Provider Type and Provider Specialty

1 Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 types and Provider Specialties The Provider type indicates what kind of Provider is doing the billing. Provider types include individuals, facilities, and vendors. The Provider s Specialty is a value indicating what field of medicine a Provider has additional education in to make him/her a specialist in a certain field. NOTE: Provider type codes may not be unique to one Provider type. A good example is Provider type 20 says MD/DO but it is used on PHD, old social workers records and CRNA s and SD providers due to pricing issues. Be sure to look at the type in conjunction with the Specialty . Specialty Code Type Code Description Specialty Type 00 90 Any Specialty Miscellaneous 00 98 Any Specialty Out of country 00 99 Any Specialty Out of area 01 20/22 General Practice (MD/DO Occupational Medicine) Physician ( or )/Group Physician (Multiple Physician Practice) 02 20/22 General Surgery Physician ( or )/Group Physician (Multiple Physician Practice) 03 20/22 Allergy Physician ( or )/Group Physician (Multiple Physician Practice) 04 20/22 Otology, Laryngology, Rhinology (Otolaryngology) Physician ( or )/Group Physician (Multiple Physician Practice) 05 20/22 Anesthesiology Physician ( or )/Group Physician (Multiple Physician Practice) 06 20/22 Cardiovascular Physician ( or )

2 /Group Physician (Multiple Physician Practice) 07 20/22 Dermatology Physician ( or )/Group Physician (Multiple Physician Practice) Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 Specialty Code Type Code Description Specialty Type 08 20/22 Family Practice Physician ( or )/Group Physician (Multiple Physician Practice) 09 20/22 Pain Management (effective 01/06/05) Physician ( or )/Group Physician (Multiple Physician Practice) 10 20/22 Gastroenterology Physician ( or )/Group Physician (Multiple Physician Practice) 11 20/22 Internal Medicine Physician ( or )/Group Physician (Multiple Physician Practice) 13 20/22 Neurology Physician ( or )/Group Physician (Multiple Physician Practice) 14 20/22 Neurological Surgery Physician ( or )/Group Physician (Multiple Physician Practice) 15 17 Pastoral Counselor (SD FEP only) Counselor 16 20/22 Obstetrics-Gynecology Physician ( or )/Group Physician (Multiple Physician Practice) 17 17 Licensed Counselor (SD FEP only) Counselor 18 20/22 Opthalmology Physician ( or )/Group Physician (Multiple Physician Practice) 20 20/22 Orthopedic Surgery Physician ( or )/Group Physician (Multiple Physician Practice) 21 21 Community Mental Health Center Community Mental Health Center 22 20/22 Pathology Physician ( or )/Group Physician (Multiple Physician Practice)

3 Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 Specialty Code Type Code Description Specialty Type 23 20/22 Sleep Medicine Physician ( or )/Group Physician (Multiple Physician Practice) 24 20/22 Plastic Surgery (Reconstructive Surgery) Physician ( or )/Group Physician (Multiple Physician Practice) 25 20/22 Physical Medicine and Rehabilitation (Physiatrist) Physician ( or )/Group Physician (Multiple Physician Practice) 26 20/22 Psychiatry Physician ( or )/Group Physician (Multiple Physician Practice) 27 20/22 Radiation Oncology Physician ( or )/Group Physician (Multiple Physician Practice) 28 20/22 Colorectal Surgery (Proctology) Physician ( or )/Group Physician (Multiple Physician Practice) 29 20/22 Pulmonary Diseases Physician ( or )/Group Physician (Multiple Physician Practice) 30 20/22 Radiology Physician ( or )/Group Physician (Multiple Physician Practice) 31 19 MRI (Magnetic Resonance Imaging) X-Ray Type Supplier 32 20/22 Perinatology Physician ( or )/Group Physician (Multiple Physician Practice) 33 20/22 Thoracic Surgery Physician ( or )/Group Physician (Multiple Physician Practice) 34 20/22 Urology Physician ( or )/Group Physician (Multiple Physician Practice)

4 35 30 Chiropractic Chiropractor Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 Specialty Code Type Code Description Specialty Type 36 20/22 Nuclear Medicine Physician ( or )/Group Physician (Multiple Physician Practice) 37 20/22 Pediatrics (Neonatology) Physician ( or )/Group Physician (Multiple Physician Practice) 38 20/22 Geriatrics Physician ( or )/Group Physician (Multiple Physician Practice) 39 20/22 Nephrology Physician ( or )/Group Physician (Multiple Physician Practice) 40 20/22 Hand Surgery Physician ( or )/Group Physician (Multiple Physician Practice) 41 20/22 Emergency Medicine (ER) Physician ( or )/Group Physician (Multiple Physician Practice) 42 20/22 Nurse Midwife (South Dakota Only) 42 33 Nurse Midwife Nurse (ARNP) 43 20/22 Certified Registered Nurse Anesthetist (CRNA) Physician ( or )/Group Physician (Multiple Physician Practice) 44 20/22 Infectious Diseases Physician ( or )/Group Physician (Multiple Physician Practice) 45 45 Speech Therapy (used for FEP) 46 20/22 Endocrinology Physician ( or )

