Provision ID's

PROVISION IDS
PROV. ID PROVISION DESCRIPTION
AAMB Air Ambulance Base Rate
AAMM Air Ambulance Mileage
ABPO ACA Mandated Breast Pump Outpatient
ABUA SUBSTANCE ABUSE IP SPECIAL APPROVAL
ABUB SUBSTANCE ABUSE OP SPECIAL APPROVAL
ABUE SUBSTANCE ABUSE OP EXTENSION
ABUF SUBSTANCE ABUSE OP FREE STANDING
ABUI SUBSTANCE ABUSE INPATIENT
ABUJ SUBSTANCE ABUSE IP SECONDARY LEVEL
ABUO SUBSTANCE ABUSE OUTPATIENT
ABUP SUBSTANCE ABUSE OP SECONDARY LEVEL
ACAI ACUPUNCTURE ANESTHESIA - IP
ACAO ACUPUNCTURE ANESTHESIA - OP
ACCO ATCP ORGAN RECIPIENT LODGING
ACTI ACUPUNCTURE TREATMENT - IP
ACTO ACUPUNCTURE TREATMENT - OP
ADCI ADULT DAY CARE - MEDICAL/SOCIAL - DAILY/HOURLY, IP
ADCO ADULT DAY CARE - MEDICAL/SOCIAL - DAILY/HOURLY, OP
ADES ATTENTION DEFICIT DISORDER / ELECTROSHOCK THERAPY
ADFA ATTENTION DEFICIT DISORDER / FAMILY COUNSELING ADULT
ADFC ATTENTION DEFICIT DISORDER / FAMILY COUNSELING CHILD
ADGO ATTENTION DEFICIT DISORDER / GROUP PSYCHOTHERAPY
ADHO ATTENTION DEFICIT DISORDER / HYPNOTHERAPY
ADIO ATTENTION DEFICIT DISORDER / INDIVIDUAL PSYCHOTHERAPY
ADMC 213D - ASSISTANCE FOR THE DISABLED/MISC CHARGES COVERED
ADMN 213D - ASSISTANCE FOR THE DISABLED/MISC CHARGES NON-COVERED
ADOC ATCP DONOR / ORGAN CHARGES
ADXA ALCOHOL DETOX IP SPECIAL APPROVAL
ADXF ALCOHOL DETOX OP FREE STANDING
ADXI ALCOHOL DETOX - IP
ADXJ ALCOHOL DETOX. IP SECONDARY LEVEL
ADXO ALCOHOL DETOX - OP
AHI ALCOHOL VISIT - IP
AHIS ALCOHOL VISIT IP SECONDARY LEVEL
AICO ARTIFICIAL INSEM/CONSULTATION OP
AIDA EXTENDED HOME HEALTH AIDE
AIDE HOME HEALTH AIDE
AIDO ARTIFICIAL INSEM/DRUGS - OP
AIIJ ARTIFICIAL INSEM/INJECTIONS
AILO ARTIFICIAL INSEM/LAB OP
AIMP ARTIFICIAL INSEM/DIAG. MEDICAL PROCEDURE - OP
AIMS ARTIFICIAL INSEM/MEDICAL/SURGICAL SUPPLIES OP
AIOV ARTIFICIAL INSEM/OFFICE VISIT
AIPA ARTIFICIAL INSEM/PATHOLOGY OP
AIPO ARTIFICIAL INSEM/PAP SMEAR OP
AIPS ARTIFICIAL INSEM/ROUTINE PAP SMEAR
AIPX ARTIFICIAL INSEM/PHYSICAL HISTORY OP
AIRL ARTIFICIAL INSEM/ROUTINE LABORATORY TEST
AIRP ARTIFICIAL INSEM/ROUTINE DIAG.MEDICAL PROCEDURE
AIRX ARTIFICIAL INSEM/ROUTINE XRAY TEST
AISR ARTIFICIAL INSEM/SURGERY
Updated: 9/21/2012

PROVISION IDS
AIXO ARTIFICIAL INSEM/XRAY - OP
ALCO ALLERGY TREATMENT/CONSULTATION OP
ALDO ALLERGY TREATMENT/DRUGS - OP
ALIJ ALLERGY TREATMENT/INJECTIONS
ALIM ALLERGY TREATMENT/IMMUNIZATION OP
ALLO ALLERGY TREATMENT/LAB OP
ALMP ALLERGY TREATMENT/DIAG. MEDICAL PROCEDURE - OP
ALMS ALLERGY TREATMENT/MEDICAL/SURGICAL SUPPLIES OP
ALOV ALLERGY TREATMENT/OFFICE VISIT
ALPA ALLERGY TREATMENT/PATHOLOGY OP
ALPX ALLERGY TREATMENT/PHYSICAL HISTORY OP
ALRL ALLERGY TREATMENT/ROUTINE LABORATORY TEST
ALRP ALLERGY TREATMENT/ROUTINE DIAG.MEDICAL PROCEDURE
ALRX ALLERGY TREATMENT/ROUTINE XRAY TEST
ALSR ALLERGY TREATMENT/SURGERY
ALTI ALLERGY TREATMENT - IP
ALTO ALLERGY TREATMENT - OP
ALTR ALLERGY TREATMENT/MALIG CHEMO OP
ALTS ALLERGY TREATMENT SERUM
ALTT ALLERGY TREATMENT/RELATED
ALTW ALLERGY TREATMENT - WELL CARE
ALXO ALLERGY TREATMENT/XRAY - OP
AMAO AMBULANCE/ALLERGY TESTING OP
AMB AMBULANCE
AMBM AMBULANCE MILEAGE
AMBN Non Emergency Ambulance Base Rate
AMCE ACA Mandated Counseling/Education Services
AMDO AMBULANCE/DRUGS - OP
AMIJ AMBULANCE/INJECTIONS
AMLO AMBULANCE/LAB OP
AMLS ACA Mandated Lab Screening
AMMN Non Emergency Ambulance Mileage
AMMP AMBULANCE/DIAG. MEDICAL PROCEDURE - OP
AMPP ACA Mandated Preventive Procedure
AMRP AMBULANCE/ROUTINE DIAG.MEDICAL PROCEDURE
AMSO ACA Mandated Miscellaneous Supplies
AMXO AMBULANCE/XRAY - OP
ANSI ANESTHESIA - IP
ANSL ANESTHESIA - LOCAL
ANSO ANESTHESIA - OP
APFI ANESTHESIA PROFESSIONAL FEE - IP
APFO ANESTHESIA PROFESSIONAL FEE - OP
ARPA ALCOHOL REHAB IP SPECIAL APPROVAL
ARPB ALCOHOL REHAB OP SPECIAL APPROVAL
ARPE ALCOHOL REHAB OP EXTENSION
ARPF ALCOHOL REHAB OP FREE STANDING
ARPI ALCOHOL REHAB - IP
ARPJ ALCOHOL REHAB IP SECONDARY LEVEL
ARPO ALCOHOL REHAB - OP
ARPP ALCOHOL REHAB OP SECONDARY LEVEL
ASAO ADDITIONAL SECOND OPINION/ALLERGY TREATMENT
ASAT ADDITIONAL SECOND OPINION/ALLERGY TEST
Updated: 9/21/2012

PROVISION IDS
ASCO ADDITIONAL SECOND OPINION/CONSULTATION OP
ASDM Additional Surgical Opinion/Durable Medical Equipment Purchase - OP
ASDO ADDITIONAL SECOND OPINION/DRUGS - OP
ASDR Additional Surgical Opinion/Durable Medical Equipment Rental - OP
ASEM ARTIFICIAL INSEMINATION
ASHT Additional Surgical Opinion/Hearing Therapy
ASIH Additional Surgical Opinion/Inhalation Therapy - OP
ASIJ ADDITIONAL SECOND OPINION/INJECTIONS
ASIM ADDITIONAL SECOND OPINION/IMMUNIZATION OP
ASLO ADDITIONAL SECOND OPINION/LAB OP
ASMC ADDITIONAL SECOND OPINION/MALIGNANT CHEMO
ASMM ADDITIONAL SECOND OPINION/MAMMOGRAM - DIAGNOSTIC OP
ASMP ADDITIONAL SECOND OPINION/DIAG. MEDICAL PROCEDURE - OP
ASMS ADDITIONAL SECOND OPINION/MEDICAL/SURGICAL SUPPLIES OP
ASMX ADDITIONAL SECONDARY OPINION/MALIGNANT CHEMOTHERAPY DRUGS - OP
ASOP ADDITIONAL SURGICAL OPINION
ASOS Additional Surgical Opinion/Orthotics-OP
ASOV ADDITIONAL SECOND OPINION/OFFICE VISIT
ASPA ADDITIONAL SECOND OPINION/PATHOLOGY OP
ASPR Additional Surgical Opinion/Prostate Specific Artigen Test
ASPS ADDITIONAL SECOND OPINION/PAP SMEAR OP
ASPT ADDITIONAL SECOND OPINION/MEDICAL PROC. THERAPEUTIC OP
ASPX ADDITIONAL SECOND OPINION/PHYSICAL HISTORY
ASPY Additional Surgical Psychological Testing-OP
ASRI ADDITIONAL SECOND OPINION/RADIOISOTOPE TEST OP
ASSI ASSISTANT SURGERY - IP
ASSO ASSISTANT SURGERY - OP
ASSP Additional Surgical Opinion/Speech Therapy
ASVP Additional Surgical Opinion/Vision Care Program
ASVT ADDITIONAL SECOND OPINION/VISION TEST OP
ASXO ADDITIONAL SECOND OPINION/XRAY OP
ATAT ALLERGY TESTING/ALLERGY TREATMENT - OP
ATCO ALLERGY TESTING/CONSULTATION OP
ATDO ALLERGY TESTING/DRUGS - OP
ATHI ALTERNATIVE THERAPY SERVICES, IP
ATHO ALTERNATIVE THERAPY SERVICES, OP
ATI ALLERGY TESTING - IP
ATII ALLERGY TESTING INTRADERMAL IP
ATIJ ALLERGY TESTING/INJECTIONS
ATKT ATHLETIC TRAINING/KINESIOTHERAPY
ATLO ALLERGY TESTING/LAB OP
ATMP ALLERGY TESTING/DIAG. MEDICAL PROCEDURE - OP
ATMS ALLERGY TESTING/MEDICAL/SURGICAL SUPPLIES OP
ATO ALLERGY TESTING - OP
ATOV ALLERGY TESTING/OFFICE VISIT
ATOW ALLERGY TESTING - WELL CARE
ATPX ALLERGY TESTING/PHYSICAL HISTORY OP
ATRE ALLERGY TESTING/RELATED
ATRL ALLERGY TESTING/ROUTINE LABORATORY TEST
ATRP ALLERGY TESTING/ROUTINE DIAG.MEDICAL PROCEDURE
ATRX ALLERGY TESTING/ROUTINE XRAY TEST
ATSI ALLERGY TESTING SCRATCH IP
Updated: 9/21/2012

PROVISION IDS
ATVO ALLERGY TESTING/VISION TEST OP
ATXO ALLERGY TESTING/XRAY - OP
AUTO AUTOPSY
AZMA ASTHMA KITS
BAMI BLOOD ADMINISTRATION - IP
BAMO BLOOD ADMINISTRATION - OP
BANK BANKING
BCHI BENIGN CHEMOTHERAPY - IP
BCHO BENIGN CHEMOTHERAPY - OP
BDRI BLOOD DERIVATIVES - IP
BDRO BLOOD DERIVATIVES - OP
BIOI BIOFEEDBACK - IP
BIOO BIOFEEDBACK - OP
BIRD BIRTHING CENTER CARE - DEPENDENT
BIRH BIRTHING CENTER
BIRM BIRTHING CENTER CARE - MEMBER
BIRS BIRTHING CENTER CARE - SPOUSE
BLCI BLOOD COMPONENTS - IP
BLCO BLOOD COMPONENTS - OP
BLDI BLOOD - IP
BLDO BLOOD - OP
BODI Bone Density Inpatient
BODO Bone Density Outpatient
BPRI BLOOD PROCESSING - IP
BPRO BLOOD PROCESSING - OP
BRCI BLOOD RELATED CHARGES - IP
BRCO BLOOD RELATED CHARGES - OP
BRRI BENIGN RADIUM / RADON THERAPY - IP
BRRO BENIGN RADIUM / RADON THERAPY - OP
BRTI BENIGN RADIOISOTOPE THERAPY - IP
BRTO BENIGN RADIOISOTOPE THERAPY - OP
BRXI BENIGN CHEMOTHERAPY DRUGS - IP
BRXO BENIGN CHEMOTHERAPY DRUGS - OP
BXTI BENIGN XRAY THERAPY - IP
BXTO BENIGN XRAY THERAPY - OP
CARD CARDIAC CARE
CATI CAT SCAN INPATIENT
CATO CAT SCAN OUTPATIENT
CCFI COORDINATED CARE FEE IP
CCFM COORDINATED CARE FEE MISC
CCFO COORDINATED CARE FEE OP
CDIS CONGENITAL SURGERY IP - SPECIAL LEVEL
CDMP CHEMOTHERAPY OP DIAG MED PROCEDURE
CDOS CONGENITAL SURGERY OP - SPECIAL LEVEL
CDRG CHEMOTHERAPY OP / DRUGS
CDSI CONGENITAL DEFECTS SURGERY - IP
CDSO CONGENITAL DEFECTS SURGERY - OP
CESC 213D - CORRECTIVE EYE SURGERY - COVERED
CESN 213D - CORRECTIVE EYE SURGERY - NON-COVERED
CFOV CHEMOTHERAPY FOLLOW-UP OFFICE VISIT
CFTI CASE FINDING TESTS - IP
CFTO CASE FINDING TESTS - OP
Updated: 9/21/2012

