Original Effective Date:
04/01/1999
Current Effective Date:
01/01/2015
Please enter the type of service code in Block 24C of the CMS 1500 claim form. (This information is optional.)
| 0 | Whole Blood |
| 1 | Medical Care |
| 2 | Surgery |
| 3 | Consultation |
| 4 | Diagnostic Radiology |
| 5 | Diagnostic Laboratory |
| 6 | Therapeutic Radiology |
| 7 | Anesthesia |
| 8 | Assistant at Surgery |
| 9 | Other Medical Items or Services |
| A | Used DME |
| B | High-Risk Screening Mammography |
| C | Low-Risk Screening Mammography |
| D | Ambulance |
| E | Enteral/Parenteral Nutrients/Supplies |
| F | Ambulatory Surgical Center (Facility Usage for Surgical Services) |
| G | Immunosuppressive Drugs |
| H | Hospice |
| J | Diabetic Shoes |
| K | Hearing Items and Services |
| L | ESRD Supplies |
| M | Monthly Capitation Payment for Dialysis |
| N | Kidney Donor |
| P | Lump Sum Purchase of DME, Prosthetics, Orthotics |
| Q | Vision Items or Services |
| R | Rental of DME |
| S | Surgical Dressings or Other Medical Supplies |
| T | Psychological Therapy |
| U | Occupational Therapy |
| V | Pneumococcal/Flu Vaccine |
| W | Physical Therapy |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |