Service Type Codes

X12 External Code Source 958 | Subset 270/271 11/1/2017 LAST UPDATED

Service Type Codes are used to identify the classification of service or benefits. This external code list is used in the 270, 271 and 278 transaction sets as of version 006010. For version 005010 and prior, the code list is defined within the X12 Implementation Guides (TR3).

Subset of Codes by Transaction: Subset 270/271 | Subset 278

1Medical Care
Medical services to diagnose and/or treat a medical condition, illness, or injury
Start: 09/20/2009
2Surgical
Surgical services provided by a healthcare provider
Start: 09/20/2009
3Consultation
Counseling and/or coordination of care with other Physicians, other qualified Healthcare Providers or agencies
Start: 09/20/2009
4Diagnostic X-Ray
Diagnostic x-ray provided by a healthcare provider
Start: 09/20/2009
5Diagnostic Lab
Diagnostic lab provided by a healthcare provider
Start: 09/20/2009
6Radiation Therapy
Radiation therapy provided by a healthcare provider
Start: 09/20/2009
7Anesthesia
Anesthesia services provided by a healthcare provider
Start: 09/20/2009
8Surgical Assistance
Assistant surgeon/surgical assistance provided by a healthcare provider if required because of the complexity of the surgical procedures
Start: 09/20/2009
10Blood
The allotment of whole blood, blood plasma, or blood derivatives
Start: 09/20/2009
11Durable Medical Equipment Used
Used equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home.
Start: 09/20/2009
12Durable Medical Equipment Purchased
Purchased equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home.
Start: 09/20/2009
18Durable Medical Equipment Rental
Rental equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home.
Start: 09/20/2009
19Pneumonia Vaccine
Services provided by a physician or other healthcare provider related to administration of Pneumococcal Pneumonia vaccination.
Start: 09/20/2009
20Second Surgical Opinion
Second professional opinion sought to verify or confirm the necessity for surgical procedures
Start: 09/20/2009
23Diagnostic Dental
The translation of data gathered by clinical and radiographic examination into an organized, classified definition of conditions present.
Start: 09/20/2009
24Periodontics
The art and science of examination, diagnosis, and treatment of diseases affecting the periodontium; a study of the supporting structures of the teeth, normal anatomy and physiology and the deviations.
Start: 09/20/2009
25Restorative
Broad term applied to any restorations to the tooth/teeth structure(s). Anterior teeth include up to five surface classifications - Mesial, Distal, Incisal, Lingual and Labial. Posterior teeth include up to five surface classifications: Mesial, Distal, Occlusal, Lingual and Buccal.
Start: 09/20/2009
26Endodontics
The branch of dentistry that is concerned with the morphology, physiology and pathology of the dental pulp and periradicular (gum) tissues.
Start: 09/20/2009
27Maxillofacial Prosthetics
The branch of prosthetics is concerned with the restoration of stomatognathic and associated facial structure that have been affected by disease, injury, surgery, or congenital defect.
Start: 09/20/2009
28Adjunctive Dental Services
Typically these services involve a drug such as anesthesia or other substances that serve as a supplemental purpose in dental therapy.
Start: 09/20/2009
30Health Benefit Plan Coverage
General healthcare benefits for the member's policy or contract
Start: 09/20/2009
33Chiropractic
Manipulations and modalities provided by a healthcare provider
Start: 09/20/2009
35Dental Care
The treatment of the teeth and their supporting structures.
Start: 09/20/2009
36Dental Crowns
An artificial replacement for the natural crown of the tooth covering all five surfaces (Anterior teeth surface classifications - Mesial, Distal, Incisal, Lingual and Labial. Posterior teeth surface classifications: Mesial, Distal, Occlusal, Lingual and Buccal.