PROVISION IDS
CGCO CONGENITAL/CONSULTATION OP
CGDO CONGENITAL/DRUGS - OP
CGIJ CONGENITAL/INJECTIONS
CGIM CONGENITAL/IMMUNIZATION OP
CGLO CONGENITAL/LAB OP
CGMP CONGENITAL/DIAG. MEDICAL PROCEDURE - OP
CGMS CONGENITAL/MEDICAL/SURGICAL SUPPLIES OP
CGOV CONGENITAL/OFFICE VISIT
CGPA CONGENITAL/PATHOLOGY OP
CGPX CONGENITAL/PHYSICAL HISTORY OP
CGRL CONGENITAL/ROUTINE LABORATORY TEST
CGRM CONGENITAL/ROUTINE DIAG.MEDICAL PROCEDURE
CGRX CONGENITAL/ROUTINE XRAY TEST
CGVO CONGENITAL/VISION TEST OP
CGXO CONGENITAL/XRAY - OP
CHC COORDINATED HOME CARE
CHCO CHEMOTHERAPY OP CONSULTATION
CHCS COORDINATED HOME CARE - SPECIAL LEVEL
CHCV COORDINATED HOME CARE VISIT
CHEM CHEMOTHERAPY SERVICES OP
CINJ CHEMOTHERAPY OP INJECTION
CIRC CIRCUMCISION
CLAB CHEMOTHERAPY OP LABORATORY
CLED CONTACT LENS COSMETIC DISPENSING FEE
CLEM CONTACT LENS MEDICAL ACQUISITION
CLEN CONTACT LENS COSMETIC ACQUISITION
CLMD CONTACT LANS MEDICAL DISPENSING FEE
CMCO COSMETIC/CONSULTATION OP
CMDO COSMETIC/DRUGS - OP
CMIJ COSMETIC/INJECTIONS
CMLO COSMETIC/LAB OP
CMMC COSMETIC/MALIGNANT CHEMOTHERAPY OP
CMMG COSMETIC/MAMMOGRAM - DIAGNOSTIC OP
CMMP COSMETIC/DIAG. MEDICAL PROCEDURE - OP
CMMS COSMETIC/MEDICAL/SURGICAL SUPPLIES OP
CMOV COSMETIC/OFFICE VISIT
CMPA COSMETIC/PATHOLOGY OP
CMPT CHEMOTHERAPY OP THERAPEUTIC PROCEDURE
CMPX COSMETIC/PHYSICAL HISTORY OP
CMRE COSMETIC/RELATED
CMRL COSMETIC/ROUTINE LABORATORY TEST
CMRM COSMETIC/ROUTINE MAMMOGRAM
CMRP COSMETIC/ROUTINE DIAG.MEDICAL PROCEDURE
CMRY COSMETIC/ROUTINE XRAY TEST
CMSS CHEMOTHERAPY OP / MEDICAL SURGICAL SUPPLIES
CMVO COSMETIC/VISION TEST OP
CMXO COSMETIC/XRAY - OP
COAD ATTENTION DEFICIT DISORDER / CONSULTATION
COIS COSMETIC SURGERY IP - SPECIAL LEVEL
CONI CONSULTATION - IP
CONM Non-Serious Mental Illness Office Consultation
CONO CONSULTATION - OP
Updated: 9/21/2012

PROVISION IDS
COOS COSMETIC SURGERY OP - SPECIAL LEVEL
COSI COSMETIC SURGERY - IP
COSM Serious Mental Illness Office Consultation
COSO COSMETIC SURGERY - OP
CPAP CHEMOTHERAPY OP PAP SMEAR
CPT CHEMOTHERAPY OP PATHOLOGY
CPYC 213D - COPAYS - COVERED
CPYN 213D - COPAYS - NON-COVERED
CRIO CHEMOTHERAPY OP RADIOISOTOPE TEST
CRPI CARDIAC REHAB PROGRAM - IP
CRPO CARDIAC REHAB PROGRAM - OP
CSMV CHEMOTHERAPY OP / SPECIAL MEDICAL VISITS
CSVI CHRISTIAN SCIENCE VISIT - IP
CSVO CHRISTIAN SCIENCE VISIT - OP
CTAO CONSULTATION/ALLERGY TREATMENT
CTAT CONSULTATION/ALLERGY TEST
CTCO CONSULTATION/CONSULTATION OP
CTDE Consultation/Durable Medical Equipment Purchase - OP
CTDO CONSULTATION/DRUGS - OP
CTDR Consultation/Durable Medical Equipment Rental - OP
CTEK CONSULTATION / EKG
CTHT Consultation/Hearing Test - OP
CTIA CONSULTATION / IMMUNIZATION ADMINISTRATION FEE
CTIH Consultation/Inhalation Therapy - OP
CTIJ CONSULTATION/INJECTIONS
CTIM CONSULTATION/IMMUNIZATION OP
CTIN CONSULTATION/INVITRO FERTILIZATION LAB
CTLH CONSULTATION/LAB HANDLING AND/OR CONVEYANCE
CTLO CONSULTATION/LAB OP
CTMC CONSULTATION/MALIGNANT CHEMO
CTMM CONSULTATION/MAMMOGRAM - DIAGNOSTIC OP
CTMP CONSULTATION/DIAG. MEDICAL PROCEDURE - OP
CTMS CONSULTATION/MEDICAL/SURGICAL SUPPLIES OP
CTMX CONSULTATION/MALIGNANT CHEMOTHERAPY DRUGS - OP
CTOS Consultation/Orthotics - OP
CTOV CONSULTATION/OFFICE VISIT
CTPA CONSULTATION/PATHOLOGY OP
CTPG CONSULTATION/CONTRACTIVE DRUGS
CTPO Consultation/Prostate Specific Antigen Tests - OP
CTPR Consultation/Preventive Care
CTPS CONSULTATION/PAP SMEAR OP
CTPT CONSULTATION/MEDICAL PROCEDURE THERAPEUTIC OP
CTPX CONSULTATION/PHYSICAL HISTORY OP
CTRI CONSULTATION/RADIOISOTOPE TEST OP
CTRK CONSULTATION / ROUTINE EKG
CTRM Consultation/Routine Mammogram
CTSO CONSULTATION/SURGERY - OP
CTSP Consultation/Speech Therapy - OP
CTSR SURGERY RELATED TO A CONSULTATION
CTVP CONSULTATION/VISION CARE PROGRAM
CTVT CONSULTATION/VISION TEST OP
CTXO CONSULTATION/XRAY - OP
Updated: 9/21/2012

PROVISION IDS
CVEA CLINIC VISIT OP EMERGENCY ACCIDENT
CVEM CLINIC VISIT OP EMERGENCY MEDICAL
CVIS CHEMOTHERAPY OP VISIT
CVOP CLINIC VISIT OP
CXRY CHEMOTHERAPY OP XRAY
DDXA DRUG DETOX IP SPECIAL APPROVAL
DDXF DRUG DETOX OP FREE STANDING
DDXI DRUG DETOX - IP
DDXJ DRUG DETOX IP SECONDARY LEVEL
DDXO DRUG DETOX - OP
DEIS DENTAL SURGERY IP - SPECIAL LEVEL
DENI DENTAL SURGERY - IP
DENO DENTAL SURGERY - OP
DEOS DENTAL SURGERY OP - SPECIAL LEVEL
DIAI DIALYSIS - IP
DIAO DIALYSIS - OP
DIET WEIGHT LOSS
DIMI DIABETIC MANAGEMENT INPATIENT
DIMO DIABETIC MANAGEMENT OUTPATIENT
DMEI DURABLE MEDICAL EQUIPMENT PURCHASE - IP
DMEO DURABLE MEDICAL EQUIPMENT PURCHASE - OP
DMGI Disease Management Inpatient
DMGO Disease Management Outpatient
DMPI DIAG. MEDICAL PROCEDURE - IP
DMPO DIAG. MEDICAL PROCEDURE - OP
DMRI DURABLE MEDICAL EQUIPMENT RENTAL - IP
DMRO DURABLE MEDICAL EQUIPMENT RENTAL - OP
DPSA DAY PSYCH SPECIAL APPROVAL
DPSY DAY PSYCH
DPSZ DAY PSYCH R & B SECONDARY LEVEL
DPV DAY PSYCH VISIT
DPVS DAY PSYCH VISIT IP SECONDARY LEVEL
DRB DAILY ROOM AND BOARD
DRE DIGITAL RECTAL EXAM
DRGI DRUGS - IP
DRGO DRUGS - OP
DRI DRUG VISIT - IP
DRIS DRUGS VISIT IP SECONDARY LEVEL
DRPA DRUG REHAB IP SPECIAL APPROVAL
DRPB DRUG REHAB OP SPECIAL APPROVAL
DRPE DRUG REHAB OP EXTENSION
DRPF DRUG REHAB OP FREE STANDING
DRPI DRUG REHAB - IP
DRPJ DRUG REHAB IP SECONDARY LEVEL
DRPO DRUG REHAB - OP
DRPP DRUG REHAB OP SECONDARY LEVEL
DRTI DIVERSIONAL / RECREATIONAL THERAPY - IP
DRTO DIVERSIONAL / RECREATIONAL THERAPY - OP
DSCO DENTAL SURGERY/CONSULTATION OP
DSDO DENTAL SURGERY/DRUGS - OP
DSIJ DENTAL SURGERY/INJECTIONS
DSLO DENTAL SURGERY/LAB OP
Updated: 9/21/2012

