field 19 edits 19... · 2019-11-05 · 10. service authorization exception code example: “exc...
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PROPRIETARY AND CONFIDENTIAL | 1
F i e l d 1 9 E d i t s
Field 19 on the CMS-1500 form is reserved for local use. MDOL has created formats for its Print Image and Link1500
customers to use in Field 19 to report information that does not have a field available on the CMS 1500 form. Enter the information into Field 19 exactly as it is shown inside the quotation marks. Format requirements are also
noted.
Indicators are case and space sensitive. It is important that the information be placed in the order it appears below (i.e.,
X-ray, Initial TX date, Date last seen by referring MD, Nature of Condition, etc.). If you do not need any piece of information
on any given claim, simply skip it. Please contact the MDOL Customer Service Department at (888) 499-5465, ext.3503
with any additional questions.
Data requirements for personal injury /auto accident and worker’s compensation claims may differ. Please review the
“Personal Injury /Auto Accident and Worker’s Compensation Companion Guide” available in the Support Documents
section.
PLEASE NOTE: First time additions of any format to field 19 should be reviewed by MDOL to determine if scanner
adjustments are necessary. Make any additions, submit your claims, and then immediately contact MDOL Customer
Support at (888) 499-5465, ext. 3503 for assistance. 1. X-Ray Date
EXAMPLE: “XRAY 01-30-2006” or “XRAY 01-30-06” FORMAT: (XRAY MM-DD-CCYY or XRAY MM-DD-YY)
2. Initial Treatment Date
EXAMPLE: “INIT 01-30-2006” or “INIT 01-30-06” FORMAT: (INIT MM-DD-CCYY or INIT MM-DD-YY)
3. Date last seen by Referring Doctor
EXAMPLE: “DATE LAST 01-30-2006” or “DATE LAST 01-30-06”
FORMAT: (DATE LAST MM-DD-CCYY or DATE LAST MM-DD-YY)
4. Nature of Condition Codes
A – Acute Condition
C – Chronic Condition
D – Non-Acute
E – Non-Life Threatening
EXAMPLE: “COND C”
F – Routine
G – Symptomatic
M – Acute Manifestation of a Chronic Condition
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*When using Code A or M, you must include the date the symptom(s) were first presented. EXAMPLE: “COND A 01-30-2006” or,”COND A 01-30-06” FORMAT: (COND A MM-DD-CCYY or COND A MM-DD-YY)
5. Supervising Provider EXAMPLE: “SUPER: NPI, FIRST NAME, LAST NAME” or
EXAMPLE: “SUPER: SAME” (Note: This will copy the data in CMS-1500 fields 17/17b to the Supervising Provider fields)
6. Ordering Provider
EXAMPLE: “ORDP: NPI, LAST NAME, FIRST NAME”
7. Purchased Service Provider
EXAMPLE: “ORDP: NPI, LAST NAME, FIRST NAME PHONE NUMBER”
8. Remarks (Maximum 80 Characters) – Used to report short notes required on the claim. Note: If the note is
specific to only 1 line item, it should be reported in the line item notes, not in field 19.
EXAMPLE: “REMARKS” OR “RMKS” then the text.
9. RX Date – Hearing and Vision Prescription Date
EXAMPLE: “RX 01-30-2006” or “RX 01-30-06”
FORMAT: (RX MM-DD-CCYY or RX MM-DD-YY) 10. Service Authorization Exception Code
EXAMPLE: “EXC 7” 1 – Immediate/Urgent Care 2 – Services Rendered in a Retroactive Period 3 – Emergency Care 4 – Client has Temporary Medicaid
5 – Request from County for Second Opinion 6 – Request for Override Pending 7 – Special Handling
11. Delay Reason Code – Used to report why a claim is submitted beyond the payer’s filing limit. Example: “DRC 8”
Delay Codes: 1 – Proof of Eligibility Unknown or Unavailable 2 – Litigation 3 – Authorization Delays 4 – Delay in Certifying Provider 5 – Delay in Supplying Billing Forms 6 – Delay in Delivery of Custom Made Appliances 7 – Third Party Processing Delay
8 – Delay in Eligibility Determination 9 – Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules 10 – Administration Delay in the Prior Approval Process 11 – Other 15 – Natural Disaster
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12. Demo 45 Example: “RMKS DEMO 45” or “RMKS DEMO45”
13. EPSDT Referral
Example: “EPSDT Y AV” or “EPSDT N NU” Yes/No Condition or Response Code (Condition Indicator – enter Y if a referral was given, N if not.) Y = Yes N = No AV - Available – Patient Refused Referral. NU - Not Used *NU must be used if EPSDT N is used. S2 - Under Treatment ST - New Services Requested
14. NDC: NDC Codes must be 11 digits: A 10-digit NDC code is padded with a 'place-holder' (zero or *) by the drug supplier to make it a HIPAA compliant 11-digit NDC code. If your code is 10 digits, please contact your supplier for the valid 11-digit code. If your code contains an asterisk (*), please replace that with a zero (0). Visit the FDA website for more information and a link to search the National Drug Code Directory: http://www.fda.gov/cder/ndc/database/docs/queryndclbl.htm NOTE: If an NDC number is used, then the Drug Dosage must also be present
Units of Measurement may be: F2 International Unit GR Gram ME Milligram ML Milliliter UN Unit
Example (Field 19): “NDC 12345678910 NDP 20 ME” (Links to any line item charge whose code begins with a J) Example (Field 24): “NDC 12345678910 NDP 20 ME” (Links only to the line item the comment is on)
15. DATE LAST WORKED
Example: “DLW 01-30-2006” or “DLW 01-30-06” FORMAT: (DLW MM-DD-CCYY or DLW MM-DD-YY)
16. NPI: BILLING, RENDERING, REFERRING & FACILITY
Example: “NRF 1234567890 NFC 0987654321” NBL ########## (Billing NPI) NRD ########## (Rendering NPI) NRF ########## (Referring NPI) NFC ########## (Facility NPI)
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17. CLAIM SUPPLEMENTAL INFORMATION (Paperwork) – Used to report when additional information is available in support of a specific claim Example: “PWK P5 EM 12345678911” or “PWK DG EL 78945612378”
Paperwork Codes:
