DME
MAC Jurisdiction C Site LinksApril 1, 2008
Healthcare Provider Taxonomy Codes (HPTC) Update April 2008
Under HIPAA, code sets that characterize a general administrative situation, rather than a medical condition or service, are referred to as non-clinical or non- medical code sets. The Healthcare Provider Taxonomy Codes (HPTC) is an external non-medical data code set designed for use in classifying health care providers according to provider type or practitioner specialty in an electronic environment, specifically within the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) health care transaction.
The HPTC is maintained by the National Uniform Claim Committee (NUCC) or standardized classification of health care providers. The NUCC updates the code set twice a year with changes effective April 1 and October 1. Visit the Washington Publishing Company website (http://www.wpc-edi.com/codes/taxonomy) for additional HPTC information and the HPTC code list, which is available in two forms:
- A free Adobe PDF download or
- An electronic representation of the list which will facilitate automatic loading of the code set. This version is available for purchase.
The HPTC is not required. However, if a HPTC is submitted it must be valid data from that code set. The HPTC is a named code set in the 837 professional implementation guide, thus carriers must validate the inbound taxonomy codes against their internal HPTC tables.
Terminated HPTC are not approved
for use after a specific date and newly approved codes are not approved for
use prior to the effective date of the code set update in which each new code
first appears.
Specialty and/or provider type codes issued by any entity other than the NUCC
are not valid and Medicare would be guilty of non-compliance with HIPAA if
Medicare contractors accepted claims that contain invalid HPTC. Taxonomy code
changes are applied to claims processed on and after the effective date of
the code set.
Although the NUCC generally posts their updates on the WPC Web page 3 months prior to the effective date, changes are not effective until April 1 or October 1 as indicated in each update.
Code changes that are effective April 1, 2008 are noted in the table below:
TYPE OF CHANGE |
PROVIDER TAXONOMY VALUE CODE |
|---|---|
Additions |
111NP0017X 173C00000X 173F00000X 1835P0018X 253J00000X |
Revisions |
207ND0101X 207NS0135X 2084A0401X 2086X0206X 2086S0127X |
