CPT/HC Provider Chronic Revenue Major Category General ...

1 RevenueCodesMajor CategoryDescriptionCPT/HCPC requiredProvider Specific * General Outpatient Psychiatric Outpatient Chronic Disease Outpatient 250 Pharmacy General ClassificationXXX253 Pharmacy - Take home drugs (LARCs only)XX254 Pharmacy - Drugs Incident to other Diagnostic ServXX255 Pharmacy - Drugs Incident to RadiologyXX258 Pharmacy - IV SolutionsXX259 Pharmacy - Other DrugsXXX260IV Therapy General ClassificationXX261IV Therapy - Infusion PumpXXX262IV Therapy - Pharmacy ServicesXXX264IV Therapy - SuppliesXX270 Med-Surgical Supplies - General ClassificationXX271 Med-Surgical Supplies - Non-Sterile SupplyXX272 Med-Surgical Supplies - Sterile SupplyXX273 Med-Surgical Supplies - Take Home SupplyXXX274 Med-Surgical Supplies - Prosthetic/Orthotic DeviceXXX275 Med-Surgical Supplies - PacemakerX276 Med-Surgical Supplies - Intraocular LensX277 Med-Surgical Supplies - Oxygen/Take HomeXXX278 Med-Surgical Supplies - Other ImplantsXX279 Med-Surgical Supplies - Other Supplies/DevicesXX280 Oncology - General ClassificationXX289 Oncology OtherXX290 DME - General ClassificationXXX291 DME-RentalXXX292 DME- Purchase of NewXXX300

2 Laboratory - General ClassificationXXX301 Laboratory - Chemistry TestsXXX302 Laboratory - Immunology TestsXX303 Laboratory - Renal Patient (Home)XX304 Laboratory - Non-Routine DialysisXX305 Laboratory - Hematology XXX306 Laboratory - Bacteriology & MicrobiologyXXX307 Laboratory - UrologyXXX309 Laboratory - Other XXX310 Pathology Lab - General ClassificationXXX311 Pathology Lab - Cytology TestsXX312 Pathology Lab - Histology TestsXX314 Pathology Lab - Biopsy TestsXX320 Radiology/Diagnositic - General ClassificationXXX321 Radiology/Diagnositic - AngiocardiographyXX322 Radiology/Diagnositic - ArthographyXX323 Radiology/Diagnositic - ArteriographyXX324 Radiology/Diagnositic - Chest X-RayXXX329 Radiology/Diagnositic -OtherXXX330 Radiology Therapy - General ClassificationXX331 Radiology Therapy - Chemotherapy (Injection)XX332 Radiology Therapy - Chemotherapy (Oral)XX333 Radiology Therapy - RadiationXX335 Radiology Therapy - Chemotherapy (IV)XXX339 Radiology Therapy - OtherXX340 Nuclear Medicine - General ClassificationXX341 Nuclear Medicine - Diagnostic ProcedureXX342 Nuclear Medicine - Therapeutic ProcedureXX343 Nuclear Medicine - DX RadiopharmaceuticalsXX344 Nuclear Medicine - RX RadiopharmaceuticalsXX349 Nuclear Medicine - OtherXX350 Computed Tomographic (CT)

3 ScanXX351CT Scan - HeadXX352CT Scan - BodyXX360 Operating Room Services - General ClassificationXX361 Operating Room Services - Minor SurgeryXX362 Operating Room Services - Organ TransplantXX369 Operating Room Services - OtherXX370 Anesthesia - General ClassificationX371 Anesthesia - Incident to RadiologyX372 Anesthesia - Incident to Other Diagnostic ServiceX380 Blood - General ClassificationXX381 Blood - Packed Red CellsXX382 Blood - Whole BloodXX383 Blood - PlasmaXX384 Blood - PlateletsXX385 Blood - LeukocytesXX386 Blood - Other ComponentsXX387 Blood - Other DerivativesXX389 Blood - OtherXX390 Blood Storage and Processing - General ClassificationXX391 Blood Admininstration ( , Transfusion)XX399 Blood Storage and Processing - OtherXX401 Imaging Services - Diagnostic MammographyXX402 Imaging Services - UltrasoundXXX403 Imaging Services - Screening MammographyXX404 Imaging Services - Pet ScanXX409 Imaging Services - OtherXX410 Respiratory Services - General ClassificationXXX412 Respiratory Services - Inhalation ServicesXXX413 Respiratory Services - Hyperbaric Oxygen TherapyXX419 Respiratory Services - Other XX421 Physical Therapy - Visit ChargeXXX424 Physical Therapy - Evaluation or Re-evaluationXXX431 Occupational Therapy - Visit ChargeXXX434 Occupational Therapy - Evaluation or Re-evaluationXXX441 Speech Therapy - Visit ChargeXXX444 Speech Therapy - Evaluation or Re-evaluationXXX450 Emergency Room - General ClassificationXX456 Emergency Room - Urgent CareXX460 Pulmonary Function - General ClassificationXXX469 Pulmonary Function - OtherXX470 Audiology - General ClassificationXX471