03 – Report Justifying Treatment Utilization Guidelines 04 – Drugs Administered 05 – Treatment Diagnosis 06 – Initial Assessment 07 – Functional Goals 08 – Plan of Treatment 09 – Progress Reports 10 – Continued Treatment 11 – Chemical Analysis 13 – Certified Test Report 15 – Justification for Admission 21 – Recovery Plan A3 – Allergies/Sensitivities Document A4 – Autopsy Report AM – Ambulance Certification AS – Admission Summary B2 – Prescription B3 – Physician Order B4 – Referral Form BR – Benchmark Testing Results BS – Baseline BT – Blanket Test Results CB – Chiropractic Justification
CK – Consent Form(s) CT – Certification D2 – Drug Profile Document DA – Dental Models DB – Durable Medical Equipment Prescription DG – Diagnostic Report DJ – Discharge Monitoring Report DS – Discharge Summary EB – Explanation of Benefits HC – Health Certificate HR – Health Clinic Records I5 – Immunization Record IR – State School Immunization Records LA – Laboratory Results M1 – Medical Record Attachment MT – Models NN – Nursing Notes OB – Operative Note OC – Oxygen Content Averaging Report OD – Orders and Treatments Document
OE – Objective Physical Examination (including Vital Signs) Document OX – Oxygen Therapy Certification OZ – Support Data for Claim P4 – Pathology Report P5 – Patient Medical History Document PE – Parenteral or Enteral Certification PN – Physical Therapy Notes PO – Prosthetics or Orthotic Certification PY – Physician’s Report PZ – Physical Therapy Certification RB – Radiology Films RR – Radiology Reports RT – Report of Tests and Analysis Report RX – Renewable Oxygen Content Averaging Report SG – Symptoms Document V5 – Death Notification XP – Photographs
Report Transmission Code:
AA = Available on Request at Provider site BM = By Mail EL = electronically only
EM = Email FX = by fax
Identification Code:
Use attachment control number
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18. AMBULANCE CERTIFICATION Example: “AMB R C 12345 Y 05 RTR Brief reason for round trip (if needed) STR Brief reason for stretcher (if needed)" Example: “AMB <Transport Code> <Transport Reason Code> <Transport Distance> <Condition or Response Code> <Condition Indicator(s)> <Round Trip Purpose Description> <Stretcher Purpose Description>” Ambulance Transport Code (Indicates type of transport)
I - Initial Trip R - Return Trip T - Transfer Trip X - Round Trip * Must include Round Trip Purpose Description if X *
Ambulance Transport Reason Code A - Patient was transported to nearest facility for care of symptoms, complaints or both. Can be used to indicate that patient was transported to a residential facility. B - Patient was transported for the benefit of a preferred physician C - Patient was transported for the nearness of family members D - Patient was transported for the care of a specialist or for availability of specialized equipment. E - Patient transferred to Rehabilitation Facility
Quantity (Transport Distance in Miles) Yes/No Condition or Response Code (Condition Indicator – enter Y if the Condition Indicator applies, N if it does not apply) Y - Yes N - No
Condition Indicator(s) REQUIRED - if more than one; enter all with no spaces (ex: 010509) 01 - Patient was admitted to hospital 04 - Patient was moved by stretcher 05 - Patient was unconscious or in shock 06 - Patient was transported in an emergency situation 07 - Patient had to be physically restrained 08 - Patient has visible hemorrhaging 09 - Ambulance service was medically necessary 12 - Patient was confined to a bed or a chair
Round Trip Purpose Description (Free-form text – Required if Ambulance Transport Code = X)
Stretcher Purpose Description (Free-form text – Required if Condition Indicator = 04)
Pick Up and Drop Off Locations. Require the use of the “Extra Screens” (see item 29) 19. CORRECTED/VOID CLAIM SUBMITTAL *** do not use for Medicare – claims will be rejected ***
Example Corrected: “CRTD 123456789” Example Void: “VOID 123456789” In examples above, 123456789 is the original claim number as assigned by the carrier (not the MD On-Line claim ID number).
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20. CARE PLAN OVERSIGHT SERVICES Example: “HHA 19-7260”
In field 23 on the CMS-1500 form, input “HHA” followed by the Care Plan Oversight Authorization Number. If also entering a CLIA number in field 23, place the CLIA information first, followed by the Care Plan Oversight information.
21. MEASUREMENT/TEST RESULT
Example: “TR R2 33.8” Example (multiple measurements): “TR R1 9.1 TR R2 27.4” Format: <MeasurementIdentifier> <MeasurementQualifier> <MeasurementValue> NOTE: This data will attach to all ‘J’ codes on the claim. See below for valid Identifiers & Qualifiers.
Measurement Identifier OG Original; Starting dosage TR Test Results Measurement Qualifier HT Height R1 Hemoglobin R2 Hematocrit R3 Epoetin Starting Dosage R4 Creatin
Measurement Value (the value of the measurement)
22. P A R T – for Chiropractors billing Medicare - Incomplete Physical Exam Information
Example: “RMKS RT” * At least 2 letters required – one must be A or R * Use P, A, R, and T (P) Pain/tenderness evaluated in terms of location, quality, and intensity; (A) Asymmetry/misalignment identified on a sectional or segmental level; (R) Range of motion abnormality (changes in active, passive, and accessory joint movements resulting in an increase or decrease of sectional or segmental mobility); and (T) Tissue, tone changes in the characteristics of continuous or associated soft tissues, including skin, fascia, muscle, and ligament; At least TWO are required, one must be A or R
23. REFERRAL/AUTHORIZATION NUMBER
Referral Number Example: “REFERRAL: 123456” Prior Authorization Number Example: “XPA:123456789012345678” Note: Referral Number in field 19 requires that you also enter the name and NPI of the Referring Provider in fields 17 and 17b. Prior Authorization numbers can be reported in Field 23 unless they exceed 14 characters in length.
24. Mammography FDA Certification Number Example: “FDA 123456” Required when mammography services are rendered by a certified mammography provider.
25. Anesthesia Time
Example: “TIME 40 BEG 1100 END 1140” Data in Field 19: Links to first charge line Data in Field 24: Links to charge line the comment is on.
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26. Billing Provider Taxonomy (Specialty) Code Example: “BTX 261QM0801X” NOTE: Rendering Provider Taxonomy Code (Loop 2310B PRV01 = PE) is based on specialty code on file: WebLink - My Account>Manage Providers
Link1500 - Maintenance>Physician/Organization
27. Assumed and Relinquished Care Dates (Medicare global surgery/shared post-op care)
Example/Format: “D090 MMDDYY D091 MMDDYY” D090 = Start/Assumed Care Date D091 = End/Relinquished Care Date
28. UNSPECIFIED CPT and HCPCS codes Procedure and Drug codes that are classified as “Unspecified”, “Miscellaneous”, etc. require an additional description identifying more specifics related to the charge.
Field 19, Claim Specific: “SV description of unclassified code”
Enter “SV” then the description of the unclassified code. The data will be linked to every line item on the claim that contains a HCPCS code beginning with J.
Example: “SV Injection triamcinolone acetonide, not otherwise specified, 10 mg”
Field 19, Line Specific: “SV# Description”
The # should be replaced with the line item number that the description should be linked to.
Enter “SV”, the line # to which this description applies, then the description of the unclassified code. The data will be linked to specified line item on the claim.
Example: “SV4 Injection triamcinolone acetonide, not otherwise specified, 10 mg”
Field 24, Line Specific:
Example: “SV Description”
The data will be linked to the line item the comment is attached to.
Note: Descriptions cannot exceed 80 positions (including spaces) in length.
29. EXTRA Data If your data does not fit in field 19, simply type the word ‘EXTRA’ in field 19. When you transmit your claim, an extra page will open on the site with options to enter data for that claim. Example: “EXTRA”
30. Hospice Employee Indicator
Required on Medicare claims involving physician services to Hospice patients (POS 34) Y –
Indicates the provider is an employee of the Hospice
N – Indicates the provider is not an employee of the Hospice
Example: “HEI Y”
31. Last Menstrual Period and Pregnancy Indicator Example: “LMP 04-18-2013 Y” Format: LMP MM-DD-CCYY Y
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32. Universal Product Numbers Field 19 Example:”UPN2 UP 185211000015 CTP 10.00 1 ML”, attaches the information to the 2nd line item. Field 24 Example: “UPN UP 185211000015 CTP 10.00 1 ML” in the comments section for the line item. Format: UPN UP 185211000015 CTP 10.00 1 ML
33. EKG Tracings or Lab Specimen Collections by an Independent Lab To report when an Independent Lab is collecting lab specimens or performing EKG tracings on a home bound patient. Note: 75 Is the only reportable option at this time. Example: “HB 75” Format: HB 75
34. C linical Trial Number To Report the National Clinical Trial Number on a claim.
Field 19 Example : “NCT 999999999” or "NCT CT99999999" Clinical trial numbers must be 8 digits
Format: NCT 12345678 or NCT CT12345678
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Field 19 - Personal Injury /Auto Accident and Worker’s Compensation Companion Guide Billing Provider Phone Number EXAMPLE: “BPPH 8881234567” FORMAT: (BPPH Billing provider phone – no dash or space) Attending Provider Reference ID EXAMPLE: “APRID CA12345” FORMAT: (APRID State License Number) Service Facility Secondary Identification EXAMPLE: “SFSI 8765432” FORMAT: (SFSI DOL’s assigned OWCP Number) Billing Provider Suffix – (credential / degree) EXAMPLE: “BPSUF AOM) FORMAT: (BPSF REQUIRED PROVIDER CREDENTIAL VALUE) – see table below
Billing Provider Reference ID (Provider’s State License Number) EXAMPLE: “BPRID NJ12345” FORMAT: (BPRID State License Number) Rendering Provider Suffix EXAMPLE: “RPSUF AOM) FORMAT: (RPSUF REQUIRED PROVIDER CREDENTIAL VALUE) – see table below
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Rendering Provider Reference ID EXAMPLE: “RPRID NJ12345” FORMAT: (RPRID State License Number) Service Facility Secondary Identification DOL’s assigned OWCP Number EXAMPLE: “SFSID USA12345” FORMAT: (SFSID DOL’s assigned OWCP Number) ADDITIONAL DATA REQUIREMENTS FOR NY WC BILLS Note enrollment on the NY WCB site is required prior to claim submission. See Appendix A for registration info. REQUIRED: If used, required fields must all be submitted Required for providers who are NY WCB-Authorized if submitter does not utilize Carisk user interface, and/or does not wish to complete Carerisk’s furnished template of required provider details prior to submission. File Information Category EXAMPLE: “K3101 D1” Format: (K3101 D1) WCB Authorization Number EXAMPLE: “K3102 7777777” FORMATL (K3012 WCB Auth Number) WCB Rating Code EXAMPLE: “K3013 AL” FORMATL (K3013 WCB RATING CODE). See Appendix B for codes. Must be UPPER CASE only OPTIONAL: If used, all optional fields must be submitted File Information Category. Optional for NY WC submitters who wish to send NY WCB Case Number EXAMPLE: “OP3101 P1” FORMAT: (OP3101 P1) WCB Case Number EXAMPLE: “OP3103 44444” FORMAT: (OP3101 WCB Case number)
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Appendix A
NEW YORK WORKER’S COMPENSATION BOARD (NY WCB) PROVIDER REGISTRATION
INSTRUCTIONS
This registration and legal agreement execution are required to be completed by all providers who
submit professional NY WC claims electronically to the NY WCB.
This is the direct link to the NY WCB registration form:
https://www.wcb.ny.gov/OnlineRegistration/onreg_xmlparticipant_confirmation.jsp
Fill out the registration form and submit. It is strongly suggested that you use an administrator email
address instead of the Doctors’. All communication will be through this email address.
