ࡱ>  bjbj .\ \ 84dnl  ! ,L13(lllllllnp^lY6!!Y6Y6l H(lukukukY6-  lukY6lukukuk 0W[Adukk>l0nlukqkXqukqukY6Y6ukY6Y6Y6Y6Y6llukY6Y6Y6nlY6Y6Y6Y6qY6Y6Y6Y6Y6Y6Y6Y6Y6\ e:  Field: R-2PH-ADJUD-CD R-Reference Number:3018 Two Phase Adjudication Cd Implemented in conjunction with the 2-Phase Adjudication enhancement on a "per client" basis in a multi-client environment. The one-byte indicator will determine whether a specific client will not support 2-Phased Adjudication ("N"), support 2-Phased Adjudication by Plan ("P"), or support 2-Phased Adjudication by Group ("G"). Value Short Long Mnemonic G 2-PHSE-GRP 2-PHASE ADJUD BY GROUP TWO-PHASE-GROUP N 2-PHSE-OFF 2-PHASE ADJUD TURNED OFF TWO-PHASE-OFF P 2-PHSE-PLN 2-PHASE ADJUD BY PLAN TWO-PHASE-PLAN ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ADDL-RESP-MSG-CD R-Reference Number:9081 NCPDP Additional Response Code NCPDP additional response code indicating any additional response messages to be sent to the pharmacy. Value Short Long Mnemonic None No additional message NONE AM AMP Aid Category Message Plan AMP DC DUR Cert DUR Certification DUR-CERT DU DUR DUR DUR FL FF Long Freeform long message FREEFORM-LONG FS FF Short Freeform short message FREEFORM-SHORT ST Stepcare Stepcare message STEPCARE TP TPL TPL Carrier TPL-CARRIER ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ADMIN-SUM-CD R-Reference Number:0075 Admin Invoice summary code Admin Invoice summary code. "S" indicates that summary invoices listing all groups and amount due are produced for each group under the customer. "I" indicates pseudo invoices are created for each individual group under the customer. "C" - create Combined participant eligibility invoice summary reports at the customer level. "N" - Normal Invoices produced without summary reports. Value Short Long Mnemonic No Sumry No Summaries NO-SUMMARY C Cust Sumry Combined Inv Summary by Cust CUSTOMER-INV-SUMRY I Pseudo Inv Pseudo Invoices by Individual PSEUDO-INV N Normal Normal Invoices; no summaries NORMAL-INVOICES S Summry Inv Summary Invoices by Group SUM-INV-GRP-AMT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-AMT-LMT-ACUM-CD R-Reference Number:4971 Amount Limit Accumulation Code Amount Limit Accumulation Code Value Short Long Mnemonic A Edit All Edit All Drug Doses EDIT-ALL-DRUGS C Edit Acute Edit Acute Drugs Only EDIT-ACUTE-DRUGS N No Edit No Edit NO-EDIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-AMT-LMT-CVRG-CD R-Reference Number:7361 Amount Limit Coverage Code Amount Limit Coverage Code Value Short Long Mnemonic F Family Family FAMILY I Individual Individual INDIVIDUAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-AMT-LMT-SPN-CD R-Reference Number:0095 Amount Limit Span Code Amount Limit Span Code Value Short Long Mnemonic D Days Days DAYS M Months Months MONTHS Y Years Years YEARS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-AMT-LMT-STAT-CD R-Reference Number:5902 Amount Limit Status Code Amount Limit Status Code Value Short Long Mnemonic D PL Exceed Plan Limits Exceeded PLAN-LIM-EXCEED N No Edit No Edit NO-EDIT P PA Req Prior Authorization Required PRIOR-AUTH-REQ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ANDA-IND R-Reference Number:0231 Abbreviated New Drug App. Provdied by FDB, Abbreviated New Drug Application will be used to calculate the GPI which is no longer being provided. Value Short Long Mnemonic 0 ANDA No ANDA No ANDA-NO 1 ANDA Yes ANDA Yes ANDA-YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ATTR-TY-CD R-Reference Number:4336 FDB attribute type cd FDB attribute type code - data provided on FDB table RNDCAT0_NDC_ATTRIBUTE. Only some of the attribute types will be stored. The valid values list will include only the attribute type codes that are currently expected to be picked up and stored on RF0110TB. Value Short Long Mnemonic 0048 ReuseAdd Reused NDC Date of Add REUSED-NDC-ADD-DT 0058 COD info Covered Outpatient Drug (COD) COD 0059 CODEffDate Covered Outpatient Drug Eff Dt COD-EFF-DT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-BRND-GENR-CD R-Reference Number:7206 GENERIC BRAND CD GENERIC BRAND CODE Value Short Long Mnemonic SPACES SPACES SPACES B BRAND BRAND NAME DRUG BRAND G GENERIC GENERIC DRUG GENERIC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-BRND-GNRIC-CD R-Reference Number:5294 Branded Generic Code Branded Generic Code Value Short Long Mnemonic A All Brand/Generic - All BRND-GENR-ALL B Brand Brand BRAND-CD G Generic Generic GENERIC-CD ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-BRND-MTHD-CD R-Reference Number:0078 Brand/generic method code Brand/generic method code. Value Short Long Mnemonic D DGPIC Generic Price Date of Change GEN-PRICE-DT-CHG G Generic Generic Indicator GEN-CLASS M GMI Generic Manufacturer Indicator GEN-MANUFACTURER N GNI Generic Named Drug Indicator GEN-NAMED-DRUG P GPI Generic Price Indicator GEN-PRICE S GSI Generic Price Spread Indicator GEN-PRICE-SPREAD T GTI Generic Therapeutic Drug Ind. GEN-THERAPEUTIC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CLM-ADJUD-REJ-CD R-Reference Number:4453 Claim Adjudication Reject Code The NCPDP reject code associated with an exception code. Notify NM MMIS when any change occurs. Value Short Long Mnemonic 01 INV BIN NM INV BIN NUMBER INV-BIN-NUM 02 INV VER INV VERSION NUMBER INV-VERSION-NUM 03 INV TRANS INV TRANSACTION CODE INV-TRANS-CD 04 INV PROCES INV PROCESSOR CONTROL NUM INV-PROCESS-NUM 05 INV PHARM INV PHARMACY NUMBER INV-PHARMACY-NUM 06 INV GROUP INV GROUP NUMBER INV-GROUP 07 INV CARDH INV CARDHOLDER ID INV-CARDHOLDER-ID 08 INV PERSON INV PERSON CODE INV-PERSON-CD 09 INV DOB INV DATE OF BIRTH INV-DATE-OF-BIRTH 10 INV GENDER INV PATIENT GENDER CODE INV-PAT-GENDER-CD 11 INV PT REL INV PATIENT RELATIONSHIP CODE INV-PAT-REL-CD 12 INV LOC INV PATIENT LOCATION INV-PAT-LOC 13 INV OTHER INV OTHER COVERAGE CODE INV-OTH-COV-CD 14 INV EL CLR INV ELIG CLARIFICATION CD INV-ELIG-CLAR-CD 15 INV DATE O INV DATE OF SERVICE INV-DT-OF-SVC 16 INV RX NUM INV RX/SERVICE REF NUMBER INV-RX-NUM 17 INV FILL INV FILL NUMBER INV-FILL-NUM 19 INV DAYS S INV DAYS SUPPLY INV-DAYS-SUPPLY 1C INV SMOKER INV SMOKER/NON-SMOKER CODE INV-SMOKER-CD 1E INV PRES INV PRES LOC CD - not D.0 INV-PRES-LOC 1K INV CTRY M/I PATIENT COUNTRY CODE INV-PAT-COUNTRY-CD 1R Vers Not VERS/RELEASE NOT SUPPORTED VER-NOT-SUPPORTED 1S INV TRAN TRANS CD/TYPE NOT SUPPORTED TRAN-TYPE-NOT-SUPP 1T NV PCN PCN Must Contain Processor/Pay INV-PCN 1U INV TRN CT TRANS COUNT NOT MATCHING INV-TRAN-COUNT 1V NO MULTI MULTIPLE TRANS NOT ALLOWED MULTI-TRAN-INVALID 1W MULT ING MULTIPLE INGRED REQ ON SINGLE MULTI-INGRED-NOT-S 1X VEND CERT VENDOR NOT CERT FOR PROCSR VENDOR-NOT-CERT 1Y CLM SEG RE CLAIM SEGMENT REQUIRED CLAIM-SEG-REQUIRED 1Z CLIN SEG R CLINICAL SEGMENT REQUIRED CLIN-SEG-REQUIRED 20 INV COMPOU INV COMPOUND CODE INV-CPD-CD 201 PtSeg201 Pt Seq not used for Trans PAT-SEG-201 202 INS SEG NA INS SEGMENT NOT USED INS-SEG-NOT-USED 203 CLM SEG NA CLM SEGMENT NOT USED CLM-SEG-NOT-USED 204 PHR SEG N PHARM SEGMENT NOT USED PHRM-PROV-SEG-NOT 205 PRSC SEGN PRESC SEGMENT NOT USED PRES-SEG-NOT-USEDQ 206 COB SEG NA COB SEGMENT NOT USED COB-SEG-NOT-USED 207 WC SEG NA WORKERS CMP SEG NOT USED WC-SEG-NOT-USED 208 DURPPS NA DUR/PPS SEGMENT NOT USED DUR-SEG-NOT-USED 209 PRC SEG NA PRICING SEGMENT NOT USED PRC-SEG-NOT-USED 21 INV SVC ID INV PRODUCT/SERVICE ID INV-PROD-SVC-ID 210 COUP SEGNA COUPON SEG NOT USED COUP-SEG-NOT-USED 211 CMP SEG NA COMPOUND SEG NOT USED CMP-SEG-NOT-USED 212 PA SEG NA PA SEGMENT NOT USED PA-SEG-NOT-USEDQ 213 CLIN SEG N CLIMICAL SEGMENT NOT USED CLIN-SEG-NOT-USED 214 ADD SEG NA ADD DOC SEGMENT NOT USED ADD-DOC-SEG-NOT 215 FAC SEG NA FACILITY SEGMENT NOT USED FAC-SEG-NOT-USED 216 NARR SEG NARRATIVE SEGMENT NOT USED NARR-SEG-NOT-USED 217 PURCH SEG PURSHASE SEG NOT USED PURCH-SEG-NOT-USED 218 SVC PRV NA SERVICE PROV SEG NOT USED SVC-PROV-SEG-NOT 219 PT ID QUAL PATIENT ID QUAL NOT USED PAT-ID-QUAL-NOT 22 INV DAW INV DAW/PROD SELECTION CD INV-DAW-PROD-SEL 220 PAT ID NA PATIENT ID NOT USED PAT-ID-NOT-USED 221 DOB NA DOB NOT USED DOB-NOT-USED 222 PT GNDR NA PATIENT GENDER NOT USED PT-GENDER-NOT-USED 223 PT NAME NA PATIENT FIRST NAME NOT USED PT-FNAME-NOT-USED 224 PT LNAM NA PATIENT LAST NAME NOT USED PT-LNAME-NOT-USED 225 PT ST NA PATIENT STREET ADDR NOT USED PT-ST-ADDR-NOT-USE 226 PT CTY NA PATIENT CITY NOT USED PT-CTY-NOT-USED 227 PT STATE N PATIENET STATE NOT USED PT-STATE-NOT-USED 228 PT ZIP NA PATIENT ZIP CD NOT USED PT-ZIP-NOT-USED 229 PT PHON NA PATIENT PHONE NOT USED PY-PHONE-NOT-USED 23 MISS INGRE MISSING INGRED COST SUBMITTED MISS-ING-CST-SUBM 230 PLACE NA PLACE OF SERVICE NOT USED PLACE-SVC-NOT-USED 231 EMP ID NA EMPLOYER ID NOT USED EMP-ID-NOT-USED 232 SMKR NA SMOKER CODE NOT USED SMOKR-CD-NOT-USED 233 PREG NA PREGNANCY IND NOT USED PREG-IND-NOT-USED 234 PT EMAIL N PATIENT EMAIL NOT USED PT-EMAIL-NOT-USED 235 PT RES NA PATIENT RESIDENCE NOT USED PT-RES-NOT-USED 236 PT ID ST N PATEINT ID STATE NOT USED PT-ID-STATE-NOT 237 CRD FNAM N CRDHLDR FST NAME NOT USED CRD-FNAME-NOT-USED 238 CRDLNAM NA CRDHLDR LST NAME NOT USED CRD-LNAME-NOT-USD 239 HOME PLN N HOME PLAN NOT USED HOME-PLAN-NOT-USED 240 PLN ID NA PLAN ID NOT USED PLAN-ID-NOT-USED 241 ELIG CLR N ELIG CLARIFICATION NOT USED ELIG-CLAR-NOT-USED 242 242 GroupID not used for trans RR-242 243 243 PersonCode not used for trans RR-243 244 244 PatRels Code not used for tran RR-244 245 245 OthPyrBINnot used for trans RR-245 246 246 OthPyrPCNnot used for trans RR-246 247 247 OthPyrCrdId not used for trans RR-247 248 248 OthPyrGroup not used for trans RR-248 249 249 MedigapId not used for trans RR-249 25 INV PRESCR INV PRESCRIBER ID INV-PRES-ID 250 250 Medicaid Ind not used for tran RR-250 251 251 ProvAcptAssgn not used tran RR-251 252 252 CMS PartD fac not for trans RR-252 253 253 MedicaidID not used for trans RR-253 254 254 MedicaidAgcy Num not used RR-254 255 255 AsocPrscSvcRefNum not used RR-255 256 256 AsocPrscSvcRefDt not used RR-256 257 257 ProcModCdCnt not used trans RR-257 258 258 ProcModCode not used trans RR-258 259 259 QtyDisp not used this trans RR-259 26 INV MEAS INV UNIT OF MEASURE INV-UNIT-OF-MEAS 260 260 FillNum not used this trans RR-260 261 261 DaysSupply not used this tran RR-261 262 262 CompCd not used this tran RR-262 263 263 DAWProdSelCd not used this trn RR-263 264 263 DtPrescibed not used this tran RR-264 265 265 Refill Auth not used this tran RR-265 266 266 RX OriginCd not used this tran RR-266 267 267 SubClarifCd Cnt not used tran RR-267 268 268 SubClarifCd not used this tran RR-268 269 269 QtyPresc not used this trans RR-269 270 270 OthCvrgCd not used this trans RR-270 271 271 SPPkg Ind not used this trans RR-271 272 272 OrigPrecs PrdSvcID QLnot trans RR-272 273 273 OrigPrecs Prd Svc ID not trans RR-273 274 274 OrigPrescQty not used this trn RR-274 275 275 Alt Id not used this trans RR-275 276 276 SchedPrescID not for trans RR-276 277 277 Unt Measre not used this trans RR-277 278 278 Lvl of Svc not used this trans RR-278 279 279 PA Type Code not for trans RR-279 28 INV DT RX INV DATE PRESCRIPTION WRITTEN INV-DT-RX-WRITTEN 280 280 PANum Sub not used for trans RR-280 281 281 IntAuth Type Id not for trans RR-281 282 282 IntAuthId not used for trans RR-282 283 283 DIspStatus not used for trans RR-283 284 284 QtyIntendDisp not for trans RR-284 285 285 DaysSplyIntend not for trans RR-285 286 286 DelayRsnCd not used for trans RR-286 287 287 TransRefNum not used for tran RR-287 288 288 PatAsgnInd not used for trans RR-288 289 289 RtofAdmin not used for trans RR-289 29 INV NUM RE INV NUM REFILLS AUTHORIZED INV-NUM-REFILLS 290 290 CompType not use for trans RR-290 291 291 McaidSubrgICN/TCN not used RR-291 292 292 PharmSvcType not used for tran RR-292 293 293 AscPresc/SVcProvId Ql not use RR-293 294 294 AscPresc/SVcProvId not used RR-294 295 295 AscPresc/SVcRefNum Ql not use RR-295 296 296 AscPresc/SVcRefNum not used RR-296 297 297 Time ofSvc not used this trans RR-297 298 298 SalesTransId not used this trn RR-298 299 299 RptPymtType not used this tran RR-299 2A INV MEDIGP INV MEDIGAP INDICATOR INV-MEDIGAP-IND 2B INV MCAID INV MEDICAID INDICATOR INV-MEDICAID-IND 2C INV PREG INV PREGNANCY INDICATOR INV-PREGNANCY-IND 2D INV 361-3D INV PROV ACCEPT ASSGN IND INV-PROV-ACCT-ASGN 2E INV 468-2E INV PRIM CARE PROV ID QUAL INV-PCP-ID-QUAL 2G INV 362-2G INV COMPOUND INGRED MOD CNT INV-CMP-ING-MOD-CT 2H INV 363-2H INV COMPOUND INGRED MOD CD INV-CMP-ING-MOD-CD 2J INV 364-2J INV PRESCRIBER FIRST NAME INV-PRES-FIRST-NAM 2K INV 365-2K INV PRESCRIBER STREET ADDR INV-PRES-STRT-ADDR 2M INV 366-2M INV PRESCRIBER CITY ADDR INV-PRES-CITY-ADDR 2N INV 367-2N INV PRESCRIBER STATE ADDR INV-PRES-STATE-ADR 2P INV 369-2P INV PRESCRIBER ZIP CD INV-PRES-ZIP-CD 2Q INV 369-2Q INV ADDITIONAL DOC TYPE ID INV-ADD-DOC-TY-ID 2R INV 370-2R INV LENGTH OF NEED INV-LENGTH-NEED 2S INV 371-2S INV LENGHT OF NEED QUAL INV-LEN-NEED-QUAL 2T INV 372-2T INV PRESCRIBER DT SIGNED INV-PRES-DT-SIGNED 2U INV 373-2U INV REQUEST STATUS INV-REQ-STATUS 2V INV 374-2V INV REQUEST PERIOD BEG DT INV-REQ-PERIOD-BEG 2W INV 375-2W INV REQ PERIOD RECERT DT INV-REQ-PD-RECERT 2X INV 376-2X INV SUPPORTING DOCN INV-SUPP-DOC 2Z INV 377-2Z INV QUEST NUM/LETTER CNT INV-QUEST-NUM 30 INV PA CD INV PA MED CERT CD & NUM INV-PA-MC-CD-NUM 300 300 PROV ID QUAL NOT USED PROV-ID-QUAL-UNUSE 301 301 PROV ID NOT USED PROV-ID-UNUSED 302 302 PRESC ID QUAL NOT USED PRESC-ID-QUAL-UNUS 303 303 PRESC ID NOT USED PRESC-ID-UNUSED 304 304 PRESC ID ASOC ADDR NOT USED PRESC-ID-ADR-UNUSE 305 305 PRESC LAST NOT USED PRESC-LNAME-UNUSED 306 306 PRESC PHONE NOT USED PRESC-PHOEN-UNUSED 307 307 PCP ID QUAL NOT USED PCP-ID-QUAL-UNUSED 308 308 PCP ID NOT USED PCP-ID-UNUSED 309 309 PCP LAST NAME NOT USED PCP-LNAME-UNUSED 310 310 PRESC FIRST NAME NOT USED PRESC-FNAME-UNUSED 311 311 PRESC STREET NOT USED PRESC-STR-UNUSED 312 312 PRESC CITY NOT USED PRESC-CITY-UNUSED 313 313 PRESC STATE NOT USED PRESC-STATE-UNUSED 314 314 PRESC ZIP CD NOT USED PRESC-ZIP-UNUSED 315 315 PRESC ALT ID QUAL NOT USED PRESC-ALT-QUAL-UNU 316 316 PRESC ALT ID NOT USED PRESC-ALT-UNUSED 317 317 PRESC ALT STATE NOT USED PREC-ALT-ST-ADDR 318 318 OTHER PAYER ID QUAL NOT USED OTH-PYR-ID-QUAL-UN 319 319 OTHER PAYER ID NOT USED OTH-PYR-UNUSED 32 INV LEVEL INV LEVEL OF SERVICE INV-LEVEL-OF-SVC 320 320 OTHER PAYER DATE NOT USED OTH-PYR-DT-UNUSED 321 321 INTERNAL CNTRL NOT USED INT-CTRL-UNUSED 322 322 OP AMT PD COUNT NOT USED OP-AMT-PD-CT-UNUSE 323 323 OP AMT PD QUAL NOT USED OP-AMT-PD-QL-UNUSE 324 324 OP AMT PD NOT USED OP-AMT-PD-UNUSED 325 325 OP REJ CNT NOT USED OP-REJ-CNT-UNUSED 326 326 OP REJ CD NOT USED OP-REJ-CD-UNUSED 327 327 OP PAT RESP COUNT NOT USED OP-PAT-RESP-CNT-UN 328 328 OP PAT RESP AMT QL NOT USED OP-PAT-RESP-AMT-QL 329 329 OP PAT RESP AMT NOT USED OP-PAT-RESP-AMT-UN 33 RX ORIGIN INV PRESCRIPTION ORIGIN CD INV-RX-ORIGIN-CD 330 330 BENEFIT STAGE CNT NOT USED BENE-STG-CNT-UNUSE 331 331 BENEFIT STAGE QUAL NOT USED BENE-STG-QL-UNUSED 332 332 BENEFIT STAGE AMT NOT USED BENE-STG-AMT-UNUSE 333 333 EMPLOYER NAME NOT USED EMP-NAME-NOT-USED 334 334 EMPLOYER STREET ADR NOT USED EMP-STR-NOT-USED 335 335 EMPLOYER CITY NOT USED EMP-CITY-NOT-USED 336 336 EMPLOYER STATE NOT USED EMP-ST-ADR-NOT-USE 337 337 EMPLOYER ZIP CD NOT USED EMP-ZIP-NOT-USED 338 338 EMPLOYER PHONE NOT USED EMP-PHONE-NOT-USED 339 339 EMPLOYER CONTACT NOT USED EMP-CNTCT-NOT-USED 34 INV SUB CL INV SUBMISSION CLARIF CODE INV-SUBM-CLAR-CD 340 340 CARRIER ID NOT USED CARR-ID-NOT-USED 341 341 CLAIM/REF ID NOT USED CLM-REF-NOT-USED 342 342 BILLING ENTIRY TYPE NOT USED BILL-ENTY-NOT-USED 343 343 PAY TO QUAL NOT USED PAY-TO-QL-NOT-USED 344 344 PAY TO ID NOT USED PAY-TO-ID-NOT-USED 345 345 PAY TO NAME NOT USED PAY-TO-NAME-NOT-US 346 346 PAY TO STREET NOT USED PAY-T0-STRT-UNUSED 347 347 PAY TO CITY NOT USED PAY-TO-CITY 348 348 PAY TO STATE NOT USED PAY-TO-ST-NOT-USED 349 349 PAY TO ZIP NOT USED PAY-TO-ZIP-NOT-USE 35 INV PRIM C INV PRIMARY CARE PROV ID INV-PCP-ID 350 350 GEN EQ PROD ID QUAL NOT USED GEN-EQ-PRD-ID-QL 351 351 GEN EQ PROD ID NOT USED GEN-EQ-PROD-ID 352 352 DUR/PPS CNT NOT USED DUR-PPS-CNT-NOT-US 353 353 REASON FOR SERVICE NOT USED RES-SVC-NOT-USED 354 354 PROF SVC CD NOT USED PROF-SVC-NOT-USED 355 355 RESULT OF SVC NOT USED RSLT-SVC-NOT-USED 356 356 DUR/PPS LOE NOT USED DUR-LOE-NOT-USED 357 357 DUR COAGENT QUAL NOT USED DUR-COAGENT-QL-NO 358 358 DUR COAGENT ID NOT USED DUR-COAGENT-NOT 360 360 DISP FEE SUBMITTED NOT USED DISP-FEE-SUB-NOT 361 361 PROF SVC FEE NOT USED PROF-SVC-FEE-NOT 362 362 PAT PAID AMT SUB NOT USED PAT-PD-AMT-SUB-NO 363 363 INCENTIVE AMT NOT USED INCENT-AMT-NOT-USE 364 364 OTH AMT CLAIMED CNT NOT USED OTH-AMT-CLM-CNT-NO 365 364 OTH AMT CLAIMED QL NOT USED OTH-AMT-CLM-CNT-QL 366 366 OTH AMT CLAIMED SUB NOT USED OTH-AMT-CLM-SUB-NO 367 267 FLAT TAX AMT SUB NOT USED FLAT-TAX-AMT-SUB-N 368 368 PCT TAX SUB NOT USED PCT-TAX-SUB-NOT 369 369 PCT TAX RATE NOT USED PCT-TAX-RATE-NOT 370 370 PCT TAX BASIS NOT USED PCT-TAX-BASIS-NOT 371 371 UC CHARGE NOT USED UC-CHRG-NOT-USED 372 372 GROSS AMT DUE NOT USED GROSS-AMT-NOT 373 373 BASIS OF COST NOT USED BASIS-COST-NOT 374 374 MEDICAID PAID AMT NOT USED MCAID-PD-AMT-NOT 375 375 COUPON VALUE AMT NOT USED COUP-VAL-AMT-NOT 376 376 COMPOUND ING DRUG COST NOT COMP-ING-COST-NOT 377 377 COMPOUND ING BASIS COST NOT COMP-ING-BASIS-NOT 378 378 COMP ING MOD CNT NOT USED COMP-INGMOD-CNT-NO 379 379 COMP ING MOD CODE NOT USED COMP-ING-MOD-CD-NO 38 INV CSTBAS INV BASIS OF COST INV-BASIS-OF-COST 380 380 AUTH REP FIRST NAME NOT USED AUTH-REP-FNAME-NOT 381 381 AUTH REP LAST NAME NOT USED AUTH-REP-LNAME-NOT 382 382 AUTH REP STREET NOT USED AUTH-REP-STREET-NO 383 383 AUTH REP CITY NOT USED AUTH-REP-CITY-NOT 384 384 AUTH REP STATE NOT USED AUTH-REP-STATE-NOT 385 358 AUTH REP ZIP NOT USED AUTH-REP-ZIP-NOT 386 386 PA NUM ASSIGNED NOT USED PA-NUM-ASSG-NOT 387 387 AUTHORIZATION NUMBER NOT USE AUTH-NUM-NOT 388 388 PA SUPPORTING DOC NOT USED PA-SUP-DOC-NOT 389 389 DIAGNOSIS CODE CNT NOT USED DIAG-CD-CNT-NOT 39 INV DIAGNO INV DIAGNOSIS CODE INV-DIAG-CD 390 390 DIAGNOSIS CODE QUAL NOT USED DIAG-CD-QUAL-NOT 391 391 DIAGNOSIS CODE NOT USED DIAG-CD-NOT 