PROVISION IDS
DSMC DENTAL SURGERY/MALIGNANT CHEMOTHERAPY OP
DSMP DENTAL SURGERY/DIAG. MEDICAL PROCEDURE - OP
DSMS DENTAL SURGERY/MEDICAL/SURGICAL SUPPLIES OP
DSOV DENTAL SURGERY/OFFICE VISIT
DSPA DENTAL SURGERY/PATHOLOGY OP
DSPX DENTAL SURGERY/PHYSICAL HISTORY OP
DSRE DENTAL SURGERY/RELATED
DSRL DENTAL SURGERY/ROUTINE LABORATORY TEST
DSRP DENTAL SURGERY/ROUTINE DIAG.MEDICAL PROCEDURE
DSRX DENTAL SURGERY/ROUTINE XRAY TEST
DSXO DENTAL SURGERY/XRAY - OP
DTI DIET THERAPY - IP
DTO DIET THERAPY - OP
DTOX DETOXIFICATION ROOM AND BOARD
DXTI DEEP XRAY THERAPY - IP
DXTO DEEP XRAY THERAPY - OP
EAAM EMERGENCY ACCIDENT/AMBULANCE
EAAT Emergency Accident Care/Allergy Testing
EABA EMERGENCY ACCIDENT BLD ADM.
EABC EMERGENCY ACCIDENT BLOOD COMP.
EABD EMERGENCY ACCIDENT BLD DERIV.
EABI ELECTIVE ABORTION - IP
EABO ELECTIVE ABORTION - OP
EABP EMERGENCY ACCIDENT BLD PROC
EABR EMERGENCY ACCIDENT BLOOD RELATED CHARGES
EAC EMERGENCY ACCIDENT CARE
EACF EMERGENCY ACCIDENT FOLLOW UP
EACG EMERGENCY ACCIDENT/CONGENITAL
EACI EMERGENCY ACCIDENT INJECTION
EACM EMERGENCY ACCIDENT/COSMETIC
EACO EMERGENCY ACCIDENT/CONSULTATION OP
EACP EMERGENCY ACCIDENT OFFICE VISIT - BILLED WITH PLACE OF TREATMENT 2
EACS EMERGENCY ACCIDENT/CARE SUPPLIES
EACT EMERGENCY ACCIDENT CAT SCAN
EACX EMERGENCY ACCIDENT CHEST XRAY
EADE Emergency Accident Care/EA Durable Medical Equipment Purchase OP
EADM EMERGENCY ACCIDENT DURABLE MED
EADP EMERGENCY ACCIDENT/DIAG. MEDICAL PROCEDURE - OP
EADR Emergency Accident Care/Durable Medical Equipment Rental
EADS EMERGENCY ACCIDENT/DENTAL SURGERY
EADX EMERGENCY ACCIDENT/DRUGS OP
EAEK EMERGENCY ACCIDENT / EKG
EAER EMERGENCY ACCIDENT EMER. ROOM SERVICES
EAHD EMERGENCY ACCIDENT VISIT / EMERGENCY ACCIDENT LAB HANDLING
EAHM EMERGENCY ACCIDENT HOSPITAL MISC.
EAHO Emergency Accident Care/Hearing Test Outpatient
EAIA EMERGENCY ACCIDENT VISIT / EMERGENCY ACCIDENT INJECTION ADMIN.
EAIH EMERGENCY ACCIDENT INHALATION THERAPY
EAIJ EMERGENCY ACCIDENT/INJECTIONS
EAIM Emergency Accident Care/Immunization
EAIN Emergency Accident Care/EA Inhalation Therapy
EAJA EMERGENCY ACCIDENT / INJECTION ADMINISTRATION FEE
Updated: 9/21/2012

PROVISION IDS
EAKG EMERGENCY ACCIDENT EKG
EAKO EMERGENCY ACCIDENT VISIT / EMERGENCY ACCIDENT EKG
EAL EMERGENCY ACCIDENT LAB
EALH EMERGENCY ACCIDENT / LAB HANDLING
EALO EMERGENCY ACCIDENT/LAB OP
EALS SPECIAL EMERGENCY ACCIDENT LAB
EAMB EMERGENCY AMBULANCE
EAME EMERGENCY ACCIDENT VISIT / EMERGENCY ACCIDENT MRI
EAMI EMERGENCY ACCIDENT/AMBULANCE MILEAGE
EAMM EMERGENCY AMBULANCE MILEAGE
EAMO EMERGENCY ACCIDENT/MAMMOGRAM - DIAGNOSTIC OP
EAMP EMERGENCY ACCIDENT DIAG. MED. PROC.
EAMR EMERGENCY ACCIDENT MRI
EAMS EMERGENCY ACCIDENT MED/SURG SUPPLIES
EAMV EMERGENCY ACCIDENT MEDICAL VISITS
EAOF EMERGENCY ACCIDENT OFFICE VISIT
EAOP Emergency Accident Care/Prosthetics Outpatient
EAOR Emergency Accident Care/Orthotics Outpatient
EAOV EMERGENCY ACCIDENT/OFFICE VISIT
EAPA EMERGENCY ACCIDENT/PATHOLOGY
EAPC Emergency Accident Care/Preventative Care
EAPE EMERGENCY ACCIDENT PET SCAN
EAPL EMERGENCY ACCIDENT PLASMA
EAPO EMERGENCY ACCIDENT/PODIATRY
EAPR EMERGENCY ACCIDENT/PROSTATE SPECIFIC ANTIGEN TESTS-OP
EAPS EMERGENCY ACCIDENT/PAP SMEAR OP
EAPT EMERGENCY ACCIDENT PATHOLOGY
EARE EMERGENCY ACCIDENT/RELATED
EARI EMERGENCY ACCIDENT RADIOISOTOPE TEST
EARK EMERGENCY ACCIDENT / ROUTINE EKG
EARO Emergency Accident Care/EA Radioisotope Test OP
EARX EMERGENCY ACCIDENT DRUGS
EASO Emergency Accident Care/EA Medical Surgical Supplies
EASR EMERGENCY ACCIDENT/SURGERY
EASS EMERGENCY ACCIDENT SPECIAL SURG CHARGES
EAST Emergency Accident Care/Speech Therapy Outpatient
EATM Emergency Accident Care/Medical Procedure Therapeutic
EAVO EMERGENCY ACCIDENT/VISION TEST OP
EAX EMERGENCY ACCIDENT XRAY
EAXO EMERGENCY ACCIDENT/XRAY OP
EAXS SPECIAL EMERGENCY ACCIDENT XRAY
ECAS ECF ALCOHOL INPATIENT SECONDARY LEVEL
ECDS ECF DRUG INPATIENT SECONDARY LEVEL
ECF ECF VISITS
ECFA ECF ALCOHOL VISIT-IP
ECFD ECF DRUG-IP
ECFM ECF MENTAL VISIT-IP
ECFT ECF TB VISIT-IP
ECFV ECF VISIT-IP
EHV ECF HOSPICE VISIT
EKGI EKG, IP
EKGO EKG, OP
Updated: 9/21/2012

PROVISION IDS
ELCO ELECTIVE ABORT/CONSULTATION OP
ELDO ELECTIVE ABORT/DRUGS - OP
ELES ELECTIVE ABORT/ELECTIVE STERILIZATION
ELIJ ELECTIVE ABORT/INJECTIONS
ELLO ELECTIVE ABORT/LAB OP
ELMM ELECTIVE ABORT/MAMMOGRAM - DIAGNOSTIC OP
ELMN ELECTIVE ABORT/MEDICAL NEC. STERILIZATION
ELMP ELECTIVE ABORT/DIAG. MEDICAL PROCEDURE - OP
ELMS ELECTIVE ABORT/MEDICAL/SURGICAL SUPPLIES OP
ELOV ELECTIVE ABORT/OFFICE VISIT
ELPA ELECTIVE ABORT/PATHOLOGY OP
ELPS ELECTIVE ABORT/PAP SMEAR
ELPX ELECTIVE ABORT/PHYSICAL HISTORY OP
ELRD ELECTIVE ABORT/ROUTINE DIAG.MEDICAL PROCEDURE
ELRE ELECTIVE ABORT/RELATED SERVICE
ELRL ELECTIVE ABORT/ROUTINE LABORATORY TEST
ELRM ELECTIVE ABORT/ROUTINE MAMMOGRAM
ELRP ELECTIVE ABORT/ROUTINE PAP SMEAR
ELRX ELECTIVE ABORT/ROUTINE XRAY TEST
ELSR ELECTIVE ABORT/SURGERY
ELXO ELECTIVE ABORT/XRAY - OP
EMAT Emergency Medical Care/Allergy Testing
EMBA EMERGENCY MEDICAL BLOOD ADMIN.
EMBC EMERGENCY MEDICAL BLOOD COMPONENTS
EMBD EMERGENCY MEDICAL BLOOD DERIV.
EMBP EMERGENCY MEDICAL BLOOD PROC.
EMBR EMERGENCY MEDICAL BLOOD RELATED SERVICES
EMC EMERGENCY MEDICAL CARE
EMCG EMERGENCY MEDICAL/CONGENITAL
EMCI EMERGENCY MEDICAL INJECTION
EMCM EMERGENCY MEDICAL/COSMETIC
EMCO EMERGENCY MEDICAL/CONSULTATION OP
EMCP EMERGENCY MEDICAL OFFICE VISIT - BILLED WITH PLACE OF TREATMENT 2
EMCT EMERGENCY MEDICAL CAT SCAN
EMCX EMERGENCY MEDICAL CHEST XRAY
EMDE Emergency Medical Care/Durable Medical Equipment purchase OP
EMDM Emergency Medical Care/Durable Medical Equipment
EMDO EMERGENCY MEDICAL DRUGS
EMDP EMERGENCY MEDICAL/DIAG. MEDICAL PROCEDURE - OP
EMDR Emergency Medical Care/Durable Medical Equipment Rental
EMDS EMERGENCY MEDICAL/DENTAL
EMDX EMERGENCY MEDICAL/DRUGS - OP
EMEK EMERGENCY MEDICAL / EKG
EMER EMERGENCY MEDICAL EMERGENCY ROOM
EMHD EMERGENCY MEDICAL VISIT / EMERGENCY MEDICAL LAB HANDLING
EMHM EMERGENCY MEDICAL HOSPITAL MISC.
EMHO Emergency Medical Care/Hearing Test Outpatient
EMIA EMERGENCY MEDICAL VISIT / EMERGENCY MEDICAL INJECTION ADMIN.
EMIH EMERGENCY MEDICAL INHALATION THERAPY
EMIJ EMERGENCY MEDICAL/INJECTIONS
EMIM Emergency Medical Care/Immunization
EMIN Emergency Medical Care/EM Inhalation Therapy
Updated: 9/21/2012

PROVISION IDS
EMJA EMERGENCY MEDICAL / INJECTION ADMINISTRATION FEE
EMKG EMERGENCY MEDICAL EKG
EMKO EMERGENCY MEDICAL VISIT / EMERGENCY MEDICAL EKG
EML EMERGENCY MEDICAL LAB
EMLH EMERGENCY MEDICAL / LAB HANDLING
EMLO EMERGENCY MEDICAL/LAB OP
EMLS SPECIAL EMERGENCY MEDICAL LAB
EMMB EMERGENCY MEDICAL/AMBULANCE
EMME EMERGENCY MEDICAL VISIT / EMERGENCY MEDICAL MRI
EMMG EMERGENCY MEDICAL/MAMMOGRAM - DIAGNOSTIC OP
EMMI EMERGENCY MEDICAL/MILEAGE
EMMP EMERGENCY MEDICAL DIAG. MEDICAL PROC.
EMMR EMERGENCY MEDICAL MRI
EMMS EMERGENCY MEDICAL MED/SURG SUPPLIES
EMMV EMERGENCY MEDICAL VISITS
EMOF EMERGENCY MEDICAL OFFICE VISIT
EMOP Emergency Medical Care/Prosthetics Outpatient
EMOR Emergency Medical Care/Orthotics
EMOV EMERGENCY MEDICAL/OFFICE VISIT
EMPA EMERGENCY MEDICAL/PATHOLOGY OP
EMPC Emergency Medical Care/Immunization
EMPE EMERGENCY MEDICAL PET SCAN
EMPH Emergency Medical Care/EM Pathology
EMPL EMERGENCY MEDICAL PLASMA
EMPO EMERGENCY MEDICAL/PODIATRY
EMPR EMERGENCY MEDICAL/PROSTATE SPECIFIC ANTIGEN TESTS-OP
EMPS EMERGENCY MEDICAL/PAP SMEAR OP
EMPT EMERGENCY MEDICAL PATHOLOGY
EMRI EMERGENCY MEDICAL RADIOISOTOPE TEST
EMRK EMERGENCY MEDICAL / ROUTINE EKG
EMRO Emergency Medical Care/EM Radioisotope OP
EMSO EMERGENCY MEDICAL/MEDICAL/SURGICAL SUPPLIES OP
EMSR EMERGENCY MEDICAL/SURGERY
EMSS EMERGENCY MEDICAL SPECIAL SURG CHARGES
EMST Emergency Medical Care/Speech Therapy Outpatient
EMTM Emergency Medical Care/Medical Procedure Therapeutic
EMVO EMERGENCY MEDICAL/VISION TEST OP
EMX EMERGENCY MEDICAL XRAY
EMXR EMERGENCY MEDICAL/XRAY - OP
EMXS SPECIAL EMERGENCY MEDICAL XRAY
ERCO EMERGENCY ROOM COPAY (WHOLE CLAIM) CREATED FOR WAL-MART
ERIS STERILIZATION REVERSAL IP-SPECIAL LEVEL
EROS STERILIZATION REVERSAL OP-SPECIAL LEVEL
ERSI EMERGENCY ROOM SERVICES-IP
ERSO EMERGENCY ROOM SERVICES-OP (NON-EMERGENCY)
ESFI Elective Sterilization Female Inpatient
ESFO Elective Sterilization Female Outpatient
ESI ELECTIVE STERILIZATION-IP
ESIS ELECTIVE STERILIZATION IP-SPECIAL LEVEL
ESO ELECTIVE STERILIZATION-OP
ESOS ELECTIVE STERILIZATION OP-SPECIAL LEVEL
ESRI STERILIZATION REVERSAL-IP
Updated: 9/21/2012