Once the registration has been submitted, the Worker’s Compensation Board will process the
registration verifying the information. If there are any problems with the registration it will be
communicated to you through the email in the registration.
When the registration has been verified and processed, an email will be sent to the email address in
the registration with instruction on how to proceed, and an attached Legal Agreement that will need
to be filled out, signed, notarized and returned hard copy to the mailing address in the instructions.
When the Legal Agreement hard copy has been received by the WCB, it will be processed, and an
email will be sent to the email address in the registration confirming the registration has been
completed, and instruction to submit forms.
You MUST submit claims with the assigned WCB authorization# provided in the email -or- enter
it into the provider’s profile in the CIC account.
The WCB tries to process all registrations and returned Legal Agreements within 48 hours on average.
(There will be times when personnel are on vacation that registration and legal agreements may take
longer to process)
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APPENDIX B – NY WCB RATING CODES
WCB Rating Code Description
AL ALLERGY/IMMUNOLOGY
AL-DLI DIAGNOSTIC LABORATORY IMMUNOLOGY
AN ANESTHESIOLOGY
AN-CCM ANESTHESIOLOGY - CRITICAL CARE
MEDICINE
AN-PM ANESTHESIOLOGY - PAIN MANAGEMENT
CAL ALLERGY/IMMUNOLOGY
CAL-DLI DIAGNOSTIC LABORATORY IMMUNOLOGY
CAN ANESTHESIOLOGY
CAN-CCM ANESTHESIOLOGY - CRITICAL CARE
MEDICINE
CAN-PM ANESTHESIOLOGY - PAIN MANAGEMENT
CCRS COLON/RECTAL SURGERY
CD DERMATOLOGY
CD-DI DERMATOLOGICAL IMMUNITY/DIAGNOSTIC
CD-DP DERMATOLOGICAL PATHOLOGY
CEM EMERGENCY MEDICINE
PROPRIETARY AND CONFIDENTIAL | 13
WCB Rating Code Description
CFP FAMILY PRACTICE
CFP-GM FAMILY PRACTICE - GERIATRIC MEDICINE
CIM INTERNAL MEDICINE
CIM-CCM INTERNAL MEDICINE - CRITICAL CARE
CIM-CD INTERNAL MEDICINE - CARDIOLOGY
CIM-CE INTERNAL MEDICINE - CARDIAC
ELECTROPHYS.
CIM-CVD INTERNAL MEDICINE - CARDIOVASCULAR
CIM-DL INTERNAL MEDICINE - DIAGNOSTIC
IMMUNOLOGY
CIM-END INTERNAL MEDICINE - ENDOCRINOLOGY
CIM-GE INTERNAL MEDICINE - GASTROENTEROLOGY
CIM-GM INTERNAL MEDICINE - GERIATIC MEDICINE
CIM-HEM INTERNAL MEDICINE - HEMATOLOGY
CIM-ID INTERNAL MEDICINE - INFECTIOUS DISEASES
CIM-NEPH INTERNAL MEDICINE - NEPHROLOGY
CIM-ONCL INTERNAL MEDICINE - MEDICAL ONCOLOGY
CIM-PD INTERNAL MEDICINE - PULMONARY
DISEASES
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WCB Rating Code Description
CIM-RHE INTERNAL MEDICINE - RHEUMATOLOGY
CNS NEUROLOGICAL SURGERY
CNS-CCM NEUROLOGICAL SURGERY - CRITICAL CARE
CNUM NUCLEAR MEDICINE
CNUM-NR NUCLEAR MEDICINE - NUCLEAR RADIOLOGY
CNUM-RP NUCLEAR MEDICINE - RADIOISOTOPIC
CO OPTHALMOLOGY
COG OBSTETRICS/GYNECOLOGY
COG-CCM OBSTETRICS/GYNECOLOGY - CRITICAL CARE
COG-MFM MATERNAL/FETAL MEDICINE
COG-ONC GYNECOLOGIC ONCOLOGY
COG-RE REPRODUCTIVE ENDOCRINOLOGY
COL OTOLARYNGOLOGY
COS ORTHOPEDIC SURGERY
COS-HS ORTHOPEDIC SURGERY - HAND SURGERY
CP PEDIATRICS
CP-CCM PEDIATRICS - CRITICAL CARE MEDICINE
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WCB Rating Code Description
CP-CD PEDIATRICS - CARDIOLOGY
CP-DL PEDIATRICS - DIAGNOSTIC IMMUNOLOGY
CP-END PEDIATRICS - ENDOCRINOLOGY
CP-GE PEDIATRICS - GASTROENTEROLOGY
CP-NEPH PEDIATRICS - NEPHROLOGY
CP-NPER PEDIATRICS - NEONATAL-PERINATAL
MEDICINE
CP-PHO PEDIATRICS - HEMATOLOGY/ONCOLOGY
CP-PUL PEDIATRICS - PULMONOLOGY
CPA PATHOLOGY
CPA-AP PATHOLOGY - ANATOMIC PATHOLOGY
CPA-BB PATHOLOGY - BLOOD BANKING
CPA-CB PATHOLOGY - CLINICAL BACTERIOLOGY
CPA-CC PATHOLOGY - CLINICAL CHEMISTRY
CPA-CLP PATHOLOGY - CLINICAL PATHOLOGY
CPA-CM PATHOLOGY - CLINICAL MICROBIOLOGY
CPA-CP PATHOLOGY - CHEMICAL PATHOLOGY
CPA-CY PATHOLOGY - CYTOPATHOLOGY