392 392 CLINICAL INFO CNT NOT USED CLIN-CNT-NOT 393 393 MEASUREMENT DATE NOT USED MSRMT-DATE-NOT 394 394 MEASUREMENT TIME NOT USED MSRMT-TIME-NOT 395 395 MEASUREMNT DIM NOT USED MSRMT-DIM-NOT 396 396 MEASUREMENT UNIT NOT USED MSRMT-UNIT-NOT 397 397 MEASUREMENT VALUE NOT USED MSRMT-VAL-NOT 398 398 REQ PERIOD BEG DT NOT USED REQ-PER-BEG-NOT 399 399 REQ PERION RECERT/REV NOT REQ-PER-RECERT-NOT 3A INV REQ TP INV REQUEST TYPE INV-REQ-TYP 3B INV RQ BEG INV REQUEST PD DATE-BEGIN INV-REQ-PD-DT-BEG 3C INV RQ END INV REQUEST PD DATE-END INV-REQ-PD-DT-END 3D INV BAS RQ INV BASIS OF REQUEST INV-BASIS-OF-REQ 3E INV AR FST INV AUTH REP FIRST NAME INV-AR-FIRST-NM 3F INV AR LST INV AUTH REP LAST NAME INV-AR-LAST-NM 3G INV AR STR INV AUTH REP STREET INV-AR-STREET 3H INV AR CTY INV AUTH REP CITY INV-AR-CITY 3J INV AR ST INV AUTH REP STATE/PROV INV-AR-ST-PR 3K INV AR ZIP INV AUTH REP ZIP/POSTAL CODE INV-AR-ZIP 3M INV AR PH INV PRESCRIBER PHONE NUM INV-PRES-PH-NUM 3N INV PR ATH INV PRIOR AUTHORIZED NUM INV-PA-NUM 3P INV AUTH INV AUTHORIZATION NUM INV-AUTH-NUM 3Q 3Q MISSING/INVALID FACILITY NAME MI-FACILITY-NAME 3R PRI ATH NR PRIOR AUTH NOT REQUIRED INV-PRIOR-AUTH-NR 3S INV SUPDOC INV PRI AUTH SUPPORT DOC INV-PA-SUP-DOC 3T ACT PA EX ACTIVE PRIOR AUTH EXISTS ACT-PA-EXISTS 3U 3U MISSING/INVALID FAC ST ADDR MI-FACILITY-STREET 3V 3V MISSING/INVALID FAC STATE MI-FAC-STATE 3W PRI AUTH PRIOR AUTH IN PROCESS PA-IN-PROCESS 3X ATH NUM NF AUTH NUM NOT FOUND AUTH-NUM-NOT-FOUND 3Y PR ATH DEN PRIOR AUTHORIZATION DENIED PA-DENIED 40 PH NOT CON PHARM NT CONT W PLAN ON DT SRV PH-NOT-CONT-ON-DOS 400 400 REQUEST STATUS NOT USED REQ-STATUS-NOT 401 401 LENGTH OF NEED QUAL NOT USED LEN-NEED-QL-NOT 402 402 LENGTH OF NEED NOT USED LEN-NEED-NOT 403 403 PRESC/SUPPLR DT SIGNED NOT PRESC-SUPL-DT-NOT 404 404 SUPPORTING DOC NOT USED SUP-DOC-NOT-USED 405 405 QUEST NUM COUNT NOT USED QUEST-NUM-CNT-NOT 406 406 QUEST NUM NOT USED QUEST-NUM-NOT-USED 407 407 QUEST PERCENT RESP NOT USED QUEST-PCT-RESP-NOT 408 408 QUEST DATE RESP NOT USED QUEST-DT-RESP-NOT 409 409 QUEST DOLLAR AMT RESP NOT QUEST-DLR-AMT-NOT 41 SUB BILL SUBMIT BILL TO OTHER PROCESSOR SUB-BILL-TO-OTH-PR 410 410 QUEST NUM RESP NOT USED QUEST-NUM-RESP 411 411 QUEST ALPHANUM RESP NOT QUEST-AN-RESP-NOT 412 412 FACILITY ID IS NOT USED FAC-ID-INVALID 413 413 FACILITY NAME NOT USED FAC-NAME-NOT-USED 414 414 FACILITY STREET NOT USED FAC-STREET-NOT-USE 415 415 FACILITY CITY NOT USED FAC-CITY-NOT-USED 416 416 FACILITY STATE NOT USED FAC-STATE-NOT-USED 417 417 FACILITY ZIP NOT USED FAX-ZIP-NOT-USED 418 418 PURCHASER ID QUAL NOT USED PURCH-ID-QUAL-NOT 419 419 PURCHASER ID NOT USED PURCH-ID-NOT-USED 420 420 PURCHASER ID ASOC STATE NOT PURCH-ID-ST-NOT 421 421 PURCHASER DOB NOT USED PURCHASE-DOB-NOT 422 422 PURCHASER GENDER NOT USED PURCH-GENDER-NOT 423 423 PURCHASER FIRST NAME NOT PURCH-FNAME-NOT 424 424 PURCHASER LAST NAME NOT PURCH-LNAME-NOT 425 425 PURCHASER STREET NOT USED PURCH-STREET-NOT 426 426 PURCHASER CITY NOT USED PURCH-CITY-NOT 427 427 PURCHASER STATE NOT USED PURCH-STATE-NOT 428 428 PURCHASER ZIP NOT USED PURCH-ZIP-NOT-USED 429 429 PURCHASER COUNTRY NOT USED PURCH-COUNTRY-NOT 430 430 PURCHASER RELSHIP NOT USED PURCH-REL-CD-NOT 431 431 RELEASED DATE NOT USED REL-DT-NOT-USED 432 432 RELEASED TIME NOT USED REL-TM-NOT-USED 433 433 SVC PROV NAME NOT USED SVC-PROV-NAM-NOT 434 434 SVC PROV STREET NOT USED SVC-PROV-STREET-NO 435 435 SVC PROV CITY NOT USED SVC-PROV-CITY-NOT 436 436 SVC PROV STATE NOT USED SVC-PROV-STATE-NOT 437 437 SVC PROV ZIP NOT USED SVC-PROV-ZIP-NOT 438 438 SELLER ID QUAL NOT USED SELLER-ID-QL-NOT 439 439 SELLER ID NOT USED SELLER-ID-NOT-USED 440 440 SELLER INTIALS NOT USED SELLER-INIT-NOT-US 441 441 OTH AMT CLM SUB GRP ERROR OTH-AMT-SUB-GRP-NO 442 442 OTH AMT PD GRP INCORRECT OP-AMT-PD-GRP-ERR 443 443 OTH PYR PAT RESP AMT GRP ERR OP-PAT-RESP-AMT-ER 444 444 BENEFIT STAGE AMT GRP ERROR BENE-STG-GROUP-ERR 445 445 DIAGNOSIS CODE GROUP ERROR DIAG-CD-GRP-ERROR 446 446 COB/OP SEG ERROR COB-SEQ-ERROR 447 447 ADD DOC SEG FORMAT ERROR ADD-DOC-SEG-ERROR 448 448 CLINICAL SEG FORMAT ERROR CLIN-SEG-FORMAT-ER 449 449 PATIENT SEG FORMAT ERROR PAT-SEG-FORMAT-ER 450 450 INS SEG INCORRECT FORMAT R450 451 451 TRN HDR SEG INCORRECT FORMAT R451 452 452 CLM SEG INCORRECT FORMAT R452 453 453 PHARM PROV SEG INCORR FMT R453 454 454 PRESC PROV SEG INCORR FMT R454 455 455 WC SEG INCORRECT FORMAT R455 456 456 PRICE SEG INCORRECT FORMAT R456 457 457 COUPON SEG INCORRECT FMT R457 458 458 PA SEG INCORRECT FORMAT R458 459 459 FAC SEG INCORRECT FORMAT R459 460 460 NARR SEG INCORRECT FORMAT R460 461 461 PURCHASER SEG INCORRECT FMT R461 462 462 SVC PROV SEG INCORRECT FMT R462 463 463 PHARM NOT CONTRCT IN NETWRK R463 464 464 SVC PROV ID QL OUT OF ORDER R464 465 465 PAT ID QUAL OUT OF ORDER R465 466 466 RX QUAL OUT OF ORDER R466 467 467 PROD SVC ID QL OUT OF ORDER R467 468 468 PROC MOD CD OUT OF ORDER R468 469 469 SUB CLARIF CD OUT OF ORDER R469 470 470 ORIG PROD SVC ID QL ORDER R470 471 471 OTHER AMT CLM SUB ORDER R471 472 472 OTHER AMT CLM CNT ORDER R472 473 473 PROV ID QL OUT OF ORDER R473 474 474 PRESC ID QL OUT OF ORDER R474 475 475 PCP ID QL OUT OF ORDER R475 476 476 COB CNT OUT OF ORDER R476 477 477 OP ID CNT OUT OF ORDER R477 478 478 OP ID QL OUT OF ORDER R478 479 479 OP AMT PD CNT OUT OF ORDER R479 480 480 OP AMT PD QL OUT OF ORDER R480 481 481 OP REJ CNT OUT OF ORDER R481 482 482 OP PAT RESP AMT CNT ORDER R482 483 483 OP PAT RESP AMT QL ORDER R483 484 484 BENE STG CNT OUT OF ORDER R484 485 485 BEN STG QL OUT OF ORDER R485 486 486 PAY-TO QL OUT OF ORDER R486 487 487 GEN EQ PROD ID QL ORDER R487 488 488 DUR/PPS CD CNT OUT OF ORDER R488 489 489 DUR CO-AGT ID QL ORDER R489 490 490 COMP ING CNT OUT OF ORDER R490 491 491 COMP ING CNT OUT OF ORDER R491 492 492 COMP ING MOD CNT ORDER R492 493 493 DIAG CD CNT OUT OF ORDER R493 494 494 DIAG CD QL OUT OF ORDER R494 495 495 CLIN INFO CNT OUT OF ORDER R495 496 496 LENGHT OF NEED QL ORDER R496 497 497 QUEST NUM OUT OF ORDER R497 498 498 ACCUM MTH OUT OF ORDER R498 499 499 ADDR CNT OUT OF ORDER R499 4B MI QUEST M/I QUESTION NUMBER/LETTER MI-QUEST-NUM 4C INV COB INV COB/OTHER PAYMENTS CNT INV-COB-OTH-PMNTS 4D 4D M/I QUESTION PERCENT RESPONSE MI-QUEST-PCT-RESP 4E INV PCP NM INV PRIM CARE PROV LAST NM INV-PCP-LAST-NM 4G 4Q M/I QUESTION DATE RESPONSE MI-QUEST-DATE-RESP 4H 4H M/I QUESTION DOLLAR AMT RESP MI-QUEST-DOLLAR-RE 4J 4J M/I QUESTION NUM RESP MI-QUEST-NUM-RESP 4K 4K M/I QUESTION ALPHANUM RESP MI-QUEST-AN-RESP 4M CMP CNT ER CMPND INGRED CNT ERROR CMPND-ING-CNT-ERR 4N 4N QUESTION NUM/COUNT MISMATCH QUEST-NUM-CNT-NOMA 4P 4P QUESTION NUM/LETTER INVALID QUEST-NUM-INVALID 4Q 4Q QUEST RESP NOT APPROPRIATE QUEST-RESP-INAPPRO 4R 4R REQUIRED QUEST NUM MISSING REQD-QUEST-MISSING 4S 4S COMPOUNT PROD ID REQ MOD CD COMP-PRD-ID-MOD-RE 4T 4T M/I ADDL DOC SEGMENT MI-ADD-DOC-SEG 4W 4W MUST USE SPECIALTY PHARM MUST-SPEC-PHARM 4X MI PAT RES M/I PATIENT RESIDENCE MI-PAT-RES 4Y 4Y PAT RES VALUE NOT SUPPORTED PAT-RES-VAL-NOT 4Z 4Z PLACE OF SERVICE NOT ON PLAN PL-SVC-NOT-PLAN 50 NM PHARM NON-MATCHED PHARMACY NUM NONM-PHARM-NUM 500 500 PAT ID QL CNT OUT OF ORDER R500 501 501 PRESC ID CNT OUT OF ORDER R501 502 502 PRESC SPCLTY CNT ORDER R502 503 503 PHONE NUM CNT ORDER R503 504 504 BENE STG QL VALUE NOT SUPP R504 505 505 OP CVRG TY VALUE NOT SUPP R505 506 506 RX QL VALUE NOT SUPPORTED R506 507 507 ADD DOC TY ID VALUE NOT SUPP R507 508 508 AUTH REP ST ADDR VALUE NOT R508 509 509 BASIS OF REQ VALUE NOT SUPP R509 51 GROUP NOT NON-MATCHED GROUP ID NONM-GROUP-ID 510 510 BILL ENTY TY IND VALUE NOT R510 511 511 CMS PART D QL FAC VALUE NOT R511 512 512 COMP CD VALUE NOT SUPPORTED R512 513 513 COMP DISP UNT FM IND NOT SUPP R513 514 514 COMP BASIS COST NOT SUPP R514 515 515 COMP PRD ID VALUE NOT SUPP R515 516 516 COMP TY VALUE NOT SUPPORTED R516 517 517 COUP TY VALUE NOT SUPPORTED R517 518 518 DUR CO-AGT QL VALUE NOT SUPP R518 519 519 DUR/PPS LV EFFORT NOT SUPP R519 52 CARDH NOT NON-MATCHED CARDHOLDER ID NONM-CARDH-ID 520 520 DELAY RSN CD VALUE NOT SUPP R520 521 521 DIAG CD QL VALUE NOT SUPP R521 522 522 DISP ST VALUE NOT SUPPORTED R522 523 523 ELIG CLARIF CD VALUE NOT SUPP R523 524 524 EMP ST ADDR VALUE NOT SUPP R524 525 525 FAC ST ADDR VALUE NOT SUPP R525 526 526 HDR RESP STS VALUE NOT SUPP R526 527 527 INT AUTH TY ID VALUE NOT SUPP R527 528 528 LENGHT OF NEED QL VALUE NOT R528 529 529 LVL OF SVC VALUE NOT SUPP R529 53 PERSON NOT NON-MATCHED PERSON CODE NONM-PERSON-CD 530 530 MEASURE DIM VALUE NOT SUPP R530 531 531 MEASURE UNIT VLAUE NOT SUPP R531 532 532 MEDICAID IND VALUE NOT SUPP R532 533 533 ORIG PRD SVC ID QL NOT SUPP R533 534 534 OTH AMT CLAIMED SUB NOT SUPP R534 535 535 OTH CVG CD VALUE NOT SUPP R535 536 RR536 OTH PYR PAT RESP CD NOT SUPP OTH-PYR-PAT-RESP 537 537 PAT ASSG IND VALUE NOT SUPP R537 538 538 PAT GENDER CD VALUE NOT SUPP R538 539 539 PAT ST ADDR VALUE NOT SUPP R539 54 NM PROD SV NON-MATCHED PRODUCT/SERVICE ID NONM-PROD-SVC 540 540 PAT-TO ST ADDR VALUE NOT SUP R540 541 541 PCT TAX BASIS SUB NOT SUPP R541 542 542 PREG IND VALUE NOT SUPPORTED R542 543 543 PRESC ID QUAL NOT SUPPORTED R543 544 544 PRESC ST ADDR VALUE NOT SUPP R544 545 545 PRESC ORIG CD VALUE NOT SUPP R545 546 546 PCP ID QL VALUE NOT SUPPORTED R546 547 547 PA TY CD VALUE NOT SUPPORTED R547 548 548 PROV ASSG IND VALUE NOT SUPP R548 549 549 PROV ID QL VALUE NOT SUPPORT R549 55 NM PROD PK NON-MATCHED PRODUCT PKG SIZE NONM-PROD-PKG 550 550 REQ ST VALUE NOT SUPPORTED R550 551 551 REQ TY VALUE NOT SUPPORTED R551 552 552 RT OF ADMIN VALUE NOT SUPP R552 553 553 SMOKER CD VALUE NOT SUPP R553 554 554 SPEC PKG IND VALUE NOT SUPP R554 555 555 TRAN CNT VALUE NOT SUPPORT R555 556 556 UNIT OF MEASURE NOT SUPPORT R556 557 557 COB SEG ON NON-COB CLAIM R557 558 558 PART D PLAN COB W/PLAN D R558 559 559 ID SUB FOR SANCTIONED PHARM R559 56 NON MTCH P NON-MATCHED PRESCRIBER ID NONM-PRESC-ID 560 560 PHARM NOT IN RETAIL NETWORK R560 561 561 PHARM NOT IN MAIL NETWORK R561 562 562 PHARM NOT IN HOSPICE NETWK R562 563 563 PHARM NOT IN VA NETWORK R563 564 564 PHARM NOT IN MILITARY NETWRK R564 565 565 PAT COUNTRY VALUE NOT SUPP R565 566 566 PAT COUNTRY CD NOT USED R566 569 RR569 CMS NOTICE OF APPEAL RIGHTS CMS-NOTE-APPEAL-RT 57 NM PA CD NONMATCHED PA/MED CERT NM-PA-MC-CD-NUM 571 571 PAT ASOC ST ADDR NOT SUPP R571 572 572 MEDIGAP ID NOT COVERED R572 573 573 PRESC ASOC ST ADDR NOT SUPP R573 574 574 COMP ING MOD CD NOT COVERED R574 575 575 PURCHR ST ADDR VALUE NOT SP R575 576 576 SVC PROV ST ADDR VALUE NOT R576 577 577 M/I OTHER PAYER ID R577 578 578 OP ID CNT MISMATCH NUM OF REP R578 579 579 OP ID CNT EXCEEDS OCC SUPP R579 58 NM PRI PRS NON-MATCHED PRIMARY PRESCRIBER NONM-PRI-PRESC 580 580 COUNT OP ID CNT INCORRECT R580 581 581 OP ID CNT NOT USED THIS TRANS R581 582 582 M/I FILL NUMBER R582 583 583 PROVIDER ID NOT COVERED R583 584 584 PURCH ID ST CD VALUE NOT SUPP R584 585 585 FILL NUM VALUE NOT SUPPORTED R585 586 586 FACILITY ID NOT COVERED R586 587 587 CARRIER ID NOT COVERED R587 588 588 ALT ID NOT COVERED R588 589 589 PAT ID NOT COVERED R589 590 590 COMP DOSAGE FORM NOT COVR R590 591 591 PLAN ID NOT COVERED R591 592 592 DUR CO-AGENT ID NOT COVERED R592 593 593 M/I DATE OF SERVICE R593 594 594 PAY-TO ID NOT COVERED R594 595 595 ASSOC PROV ID NOT COVERED R595 596 596 COMP PREP TIME NOT USED R596 597 597 LTC - PKG TYPE NOT SUPPORTED R597 598 598 MORE THAN ONE PAT FOUND R598 5C INV PY COV INV OTHER PAYER COV TYPE INV-OTHPYR-COV-TYP 5E INV PY REJ INV OTHER PAYER REJECT CNT INV-OTHPYR-REJ-CNT 5J 5J M/I FACILITY CITY ADDRESS R5J 60 NOT CV AGE PROD/SVC NOT COVERED-PAT AGE PS-NC-PAT-AGE 600 600 COVERAGE OUTSIDE SUBMIT DOS R600 606 606 BRND DRUG/SPECIFIC LBLR CD R606 61 NOT CV GEN PROD/SVC NOT COVRD-PAT GENDER PS-NC-PAT-GENDER 612 612 LTC DISP,INVALID SCC COMBO R612 613 613 M/I PKG MTHDLGY/DISP FREQ R613 617 617 CMPND DRUG COST IS NEGATIVE R617 618 618 PRESC DEA NOT VALID FOR DRUG R618 619 619 PRESC TYPE I NEEDED R619 62 NM MSMTCH PAT/CARD HOLDER NAME MISMATCH PAT-CARD-NM-MSMTCH 63 ID NOT COV INSTIT PAT PROD/SVC ID NOT COV SVC-ID-NOT-COV 64 PRI AT MIS CLM SUB DOES NOT MTCH PRI AUTH CLM-PRI-AUTH-MIS 645 645 REPACKAGED PROD NOT COVERED R645 647 647 QTY PRES REQ FOR CII RX R647 648 648 QTY PRES NOT MATCHING ORIG RX R648 65 NOT COV PATIENT NOT COVERED PAT-NOT-COV 650 650 FILL DT >60 DAYS FROM DT PRESC R650 66 MAX AGE EX PATIENT AGE EXCEEDS MAXIMUM MAX-AGE-EXCEEDED 67 DOS LT ELI FILLED BEFORE COV EFFECTIVE FILLED-BEF-COV-EFF 68 DOS GT EXP FILLED AFTER COVERAGE EXPIRED FILLED-AFT-COV-EXP 69 DOC GT TRM FILLED AFTER COV TERMINATED FILLED-AFT-COV-TRM 6C INV ID QUA INV OTHER PAYER ID QUALIFIER INV-OTHPYR-ID-QUAL 6D 6D M/I FACILITY ZIP CD MI-FAC-ZIP-CD 6E INV REJ CD INV OTHER PAYER REJECT CODE INV-OTHPYR-REJ-CD 6G 6G COB/OP SEG REQ FOR ADJUD COB-SEG-REQ 6H 6H COUPON SEG REQ FOR ADJUD R6H 6J 6J INS SEG REQ FOR ADJUD INS-SEG-REQ 6K 6K PAT SEG REQ FOR ADJUD PAT-SEG-REQ 6M 6M PHARM PROV SEG REQ FOR ADJ PHARM-PROV-SEG-REQ 6N 6N PRES SEG REQ FOR ADJUD PRESC-SEG-REQ 6P 6P PRICING SEG REQ FOR ADJUD PRICE-SEG-REQ 6Q 6Q PA SEG REQ FOR ADJUD PA-SEG-REQ 6R 6R WORKERS COMP SEG REQ WC-SEG-REQ 6S 6S TRANS SEG REQ FOR ADJUD TRAN-SEG-REQ 6T 6T COMP SEG REQ FOR AJDUD COMP-SEG-REQ 6U 6U COMP SEG FORMAT INCORRECT COMP-SEG-FORMAT 6V 6V MULT-ING COMP NOT SUPPORTED MULT-ING-COMP-NOT 6W 6W DUR/PPS SEG REQ FOR ADJUD DUR-PPS-SEG-REQ 6X 6X DUR/PPS SEG FORMAT INCORRECT DUR-PPS-SEG-FORMAT 6Y 6Y NOT AUTH TO SUBMIT ELECTRON NOT-AUTH-SUB-ELECT 6Z 6Z PROV NOT ELIG FOR SERVICE PROV-INELIG-SVC 70 NOT CVRD PRODUCT/SERVICE NOT COVERED PROD-SERV-NOT-COV 71 PRESCR NOT PRESCRIBER NOT COVERED PRESCR-NOT-COV 72 PR PRES NC PRIMARY PRESCRIBER NOT COVERED PR-PRESCR-NOT-COV 73 REFILLS NO REFILLS NOT COVERED REFILLS-NOT-COV 74 PMT MT EX OTH CAR PMT MEETS/EXCEEDS PYBL OTH-CARR-PMT-MT-EX 75 PRIOR AUTH PRIOR AUTH REQUIRED PRIOR-AUTH-REQ 76 PLAN LMTS PLAN LIMITATIONS EXCEEDED PLAN-LMTS-EXCEED 77 ID DISCON DISCONTINUED PRODUCT/SVC ID NO PR-ID-DISCONTINUED 78 CST EXC MX COST EXCEEDS MAXIMUM COST-EXCEEDS-MAX 79 REFILL TOO REFILL TOO SOON REFILL-TOO-SOON 7A 7A PROV DOESNT MATCH AUTH PROV-NOT-EQ-AUTH 7B 7B PROV ID QL VALUE NOT SUPP PRV-ID-QL-NOT-SUPP 7C INV OTHPYR INV OTHER PAYER ID INV-OTHER-PAYER-ID 7D 7D NON-MATCHED DOB NO-MATCH-DOB 7E INV DURPSS INV DUR/PPS CODE COUNTER INV-DUR-PSS-CD-CNT 7F 7F FUTURE DATE DOB NOT ALLOWED FUTURE-DOB 7G 7G FUTURE DATE DOB NOT ALLOWED FUTURE-DATE-DOB 7H 7H NON-MATCHED GENDER CD NO-MATCH-GENDER 7J 7J PAR REL CD VALUE NOT SUPP PAT-REL-CD-NOT-SUP 7K OTH CVG PY OTHER COVERAGE-PAYER AMT OTH-CVRG-PAYER-AMT 7M 7M OCC DISCREPANCY OCC-DISCREPANCY 7N 7N PAT ID QL VALUE NOT SUPP PAT-ID-QL-NOT-SUPP 7P 7P COB CNT EXCEEDS NUM SUPP COB-PYMT-CVG-CNT 7Q 7Q OP ID QL VALUE NOT SUPPORTED OP-ID-QL-NOT-SUPP 7R 7R OP AMT PD CNT EXCEEDS NUM OP-AMT-PD-CNT-EXC 7T 7T QTY INTEND TO DISP REQ PART QTY-INTENDED-REQ 7U 7U DAYS SUPP INTEND REQ PARTIAL DAY-SUPP-INT-REQ 7V 7V DUPLICATE REFILLS DUP-REFILL 7W 7W REFILLS EXCEED ALLOWABLE REFILL-EXCEED-ALLW 7X 7X DAYS SUPPLY OVER PLAN LIMITS DAY-SUPP-OVER-PLAN 7Y 7Y COMPOUNDS NOT COVERED COMP-NOT-COVERED 7Z 7Z COMPOUND REQ 2+ INGREDIENTS COMP-REQ-MIN-TWO 80 DIAG MSTCH DRUG-DIAGNOSIS MISMATCH DRUG-DIAG-MISMATCH 81 TOO OLD CLAIM TOO OLD CLM-TOO-OLD 82 POST DATED CLAIM IS POST-DATED POST-DATED-CLM 83 DUP PAID DUPLICATE PAID/CAPTURED CLAIM DUP-PAID-CAPT-CLM 84 CLM NOT PD CLAIM HAS NOT BEEN PAID/CAPTRD CLM-NOT-PD 85 CLM NOT PR CLAIM NOT PROCESSED CLM-NOT-PROCESSED 86 MAN REV SUBMIT MANUAL REVERSAL SUBM-MANUAL-REV 87 REV NP REVERSAL NOT PROCESSED REV-NOT-PROC 88 DUR REJECT DUR REJECT ERROR DUR-REJECT-ERROR 89 REJ FEE PD REJECTED CLAIM FEES PAID REJ-CLM-FEES-PD 8A 8A COMPOUND REQ COVERED ING COMP-REQ-COVERED 8B 8B COMPOUND SEG MISSING COMP-SEG-MISSING 8C INV FAC ID INV FACILITY ID INV-FACILITY-ID 8D 8D COMP SEG PRESENT ON NON-CMP COMP-SEG-PRESENT 8E INV DP LOE INV DUR/PPS LVL OF EFFORT INV-DUR-PPS-LOE 8G 8G PRD/SVC ID REQ ZERO FOR COMP D7-MUST-BE-ZERO 8H 8H PRD/SVC ONLY ON COMP CLAIM PROD-CVRD-COMP 8J 8J INCORRECT PRD/SVC ID PAYER PRD-FOR-PROCESSOR 8K 8K DAW CD VALUE NOT SUPPORTED DAW-CD-NOT-SUPP 8M 8M SUM OF ING COSTS MISMATCH COMP-COST-SUM-ERR 8N 8N FUTURE DT WRITTEN NOT ALLOW FUTURE-DT-WRITTEN 8P 8P DT WRITTEN DIFF ON PREV FILING DT-WRITTEN-DIFF 8Q 8Q EXCESSIVE REFILLS AUTHORIZED EXCESS-REFILL-AUTH 8R 8R SUB CLARIF CD NOT SUPPORTED SUB-CLR-CD-NOT-SUP 8S 8S BASIS OF COST NOT SUPPORTED BASIS-COST-NOT-SUP 8T 8T U&C MUST BE OVER ZERO UC-MUST-BE-PRESENT 8U 8U GAD MUST BE OVER ZERO GAD-MUST-BE-PRSNT 8V 8V NEG AMT NOT SUPP IN OP AMT OP-AMT-NEGATIVE 8W 8W OCC AND OP AMT PD DISCREP OCC-OP-AMT-DISCREP 8X 8X COLL FROM CARDHOLDER NOT AL CRDHLDR-COLL-NOT 8Y 8Y EXCESSIVE AMOUNT COLLECTED EXCESS-AMT-COLL 8Z 8Z PRD ID QL VALUE NOT SUPPORTED PROD-ID-QL-NOT-SUP 90 HST HNG UP HOST HUNG UP HOST-HUNG-UP 91 HST RES ER HOST RESPONSE ERROR HOST-RESP-ERROR 92 SYS UNAVL SYSTEM/HOST UNAVAILABLE SYS-HOST-UNAVAIL 95 TIME OUT TIME OUT TIME-OUT 96 SCH DOWNTM SCHEDULED DOWNTIME SCHEDULED-DOWNTIME 97 PYR UNAVL PAYER UNAVAILABLE PAYER-UNAVAILABLE 98 CONN DOWN CONNECTION TO PAYER DOWN CON-TO-PAYER-DOWN 99 HST PRC ER HOST PROCESSING ERROR HOST-PROCESS-ERROR 9B 9B RSN FOR SVC VALUE NOT SUPP R9B 9C 9C PROF SVC CD VALUE NOT SUPP R9C 9D 9D RES OF SVC CD VALUE NOT SUPP R9D 9E 9E QTY DOES NOT MATCH DISP UNIT R9E 9G 9G QTY DISP EXCEEDS MAX ALLOW R9G 9H 9H QTY NOT VALID FOR PROD SUB R9H 9J 9J FUT OTH PAYER DT NOT ALLOW R9J 9K 9K COMP ING CNT EXCEEDS NUM SUP R9K 9M 9M MIN TWO INGREDIENTS REQUIRED R9M 9N 9N COMP ING QTY EXCEEDS MAX R9N 9Q 9Q RT OF ADMIN SUB NOT COVERED R9Q 9R 9R RX SVC NUM QL NOT COVERED R9R 9S 9S FUT ASOC RX DT NOT ALLOWED R9S 9T 9T PA TYPE CD SUB NOT COVERED R9T 9U 9U PROV ID QL SUB NOT COVERED R9U 9V 9V PRESC ID QL SUB NOT COVERED R9V 9W 9W DUR/PPS CD CNT EXCEEDS LMT R9W 9X 9X COUPON TY SUB NOT COVERED R9X 9Y 9Y CMP PROD ID QL SUB NOT COVER R9Y 9Z 9Z DUP PROD ID IN COMPOUND R9Z A1 A1 ID SUB ASSOC WITH SANCTIONED RA1 A2 A2 ID SUB ASSOC DESCEASED RA2 A5 A5 NOT COVERED UNDER PART D RA5 A6 A6 MED MAY BE UNDER PART D RA6 A7 A7 M/I INTERNAL CONTROL NUMBER RA7 A9 TRANS CNT INV TRANSACTION COUNT INV-TRANS-CNT AA SPNDDN NM PATIENT SPENDDOWN NOT MET PAT-SPNDDN-NOT-MET AB DT GT FILL DATE WRITTEN IS GT DATE FILLED DT-WRT-AFT-FILLED AC N PART MAN PROD NOT COV-NON-PART MANUFCTR PROD-NON-PART-MANF AD INELG BILL BILLING PROV INELGIBLE TO BILL PROV-INELIG-TOBILL AE QMB BL MED QMB BILL MEDICARE QMB-BILL-MEDICARE AF MGD CARE PAT ENROLLED UNDER MGD CARE PAT-UNDER-MGD-CARE AG SUPLY LMT DAYS SUPPLY LIMIT FOR PROD/SVC DAYS-SUPPLY-LIMIT AH PKG NURS UNIT DOSE PKG FOR NURSING HOME UNIT-DOSE-PKG-NURS AJ GENERC REQ GENERIC DRUG REQUIRED GENERIC-DRUG-REQ AK INV VENDOR INV SOFTWARE VENDR/CERT ID INV-SOFTWARE-VENDR AM SEG ID INV SEGMENT IDENTIFICATION INV-SEGMENT-ID AQ AQ M/i FACILITY SEG RAQ B2 PROV ID QU INV SERVICE PROV ID QUALIFIER INV-SVC-PRVID-QUAL BA BA CMP BAS COST SUB NOT COVER RBA BB BB DIAG CD QL SUB NOT COVERED RBB BC BC FUT MEASURMT DT NOT ALLOW RBC BD BD SENDER NOT AUTH TO SUB FILE RBD BE SVC FEE INV PROF SVC FEE SUBMITTED INV-PROF-SVC-FEE BF BF M/I FILE TYPE RBF BG BG SENDER NOT CERT FOR PROCESR RBG BH BH M/I SENDER ID RBH BJ BJ TRANS TYPE VALUE NOT SUPP RBJ BK BK M/I TRANSMISSION TYPE RBK BM BM M/I NARRATIVE MESSAGE RBM CA INV PAT FN INV PATIENT FIRST NAME INV-PAT-FIRST-NM CB INV PAT LN INV PATIENT LAST NAME INV-PAT-LAST-NM CC INV CH FN INV CARDHOLDER FIRST NAME INV-CARDH-FIRST-NM CD INV CH LN INV CARDHOLDER LAST NAME INV-CARDH-LAST-NM CE INV HOME P INV HOME PLAN INV-HOME-PLAN CF INV EM NM INV EMPLOYER NAME INV-EMP-NM CG INV EM STR INV EMPLOYER STREET ADDR INV-EMP-STREET CH INV EM CTY INV EMPLOYER CITY INV-EMP-CITY CI INV EM ST INV EMPLOYER STATE/PROVINCE INV-EMP-STATE-PROV CJ INV EM ZIP INV EMPLOYER ZIP/POSTAL CD INV-EMP-ZIP-PO-CD CK INV EM PH INV EMPLOYER PHONE NUMBER INV-EMP-PHONE CL INV EM CON INV EMPLOYER CONTACT NAME INV-EMP-CONTACT CM INV PT STR INV PATIENT STREET ADDRESS INV-PAT-STREET CN INV PT CTY INV PATIENT CITY INV-PAT-CITY CO INV PT ST INV PATIENT STATE/PROVINCE INV-PAT-STATE-PROV CP INV PT ZIP INV PATIENT ZIP/POSTAL CD INV-PAT-ZIP-PO-CD CQ INV PT PH INV PATIENT PHONE NUMBER INV-PAT-PHONE CR INV CARR INV CARRIER ID INV-CARR-ID CW INV ALT ID INV ALTERNATE ID INV-ALT-ID CX INV PT QUA INV PATIENT ID QUALIFIER INV-PAT-ID-QUAL CY INV PT ID INV PATIENT ID INV-PAT-ID CZ INV EM ID INV EMPLOYER ID INV-EMP-ID DC INV DS FEE INV DISPENSING FEE SUBMITTED INV-DISP-FEE-SUBM DN INV BASIS INV BASIS OF CST DETERMINATION INV-BASIS-COST-DET DQ INV CST INV USUAL AND CUSTOMARY CHG INV-USUAL-AND-CUST DR INV PR LN INV PRESCRIBER LAST NAME INV-PRESCR-LAST-NM DT INV UN DSE INV UNIT DOSE INDICATOR INV-UNIT-DOSE-IND DU INV GA DUE INV GROSS AMOUNT DUE INV-GROSS-AMT-DUE DV OTH PY AMT INV OTHER PAYER AMOUNT PD INV-OTH-PAYER-AMT DX INV PP AMT INV PATIENT PAID AMT SUBM INV-PAT-PD-AMT-SUB DY INV DT INJ INV DATE OF INJURY INV-DT-OF-INJURY DZ INV CLM RF INV CLAIM/REFERENCE ID INV-CLM-REF-ID E1 INV PR SVC INV PRODUCT/SVC QUALIFIER INV-PROD-SVC-ID-Q E2 M/I rt Adm M/I ROUTE OF ADMINISTRATION MI-RT-ADMIN E3 INV IN AMT INV INCENTIVE AMOUNT SUBMITTED INV-INC-AMT-SUBM E4 INV REASON INV REASON FOR SERVICE CODE INV-REASON-FOR-SVC E5 INV PR SVC INV PROFESSIONAL SERVICE CODE INV-PROF-SVC-CD E6 INV ROS CD INV RESULT OF SERVICE CODE INV-RESULT-OF-SVC E7 INV QTY DS INV QUANTITY DISPENSED INV-QTY-DISPENSED E8 INV OP DT INV OTHER PAYER DATE INV-OTHER-PAYER-DT E9 INV PR ID INV PROVIDER ID INV-PROVIDER-ID EA INV PR PRD INV ORIG PRESC PROD/SVC CD INV-ORIG-PRES-PROD EB INV PR QTY INV ORIG PRESCRIBED QTY INV-ORIG-PRES-QTY EC INV CIC CT INV COMPND INGRED COMP COUNT INV-CI-COMP-CNT ED INV CI QTY INV COMPOUND INGREDIENT QTY INV-CI-QTY EE INV CI CST INV COMPND INGRED DRUG COST INV-CI-DRUG-COST EF INV CD FRM INV COMP DOSAGE FORM DESC CODE INV-CM-DS-FRM-DESC EG INV CD UFI INV CMP DISP UNIT FORM IND INV-CD-UNIT-FRM EH INV CM RTE INV CMP RTE OF ADMINISTRATION INV-CM-RTE-ADMIN EJ INV RX PRD INV ORIG PRESCRIBED PRD/SVC ID INV-ORIG-PRESC-PRD EK INV SCH RX INV SCHEDULED RX ID NUMBER INV-SCH-RX-ID-NUM EM INV RX SVC INV RX/SVC REF NUM QUALIFIER INV-RX-SVC-REF-NUM EN INV ARX RF INV ASSOC RX/SVC REF NUM INV-ASOC-RX-REF EP INV ARX DT INV ASSOC RX/SERVICE DATE INV-ASOC-RX-SVC-DT ER INV MOD CD INV PROCEDURE MODIFIER CODE INV-PROC-MOD-CD ET INV RX QTY INV QUANTITY PRESCRIBED INV-QTY-PRESCRIBED EU INV PA TYP INV PRIOR AUTH TYPE CODE INV-PA-TYPE-CD EV INV PA NUM INV PRIOR AUTH NUM SUBMITTED INV-PA-NUM-SUBM EW INV IA TYP INV INTERMEDIARY AUTH TYPE ID INV-INT-AUTH-TP-ID EX INV IA ID INV INTERMEDIARY AUTH ID INV-INT-AUTH-ID EY INV PR ID INV PROVIDER ID QUALIFIER INV-PROV-ID-QUAL EZ INV PRS ID INV PRESCRIBER ID QUALIFIER INV-PRESCR-ID-QUAL FO INV PLN ID INV PLAN ID INV-PLAN-ID G1 G1 M/I COMPOUND TYPE RG1 G2 G2 M/I CMS PART D QUAL FACILITY RG2 G4 G4 PHYSICIAN MUST CONTACT PLAN RG4 G5 G5 PHARMACIST MUST CONTCT PLAN RG5 G6 G6 PHARM NOT IN SPECIALTY NETWK RG6 G7 G7 PHARM NOT IN HOME INF NETWK RG7 G8 G8 PHARM NOT IN LTC NETWORK RG8 G9 G9 PHARM NOT IN 90DAY RETAIL NTW RG9 GE INV % STAX INV PCNT SALES TAX AMT SUBM INV-PCNT-STAX-AMT GH 6H COUPON SEG REQ FOR ADJUD COUP-SEG-REQ H1 INV M TIME INV MEASUREMENT TIME INV-MEAS-TM H2 INV M DIM INV MEASUREMENT DIMENSION INV-MEAS-DIM H3 INV M UNIT INV MEASUREMENT UNIT INV-MEAS-UNIT H4 INV M VAL INV MEASUREMENT VALUE INV-MEAS-VALUE H5 INV PCPLOC INV PRIM CARE PROV LOC CD INV-PRI-CARE-PROV H6 INV DUR CA INV DUR CO-AGENT ID INV-DUR-CO-AGENT H7 INV OAC CT INV OTH AMT CLM SUBM COUNT INV-OAC-SUB-CNT H8 INV OAC QL INV OTH AMT CLM SUBM QUAL INV-OAC-SUB-QUAL H9 INV OAC SB INV OTH AMT CLAIMED SUBMITTED INV-OAC-SUB HA INV F STAX INV FLAT SALES TAX AMT SUBM INV-FLAT-STAX-AMT HB INV OP AMT INV OTH PAYER AMT PAID COUNT INV-OP-AMT-PD-CNT HC INV OPA Q INV OTH PAYER AMT PAID QUAL INV-OP-AMT-PD-QUAL HD INV DSP ST INV DISPENSING STATUS INV-DISP-STATUS HE INV % STS INV PCNT SALES TAX RATE SUBM INV-PCNT-STAX-SUBM HF QTY TB DSP INV QTY INTENDED TO BE DISP INV-QTY-TO-BE-DISP HG DS TB DSP INV DAYS SUP INTEND TO BE DISP INV-DS-TO-BE-DISP HN INV EMAIL INV PATIENT E-MAIL ADDRESS INV-PAT-EMAIL-ADDR J9 INV COAGNT INV DUR CO-AGENT ID QUALIFIER INV-DUR-CO-AGNT-ID JE INV STAX B INV PCNT SALES TAX BASIS SUBM INV-PCNT-STAX-BAS K5 K5 M/I TRANSACTION REF NUM RK5 KE INV COUPON INV COUPON TYPE INV-COUPON-TYPE M1 NOT COVER NOT COVERED IN THIS AID CATEG NOT-COV-AID-CAT M2 RECIP LOCK RECIPIENT LOCKED IN RECIP-LOCKED-IN M3 PA MC ERR HOST PA/MC ERROR HOST-PA-MC-ERR M4 RX NUM TIM RX NUM TIME LIMIT EXCEEDED RX-NUM-TIME-LMT M5 REQ MANUAL REQUIRES MANUAL CLAIM REQ-MANUAL-CLM M6 ELIG ERR HOST ELIGIBILITY ERROR HOST-ELIG-ERR M7 DRUG FL ER HOST DRUG FILE ERROR HOST-DRUG-FILE-ERR M8 PROV FL ER HOST PROVIDER FILE ERROR HOST-PROV-FILE-ERR ME INV COUPON INV COUPON NUMBER INV-COUPON-NUM MG INV OP BIN M/I OTHER PAYER BIN NUM INV-OP-BIN MH INV OP PCN M/I OTHER PAYER PCN INV-OPP-OCN MJ INV OP GRP M/I OTHER PAYER GROUP ID INV-OP-GROUP-ID MK INV BIN M NON-MATCHED OTHER PYR BIN NON-MTCH-OP-BIN MM INV PCN P NON-MATCHED OTHER PYR PCN NON-MTCH-OP-PCN MP NO CVRG CR OP CARDHOLDER ID NOT COVERED OP-CARDHLDR-NO-CVR MR PROD FMLY PRODUCT NOT ON FORMULARY PROD-NOT-FORMULARY MS MULT CRDHR MULTI-CARDHOLDER FOUND MULTI-CRDHDLR MT INV PT ASG M/I PT ASSIGN IND INV-PT-ASSGN-IND MU BENE ST CN M/I BENEFIT STAGE COUNT INV-BENE-ST-CNT MV MI BENE ST M/I BENEFIT STAGE QUAL INV-BENE-STAGE MW BENE ST AM M/I BENEFIT STAGE AMOUNT INV-BENE-ST-AMT MX BENE ST CN M/I BENEFIT STAGE COUNT ERROR BENE-ST-AMT-CNT MY INV ADR CN M/I ADDRESS COUNT INV-ADDR-CNT MZ ERR OVRFL ERROR OVERFLOW ERROR-OVERFLOW N1 PAT MATCH NO PATIENT MATCH FOUND NO-PT-MATCH N3 MCAID PD A M/I MEDICAID PAID AMOUNT INV-MCAID-PD-AMT N4 MCAID SUBR M/I MCAID SUBROGATION INT INV-MCAID-SUBR-INT N5 MCAID ID M/I MCAID ID NUMBER INV-MCAID-ID N6 MCAID AGCY M/I MCAID AGNCY NUM INV-MCAID-AGNCY N7 PA CODE USE PA CODE FOR TRANSITION USE-PA-CODE-N7 N8 PA EMER FI USE PA CODE FOR EMER FILL USE-PA-EMER-FILL N9 PA LOC CHG USE PA CODE FOR LEVEL OF CARE USE-PA-LOC NA INV-ADR Q M/I ADDRESS QUALIFIER INV-ADR-QUAL-NA NB INC CLNT M/I CLIENT NAME INV-CLIENT-NAME NC INV DISC D M/I DISCONTINUE DATE QUAL INV-DISC-DT-QUAL ND INV DSC DT M/I DISCONTINUE DATE INV-DISC-DT NE INV CP AMT INV COUPON VALUE AMT INV-COUPON-VAL-AMT NF EZ OP CAP M/I EASY OPEN CAP IND INV-EZ-CAP-IND NG INV EFF DT M/I EFFECTIVE DATE INV-EFF-DT-NG NH INV EXP DT M/I EXPIRATION DATE INV-EXPIR-DT NJ INV FILE T M/I FILE STRUCTURE TYPE INV-FILE-TYPE NK INACT PRES M/I INACTIVE PRESC IND INV-INACT-PRESC-IN NM LABEL DIR M/I LABEL DIRECTIONS INV-LABEL-DIRECTN NN TRANS REJ TRANS REJ AT SW/INTERMEDIARY TRANS-REJ-SW-INTER NP INV PP RSQ INV PAYER-PAT RESP AMT QUAL INV-OPP-RES-AMT-Q NQ INV PP RES INV PAYER-PAT RESP AMOUNT INV-OPP-RES-AMT NR INV PP REC INV PAYER-PAT RESP AMT COUNT INV-OPP-RES-AMT-CT NU CRDHLD NU M/I OTHER PAYER CARDHLDR ID INV-OP-CARDHLD-NU NV DELAY RSN M/I DELAY REASON CODE INV-DELAY-REASON NW RECENT DT M/I MOST RECENT DT FILLED INV-RECENT-DT NX SCC COUNT M/I SUB CLARIFICATION CD CNT INV-SUB-CC-COUNT NY NUM FILLS M/I NUMBER OF FILLS TO DATE INV-NUM-FILLS-NY P0 P0 NON-ZERO REQ FOR VACCINE AD RP0 P1 AS RX NF ASSOCIATED RX/SVC REF NUM NF AS-RX-SVC-REF-NF P2 CLIN OT SQ CLINICAL INFO CNTR OUT OF SEQ CL-IN-CNTR-OOS P3 CING NE RP CPD INGR COMP CNT NE REPTIONS CPD-ING-CNT-NE-REP P4 COB NE REP COB/OTH PY CNT NE REPETITIONS COB-OTH-CNT-NE-REP P5 COUP EXP COUPON EXPIRED COUPON-EXP P6 DOS LT DOB DATE OF SERVICE PRIOR TO DOB DOS-LT-DOB P7 DIAG NE RP DIAG CD CNT NE NUM REPETITIONS DIAG-CD-CNT-NE-REP P8 DUR PP OOS DUR/PPS CD CNTR OUT OF SEQ DUR-PPS-CD-CNT-OOS P9 FIELD NONR FIELD IS NON-REPEATABLE FIELD-NON-REPEATBL PA PA EX NR PA EXHAUSTED/NOT RENEWABLE PA-EXH-NOT-RENEW PB INV X4 CD INV TRANS CNT FOR TRANS CODE INV-TRANS-CNT-CD PC INV CLM SG INV CLAIM SEGMENT INV-CLM-SEG PD INV CLN SG INV CLINICAL SEGMENT INV-CLINICAL-SEG PE INV COB SG INV COB/OTHER PAYMENTS SEG INV-COB-OTH-PY-SEG PF INV CPD SG INV COMPOUND SEGMENT INV-CPD-SEG PG INV COU SG INV COUPON SEGMENT INV-COUPON-SEG PH INV DUR SG INV DUR/PPS SEGMENT INV-DUR-PPS-SEG PJ INV INS SG INV INSURANCE SEGMENT INV-INS-SEG PK INV PAT SG INV PATIENT SEGMENT INV-PAT-SEG PM INV PH SG INV PHARMACY PROVIDER SEG INV-PHARM-PROV-SEG PN INV PRS SG INV PRESCRIBER SEGMENT INV-PRES-SEG PP INV PRC SG INV PRICING SEGMENT INV-PRICING-SEG PQ PQ M/I NARRATIVE SEG RPQ PR INV PA SG INV PRIOR AUTH SEGMENT INV-PA-SEG PS INV TRH SG INV TRANSACTION HDR SEG INV-TRANS-HDR-SEG PT INV WC SG INV WORKERS COMP SEGMENT INV-WORK-COMP-SEG PU PU M/I NUM OF FILLS REMAINING RPU PV NM ASRX DT NON-MATCH ASSOC RX/SVC DT NONM-AS-RX-SVC-DT PW NM EMP ID NON-MATCHED EMPLOYER ID NONM-EMPLOYER-ID PX NM OTH PYR NON-MATCHED OTHER PAYER ID NONM-OTH-PYR-ID PY NM UNT FRM NON-MATCH UNIT FORM/RT ADMIN NONM-UNIT-FORM-ROA PZ NM UNT MEA NON-MATCH UNIT OF MEA TO PRD NONM-UNIT-MEA-PROD R0 R0 PROF SVC CD REQ FOR VACCINE RR0 R1 CSCT NE NR OTH AMT CLM SUB CT NE NUM REP OTH-AMT-CSCT-NE-NR R2 PRJ NE NR PYR REJ CT NE NUM REP OTH-PYR-RCT-NE-NR R3 CCT NE NR PROC MOD CODE CT NE NUM REP PROC-MOD-CCT-NE-NR R4 PMCC NE RP PROC MOD CD INV FOR PROD/SVC PROC-MOD-CD-INV-PS R5 PSID0 WH 6 PS ID MUST= 0 IF PS ID QUAL=6 PS-ID0-WHEN-QUAL6 R6 PS NOT APP PROD/SVC NOT APPR FOR LOC PS-NOT-APP-FOR-LOC R7 REP SEG NA REP SEG NOT ALLOWED IN SAME TR REP-SEG-NA-IN-SAME R8 SYNTAX ER SYNTAX ERROR SYNTAX-ERROR R9 GAD NF FRM VAL IN GR AMT DOES NF PRI FORM VAL-IN-GAD-NF-FORM RA PA REV OOO PA REVERSAL OUT OF ORDER PA-REV-OUT-OF-ORD RB MP NO ALWD MULT PARTIALS NOT ALLOWED MUL-PAR-NOT-ALLOWD RC ENT PR CM DIFF DRUG ENTITY-PARTIAL/COMP DIFF-DRG-ENT-PR-CM RD CH PR CM DIFF CRDHLDR/GRP ID-PART/COMP MISM-CH-GRP-PR-CM RE CPD PID QL INV COMP PROD ID QUALIFIER INV-CPD-PID-QUAL RF IMP DSP PR IMP ORD-DISP STAT CD PART FL IMP-DSP-STAT-PR-FL RG INV CMP TR IMV ASOC RX/SVC REF-CMP TRNS INV-ARX-SVC-REF-CM RH INV CMP DT INV ASOC RX/SVC REF DT-CMP TRA INV-ARX-SVC-DT-CM RJ PFIL NOF ASOC PARTIAL TRANS NOT ON FL ASOC-PFIL-NOT-FL RK PFIL NO SP ASOC PARTIAL TRANS NOT SUPRT PFIL-NOT-SUPPORTED RL RL TRANSITIONAL BENEFIT/RESUBMIT RRL RM FIELD SEQ MAND FIELDS OUT OF SEQUENCE FIELDS-OUT-OF-SEQ RN PL EXC PF PLAN LMT EXC ON INT PART FL PL-LIM-EXC-INT-PFV RP OOS P REV OUT OF SEQ P REV ON PART FL TR OOS-P-REV-PART-FL RQ RQ M/I ORIGINAL DISPENSED DATE RRQ RR RR M/I PAT ID QL COUNT RRR RS INV RX DT INV ASOC RX/SVC DT ON PART TR INV-ASOC-RX-SV-DT RT INV RX REF INV ASOC RX/SVC RF ON PART TR INV-ASOC-RX-SV-REF RU MAN BF OPT MAND DATA ELE MUST BE BEF OPT MAN-DAT-BF-OPT-DAT RV MUL RPT NS MUL REVERSALS PER TRANS NS MUL-REV-PER-TR-NS RW RW M/I PRESCRIBED DRUG DESC RRW RX RX M/I PRESCIBER ID COUNT RRX RY RY M/I PRESCIBER SPECIALTY RRY RZ RZ M/I PRESCIBER SPECIALTY CNT RRZ S0 S0 ACCUM MTH CNT NOT MATCH RS0 S1 INV ACC YR M/I ACCUMULATOR YEAR INV-ACCUM-YT S2 INV TRAN M/I TRANSACTION IDENTIFIER INV-TRAN-ID S3 INV PT OOP M/i ACCUM PT OOP AMT INV-ACCUM-PT-OOP S4 INV ACC AM M/I ACCUM GROSS COST AMT INV-ACCUM-CVD-AMT S5 INV-DT-TIM M/i DATE TIME INV-DATE-TIME S6 INV ACC MT M/I ACCUMULATOR MONTH INV-ACCUM-MONTH S7 INV ACCMTC M/I ACCUMULATOR MONTH CNT INV-ACCUM-MTH-CNT S8 NON-MTC TR NON-MATHCED TRAN ID NON-MATCH-TRAN-ID S9 INV-FIN-RP M/I FIN INOF TRAN SEG INV-FIN-INFO-RPT SA INV-QTY-DS M/I QTY DISPENSED TO DATE INV-QTY-DISP-TO-DT SB INV REC D M/I RECORD DELIMITER INV-REC-DELIMITER SC INV REM QT M/I REMAINING QTY INV-REM-QTY SD INV SENDR M/I SENDER NAME INV-SENDER-NAME SE INV PROC C M/I PROC MODIFIER CD COUNT INV-PROC-MOD-CD-CT SF INV OP AMT OTHER PYR AMT PD CNT ERROR OP-AMT-PD-CNT-ERR SG SCC CNT ER SUB CLARIF CD COUNT ERROR SCC-COUNT-ERROR SH OP PAT ERR OTHER PYR PT RESP CNT ERR OP-PAT-RSP-CNT-ERR SJ INV PH CNT M/I TOT CNT SEND/REC PHARM REC INV-CNT-PHARM-REC SK INV XFR FL M/I TRANSFER FLAG INV-TRANSFER-FLAG SM INV XFR TY M/I TRANSFER TYPE INV-TRANSFER-TYPE SN INV PKH CS M/I PACKAGE ACQ COST INV-PKG-ACQ-COST SP INV UNIQ I M/I UNIQUE REC ID INV-UNIQ-REC-ID SQ INV UNIQ Q M/I UNIQUE REC ID QUAL INV-UNIQ-REC-ID-QU SW PAT OOP AM ACC PAT OOP NEG AMT PAT-OOP-AMT-ERR T0 T0 ACCUM MTH CNT TOO LARGE RT0 T1 T1 REQUEST FINANCIAL SEQ REQ RT1 T2 T2 M/I REQUEST REFERENCE SEG RT2 T3 T3 OUT OF ORDER DATE TIME RT3 T4 T4 DUPLICATE DATE TIME RT4 TD TD M/I PHARMACIST INITIALS RTD TE INV CPD PR INV COMPOUND PRODUCT ID INV-CPD-PROD-ID TF TF M/I TECH INITIALS RTF TG TG ADDR CNT DOES NOT MATCH RTG TH TH PAT ID QL CNT DOES NOT MATCH RTH TJ TJ PRESC ID CNT DOES NOT MATCH RTJ TK TK PRESC SPEC CNT No MATCH RTK TM TM PHONE NUM CNT NO MATCH RTM TN TN EMER FILL/RESUBMIT CLAIM RTN TP TP LVL OF CARE CHG/RESUBMIT RTP TQ TQ DOSAGE EXCEEDS LBL LIMIT RTQ TR TR M/I BILLING ENTITY TY IND RTR TS TS M/I PAY TO QUALIFIER RTS TT TT M/I PAY TO ID RTT TU TU M/I PAY TO NAME RTU TV TV M/I PAY TO STREET ADDRESS RTV TW TW M/I PAY TO CITY ADDRESS RTW TX TX M/I PAY TO STATE ADDRESS RTX TY TY M/I PAY TO ZIP CD RTY TZ TZ M/I GENERIC EQ PROD ID QUAL RTZ U0 U0 M/I SENDING PHARMACY ID RU0 U7 U7 M/I PHARMACY SERVICE TYPE RU7 UA UA M/I GENERIC EQUIV PROD ID RUA UE INV CIB CD INV CPD ING BASIS OF CST DET INV-CPD-ING-BC-DET UU UU DAW0 NOT FOR AVAIL GENERICS RUU UZ UZ OTH PAYER CVRG TY REQ REVER RUZ V0 V0 M/I TELEPHONE NUM COUNT RV0 VA VA PAY TO QUAL NOT SUPPORTED RVA VB VB GENR EQUIV PROD ID QL NOT SUPT RVB VC VC PHARM SVC TY VALUE NOT SUPT RVC VD VD ELIG SEARCH TIME FRAME EXCEED RVD VE VE INV DIAGNOSIS CODE COUNT INV-DIAG-CD-CT W0 W0 M/I TELEPHONE NUM QUALIFIER RW0 W5 W5 M/I BED RW5 W6 W6 M/I FACILITY UNIT RW6 W7 W7 M/I HOURS OF ADMINISTRATION RW7 W8 W8 M/I ROOM RW8 W9 W9 ACCUM GROSS CVRD COST AMT RW9 WE INV DCD QU INV DIAGNOSIS CODE QUALIFIER INV-DIAG-CD-QUAL X0 X0 M/I ASSOC RX SVC FILL NUMBER RX0 X1 X1 ACCUM PT PAID EXCEEDS MAX RX1 X2 X2 ACCUM GROSS COST EXCEEDS MX RX2 X3 X3 ACCUM MONTHS OUT OF ORDER RX3 X4 X4 ACCUM YR NOT CURR OR PRIOR RX4 X5 X5 M/I FIN INFO RPT REQ INS SEG RX5 X6 X6 M/I REQUEST FINANCIAL SEG RX6 X7 X7 FIN INGO RPT REQ INS SEG RX7 X8 X8 PROC MOD CD CNT EXCEEDS MAX RX8 X9 X9 DIAG CD CNT EXCEEDS MAX RX9 XE INV CLINCT INV CLINICAL INFO COUNTER INV-CLIN-INFO-CT XZ XZ M/I ASSOCRX SVC REF NUM QUAL RXZ Y0 Y0 M/I PURCHASER LAST NAME RY0 Y1 Y1 M/I PURCHASER STREET ADDRESS RY1 Y2 Y2 M/I PURCHASER CITY ADDRESS RY2 Y3 Y3 M/I PURCHASER STATE CD RY3 Y4 Y4 M/I PURCHASER ZIP CD RY4 Y5 Y5 M/I PURCHASER COUNTRY CD RY5 Y6 Y6 M/I TIME OF SERVICE RY6 Y7 Y7 M/I ASSOC RX SVC PROV ID QUAL RY7 Y8 Y8 M/I ASSOC RX SVC PROV ID RY8 Y9 Y9 M/I SELLER ID RY9 YA YA COMP ING MOD CD CNT EXCEEDED RYA YB YB OTH AMT SUB CNT EXCEEDS MAX RYB YC YC OP REJ CNT EXCEEDS MAX RYC YD YD OP PAT RESP AMT CNT EXC MAX RYD YE YE SUB CLARIF CD CNT EXCEED MAX RYE YF YF QUEST NUM/LTR CNT EXCEEDS RYF YG YG BENEFIT STG CNT EXCEEDS MAX RYG YH YH CLIN INFO CNT EXCEEDS MAX RYH YJ YJ MEDICAID AGCY NUM NOT USED RYJ YK YK M/I SERVICE PROVIDER NAME RYK YM YM M/I SVC PROVIDER ST ADDRESS RYM YN YN M/I SVC PROVIDER CITY ADDRESS RYN YP YP M/I SVC PROVIDER ST ADDRESS RYP YQ YQ M/I SVC PROVIDER ZIP CD RYQ YR YR M/I PAT ID ASSOC ST ADDRESS RYR YS YS M/I PURCHASER RELATIONSHIP CD RYS YT YT M/I SELLER INITIALS RYT YU YU M/I PURCHASER ID QUAL RYU YV YV M/I PURCHASER ID RYV YW YW M/I PURCHASER ID ASOC ST CD RYW YX YX M/I PURCHASER DOB RYX YZ YZ M/I PURCHASER FIRST NAME RYZ Z0 Z0 PURCH COUNRTY CD NOT SUPP RZ0 Z1 Z1 PRESC ALT ID QUAL NOT SUPP RZ1 Z2 Z2 M/I PURCHASER SEG RZ2 Z3 Z3 PURCH SEG ON NON-CNTRL SUB RZ3 Z4 Z4 PURCH SEG REQ ON CONTROLLED RZ4 Z5 Z5 M/I SVC PROVIDER SEG RZ5 Z6 Z6 SVC PROV SEG ON NON-CONTRLD RZ6 Z7 Z7 SVC PROV SEQ REQ CONTROLLED RZ7 Z8 Z8 PURCH REL CD NOT SUPPORTED RZ8 Z9 Z9 PRESC ALT ID NOT COVERED RZ9 ZA ZA COB/OTHER PMNT SEQ REQ COB-OTH-PYMT-REQ ZB ZB M/I SELLER ID QUAL MI-SELLER-ID-QUAL ZC ZC ASSOC RX PRESC ID QUAL NOT ASSOC-PROV-ID-QL ZD ZD ASSOC RX REF NOT SUPPORTED ASSOC-RX-REF-QUAL ZE INV MEA DT INV MEASUREMENT DATE INV-MEAS-DT ZF ZF M/I SALES TRANSACTION ID MII-SALES-TRAN ZK ZK M/I PRESC ID ASSOC STATE CD RZK ZM ZM M/I PRESC ALT ID QUAL RZM ZN ZN PURCH ID QIAL NOT SUPP FOR PYR RZN ZP ZP M/I PRESC ALT ID RZP ZQ ZQ M/I PRESC ALT ID ASOC STATE CD RZQ ZS ZS M/I REPORTED PAYMENT TYPE RZS ZT ZT M/I RELEASED DATE RZT ZU ZU M/I RELEASED TIME RZU ZV ZV REPT PYMT TYPE NOT SUPPORTED RZV ZW ZW M/I COMPOUND PREP TIME RZW ZX ZX M/I CMS PART D CONTRACT ID RZX ZY ZY M/I MED PART D PBP RZY ZZ ZZ CRDHLD ID INACT NEW ID ON FILE RZZ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CLM-EXC-CD R-Reference Number:1737 