Start: 09/20/2009
37Dental Accident
Supplies or appliances for care of teeth due to accidental injury provided by healthcare provider
Start: 09/20/2009
38Orthodontics
The area of dentistry concerned with the supervision, guidance, and correction of the growing and mature orofacial structures. This includes conditions that require movement of the teeth or correction of the malrelationships and malformations of related structures by the adjustment of relationships between and among teeth and facial bones by the application of forces or the stimulation and redirection of functional forces within the craniofacial complex.
Start: 09/20/2009
39Prosthodontics
The part of dentistry pertaining to the restoration and maintenance of oral function, comfort, appearance and health of the patient by replacement of missing teeth and contiguous tissues with artificial substitutes. It has three main branches: removable prosthodontics, fixed prosthodontics and maxillofacial prosthetics.
Start: 09/20/2009
40Oral Surgery
Diagnosis and treatment of disorders of the mouth, teeth, jaws and facial structure provided by a healthcare provider
Start: 09/20/2009
41Preventive Dental
The dental procedures in dental practice and health programs that prevent the occurrence of oral diseases.
Start: 09/20/2009 | Last Modified: 01/24/2010
42Home Health Care
Healthcare services rendered in the home by a healthcare provider
Start: 09/20/2009
45Hospice
An integrated set of services and supplies to provide palliative and supportive care to terminally ill patients.
Start: 09/20/2009
47Hospitalization
Hospital Inpatient and Outpatient services and supplies for a patient who may or may not have been admitted to a hospital, for the purpose of receiving medical care or other health services.
Start: 09/20/2009
54Long Term Care
Care provided for an individual when they cannot care for themselves within the home or in a facility
Start: 09/20/2009
56Medically Related Transportation
Ambulance, Ambulate or other Medical transport services
Start: 09/20/2009
60General Benefits
Indicates whether a patient has active or inactive medical coverage for the service date requested.
Start: 09/20/2009
61In-vitro Fertilization
Services to treat infertility
Start: 09/20/2009
62MRI Scan
Diagnostic MRI (Magnetic Resonance Imaging) services.
Start: 09/20/2009
64Acupuncture
A system of alternative treatment that involves pricking the skin or tissues with needles
Start: 09/20/2009
65Newborn Care
Management of the infant during the transition to extra uterine life and subsequent period of stabilization
Start: 09/20/2009
66Pathology
Creation of slides from tissues and its interpretation provided by a healthcare provider
Start: 09/20/2009
67Smoking Cessation
Treatment to assist in the discontinuation of the use of nicotine
Start: 09/20/2009
68Well Baby Care
Medical services and physician visits which are recommended by the American Pediatric Association as appropriate and routine care for a child to a specific age limit.
Start: 09/20/2009
69Maternity
Services related to maternity care including related conditions resulting in childbirth when provided, or ordered and billed by a physician or nurse midwife
Start: 09/20/2009
70Transplants
Services related to the transfer of living organs or tissue from one body to another.
Start: 09/20/2009
71Audiology
Services related to hearing disorders, including evaluation of hearing function and rehabilitation of patients with hearing impairment
Start: 09/20/2009
74Private Duty Nursing
A nurse who is hired to provide focused care to an individual patient in a hospital, clinic, nursing home or patient's home
Start: 09/20/2009
75Prosthetics
A device that is used to replace a part of the body that is missing.
Start: 09/20/2009 | Last Modified: 07/01/2016
76Dialysis
The process by which uric acid and urea are removed from circulating blood by means of a dialyzer
Start: 09/20/2009
78Chemotherapy
The treatment of disease by means of chemicals that have a specific toxic effect upon the disease-producing microorganisms or that selectively destroy cancerous tissue.
Start: 09/20/2009
79Allergy Testing
A skin or blood test to determine what substance, or allergen, may trigger an allergic response in a person
Start: 09/20/2009
80Immunizations
The introduction of a vaccine with the goal of producing immunity
Start: 09/20/2009
81Routine Physical
A physical examination performed on asymptomatic patients for medical screening purposes.
Start: 09/20/2009
82Family Planning
Educational services that assists individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility.