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WCB Rating Code Description
CPA-DP PATHOLOGY - DERMATOPATHOLOGY
CPA-FOP PATHOLOGY - FORENSIC PATHOLOGY
CPA-HEM PATHOLOGY - HEMATOLOGY
CPA-IP PATHOLOGY - IMMUNOLOGY
CPA-MC PATHOLOGY - MEDICAL CHEMISTRY
CPA-MMB PATHOLOGY - MEDICAL MICROBIOLOGY
CPA-NP PATHOLOGY - NEUROPATHOLOGY
CPA-PA PATHOLOGY - PATHOLGIC ANATOMY
CPA-RP PATHOLOGY - RADIOISOTOPIC
CPM PREVENTIVE MEDICINE
CPM-AM PREVENTIVE MEDICINE - AEROSPACE
MEDICINE
CPM-GPM GENERAL PREVENTIVE MEDICINE
CPM-OM OCCUPATIONAL MEDICINE
CPM-PH PREVENTIVE MEDICINE - PUBLIC HEALTH
CPMR PHYSICAL MEDICINE/REHABILITATION
CPN PSYCHIATRY/NEUROLOGY
CPN-CHN CHILD NEUROLOGY
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WCB Rating Code Description
CPN-CHP CHILD PSYCHIATRY
CPN-N NEUROLOGY
CPN-P PSYCHIATRY
CPS PLASTIC SURGERY
CPS-HS PLASTIC SURGERY - HAND SURGERY
CR RADIOLOGY
CR-DRA RADIOLOGY - DIAGNOSTIC RADIOLOGY
CR-DRNR DIAGNOSTIC RADIOLOGY/NUCLEAR
MEDICINE
CR-DRO RADIOLOGY - DIAGNOSTIC
ROENTGENOLOGY
CR-DRP DIAGNOSTIC RADIOLOGICAL PHYSICS
CR-MNP RADIOLOGY - MEDICAL NUCLEAR PHYSICS
CR-R RADIOLOGY - RADIOLOGY
CR-RAO RADIOLOGY - RADIOLOGICAL ONCOLOGY
CR-RO RADIOLOGY - ROENTGENOLOGY
CR-RP RADIOLOGY - RADIOLOGICAL PHYSICS
CR-RT RADIOLOGY - RADIUM THERAPY
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WCB Rating Code Description
CR-TRA RADIOLOGY - THERAPEUTIC RADIOLOGY
CR-TRP THERAPEUTIC RADIOLOGICAL PHYSICS
CRS COLON/RECTAL SURGERY
CS SURGERY
CS-GVS SURGERY - GENERAL VASCULAR SURGERY
CS-HS SURGERY - HAND SURGERY
CS-PDS SURGERY - PEDIATRIC SURGERY
CS-SCC SURGERY - SURGICAL CRITICAL CARE
CTS THORACIC SURGERY
CU UROLOGY
D DERMATOLOGY
D-DI DERMATOLOGICAL IMMUNITY/DIAGNOSTIC
D-DP DERMATOLOGICAL PATHOLOGY
DC CHIROPRACTIC
DPM PODIATRY
EM EMERGENCY MEDICINE
FP FAMILY PRACTICE
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WCB Rating Code Description
FP-GM FAMILY PRACTICE - GERIATRIC MEDICINE
GP GENERAL PRACTICE
IM INTERNAL MEDICINE
IM-CCM INTERNAL MEDICINE - CRITICAL CARE
IM-CD INTERNAL MEDICINE - CARDIOLOGY
IM-CE INTERNAL MEDICINE - CARDIAC
ELECTROPHYS.
IM-CVD INTERNAL MEDICINE - CARDIOVASCULAR
IM-DL INTERNAL MEDICINE - DIAGNOSTIC
IMMUNOLOGY
IM-END INTERNAL MEDICINE - ENDOCRINOLOGY
IM-GE INTERNAL MEDICINE - GASTROENTEROLOGY
IM-GM INTERNAL MEDICINE - GERIATIC MEDICINE
IM-HEM INTERNAL MEDICINE - HEMATOLOGY
IM-ID INTERNAL MEDICINE - INFECTIOUS DISEASES
IM-NEPH INTERNAL MEDICINE - NEPHROLOGY
IM-ONCL INTERNAL MEDICINE - MEDICAL ONCOLOGY
IM-PD INTERNAL MEDICINE - PULMONARY
DISEASES
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WCB Rating Code Description
IM-RHE INTERNAL MEDICINE - RHEUMATOLOGY
NS NEUROLOGICAL SURGERY
NS-CCM NEUROLOGICAL SURGERY - CRITICAL CARE
NUM NUCLEAR MEDICINE
NUM-NR NUCLEAR MEDICINE - NUCLEAR RADIOLOGY
NUM-RP NUCLEAR MEDICINE - RADIOISOTOPIC
O OPTHALMOLOGY
OG OBSTETRICS/GYNECOLOGY
OG-CCM OBSTETRICS/GYNECOLOGY - CRITICAL CARE
OG-MFM MATERNAL/FETAL MEDICINE
OG-ONC GYNECOLOGIC ONCOLOGY
OG-RE REPRODUCTIVE ENDOCRINOLOGY
OL OTOLARYNGOLOGY
OPAL ALLERGY/IMMUNOLOGY
OPAL-DLI DIAGNOSTIC LABORATORY IMMUNOLOGY
OPAN ANESTHESIOLOGY
OPAN-CCM ANESTHESIOLOGY - CRITICAL CARE
MEDICINE
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WCB Rating Code Description
OPAN-PM ANESTHESIOLOGY - PAIN MANAGEMENT
OPCAL ALLERGY/IMMUNOLOGY
OPCAL-DLI DIAGNOSTIC LABORATORY IMMUNOLOGY
OPCAN ANESTHESIOLOGY
OPCAN-CCM ANESTHESIOLOGY - CRITICAL CARE
MEDICINE
OPCAN-PM ANESTHESIOLOGY - PAIN MANAGEMENT
OPCCRS COLON/RECTAL SURGERY
OPCD DERMATOLOGY
OPCD-DI DERMATOLOGICAL IMMUNITY/DIAGNOSTIC
OPCD-DP DERMATOLOGICAL PATHOLOGY
OPCEM EMERGENCY MEDICINE
OPCFP FAMILY PRACTICE
OPCFP-GM FAMILY PRACTICE - GERIATRIC MEDICINE
OPCIM INTERNAL MEDICINE
OPCIM-CCM INTERNAL MEDICINE - CRITICAL CARE
OPCIM-CD INTERNAL MEDICINE - CARDIOLOGY
OPCIM-CE INTERNAL MEDICINE - CARDIAC ELECTROPHYS.