4 Audiology - DiagnosticXX472 Audiology - TreatmentXX479 Audiology - Other X480 Cardiology - General ClassificationXXX481 Cardiology - Cardiac Cath LabXX482 Cardiology - Stress TestXX483 Cardiology - EchocardiologyXX489 Cardiology -OtherXX490 Ambulatory Surgical Care General ClassificationXX499 Ambulatory Surgical Care - OtherXX510 Clinic General ClassificationXXX511 Clinic - Chronic Pain ClinicXXX513 Clinic - Psychiatric ClinicXXX514 Clinic - OB-GYN ClinicXX515 Clinic - Pediatric ClinicXX516 Clinic - Urgent Care ClinicXX519 Clinic - Other ClinicXXX530 Osteopathic Services - General ClassificationXX569 Medical Social Services - Other (Child First)X610 Magnetic Resonance Technology (MRT)XX611 MRI - Brain (including Brainstem)XX612 MRI - Spinal Cord (including Spine)XX614 MRI - OtherXX615 MRA - Head & NeckXX616 MRA - Lower ExtremitiesXX618 MRA - OtherXX619 MRT - OtherXX621 Medical/Surgical Supplies - Incident to RadiologyXX622 Medical/Surgical Supplies - Incident to Other DXXX623 Medical/Surgical Supplies - Surgical DressingsXXX634 Pharmacy - Erythropoietin (EPO) < 10,000 unitsXX635 Pharmacy - Erythropoietin (EPO) 10,000 unitsXX636 Pharmacy - Drugs requiring Detailed CodingXXX681 Trauma Response - Level IX 682 Trauma Response - Level IIX 683 Trauma Response - Level IIIX700 Cast Room - General ClassificationXX710 Recovery Room - General ClassificationX720 Labor Room/Delivery - General ClassificationXX721 Labor Room/Delivery - LaborXX722 Labor Room/Delivery - Delivery RoomXX723 Labor Room/Delivery - CircumcisionXX724 Labor Room/Delivery - Birthing CenterXX729 Labor Room/Delivery - OtherXX730 Electrocardiogram (EKG/ECG)

5 - General ClassificationXXX731 Electrocardiogram (EKG/ECG) - Holter MontXX732 Electrocardiogram (EKG/ECG) - TelemetryXX739 Electrocardiogram (EKG/ECG) - OtherXXX740 Electroencephalogram (EEG) - General ClassificationXXX750 Gastro-Intestinal Services - General ClassificationXX760 Specialty Services - General ClassificationXXX761 Specialty Services - Treatment RoomXXX762 Specialty Services - ObservationXX769 Specialty Services - Other (CARES)XX771 Preventative Care Services - Vaccine AdministrationXX790 extra - corporeal Shock Wave TherapyXX810 Organ AcquisitXX819 Other DonorXX820 Hemodialysis - Outpatient or Home DialysisXX821 Hemodialysis - Composite or Other RateXX823 Hemodialysis - Home EquipmentXX824 Hemodialysis - Home Maintenance/100%XX825 Hemodialysis - Home Support ServicesXX829 Hemodialysis - Other Hemodialysis OutpatientXX830 Peritoneal Dialysis - Outpatient or HomeXX831 Peritoneal Dialysis - Composite or Other RateXX839 Peritoneal Dialysis - Home/OtherXX840 CAPD - Outpatient or HomeXX841 CAPD - Composite or Other RateXX842 CAPD - Home/SuppliesXX845 CAPD - Home/Support ServicesXX849 CAPD - OtherXX850 Continuous Cycling Peritoneal Dialysis (CCPD)

6 XX851 CCPD - Composite or Other RateXX859 CCPD - OtherXX881 Miscellaneous Dialysis - Ultra-fitrationXX889 Miscellaneous Dialysis - OtherXX900 Behavior Health Treatments/ServicesXXXX901 Behavior Health Treatments/Services - Electro ShockXXX902 Behavior Health Treatments/Services - Milieu TherapyXX905 Behavior Health Treatments/Services - IOP/PsychXXX906 Behavior Health Treatments/Services - IOP/Chem DepXXX907 Behavior Health Treatments/Services - CommunityXX913 Behavior Health Treatments/Services - Partial IntensvXXX914 Behavior Health Treatments/Services - Indiv TherapyXXXX915 Behavior Health Treatments/Services - Group TherapyXXXX916 Behavior Health Treatments/Services - Family TherapyXXXX918 Behavior Health Treatments/Services - TestingXXXX919 Behavior Health Treatments/Services - OtherXXXX920 Other Diagnostic Services - General ClassificationXXX921 Other Diagnostic Services - Peripheral Vascular LabXX922 Other Diagnostic Services - Electromyelogram (EMG)XXX923 Other Diagnostic Services - Pap SmearXX924 Other Diagnostic Services - Allergy TestXX925 Other Diagnostic Services - Pregnancy TestXX929 Other Diagnostic Services - Other XXX940 Other Therapeutic Services - General ClassifactionXXX943 Other Therapeutic Services - Cardiac RehabilitationXXX948 Other Therapeutic Services - Pulmonary RehabilitationXXX949 Other Therapeutic Services -OtherXXX953 Tobacco Cessation Group CounselingXXX