Claim Exception Code Indicates the code (number) of the claim exception. Value Short Long Mnemonic 4001 MI BIN Missing/Invalid BIN INVALID-BIN 4002 MI Version Missing/Invalid Version INVALID-VERSION 4003 Unused Ver Unaccepted Version UNACCEPTED-VERSION 4004 MI Tran 32 Missing/Invalid Tran Code 3.2 INVALID-TRAN-32 4005 MI Tran 51 Missing/Invalid Tran Code 5.1 INVALID-TRAN-51 4006 Unused Trn Unaccepted Tran Code UNACCEPTED-TRAN 4007 MI Proc Missing/Invalid Processor INVALID-PROC 4010 InvMiss CH Invalid/Missing Cardholder INV-MISS-CARDHLDR 4023 InvMissDOS Invalid/Missing Date of Serv MISS-INV-DOS 4038 InvSIngCst Invalid Submitted Ingred Cost INV-SUBM-INGR-COST 4048 MI Req Typ Missing/Invalid Req Type INVALID-REQ-TYPE 4074 MI COB Ct Missing/Invalid COB Count INVALID-COB-CNT 4082 Bad Group Group Not Found GROUP-NOT-FOUND 4083 NoGrpFDOS Invalid Group on FDOS NONM-GROUP-ID-FDOS 4086 CrdHldrNF Cardholder (HH) ID Not Found CRDHLDR-NOT-FOUND 4088 MbrNotFnd Member ID Not Found MEMBER-NOT-FOUND 4097 Pat NotCov Patient Not Covered PAT-NOT-COV 4099 Pat NC COE Patient Not Covered COE PAT-NOT-COV-COE 4110 Cln Cnt Sq Clin Cnt Out of Sequence CLIN-CNT-OUT-OF-SQ 4111 Encdenial Encounter Claim Denial ENCDENIAL 4114 NotCovPlan Not Covered On Plan NOT-COVERD-ON-PLAN 4185 Exact Dup Exact Duplicate EXACT-DUPLICATE 4188 Sys Error System Error - Clm Not Process SYSTEM-ERROR 4211 MI Soft Vn Missing/Invalid Software Vend INVALID-SOFT-VEND 4212 MI Seg ID Missing/Invalid Segment ID INVALID-SEG-ID 4213 MI Tran Ct Missing/Invalid Trans Count INVALID-TRAN-CNT 4230 MIGrossAmt Missing Gross Amount GROSS-AMT-NOT-SENT 4236 MI CMPD Ct Missing/Invalid Compound Count INVALID-CMPD-CNT 4267 Inv COBP C COB Pd Cnt Does Not Match Subm MISMATCH-COB-PD-CT 4291 AidCatMsg Aid Category Msg Plan AID-CAT-MSG-PLAN 4297 Tran Ct Hi Trans Cnt to High for Tran Cd ONLY-1-TRAN-ALLW 4298 MI Clm Seg Missing/Invalid Claim Segment MISSING-CLM-SEG 4299 Inv Clm Sg Clm Seg Invalid with Request INVALID-CLM-SEG 4300 Inv Cln Sg Clin Seg Invalid with Request INVALID-CLIN-SEG 4303 Inv COB Sg COB Seg Invalid with Request INVALID-COB-SEG 4304 MisCmpdSeg Missing Compound Segment MISSING-CMPD-SEG 4305 Inv CPD Sg Cmpd Seg Invalid with Request INVALID-CMPD-SEG 4308 Inv DUR Sg DUR Seg Invalid with Request INVALID-DUR-SEG 4309 MisInsrSeg Missing Insurance Segment MISSING-INSR-SEG 4314 Inv Phm Sg Phrm Seg Invalid with Request INVALID-PHRM-SEG 4316 Inv Prs Sg Prsc Seg Invalid with Request INVALID-PRSC-SEG 4317 MisPrcSeg Missing Price Segment MISSING-PRIC-SEG 4318 Inv Prc Sg Pric Seg Invalid with Request INVALID-PRIC-SEG 4319 MisPASeg Missing Prior Auth Segment MISSING-PA-SEG 4320 Inv PA Seg PA Seg Invalid with Request INVALID-PA-SEG 4321 Inv Hdr Sg Missing/Invalid Hdr Segment INVALID-HDR-SEG 4324 Inv Wrk Sg Wrk Seg Invalid with Request INVALID-WRK-SEG 4327 Inv DUR Ct Missing/Invalid DUR/PPS Count INVALID-DUR-CNT 4328 Inv CMPD C CMPD Count Does Not Match Subm MISMATCH-CMPD-CNT 4329 Inv COB Ct COB Count Does Not Match Subm MISMATCH-COB-CNT 4331 Inv Diag C Diag Count Does Not Match Subm MISMATCH-DIAG-CNT 4332 DUR Cnt Sq DUR/PPS Cnt Out of Sequence DUR-CNT-OUT-OF-SEQ 4348 InvOAMT C Oth Amt Cnt Does Not Match Sub MISMATCH-OAMT-CNT 4349 Inv COBR C COB Rj Cnt Does Not Match Subm MISMATCH-COB-RJ-CT 4350 Inv PMod C PMod Cnt Does Not Match Subm MISMATCH-PMOD-CNT 4354 Repeat Seg Repeating Segment Not Allowed REPEAT-SEGMENT 4359 MI Diag Ct Missing/Invalid Diagnosis Cnt INVALID-DIAG-CNT 4361 Inv Clin C Missing/Invalid Clinical Count INVALID-CLIN-CNT 4364 TblsSysErr System Error- - Table Issues TBLS-SYSTEM-ERROR 4379 MbrLocked Member ID is Currently Locked MEMBER-IS-LOCKED 4384 Sbmt-41H Submt to primary processor 41H SUBMIT-TO-PRIM4384 4396 Sbmt-41Ga Submt to primary processor 41G SUBMT-TO-PRIM4396 4397 Sbmt-41Gb Submt to primary processor 41G SUBMT-TO-PRIM4397 4409 ClmTimeout POS Claim Processing Timeout POS-CLAIM-TIMEOUT 4410 SysNotAvai System Not Available SYS-NOT-AVAILABLE 4415 No Excepts No Exceptions Were Loaded NO-EXCEPTIONS-LOAD 4434 InvCHAltID Invalid Cardholder Alt ID INVALID-CH-ALT-ID 4437 InvBatchTy Invalid Batch Type Code INVALID-BATCH-TYPE 4438 InvLineCnt Invalid Line Item Count INVALID-LI-ITM-CNT 4658 MIUACamt Missing UAC Amount UAC-AMT-NOT-SENT 4689 NoMatGrpid Non-matched group-id NONMATCH-GROUP-ID 4751 InvMiINGrp Indiana Missing/Invalid Group INDIANA-MI-GROUP 4824 M/I COB Pt MisMatch COB Pat Resp Amt MISMATCH-COB-PT-CT 4825 M/I COB Bn MisMarch COB Benefit Stage MISMATCH-COB-BN-CT 4826 SubOvrdCT MisMatch Sub Clarif Cd MISMATCH-SUB-OVD 4827 InvSubOvrd Invalid Sub Clarif Cd INVALID-SUB-OVD-CT 4828 M/I CmpdMd MisMatch Compound Mod Cd MISMATCH-CMPDMOD 4829 InvCmpdMd Invalid Compound Mod Cd INVALID-CMPDMOD-CT 4841 InvU&CAmt Invalid U&C Charge Amount INV-UC-CHARGE-AMT 4866 PatNotCov Patient is Not Covered PAT-NOT-COVERED 4899 Max Excep Reached Max Allowed Exceptions MORE-THAN-MAX-EXC 4985 InvMbrSpan Invalid Member Span INVALID-MBRSPAN ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CLM-EXC-DISP-CD R-Reference Number:0156 Claim Exception Disposition Indicates claim actions possible when exceptions post. Value Short Long Mnemonic Bypass Bypass the Edit BYPASS 0 NotSpec Not Specified NOT-SPECIFIED 1 SuperSusp Super Suspend Clm on Revw SUPER-SUSP 2 Deny&Rpt Deny & Report Clm on Revw DENY-AND-REPORT 3 Deny Deny Claims on Review DENY 4 Suspend Suspend Claims on Review SUSPEND 5 Pay & Rpt Pay & Report Claims on Revw PAY-AND-REPORT 6 Pay Pay Claims on Review PAY R Reject Reject Claims on Review REJECT Z Ignore Ignore Claims on Review IGNORE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CMS-COD-CD R-Reference Number:1999 CMS COD A category that identifies whether or not a product meets the statutory definition of a covered outpatient drug in accordance with sections 1927(k)(2) to 1927(k)(4) of the Social Security Act. NDCs with a COD Status of DESI 5/6 are not eligible for coverage or rebates under the Medicaid Drug Rebate Program. Value Short Long Mnemonic 01 ANDA Abbrev New Drug Application ANDA 02 BLA Bioligical License Application BLA 03 NDA New Drug Application NDA 04 NDA generi NDA Authorized Generic NDA-AUTH-GENERIC 05 DESI5 LTE/IRS drug for all indic DESI5 06 DESI6 LTE/IRS drug withdrawn mtk DESI6 07 PreNatal RX PreNatal Vitamin/Fluoride RX-PRENATAL 08 Supplement RX Dietary Supplement RX-SUPPLEMENT 09 OTCtentati OTC Monograph Tentative OTC-TENTATIVE 10 OTCfinal OTC Monograph Final OTC-FINAL 11 UnappShort Unapproved Drug - shortage UNAPP-DRUG-SHORTAG 12 UnappII Unapproved1927(k)(2)(A)(ii) UNAPP-DRUG-II 13 UnappIII Unapproved 1927(k)(2)(A)(iii) UNAPP-DRUG-III ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CMS-DESI-CD R-Reference Number:5139 CMS Desi code VV Field: 1819 DESI Code. Value Short Long Mnemonic Not Spec Unspecified NOT-SPEC 0 No Info NDC not on HCFA Tape NO-INFO 1 Desi Desi DESI 2 No Desi Safe and Effective or Not Desi NO-DESI 3 Review Desi Under Review REVIEW 4 Lte Some Desi Lte For Some Indications LTE-SOME 5 NC Lte All Non Covered Le for all INDS NC-LTE-ALL 6 NC Off Mkt Non Covered Removed frm Market NC-OFF-MKT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CMS-SRC-CD R-Reference Number:9234 Source Code CMS Source Code. Value Short Long Mnemonic M MANUAL MANUAL ENTERED MANUAL S SYSTEM SYSTEM ENTERED SYSTEM ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CNTL-CD R-Reference Number:6217 Control Code Control Code. Value Short Long Mnemonic I Not Spec Code Not Specific NOT-SPEC M MAD Rev MAD Review MAD-REVIEW N No Control No Special Control NO-CONTROL S Suspend Suspend Code SUSPEND ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-COST-BASIS-CD R-Reference Number:0132 Ingredient cost basis Ingredient cost basis. This setting instructs PDCSx2 which set of prices to use from the Drug File and at what percentage reduction. Value Short Long Mnemonic A AWP - PC AWP LESS PERCENTAGE AWP-LESS-PERCENTAG B BLP - PC BASELINE LESS PERCENTAGE BLP-LESS-PERCENTAG C ACA FUL ACA Federal Upper Limit ACA-FED-UP-LMT D DIR - PC DIRECT LESS PERCENTAGE DIR-LESS-PERCENTAG E MDACAFUL Medi-Span ACA Fed Upper Limit MDSP-FED-UP-LMT F FMAC - PC FEDMAC LESS PERCENTAGE FMAC-LESS-PERCENTA G AMP - PC AMP LESS PERCENTAGE AMP-LESS-PERCENTAG H MDAWP-PC Medi-Span AWP Less Percentage MDSP-AWP-LESS-PCT I MDAWP+PC Medi-Span AWP Plus Percentage MDSP-AWP-PLUS-PCT J MDDIR-PC Medi-Span DIR Less Percentage MDSP-DIR-LESS-PCT K MDDIR+PC Medi-Span DIR Plus Percentage MDSP-DIR-PLUS-PCT L MDFUL-PC Medi-Span FUL Less Percentage MDSP-FUL-LESS-PCT M SMAC - PC STATE MAC LESS PERCENTAGE SMAC-LESS-PERCENTA N MDFUL+PC Medi-Span FUL Plus Percentage MDSP-FUL-PLUS-PCT O AMP + PC AMP PLUS PERCENTAGE AMP-PLUS-PERCENTAG P DIR + PC DIRECT PLUS PERCENTAGE DIR-PLUS-PERCENTAG Q SWP-PC SWP LESS PERCENTAGE SWP-LESS-PERCENTAG R SWP+PC SWP PLUS PERCENTAGE SWP-PLUS-PERCENTAG S SUB - PC SUBMITTED LESS PERCENTAGE SUB-LESS-PERCENTAG T SMAC * PC STATE MAC TIMES PERCENTAGE SMAC-TIMES-PERCENT U MDWAC-PC Medi-Span WAC Less Percentage MDSP-WAC-LESS-PCT V SMAC + PC STATE MAC PLUS PERCENTAGE SMAC-PLUS-PERCENT W WNUP + PC WNUP PLUS PERCENTAGE WNUP-PLUS-PERCENT X AWP + PC AWP PLUS PERCENTAGE AWP-PLUS-PERCENTAG Y MDWAC+PC Medi-Span WAC Plus Percentage MDSP-WAC-PLUS-PCT Z MAWP - PC MEDICAID AWP LESS PERCENTAGE MCAID-AWP-LESS-PC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CUST-DUPCK-CD R-Reference Number:0080 Dupe Check Code Duplication check code - blank means none Value Short Long Mnemonic None No Dup Check NONE C Customer Customer Dup Check CUSTOMER G Group Group Dup Check GROUP ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CUST-FEE-TY-CD R-Reference Number:0081 Customer Fee Type Code Type of Claim this fee applies to. E.G. Special; number of participants; POS; paper; card request; manual eligibility; PA. Value Short Long Mnemonic A Reversals Reversals REVERSALS B Paper Rev Paper Reversals PAPER-REVERSALS C Card Req Card Request Fee CARD-REQUEST-FEE E Employee Employee Fee EMPLOYEE-FEE F Adjustment Adjustments ADJUSTMENTS G Paper Adj Paper Adjustments PAPER-ADJUSTMENTS H Errotxnadj Error Trans Adjustment ERRON-TRANS-ADJUST J Pprerrtxad Paper Error Trans Adjustment PAPER-ERRON-TX-ADJ K SD-Revrsl Same Day Reversal SAME-DAY-REVERSAL L PaperSDRev Paper Same Day Reversal PAPER-SD-REVERSAL M Manual Adm Manual Eligibility Admin Fee MAN-ELIG-ADD-FEE N Participnt Number of Participants Fee PARTICIPANT-FEE P POS POS Claim Fee POS-CLAIM-FEE R Paper Paper Claim Fee PAPER-CLAIM-FEE S Special Special Fee SPECIAL-FEE-AMOUNT Z Manual Manual MANUAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CUST-HRARCHY-CD R-Reference Number:3232 Customer Hierarchy Code The code that identifies the category of data defined on the record (pharmacy, non-pharmacy, participant, etc) Value Short Long Mnemonic BI Participan Participant PARTICIPANT CP CustParts Customer Number of Partitions R-CUST-PARTS-NUM MK CustMnths Customer Months to Keep R-MONTHS-KEEP-NUM NP Non-Pharm Non-Pharmacy Provider NON-PHARMACY-PROV NX NonPharArc Non-Pahrmacy Archived Provider NON-PHARM-ARCHV PH Pharmacy Pharmacy Provider PHARMACY-PROV PX PharmArc Pharmacy-Archived Provider PHARMACY-ARCHV ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CUST-ID R-Reference Number:7281 Customer ID Customer ID uniquely identifies a customer for whom PDCSx2 is being run. Value Short Long Mnemonic 000111 HlthSource HealthSource-Hudson Hlth Plan HEALTHSOURCE-HHP 000501 KnightText Knight Textile Corp KNIGHT-TEXT-CORP 000644 HousHlthCa Houston Healthcare Complex HOUSTON-HLTHCARE 000680 HealthRigh HealthRight HEALTHRIGHT 000744 FamHlthCr1 Family Health Care Plus-1 FAM-HLTH-CRE-PLS-1 000747 FamHlthCr2 Family Health Care Plus-2 FAM-HLTH-CRE-PLS-2 000775 IA MCaid Iowa Medicaid IOWA-MCAID 000822 Mjoseph-1 Mjoseph & Associates-1 MJOSEPH-ASSOC-1 000823 Mjoseph-2 Mjoseph & Associates-2 MJOSEPH-ASSOC-2 000824 Mjoseph-3 Mjoseph & Associates-3 MJOSEPH-ASSOC-3 000833 FLHlthCar1 FL Health Care Plan - 1 FL-HLTH-CARE-PLAN1 000834 FLHlthCar2 Florida Health Care Plan - 2 FL-HLTH-CARE-PLAN2 000920 PalmettoBr Palmetto Brick PALMETTO-BRICK 002000 Kingsville Kingsville FFS Med Plans 2 & 3 KINGSVILLE-FFS-2-3 002007 FBJohnston Fred B. Johnston Company INC FRED-B-JOHNSTON-CO 002011 WPHD&G Wms,Prkr,Hrrisn,Dietz,GetzenPA WMS-PRKR-HRSN-DZ-G 002012 KingsFFS1 Kingsville FFS Med Plan 1 KINGSVILLE-FFS-1 002025 Aneco FFS Aneco FFS Plan ANECO-FFS 002030 TelephSvFL Telephone Services, Inc of FL TELEPHONE-SVC-FL 004300 ACS ACS ACS 004800 WesleyCom Wesley Commons WESLEY-COMMONS 005100 LeCreuset Le Creuset of America Inc LECREUSET-AMERICA 005500 ChargWool Chargeurs Wool, (USA) Inc CHARGEURS-WOOL 006420 MT MH Montana Mental Health MONTANA-MH 00T061 FL 1stAdm1 Florida 1st Administrators-1 FL-1ST-ADMIN-1 00T064 FL 1stAdm2 Florida 1st Administrators-2 FL-1ST-ADMIN-2 123123 FL MCaid Florida Medicaid FLORIDA-MCAID 150 MT MCaid Montana Medicaid MONTANA-MCAID 165 WV MCaid West Virginia Medicaid WEST-VA-MCAID 190 WY MCaid Wyoming Medicaid WYOMING-MCAID 200 FLCompHlth FL Comprehensive Hlth Assoc FL-COMP-HLTH-ASSOC 250 WA MCaid Washington Medicaid WASHINGTON-MCAID 300 WV WC West Virginia Workers' Comp WEST-VA-WC 333111 SCSrsSlvr SC Seniors - Silver Card SC-SENIOR-SLVR-CRD 555500 Healthspan Healthspan Hlth Plan HEALTHSPAN-HLTH-PL 555520 FlorimUSA Florim USA FLORIM-USA 555527 TennCare TennCare (Tennessee Mcaid) TENNCARE 555565 SmithMech Smith Mechanical Contract SMITH-MECH-CONT 555568 CentralDis Central Distributors CENTRAL-DISTRIBU 705000 R&B Inc R & B Inc R-B-INC COENCO CO ENCO Colorado Encounters CO-ENCO COLORA CO MCaid Colorado Medicaid COLORADO-MCAID ENT013 CtyCorpChr City of Corpus Christi CITY-CORPUSCHRIST ENT017 FndSteelWr Foundation Steel & Wire FOUND-STEEL-WIRE ENT018 BHMV B.H.M.V BHMV ENT023 RegTransAu Regional Transportation Author REG-TRANSPORT-AUTH ENT031 IndFabCorp Indust Fabricators CorpusChris IND-FAB-CORPUS-CHR ENT032 MemNeuro Memorial Neurological Assoc MEM-NEURO-ASSOC ENT037 StringerBu Stringer Business Systems STRINGER-BUS-SYS ENT039 Kingsville City of Kingsville CITY-OF-KINGSVILLE FHA001 BrandLable Brand Lable BRAND-LABLE FHA005 FoleyAssoc Foley & Associates FOLEY-ASSOC FHA014 Pajcic Pajcic & Pajcic PAJCIC-PAJCIC FHA016 CoastConst Coastal Construction Products COASTAL-CONST-PROD FHA024 LakeCareSy Lake Care Systems LAKE-CARE-SYSTEMS FHA025 ATP Tour ATP Tour ATP-TOUR FHA035 Timuquana Timuquana Country Club TIMUQUANA-CNTRY-CL FHA040 BartlettMg Bartlett Management Svcs BARTLETT-MGMT-SVC FHA041 Cl1&2 Harn Class I & II Harness CLASS-I-II-HARNESS FHA042 FL Schl Bk Florida School Book Depository FL-SCHL-BOOK-DEPOS FHA044 Leonards Leonards Studios LEONARDS-STUDIOS FHA045 SmthHlsyBs Smith, Hulsey & Busey SMITH-HULSEY-BUSEY FHA050 LorettoHos Loretto Hospital LORETTO-HOSPITAL FHA051 SkinnerNur Skinner Nurseries SKINNER-NURSERIES FHA052 Wolv Anest Wolverine Anesthesia Consult WOLVERINE-ANEST-CO FHA053 Oxbow Oxbow Corp & Affiliates OXBOW-CORP-AFFILIA FHA055 ManningBld Manning Building Supply MANNING-BLDG-SUP GEN001 EntrustStJ Entrust St John's Hospital ENTRUST-STJOHN-HOS GEN003 WebbMurr Webb, Murray & Assoc WEBB-MURRAY-ASSOC GEN008 EntrustGen Entrust Genex Plus Group ENTRUST-GENEX-PLUS GEN012 FportWeld Freeport Welding FREEPORT-WELDING GEN019 HoustonCar Houston Cardiovascular Assoc HOUSTON-CARDIOVASC GEN034 MeldenHunt Melden & Huntebpt MELDEN-HUNTEBPT GEN042 GulfCompre Gulf Compress EBPT GULFF-COMPRESS-EBP GEN046 AMFED AMFED Employer Svcs AMFED-EMPL-SVCS GEN048 HSConstr H & S Constructors Inc HS-CONSTRUCTORS GEN050 WmsPaving Williams Paving, Co LLC WMS-PAVING-CO GEN051 WilsonWeld Wilson's Welding Svc/EBPT WILSONS-WELD-EBPT GEN052 CorChrHsg Corpus Christi Housing Auth CORPUS-CHR-HSG-AUT HAWAII HI MCaid Hawaii Medicaid HAWAII-MCAID INCAID IN Hlth Indiana Medicaid - OMPP INCAID-HEALTH INSENR IN Seniors Indiana Seniors INDIANA-SENIORS LTCPA LTCPA LTC Card LTC-CARD MDADAP MD ADAP Maryland AIDS Drug Assistance MD-ADAP MDBCCD MD BCCD Maryland Breast Cervical Cance MD-BCCD MDKDP MD KDP Maryland Kidney Disease MD-KDP MDMEDI MD MCAID Maryland Medicaid MD-MEDI MISSIS MS MCaid Mississippi Medicaid MISSISSIPPI-MCAID MOSENR MO Seniors Missouri Seniors MISSOURI-SENIORS NCSENR NC Seniors North Carolina Seniors NC-SENIORS NEBMED NE MCaid Nebraska Medicaid NEBRASKA-MCAID NEWMEX NM MCaid New Mexico Medicaid NEW-MEXICO-MCAID NMENCO NMENCO New Mexico Encounters NEW-MEXICO-ENC OHBCMH OH BCMH OHIO MEDICAID OHIOBCMH-MCAID OHWORK OH WC Ohio Workers' Compensation OHIO-WORKERS-COMP OWCP DOL Department of Labor DEPT-OF-LABOR SCDMH SC DOMH SC Department of Mental Hlth SC-DEPT-MENT-HLTH ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-CUST-PART-NUM R-Reference Number:4329 Customer ID Partition Number Customer Identification Partition Number. This is used for the primary reason of the flexibility available with Partitioned Databases. This is the internal customer identifier that also serves to partition the database. This column is strictly for internal use only. It will be used in the keys of all tables that need to be linked to the customer. Use R_CUST_ID externally on all screens, reports, memos, etc. Value Short Long Mnemonic 0000 All Custs Applies to All Customers ALL-CUSTOMERS 0001 Mass Hlth Massachusetts Health MASSA-HEALTH 0100 IN Hlth Indiana Health INCAID-HEALTH 0200 WA MCaid Washington Medicaid WASHINGTON-MCAID 0300 DC ADAD DC ADAD (TrOOP) DC-ADAD 0400 NM MCaid New Mexico Medicaid NEW-MEXICO-MCAID 0500 IA MCaid Iowa Medicaid IOWA-MCAID 0600 NMENCO New Mexico Encounters NEW-MEXICO-ENC 0700 CO MCaid Colorado Medicaid COLORADO-MCAID 0800 OH WC Ohio Workers' Compensation OHIO-WORKERS-COMP 0900 MD MCAID Maryland Medicaid MD-MCAID 1000 HI MCaid Hawaii Medicaid HAWAII-MCAID 1010 WV WC West Virginia Workers' Comp WEST-VA-WC 1011 MD BCCDT Maryland BCCDT MD-BCCDT 1012 MD MADAP Maryland MADAP MD-MADAP 1013 MD KDP Maryland KDP MD-KDP 1015 COENCO Colorado Encounters COLORADO-ENC 1020 CtyCorpChr City of Corpus Christi CITY-CORPUSCHRISTI 1022 FLCompHlth FL Comprehensive Hlth Assoc FL-COMP-HLTH-ASSOC 1023 ACS ACS ACS 1025 HlthSource HealthSource-Hudson Hlth Pln HEALTHSOURCE-HHP 1027 