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WCB Rating Code Description
OPCIM-CVD INTERNAL MEDICINE - CARDIOVASCULAR
OPCIM-DL INTERNAL MEDICINE - DIAGNOSTIC
IMMUNOLOGY
OPCIM-END INTERNAL MEDICINE - ENDOCRINOLOGY
OPCIM-GE INTERNAL MEDICINE - GASTROENTEROLOGY
OPCIM-GM INTERNAL MEDICINE - GERIATIC MEDICINE
OPCIM-HEM INTERNAL MEDICINE - HEMATOLOGY
OPCIM-ID INTERNAL MEDICINE - INFECTIOUS DISEASES
OPCIM-NEPH INTERNAL MEDICINE - NEPHROLOGY
OPCIM-ONCL INTERNAL MEDICINE - MEDICAL ONCOLOGY
OPCIM-PD INTERNAL MEDICINE - PULMONARY
DISEASES
OPCIM-RHE INTERNAL MEDICINE - RHEUMATOLOGY
OPCNS NEUROLOGICAL SURGERY
OPCNS-CCM NEUROLOGICAL SURGERY - CRITICAL CARE
OPCNUM NUCLEAR MEDICINE
OPCNUM-NR NUCLEAR MEDICINE - NUCLEAR RADIOLOGY
OPCNUM-RP NUCLEAR MEDICINE - RADIOISOTOPIC
PROPRIETARY AND CONFIDENTIAL | 23
WCB Rating Code Description
OPCO OPTHALMOLOGY
OPCOG OBSTETRICS/GYNECOLOGY
OPCOG-CCM OBSTETRICS/GYNECOLOGY - CRITICAL CARE
OPCOG-MFM MATERNAL/FETAL MEDICINE
OPCOG-ONC GYNECOLOGIC ONCOLOGY
OPCOG-RE REPRODUCTIVE ENDOCRINOLOGY
OPCOL OTOLARYNGOLOGY
OPCOS ORTHOPEDIC SURGERY
OPCOS-HS ORTHOPEDIC SURGERY - HAND SURGERY
OPCP PEDIATRICS
OPCP-CCM PEDIATRICS - CRITICAL CARE MEDICINE
OPCP-CD PEDIATRICS - CARDIOLOGY
OPCP-DL PEDIATRICS - DIAGNOSTIC IMMUNOLOGY
OPCP-END PEDIATRICS - ENDOCRINOLOGY
OPCP-GE PEDIATRICS - GASTROENTEROLOGY
OPCP-NEPH PEDIATRICS - NEPHROLOGY
OPCP-NPER PEDIATRICS - NEONATAL-PERINATAL
MEDICINE
24 | PROPRIETARY AND CONFIDENTIAL
WCB Rating Code Description
OPCP-PHO PEDIATRICS - HEMATOLOGY/ONCOLOGY
OPCP-PUL PEDIATRICS - PULMONOLOGY
OPCPA PATHOLOGY
OPCPA-AP PATHOLOGY - ANATOMIC PATHOLOGY
OPCPA-BB PATHOLOGY - BLOOD BANKING
OPCPA-CB PATHOLOGY - CLINICAL BACTERIOLOGY
OPCPA-CC PATHOLOGY - CLINICAL CHEMISTRY
OPCPA-CLP PATHOLOGY - CLINICAL PATHOLOGY
OPCPA-CM PATHOLOGY - CLINICAL MICROBIOLOGY
OPCPA-CP PATHOLOGY - CHEMICAL PATHOLOGY
OPCPA-DP PATHOLOGY - DERMATOPATHOLOGY
OPCPA-FOP PATHOLOGY - FORENSIC PATHOLOGY
OPCPA-HEM PATHOLOGY - HEMATOLOGY
OPCPA-IP PATHOLOGY - IMMUNOLOGY
OPCPA-MC PATHOLOGY - MEDICAL CHEMISTRY
OPCPA-MMB PATHOLOGY - MEDICAL MICROBIOLOGY
OPCPA-NP PATHOLOGY - NEUROPATHOLOGY
PROPRIETARY AND CONFIDENTIAL | 25
WCB Rating Code Description
OPCPA-PA PATHOLOGY - PATHOLGIC ANATOMY
OPCPA-RP PATHOLOGY - RADIOISOTOPIC
OPCPM PREVENTIVE MEDICINE
OPCPM-AM PREVENTIVE MEDICINE - AEROSPACE
MEDICINE
OPCPM-GPM GENERAL PREVENTIVE MEDICINE
OPCPM-OM OCCUPATIONAL MEDICINE
OPCPM-PH PREVENTIVE MEDICINE - PUBLIC HEALTH
OPCPMR PHYSICAL MEDICINE/REHABILITATION
OPCPN PSYCHIATRY/NEUROLOGY
OPCPN-CHN CHILD NEUROLOGY
OPCPN-CHP CHILD PSYCHIATRY
OPCPN-N NEUROLOGY
OPCPN-P PSYCHIATRY
OPCPS PLASTIC SURGERY
OPCPS-HS PLASTIC SURGERY - HAND SURGERY
OPCR RADIOLOGY
OPCR-DRA RADIOLOGY - DIAGNOSTIC RADIOLOGY
26 | PROPRIETARY AND CONFIDENTIAL
WCB Rating Code Description
OPCR-DRNR DIAGNOSTIC RADIOLOGY/NUCLEAR
MEDICINE
OPCR-DRO RADIOLOGY - DIAGNOSTIC
ROENTGENOLOGY
OPCR-DRP DIAGNOSTIC RADIOLOGICAL PHYSICS
OPCR-MNP RADIOLOGY - MEDICAL NUCLEAR PHYSICS
OPCR-R RADIOLOGY - RADIOLOGY
OPCR-RAO RADIOLOGY - RADIOLOGICAL ONCOLOGY
OPCR-RO RADIOLOGY - ROENTGENOLOGY
OPCR-RP RADIOLOGY - RADIOLOGICAL PHYSICS
OPCR-RT RADIOLOGY - RADIUM THERAPY
OPCR-TRA RADIOLOGY - THERAPEUTIC RADIOLOG
OPCR-TRP THERAPEUTIC RADIOLOGICAL PHYSICS
OPCRS COLON/RECTAL SURGERY
OPCS SURGERY
OPCS-GVS SURGERY - GENERAL VASCULAR SURGERY
OPCS-HS SURGERY - HAND SURGERY
OPCS-PDS SURGERY - PEDIATRIC SURGERY
PROPRIETARY AND CONFIDENTIAL | 27
WCB Rating Code Description
OPCS-SCC SURGERY - SURGICAL CRITICAL CARE
OPCTS THORACIC SURGERY
OPCU UROLOGY
OPD DERMATOLOGY
OPD-DI DERMATOLOGICAL IMMUNITY/DIAGNOSTIC
OPD-DP DERMATOLOGICAL PATHOLOGY
OPEM EMERGENCY MEDICINE
OPFP FAMILY PRACTICE
OPFP-GM FAMILY PRACTICE - GERIATRIC MEDICINE
OPGP GENERAL PRACTICE
OPIM INTERNAL MEDICINE
OPIM-CCM INTERNAL MEDICINE - CRITICAL CARE
OPIM-CD INTERNAL MEDICINE - CARDIOLOGY
OPIM-CE INTERNAL MEDICINE - CARDIAC
ELECTROPHYS.