PROVISION IDS
ESRO STERILIZATION REVERSAL-OP
ESTI ELECTROSHOCK THERAPY-IP
ESTO ELECTROSHOCK THERAPY-OP
ESUR EMERGENCY SURGERY
ETAI ELECTROSHOCK THERAPY ANESTHESIA-IP
ETAO ELECTROSHOCK THERAPY ANESTHESIA-OP
EWVS EAR WAX VISIT
EXPI EXPERIMENTAL PROCEDURES-IP
EXPO EXPERIMENTAL PROCEDURES-OP
FAAO FAMILY CON. (ADULT)/ALLERGY TREATMENT
FACO FAMILY CON. (ADULT)/CONSULTATION OP
FADO FAMILY CON. (ADULT)/DRUGS - OP
FAID FIRST AID
FAIJ FAMILY CON. (ADULT)/INJECTIONS
FALO FAMILY CON. (ADULT)/LAB OP
FAMP FAMILY CON. (ADULT)/DIAG. MEDICAL PROCEDURE - OP
FAOV FAMILY CON. (ADULT)/OFFICE VISIT
FAPT FAMILY CON. (ADULT) PSYCHOLOGICAL TESTING
FASO FAMILY CON. (ADULT)//SURGICAL SUPPLIES OP
FAXO FAMILY CON. (ADULT)/XRAY - OP
FCAB FAMILY COUNSELING ADULT-OP SPECIAL APPRV.
FCAI FAMILY COUNSELING ADULT-IP
FCAJ FAMILY COUNSEL ADULT-OP SECONDARY LEVEL
FCAO FAMILY COUNSELING ADULT-OP
FCAS FAMILY COUNSEL ADULT IP SECONDARY LEVEL
FCCA FAMILY CON. (CHILD)/ALLERGY TREATMENT
FCCB FAMILY COUNSELING CHILD-OP SPECIAL APPRV.
FCCC FAMILY CON. (CHILD)/CONSULTATION OP
FCCI FAMILY COUNSELING CHILD-IP
FCCJ FAMILY COUNSEL CHILD-OP SECONDARY LEVEL
FCCO FAMILY COUNSELING CHILD-OP
FCCS FAMILY COUNSEL CHILD IP SECONDARY LEVEL
FCDO FAMILY CON. (CHILD)/DRUGS - OP
FCIJ FAMILY CON. (CHILD)/INJECTIONS
FCLO FAMILY CON. (CHILD)/LAB OP
FCMP FAMILY CON. (CHILD)/DIAG. MEDICAL PROCEDURE - OP
FCOV FAMILY CON. (CHILD)/OFFICE VISIT
FCPT FAMILY CON. (CHILD)/PSYCHOLOGICAL TESTING
FCRX FAMILY CON. (CHILD)/ROUTINE XRAY TEST
FCSO FAMILY CON. (CHILD)/SURGICAL SUPPLIES OP
FCXO FAMILY CON. (CHILD)/XRAY - OP
FHI FAITH HEALER-IP
FHO FAITH HEALER-OP
FOTI FUNCTIONAL OCCUPATIONAL THERAPY-IP
FOTO FUNCTIONAL OCCUPATIONAL THERAPY-OP
FPO FAMILY PLANNING
FRAA GLASSES FRAMES ACQUISITION
FRAD GLASSES FRAMES DISPENSING FEE
FRAM GLASSES FRAMES
FRAR GLASSES FRAMES REPLACEMENT
GPB GROUP PSYCHOTHERAPY OP SPECIAL APPROVAL
GPCO GROUP PSYCHOTHERAPY/CONSULTATION OP
Updated: 9/21/2012

PROVISION IDS
GPDO GROUP PSYCHOTHERAPY/DRUGS - OP
GPI GROUP PSYCHOTHERAPY IP
GPIJ GROUP PSYCHOTHERAPY/INJECTIONS
GPJ GROUP PSYCHOTHERAPY OP SECONDARY LEVEL
GPLO GROUP PSYCHOTHERAPY/LAB OP
GPMP GROUP PSYCHOTHERAPY/DIAG. MEDICAL PROCEDURE - OP
GPMS GROUP PSYCHOTHERAPY/ SUPPLIES OP
GPO GROUP PSYCHOTHERAPY OP
GPOV GROUP PSYCHOTHERAPY/OFFICE VISIT
GPPT GROUP PSYCHOTHERAPY/PSYCHOLOGICAL TESTING
GPS GROUP PSYCHOTHERAPY IP SECONDARY LEVEL
GPXO GROUP PSYCHOTHERAPY/XRAY - OP
GREF BEREAVEMENT COUNSELING
GRH GROUP HOME
HAAC HEARING AID ACQUISITION
HADF HEARING AID DISPENSING FEE
HAEV HEARING AID EVALUATION
HAID HEARING AID
HAMD EAR MOLDS
HCPI HEARING CARE PROGRAM-IP
HCPM HOSPICE COUNSEL/PROBLEM MANAGEMENT
HCPO HEARING CARE PROGRAM-OP
HEAR AUDIOMETRIC TEST FOR HEARING AID
HECO HEARING CONFORMITY EXAMINATION
HHP HOME HEMOPHILIA PROGRAM
HHRX HOME HEMOPHILIA DRUGS
HHV HOME HOSPICE VISIT
HIT HOME INFUSION THERAPY
HMI HOSPITAL MISC.-IP
HMO HOSPITAL MISC.-OP
HONM Non-Serious Mental Illness Outpatient Consultation
HOSM Serious Mental Illness Outpatient Consultation
HOSP HOSPICE PROGRAM
HPCC 213D - HMO PCP COPAY - COVERED - 213PC - GROUPING 15
HPCN 213D - HMO PCP COPAY - NON COVERED - 213PN - GROUPING 15
HSCC 213D - HMO SPECIALIST COPAY - COVERED - 213MC - GROUPING 16
HSCN 213D - HMO SPECIALIST COPAY - NON COVERED - 213MN - GROUPING 16
HTEI HEARING TEST-IP
HTEO HEARING TEST-OP
HTI HEARING THERAPY-IP
HTO HEARING THERAPY-OP
HVD HOSPITAL VISIT-IP
HVIS HOME VISIT
HVO HOSPITAL VISIT-OP
HWCC 213D - HMO WELLNESS COPAY - COVERED - 213WC - GROUPING 14
HWCN 213D - HMO WELLNESS COPAY - NON COVERED - 213WN - GROUPING 14
HWH HALF-WAY HOUSE
HYPB HYPNOTHERAPY OP SPECIAL APPROVAL
HYPI HYPNOTHERAPY-IP
HYPJ HYPNOTHERAPY-OP SECONDARY LEVEL
HYPO HYPNOTHERAPY-OP
HYPS HYPNOTHERAPY IP SECONDARY LEVEL
Updated: 9/21/2012

PROVISION IDS
ICHR FIRST TIME CHIROPRACTOR VISIT
ICUN ICU NURSERY ROOM AND BOARD
ICUR ICU ROOM AND BOARD
ICV INTENSIVE CARE VISIT-IP
IEKO INTERPRETATION ELECTROCARDIOGRAM OP
IFCO INVITRO FERT/CONSULTATION OP
IFDO INVITRO FERT/DRUGS - OP
IFIJ INVITRO FERT/INJECTIONS
IFIM INVITRO FERT/IMMUNIZATION OP
IFLO INVITRO FERT/LAB OP
IFMP INVITRO FERT/DIAG. MEDICAL PROCEDURE - OP
IFMS INVITRO FERT/MEDICAL/SURGICAL SUPPLIES OP
IFOV INVITRO FERT/OFFICE VISIT
IFPA INVITRO FERT/PATHOLOGY OP
IFPS INVITRO FERT/PAP SMEAR OP
IFPX INVITRO FERT/PHYSICAL HISTORY OP
IFRD INVITRO FERT/ROUTINE DIAG.MEDICAL PROCEDURE
IFRE INVITRO FERT/RELATED
IFRL INVITRO FERT/ROUTINE LABORATORY TEST
IFRP INVITRO FERT/ROUTINE PAP SMEAR
IFRX INVITRO FERT/ROUTINE XRAY TEST
IFXO INVITRO FERT/XRAY - OP
IHI INHALATION THERAPY-IP
IHO INHALATION THERAPY-OP
IHV INPATIENT HOSPICE VISIT
IJHD HIGH DOLLAR INJECTABLE DRUGS SUPPLIED BY MCKESSON
ILBO INTERPRETATION LAB OP
IMCO IMMUNIZATION/CONSULTATION
IMGD GARDISIL IMMUNIZATION
IMM IMMUNIZATION-OP
IMMA IMMUNIZATION ADMINISTRATION FEE
IMMI IMMUNIZATION INPATIENT HOSPITAL
IMOV IMMUNIZATION/OFFICE VISIT
IMPT IMMUNIZATION/MEDICAL PROCEDURE THERAPEUTIC OP
IMPX IMMUNIZATION/PHYSICAL HISTORY
IMWB IMMUNIZATION/WELL BABY CARE EXAM
INJ INJECTIONS
INJA INJECTION ADMINISTRATION FEE
INVI IN-VITRO FERTILIZATION
INVI INVITRO FERTILIZATION LAB
IOCD INTENSIVE OP CHEMICAL DEPENDENCY
IOPS INTENSIVE OP PSYCHIATRIC SERVICE
IPB INDIVIDUAL PSYCHOTHERAPY OP SPECIAL APP.
IPCO INDIVIDUAL PSYCHOTHERAPY/CONSULTATION OP
IPCR INDIVIDUAL PSYCHOTHERAPY/CONGENITAL RELATED
IPDO INDIVIDUAL PSYCHOTHERAPY/DRUGS - OP
IPI INDIVIDUAL PSYCHOTHERAPY-IP
IPIJ INDIVIDUAL PSYCHOTHERAPY/INJECTIONS
IPJ INDIVIDUAL PSYCHOTHERAPY-OP SECONDARY LEVEL
IPLO INDIVIDUAL PSYCHOTHERAPY/LAB OP
IPMP INDIVIDUAL PSYCHOTHERAPY/DIAG. MEDICAL PROCEDURE - OP
IPMS INDIVIDUAL PSYCHOTHERAPY/SURGICAL SUPPLIES OP
Updated: 9/21/2012

PROVISION IDS
IPO INDIVIDUAL PSYCHOTHERAPY-OP
IPOV INDIVIDUAL PSYCHOTHERAPY/OFFICE VISIT
IPPO INTERPRETATION PAP SMEAR OP
IPPT INDIVIDUAL PSYCHOTHERAPY/PSYCHOLOGICAL TESTING
IPS INDIVIDUAL PSYCHOTHERAPY-IP SECONDARY LEVEL
IPSO INTERPRETATION PROSTATE SPECIFIC ANTIGEN TESTS OP
IPTO INTERPRETATION PATHOLOGY OP
IPXO INDIVIDUAL PSYCHOTHERAPY/XRAY - OP
IRCL INTERPRETATION ROUTINE COLORECTAL CANCER SCREENING LAB
IRCX INTERPRETATION ROUTINE COLORECTAL CANCER SCREENING XRAY
IRLB INTERPRETATION ROUTINE LABORATORY TEST
IRPP INTERPRETATION ROUTINE PAP SMEAR
IRPS INTERPRETATION ROUTINE PROSTATE CANCER SCREENING
IRXO INTERPRETATION XRAY OP
IRXR INTERPRETATION ROUTINE XRAY TEST
ISII INTERNAL SURGICAL IMPLANTS-IP
ISIO INTERNAL SURGICAL IMPLANTS-OP
ISTI INSULIN SHOCK THERAPY-IP
ISTO INSULIN SHOCK THERAPY-OP
ITS ITS - SERVICE NOT VALID IN BLUE CHIP
JUNK PERSONAL ITEMS
KITI ADMISSION/COMFORT KITS-IP
KITO ADMISSION/COMFORT KITS-OP
LABF LAB SERVICE OP RELATED TO FOCUS PROCEDURES
LABH HANDLING AND/OR CONVEYANCE OF LAB
LABI LAB-IP
LABM LAB MISCELLANEOUS
LABO LAB-OP
LBIF BIFOCAL VISION LENS
LCM LARGE CASE MANAGEMENT
LCNC CONTACT LENS COSMETIC
LCNT CONTACT LENS
LENT VENTRICULAR LENS
LPAC 213D - LIMITED PURPOSE FSA - COVERED
LPAN 213D - LIMITED PURPOSE FSA - NON-COVERED
LPBC 213D - LIMITED PURPOSE HCA - COVERED
LPBN 213D - LIMITED PURPOSE HCA - NON-COVERED
LSNG SINGLE VISION LENS
LTCC 213D - LONG TERM CARE - COVERED
LTCN 213D - LONG TERM CARE - NON-COVERED
LTRI TRIFOCAL VISION LENS
MAGI MAMMOGRAM - DIAGNOSTIC IP
MAGO MAMMOGRAM - DIAGNOSTIC OP
MAIG MARRIAGE COUNSELING
MAJA MAJOR DENTAL CARE
MAJB GOLD FOIL RESTORATIONS
MAJC INLAY/PORCELAIN RESTORATIONS
MAJD CROWN RESTORATION
MAJE PROSTHODONTIC CARE
MAJF DENTURES/PONTICS
MAJG DENTURE REBASE
MAJH DENTURE ADJUSTMENTS
Updated: 9/21/2012