HealthRigh HealthRight HEALTHRIGHT 1028 FL 1stAdm1 Florida 1st Administrators-1 FL-1ST-ADMIN-1 1029 MT MH Montana Mental Health MONTANA-MH 1030 FL 1stAdm2 Florida 1st Administrators-2 FL-1ST-ADMIN-2 1034 IN Seniors Indiana Seniors INDIANA-SENIORS 1035 MJoseph MJoseph MJOSEPH 1036 FLHlthCare FL Health Care Plan FL-HLTH-CARE-PLAN 1044 HousHlthCa Houston Healthcare Complex HOUSTON-HLTHCARE 1052 Aneco FFS Aneco FFS Plan ANECO-FFS 1053 SC DOMH SC Department of Mental Hlth SC-DEPT-MENT-HLTH 1056 FamHlthCr2 Family Health Care Plus-2 FAM-HLTH-CRE-PLS-2 1071 R&B Inc R & B Inc. R-B-INC 1081 Kingsville Kingsville FFS Med Plans 2&3 KINGSVILLE-FFS-2-3 1082 TelephSvFL Telephone Services, Inc of FL TELEPHONE-SVC-FL 1084 FlorimUSA Florim USA FLORIM-USA 1088 EntrustStJ Entrust St John's Hospital ENTRUST-STJOHN-HOS 1091 RegTransAu Regional Transportation Author REG-TRANSPORT-AUTH 1093 Kingsville City of Kingsville CITY-OF-KINGSVILLE 1094 Oxbow Oxbow Corp & Affiliates OXBOW-CORP-AFFILIA 1096 FamHlthCr1 Family Health Care Plus-1 FAM-HLTH-CRE-PLS-1 1098 KnightText Knight Textile Corp KNIGHT-TEXT-CORP 1099 AMFED AMFED Employer Svcs AMFED-EMPL-SVCS 1101 Healthspan Healthspan Hlth Plan HEALTHSPAN-HLTH-PL 1104 LorettoHos Loretto Hospital LORETTO-HOSPITAL 1107 FBJohnston Fred B. Johnston Company INC FRED-B-JOHNSTON-CO 1109 PalmettoBr Palmetto Brick PALMETTO-BRICK 1114 Cl1&2 Harn Class I & II Harness CLASS-I-II-HARNESS 1123 SmthHlsyBs Smith, Hulsey & Busey SMITH-HULSEY-BUSEY 1126 LeCreuset Le Creuset of America Inc LECREUSET-AMERICA 1130 WesleyCom Wesley Commons WESLEY-COMMONS 1131 WPHD&G Wms,Prkr,Hrrisn,Dietz,GetzenPA WMS-PRKR-HRSN-DZ-G 1133 SkinnerNur Skinner Nurseries SKINNER-NURSERIES 1136 StringerBu Stringer Business Systems STRINGER-BUS-SYS 1137 Wolv Anest Wolverine Anesthesia Consult WOLVERINE-ANEST-CO 1139 HSConstr H & S Constructors Inc HS-CONSTRUCTORS 1146 LakeCareSy Lake Care Systems LAKE-CARE-SYSTEMS 1150 FoleyAssoc Foley & Associates FOLEY-ASSOC 1154 WebbMurr Webb, Murray & Assoc WEBB-MURRAY-ASSOC 1155 BartlettMg Bartlett Management Svcs BARTLETT-MGMT-SVC 1157 SmithMech Smith Mechnical Contract SMITH-MECH-CONT 1164 ManningBld Manning Building Supply MANNING-BLDG-SUP 1172 CentralDis Central Distributors CENTRAL-DISTRIBU 1181 CoastConst Coastal Construction Products COASTAL-CONST-PROD 1184 CorChrHsg Corpus Christi Housing Auth CORPUS-CHR-HSG-AUT 1185 IndFabCorp Indust Fabricators CorpusChris IND-FAB-CORPUS-CHR 1187 FportWeld Freeport Welding FREEPORT-WELDING 1191 ATP Tour ATP Tour ATP-TOUR 1197 Leonards Leonards Studios LEONARDS-STUDIOS 1199 BrandLable Brand Lable BRAND-LABLE 1202 MemNeuro Memorial Neurological Assoc MEM-NEURO-ASSOC 1208 Pajcic Pajcic & Pajcic PAJCIC-PAJCIC 1210 HoustonCar Houston Cardiovascular Assoc HOUSTON-CARDIOVASC 1213 FL Schl Bk Florida School Book Depository FL-SCHL-BOOK-DEPOS 1223 BHMV B.H.M.V. BHMV 1225 Timuquana Timuquana Country Club TIMUQUANA-CNTRY-CL 1227 KingsFFS1 Kingsville FFS Med Plan 1 KINGSVILLE-FFS-1 1232 EntrustGen Entrust Genex Plus Group ENTRUST-GENEX-PLUS 1233 WilsonWeld Wilson's Welding Svc/EBPT WILSONS-WELD-EBPT 1236 FndSteelWr Foundation Steel & Wire FOUND-STEEL-WIRE 1237 MeldenHunt Melden & Huntebpt MELDEN-HUNTEBPT 1242 GulfCompre Gulf Compress EBPT GULF-COMPRESS-EBPT 1248 ChargWool Chargeurs Wool, (USA) Inc CHARGEURS-WOOL 1297 NC Seniors North Carolina Seniors NC-SENIORS 1320 WmsPaving Williams Paving Co, LLC WMS-PAVING-CO 1412 LTCPA LTCPA - Medicare D LTCPA-CMS 1500 DC MCaid DC Medicaid DC-MCAID 1600 FL MCaid Florida Medicaid FLORIDA-MCAID 1700 DC ADAP DC ADAP DC-ADAP 1800 DC ALLI DC ALLIANCE DC-ALLI 1810 WY MCaid Wyoming Medicaid WYOMING-MCAID 1815 OH BCMH OHIO BCMH OHIO-BCMH 1820 MO Seniors Missour Seniors MISSOURI-SENIORS 1900 MT MCaid Montana Medicaid MONTANA-MCAID 2000 DOL Department of Labor DEPT-OF-LABOR 2001 NE MCaid Nebraska Medicaid NEBRASKA-MCAID 2100 OH MCaid Ohio Medicaid OHIO-MCAID ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DAY-SPLY-ACUM-CD R-Reference Number:3161 Days Supply Accumulation Code Days Supplied Accumulation Code Value Short Long Mnemonic A Edit All Edit All Drug Doses EDIT-ALL-DRUGS C Edit Acute Edit Acute Drugs Only EDIT-ACUTE N No Edit No Edit Required NO-EDIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DAY-SPLY-CVRG-CD R-Reference Number:7335 Days Supplied Coverage Code Days Supplied Coverage Code Value Short Long Mnemonic F Family Family FAMILY I Individual Individual INDIVIDUAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DAY-SPLY-SPN-CD R-Reference Number:8741 Days Supplied Span Code Days Supplied Span Code Value Short Long Mnemonic D Days Days DAYS M Months Months MONTHS Y Years Years YEARS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DAY-SPLY-STAT-CD R-Reference Number:6784 Days Supplied Status Code Days Supplied Status Code Value Short Long Mnemonic D PL Exceed Plan Limits Exceeded PLAN-LIM-EXCEEDED N No Edit No Edit Required NO-EDIT P PA Req Prior Authorization Required PA-REQUIRED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DED-ACUM-CD R-Reference Number:3406 Deductible accumulator Code Deductible accumulator indicator indicates whether a deductible must be met monthly, quarterly or annually. Value Short Long Mnemonic A Annaully Deductible to be met Annually DED-MET-ANNUALLY M Monthly Deductible to be met Monthly DED-MET-MONTHLY N None No time set to meet deductible DED-MET-NONE Q Quarterly Deductible to be met Quarterly DED-MET-QUARTERLY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DESI-DRUG-IND R-Reference Number:4746 DESI Drug Indicator DESI Drug Indicator indicates whether a DESI drug (a drug found on the HCFA Drug Efficacy Study Implementation list or a drug considered less than effective) should be covered or not covered by the plan. Value Short Long Mnemonic Not Enterd DESI Drug Not Specified NOT-SPECIFIED N Desi Nt Cv DESI Drug Not Covered DESI-DRUG-NOT-CVRD Y Desi Cvrd DESI Drug Covered DESI-DRUG-COVERED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DIAG-ABORT-IND R-Reference Number:1754 Diagnosis - Abort Indicator Indicates (Y/N) if diagnosis is related to an abortion procedure. Value Short Long Mnemonic N NO DIAG NO DIAGNOSIS ABORTION NO-DIAG-ABORT-IND Y DIAG ABORT DIAGNOSIS ABORTION PROCED DIAGNOSIS-ABORT-IN ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DIAG-EPSDT-IND R-Reference Number:1762 Diagnosis EPSDT Indicator Diagnosis EPSDT Indicator. Indicates whether this diagnosis is EPSDT related. Value Short Long Mnemonic N NO EPSDT NO EPSDT DIAGNOSIS IND NO-EPSDT-IND Y EPSDT IND EPSDT DIAGNOSIS IND EPSDT-IND ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DIAG-PA-IND R-Reference Number:1773 Ref Diagnosis PA Indicator VV Field: 0073 Indicates whether a prior authorization is required for the service type. Value Short Long Mnemonic A PA Always Prior Authorization Always PA-ALWAYS B PA Sometim Prior Authorization Sometimes PA-SOMETIM Z No PA No PriorAuthorization Required NO-PA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DIAG-SCRNG-CD R-Reference Number:0040 Diagnosis Screening code Indicates screening that occurred in relation to diagnosis. Value Short Long Mnemonic B DiabScrn Diabetes Screening DIABSCRN C Phys Exam Physical Examination PHYS-EXAM D Dent Scrn Dental Screening DENT-SCRN E Educ Scrn Education Screening EDUC-SCRN G GenitalScr Genital Screening GENITALSCR H Hear Scrn Hearing Screening HEAR-SCRN I ImmunScrn Immunization Screening IMMUNSCRN K Sickle Scr Sickle Cell Screening SICKLE-SCR L Dvlpm Scrn Developmental Screening DVLPM-SCRN M Med Scrn Medical Screening MED-SCRN N Nutr Scrn Nutrition Screening NUTR-SCRN O Other Lab Other Lab Screening OTHER-LAB P Lead Scrn Lead Screening LEAD-SCRN Q TB Scrn TB Screening TB-SCRN R CardioScrn Cardiovascular Screening CARDIOSCRN S Other Scrn Other Screening OTHER-SCRN T HGB-HCT HGB-HCT Screening HGB-HCT U Urine Scrn Urinalysis Screening URINE-SCRN V Vision Scr Vision Screening VISION-SCR Z None None NONE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DIAG-STERIL-IND R-Reference Number:1776 Ref Diagnosis Steril. Ind Indicates if diagnosis is sterilization related. Value Short Long Mnemonic N NO STERIL NO STERILIZATION DIAGNOSIS NO-STERILIZATION Y STERILIZAT STERILIZATION DIAGNOSIS IND STERILIZATION-IND ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DIS-DURAT-CD R-Reference Number:7241 Inferred Disease Duration A code indicating if the associated inferred disease occurs for a finite or infinite time period. Value Short Long Mnemonic F FINITE FINITE FINITE I INFINITE INFINITE INFINITE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DOSE-FMLY-DESC R-Reference Number:1824 Dosage Family Description Drug Dosage Formulary Description. Description of dose. Value Short Long Mnemonic 1B BLADIRRIG BLADDER IRRIGATION 1B-BLAD-IRRIG 1C CACHET CACHET 1C-CACHET 1D CAPHARD CAPSULE, HARD 1D-CAP-HARD 1E CAPSOFT CAPSULE, SOFT 1E-CAP-SOFT 1F COATEDTAB COATED TABLET 1F-COATED-TAB 1G COLLODION COLLODION 1G-COLLODION 1H COMPRLOZ COMPRESSED LOZENGE 1H-COMPR-LOZ 1I CONCHDSOL CONC FOR HAEMODIALYSIS SOLN 1I-CON-HDSOL 1J CONCRCTSOL CONC FOR RECTAL SOLUTION 1J-CON-RCT-SOL 1K CONCSOLINF CONC FOR SOLUTION FOR INFUSION 1K-CON-INF-SOL 1L CONCSOLINJ CONC FOR SOLN FOR INJECTION 1L-CON-INJ-SOL 1M CUTANEMUL CUTANEOUS EMULSION 1M-CUTAN-EMUL 1N CUTANFOAM CUTANEOUS FOAM 1N-CUTAN-FOAM 1O CUTANPASTE CUTANEOUS PASTE 1O-CUTAN-PASTE 1P CUTANPWD CUTANEOUS POWDER 1P-CUTAN-POWDER 1Q CUTANSOL CUTANEOUS SOLUTION 1Q-CUTAN-SOL 1R CUTANSPPWD CUTANEOUS SPRAY, POWDER 1R-CUTAN-SP-PWD 1S CUTANSPSOL CUTANEOUS SPRAY, SOLUTION 1S-CUTAN-SP-SOL 1T CUTANSPSUS CUTANEOUS SPRAY, SUSPENSION 1T-CUTAN-SP-SUS 1U CUTANSTICK CUTANEOUS STICK 1U-CUTAN-STICK 1V CUTANSUS CUTANEOUS SUSPENSION 1V-CUTAN-SUS 1W DENTALEML DENTAL EMULSION 1W-DENTAL-EMUL 1X DENTALGEL DENTAL GEL 1X-DENTAL-GEL 1Y DENTALPOWD DENTAL POWDER 1Y-DENTAL-POWDER 1Z DENTALSOLN DENTAL SOLUTION 1Z-DENTAL-SOLN 2A DENTALSTCK DENTAL STICK 2A-DENTAL-STICK 2B DENTALSUS DENTAL SUSPENSION 2B-DENTAL-SUSP 2C EARCREAM EAR CREAM 2C-EAR-CREAM 2D EARDROPEML EAR DROPS, EMULSION 2D-EAR-DROP-EMUL 2E EARDROPSOL EAR DROPS, SOLUTION 2E-EAR-DROP-SOL 2F EARDROPSUS EAR DROPS, SUSPENSION 2F-EAR-DROP-SUSP 2G EARGEL EAR GEL 2G-EAR-GEL 2H EAROINT EAR OINTMENT 2H-EAR-OINT 2I EARPOWDER EAR POWDER 2I-EAR-POWDER 2J EARSPYEMUL EAR SPRAY, EMULSION 2J-EAR-SPRAY-EMUL 2K EARSPYSOLN EAR SPRAY, SOLUTION 2K-EAR-SPRAY-SOLN 2L EARSPYSUSP EAR SPRAY, SUSPENSION 2L-EAR-SPRAY-SUSP 2M EARSTICK EAR STICK 2M-EAR-STICK 2N EARTAMPON EAR TAMPON 2N-EAR-TAMPON 2O EARWSHEMUL EAR WASH, EMULSION 2O-EAR-WASH-EMUL 2P EARWSHSOLN EAR WASH, SOLUTION 2P-EAR-WASH-SOLN 2Q EFFVAGTAB EFFERVESCENT VAGINAL TABLET 2Q-EFF-VAG-TAB 2R EMULINFUS EMULSION FOR INFUSION 2R-EMUL-INFUS 2S EMULINJECT EMULSION FOR INJECTION 2S-EMUL-INJECT 2T ENDOCERGEL ENDOCERVICAL GEL 2T-ENDO-CERV-GEL 2U ETPIPSSOL ENDOTRACHEOPULMONARY INST PWDR 2U-ETPIPS-SOL 2V ETPIPWDSOL ENDOTRACHEOPULMONARY INST PWDR 2V-ETPIP-PWD-SOL 2W ETPISOLN ENDOTRACHEOPULMONARY INST SOLN 2W-ETPIP-SOLN 2X ETPISUSP ENDOTRACHEOPULMONARY INST SUSP 2X-ETPIP-SUSP 2Y EYECREAM EYE CREAM 2Y-EYE-CREAM 2Z EYDRPPSSOL EYE DROPS, PWDR/SOLV FOR SOLN 2Z-EYE-DRP-PS-SOL 3A EYDRPPSSUS EYE DROPS, PWDR/SOLV FOR SUSP 3A-EYE-DRP-PS-SUS 3B EYDROPPR EYE DROPS, PROLONGED RELEASE 3B-EYE-DROP-PR 3C EYDROPSOL EYE DROPS, SOLUTION 3C-EYE-DROP-SOLN 3D EYDROPREC EYE DROPS, SOLV FOR RECONSTIT 3D-EYE-DROP-SREC 3E EYDROPSUSP EYE DROPS, SUSPENSION 3E-EYE-DROP-SUSP 3F EYEGEL EYE GEL 3F-EYE-GEL 3G EYELOTION EYE LOTION 3G-EYE-LOTION 3H EYELOTSREC EYE LOTION, SOLV FOR RECONSTIT 3H-EYE-LOTION-SREC 3I EYEOINT EYE OINTMENT 3I-EYE-OINTMENT 3J FILMCOTTAB FILM COATED TABLET 3J-FILM-COT-TABL 3K GARGLE GARGLE 3K-GARGLE 3L GARGPWDSOL GARGLE, POWDER FOR SOLUTION 3L-GARGLE-PWD-SOL 3M GARGTABSOL GARGLE, TABLET FOR SOLUTION 3M-GARGLE-TAB-SOL 3N GRCAPHARD GASTRO-RESISTANT CAPSULE, HARD 3N-GR-CAP-HARD 3O GRCAPSOFT GASTRO-RESISTANT CAPSULE, SOFT 3O-GR-CAP-SOFT 3P GRGRANULES GASTRO-RESISTANT GRANULES 3P-GR-GRANULES 3Q GRTABLET GASTRO-RESISTANT TABLET 3Q-GR-TABLET 3R GASTROEEML GASTROENTERAL EMULSION 3R-GASTRO-EMUL 3S GASTROESOL GASTROENTERAL SOLUTION 3S-GASTRO-SOLN 3T GASTROESUS GASTROENTERAL SUSPENSION 3T-GASTRO-SUSP 3U GINGIVGEL GINGIVAL GEL 3U-GINGIV-GEL 3V GINGIVPAST GINGIVAL PASTE 3V-GINGIV-PASTE 3W GINGIVSOLN GINGIVAL SOLUTION 3W-GINGIV-SOLN 3X GRANORSOL GRANULES FOR ORAL SOLUTION 3X-GRAN-ORAL-SOLN 3Y GRANORSUS GRANULES FOR ORAL SUSPENSION 3Y-GRAN-ORAL-SUSP 3Z GRANSYRUP GRANULES FOR SYRUP 3Z-GRAN-SYRUP 4B IMPLCHAIN IMPLANTATION CHAIN 4B-IMPL-CHAIN 4C IMPLTABLET IMPLANTATION TABLET 4C-IMPL-TABLET 4D IMPRDRESS IMPREGNATED DRESSING 4D-IMPR-DRESS 4E INHALEMUL INHALATION EMULSION 4E-INHAL-EMUL 4F INHALGAS INHALATION GAS 4F-INHAL-GAS 4G INHALPWD INHALATION POWDER 4G-INHAL-PWD 4H INHPWDHDCP INHALATION POWDER, HARD CAP 4H-INHAL-PWD-HDCP 4I INHPWDPDSP INHALATION POWDER, PRE-DISPENS 4I-INHAL-PWD-PDSP 4J INHALSOLN INHALATION SOLUTION 4J-INHAL-SOLN 4K INHALSUSP INHALATION SUSPENSION 4K-INHAL-SUSP 4L INHVAPLIQ INHALATION VAPOUR, LIQUID 4L-INHAL-VAP-LIQ 4M INHVAPOINT INHALATION VAPOUR, OINTMENT 4M-INHAL-VAP-OINT 4N INHVAPSOL INHALATION VAPOUR, SOLUTION 4N-INHAL-VAP-SOL 4O INHVAPTAB INHALATION VAPOUR, TABLET 4O-INHAL-VAP-TAB 4Q MRCAPSULE MODIFIED RELEASE CAPSULE 4Q-MR-CAPSULE 4R MRGRANULES MODIFIED RELEASE GRANULES 4R-MR-GRANULES 4S MRTABLET MODIFIED RELEASE TABLET 4S-MR-TABLET 4T MWTABSOLN MOUTH WASH, TABLET FOR SOLN 4T-MW-TAB-SOLN 4U MABUCTAB MUCO-ADHESIVE BUCCAL TABLET 4U-MA-BUC-TAB 4V NASALCREAM NASAL CREAM 4V-NASAL-CREAM 4W NASDRPEML NASAL DROPS, EMULSION 4W-NASAL-DRP-EMUL 4X NASDRPSOL NASAL DROPS, SOLUTION 4X-NASAL-DRP-SOLN 4Y NASDRPSUS NASAL DROPS, SUSPENSION 4Y-NASAL-DRP-SUSP 4Z NASALGEL NASAL GEL 4Z-NASAL-GEL 5A NASOINT NASAL OINTMENT 5A-NASAL-OINT 5B NASPWD NASAL POWDER 5B-NASAL-POWDER 5C NASSPYEML NASAL SPRAY, EMULSION 5C-NASAL-SPRAY-EMU 5D NASSPYSOL NASAL SPRAY, SOLUTION 5D-NASAL-SPRAY-SOL 5E NASSPYSUS NASAL SPRAY, SUSPENSION 5E-NASAL-SPRAY-SUS 5F NASALSTICK NASAL STICK 5F-NASAL-STICK 5G NASALWASH NASAL WASH 5G-NASAL-WASH 5H OPTHINSERT OPTHALMIC INSERT 5H-OPTH-INSERT 5I ORALDRPEML ORAL DROPS, EMULSION 5I-ORAL-DRP-EMUL 5J ORALDRPSOL ORAL DROPS, SOLUTION 5J-ORAL-DRP-SOLN 5K ORALDRPSUS ORAL DROPS, SUSPENSION 5K-ORAL-DRP-SUSP 5L ORALEMUL ORAL EMULSION 5L-ORAL-EMUL 5M ORALGEL ORAL GEL 5M-ORAL-GEL 5N ORALLYOPH ORAL LYOPHILISATE 5N-ORAL-LYOPH 5O ORALPOWDER ORAL POWDER 5O-ORAL-POWDER 5P ORMCAPSOFT OROMUCOSAL CAPSULE, SOFT 5P-OROMU-CAP-SOFT 5Q OROMUDROPS OROMUCOSAL DROPS 5Q-OROMU-DROPS 5R OROMUGEL OROMUCOSAL GEL 5R-OROMU-GEL 5S OROMUPASTE OROMUCOSAL PASTE 5S-OROMU-PASTE 5T OROMUSOLN OROMUCOSAL SOLUTION 5T-OROMU-SOLN 5U OROMUSPSOL OROMUCOSAL SPRAY, SOLUTION 5U-OROMU-SPR-SOLN 5V OROMUSUSP OROMUCOSAL SUSPENSION 5V-OROMU-SUSP 5W PSENDOCGEL PWDR/SOLV FOR ENDOCERVICAL GEL 5W-PS-ENDOCRV-GEL 5X PSORALSOLN PWDR/SOLV FOR ORAL SOLUTION 5X-PS-ORAL-SOLN 5Y PSORALSUSP PWDR/SOLV FOR ORAL SUSPENSION 5Y-PS-ORAL-SUSP 5Z PSSOLINFUS PWDR/SOLV FOR INFUSION SOLUTN 5Z-PS-SOL-INFUS 6A PSSOLINJEC PWDR/SOLV FOR INJECTION SOLN 6A-PS-SOL-INJEC 6B PSSUSPINJ PWDR/SOLV FOR INJECTION SUSP 6B-PS-SUSP-INJEC 6C PBLADIRRIG POWDER FOR BLADDER IRRIGATION 6C-PWD-BLAD-IRRIG 6D POWDORSOLN POWDER FOR ORAL SOLUTION 6D-PWD-ORAL-SOLN 6E POWDORSUSP POWDER FOR ORAL SUSPENSION 6E-PWD-ORAL-SUSP 6F POWDRCTSOL POWDER FOR RECTAL SOLUTION 6F-PWD-RCTL-SOLN 6G POWDRCTSUS POWDER FOR RECTAL SUSPENSION 6G-PWD-RCTL-SUSP 6H POWDSOLINF POWDER FOR INFUSION SOLUTION 6H-PWD-SOLN-INF 6I POWDSOLINJ POWDER FOR INJECTION SOLUTION 6I-PWD-SOLN-INJ 6J POWDSUSINJ POWDER FOR INJECTION SUSPENS 6J-PWD-SUSP-INJ 6K POWDSYRUP POWDER FOR SYRUP 6K-PWD-SYRUP 6L PRESINHEML PRESSURIZED INHAL, EMULSION 6L-PRES-INH-EMUL 6M PRESINHSOL PRESSURIZED INHAL, SOLUTION 6M-PRES-INH-SOLN 6N PRESINHSUS PRESSURIZED INHAL, SUSPENSION 6N-PRES-INH-SUSP 6O PRCAPHARD PROLONGED RELEASE CAPSULE, HRD 6O-PR-CAP-HARD 6P PRCAPSOFT PROLONGED RELEASE CAPSULE, SFT 6P-PR-CAP-SOFT 6Q PRGRANULES PROLONGED RELEASE GRANULES 6Q-PR-GRANULES 6S RNGENERAT RADIONUCLIDE GENERATOR 6S-RN-GENERATOR 6T RPPRECURS RADIOPHARMACEUTICAL PRECURSOR 6T-RP-PRECURSOR 6U RECTCAPSFT RECTAL CAPSULE, SOFT 6U-RCTL-CAP-SOFT 6V RECTALCRM RECTAL CREAM 6V-RCTL-CREAM 6W RECTALEMUL RECTAL EMULSION 6W-RCTL-EMUL 6X RECTALFOAM RECTAL FOAM 6X-RCTL-FOAM 6Y RECTALGEL RECTAL GEL 6Y-RCTL-GEL 6Z RECTALOINT RECTAL OINTMENT 6Z-RCTL-OINTMENT 7A RECTALSOLN RECTAL SOLUTION 7A-RCTL-SOLN 7B RECTALSUSP RECTAL SUSPENSION 7B-RCTL-SUSP 7C RECTALTAMP RECTAL TAMPON 7C-RCTL-TAMPON 7D SEALANT SEALANT 7D-SEALANT 7E SOLNHAEMOD SOLUTION FOR HAEMODIALYSIS 7E-SOLN-HAEMOD 7F SOLNHFILTR SOLUTION FOR HAEMOFILTRATION 7F-SOLN-HFILTR 7G SOLINFUS SOLUTION FOR INFUSION 7G-SOLN-INFUS 7H SOLINJ SOLUTION FOR INJECTION 7H-SOLN-INJECT 7I SOLIOPHSIS SOLUTION FOR IONTOPHORESIS 7I-SOLN-IOPHSIS 7J SOLNORGPRS SOLN FOR ORGAN PRESERVATION 7J-SOLN-ORG-PRS 7L SOLVNPARNT SOLVENT FOR PARENTERAL USE 7L-SOLVNT-PARNT 7M STOMIRRIG STOMACH IRRIGATION 7M-STOM-IRRIG 7N SUSPINJECT SUSPENSION FOR INJECTION 7N-SUSP-INJECT 7O TABRCTSOLN TABLET FOR RECTAL SOLUTION 7O-TAB-RCTL-SOLN 7P TABRCTSUSP TABLET FOR RECTAL SUSPENSION 7P-TAB-RCTL-SUSP 7Q TABVAGSOLN TABLET FOR VAGINAL SOLUTION 7Q-TAB-VAG-SOLN 7R TDPATCH TRANSDERMAL PATCH 7R-TD-PATCH 7S URETHGEL URETHRAL GEL 7S-URETH-GEL 7T URETHSTICK URETHRAL STICK 7T-URETH-STICK 7U VAGINCPHRD VAGINAL CAPSULE, HARD 7U-VAG-CAP-HARD 7V VAGINCPSFT VAGINAL CAPSULE, SOFT 7V-VAG-CAP-SOFT 7W VAGINCREAM VAGINAL CREAM 7W-VAG-CREAM 7X VAGDEVICE VAGINAL DEVICE 7X-VAG-DEVICE 7Y VAGINEMUL VAGINAL EMULSION 7Y-VAG-EMUL 7Z VAGINFOAM VAGINAL FOAM 7Z-VAG-FOAM 8A VAGINGEL VAGINAL GEL 8A-VAG-GEL 8B VAGINOINT VAGINAL OINTMENT 8B-VAG-OINTMENT 8C VAGINSOLN VAGINAL SOLUTION 8C-VAG-SOLN 8D VAGINSUSP VAGINAL SUSPENSION 8D-VAG-SUSP 8E VAGINTAB VAGINAL TABLET 8E-VAG-TAB 8F VAGINTAMP VAGINAL TAMPON 8F-VAG-TAMPON 8G WOUNDSTICK WOUND STICK 8G-WOUND-STICK AA AEROSOL AEROSOL (ML) AA-AEROSOL AB AEROSOL AEROSOL (GM) AB-AEROSOL AC AEROSOL AEROSOL (EA) AC-AEROSOL AD AER REFILL AEROSOL REFILL (ML) AD-AER-REFILL AE AER REFILL AEROSOL REFILL (EA) AE-AER-REFILL AF FOAM AEROSOL, FOAM AF-FOAM AG AER REFILL AEROSOL REFILL (GM) AG-AER-REFILL