Start: 09/20/2009
84Abortion
Services related to the elective termination of a pregnancy
Start: 09/20/2009
86Emergency Services
Services provided by healthcare providers for the treatment of a sudden and unexpected medical condition or injury which requires immediate medical attention
Start: 09/20/2009
88Retail/Independent Pharmacy
A licensed entity that dispenses prescription drugs and provides professional pharmacy services, such as clinical pharmacy consulting respective to the dispensing function. The entity may be a retail/chain or independent pharmacy or any other entity which dispenses prescription drugs.
Start: 09/20/2009 | Last Modified: 05/01/2017
90Mail Order Pharmacy
A mail order pharmacy delivers medications directly to patients through the mail.
Start: 09/20/2009 | Last Modified: 05/01/2017
91Brand Name Prescription Drug
The original formulation of a prescription drug, approved by the FDA for distribution.
Start: 09/20/2009
92Generic Prescription Drug
Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts.
Start: 09/20/2009
93Podiatry
Professional services of a physician or other healthcare provider for the care or treatment of conditions of the foot.
Start: 09/20/2009
A6Psychotherapy
Professional services, including individual or group therapy by providers such as psychiatrists, psychologists, clinical social workers, or psychiatric nurses.
Start: 09/20/2009
ADOccupational Therapy
Professional and facility occupational therapy services performed by an occupational therapist, physician or other healthcare provider at a hospital, office or other covered facility.
Start: 09/20/2009
AFSpeech Therapy
Professional and facility speech therapy services performed by a speech therapist, physician or other healthcare provider at a hospital, office or other covered facility.
Start: 09/20/2009
AGSkilled Nursing Care
Services for a patient in a skilled nursing facility for the purpose of receiving medical care or other health services.
Start: 09/20/2009
AISubstance Abuse
Services provided at a hospital, office or other covered facility as they are related to the diagnosis and treatment of Substance Abuse.
Start: 09/20/2009
ALOptometry
Routine vision services furnished by an optometrist. May include coverage for eyeglasses, contact lenses, routine eye exams, and/or vision testing for the prescribing or fitting of eyeglasses or contact lenses.
Start: 09/20/2009
AMFrames
The framework for a pair of eyeglasses
Start: 09/20/2009
AOLenses
A piece of transparent substance having two opposite surfaces either both curved or one curved and one plane, used in an optical device in correcting defects of vision.
Start: 09/20/2009
APRoutine Eye Exam
A series of tests to evaluate an individual's vision and check for eye diseases.
Start: 09/20/2009
AQNonmedically Necessary Physical (These physicals are required by other entities e.g., insurance application, pilot license, employment or school)
A physical examination performed on asymptomatic patients for medical screening purposes.
Start: 09/20/2009
B2Brand Name Prescription Drug - Formulary
Lists of brand name drugs covered and published by the health plan/payer/processor/PBM to help physicians reach clinically and economically appropriate prescribing decisions for patients.
Start: 09/20/2009
B3Brand Name Prescription Drug - Non-Formulary
A brand name drug that is not listed on the covered and published list of the health plan/payer/processor/PBM.
Start: 09/20/2009
BBPsychiatric Treatment Partial Hospitalization
A step-down transition from acute inpatient care or an alternative to inpatient treatment for the practice or science of diagnosing and treating mental disorders.
Start: 09/20/2009
BCDay Care (Psychiatric)
A step-down transition from acute inpatient care or an alternative to inpatient treatment for the practice or science of diagnosing and treating mental disorders.
Start: 09/20/2009
BEMassage Therapy
The manipulation of muscles and other soft tissues of the body by a therapist for the treatment of health conditions such as pain, cancer, fibromyalgia, HIV/AIDS, depression.
Start: 09/20/2009
BFPulmonary Rehabilitation
Services and instructional guidance administered to an individual suffering from respiratory disease in an attempt to improve the quality of life for the patient.
Start: 09/20/2009
BGCardiac Rehabilitation
Services and instructional guidance rendered by a physician or other healthcare provider in a hospital or covered facility that are designed to help an individual recover from a cardiovascular event
Start: 09/20/2009
BTGynecological
Medical care and management of the female reproductive system and associated disorders provided by a physician or other healthcare provider.