5 /Group Physician (Multiple Physician Practice) 47 19 Freestanding Mammography Center X-Ray Type Supplier 48 32 Podiatry Podiatrist 49 70 Surgery Center 50 20/22 Nurse Practitioner (South Dakota only) Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 Specialty Code Type Code Description Specialty Type 50 33 Nurse Practitioner Nurse (ARNP) 51 19 PET Scan X-Ray Type Supplier 52 52 Orthotics and Prosthetics 53 53 Freestanding Sleep Centers 54 17 Licensed Marriage Family Therapist (LMFT) 55 17 Licensed Mental Health Counselor (LMHC) 57 57 Federally Qualified Health Centers (FQHC) 59 59 Ambulance 60 44 Home Health Agency (prov.)

6 # begins with 67_ _ _) 60 60 Public Health, Welfare or Rural Health 60 72 Hospice 61 61 Public Health, Voluntary Health or Charitable Agencies 62 20 Psychologist (Billing Independent) Physician ( or )/Group Physician (Multiple Physician Practice) 63 19 Portable X-ray Supplier (billing independently) X-Ray Type Supplier 63 24 Independent Physiological Lab 64 40 Audiologist 65 34 Independent LPT (Licensed Physical Therapist) 65 34 Allied Health Clinics (for special processing as professional Provider ) 66 20/22 Rheumatology Physician ( or )/Group Physician (Multiple Physician Practice) 67 58 Occupational Therapist 69 23 Independent Laboratory (Billing Independently) 70 22 Multi Specialty Clinic Group Physician (Multiple Physician Practice)

7 71 19 Freestanding Radiology Center X-Ray Type Supplier 72 19 Freestanding Radiation Oncology Center X-Ray Type Supplier Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 Specialty Code Type Code Description Specialty Type 73 34 Physiotherapy 74 20/22 Qualified Mental Health Professional (QMHP) (South Dakota only) Physician ( or )/Group Physician (Multiple Physician Practice) 75 28 Optometrist 75 29 Dispensing Optician 76 20/22 Peripheral Vascular Disease (effective 01/06/05) Physician ( or )/Group Physician (Multiple Physician Practice) 77 20/22 Vascular Surgery (effective 01/06/05) Physician ( or )/Group Physician (Multiple Physician Practice) 78 20/22 Cardiac Surgery (effective 01/06/05) Physician ( or )/Group Physician (Multiple Physician Practice) 79 20/22 Cardiac Electrophysiology Physician ( or )/Group Physician (Multiple Physician Practice) 80 20/22 Licensed Clinical Social Worker (should not be using this use 80/38 when WHPI) (only LSW under CMHC) Physician ( or )/Group Physician (Multiple Physician Practice) 80 38 Licensed Clinical Social Worker (All LISW) 81 20/22 Critical Care (Intensivist) (effective 01/06/05) Physician ( or )/Group Physician (Multiple Physician Practice)

8 82 20/22 Hematology Physician ( or )/Group Physician (Multiple Physician Practice) 86 25 Intermediate Care Facility Government Hospital Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 Specialty Code Type Code Description Specialty Type 86 63 Acute Care (60_ _ _ ), Swing Bed (6U_ _ _), Rehab Center (6T_ _ _), Psychiatric (6S_ _ ), Alcohol/Drug (6V_ _ _), Mental Health (64_ _ _), Renal (ESRD) Hospital 86 63 Community Mental Health Center (starts with 646 ), or Mental Health Facility (starts with 640 ) 86 64 Psychiatric Mental Institute for Children (PMIC) Hospital 86 65 Government VA Hospital 86 68 Substance Abuse and Alcohol Abuse (68_ _ _) 86 71 Birthing Center 86 80 Skilled Nursing Facility (65_ _ _) Swing Bed or Rehab (66_ _ _) 86 81 Home Infusion Therapy 87 26 Pharmacy (IPSC/Blue Rx/CMM) 87 69 Home Medical Equipment 88 ANY Dummy Specialty used on dummy Provider numbers 89 20 Clinical Nurse Specialist (South Dakota only)

9 89 33 Clinical Nurse Specialist 90 20/22 Medical Oncology Physician ( or )/Group Physician (Multiple Physician Practice) 91 27 General Dentist 92 27 Oral Surgeon 93 27 Orthodontist 94 27 Pedodontist 95 27 Periodontist 96 27 Endodontist Master AppendixProvider Type and Provider Specialty Provider Type and Provider Specialty Wellmark BCBS July 24, 2006 Specialty Code Type Code Description Specialty Type 97 20 Physician Assistant (South Dakota only) 97 40 Physician Assistant 98 27 Prosthodont