AH AER W/ADAP AEROSOL W/ADAPTER (ML) AH-AER-W-ADAP AI AER W/ADAP AEROSOL W/ADAPTER (EA) AI-AER-W-ADAP AJ AER W/ADAP AEROSOL W/ADAPTER (GM) AJ-AER-W-ADAP AK AER POWDER AEROSOL, POWDER (EA) AK-AER-POWDER AL AMPUL-NEB. AMPUL FOR NEBULIZATION (ML) AL-AMPUL-NEB AM MIST AEROSOL, MIST AM-MIST AN VIAL-NEB. VIAL, NEBULIZER AN-VIAL-NEB AO AER BR.ACT AEROSOL, BREATH ACTIVATED AO-AERO-BRTH-ACTV AP AERO POWD AEROSOL, POWDER (GM) AP-AERO-POWD AQ SPRAY SPRAY (GM) AQ-SPRAY AR SPRAY RFL SPRAY REFILL (ML) AR-SPRAY-RFL AS SPRAY AEROSOL, SPRAY (ML) AS-SPRAY AT SPRAY/PUMP AEROSOL, SPRAY W/PUMP (ML) AT-SPRAY-PUMP AU SPRAY SPRAY, NON-AEROSOL (ML) AU-SPRAY-NON-AERO AV FOAM (ML) FOAM (ML) AV-FOAM AW FOAM/APPL. AEROSOL, FOAM WITH APPLICATOR AW-FOAM-APPL AX SPRAY SPRAY, NON-AEROSOL (EA) AX-SPRAY-NON-AERO AY AER POW BA AEROSOL POWDER, BREATH ACTV AY-AERO-SPRAY AZ AERO POWD AEROSOL, POWDER (ML) AZ-AERO-POWDER BA BATH (EA) BATH (EA) BA-BATH BB BATH (ML) BATH (ML) BB-BATH BC BATH (GM) BATH (GM) BC-BATH BD SPRAY SPRAY, NON-AEROSOL (GM) BD-SPRAY-NON-AERO CA CAPSULE CAPSULE (HARD, SOFT, ETC.) CA-CAPSULE CB CAP.SR 12H CAPSULE, SUSTAINED REL, 12HR CB-CAP-SR-12HR CC CAP.SR 24H CAPSULE, SUSTAINED REL, 24HR CC-CAP-SR-24HR CD CAP W/DEV CAPSULE, W/ INHALATION DEVICE CD-CAP-WITH-DEV CE CAPSULE EC CAPSULE, ENTERIC COATED CE-CAPSULE-EC CF CAPSULE DR CAPSULE, DELAYED RELEASE CF-CAPSULE-EC CK CAP SPRINK CAPSULE, SPRINKLE CK-SPRINKLE CL SPRINKLE CAPSULE, SPRINKLE SUST ACTION CL-CAP-SPR-SA CO CAP12H PEL CAPSULE, 12HR SUST RELEASE PEL CO-CAP-12H-PEL CP CAP24H PEL CAPSULE, 24HR SUST RELEASE PEL CP-CAP-PELLET CQ CAP SEQ CAPSULE, SEQUENTIAL CQ-CAP-SEQ CS CAPSULE SA CAPSULE, SUSTAINED ACTION CS-CAPSULE-SA CT CAPSULE CR CAPSULE, DEGADABLE CTL RELEASE CT-CAPSULE-DCR DP DROPERETTE DROPERETTE, SINGLE-USE DRP DSP DP-DROPERETTE EA EACH EACH EA-EACH EB BAR BAR EB-BAR EC CAKE CAKE EC-CAKE ED MED. SOAP SOAP, MEDICATED (EA) ED-MED-SOAP EE LIQ. SOAP SOAP, LIQUID EE-LIQ-SOAP EF DENT. CONE DENTAL CONE EF-DENT-CONE EG STICK (GM) STICK (GM) EG-STICK EH STICK (EA) STICK (EA) EH-STICK EI CEMENT CEMENT (GM) EI-CEMENT EJ PLASTER PLASTER EJ-PLASTER EK POULTICE POULTICE EK-POULTICE EL MED. SWAB SWAB, MEDICATED EL-MED-SWAB EM MED. CONE CONE, MEDICATED EM-MED-CONE EN MED. TAPE TAPE, MEDICATED EN-MED-TAPE EP MED. SOAP SOAP, MEDICATED (ML) EP-MED-SOAP ER MED. SOAP SOAP, MEDICATED (GM) ER-MED-SOAP ET MED. PAD PADS, MEDICATED (EA) ET-MED-PAD FA FLASK (ML) FLASK FOR LIQUIDS FA-FLASK FB FLASK (GM) FLASK FOR SOLIDS FB-FLASK FI FILM FILM, MEDICATED FI-FILM FS SHEET SHEET (EA) FS-SHEET GA GAS GAS GA-GAS GH INHALER INHALER (ML) GH-INHALER GI INHALER INHALER (EA) GI-INHALER GJ INHALER INHALER (GM) GJ-INHALER GK DISK W/DEV DISK, WITH INHALATION DEVICE GK-DISK-WITH-INH GZ INHALERKIT INHALER KIT GZ-INHALER-KIT HA INFUS. BTL INFUSION BOTTLE (EA) HA-INFUS-BTL HB INFUS. BTL INFUSION BOTTLE (ML) HB-INFUS-BTL HC PIPETTE PIPETTE (EA) HC-PIPETTE HD PIPETTE PIPETTE (ML) HD-PIPETTE HE ALLERGEN ALLERGEN HE-ALLERGEN HF TINE,SUSP. TINE, SUSPENSION (EA) HF-TINE-SUSP HG AMP W/DEV. AMPUL WITH DEVICE (ML) HG-AMP-WITH-DEV HH AMPUL AMPUL (ML) HH-AMPUL HI CARTRIDGE CARTRIDGE (EA) HI-CARTRIDGE HJ CARTRIDGE CARTRIDGE (ML) HJ-CARTRIDGE HK FROZ.PIGGY IV SOLUTIONS, PIGGYBACK FROZEN HK-FROZEN-PIGGY HM IV SOLN. INTRAVENOUS SOLUTION HM-IV-SOLN HN PIGGYBACK INTRAVENOUS SOL, PIGGYBACK(EA) HN-PIGGYBACK HP PIGGYBACK INTRAVENOUS SOL, PIGGYBACK(ML) HP-PIGGYBACK HQ DISP SYRIN DISPOSABLE SYRINGE (ML) HQ-DISP-SYRIN HR AMPUL AMPUL (EA) HR-AMPUL HS VIAL VIAL(SDV, MDV OR ADDITIVE)(EA) HS-VIAL HT SKIN TEST SKIN TEST HT-SKIN-TEST HU PLAST. BAG PLASTIC BAG, INJECTION (EA) HU-PLAST-BAG HW ADD. SYRIN ADDITIVE SYRINGE HW-ADD-SYRIN HX DISP SYRIN DISPOSABLE SYRINGE (EA) HX-DISP-SYRIN HY IP SOLN. INTRAPERITONEAL SOLUTION HY-IP-SOLN HZ PLAST. BAG PLASTIC BAG, INJECTION (ML) HZ-PLAST-BAG IA IMPLANT IMPLANT (EA) IA-IMPLANT IGH-VALUE VIAL VIAL(SDV, MDV OR ADDITIVE)(ML) HV-VIAL JA JELLY JELLY JA-JELLY JB JEL JEL (ML) JB-JEL JC GEL GEL (ML) JC-GEL JD JEL JEL (GM) JD-JEL JE BEADS BEADS JE-BEADS JF GEL GEL (EA) JF-GEL JG GEL GEL (GM) JG-GEL JH PUDDING PUDDING (EA) JH-PUDDING JI GLOBULE GLOBULE JI-GLOBULE JJ PUDDING PUDDING (GM) JJ-PUDDING JS SOL-GEL GEL-FORMING SOLUTION JS-SOL-GEL JT JEL/PF APP JELLY W/ PREFILLED APPLIC (ML) JT-JEL-PF-APP JU GEL/PF APP GEL W/ PREFILLED APPLIC (GM) JU-GEL-PF-APPL JV GEL W/APPL GEL WITH APPLICATOR JV-GEL-APPL JW JELLY/APPL JELLY WITH APPLICATOR JW-JELLY-APPL JX GEL W/APPL GEL WITH APPLICATOR (ML) JX-GEL-WITH-APPL KA CREAM(GM) CREAM (GRAMS) KA-CREAM KL LUBRICANT LUBRICANT KL-LUBRICANT KM CREAM (ML) CREAM (ML) KM-CREAM KP PASTE PASTE KP-PASTE KT TOOTHPASTE TOOTHPASTE KT-TOOTHPASTE KV CRM/PF APP CREAM WITH PREFILLED APPL KV-CREAM-PF-APPL KW CREAM/APPL CREAM WITH APPLICATOR KW-CREAM-APPL OA OINT. (GM) OINTMENT (GM) OA-OINTMENT OB OINT. (ML) OINTMENT (ML) OB-OINTMENT OC OINT. (EA) OINTMENT (EA) OC-OINTMENT OV OIN/PF APP OINTMENT WITH P/F APPLICATOR OV-OINT-PF-APPL OW OINT/APPL. OINTMENT WITH APPLICATOR OW-OINT-APPL PA POWDER POWDER (GM) PA-POWDER PB LEAVES LEAVES (GM) PB-LEAVES PC CRYSTALS CRYSTALS PC-CRYSTALS PD SUSP RECON RECONSTITUTED SUSPENSION, ORAL PD-SUSP-RECON PE POWD EFFER POWDER EFFERVESCENT PE-POWDER-EFFER PF FLAKES FLAKES (GM) PF-FLAKES PG GRANULES GRANULES;POWDER-LIKE,NON-EFF PG-GRANULES PH DROP RECON DROPS, RECONSTITUTED, ORAL PH-DROP-RECON PI SOLN RECON SOLUTIONS, RECONSTITUTED, ORAL PI-SOLN-RECON PJ SUS.12H SR SUSPENSION, SUST RLS, 12HR PJ-SUS-12HR PK PATCH TDWK PATCH, TRANSDERMAL WEEKLY PK-PATCH-TD-WKLY PL CLEANSER CLEANSER PL-CLEANSER PM LUMP LUMP PM-LUMP PN CLEANSER CLEANSER PN-CLEANSER PO EFFPOWDPKT EFFERVESCENT POWDER IN PACKET PO-EFF-POWD-PKT PP PACKET PACKET PP-PACKET PQ PATCH TDBW PATCH, TRANSDERMAL BIWEEKLY PQ-PATCH-TD-BIWKLY PR PATCH TD72 PATCH, TRANSDERMAL 72 HOURS PR-PATCH-TD-72HR PS ADH. PATCH ADHESIVE PATCH, MEDICATED PS-ADH-PATCH PT TOOTH POWD TOOTH POWDER PT-TOOTH-POWD PU POWDER POWDER (EA) PU-POWDER PV PATCH TD24 PATCH, TRANSDERMAL 24 HOURS PV-PATCH-TD-24HR PW TEA (EA) TEA (EA) PW-TEA PX TEA (GM) TEA (GM) PX-TEA PY SUS.24H SR SUSPENSION, 24 HR SUST RELEASE PY-SUS-24HR-SR PZ SUSP PACKT SUSPENSION IN PACKET (EA) PZ-SUSP-PACKT QA SUPP.RECT SUPPOSITORY, RECTAL QA-SUPPOS QB INSERT INSERT QB-INSERT QC SUPP.VAG SUPPOSITORY, VAGINAL QC-SUPP-VAG QV VAG RING RING, VAGINAL QV-VAG-RING RA SOLTN(GM) SOLUTION (GM) RA-SOLUTION RB EMULSN(GM) EMULSION (GM) RB-EMULSION RC SHAMPO(GM) SHAMPOO (GM) RC-SHAMPOO RD SHAMPO LOT SHAMPOO LOTION (GM) RD-SHAMPOO-LOT RE SHAMPO CRM SHAMPOO CREAM (GM) RE-SHAMPOO-CRM RF SYRUP(GM) SYRUP (GM) RF-SYRUP RG SUS MC REC SUSP, MICROCAP RECONSTITUTED RG-SUS-MC-REC SA SOLUTION SOLUTION, TOPICAL/EENT SA-SOLUTION SB FL EXTRACT FLUID EXTRACT SB-FL-EXTRACT SC ORAL SUSP SUSP., ORAL (FINAL DOSE) (ML) SC-ORAL-SUSP SD DOUCHE DOUCHE SD-DOUCHE SE ELIXIR ELIXIR SE-ELIXIR SF ENEMA ENEMA (ML) SF-ENEMA SG ENEMA ENEMA (EA) SG-ENEMA SH EXPECT. EXPECTORANT SH-EXPECT SI LINIMENT LINIMENT SI-LINIMENT SJ SOLUTION SOLUTION, ORAL SJ-SOLUTION SK LOTION LOTION SK-LTION SL LIQUID LIQUID SL-LIQUID SM MOUTHWASH MOUTHWASH SM-MOUTHWASH SN DROPS SUSP SUSP, DROPS FINAL DOSAGE FRM SN-DROPS-SUSP SO DROPS DROPS SO-DROPS SP SPIRIT SPIRIT SP-SPIRIT SQ OIL OIL SQ-OIL SR SUSPENSION SUSPENSION, TOPICAL SR-SUSPENSION SS SHAMPOO SHAMPOO SS-SHAMPOO ST SYRUP SYRUP ST-SYRUP SU EMULSION EMULSION SU-EMULSION SV GRAN. EFF. GRANULES, EFFERVESCENT SV-GRAN-EFF SW IRRIG SOLN SOLUTION, IRRIGATING SW-IRRIG-SOLN SX TINCTURE TINCTURE SX-TINCTURE SY ORAL CONC. CONCENTRATE, ORAL SY-ORAL-CONC SZ LOTION LOTION SZ-LOTION TA TABLET TABLET TA-TABLET TB TABLET SOL TABLET, SOLUBLE TB-TABLET-SOL TC TAB CHEW TABLET, CHEWABLE TC-TAB-CHEW TD DISK DISK TD-DISK TE TABLET EC TABLET, ENTERIC COATED TE-TABLET-EC TF TABLET EFF TABLET, EFFERVESCENT TF-TABLET-EFF TG GUM GUM TG-GUM TH TABLET HYP TABLET, HYPODERMIC TH-TABLET-HYP TI TAB.SR 24H TABLET, SUST RLS, 24HR TI-TABLET-SR-24HR TJ TAB DISPER TABLET, DISPERSABLE TJ-TAB-DISPER TK GUM(GM) GUM (GM) TK-GUM TL LOZENGE LOZENGE TL-LOZENGE TM TAB.SR 12H TABLET, SUST RLS, 12HR TM-TABLET-SR-12HR TN TAB GRAN TABLET, GRANULE-LIKE OR PACKET TN-GRANULES TO TAB SR SEQ TABLET, SUST RELEASE 12HR SEQ TO-TAB-SR-SEQ TP PELLET PELLET TP-PELLET TQ TAB PRT SR TABLET, SUST REL PART/CRYSTALS TQ-TAB-PRT-SR TR TAB PART PARTICLES IN TABLET, PH DEPEND TR-TAB-PART TS TABLET SA TABLET, SUSTAINED ACTION TS-TABLET-SA TT TROCHE TROCHE TT-TROCHE TU TAB SUBL TABLET, SUBLINQUAL TU-TAB-SUBL TV TAB BUCCAL TABLE, BUCCAL TV-TAB-BUCCAL TW WAFER WAFER TW-WAFER TX PILL PILL TX-PILL TY TAB BUC SA TABLET, BUCCAL SUSTAINED ACTIO TY-TAB-BUC-SA TZ TAB SA OSM TABLET, OSMOTIC LASER-DRILLED TZ-TABLET-SA UA TABLET SEQ TABLET, SEQUENTIAL UA-TABLET-SEQ UB TAB MPHASE TABLET, MULTIPHASIC RELEASE UB-TAB-MPHASE UL TAB DIS LN TABLET, DISPERSIBLE LINGUAL UL-TAB-DIS-LN UN UNIT UNIT UN-UNIT WA WAX WAX (GM) WA-WAX WB TAR TAR (GM) WB-TAR WH WHIP WHIP (GM) WH-WHIP YA NEEDLE NEEDLE, REUSABLE YA-NEEDLE YB BULK BULK YB-BULK YC SYRINGE SYRINGE, REUSABLE YC-SYRINGE YD DIAPHRAGM DIAPHRAGM YD-DIAPHRAGM YE BANDAGE BANDAGE YE-DRESSING YF LENS LENS YF-LENS YG GAUZE GAUZE, NON-MEDICATED YG-GAUZE YH DIS NEEDLE NEEDLE, DISPOSABLE YH-DIS-NEEDLE YI IUD INTRAUTERINE DEVICE YI-IUD YJ CRWL SYRIN SYRINGE, CORNWALL YJ-CRWL-SYRIN YK KIT KIT YK-KIT YL DISP SYRIN SYRINGE, EMPTY DISPOSABLE YL-DISP-SYRIN YM PAD PAD YM-PAD YN TAMPON TAMPON YN-TAMPON YO TOWELETTE TOWELETTE YO-TOWELETTE YP IP SET INTRAPERITONEAL ADMIN. SETS YP-IP-SET YQ IV SET IV ADMIN. SETS - PARAPHERNALIA YQ-IV-SET YR STRIP STRIP YR-STRIP YS SUTURE SUTURE YS-SUTURE YT TAPE TAPE YT-TAPE YU IRRIG SET IRRIGATION SET YU-IRRIG-SET YV SPONGE SPONGE YV-SPONGE YW SWAB SWAB, NON-MEDICATED YW-SWAB YX IV ACCESS. IV ADMIXTURE ACCESSORIES YX-IV-ACCESS YY KIT,REFILL KIT,REFILL YY-KIT-REFILL YZ BLOOD SET BLOOD ADMINISTRATION SET YZ-BLOOD-SET ZA MISCELL. MISCELLANEOUS ZA-MISCELL ZB BOX BOX ZB-BOX ZC BOTTLE BOTTLE ZC-BOTTLE ZD COMBO. PKG COMBINATION PACKAGE ZD-COMBO-PKG ZE CARTON CARTON ZE-CARTON ZP PACKAGE PACKAGE ZP-PACKAGE ZT TRAY TRAY ZT-TRAY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRAMS-EXTRT-IND R-Reference Number:0859 DRAMS Extract Indicator Indicates whether the client will have claims extracted to be sent to DRAMS. Value Short Long Mnemonic N NO NO NO Y YES YES YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRAMS-TCNCNV-IND R-Reference Number:4696 DRAMS TCN Conversion Ind Indicates whether the TCNs of claims converted to X2 will be converted back to the original TCN for DRAMS. Value Short Long Mnemonic N NO NO NO Y YES YES YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRG-THR-CHAR3-CD R-Reference Number:1804 Ref Drug Thera Class Cd Indicates the therapeutic classes to which drugs and other prescribed agents may belong. Value Short Long Mnemonic A1A Glycosides Digitalis Glycosides GLYCOSIDES A1B Xanthines Xanthines XANTHINES A1C Inotropic Inotropic Drugs INOTROPIC A1D Broncho General Bronchodilator Agents BRONCHO A2A Arrhythmic Antiarrhythmics ARRHYTHMIC A4A Hypotensi3 Hypotensives, Vasodilators HYPOTENSI3 A4B Hypotensi2 Hypotensives, Sympatholytic HYPOTENSI2 A4C Hypotensiv Hypotensives, Ganglionic Block HYPOTENSIV A4D Hypotensi4 Hypotensives,Ace Blocking Type HYPOTENSI4 A4E Hypotensi5 Hypotensives,Veratrum Alkaloid HYPOTENSI5 A4F Hypotensi6 Hypoten, Angio Recptr Antag HYPOTENSI6 A4Y Hypotensi1 Hypotensives, Miscellaneous HYPOTENSI1 A6U Cardiovas Cardiovascular Diag-Radiopaqu CARDIOVAS A6V Cardiovas1 Cardiovascular Diag Non Radio CARDIOVAS1 A7A Arteriolar Vasoconstrictors, Arteriolar ARTERIOLAR A7B Coronary Vasodilators, Coronary CORONARY A7C Peripheral Vasodilators, Peripheral PERIPHERAL A7D Peripheral Vasodilators, Peripheral (cont PERIPHERAL1 A7E Vasodil Vasodilators, Miscellaneous VASODIL A7F Veinotoni Veinotonics/Vasculoprotectors VEINOTONI A7G Inhibit10 C-GMP Phosphodiesterase typ5 INHIBITOR10 A80 Venoscler Venosclerosing Agents VENOSCLER A9A Calcium Calcium Channel Blocking Agnts CALCIUM B0A Inhalation General Inhalation Agents INHALATION B0P Gases Inert Gases GASES B1A Surfactant Lung Surfactants SURFACTANT B3A Mucolytics Mucolytics MUCOLYTICS B3J Expectrnts Expectorants EXPECTRNTS B3K Cough/Cold Cough and Cold Preparations COUGH-COLD B3M Respiratry Respiratory Trct Radiopaq Diag RESPIRATRY B3N Decongesta Decongestant-analygesic-expect DECON-ANALG-EXPECT B3O Ana-1st-gn 1st Gen Antihistimine-deconges ANTIHST-DECON-ANA1 B3P Non-Narc-A Non-Narc Antituss-1stGen Antih NON-NARC-ANTITUSS1 B3Q NarcoticA Narcotic Antituss-1stGen Antih NARC-ANTITUSS1 B3R Non-Narc-A Non-Narcotic Antituss-1stGen A NON-NARC-ANTITUSS2 B3S Non-Narc-A Non-Narcotic Antituss-1stGen A NON-NARC-ANTITUSS3 B3T Non-Narcot Non-Narcotic Antitussive and E NON-NARC-ANTITUSS4 B3V 1st-Gen-An 1stGen Antihist-decongestant- ANTIHIST-DECONG-1S B3X 1st-Gen-An 1stGen Antihist-decongestant- ANTHST-DECONG-ANTI B3Y 1st-Gen-An 1stGen Antihist-decongestant- ANTHST-DECONG-EXP1 B3Z 1st-Gen-An 1stGen Antihist-expectorant ANTIHIST-EXPECTOR1 B4A Non-Narcot Non-Narcotic Antitussive-Analg NON-NARC-ANTITUS1 B4B Non-Narcot Non-Narcotic Antitussive-Analg NON-NARC-ANTITUS2 B4C NarcoticA Narcotic Antitussive-Anticholi NARC-ANTITUS-ANTIC B4D NarcoticA Narcotic Antitussive-Antihist NARC-ANTITUS-ANTIH B4E Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS3 B4G Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS4 B4H NarcoticA Narcotic Antitussive-Antihist NARCOTIC-ANTITUS5 B4I Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS6 B4J NarcoticA Narcotic Antitussive-Antihist NARC-ANTITUSS2 B4K NarcoticA Narcotic Antitussise-Decongest NARC-ANTITUSS3 B4L Non-Narcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS7 B4M Non-Narcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS8 B4N NarcAntit Narcotic Antituss-Antihist NARC-ANTITUSS4 B4P Non-NarcA Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS9 B4Q NarcoticA Narcarcotic-Antituss-Decongest NARC-ANTITUSS5 B4R NonNarcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS10 B4S Narcotic A Narc Antituss-Expectorant Comb NARC-ANTITUSS6 B4T Narcotic- Decongest Analgesic non-salica DECONGEST-ANALGESI B4U Decongesta Decongestant-anticholoiingert1 DECONGEST-ANTICHOL B4W Decongesta Decongestant-Expectorabt combo DECONGESTS-EXPECTO B4X Expectoran Expectorant combinations other EXPECTORANT-COMBIN B50 NON-NARCOT NON-NARC ANTITUSS-ANALGESIC NON-NARCOTIC-ANTIT B5D Decongest- Deconestant Analgesic DECONGEST-ANALGES2 B5E Decongest Decongest AnalgesicMixedZanth DECONGEST-ANALGES3 B5F DecongestA Decongest AnalgesicMixedZanth DECONGEST-ANALGES4 B5G DecongestA Decongestant, cookie spo;se DECONGEST-NSAID-CO B5H 1st-gen-an 1st Gen antihist, decon, nosay ANTIHIST-DECON-NSA B5I Decongest- Decongestant Analygesic nonsal DECONGEST-ANALGES5 B5J Decon-anal Decon Analgesic non-salicylat DECON-ANALGESIC B5K DECONGEST- DECON-ANALGESIC,SALICYLATE DECONGEST-ANALGES6 B5L GEN1 ANTIH GEN1ANTIHIST-DECON-ANALGESIC GEN1-ANTIHIST-DECO B5M 1ST GEN AN GEN1 ANTIHIST-DECONGEST-ANA GEN1-ANTIHIST-ANAL B5N 1ST GEN AN GEN1 ANTIHIST-DECON-ANALGES GEN1-ANTIHIST-DEC2 B5P DecongestA DECON-ANALGESIC,SALICYL-EXPECT DECON-ANALGESIC2 B5S 1ST GENERA GEN1 ANTIHISTAMINE-ANALGESIC GEN1-ANTIHIST2 B5T 1ST GENERA GEN1 ANTIHISTAMINE-Abalgesic GEN1-ANTIHIST3 BY4 Expectoran Expectorant mixtures EXPECTORANT-MIXTUR C0B Water Water WATER C0C Acidosis Drugs Used to Treat Acidosis ACIDOSIS C0D Alcoholic Antialcoholic Preparations ALCOHOLIC C0K Bicarbonat Bicabonate Producing/Contain BICARBONATE C1A Depleters Electrolyte Depleters DEPLETERS C1B Sodium Sodium/Saline Preparations SODIUM C1D Potassium Potassium Replacement POTASSIUM C1F Calcium1 Calcium Replacement CALCIUM1 C1H Magnesium Magnesium Replacement MAGNESIUM C1P Phosphate Phosphate Replacement PHOSPHATE C1W Electrolyt Electrolyte Maintenance ELECTROLYT C1Z Electroly1 Electrolyte Maintenance (cont) ELECTROLY1 C2H Gases1 Respiratory Gases GASES1 C3B Iron Iron Replacement IRON C3C Zinc Zinc Replacement ZINC C3H Iodine Iodine Containing Agents IODINE C3M Mineral Mineral Replacement, Misc. MINERAL C4G Insulins Insulins INSULINS C4K Hypoglyce1 Hypoglycem Insul Release Stim HYPOGLYCE1 C4L Hypoglycem Hypoglycem,Biguanid Non-Sulfon HYPOGLYCEM C4M Hypoglyce2 Hypo, Alpha-Glucosidase(N-S) HYPOGLYCE2 C4N Hypoglyce3 Hypo,Insulin-Respnse Inhans(NS HYPOGLYCE3 C4O Hypoglyce4 Hypo, Absorption Modifie( Unsp HYPOGLYCE4 C4P Hypoglyce5 Hypoglycemics, Unspec. Mech HYPOGLYCE5 C4Q Hypoglyce6 Hypoglycemics, Combination HYPOGLYCE6 C5A Carbo Carbohydrates CARBO C5B Protein Protein Replacement PROTEIN C5C Formulas Infant Formulas FORMULAS C5D Diet Foods Diet Foods DIET-FOODS C5E Geriatric Geriatric Supplements GERIATRIC C5F Food Supp Food Supplements, Misc. FOOD-SUPP C5G Food Oils Food Oils FOOD-OILS C5H Nucleic Nucleic Acid/Nucleotide Supp NUCLEIC C5J IV Sol3 IV Solutions: Dextrose/Water IV-SOL3 C5K IV Sol1 IV Solutions: Dextrose Saline IV-SOL1 C5L IV Sol2 IV Solutions: Dextrose/Ringers IV-SOL2 C5M IV Sol IV Sol: Dextrose/Lactact Ring IV-SOL C5N Protein1 Protein Replacement (Cont 1) PROTEIN1 C5O Solutions Solutions, Miscellaneous SOLUTIONS C5P Protein2 Protein Replacement (Cont 2) PROTEIN2 C5Q Tonic Tonic TONIC C5R IV-Sol4 IV Sol:Dextrose-Water (Cont1) IV-SOL4 C5S Protein3 Protein Replacement (Cont 3) PROTEIN3 C5T Food-Supp Food Supplements, Misc (Cont1) FOOD-SUPP1 C6A Vitamin A Vitamin A Preparations VITAMIN-A C6B Vitamin B Vitamin B Preparations VITAMIN-B C6C Vitamin C Vitamin C Preparations VITAMIN-C C6D Vitamin D Vitamin D Preparations VITAMIN-D C6E Vitamin E Vitamin E Preparations VITAMIN-E C6F Prenatal Prenatal Vitamin Preparations PRENATAL C6G Geriatric1 Geriatric Vitamin Preparations GERIATRIC1 C6H Pediatric Pediatric Vitamin Preparations PEDIATRIC C6J Bioflavon Bioflavonoids BIOFLAVON C6K Vitamin K Vitamin K Preparations VITAMIN-K C6L Vit B12 Vitamin B12 Preparations VIT-B12 C6M Folic Acid Folic Acid Preparations FOLIC-ACID C6N Niacin Niacin Preparations NIACIN C6P Panthenol Panthenol Preparations PANTHENOL C6Q Vitamin B6 Vitamin B6 Preparations VITAMIN-B6 C6R Vitamin B2 Vitamin B3 Preparations VITAMIN-B2 C6T Vitamin B1 Vitamin B1 Preparations VITAMIN-B1 C6Z