Start: 09/20/2009
BUObstetrical
Medical care and management related to the care of a woman prior, during and after pregnancy, provided by a physician or other healthcare provider.
Start: 09/20/2009
BYPhysician Visit - Sick
Professional services rendered by a physician or other healthcare provider during a non-routine visit related to a illness.
Start: 09/20/2009
BZPhysician Visit - Well
Professional services rendered by a physician or other healthcare provider during a routine or preventative care visit.
Start: 09/20/2009
CKScreening X-ray
X-ray services provided by a physician or other healthcare provider for the purpose of preventative care.
Start: 09/20/2009
CLScreening laboratory
Laboratory services provided by a physician or other healthcare provider for the purpose of preventative care.
Start: 09/20/2009
CMMammogram, High Risk Patient
Mammography services for patients that have been identified with a greater than normal risk for breast cancers and related diseases.
Start: 09/20/2009
CNMammogram, Low Risk Patient
Mammography services for patients that have been identified with a normal risk for breast cancers and related diseases.
Start: 09/20/2009
COFlu Vaccination
Services provided by a physician or other healthcare provider related to the administration of influenza virus vaccination.
Start: 09/20/2009
DGDermatology
Services provided by a physician or other healthcare provider involving the skin and its diseases.
Start: 09/20/2009
DSDiabetic Supplies
Blood sugar (glucose) test strips, monitors, insulin, lancet devices and lancets, glucose control solutions used to monitor and assist in the treatment of diabetes.
Start: 09/20/2009
E0Applied Behavioral Analysis Therapy
Services related to the assessment and treatment of learning and/or developmental disabilities to include techniques and principles to bring about meaningful and positive changes in behavior, improve attention, focus, memory, academics and/or increase language, communication and social skills.
Start: 09/20/2009 | Last Modified: 07/01/2017
E10Radiographs
An image or picture produced on a radiation-sensitive film emulsion by exposure to ionizing radiation direct through an area, region, or substance of interest, followed by chemical processing of the film
Start: 01/24/2010
E11Diagnostic Imaging
The use of radiographic, sonographic, and other technologies to create a graphic depiction of the body parts in question.
Start: 01/24/2010
E14Fixed Prosthodontics
The branch of prosthodontics concerned with the replacement or restoration of teeth by artificial substitutes that are not readily removable such as fixed partial dentures, pontics and abutments.
Start: 01/24/2010
E15Removable Prosthodontics
The branch of prosthodontics concerned with the replacement or restoration of teeth by artificial substitutes that are readily removable such as a denture, partial denture and interim prosthesis.
Start: 01/24/2010
E16Intraoral Images - Complete Series
Complete set of images using radiographic, sonographic, and other technologies representing an image or set of images within the oral cavity.
Start: 01/24/2010
E17Oral Evaluation
The art and science of evaluation to make a clinical judgment or appraisal of a patient's dental health or condition.
Start: 01/24/2010
E18Dental Prophylaxis
A series of procedures where plaque, calculus, and stain are removed from the teeth often referred to as "prophy" or teeth cleaning.
Start: 01/24/2010
E19Panoramic Images
A tomogram of the jaws, taken with a specialized machine designed to present a panoramic view of the full circumferential length of the jaws on a single film.
Start: 01/24/2010
E20Sealants
A resinous material designed for application to the occlusal surfaces of posterior teeth to seal the surface irregularities and prevent the carious process.
Start: 01/24/2010
E21Fluoride Treatments
A separate process from dental prophylaxis of applying prescription strength fluoride product designed to prevent caries.
Start: 01/24/2010
E22Dental Implants
A device, usually alloplastic, that is surgically inserted into or onto the oral tissue. To be used as a prosthodontic abutment, it should remain quiescent and purely secondary to local tissue physiology.