PROVISION IDS
MAJI DENTAL CORE POST
MAJJ ABUTMENT CROWNS
MAJK UPPER DENTURE RELINING
MAJL DENTAL PROSTHESES MISCELLANEOUS
MAJM LOWER DENTURE RELINING
MAMA MAMMOGRAM ADD-ON
MAMI MAMMOGRAM SPECIAL LEVEL IP
MAMO MAMMOGRAM SPECIAL LEVEL OP
MASI MASSAGE, IP
MASO MASSAGE, OP
MBD MULTI BIRTH OB-DEPENDENT
MBM MULTI BIRTH OB-MEMBER
MBS MULTI BIRTH OB-SPOUSE
MCCO MALIGNANT CHEMO/CONSULTATION OP
MCDO MALIGNANT CHEMO/DRUGS - OP
MCDS MALIGNANT CHEMO/DENTAL SURGERY
MCHI MALIGNANT CHEMOTHERAPY-IP
MCHO MALIGNANT CHEMOTHERAPY-OP
MCIN MALIGNANT CHEMO/INJECTIONS
MCLO MALIGNANT CHEMO/LAB OP
MCMA MALIGNANT CHEMO/MAMMOGRAM - DIAGNOSTIC OP
MCMP MALIGNANT CHEMO/DIAG. MEDICAL PROCEDURE - OP
MCMS MALIGNANT CHEMO/MEDICAL/SURGICAL SUPPLIES OP
MCOI MEDICARE COINSURANCE
MCOV MALIGNANT CHEMO/OFFICE VISIT
MCPA MALIGNANT CHEMO/PATHOLOGY OP
MCPO MALIGNANT CHEMO/PODIATRY SURGERY
MCPP MALIGNANT CHEMO/PAP SMEAR OP
MCPR MALIGNANT CHEMO/PROSTATE SPECIFIC ANTIGEN TESTS-OP
MCRE MALIGNANT CHEMO/RELATED
MCRX MALIGNANT CHEMO/ROUTINE XRAY TEST
MCSR MALIGNANT CHEMO/SURGERY
MCVT MALIGNANT CHEMO/VISION TEST
MCXO MALIGNANT CHEMO/XRAY - OP
MDED MEDICARE DEDUCTIBLE
MDRI DEEP MALIGNANT RADIUM/RADON THERAPY-IP
MDRO DEEP MALIGNANT RADIUM/RADON THERAPY-OP
MECF MEDICARE ECF DAYS
MEHV MENTAL HOME VISIT
MEOV MENTAL OFFICE VISIT
MGSD MEDICARE GROUP SUPPLEMENTAL DAYS
MHVO MENTAL HOSPITAL VISIT OUTPATIENT
MLTR MEDICARE LIFETIME RESERVE
MMI MUSCLE MANIPULATION-IP
MMO MUSCLE MANIPULATION-OP
MMSI MEDICAL MISCELLANEOUS SERVICE- IP.
MMSO MEDICAL MISCELLANEOUS SERVICE - OP.
MNI MENTAL VISIT-IP
MPCI MEDICARE PROJECT CODE - IP
MPCO MEDICARE PROJECT CODE - OP
MPTI MEDICAL PROCEDURE THERAPEUTIC-IP
MPTO MEDICAL PROCEDURE THERAPEUTIC-OP
Updated: 9/21/2012

PROVISION IDS
MRII MRI (MAGNETIC RESONANCE IMAGING) - IP
MRIO MRI (MAGNETIC RESONANCE IMAGING) - OP
MRTI MALIGNANT RADIOISOTOPE THERAPY - IP
MRTO MALIGNANT RADIOISOTOPE THERAPY - OP
MRXI MALIGNANT CHEMOTHERAPY DRUGS - IP
MRXO MALIGNANT CHEMOTHERAPY DRUGS - OP
MSHI MEDICAL/SURGICAL SUPPLIES TAKEN HOME - IP
MSHO MEDICAL/SURGICAL SUPPLIES TAKEN HOME - OP
MSSI MEDICAL/SURGICAL SUPPLIES - IP
MSSO MEDICAL/SURGICAL SUPPLIES - OP
NBCS CONTRACEPTIVE MANAGEMENT / CONSULTATION
NBDO CONTRACEPTIVE MANAGEMENT / DRUGS OP
NBEK CONTRACEPTIVE MANAGEMENT / EKG
NBGN CONTRACEPTIVE MANAGEMENT / ORAL CONTRACEPTIVES GENERIC
NBIJ CONTRACEPTIVE MANAGEMENT / INJECTION
NBIM CONTRACEPTIVE MANAGEMENT / IMMUNIZATION
NBLO CONTRACEPTIVE MANAGEMENT / LAB
NBMM CONTRACEPTIVE MANAGEMENT / MAMMOGRAM
NBMP CONTRACEPTIVE MANAGEMENT / DIAGNOSTIC MEDICAL PROCEDURE
NBMS CONTRACEPTIVE MANAGEMENT / MEDICAL SURGICAL SUPPLIES
NBOV CONTRACEPTIVE MANAGEMENT / OFFICE VISIT
NBPG CONTRACEPTIVE MANAGEMENT / ORAL CONTRACEPTIVES BRAND NAME
NBPS CONTRACEPTIVE MANAGEMENT / PAP SMEAR
NBPT CONTRACEPTIVE MANAGEMENT / PATHOLOGY
NBPX CONTRACEPTIVE MANAGEMENT / ROUTINE PHYSICAL EXAM
NBRD CONTRACEPTIVE MANAGEMENT / ROUTINE DIAGNOSTIC MEDICAL PROCEDURE
NBRK CONTRACEPTIVE MANAGEMENT / ROUTINE EKG
NBRL CONTRACEPTIVE MANAGEMENT / ROUTINE LAB
NBRM CONTRACEPTIVE MANAGEMENT / ROUTINE MAMMOGRAM
NBRP CONTRACEPTIVE MANAGEMENT / ROUTINE PAP SMEAR
NBRX CONTRACEPTIVE MANAGEMENT / ROUTINE XRAY
NBWV CONTRACEPTIVE MANAGEMENT / WELL GYNE VISIT
NBXO CONTRACEPTIVE MANAGEMENT / XRAY
NCBI NATURAL CHILD BIRTH INSTRUCTIONS
NCDH NUTRITIONAL COUNSELING, DIETICIAN OP HOSP VISIT
NCDI NUTRITIONAL COUNSELING, DIETICIAN IP HOSP VISIT
NCDO NUTRITIONAL COUNSELING, DIETICIAN OFFICE VISIT
NCNH NUTRITION CLASSES, NON-PHYSICIAN PROVIDER, OP HOSP
NCNI NUTRITION CLASSES, NON-PHYSICIAN PROVIDER, IP HOSP
NCNO NUTRITION CLASSES, NON-PHYSICIAN PROVIDER, OFFICE
NCRC NEWBORN CIRCUMCISION
NCSV NON-COVERED SERVICES - CATEGORY II CPT/C, H & T HCPCS CODES
NHV NURSING HOME VISIT - IP
NNBC NEWBORN CARE - IP
NOGN CONTRACEPTIVE DRUGS / ORAL / GENERIC
NONC NON COVERED SERVICES
NOOB CONTRACEPTIVES (EXCLUDING ORAL CONTRACEPTIVE DRUGS)
NOPG CONTRACEPTIVE DRUGS / ORAL / BRAND NAME
NPRX NON-PREFERRED, NON-FORMULARY PRESCRIPTION DRUG
NPSA NIGHT PSYCH SPECIAL APPROVAL
NPSY NIGHT PSYCH ROOM AND BOARD
NPSZ NIGHT PSYCH R & B SECONDARY LEVEL
Updated: 9/21/2012

PROVISION IDS
NPV NIGHT PSYCH VISIT
NPVS NIGHT PSYCH VISIT IP SECONDARY LEVEL
NRB NURSERY ROOM AND BOARD
NRSI NURSING SERVICES - IP
NRSO NURSING SERVICES - OP
NTFH MEDICAL NUTRITION THERAPY, RE-ASSESSMENT OP HOSP
NTFI MEDICAL NUTRITION THERAPY, RE-ASSESSMENT IP HOSP
NTFO MEDICAL NUTRITION THERAPY, RE-ASSESSMENT OFFICE
NTGH MEDICAL NUTRITION THERAPY, INITIAL, GROUP, OP HOSP
NTGI MEDICAL NUTRITION THERAPY, INITIAL, GROUP, IP HOSP
NTGO MEDICAL NUTRITION THERAPY, INITIAL, GROUP, OFFICE
NTIH MEDICAL NUTRITION THERAPY, INITIAL, INDIVIDUAL, OP HOSP
NTII MEDICAL NUTRITION THERAPY, INITIAL, INDIVIDUAL, IP HOSP
NTIO MEDICAL NUTRITION THERAPY, INITIAL, INDIVIDUAL, OFFICE
OBCD OB COMPLICATED - DEPENDENT
OBCM OB COMPLICATED - MEMBER
OBCS OB COMPLICATED - SPOUSE
OBHD OB NORMAL - DEPENDENT - HOME
OBHM OB NORMAL - MEMBER - HOME
OBHS OB NORMAL - SPOUSE - HOME
OBND OB NORMAL - DEPENDENT
OBNM OB NORMAL - MEMBER
OBNS OB NORMAL - SPOUSE
OCLA OVARIAN CANCER SCREENING LAB - OP
OCLI OVARIAN CANCER SCREENING LAB - IP
OCSG OVARIAN CANCER SCREENING SURGERY - OP
OCSI OVARIAN CANCER SCREENING SURGERY - IP
OCXI OVARIAN CANCER SCREENING XRAY - IP
OCXR OVARIAN CANCER SCREENING XRAY - OP
ONER OUT OF NETWORK EMERGENCY ROOM
OPDR OUTPATIENT DAYS REDUCTION PROVISION
OPSG OP SURGERY
ORGI HUMAN ORGAN TRANSPLANT - IP
ORGO HUMAN ORGAN TRANSPLANT - OP
ORIS ORGAN TRANSPLANT IP - SPECIAL LEVEL
OROS ORGAN TRANSPLANT OP - SPECIAL LEVEL
ORTA ORTHODONTIC CARE
ORTB ORTHODONTIC RETENTION
OSI ORTHOTICS - INPATIENT
OSO ORTHOTICS - OUTPATIENT
OSOH HANDLING AND/OR CONVEYANCE OF ORTHOTIC/PROSTHETIC
OTDC 213D - OVER THE COUNTER DRUGS - COVERED
OTDN 213D - OVER THE COUNTER DRUGS - NON-COVERED
OVAD ATTENTION DEFICIT DISORDER / OFFICE VISIT
OVAO OFFICE VISIT/ALLERGY TREATMENT
OVAT OFFICE VISIT/ALLERGY TESTING
OVBD OFFICE VISIT/BENIGN CHEMOTHERAPY DRUG
OVBO OFFICE VISIT / BONE DENSITY TEST
OVCL OFFICE VISIT/ROUTINE COLORECTAL CANCER SCREENING LAB
OVCO OFFICE VISIT/CONSULTATION OP
OVCT OFFICE VISIT / CAT SCAN
OVCX OFFICE VISIT/ROUTINE COLORECTAL CANCER SCREENING XRAY
Updated: 9/21/2012