Multi-Vit Multi-Vitamin Preparations MULTI-VIT C7A Inhibator Purine Inhibitors INHIBATOR C7B Inhibitor4 Decarboxylase Inhibitors INHIBITOR4 C7C Inhibitor5 Dipeptidase Inhibitors INHIBITOR5 C7D Metabolic1 Metabolic Deficiency Agents METABOLIC1 C7E Appetite Appetite Stimulants APPETITE C8A Poison2 Metallic Poison Agents POISON2 C8B Poison Acid & Alkali Poison Antidotes POISON C8D Poision1 Agricultural Poison Antidotes POISION1 C8E Antidotes Antidotes, Miscellaneous ANTIDOTES D0U Intestinal Gastrointestinal Radiopaq Diag INTESTINAL D1A Periodont Periodontal Collagenase Inhibi PERIDONTAL D1D Dental Dental Aids and Preparations DENTAL D2A Fluoride Fluoride Preparations FLUORIDE D2D Tooth Ache Tooth Ache Preparations TOOTH-ACHE D2M Dent Misc Dental Preparations Misc DENT-MISC D4A Acid Acid Replacement ACID D4B Antacids Antacids ANTACIDS D4C Stomatol Agents for Stomatological Use STOMATOLOGICAL D4D Antidiarrh Antidiarrheal Microorganisms ANTIDIARRHEAL D4E Antiulcer Antiulcer Preparations ANTIULCER D4F Antiulcer1 Anti-Ulcer-H. Pylori Agents ANTIULCER1 D4G Gas Enzyme Gastric Ensymes GAS-ENZYME D4H Mucositis Oral Mucositis/Stomatitis Agen MUCOSITIS D4I Mucositis2 Oral Mucositis/Stom Anti-Infla MUCOSITIS2 D4K Gastric Gastric Acid Secretion Reducer GASTRIC D4L Saliva Saliva Substitute Agents SALIVA D4N Flatulents Antiflatulents FLATULENTS D4T Gas Funct1 Gastric Function Diagnostics GAS-FUNCT1 D4U Gas Funct Gastric Funct Radiopaque Diag GAS-FUNCT D5A Fat-Absorp Fat Absorption Decreasing Agnt FAT-ABSORPTION D5P Intestina1 Intestinal Absorbnts/Protectnt INTESTINA1 D6A Colon Drgs to TX Chrnic Inflam Colon COLON D6D Diarrhea Antidiarrheals DIARRHEA D6H Hemorrhoid Hemorrhoidal Agents HEMORRHOID D6S Lax/Cath1 Laxatives and Cathartics LAX-CATH1 D6T Lax/Cath Laxatives & Cathartics (cont) LAX-CATH D7A Bile Salts Bile Salts BILE-SALTS D7B Choleretic Choleretics CHOLERETIC D7C Heptc-Diag Hepatic Diagnostics HEPATIC-DIAG D7J Heptc-Dysf Hepatic Dysftn Preven/Therapy HEPATIC-DYSF D7L Bile Salt Bile Salt Sequestrants BILE-SALT D7T Biliary1 Biliary Diagnostics BILIARY1 D7U Biliary Biliary Diagnostic, Radiopaque BILIARY D8A Enzymes1 Pancreatic Enzymes ENZYMES1 D8B Pancreatic Pancreatic Diagnostics PANCREATIC D9A Inhibitor2 Ammonia Inhibitors INHIBITOR2 F1A Androgenic Androgenic Agents ANDROGENIC F2A Impotency Drugs to treat Impotency IMPOTENCY G0U Uterine Uterine Radiopaque Diag Agnts UTERINE G1A Estrogenic Estrogenic Agents ESTROGENIC G1B Estro/Andr Estrogen/Androgen Combinations ESTRO-ANDR G2A Progest Progestational Agents PROGEST G2B Progest1 Progestational Agents (Cont 1) PROGEST1 G3A Oxytocics Oxytocics OXYTOCICS G8A Contracept Contraceptive, Oral CONTRACEPT G8B Contracep1 Contraceptives, Implantable CONTRACEP1 G8C Contracep3 Conctraceptives, Injectable CONTRACEP3 G9A Contracep2 Contraceptives, Intravaginal CONTRACEP2 H0A Anestheti3 Local Anesthetics ANESTHETI3 H0B Anestheti4 Local Anesthetics (cont1) ANESTHETI4 H0C Anestheti5 Local Anesthetics (cont2) ANESTHETIC5 H0E Mltpl-Scle Agents/ Treat Mltpl Sclerosis MLTPL-SCLEROSIS H1U Spinal Cerebral Spinal Radio Diag SPINAL H2A Nerv Syst Central Nervous Syst Stimulant NERV-SYST H2B Anestheti1 General Anesthetics, Inhalent ANESTHETI1 H2C Anesthetic General Anesthetic, Injectable ANESTHETIC H2D Barbiturat Barbiturates BARBITURAT H2E Barbitura1 Sedative-Hypno,Non Barbiturate BARBITURA1 H2F Anxiety Anti-Anxiety Drugs ANXIETY H2G Psychotic1 Anti-Psychotics,Phenothiazines PSYCHOTIC1 H2H Inhibitor6 Monoamine Oxidase(MAO) Inhibit INHIBITOR6 H2I Psychotic2 Anti-Psychotic,Phenothiaz(cnt1 PSYCHOTIC2 H2J Depressan1 Antidepressants DEPRESSAN1 H2K Depressant Antidepressant Combinations DEPRESSANT H2L Psychotics Anti-Psychotics,Non-Phenothiaz PSYCHOTICS H2M Anti-Mania Anti-Mania Drugs ANTI-MANIA H2N Depressan2 Antidepressants (cont) DEPRESSAN2 H2O Physotics2 Anti-Psych,Nn-Phenothiaz (con1 PSYCHOTICS2 H2P Anxiety1 Anti-Anxiety Drugs (cont) ANXIETY1 H2Q Babitura2 Sed-Hypno,Nn Barbiturate(con1 BARBITURA2 H2R Pruritics Anti-Pruritics PRURITICS H2T Alcohol Alcohol, Systemic Use ALCOHOL H2V Narco/Hype Anti-Narcolepsy/Anti-Hyperkin NARCO-HYPE H2Z Antagonis2 Benzodaizepine Antagonists ANTAGONIS2 H3A Analgesic1 Analgesics, Narcotics ANALGESIC1 H3B Analgesic2 Analgesics, Narcotics (cont) ANALGESIC2 H3C Analgesic3 Analgesics, Non-Narcotics ANALGESIC3 H3D Analgesic4 Analgesics, Salycylates ANALGESIC4 H3E Analgesic Analgesic/Antipyretic, Non-Sal ANALGESIC H3F Migraine Anit-Migraine Preparations MIGRAINE H3G Analgesics Analgesics, Miscellaneous ANALGESICS H3H Analgesic5 Analgesics Narc Anesth Adj ANALGESIC5 H3T Antagonis1 Narcotic Antagonists ANTAGONIS1 H3W Narcotic Narcotic Withdrawal Therpy NARCOTIC H4B Convulsnts Anti-Convulsants CONVULSNTS H4C Convulsan1 Anti-Convulsants (cont 1) CONVULSAN1 H4T Hallucingn Hallucinogens HALLUCINGN H5A Neurotonic Neurontonics/Cerebro Acc Agnt NEUROTONICS H5B Neuropathi Neuropathic Agents NEUROPATHIC H6A Anti-Park Anti-Parkinsonism Drugs, Other ANTI-PARK H6B Anti-Park1 Anti-Parkinsonism/Cholinergic ANTI-PARK1 H6C Antitussiv Antitussives, Non-Narcotic ANTITUSSIV H6D Antitusiv1 Antitussiv, Nn-Narcotic (con1) ANTITUSIV1 H6E Emetics1 Emetics EMETICS1 H6H Relaxants Skeletal Muscle Relaxants RELAXANTS H6I Amyotrophi Amyotrophic Lateral Scloerosis AMYOTROPHIC H6J Emetics Anti-Emetics/AntiVertigo Agent EMETICS H6L Movement Movement Disorders(Drug Therpy MOVEMENT H6N Antitussiv Antitussives, Narcotic ANTITUSSIVE J1A Parasympa Parasympathetic Agents PARASYMPA J1B Inhibitor3 Cholinesterase Inhibitors INHIBITOR3 J2A Alkaloids Belladonna Alkaloids ALKALOIDS J2B Cholinerg2 Anti-Cholinergics, Quaternary CHOLINERG2 J2C Cholinerg1 Anti-Cholinergics, Other CHOLINERG1 J2D Cholinergi Anti-Cholinergics/Antispasmodi CHOLINERGI J2E Clolinerg3 Anti-Cholingics/Antispas (con1 CLOLINERG3 J3A Stimulants Smoking Deter(Ganglionic Stim STIMULANTS J4A Block Agnt Ganglionic Blocking Agents BLOCK-AGNT J5A Adrenergi1 Adrenergic Agnt,Catecholamines ADRENERGI1 J5B Adrenergi2 Adrenergic,Aromat,non-Catechol ADRENERGI2 J5C Adrenergic Adrenergic Agents,Non-Aromatic ADRENERGIC J5D Adrenergi4 Beta-Adrenergic Agents ADRENERGI4 J5E Sympatho Sympathomimetic Agents SYMPATHO J5F Anaphylaxi Anaphylaxis Therapy Agents ANAPHYLAXIS J5G Adrenergi7 Beta-Adrenergics & Glucocortoi ADRENERGI7 J5H Adrenergi8 Adrenergic Vasopressor Agnts ADRENERGI8 J7A Adrenergi6 Alpha/Beta Adrenergic Block ADRENERGI6 J7B Adrenergi3 Alpha-Adrenergic Blocking Agnt ADRENERGI3 J7C Adrenergi5 Beta-Adrenergic Blocking Agnts ADRENERGI5 J7D Adrenergi9 Beta-Adrenergics Block (con1) ADRENERGI9 J8A Anorexic Anorexic Agents ANOREXIC J9A Intestina2 Intestinal Motility Stimulants INTESTINA2 J9B Spasmodic Antispasmodic Agents SPASMODIC L0B Enzymes3 Topcl/Muc Membr/Subcut Enzymes ENZYMES3 L0C Diabetic1 Diabetid Ulcer Prep, Topical DIABETIC1 L1A Psoriatic Antipsoriatic Agents, Systemic PSORIATIC L1B Acne Acne Agents, Systemic ACNE L1C Hypertrico Hypertricotic Agents, Systemic HYPERTRICHOTIC L2A Emollients Emollients EMOLLIENTS L3A Protective Protectives PROTECTIVE L3B Protectiv1 Protectives (Continued 1) PROTECTIV1 L3C Protectiv2 Protectives (Continued 2) PROTECTIV2 L3E Protectiv4 Protectives (Continued 3) PROTECTIV4 L3P Pruritics1 Anti-Pruritics, Topical PRURITICS1 L4A Astringent Astringents ASTRINGENT L5A Keratolyti Keratolytics KERATOLYTI L5B Sunscreens Sunscreens SUNSCREENS L5C Abrasives Abrasives ABRASIVES L5D Depilator Depilatories DEPILATOR L5E Seborrheic Antiseborrheic Agents SEBORRHEIC L5F Psoriatics Antipsoriatics Agents PSORIATICS L5H Acne1 Acne Agents, Topical ACNE1 L5I Wound Wound Healing Agents, Local WOUND L6A Irritants Irritants/Counter-Irritants IRRITANTS L6B Irritants1 Irritants/Counter-Irrit (cont) IRRITANTS1 L7A Shampoos Shampoos/Lotion SHAMPOOS L8A Deodorants Deodorants DEODORANTS L8B Antipersp Antiperspirants ANTIPERSP L9A Topical Topical Agents, Miscellaneous TOPICAL L9B Vitamin A1 Vitamin A Derivatives VITAMIN-A1 L9C Pigmentat Hypopigmentation Agents PIGMENTATION L9D Pigmentat1 Topical Hyperpigmentation Agnt PIGMENTATION1 L9E Topical 1 Topical Agents, Misc (cont 1) TOPICAL1 L9F Cosmetic Cosmetic/Skin Coloring/Dye Top COSMETIC M0A Blood7 Blood Components BLOOD7 M0B Plasma1 Plasma Proteins PLASMA1 M0C Blood1 Blood Factors, Miscellaneous BLOOD1 M0D Plasma Plasma Expanders PLASMA M0E Hemophilic Anti-Hemophilic Factors HEMOPHILIC M0F Factor IX Factor IX Preparations FACTOR-IX M0G Antiporphy Antiporphyria Factors ANTIPORPHY M0H Factor II Factor II Preparations FACTOR-II M0J Factor VII Factor VII Preparations FACTOR-VII M0K Factor X Factor X Preparations FACTOR-X M0R Blood Blood Albumin Preparations BLOOD M0S Blood6 Synthetic Blood Preparations BLOOD6 M0U Blood4 Blood Volume Diagnostics BLOOD4 M3A Blood5 Occult Blood Tests BLOOD5 M3B Blood3 Blood Urea Nitrogen Tests BLOOD3 M4A Blood2 Blood Sugar Diagnostics BLOOD2 M4B IV Fat IV Fat Emulsions IV-FAT M4E Lipotropic Lipotropics LIPOTROPIC M4F Leprotics1 Lipotropics, (cont) LEPROTICS1 M4G Hyprglycem Hyperglycemics HYPRGLYCEM M4H Lipids Agents /affect Cellular Lipids LIPIDS M93 Inhibtor11 Thrombin Inhibitor,Hirudin Typ INHIBITOR11 M9A Hemostatic Topical Hemostatics HEMOSTATIC M9D Fibrinolyt Anti-Fibrinolytic Agents FIBRINOLYT M9F Enzymes2 Thrombolytic Enzymes ENZYMES2 M9J Citrates Citrates as Anticoagulants CITRATES M9K Heparin Heparin & Related Preparations HEPARIN M9L Coagulant1 Oral Anticoagulants,Coumarin COAGULANT1 M9M Coagulant2 Oral Anticoagulants,Inandione COAGULANT2 M9P Inhibitor9 Platelet Aggregation Inhibitor INHIBITOR9 M9R Coagulants Coagulants COAGULANTS M9S Hemorrheol Hemorrheologic Agents HEMORRHEOL N1A Depressan3 Erythroid Depressants DEPRESSAN3 N1B Hematinics Hematinics, Other HEMATINICS N1C Stimulant1 Leukocyte (WBC) Stimulants STIMULANT1 N1D Platelet Platelet Reducing Agents PLATELET N1E Platelet1 Platelet Proliferation Stimula PLATELET1 P0A Fertility Fertility Stim Prep, Non FSH FERTILITY P0B Hormones2 Follicle Stim/Luteiniz Hormone HORMONES2 P0C Pregnancy Pregnancy Facilitng/Maint Horm PREGNANCY P1A Hormones3 Growth Hormones HORMONES3 P1B Somatostat Somatostatic Agents SOMATOSTAT P1C Luteiniz Luteinizing Hormones LUTEINIZ P1E Hormones Adrenocorticotrophic Hormones HORMONES P1F Pituitary Pituitary Suppressive Agents PITUITARY P1G Inhibitor Adrenal Steroid Inhibitors INHIBITOR P1U Metabolic Metabolic Function Diagnostics METABOLIC P2B Hormones1 Antidiuretic/Vasopressor Hormo HORMONES1 P2Z Pituitary1 Posterior Pituitary Prep PITUITARY1 P3A Hormones5 Thyroid Hormones HORMONES5 P3B Thyroid1 Thyroid Function Diagnostic Ag THYROID1 P3L Thyroid Anti-Thyroid Preparations THYROID P4A Hormones4 Parathyroid Hormones HORMONES4 P4L Bone Resor Bone Resorpr Suppress Agnt BONE-RESORPT P5A Glucocorti Glucocorticoids GLUCOCORTI P5B Glucocort1 Glucocorticoids(cont1) GLUCOCORT1 P5C Glucocort2 Glucocorticoids(cont 2) GLUCOCORT2 P5S Mineraloco Mineralocorticoids MINERALOCO P5T Antagonist Aldosterone Antagonists(Obsol) ANTAGONIST P6A Hormone Pineal Hormone Agents HORMONE Q0A Topical 13 Topical Prep,Non-Medicinal TOPICAL-13 Q1A Topical 10 Topical Ear Preparations TOPICAL-10 Q2U Eye Diag Eye Diagnostic Agents EYE-DIAG Q3A Rectal Rectal Preparations RECTAL Q3B Rectal1 Rectal/Lower Bowel Glucocort RECTAL1 Q3D Hemorrhoi1 Hemorrhoidal Preparations HEMORRHOI1 Q3H Anestheti2 Hemorrhoid,Local/Rectal Anesth ANESTHETI2 Q3S Laxatives Laxatives, Local/Rectal LAXATIVES Q4A Vaginal5 Vaginal Preparations VAGINAL5 Q4B Vaginal3 Vaginal Antiseptics VAGINAL3 Q4F Vaginal1 Vaginal Antifungals VAGINAL1 Q4G Vaginal7 Vaginal Antifungals-Antibact VAGINAL7 Q4K Vaginal4 Vaginal Estrogen Preparatioans VAGINAL4 Q4L Vanginal8 Vaginal Lubricants Preparation VAGINAL8 Q4R Vaginal2 Vaginal Antiparasiticts VAGINAL2 Q4S Vaginal6 Vaginal Sulfonamides VAGINAL6 Q4W Vaginal Vaginal Antibiotics VAGINAL Q5A Topical 14 Topical Preparations, Misc. TOPICAL-14 Q5B Topical 12 Topical Prep, Antibacterials TOPICAL-12 Q5C Topical 16 Topicals, Hypertrichotic Agent TOPICAL-16 Q5D Topical 08 Topical Antipsoriatics(obsol) TOPICAL-08 Q5E Topical 17 Topical Anti-Inflam Nn Steroid TOPICAL-17 Q5F Topical 03 Topical Antifungals TOPICAL-03 Q5G Topical 18 Topical Antifungals- Antibact TOPICAL-18 Q5H Topical 11 Topical Local Anesthetics TOPICAL-11 Q5I Topical 19 Topical Veinotonic/Vasculoprot TOPICAL-19 Q5J Topical 20 Top Hormonal, Otherwise Unspec TOPICAL-20 Q5L Bath Therapeutic Bath/Mineral Salts BATH Q5N Topical 05 Topical Antineoplastics TOPICAL-05 Q5O Topical-21 Top Antiedema/Anti Inflam Agnt TOPICAL-21 Q5P Topical 04 Top Antiinflammatory Steroidal TOPICAL-04 Q5Q Topical-22 Top Antibio-Antibac-Antifung- TOPICAL-22 Q5R Topical 06 Topical Antiparasitics TOPICAL-06 Q5S Topical 15 Topical Sulfonamides TOPICAL-15 Q5U Topical-23 Topical Cellulite Agents TOPICAL-23 Q5V Topical 09 Topical Antivirals TOPICAL-09 Q5W Topical 01 Topical Antibiotics TOPICAL-01 Q5X Topical-24 Top Antibio/Antiinflam Steroid TOPICAL-24 Q5Y Topical-25 Topical Androgenic Agents TOPICAL-25 Q6A Eye Prep Eye Preparations, Misc. EYE-PREP Q6B Eye Eye Anti-Infectives (RX Only) EYE Q6C Eye9 Eye Vasoconstrictors (RX Only) EYE9 Q6D Eye8 Eye Vasoconstrictor (OTC Only) EYE8 Q6E Eye5 Eye Irrigations EYE5 Q6F Cont Lens Contact Lens Preparations CONT-LENS Q6G Miotics Miotics/Othr Intraoc. Pres Red MIOTICS Q6H Eye6 Eye Local Anesthetics EYE6 Q6I Eye10 Eye Anitbiotic/Cortoid Combo EYE10 Q6J Mydriatics Mydriatics MYDRIATICS Q6K Ophthalmic Ophthalmic-Otic Combinations OPHTHALMIC Q6L Eye11 Eye Antioxidant, Local Agents EYE11 Q6M Ophthalmi1 Ophthalmic-Otic Anti-Infective OPHTHALMIC1 Q6N Ophthalmi2 Ophthalmic-Otic Antibiot-Corti OPHTHALMIC2 Q6O Ophthalmi3 Ophthalmic-Otic Anti-Inflammat OPHTHALMIC3 Q6P Eye3 Eye Antiinflammatory Agents EYE3 Q6Q Ophthalmi4 Ophthalmic-Otic Anitfungal Agn OPHTHALMIC4 Q6R Eye12 Eye Antihistamines EYE12 Q6S Eye7 Eye Sulfonamides EYE7 Q6T Tears Artificial Tears TEARS Q6V Eye4 Eye Antivirals EYE4 Q6W Eye2 Eye Antibiotics EYE2 Q6Y Eye Prep1 Eye Preparations, Misc. (OTC) EYE-PREP1 Q6Z Eye1 Eye Anti-Infectives,(OTC Only) EYE1 Q7A Nose Prep5 Nose Preparations, Misc. (RX) NOSE-PREP5 Q7B Nose Prep1 Nose Prep, Misc. Anti-Infectiv NOSE-PREP1 Q7C Nose Prep3 Nose Prep,Vasoconstrictor (RX) NOSE-PREP3 Q7D Nose Prep4 Nose Prep,Vasoconstrictor(OTC) NOSE-PREP4 Q7E Nasal Nasal Antihistamine NASAL Q7F Nasal1 Nasal Prep Anti-Inflamm-Antibi NASAL1 Q7G Nasal2 Nasal Prep Irritnts/Cntr-Irrit NASAL2 Q7H Nasal3 Nasal Mast Cell Stabilizers NASAN3 Q7P Nose Prep2 Nose Prep,Antiinflammatory NOSE-PREP2 Q7W Nose Prep Nose Prep, Antibiotics NOSE-PREP Q7Y Nose Prep6 Nose Preparations, Misc(OTC) NOSE-PREP6 Q8A Ear Prep4 Ear Preparation,Misc.(RX Only) EAR-PREP4 Q8B Ear Prep3 Ear Prep, Misc. Anti-Infective EAR-PREP3 Q8F Otic Prep Otic Prep, Anti-Inflam Antibio OTIC-PREP Q8H Ear Prep5 Ear Preparations, Local Anesth EAR-PREP5 Q8P Ear Prep1 Ear Prep, Antiinflammatory EAR-PREP1 Q8R Ear Prep2 Ear Prep, Ear Wax Removers EAR-PREP2 Q8W Ear Prep Ear Prep, Antibiotics EAR-PREP Q8Y Ear Prep6 Ear Preparations, Misc. (OTC) EAR-PREP6 Q9A Urological Urological Irrigations UROLOGICAL Q9B Prostate Benign Prostatic Hypetrophy PROSTATE R1A Urinary1 Urinary Tract Antispasmodic URINARY1 R1B Diuretics4 Osmotic Diuretics DIURETICS4 R1C Diuretics2 Inorganic Salt Diuretics DIURETICS2 R1D Diuretics3 Mercurial Diuretics DIURETICS3 R1E Inhibitor7 Carbonic Anhydrase Inhibitors INHIBITOR7 R1F Diuretics6 Thiazide & Related Diurectics DIURETICS6 R1G Diuretics7 Thiazide & Rltd Diuretics(cont DIURETICS7 R1H Diuretics5 Potassium Sparing Dirutetics DIURETICS5 R1J Diuretics Aminouracil Diuretics DIURETICS R1K Diuretics1 Diuretics, Miscellaneous DIURETICS1 R1L Diuretics9 Potassium Sparing Diur in Comb DIURETICS9 R1M Diuretic10 Loop Diuretics DIURETICS10 R1R Uricosuric Uricosuric Agents URICOSURIC R1S Urinary PH Urinary PH Modifiers URINARY-PH R1T Renal Comp Renal Competers RENAL-COMP R1U Renal Renal Function Diag Agnts RENAL R2U Urinary Urinary Tract Radiopaque Diag URINARY R3U Urine Tes1 Urine Glucose Test Aids URINE-TES1 R3V Urine Tes3 Urine Test Aids, Misc. URINE-TES3 R3W Urine Test Urine Acetone Test Aids URINE-TEST R3Y Urine Tes2 Urine Multiple Test Aids URINE-TES2 R3Z Urine Tes4 Urine Glucse/Acetone Tst Strip URINE-TES4 R4A Kidney Kidney Stone Agents KIDNEY R5A Urinary2 Urinary Tract Anest/Analg (Azo URINARY2 R5B Urinary3 Urinary Tract Analgesic Agents URINARY3 S1A Joint Tiss Joint Tissue Replacement JOINT-TISSU S2A Colchicine Colchicine COLCHICINE S2B Nsaids NSAids, Cyclooxygenase Inhib NSAIDS S2C Gold Salts Gold Salts GOLD-SALTS S2D Nsaids1 NSAids, Cyclooxygenase (cont1) NSAIDS1 S2E Nsaids2 Nsaids,Cyclooxygenase(cont2) NSAIDS2 S2G Bone Disor Drugs Acting on Bone Disorders BONE-DISORDER S2H AntiInflam Anti-Inflam, Antiarthriti Misc ANTI-INFLAMM S2I AntiInfla1 Anti-Inflam,Pyrimidine Synt In ANTI-INFLAMM1 S2J AntiInfla2 Anti-Inflam Tumor Necrosis Fct ANTI-INFLAMM2 S2L Nsaids3 Nsaids, Cyclooygenase 2 Inhib NSAIDS3 S7A Neuromusc Neuromuscular Blocking Agents NEUROMUSC S7B Muscle Skeletal Muscle, Others MUSCLE U5A Homeopath1 Homeopathic Drugs HOMEOPATH1 U5B Herb Drgs Herbal Drugs HERB-DRGS U5C Herb Drgs Herbal Drugs (cont 1) HERB-DRGS1 U5D Herb Drgs Herbal Drugs (cont 2) HERB-DRGS2 U5E Herb Drgs Herbal Drugs (cont 3) HERB-DRGS3 U5F Animl-Hmn Animal/Human Derived Agents ANIMAL-HUMAN U5G Herb Drgs Herbal Drugs (cont 4) HERB-DRGS4 U5H Herb Drgs Herbal Drugs (cont 5) HERB-DRGS5 U5I Herb Drgs Herbal Drugs (cont 6) HERB-DRGS6 U5J Herb Drgs Herbal Drugs (cont 7) HERB-DRGS7 U5X Anthroposo Anthroposophic Drugs ANTHROPOSOPHIC U6A Adjuvants1 Pharmaceutical Adjuvants, Tab ADJUVANTS1 U6B Adjuvants Pharm Adjuvants, Coating Agnts ADJUVANTS U6E Ointment1 Ointment/Cream Bases OINTMENT1 U6F Ointment Hydrophilic Cream/Ointment Bas OINTMENT U6H Solvents1 Solvents SOLVENTS1 U6J Solvents2 Solvents (Continued 1) SOLVENTS2 U6K Solvents3 Solvents (Continued 2) SOLVENTS3 U6L Solvents Solevents (Continued 3) SOLVENTS U6N Vehicles Vehicles VEHICLES U6P Vehicles1 Vehicles (Continued) VEHICLES1 U6S Propellant Propellants PROPELLANT U6T Propellan1 Propellants (Continued) PROPELLAN1 U6W Chemicals Bulk Chemicals CHEMICALS U7A Susp