Start: 01/24/2010
E23Temporomandibular Joint Dysfunction
Services related to the Impaired function of the temporomandibular articulation of the jaw.
Start: 01/24/2010
E24Retail Pharmacy Prescription Drug
Dispenses prescription drugs and provides professional pharmacy services, such as clinical pharmacy consulting respective to the dispensing function. The entity may be a retail/chain or independent pharmacy or any other entity which dispenses prescription drugs.
Start: 06/06/2010 | Last Modified: 11/01/2017 | Stop: 11/01/2017
E25Long Term Care Pharmacy
Long term care pharmacy serve the residents of nursing homes, assisted care facilities, extended care facilities, retirement homes, or post acute care. These are considered "closed door pharmacies"
Start: 06/06/2010
E28Dietary/Nutritional Services
Nutrition and diet counseling such as: weight management, eating disorders, pregnancy, pediatric, food allergy, diabetes, celiac disease
Start: 01/29/2012
E33Intensive Cardiac Rehabilitation
A group of physical activities designed to help a patient recover from a cardiovascular event
Start: 06/02/2013
E36Convenience Care
A category of walk-in clinic located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses
Start: 06/02/2013
E37Telemedicine
Services provided via telecommunication and/or information technology venues to provide clinical health services.
Start: 07/01/2015
Technical Note: Services performed that are related to telemedicine; not a place of service.
E38Pharmacist Services
Clinical services provided by a pharmacist
Start: 07/01/2015
E39Diabetic Education
Patient educational program designed to bring awareness of diabetes, what it takes to treat it, and the necessary changes that should be made to improve their lifestyle.
Start: 03/01/2016
E40Early Intervention
Services related to treatment for babies or toddlers with developmental delays or disabilities.
Start: 11/01/2016
EAPreventive Services
Preventive services such as check-ups, patient counseling and screenings to prevent illness, disease and other health-related problems.
Start: 09/20/2009
EBSpecialty Pharmacy
Specialty pharmacies are designed to efficiently deliver medications with specialized handling, storage, and distribution requirements. Specialty pharmacies are also designed to improve clinical and economic outcomes for patients with complex, often chronic and rare conditions, with close contact and management by clinicians.
Start: 09/20/2009
ECDurable Medical Equipment New
New equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home.
Start: 09/20/2009
EDCAT Scan
A multi-dimensional diagnostic image of a cross section of the body that is useful in diagnosing disease
Start: 09/20/2009
EFContact Lenses
A thin lens placed directly on the surface of the eye. Contact Lenses are considered medical devices
Start: 09/20/2009
F1Medical Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
F2Social Work Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
F3Dental Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
F4Hearing Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
F5Prescription Drug Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
F6Vision Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
F7Orthodontia Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
F8Mental Health Coverage
This code will be used by the payer on the 271 response to show coverage type. This code cannot be submitted with the 270 Inquiry.
Start: 11/01/2015
GFGeneric Prescription Drug - Formulary
Lists of generic drugs covered and published by the health plan/payer/processor/PBM to help physicians reach clinically and economically appropriate prescribing decisions for patients.
Start: 09/20/2009
GNGeneric Prescription Drug - Non-Formulary
A generic drug that is not listed on the covered and published list of the health plan/payer/processor/PBM.
Start: 09/20/2009
MHMental Health
Mental Health services provided by a physician or other healthcare providers who are trained and educated to perform services related to mental health and may be licensed or practice within the scope or licensure or training.
Start: 09/20/2009
PEPositron Emission Tomography (PET) Scan
A nuclear imaging examination which reveals molecular function and activity.
Start: 09/20/2009
PTPhysical Therapy
Services and care related to evaluation and treatment of injury or disorders
Start: 09/20/2009
SMHSerious Mental Health
Services for disorders characterized by severe deficits and pervasive impairment in multiple areas of development.
Start: 01/30/2011
UCUrgent Care
Medical services and supplies provided by physicians or other healthcare providers for the treatment of an urgent medical condition or injury which requires medical attention.
Start: 09/20/2009