs (NCPDP), and three data content organizations ‐ the American Dental Association (ADA) Dental Content Committee (DeCC), National Uniform Billing Committee (NUBC), and National Uniform Claim Committee (NUCC). The DSMO reviews change requests to the HIPAA designated standards and requests for new standards and code sets to be adopted.
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:
Submitters of the form should follow up with their specific payer(s) regarding their transition timeline information.
Who Are We?
The National Uniform Claim Committee (NUCC) is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the non-institutional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare and Medicaid Services (CMS) as a critical partner. The committee is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.
The NUCC was formally named in the administrative simplification section of the HIPAA of 1996 as one of the organizations to be consulted by the American National Standards Institute's accredited SDOs and the Secretary of HHS as they develop, adopt, or modify national standards for health care transactions. As such, the NUCC is intended to have an authoritative voice regarding national standard content and data definitions for non-institutional health care claims in the United States. The NUCC's recommendations in this area are explicitly designed to complement and expedite the work of the Accredited Standards Committee Electronic Data Interchange (ASC X12N) in complying with the provisions of P.L. 104-191.
The NUCC is comprised of the key parties affected by health care electronic data interchange (EDI) - those at either end of a health care transaction, generally payers and providers. Criteria for membership include a national scope and representation of a unique constituency affected by health care EDI, with an emphasis on maintaining or enhancing the provider/payer balance. Each committee member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Representatives are responsible for communicating information between the committee and the group(s) they represent.