PROVISION IDS
OVCY OFFICE VISIT CALENDAR YEAR
OVDE Office Visit/Durable Medical Equipment Purchase - OP
OVDM OFFICE VISIT/DIABETIC MANAGEMENT OUTPATIENT
OVDO OFFICE VISIT/DRUGS - OP
OVDR Office Visit/Durable Medical Equipment Rental - OP
OVDX OFFICE VISIT/DEEP XRAY
OVEK OFFICE VISIT / EKG
OVFO OFFICE VISIT/FUNCTIONAL OCCUPATIONAL THERAPY OP
OVGD OFFICE VISIT / GARDISIL IMMUNIZATION
OVHI OFFICE VISIT/HOME INFUSION
OVHT OFFICE VISIT/HEARING TEST OP
OVIA OFFICE VISIT / IMMUNIZATION ADMINISTRATION FEE
OVIH Office Visit/Inhalation Therapy - OP
OVIJ OFFICE VISIT/INJECTIONS
OVIM OFFICE VISIT/IMMUNIZATION OP
OVIN OFFICE VISIT/INVITRO FERTILIZATION LAB
OVIS OFFICE VISIT
OVJA OFFICE VISIT / INJECTION ADMINISTRATION FEE
OVLH OFFICE VISIT/LAB HANDLING AND/OR CONVEYANCE
OVLO OFFICE VISIT/LAB OP
OVMC OFFICE VISIT/MALIGNANT CHEMOTHERAPY OP
OVMD OFFICE VISIT/MALIGNANT CHEMOTHERAPY DRUGS
OVMG OFFICE VISIT/MAMMOGRAM - DIAGNOSTIC OP
OVMM OFFICE VISIT/MUSCLE MANIPULATION
OVMP OFFICE VISIT/DIAG. MEDICAL PROCEDURE - OP
OVMS OFFICE VISIT/MEDICAL/SURGICAL SUPPLIES OP
OVMT OFFICE VISIT/MECHANO THERAPY - OP
OVNM Non-Serious Mental Illness Office Visit
OVOL OFFICE VISIT / OVARIAN CANCER SCREENING LAB
OVOP OFFICE VISIT - BILLED WITH PLACE OF TREATMENT 2
OVOS Office Visit/Orthotics - OP
OVOV OFFICE VISIT/OFFICE VISIT
OVOX OFFICE VISIT / OVARIAN CANCER SCREENING XRAY
OVPA OFFICE VISIT/PATHOLOGY OP
OVPC OFFICE VISIT/PREVENTIVE CARE
OVPE OFFICE VISIT / PET SCAN
OVPG OFFICE VISIT/CONTRACEPTIVE DRUGS
OVPR OFFICE VISIT/PROSTATE SPECIFIC ANTIGEN TESTS-OP
OVPS OFFICE VISIT/PAP SMEAR OP
OVPT OFFICE VISIT/MEDICAL PROCEDURE - THERAPEUTIC OP
OVPX OFFICE VISIT/PHYSICAL HISTORY OP
OVRD OFFICE VISIT/ROUTINE DIAG.MEDICAL PROCEDURE
OVRH OFFICE VISIT/ROUTINE LAB HANDLING AND/OR CONVEYANCE
OVRI OFFICE VISIT/RADIOISOTOPE TEST OP
OVRK OFFICE VISIT / ROUTINE EKG
OVRL OFFICE VISIT/ROUTINE LABORATORY TEST
OVRM OFFICE VISIT/ROUTINE MAMMOGRAM
OVRP OFFICE VISIT/ROUTINE PAP SMEAR
OVRX OFFICE VISIT/ROUTINE XRAY TEST
OVSA OFFICE VISIT/ROUTINE PROSTATE SPECIFIC ANTIGEN (PSA) TEST
OVSM Serious Mental Illness Office Visit
OVSO OFFICE VISIT/SURGERY - OP
Updated: 9/21/2012

PROVISION IDS
OVSR SURGERY RELATED TO AN OFFICE VISIT
OVST OFFICE VISIT/SPEECH THERAPY-OP
OVTI ORTHOPTIC / VISION THERAPY - IP
OVTO ORTHOPTIC / VISION THERAPY - OP
OVVD OFFICE VISIT / DIAGNOSTIC VISION TESTING
OVVP OFFICE VISIT/VISION CARE PROGRAM
OVVT OFFICE VISIT/VISION TEST OP
OVXO OFFICE VISIT/XRAY - OP
PAPI PAP SMEAR - IP
PAPO PAP SMEAR - OP
PASS OVERNIGHT PASS ROOM AND BOARD
PAT PRE-ADMISSION TESTING
PCI PASTORAL COUNSELING INDIVIDUAL - IP
PCIG PASTORAL COUNSELING GROUP INPATIENT
PCO PASTORAL COUNSELING INDIVIDUAL - OP
PCOG PASTORAL COUNSELING GROUP OUTPATIENT
PETI PET (POSITRON EMISSION TOMOGRAPHY) SCAN - IP
PETO PET (POSITRON EMISSION TOMOGRAPHY) SCAN - OP
PFCI MEDICARE PROFESSIONAL COMPONENTS - IP
PFCO MEDICARE PROFESSIONAL COMPONENTS - OP
PHI PARTIAL HOSPITALIZATION (INTENSIVE)
PLAI PLASMA - IP
PLAO PLASMA - OP
PMFI PHARMACY MISCELLANEOUS FEE - IP
PMFO PHARMACY MISCELLANEOUS FEE - OP
PMTI PHYSICAL / MECHANO THERAPY - IP
PMTO PHYSICAL / MECHANO THERAPY - OP
POCO PODIATRY/CONSULTATION OP
PODI PODIATRIC SURGERY - IP
PODO PODIATRIC SURGERY - OP
PODX PODIATRY/DRUGS - OP
POIJ PODIATRY/INJECTIONS
POIS PODIATRIC SURGERY IP - SPECIAL LEVEL
POLO PODIATRY/LAB OP
POMP PODIATRY/DIAG. MEDICAL PROCEDURE - OP
POMS PODIATRY/MEDICAL/SURGICAL SUPPLIES OP
POOS PODIATRIC SURGERY OP - SPECIAL LEVEL
POOV PODIATRY/OFFICE VISIT
POPA PODIATRY/PATHOLOGY OP
POPX PODIATRY/PHYSICAL HISTORY OP
PORD PODIATRY/ROUTINE DIAG.MEDICAL PROCEDURE
PORE PODIATRY/RELATED
PORL PODIATRY/ROUTINE LABORATORY TEST
PORX PODIATRY/ROUTINE XRAY TEST
POXO PODIATRY/XRAY - OP
PPFI PATHOLOGY PROFESSIONAL FEE - IP
PPFO PATHOLOGY PROFESSIONAL FEE - OP
PRAI PROSTHETICS - IP
PRAO PROSTHETICS - OP
PRCC 213D - PREVENTIVE CARE - COVERED
PRCN 213D - PREVENTIVE CARE - NON-COVERED
PREA PREVENTIVE DENTAL CARE
Updated: 9/21/2012

PROVISION IDS
PREB PREVENTIVE DENTAL INITIAL EXAM
PREC PREVENTIVE DENTAL PERIODIC EXAM
PRED PREVENTIVE DENTAL PROPHYLAXIS
PREE PREVENTIVE DENTAL FLUORIDE
PREF PREVENTIVE DENTAL MISCELLANEOUS
PREG DENTAL SPACE MAINTAINERS
PREH PREVENTIVE DENTAL XRAYS
PREI TEMMPROMANDIBULAR JOINT SERVICES
PREX PROSTHETIC EXCEPTION COVERAGE
PRHI HUMAN HAIR WIG
PRHO HUMAN HAIR WIG
PRIA PRIMARY DENTAL CARE
PRIB ENDONTICS ROOT CANAL
PRIC PERIODONTIC CARE
PRID PERIODONTIC GUM TREATMENT
PRIE PERIODONTAL FULL MOUTH SCALING
PRIF PERIODONTAL QUADRANT SCALING
PRIG PERIODONTAL INITIAL EXAM
PRII PRIMARY DENTAL CARE MISCELLANEOUS
PRIJ DENTAL ORAL SURGERY ROUTINE
PRIK DENTAL ORAL SURGERY COMPLEX
PRIL DENTAL ORAL SURGERY MISCELLANEOUS
PRIM INELIGIBLE DENTAL SERVICES
PRIN RESTORATIVE DENTAL CARE
PRIO DENTAL ANESTHESIA
PRMC 213D - PREMIUMS - COVERED
PRMN 213D - PREMIUMS - NON-COVERED
PRSI SYNTHETIC HAIR WIG
PRSM LENSES WITH PRISMS
PRSO SYNTHETIC HAIR WIG
PRVC PREVENTIVE CARE
PSAI PROSTATE SPECIFIC ANTIGEN TESTS - IP
PSAO PROSTATE SPECIFIC ANTIGEN TESTS - OUTPATIENT
PSCO PROSTATE SPECIFIC ANTIGEN TEST/CONSULTATION
PSI PSYCHOLOGICAL TESTING - IP
PSIS PSYCHOLOGICAL TESTING IP - SECONDARY LEVEL
PSO PSYCHOLOGICAL TESTING - OP
PSOV PROSTATE SPECIFIC ANTIGEN TEST/OFFICE VISIT
PSPX PROSTATE SPECIFIC ANTIGEN/PHYSICAL HISTORY
PSRE PROSTATE SPECIFIC ANTIGEN/RELATED
PSYA PSYCHIATRIC ADMISSION IP SPECIAL APPROVAL
PSYB PSYCHIATRIC SERVICES OP - SPECIAL APPROVAL
PSYI PSYCHIATRIC ADMISSION - IP
PSYJ PSYCH ADMISSION - IP SECONDARY LEVEL
PSYO PSYCHIATRIC SERVICES - OP
PSYP PSYCHIATRIC SERVICES OP SECONDARY LEVEL
PTAT PHYSICAL THERAPY/ALLERGY TREATMENT
PTCO PHYSICAL THERAPY/CONSULTATION OP
PTDO PHYSICAL THERAPY/DRUGS - OP
PTEC 213D - PROCEDURES/TREATMENTS/EQUIP/PSYCH/PREV - COVERED
PTEN 213D - PROCEDURES/TREATMENTS/EQUIP/PSYCH/PREV - NON-COVERED
PTI PATHOLOGY - IP
Updated: 9/21/2012

PROVISION IDS
PTIJ PHYSICAL THERAPY/INJECTIONS
PTIM PHYSICAL THERAPY/IMMUNIZATION OP
PTLO PHYSICAL THERAPY/LAB OP
PTMC PHYSICAL THERAPY/MALIGNANT CHEMO
PTMP PHYSICAL THERAPY/DIAG. MEDICAL PROCEDURE - OP
PTMS PHYSICAL THERAPY/MEDICAL/SURGICAL SUPPLIES OP
PTO PATHOLOGY - OP
PTOV PHYSICAL THERAPY/OFFICE VISIT
PTPH PHYSICAL THERAPY/PHYSICAL HISTORY OP
PTPO PHYSICAL THERAPY/PODIATRY SURGERY
PTRE PHYSICAL THERAPY RELATED SERVICE
PTRI PHYSICAL REHAB PROGRAM - IP
PTRL PHYSICAL THERAPY/ROUTINE LABORATORY TEST
PTRO PHYSICAL REHAB PROGRAM - OP
PTRP PHYSICAL THERAPY/ROUTINE DIAG.MEDICAL PROCEDURE
PTRX PHYSICAL THERAPY/ROUTINE XRAY TEST
PTSR PHYSICAL THERAPY/SURGERY
PTVT PHYSICAL THERAPY/VISION TEST OP
PTXO PHYSICAL THERAPY/XRAY - OP
PVIM PREVENTIVE CARE - IMMUNIZATION
PVPR PREVENTIVE CARE - ROUTINE
PVPS PREVENTIVE CARE - PROSTATE SPECIFIC ANTIGEN TESTS - OUTPATIENT
PVPX PREVENTIVE CARE - PHYSICAL HISTORY
PVRC PREVENTIVE CARE - CHEST XRAY - OP
PVRD PREVENTIVE CARE - ROUTINE DIAG. MEDICAL PROCEDURE
PVRL PREVENTIVE CARE - ROUTINE LABORATORY TEST
PVRM PREVENTIVE CARE - ROUTINE MAMMOGRAM
PVRP PREVENTIVE CARE - ROUTINE PAP SMEAR
PVRX PREVENTIVE CARE - ROUTINE XRAY TEST
PVTA PRIVATE R AND B - ALL PRIVATE HOSPITAL
PVTR PRIVATE ROOM AND BOARD
PVVC PREVENTIVE CARE - VISION CARE PROGRAM - OP
PVWB PREVENTIVE CARE WELL BABY OP
PXAL PHYSICAL EXAM/PHYSICAL ALLERGY TEST
PXAT PHYSICAL EXAM/ALLERGY TREATMENT
PXCL PHYSICAL EXAM/ROUTINE COLORECTAL CANCER SCREENING LAB
PXCO PHYSICAL EXAM/CONSULTATION OP
PXCX PHYSICAL EXAM/ROUTINE COLORECTAL CANCER SCREENING XRAY
PXDE Physical History/Durable Medical Equipment Purchase - OP
PXDO PHYSICAL EXAM/DRUGS - OP
PXDR Physical History/Durable Medical Equipment Rental - OP
PXEK ROUTINE PHYSICAL EXAM / EKG
PXGD PHYSICAL EXAM / GARDISIL IMMUNIZATION
PXH PORTABLE XRAY - HOME
PXHT PHYSICAL EXAM/HEARING THERAPY
PXI PHYSICAL EXAM IP
PXIA PHYSICAL EXAM / IMMUNIZATION ADMINISTRATION FEE
PXIH Physical History/Inhalation Therapy - OP
PXIJ PHYSICAL EXAM/INJECTIONS
PXIM PHYSICAL EXAM/IMMUNIZATION OP
PXLH PHYSICAL EXAM/LAB HANDLING AND/OR CONVEYANCE
PXLO PHYSICAL EXAM/LAB OP
Updated: 9/21/2012