OPIM-CVD INTERNAL MEDICINE - CARDIOVASCULAR
OPIM-DL INTERNAL MEDICINE - DIAGNOSTIC IMMUNOLOGY
OPIM-END INTERNAL MEDICINE - ENDOCRINOLOGY
28 | PROPRIETARY AND CONFIDENTIAL
WCB Rating Code Description
OPIM-GE INTERNAL MEDICINE - GASTROENTEROLOGY
OPIM-GM INTERNAL MEDICINE - GERIATIC MEDICINE
OPIM-HEM INTERNAL MEDICINE - HEMATOLOGY
OPIM-ID INTERNAL MEDICINE - INFECTIOUS DISEASES
OPIM-NEPH INTERNAL MEDICINE - NEPHROLOGY
OPIM-ONCL INTERNAL MEDICINE - MEDICAL ONCOLOGY
OPIM-PD INTERNAL MEDICINE - PULMONARY
DISEASES
OPIM-RHE INTERNAL MEDICINE - RHEUMATOLOGY
OPNS NEUROLOGICAL SURGERY
OPNS-CCM NEUROLOGICAL SURGERY - CRITICAL CARE
OPNUM NUCLEAR MEDICINE
OPNUM-NR NUCLEAR MEDICINE - NUCLEAR RADIOLOGY
OPNUM-RP NUCLEAR MEDICINE - RADIOISOTOPIC
OPO OPTHALMOLOGY
OPOG OBSTETRICS/GYNECOLOGY
OPOG-CCM OBSTETRICS/GYNECOLOGY - CRITICAL CARE
OPOG-MFM MATERNAL/FETAL MEDICINE
PROPRIETARY AND CONFIDENTIAL | 29
WCB Rating Code Description
OPOG-ONC GYNECOLOGIC ONCOLOGY
OPOG-RE REPRODUCTIVE ENDOCRINOLOGY
OPOL OTOLARYNGOLOGY
OPOS ORTHOPEDIC SURGERY
OPOS-HS ORTHOPEDIC SURGERY - HAND SURGERY
OPP PEDIATRICS
OPP-CCM PEDIATRICS - CRITICAL CARE MEDICINE
OPP-CD PEDIATRICS - CARDIOLOGY
OPP-DL PEDIATRICS - DIAGNOSTIC IMMUNOLOGY
OPP-END PEDIATRICS - ENDOCRINOLOGY
OPP-GE PEDIATRICS - GASTROENTEROLOGY
OPP-NEPH PEDIATRICS - NEPHROLOGY
OPP-NPER PEDIATRICS - NEONATAL-PERINATAL
MEDICINE
OPP-PHO PEDIATRICS - HEMATOLOGY/ONCOLOGY
OPP-PUL PEDIATRICS - PULMONOLOGY
OPPA PATHOLOGY
OPPA-AP PATHOLOGY - ANATOMIC PATHOLOGY
30 | PROPRIETARY AND CONFIDENTIAL
WCB Rating Code Description
OPPA-BB PATHOLOGY - BLOOD BANKING
OPPA-CB PATHOLOGY - CLINICAL BACTERIOLOGY
OPPA-CC PATHOLOGY - CLINICAL CHEMISTRY
OPPA-CLP PATHOLOGY - CLINICAL PATHOLOGY
OPPA-CM PATHOLOGY - CLINICAL MICROBIOLOGY
OPPA-CP PATHOLOGY - CHEMICAL PATHOLOGY
OPPA-DP PATHOLOGY - DERMATOPATHOLOGY
OPPA-FOP PATHOLOGY - FORENSIC PATHOLOGY
OPPA-HEM PATHOLOGY - HEMATOLOGY
OPPA-IP PATHOLOGY - IMMUNOLOGY
OPPA-MC PATHOLOGY - MEDICAL CHEMISTRY
OPPA-MMB PATHOLOGY - MEDICAL MICROBIOLOGY
OPPA-NP PATHOLOGY - NEUROPATHOLOGY
OPPA-PA PATHOLOGY - PATHOLGIC ANATOMY
OPPA-RP PATHOLOGY - RADIOISOTOPIC
OPPM PREVENTIVE MEDICINE
OPPM-AM PREVENTIVE MEDICINE - AEROSPACE
MEDICINE
PROPRIETARY AND CONFIDENTIAL | 31
WCB Rating Code Description
OPPM-GPM GENERAL PREVENTIVE MEDICINE
OPPM-OM OCCUPATIONAL MEDICINE
OPPM-PH PREVENTIVE MEDICINE - PUBLIC HEALTH
OPPMR PHYSICAL MEDICINE/REHABILITATION
OPPN PSYCHIATRY/NEUROLOGY
OPPN-CHN CHILD NEUROLOGY
OPPN-CHP CHILD PSYCHIATRY
OPPN-N NEUROLOGY
OPPN-P PSYCHIATRY
OPPS PLASTIC SURGERY
OPPS-HS PLASTIC SURGERY - HAND SURGERY
OPR RADIOLOGY
OPR-DRA RADIOLOGY - DIAGNOSTIC RADIOLOGY
OPR-DRNR DIAGNOSTIC RADIOLOGY/NUCLEAR
MEDICINE
OPR-DRO RADIOLOGY - DIAGNOSTIC
ROENTGENOLOGY
OPR-DRP DIAGNOSTIC RADIOLOGICAL PHYSICS
32 | PROPRIETARY AND CONFIDENTIAL
WCB Rating Code Description
