Condition Codes 90 and 91 Approved for Professional Claims Use, Effective Immediately

January 19, 2021

The NUCC has approved the use of Condition Codes 90 and 91 for immediate use on the 1500 Claim Form and in the 837 Professional as follows:

90 - Service provided as part of an Expanded Access (EA) approval
91 - Service provided as part of an Emergency Use Authorization (EUA)

The Centers for Medicare & Medicaid Services (CMS) recently released MLN Matters MM12049 on the use of these Condition Codes for Medicare claims effective February 1, 2021.

The complete list of Condition Codes available for use in the professional claim is available on the Condition Codes page under the Code Sets tab.

Updates Released to Provider Taxonomy and Provider Characteristics Code Sets

January 4, 2021

The NUCC has released the semi-annual updates to the Health Care Provider Taxonomy and Provider Characteristics code sets. The changes to both code sets go into effect on April 1, 2021, with one exception. Provider Characteristic code 6K “This provider offers a vaccine for COVID-19” went into effect on January 1, 2021.

Web pages with the list of new and modified codes for both code sets are available from the Code Sets drop down menu. The complete Provider Taxonomy code set is available at: www.nucc.org/taxonomy. The complete Provider Characteristics code set is available at: https://www.nucc.org/index.php/code-sets-mainmenu-41/provider-characteristics-mainmenu-39.

1500 Claim Form Renewed by OMB

October 21, 2020

The Office of Management and Budget (OMB) has completed its review and renewed the 1500 claim form for use by government programs, most notably Medicare. The form has been renewed in its current format, with no changes to the OMB number, data fields, or other text on the form.

Forms with the 02/12 NUCC approval date and OMB number 0938-1197 (02-12) remain in effect and valid.

The renewal of the 1500 claim form by OMB occurs every three years and is outside the scope of the NUCC's work.

Display Names Added to Taxonomy Code Set Look-up Tool

September 17, 2020

The Health Care Provider Taxonomy look-up tool has recently been updated to format that is easier to navigate. The left-hand side of the page is an expandable list that includes an introduction and help page. The codes are presented within the hierarchical three Levels and the list can be expanded or collapsed. Clicking on a code brings up its details on the right-hand side of the page, including the new display name, definition, and effective date. The display name has been added to give a more consumer-friendly, but still accurate, name for the code.

The new display names will be added to the CSV file in the January 2021 release of the code set.

2020 Annual 1500 Instruction Manual Released

July 1, 2020

The NUCC has released its annual, updated version of its 1500 Health Insurance Claim Form Reference Instruction Manual. The updated instruction manual, Version 8.0 7/20, goes into effect immediately and is available under the 1500 Claim Form tab.

No changes were made since the Version 6.0 7/18 manual was released. A change log is available on the 1500 Instructions page and states that no changes were made to the manual during the previous year. Any interim changes, clarifications, or corrections to the instructions following this release will be posted on the NUCC website.

For more information on the 1500 Health Insurance Claim Form Reference Instruction Manual, email This email address is being protected from spambots. You need JavaScript enabled to view it..

Do NOT email, fax, or mail completed 1500 Claim Forms to the NUCC. The NUCC does not process claims. Send completed forms to the appropriate payer.

NUCC Approves Use of Condition Code DR for Professional Claims for COVID-19 Related Claims, Effective Immediately

March 24, 2020

The NUCC has approved the use of Condition Code “DR – Disaster Related” effective immediately for COVID-19 related claims on the 1500 Claim Form and in the 837 Professional. The codes available for use for COVID-19 related claims are:

Condition Code DR - Disaster related; Reported at the claim level in Item Number 10d
Modifier CR - Catastrophe/disaster related; Reported at the service line level in Item Number 24D

The Centers for Medicare & Medicaid Services (CMS) recently released MLN Matters SE20011 on the use of Condition Code DR and Modifier CR for COVID-19 related Medicare claims. For Medicare, Condition Code DR is reported only in the institutional claim (electronic ASC X12 837I or paper UB-04). The NUCC has approved the use of Condition Code DR in the professional claim (electronic ASC X12 837P or paper 1500) due to the business need by other payers to identify COVID-19 related claims, as it can be used to trigger internal payer steps or processing of claims (e.g. a different routing of the claim for processing).

The complete list of Condition Codes available for use in the professional claim is available on the Condition Codes page under the Code Sets tab.

New Provider Characteristics Code for COVID-19 Testing, Effective 4/1/20

March 23, 2020

The NUCC has released a new Health Care Provider Characteristics code to identify providers offering COVID-19 testing. The new code will go into effect out-of-cycle on April 1, 2020. The new code is "6J - This provider offers testing for COVID-19."

The complete code set is available under the "Code Sets" tab.

Questions about the DSMO Process?

The Designated Standards Maintenance Organizations (DSMO) have created a presentation "Understanding the HIPAA Processes" to provide information on the HIPAA transactions, code sets, and operating rules processes under HIPAA. The presentation was developed to satisfy an industry need to have in one concise document the process of how to request changes to HIPAA mandated standards.

The presentation is available here: DSMO: Understanding the HIPAA Process

The DSMO includes three American National Standards Institute (ANSI) Accredited standard development organizations ‐ Accredited Standards Committee (ASC) X12, Health Level Seven (HL7) International, and the National Council for Prescription Drug Programs (NCPDP), and three data content organizations ‐ the American Dental Association (ADA) Dental Content Committee (DeCC), National Uniform Billing Committee (NUBC), and National Uniform Claim Committee (NUCC). The DSMO reviews change requests to the HIPAA designated standards and requests for new standards and code sets to be adopted.

Resources for Implementing the 02/12 1500 Claim Form

Payers may begin accepting the 02/12 1500 Claim Form as of January 6, 2014. The following resources will assist your organization in implementing the revised form:

Submitters of the form should follow up with their specific payer(s) regarding their transition timeline information.

Who Are We?

The National Uniform Claim Committee (NUCC) is a voluntary organization that replaced the Uniform Claim Form Task Force in 1995. The committee was created to develop a standardized data set for use by the non-institutional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare and Medicaid Services (CMS) as a critical partner. The committee is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.

The NUCC was formally named in the administrative simplification section of the HIPAA of 1996 as one of the organizations to be consulted by the American National Standards Institute's accredited SDOs and the Secretary of HHS as they develop, adopt, or modify national standards for health care transactions. As such, the NUCC is intended to have an authoritative voice regarding national standard content and data definitions for non-institutional health care claims in the United States. The NUCC's recommendations in this area are explicitly designed to complement and expedite the work of the Accredited Standards Committee Electronic Data Interchange (ASC X12N) in complying with the provisions of P.L. 104-191.

The NUCC is comprised of the key parties affected by health care electronic data interchange (EDI) - those at either end of a health care transaction, generally payers and providers. Criteria for membership include a national scope and representation of a unique constituency affected by health care EDI, with an emphasis on maintaining or enhancing the provider/payer balance. Each committee member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Representatives are responsible for communicating information between the committee and the group(s) they represent.