PROVISION IDS
PXMC PHYSICAL EXAM/MALIGNANT CHEMO
PXMM PHYSICAL EXAM/MAMMOGRAM - DIAGNOSTIC OP
PXMP PHYSICAL EXAM/DIAG. MEDICAL PROCEDURE - OP
PXMS PHYSICAL EXAM/MEDICAL/SURGICAL SUPPLIES OP
PXMT Physical History/ Medical Procedure Therapeutic - OP
PXO PHYSICAL EXAM OP (Routine)
PXOL PHYSICAL EXAM / OVARIAN CANCER SCREENING LAB
PXOP ROUTINE OFFICE VISIT - BILLED WITH PLACE OF TREATMENT 2
PXOS Physical History/Orthotics - OP
PXOV PHYSICAL EXAM/OFFICE VISIT
PXOX PHYSICAL EXAM / OVARIAN CANCER SCREENING XRAY
PXPA PHYSICAL EXAM/PATHOLOGY OP
PXPC PHYSICAL EXAM/PREVENTIVE CARE
PXPG PHYSICAL EXAM/CONTRACTIVE DRUGS
PXPR PHYSICAL EXAM/PROSTATE SPECIFIC ANTIGEN TESTS-OP
PXPS PHYSICAL EXAM/PAP SMEAR OP
PXR PORTABLE XRAY - HOSPITAL
PXRB PHYSICAL EXAM / ROUTINE BONE DENSITY
PXRD PHYSICAL EXAM/ROUTINE DIAG.MEDICAL PROCEDURE
PXRE PHYSICAL EXAM/PHYSICAL HISTORY OP
PXRH PHYSICAL EXAM/ROUTINE LAB HANDLING AND/OR CONVEYANCE
PXRI Physical History/Radioisotope Test - OP
PXRK ROUTINE PHYSICAL EXAM / ROUTINE EKG
PXRL PHYSICAL EXAM/ROUTINE LABORATORY TEST
PXRM PHYSICAL EXAM/ROUTINE MAMMOGRAM
PXRP PHYSICAL EXAM/ROUTINE PAP SMEAR
PXRS PHYSICAL EXAM / ROUTINE SLEEP STUDY
PXRX PHYSICAL EXAM/ROUTINE XRAY TEST
PXSA PHYSICAL EXAM/ROUTINE PROSTATE SPECIFIC ANTIGEN (PSA) TEST
PXSP Physical History/Speech Therapy - OP
PXVP PHYSICAL EXAM/VISION CARE PROGRAM
PXVT PHYSICAL EXAM/VISION TEST OP
PXXY PHYSICAL EXAM/XRAY - OP
PYT PSYCHIC TESTING
RAMA ROUTINE MAMMOGRAM ADD-ON
RBAC REGULAR BIFOCAL LENS ACQUISITION
RBDS REGULAR BIFOCAL LENS DISPENSING
RBIF REPLACEMENT BIFOCAL VISION LENS
RBOD Routine Bone Density
RBRE ROUTINE CLINICAL BREAST EXAM
RCAN ROUTINE COLONOSCOPY ANESTHESIA
RCCS ROUTINE COLORECTAL CANCER SCREENING SURGERY
RCLA ROUTINE COLORECTAL CANCER SCREENING LAB
RCNT REPLACEMENT CONTACT LENS
RCPT ROUTINE COLONOSCOPY PATHOLOGY
RCXI CHEST XRAY - IP
RCXO CHEST XRAY - OP
RCXR ROUTINE COLORECTAL CANCER SCREENING XRAY
RDG DIAGNOSIS RELATED GROUPS (DRG)
RDM REPLACEMENT DURABLE MEDICAL EQUIPMENT
RDMP ROUTINE DIAG. MEDICAL PROCEDURE
RDRG RADIATION THERAPY / DRUGS
Updated: 9/21/2012

PROVISION IDS
REHB REHABILITATION ROOM AND BOARD
REIN REINSURANCE H.M.O.I.
REKG ROUTINE EKG
RENT REPLACEMENT LENTICULAR LENS
REXI REFLEXOLOGY, IP
REXO REFLEXOLOGY, OP
RFCI ROUTINE FOOT CARE, INPATIENT
RFCO ROUTINE FOOT CARE, OUTPATIENT
RHBT MEDICAL REHABILITATION DAY PROGRAM
RII RADIOISOTOPE TEST - IP
RIO RADIOISOTOPE TEST - OP
RITI RADIOISOTOPE THERAPY - IP
RITO RADIOISOTOPE THERAPY - OP
RLAB ROUTINE LABORATORY TEST
RLBH HANDLING AND/OR CONVEYANCE OF ROUTINE LAB
RLED REGULAR SINGLE LENSES DISPENSING FEE
RLEN REGULAR SINGLE LENSES ACQUISITION
RMAM ROUTINE MAMMOGRAM
RMAA ALTERNATE PROVISION FOR ROUTINE MAMMOGRAM ADD-ON
RMCO RADIOISOTOPE MATERIAL/CONSULTATION
RMOV RADIOISOTOPE MATERIAL/OFFICE VISIT
RMPX RADIOISOTOPE MATERIAL/PHYSICAL HISTORY
RMSI RADIOISOTOPE MATERIAL / SUPPLIES - IP
RMSO RADIOISOTOPE MATERIAL / SUPPLIES - OP
RMSS RADIATION THERAPY / MEDICAL SURGICAL SUPPLIES
ROAC 213D - PREVIOUS CARRIER HCA RUN-OUT - COVERED - 213HC - GROUPING 13
ROAN 213D - PREVIOUS CARRIER HCA RUN-OUT - NON COVERED 213HN - GROUP 13
RRIO RADIATION THERAPY / RADIOISOTOPE TEST
RPAI REPLACEMENT PROSTHETIC - ACCIDENT IP
RPAO REPLACEMENT PROSTHETIC - ACCIDENT OP
RPAP ROUTINE PAP SMEAR
RPCI REPLACEMENT PROSTHETIC - CHILD IP
RPCN ROUTINE PAP SMEAR CONSULTATION
RPCO REPLACEMENT PROSTHETIC - CHILD OP
RPDL ROUTINE PAP SMEAR LAB
RPEX ROUTINE PAP SMEAR PHYSICAL EXAM
RPFI RADIOLOGY PROFESSIONAL FEE - IP
RPFO RADIOLOGY PROFESSIONAL FEE - OP
RPMI REPLACEMENT PROSTHETIC MEDICAL CND - IP
RPMO REPLACEMENT PROSTHETIC MEDICAL CND - OP
RPNV ROUTINE PRE-NATAL VISIT - OP
RPOF ROUTINE PAP SMEAR OFFICE VISIT
RPOK ROUTINE PROCTOSCOPY (NO BIOPSY)
RPOV ROUTINE POST-NATAL VISIT - OP
RPRL ROUTINE PAP SMEAR ROUTINE LAB
RPSA ROUTINE PROSTATE CANCER SCREENING PSA TEST
RPTO REHABILITATIVE PHYSICAL THERAPY
RRIO RADIATION THERAPY / RADIOISOTOPE TEST
RRTI RADIUM/RADON THERAPY - IP
RRTO RADIUM/RADON THERAPY - OP
RSMV RADIATION THERAPY / SPECIAL MEDICAL VISITS
RSLP ROUTINE SLEEP STUDY
Updated: 9/21/2012

PROVISION IDS
RSNG REPLACEMENT SINGLE VISION LENS
RSPT RESPITE CARE ROOM AND BOARD
RTAC REGULAR TRIFOCAL LENS ACQUISITION
RTCO RADIATION THERAPY / CONSULTATION
RTDM RADIATION THERAPY / DIAGNOSTIC MEDICAL PROCEDURE
RTDS REGULAR TRIFOCAL LENS DISPENSING
RTF RESIDENTIAL TREATMENT FACILITY
RTHV RADIATION THERAPY / HOSPITAL VISIT OP
RTIN RADIATION THERAPY / INJECTION
RTLA RADIATION THERAPY / LAB
RTMP RADIATION THERAPY / MEDICAL PROCEDURE THERAPEUTIC
RTMS RADIATION THERAPY / MEDICAL SURGICAL SUPPLIES
RTOV RADIATION THERAPY / OFFICE VISIT
RTPA RADIATION THERAPY / PAP SMEAR
RTPI RADIATION THERAPY TREATMENT PLANNING - IP
RTPO RADIATION THERAPY TREATMENT PLANNING - OP
RTPT RADIATION THERAPY / PATHOLOGY
RTRI REPLACEMENT TRIFOCAL VISION LENS
RTXR RADIATION THERAPY / XRAY
RVTO ROUTINE VISION TEST
RXGN PRESCRIPTION DRUGS GENERIC
RXHI DRUGS TAKEN HOME INPATIENT
RXHO DRUGS TAKEN HOME OUTPATIENT
RXMN PRESCRIPTION DRUGS MAINTENANCE
RXRY ROUTINE XRAY TEST
SAC SUPPLEMENTAL ACCIDENT
SAIJ SELF ADMINISTERED SPECIALTY DRUGS
SANS SPECIAL ANESTHESIA
SASO SPECIAL ASSISTANT SURGERY
SBAC SPECIAL BIFOCAL LENS ACQUISITION
SBAM SPECIAL OP BLOOD ADMINISTRATION
SBDS SPECIAL BIFOCAL LENS DISPENSING
SBLD SPECIAL OP BLOOD
SBPR SPECIAL OP BLOOD PROCESSING
SCON SPECIAL OP CONSULTATION
SCPC 213D - SMOKING CESSATION - COVERED - 213SC - GROUPING 12
SCPN 213D - SMOKING CESSATION - NON COVERED - 213SN - GROUPING 12
SCSO SURGERY RELATED SERVICES
SDIO SPECIAL DIALYSIS-OP
SDMP SPECIAL OP DIAG MED PROCEDURE
SEC SPECIAL OP EMERGENCY CARE
SECF SPECIAL OP EMERGENCY FOLLOW UP
SHIN SHINGLES VACCINE
SHMO SPECIAL TREATMENT ROOM
SHVD SURGERY RELATED IP MEDICAL VISIT
SICK SPECIAL ILL BABY CARE
SIH SPECIAL OP INHALATION THERAPY
SINJ SPECIAL OP INJECTIONS
SLAB SPECIAL OP LABORATORY
SLED SPECIAL SINGLE LENS DISPENSING FEE
SLEN SPECIAL SINGLE LENSES ACQUISITION
SLPI SLEEP STUDY, IP
Updated: 9/21/2012