OPR-MNP RADIOLOGY - MEDICAL NUCLEAR PHYSICS
OPR-R RADIOLOGY - RADIOLOGY
OPR-RAO RADIOLOGY - RADIOLOGICAL ONCOLOGY
OPR-RO RADIOLOGY - ROENTGENOLOGY
OPR-RP RADIOLOGY - RADIOLOGICAL PHYSICS
OPR-RT RADIOLOGY - RADIUM THERAPY
OPR-TRA RADIOLOGY - THERAPEUTIC RADIOLOGY
OPR-TRP THERAPEUTIC RADIOLOGICAL PHYSICS
OPS SURGERY
OPS-GVS SURGERY - GENERAL VASCULAR SURGERY
OPS-HS SURGERY - HAND SURGERY
OPS-PDS SURGERY - PEDIATRIC SURGERY
OPS-SCC SURGERY - SURGICAL CRITICAL CARE
OPTS THORACIC SURGERY
OPU UROLOGY
OS ORTHOPEDIC SURGERY
OS-HS ORTHOPEDIC SURGERY - HAND SURGERY
PROPRIETARY AND CONFIDENTIAL | 33
WCB Rating Code Description
P PEDIATRICS
P-CCM PEDIATRICS - CRITICAL CARE MEDICINE
P-CD PEDIATRICS - CARDIOLOGY
P-DL PEDIATRICS - DIAGNOSTIC IMMUNOLOGY
P-END PEDIATRICS - ENDOCRINOLOGY
P-GE PEDIATRICS - GASTROENTEROLOGY
P-NEPH PEDIATRICS - NEPHROLOGY
P-NPER PEDIATRICS - NEONATAL-PERINATAL
MEDICINE
P-PHO PEDIATRICS - HEMATOLOGY/ONCOLOGY
P-PUL PEDIATRICS - PULMONOLOGY
PA PATHOLOGY
PA-AP PATHOLOGY - ANATOMIC PATHOLOGY
PA-BB PATHOLOGY - BLOOD BANKING
PA-CB PATHOLOGY - CLINICAL BACTERIOLOGY
PA-CC PATHOLOGY - CLINICAL CHEMISTRY
PA-CLP PATHOLOGY - CLINICAL PATHOLOGY
PA-CM PATHOLOGY - CLINICAL MICROBIOLOGY
34 | PROPRIETARY AND CONFIDENTIAL
WCB Rating Code Description
PA-CP PATHOLOGY - CHEMICAL PATHOLOGY
PA-CY PATHOLOGY - CYTOPATHOLOGY
PA-DP PATHOLOGY - DERMATOPATHOLOGY
PA-FOP PATHOLOGY - FORENSIC PATHOLOGY
PA-HEM PATHOLOGY - HEMATOLOGY
PA-IP PATHOLOGY - IMMUNOLOGY
PA-MC PATHOLOGY - MEDICAL CHEMISTRY
PA-MMB PATHOLOGY - MEDICAL MICROBIOLOGY
PA-NP PATHOLOGY - NEUROPATHOLOGY
PA-PA PATHOLOGY - PATHOLGIC ANATOMY
PA-RP PATHOLOGY - RADIOISOTOPIC
PM PREVENTIVE MEDICINE
PM-AM PREVENTIVE MEDICINE - AEROSPACE
MEDICINE
PM-GPM GENERAL PREVENTIVE MEDICINE
PM-OM OCCUPATIONAL MEDICINE
PM-PH PREVENTIVE MEDICINE - PUBLIC HEALTH
PMR PHYSICAL MEDICINE/REHABILITATION
PROPRIETARY AND CONFIDENTIAL | 35
WCB Rating Code Description
PN PSYCHIATRY/NEUROLOGY
PN-CHN CHILD NEUROLOGY
PN-CHP CHILD PSYCHIATRY
PN-N NEUROLOGY
PN-P PSYCHIATRY
PS PLASTIC SURGERY
PS-HS PLASTIC SURGERY - HAND SURGERY
PSY PSYCHOLOGY
R RADIOLOGY
R-DRA RADIOLOGY - DIAGNOSTIC RADIOLOGY
R-DRNR DIAGNOSTIC RADIOLOGY/NUCLEAR
MEDICINE
R-DRO RADIOLOGY - DIAGNOSTIC
ROENTGENOLOGY
R-DRP DIAGNOSTIC RADIOLOGICAL PHYSICS
R-MNP RADIOLOGY - MEDICAL NUCLEAR PHYSICS
R-R RADIOLOGY - RADIOLOGY
R-RAO RADIOLOGY - RADIOLOGICAL ONCOLOGY
36 | PROPRIETARY AND CONFIDENTIAL
WCB Rating Code Description
R-RO RADIOLOGY - ROENTGENOLOGY
R-RP RADIOLOGY - RADIOLOGICAL PHYSICS
R-RT RADIOLOGY - RADIUM THERAPY
R-TRA RADIOLOGY - THERAPEUTIC RADIOLOGY
R-TRP THERAPEUTIC RADIOLOGICAL PHYSICS
S SURGERY
S-GVS SURGERY - GENERAL VASCULAR SURGERY
S-HS SURGERY - HAND SURGERY
S-PDS SURGERY - PEDIATRIC SURGERY
S-SCC SURGERY - SURGICAL CRITICAL CARE
TS THORACIC SURGERY
U UROLOGY