PROVISION IDS
SLPO SLEEP STUDY, OP
SLV SUPERVISED LIVING
SMC SUPPLEMENTAL EMERGENCY MEDICAL CARE
SMCH Serious Mental Illness Outpatient Family Counseling - Child
SMEH Serious Mental Illness Outpatient Electroshock Therapy
SMES Serious Mental Illness Office Electroshock Therapy
SMFA Serious Mental Illness Office Family Counseling - Adult
SMFC Serious Mental Illness Office Family Counseling - Child
SMFH Serious Mental Illness Outpatient Family Counseling - Adult
SMGH Serious Mental Illness Outpatient Group Psychotherapy
SMGO Serious Mental Illness Office Group Psychotherapy
SMHH Serious Mental Illness Outpatient Hypnotherapy
SMHO Serious Mental Illness Office Hypnotherapy
SMIH Serious Mental Illness Outpatient Individual Psychotherapy
SMIO Serious Mental Illness Office Individual Psychotherapy
SMIS STERILIZATION NECESSARY IP - SPECIAL LEVEL
SMNI STERILIZATION MEDICALLY NECESSARY - IP
SMNO STERILIZATION MEDICALLY NECESSARY - OP
SMOK SMOKING CESSATION
SMOS STERILIZATION NECESSARY OP - SPECIAL LEVEL
SMPT SPECIAL OP THERAPEUTIC PROCEDURE
SMRI SUPERFICIAL MALIGNANT RADIUM/RADON THERAPY - IP
SMRO SUPERFICIAL MALIGNANT RADIUM/RADON THERAPY - OP
SMS SPECIAL OP SUPPLIES
SMVI SPECIAL MEDICAL VISITS - IP
SMVO SPECIAL MEDICAL VISITS - OP
SOSI SOCIAL SERVICES INPATIENT
SOSO SOCIAL SERVICES OUTPATIENT
SPAP SPECIAL OP PAP SMEAR
SPHI SURGERY IP PHYSICAL THERAPY
SPHO SURGERY OP PHYSICAL THERAPY
SPRT SPECIAL OP PRE TESTING
SPSM SPEECH THERAPY FOR SERIOUS MENTAL ILLNESS - OP
SPT SPECIAL OP PATHOLOGY
SPTI SPEECH THERAPY - IP
SPTO SPEECH THERAPY - OP
SRAO SURGERY/ALLERGY TESTING OP
SRAT SURGERY/ALLERGY TREATMENT OP
SRCO SURGERY/CONSULTATION OP
SRCT STERILIZATION REVERSAL/CONSULTATION OP
SRDM STERILIZATION REVERSAL/DIAG. MEDICAL PROCEDURE - OP
SRDO SURGERY/DRUGS - OP
SRDP SURGERY/ROUTINE DIAG.MEDICAL PROCEDURE
SRDX STERILIZATION REVERSAL/DRUGS - OP
SRGI SURGERY - IP
SRGO SURGERY - OP
SRIJ SURGERY/INJECTIONS
SRIM SURGERY/IMMUNIZATION OP
SRIN STERILIZATION REVERSAL/INJECTIONS
SRIO SPECIAL OP RADIOISOTOPE TEST
SRIS SURGERY IP - SPECIAL LEVEL
SRLB SURGERY/LAB OP
Updated: 9/21/2012

PROVISION IDS
SRLO STERILIZATION REVERSAL/LAB OP
SRLT STERILIZATION REVERSAL/ROUTINE LABORATORY TEST
SRMC SURGERY/MALIGNANT CHEMOTHERAPY OP
SRMO SURGERY/MAMMOGRAM - DIAGNOSTIC OP
SRMP SURGERY/DIAG. MEDICAL PROCEDURE - OP
SRMS SURGERY/MEDICAL/SURGICAL SUPPLIES OP
SRO SUTURE REMOVAL - OP
SROF STERILIZATION REVERSAL/OFFICE VISIT
SROS SURGERY OP - SPECIAL LEVEL
SROV SURGERY/OFFICE VISIT
SRPA STERILIZATION REVERSAL/PATHOLOGY OP
SRPH SURGERY/PHYSICAL HISTORY OP
SRPO SURGERY/PAP SMEAR OP
SRPR SURGERY/PROSTATE SPECIFIC ANTIGEN TESTS-OUTPATIENT
SRPS STERILIZATION REVERSAL/ROUTINE PAP SMEAR
SRPT SURGERY/PATHOLOGY OP
SRRD STERILIZATION REVERSAL/ROUTINE DIAG.MEDICAL PROCEDURE
SRRL SURGERY/ROUTINE LABORATORY TEST
SRRM SURGERY/ROUTINE MAMMOGRAM
SRRP SURGERY/ROUTINE PAP SMEAR
SRRT STERILIZATION REVERSAL/ROUTINE XRAY TEST
SRRX SPECIAL OP DRUGS
SRSS STERILIZATION REVERSAL/MEDICAL/SURGICAL SUPPLIES OP
SRTO OP FACILITY SERVICES RELATED TO RADIATION THERAPY
SRVO SURGERY/VISION TEST OP
SRXO STERILIZATION REVERSAL/XRAY - OP
SRXT SURGERY/ROUTINE XRAY TEST
SRXY SURGERY/XRAY - OP
SSCI SPECIAL SURGICAL CHARGES - IP
SSCO SPECIAL SURGICAL CHARGES - OP
SSTO SPECIAL SPEECH THERAPY OUTPATIENT
STAC SPECIAL TRIFOCAL LENS ACQUISITION
STDS SPECIAL TRIFOCAL LENS DISPENSING
STI SHOCK THERAPY - IP
STO SHOCK THERAPY - OP
STRF Sterilization Female
STRI STERILIZATION - IP
STRO STERILIZATION - OP
SVIS SURGERY OP VISIT
SXRY SPECIAL OP XRAY
SXTI SUPERFICIAL XRAY THERAPY - IP
SXTO SUPERFICIAL XRAY THERAPY - OP
TABI THERAPEUTIC ABORTION - IP
TABO THERAPEUTIC ABORTION - OP
TAX STATE AND LOCAL SALES TAX
TBV TB VISIT - IP
TCOB TEXAS HMO OUTPATIENT OB SERVICES COPAY
TCOP TEXAS CO-PAY
TCSG TEXAS HMO OUTPATIENT SURGERY COPAY
THDX TEXAS HMO ONLY-NO COPAY APPLIED FOR OP DIAG PROC WITH BIT 143 ON
THMP TEXAS HMO ONLY-NO COPAY APPLIED FOR MED THER PROC WITH BIT 143 ON
THOB TEXAS HMO ONLY-NO COPAY APPLIED FOR OB PROC CODES WITH BIT 143 ON
Updated: 9/21/2012

PROVISION IDS
THSG TEXAS HMO ONLY-NO COPAY APPLIED FOR OP SURGERY WITH BIT 143 ON
TINT LENSES WITH ROSE TINT
TRAN ATCP ORGAN RECIPIENT TRANSPORTATION
UCEA URGENT CARE OP EMERGENCY ACCIDENT
UCEM URGENT CARE OP EMERGENCY MEDICAL
UCOP URGENT CARE OP
VASI Visual Acuity Inpatient
VASO Visual Acuity Outpatient
VCPI VISION CARE PROGRAM - IP
VCPO VISION CARE PROGRAM - OP
VHDC 213D - VISION/HEARING/DENTAL - COVERED
VHDN 213D - VISION/HEARING/DENTAL - NON-COVERED
VMIS VISION MISCELLANEOUS SERVICES
VOCI VOCATIONAL COUNSELING - IP
VOCO VOCATIONAL COUNSELING - OP
VTAO VISION TESTING/ALLERGY TREATMENT
VTAT VISION TESTING/ ALLERGY TEST
VTCG EYE EXAMINATION FOR CONTACTS / GLASSES
VTCO VISION TESTING/CONSULTATION OP
VTDO VISION TESTING/DRUGS - OP
VTI VISION TEST - IP
VTID VISION TEST DIAGNOSTIC - IP
VTIJ VISION TESTING/INJECTIONS
VTLO VISION TESTING/LAB OP
VTO ROUTINE VISION EXAM - OP
VTOD VISION TEST DIAGNOSTIC - OP
VTOR VISION TEST ROUTINE
VTOV VISION TESTING/OFFICE VISIT
VTPA VISION TESTING/PATHOLOGY OP
VTPO VISION TESTING/PHYSICAL HISTORY OP
VTRE VISION TESTING/VISION TEST OP
VTRL VISION TESTING/ROUTINE LABORATORY TEST
VTRP VISION TESTING/ROUTINE DIAG.MEDICAL PROCEDURE
VTRX VISION TESTING/ROUTINE XRAY TEST
VTSO VISION TESTING/MEDICAL VISION TESTING/SURGICAL SUPPLIES OP
VTXO VISION TESTING/XRAY - OP
VVIS VISION SERVICES WITH OFFICE VISIT
WBAG Well Baby Care/Allergy Testing
WBAT WELL BABY/ALLERGY TREATMENT
WBCO WELL CHILD CARE - OP NEWBORN THRU AGE 11
WBCS WELL BABY/CONSULTATION OP
WBDM Well Baby Care/Durable Medical Equipment Purchase - OP
WBDO WELL BABY/DRUGS - OP
WBDR Well Baby Care/Durable Medical Equipment Rental- OP
WBGD WELL BABY EXAM / GARDISIL IMMUNIZATION
WBHT WELL BABY/HEARING THERAPY
WBIA WELL BABY / IMMUNIZATION ADMINISTRATION FEE
WBIH Well Baby Care/Inhalation Therapy - OP
WBIJ WELL BABY/INJECTIONS
WBIM WELL BABY/IMMUNIZATION OP
WBLO WELL BABY/LAB OP
WBMC WELL BABY/MALIGNANT CHEMO
Updated: 9/21/2012

PROVISION IDS
WBMP WELL BABY/DIAG. MEDICAL PROCEDURE - OP
WBMS WELL BABY/MEDICAL/SURGICAL SUPPLIES OP
WBOS Well Baby Care/Orthotics - OP
WBOV WELL BABY/OFFICE VISIT
WBPC WELL BABY/PREVENTIVE CARE
WBPH WELL BABY/PHYSICAL HISTORY OP
WBPO WELL BABY/PODIATRY SURGERY
WBRE WELL BABY/RELATED SERVICE
WBRH WELL BABY EXAM / ROUTINE LAB HANDLING
WBRL WELL BABY/ROUTINE LABORATORY TEST
WBRP WELL BABY/ROUTINE DIAG.MEDICAL PROCEDURE
WBRX WELL BABY/ROUTINE XRAY TEST
WBSP Well Baby Care/Speech Therapy
WBTO Well Baby Care/Medical Procedure Therapeutic - OP
WBVP WELL BABY/VISION CARE PROGRAM
WBVT WELL BABY/VISION TEST OP
WBXO WELL BABY/XRAY - OP
WIGS SCALP PROSTHESIS
WLPC 213D - WEIGHT LOSS PROGRAM - COVERED - 213JC - GROUPING 11
WLPN 213D - WEIGHT LOSS PROGRAM - NON COVERED - 213JN - GROUPING 11
WTI HYDROTHERAPY - IP
WTO HYDROTHERAPY - OP
WVAL WELL GYNE VISIT / ALLERGY TESTING
WVAT WELL GYNE VISIT / ALLERGY TREATMENT
WVDO WELL GYNE VISIT / DRUGS OP
WVEK WELL GYNE VISIT / EKG
WVIJ WELL GYNE VISIT / INJECTION
WVIM WELL GYNE VISIT / IMMUNIZATION
WVIS WELLNESS VISIT FOR RPAP AND RMAM
WVLO WELL GYNE VISIT / LAB OP
WVMC WELL GYNE VISIT / MALIGNANT CHEMOTHERAPY
WVMM WELL GYNE VISIT / MAMMOGRAM
WVMP WELL GYNE VISIT / DIAGNOSTIC MEDICAL PROCEDURE
WVMS WELL GYNE VISIT / MEDICAL SURGICAL SUPPLIES
WVPA WELL GYNE VISIT / PATHOLOGY
WVPS WELL GYNE VISIT / PAP SMEAR
WVRD WELL GYNE VISIT / ROUTINE DIAGNOSTIC MEDICAL PROCEDURE
WVRK WELL GYNE VISIT / ROUTINE EKG
WVRL WELL GYNE VISIT / ROUTINE LAB
WVRM WELL GYNE VISIT / ROUTINE MAMMOGRAM
WVRP WELL GYNE VISIT / ROUTINE PAP SMEAR
WVRX WELL GYNE VISIT / ROUTINE XRAY
WVXY WELL GYNE VISIT / XRAY OP
XRYF XRAY SERVICES OP RELATED TO FOCUS PROCEDURES
XRYI XRAY - IP
XRYM XRAY MISCELLANEOUS
XRYO XRAY - OP
Updated: 9/21/2012

Updated: 9/21/2012
PROVISION IDS