Agnts Suspending Agents SUSP-AGNTS U7B Susp Agnt1 Suspending Agents (Cont 1) SUSP-AGNT1 U7C Susp Agnt2 Suspending Agents (Cont 2) SUSP-AGNT2 U7D Surfactan1 Surfactants SURFACTAN1 U7E Surfactan2 Surfactants (Continued) SURFACTAN2 U7H Antioxidan Anticorrosive Agents ANTIOXIDAN U7J Chelating Chelating Agents CHELATING U7K Flav Agnts Flavoring Agents FLAV-AGNTS U7L Flav Agnt1 Flavoring Agents (Cont 1) FLAV-AGNT1 U7M Flav Agnt2 Flavoring Agents (Cont 2) FLAV-AGNT2 U7N Sweeteners Sweeteners SWEETENERS U7P Perfumes Perfumes PERFUMES U7Q Color Agnt Coloring Agents COLOR-AGNT U7R Color Agn1 Coloring Agents (Continued) COLOR-AGN1 U7Z Bondng Agn Bonding/Catalyst Agents BONDING-AGNTS V1A Alkylating Alkylating Agents ALKYLATING V1B Metabolite Anti-Metabolites METABOLITE V1C Alkaloids1 Vinca Alkaloids ALKALOIDS1 V1D Neoplasti1 Antibiotic Anti-Neoplastics NEOPLASTI1 V1E Neoplasti2 Steroid Anti-Neoplastics NEOPLASTI2 V1F Neoplastic Anti-Neoplastics, Misc. NEOPLASTIC V1G Therapeutc Redioactive Theraputic Agnts THERAPEUTIC V1H Neoplasti3 Antineoplastic, Misc. (cont 1) NEOPLASTI3 V1I Chemother1 Chemotherapy Antidotes CHEMOTHERA1 V1J Androgeni1 Antiandrogenic Agents ANDROGENIC1 V1K Neoplasti4 Antineoplastic Antibody/Antibd NEOPLASTI4 V2A Neoplasm Neoplasm Monoclonal Diag Agnt NEOPLASM W1A Penicillin Penicillins PENICILLIN W1B Cephalospo Cephalosporins CEPHALOSPO W1C Tetracycli Tetracyclines TETRACYCLI W1D Macrolides Macrolides MACROLIDES W1E Chloramph Chloramphenicol & Derivatives CHLORAMPH W1F Aminoglyco Aminoglycosides AMINOGLYCO W1G Antibioti1 Antitubercular Antibiotics ANTIBIOTI1 W1H Aminocycli Aminocyclitols AMINOCYCLI W1I Penicilli1 Penicillins (Continued) PENICILLI1 W1J Vancomycin Vancomycin and Derivatives VANCOMYCIN W1K Lincosamid Lincosamides LINCOSAMID W1L Topical 02 Antibiotics TOPICAL-02 W1N Polymyxin Polymyxin & Derivatives POLYMYXIN W1P Betalactam Betalactams BETALACTAM W1Q Quinolones Quinolones QUINOLONES W1R Inhibitors Beta-Lactamase Inhibitors INHIBITORS W1S Thienamyci Thienamycins THIENAMYCI W1T Cephalosp1 Cephalosporins (Continued) CEPHALOSP1 W1V Antibioti2 Steroidal Antibiotics ANTIBIOTI2 W2A Sulfonamid Absorbable Sulfonamides SULFONAMID W2B Sulfonami1 Non-Absorbable Sulfonamides SULFONAMI1 W2C Sulfonami2 Absorbable Sulfonamides (con 1 SULFONAMI2 W2E Mycobatrm Anti-Mycobaterium Agents MYCOBATRM W2F Nitrofuran Nitrofuran Derivatives NITROFURAN W2G Chemothera Chemotherapeutic,Antibact,Misc CHEMOTHERA W2Y Infective1 Anti-Infectives,Misc(Antibact) INFECTIVE1 W3A Antibiotic Antifungal Antibiotics ANTIBIOTIC W3B Antifungal Antifungal Agents ANTIFUNGAL W3C Antifunga1 Antifungal Agents (Continued) ANTIFUNGA1 W3D Antifunga2 Antifungal Agents (cont 2) ANTIFUNGA2 W4A Malarial Anti-Malarial Drugs MALARIAL W4C Amebacides Amebacides AMEBACIDES W4E Trichomon Trichomonacides TRICHOMON W4F Infectives Anti-Infect,Misc(Antiparasit) INFECTIVES W4K Protozoal Anti-Protozoal Drugs, Misc PROTOZOAL W4L Anthelmin Anthelmintics ANTHELMIN W4M Topical 07 Topical Antiparasitics (Cont) TOPICAL-07 W4N Repellants Insect Repellants REPELLANTS W4O Antihelmi1 Anthelmintics (cont 1) ANTHELMIN1 W4P Leprotics Anti-Leprotics LEPROTICS W4Q Inscticide Insecticides INSCTICIDE W5A Antivirals Antivirals, General ANTIVIRALS W5B Antiviral1 Antivirals, HIV-Specific ANTIVIRAL1 W5C Antiviral2 Antivirals, HIV-Spec Protease ANTIVIRAL2 W5D Antiviral3 Antiviral Monoclonal Antibodie ANTIVIRAL3 W5E HepatitisA Hepatitis A Treatment Agents HEPATITISA W5F HepatitisB Hepatitis B Treatment Agents HEPATITISB W5G HepatitisC Hepatitis C Treatment Agents HEPATITISC W70 Vaccine10 Gram Postve Rod/Bacillus Vacci VACCINES10 W7B Vaccines9 Viral/Tumorigenic Vaccines VACCINES9 W7C Vaccines4 Influenza Virus Vaccines VACCINES4 W7F Vaccines5 Mumps/Related Virus Vaccines VACCINES5 W7H Vaccines Enteric Virus Vaccines VACCINES W7I Immunosti Immunostimulants, Bacterial IMMUNOSTIMULANTS W7J Vaccines6 Neurotoxic Virus Vaccines VACCINES6 W7K Antisera Antisera ANTISERA W7L Vaccines2 Gram Positive Cocci Vaccines VACCINES2 W7M Vaccines3 Gram(-)Bacilli(Non-Enteric)Vac VACCINES3 W7N Vaccines8 Toxin-Prod Bacilli Vac/Toxoids VACCINES8 W7P Vaccines7 Rickettsial Vaccines VACCINES7 W7Q Vaccines1 Gram Negative Cocci Vaccines VACCINES1 W7R Vaccine11 Spirochete Vaccines VACCINES11 W7S Antivenins Antivenins ANTIVENINS W7T Skin Test Antigenic Skin Tests SKIN-TEST W7U Extracts1 Hymenoptera Extracts EXTRACTS1 W7V Extracts2 Rhus Extracts(Psn Oak,Psn Ivy) EXTRACTS2 W7W Extracts Allerginc Extracts,Therapeutic EXTRACTS W7X Bacteria Bacteria, Aerobic/Anaerobic Ag BACTERIA W7Y Fungi Fungi/Yeast Preparations FUNGI W7Z Vaccine Vaccine/Toxoid Prep,Combinatns VACCINE W8A Antisepti2 Heavy Metal Antiseptics ANTISEPTI2 W8B Actv Agnts Surface Active Agents ACTV-AGNTS W8C Antisepti3 Iodine Antiseptics ANTISEPTI3 W8D Oxidizing Oxidizing Agents OXIDIZING W8E Antiseptic Antiseptics, General ANTISEPTIC W8F Irrigants Irrigants IRRIGANTS W8G Antisepti1 Antiseptics, Miscellaneous ANTISEPTI1 W8H Mouthwash Mouthwashes MOUTHWASH W8I Antisepti4 Anticeptics, Misc (cont 1) ANTISEPTI4 W8J Antibctrl Antibacterial Agents, Misc. ANTIBCTRL W8K Antisepti5 Anticeptics, Misc (cont 2) ANTISEPTI5 W8T Preserv Preservatives PRESERV X0A Blood Test Blood Testing Prep, In-Vitro BLOOD-TEST X1A Condoms Condoms CONDOMS X1B Diaphragms Diaphragms/Cervical Cap DIAPHRAGMS X1C IUD IUD's IUD X1D Preg-test1 Pregnancy/Ovulation Tests (Obs PREG-TESTS1 X1F Preg-test2 Pregnancy Tests PREG-TESTS2 X1G Ovulation Ovulation Tests OVULATION X2A Needles Needles/Needleless Devices NEEDLES X2B Syringes Syringes & Accessories SYRINGES X3A Ostomy Ostomy Supplies OSTOMY X4B Incontinen Incontinence Supplies INCONTINEN X5A Med Supp Medical Supplies, Misc. MED-SUPP X5B Bandages Bandages,Gauze,Tape/Rel Supp BANDAGES X5C Med Supp1 Medical Supplies, Misc(Cont 1) MED-SUPP1 X5D Gloves Gloves GLOVES X5E Bandages1 Bandages & Reltd Supp (cont 1) BANDAGES1 X5F Aseptic Aseptic Tests & Accessories ASEPTIC X5G Gowns Gowns/Smocks GOWNS X6A Med Supp4 Medical Supplies,Misc(Cont 2) MED-SUPP4 X6D Dental1 Dental Supplies DENTAL1 X7A Contact Ln Contact Lens Prep.Gas,Hard Sft CONTACT-LNS X8A Admin Set1 Parenteral Admin Sets ADMIN-SET1 X8B Admin Sets Blood Administration Sets ADMIN-SETS X8C Admin Set2 Irrigation Administration Sets ADMIN-SET2 X8P Med Supp2 Medical Supplies, Misc(Cont 3) MED-SUPP2 X8V Med Supp3 Medical Supplies, Misc(Cont 4) MED-SUPP3 Y0A Med Equip2 Durable Medical Equip., Misc MED-EQUIP2 Y0B Crutches Crutches CRUTCHES Y0D Bed Boards Bed Boards BED-BOARDS Y0E Impotency1 Impotency Devices IMPOTENCY1 Y1A Feed Devic Feeding Devices FEED-DEVIC Y1B Thermomtr Thermometers THERMOMTR Y2G Clean Air Clean Air Centers CLEAN-AIR Y3A Med Equip Durable Med Equip,Misc(Grp 1) MED-EQUIP Y3C Med Equip1 Durable Med Equip,Misc(Grp 2) MED-EQUIP1 Y4A Cntraceptv Diaphragms CNTRACEPTV Y4B Catheters Catheters and Related Devices CATHETERS Y5A Braces Braces and Related Devices BRACES Y5C Wtr Bottle Hot Water Bottle&Reltd Devices WTR-BOTTLE Y7A Inhalers Respiratory Aids,Devices, Eqp INHALERS Y7B Procedural Medical Procedural Aids PROCEDURAL Y8A Hearng Aid Hearing Aids and Related Devic HEARNG-AID Y8B Rub Syring Rubber Syringes RUB-SYRING Y9A Diabetic Diabetic Supplies DIABETIC Z1A Histamine Histamine Preparations HISTAMINE Z1C Serotonin1 Serotonin and Derivatives SEROTONIN1 Z1D Enzymes Enzyme Replcmnt(Ubiquit Enzym) ENZYMES Z1E Antioxidan Antioxidant Agents ANTIOXIDANT Z1F Immune Immune System Cell Groups IMMUNE Z2A AntiHistam Anti-Histamines HISTAMINES Z2B AntiHista1 Anti-Histamines (Continued) HISTAMINE1 Z2C Serotonin Anti-Serotonin Drugs SEROTONIN Z2D Inhibitor8 Histamine H2 Inhibitors INHIBITOR8 Z2E Immunosupp Immunosuppresives IMMUNOSUPP Z2F Stabilizer Mast Cell Stabilizers STABILIZER Z2G Immunomod Immunomodulators IMMUNOMOD Z2H Inhibitor0 Systemic Enzyme Inhibitors INHIBITOR0 Z2I AntiHista2 AntiHistamines (cont 2) HISTAMINE2 Z2O 2ST GEN AM 2ND GEN ANTIHISTAMINE & DECONG GEN2-ANTIHISTAMINE Z2P ANTIHISTAM ANTIHISTAMINES - 1ST GENERATIO ANTIHISTAMINES-1GE Z2Q ANTIHISTAM ANTIHISTAMINES - 2ST GENERATIO ANTIHISTAMINES-2G1 Z3G Misc Agnts Miscellaneous Agents MISC-AGNTS Z4A Prostaglan Prostaglandins PROSTAGLANDINS Z4B Antagonis3 Leukotriene Receptor Antagonis ANTAGONIS3 Z4C Inhibtor10 Thromboxane A2 Inhibitors INHIBITORS10 Z9A Drugs Unclassified Drugs DRUGS Z9D Diag Prep Diagnostic Preparations, Misc. DIAG-PREP ZZN 1ST GEN AM 1ST GEN ANTIHISTAMINE & DECONG GEN1-ANTIHIST ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-ALRGY-CD R-Reference Number:1805 Drug Allergy Code Indicates a drug allergy code for the agent. Value Short Long Mnemonic 00 NONE NONE NONE 01 PENICIL PENICIL;CEPHAL;CARBAP;AZTREONA PENI-CEPH-CARB-AZT 02 GLUCOCORT GLUCOCORTICOIDS GLUCOCORTICOIDS 03 SALICYLATE SALICYLATES;NSAID;PYRAZOLES SALICYL-NSAID-PYRA 04 CODEINE CODEINE CODEINE 05 MORPHINE MORPHINE MORPHINE 06 BARBITURAT BARBITURATES BARBITURATES 07 TETRACYCL TETRACYCLINES TETRACYCLINES 08 PHENOTHIAZ PHENOTHIAZINES PHENOTHIAZINES 09 MICROLIDE MICROLIDE ANTIBIOTICS MICROLIDE-ANTIBIOT 10 AMINOGLYCO AMINOGLYCOSIDES AMINOGLYCOSIDES 11 NITROFURAN NITROFURANS NITROFURANS 12 MEPERIDINE MEPERIDINE;FENTANYL MEPERIDINE-FENTANY 13 CARBAMAZEP CARBAMAZEP;TRICYCLIC ANTI-DEP CARBAM-TRIC-ANTI-D 14 HTDANTOINS HYDANTOINS HYDANTOINS 15 THIAZIDES THIAZIDES;SULFON;BUMET;FUROSE THIA-SULF-BUM-FUR 16 HEPARIN HEPARIN HEPARIN 17 ACETAMINOP ACETAMINOPHEN ACETAMINOPHEN 18 ALLOPURINO ALLOPURINOL ALLOPURINOL 19 BENZODIAZE BENZODIAZEPINES BENZODIAZEPINES 20 ISONIAZID ISONIAZID;NIACIN;ETHION;PYRAZ ISON-NIACIN-ETH-PY 21 INSULINS INSULINS EXCEPT HUMAN INSULINS-EXCEPT-HU 22 XANTHINES XANTHINES XANTHINES 23 OXYCODONE OXYCODONE OXYCODONE 24 PENTAZOCIN PENTAZOCINE PENTAZOCINE 25 PROPOXYPHE PROPOXYPHENE PROPOXYPHENE 26 QUINIDINE QUINIDINE;QUININE QUINIDINE-QUININE 27 PYRIMETHAM PYRIMETHAMINE PYRIMETHAMINE 28 TETANUS TO TETANUS TOXOID TETANUS-TOXOID 29 IODINE IODINE IODINE 30 CLINIDAMYC CLINIDAMYCIN;LINCOMYCIN CLINIDAMYCIN-LINCO 31 PROBENECID PROBENECID PROBENECID 32 PAPAVERINE PAPAVERINE PAPAVERINE 33 HYDRALAZIN HYDRALAZINE HYDRALAZINE 34 BETA ADREN BETA-ADRENERGIC BLOCKERS BETA-ADRENERGIC-BL 35 CHLORAL HY CHLORAL HYDRATE CHLORAL-HYDRATE 36 FOLIC ACID FOLIC ACID FOLIC-ACID 37 ANTICHOLIN ANTICHOLINERGICS ANTICHOLINERGICS 38 METHYLPHEN METHYLPHENIDATE METHYLPHENIDATE 39 NITROGEN M NITROGEN MUSTARDS NITROGEN-MUSTARDS 40 DOXORUBICI DOXORUBICIN DOXORUBICIN 41 ASPARAGINA ASPARAGINASE ASPARAGINASE 42 MUSCLE REL SKELETAL MUSCLE RELAXANTS SKELETAL-MUSCLE-RE 43 DANTROLENE DANTROLENE DANTROLENE 44 RAUWOLFIA RAUWOLFIA ALKALOIDS RAUWOLFIA-ALKALOID 45 METHYLDOPA METHYLDOPA;METHYLDOPATE METHYLDOPA-METHYLD 46 ANES AMIDE LOCAL ANESTHETICS - AMIDE TYP LOCAL-ANESTHET-AMI 47 ANES ESTER LOCAL ANESTHETICS - ESTER TYP LOCAL-ANESTHET-EST 48 ANES UNCLA LOCAL ANESTHETICS - UNCLASSIF LOCAL-ANESTHET-UNC 49 OPIOID NAR OPIOID NARCOTICS (OTHER) OPIOID-NARCOTICS 50 ACE INHIBI ACE INHIBITORS ACE-INHIBITORS 51 FOUR AMINO 4 AMINOQUINOLONES FOUR-AMINOQUINOLON 52 PRIMAQUINE PRIMAQUINE;IODOQUINOL PRIMAQUINE-IODOQUI 53 CHLORAMPHE CHLORAMPHENICOL CHLORAMPHENICOL 54 HETASTARCH HETASTARCH HETASTARCH 55 IRON DEXTR IRON DEXTRAN IRON-DEXTRAN 56 IMMUNE SER IMMUNE SERUMS IMMUNE-SERUMS 57 DEFEROXAMI DEFEROXAMINE DEFEROXAMINE 58 VACCINES VACCINES VACCINES 59 GOLD SALTS GOLD SALTS GOLD-SALTS 60 HALOPERIDO HALOPERIDOL HALOPERIDOL 61 QUINOLONE QUINOLONE ANTI INFECTIVES QUINOLONE-ANTI-INF 62 TRIMETHOPR TRIMETHOPRIM TRIMETHOPRIM 63 VANCOMYCIN VANCOMYCIN VANCOMYCIN 64 CALCITONIN CALCITONIN (HUMAN, SALMON) CALCITONIN-HUMAN-S 65 CALCIUM CALCIUM CHANNEL BLOCKERS CALCIUM-CHNL-BLOCK 66 ANTIHIST ANTIHISTAMIN TOPICAL, SYSTEMIC ANTIHIST-TOPICAL-S 67 METRONIDAZ MATRONIDAZOLE METRONIDAZOLE 68 WARFARIN WARFARIN WARFARIN 69 ZIDOVUDINE ZIDOVUDINE ZIDOVUDINE 70 FLUOXETINE FLUOXETINE FLUOXETINE 71 CYCLOSPOR CYCLOSPORINE CYCLOSPORINE 72 ETOPO TENI ETOPSIDE, TENIPOSIDE ETOPOSIDE-TENIPOSI 73 PACLITAXEL PACLITAXEL PACLITAXEL 74 H2 ANTAGS H2 ANTAGONISTS H2-ANTAGONISTS 75 POT SPARE POTASSIUM SPARING DIRURETICS POT-SPARING-DIRURS 76 NICOTINE NICOTINE NICOTINE 77 ONDAN GRAN ONDANSETRON AND GRANISETRON ONDANSETRON-GRANIS 78 SYMPATHOMI SYMPATHOMIMETICS BETA-ADRENERGIC-AG 79 PHENAZOPYR PHENAZOPYRIDINE PHENAZOPYRIDINE 80 STREPTOKIN STREPTOKINASE STREPTOKINASE 81 AMPHOTER B AMPHOTERICIN B AMPHOTERICIN-B 82 DESMOPRESS DESMOPRESSIN DESMOPRESSIN 83 ATRACURIUM ATRACURIUM AND REL ISOMERS ATRACURIUM-REL-ISO 84 OMEPRAZOLE OMEPRAZOLE/LANSOPRAZOLE OMEPRAZOLE-LANSOPR 85 ACYCLOVIR ACYCLOVIR/VALACYCLOVIR ACYCLOVIR-VALACYCL 86 FENFLURAMN FENFLURAMINE/DEXFENFLURAMINE FENFLURAMINE-DEXFE 87 NEVIRAPINE NEVIRAPINE NEVIRAPINE 88 NITROGLYC NITROGLYCERIN NITROGLYCERIN 89 TERBINAFIN TERBINAFINE/BUTENAFINE TERBINAFINE-BUTENA 90 LAMIVUDINE LAMIVUDINE LAMIVUDINE 91 VIT A DER VITAMIN A DRIVATIVE VITAMIN-A-DERIVAT 92 FACTOR IX FACTOR IX (HAMSTER) FACTOR-IX-HAMSTER 93 DELAVIRDIN DELAVIRDINE DELAVIRDINE 94 TACROLIMUS TACROLIMUS TACROLIMUS 95 MURINE ANT MURINE ANTIBODY-CONT PRODUCTS MURINE-ANTIBODY-PR 96 GADOLINIUM GADOLINIUM-CONTAINING AGENTS GADOLINIUM-AGENTS 97 PHENYLTRIA PHENYLTRIAZINE ANTICONVULSANT PHENYLTRIAZ-ANTICO 98 HYALURONAT HYALURONATE SODIUM HYALURONATE-SODIUM ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-CARD-FMT-CD R-Reference Number:0028 Drug Card Format Code Drug Card Format Code. A-Z indicates input drug format letter for card that is to be produced for members. Value Short Long Mnemonic O Card O Drug Card Format O DRUG-CARD-FMT-O A Card A Drug Card Format A DRUG-CARD-FMT-A B Card B Drug Card Format B DRUG-CARD-FMT-B C Card C Drug Card Format C DRUG-CARD-FMT-C D Card D Drug Card Format D DRUG-CARD-FMT-D E Card E Drug Card Format E DRUG-CARD-FMT-E F Card F Drug Card Format F DRUG-CARD-FMT-F G Card G Drug Card Format G DRUG-CARD-FMT-G H Card H Drug Card Format H DRUG-CARD-FMT-H I Card I Drug Card Format I DRUG-CARD-FMT-I J Card J Drug Card Format J DRUG-CARD-FMT-J K Card K Drug Card Format K DRUG-CARD-FMT-K L Card L Drug Card Format L DRUG-CARD-FMT-L M Card M Drug Card Format M DRUG-CARD-FMT-M N Card N Drug Card Format N DRUG-CARD-FMT-N NO NO Card No Drug Card NO-DRUG-CARD-FMT P Card P Drug Card Format P DRUG-CARD-FMT-P Q Card Q Drug Card Format Q DRUG-CARD-FMT-Q R Card R Drug Card Format R DRUG-CARD-FMT-R S Card S Drug Card Format S DRUG-CARD-FMT-S T Card T Drug Card Format T DRUG-CARD-FMT-T U Card U Drug Card Format U DRUG-CARD-FMT-U UN Unknown Unknown Drug Card Format DRUG-CARD-FMT-UN V Card V Drug Card Format V DRUG-CARD-FMT-V W Card W Drug Card Format W DRUG-CARD-FMT-W X Card X Drug Card Format X DRUG-CARD-FMT-X Y Card Y Drug Card Format Y DRUG-CARD-FMT-Y Z Card Z Drug Card Format Z DRUG-CARD-FMT-Z ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-CAT-CD R-Reference Number:0311 Category Code Indicates the category the drug or agent belongs to. Value Short Long Mnemonic Not Entere Not Entered NOT-ENTERED 0 Unspec Unspecified UNSPEC 1 Impotency Drug to Treat Impotency IMPOTENCY 2 Growth Hor Growth Hormones,GHRH,Rel Agnts GRWTH-HORM A Anti Anxty Anti-Anxiety Agents ANTI-ANX B Fertility Fertility Agents FERTILITY C ContraOral Contraceptives, Oral CONTRAORAL D Diag Diagnositics DIAG E Fluoride Fluoride Preparations FLUORIDE F Antiobes Antiobesity Drugs/Amphetamines ANTIOBES G Antacids Antacids ANTACIDS H Hematinics Hematinics HEMATINICS I Insulins Insulins INSULINS J Smoking Smoking Deterrents SMOKING K AIDS AIDS Related Drugs AIDS L Laxatives Laxatives LAXATIVES M ReuseNdls Reusable Needles REUSENDLS N DispNdls Disposable Needles DISPNDLS O ReuseSyrng Reusable Syringes, Non-Insulin REUSESYRNG P DispSyrng Disposable Syringes, Non-Insul DISPSYRNG Q ReuseSyrIn Reusable Syringes - Insulin REUSESYRIN R DispSyrIn Disposable Syringes - Insulin DISPSYRIN S Diabetic Diabetic Supplies, Miscellaneo DIABETIC T ContraTop Contraceptives, Topical CONTRATOP U Cosmetic Cosmetic Products COSMETIC V Vitamins Vitamins, Commonly Excluded VITAMINS W ContraImpl Contraceptives, Implantable CONTRAIMPL Y Ostomy Ostomy Supplies OSTOMY Z Atten Defc Attention Deficit Disorder ATTENDEFC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-CLS-CD R-Reference Number:1814 Drug Class Indicates the drug class an agent belongs to, for example, whether the agent requires a prescription or is considered over-the-counter. Value Short Long Mnemonic Not Entere Not Entered NOT-ENTERED F Prescript Federal Legend-Prescript. Only PRESCRIPT O OTC Over the Counter OTC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-CNTL-CD R-Reference Number:1866 Drug Control Code Codes that control the processing of the drug. Value Short Long Mnemonic 0 NoCovElig Not Covered Dual Elig NOCOVDELIG D DualCov Covered for Dual Elig DUALCOV ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-CVRG-CD R-Reference Number:3089 drug coverage cd MT version - drug coverage code Value Short Long Mnemonic N NotCovered Not Covered N Y Covered Covered Y ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-DEA-CD R-Reference Number:0314 Ref Drug DEA Code Indicates the drug enforcement agency rating for the drug or agent. Controlled substances can only be prescribed and dispensed by persons with a DEA number on file. Value Short Long Mnemonic 0 NoControl No Control NO-DEA-CONTROL 1 Sched1 LSD,Heroin,Marijuana-Research SCHED1-RESEARCH 2 Sched2 Morphine, Etc - Most Abused SCHED2-MOST-ABUSED 3 Sched3 Codeine, Etc. - Less Abused SCHED3-LESS-ABUSED 4 Sched4 Valium, Etc. - Potential Abuse SCHED4-POTEN-ABUSE 5 Sched5 Controlled Sale by Pharmacy SCHED5-CONTROLLED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-DESI-CD R-Reference Number:1819 Drug Efficacy Study Indicator Indicates whether the drug is a DESI (Drug Efficacy Study Indicator) agent. DESI drugs have not been proven scientifically to have therapeutic effect and are not usually covered by Medicaid programs. This is the IRS DESI Code. Value Short Long Mnemonic Not Spec Unspecified NOT-SPEC 0 No Info NDC not on HCFA Tape NO-INFO 1 Desi Desi DESI 2 No Desi Safe and Effective or Not Desi NO-DESI 3 Review Desi Under Review REVIEW 4 Lte Some Desi Lte For Some Indications LTE-SOME 5 NC Lte All Non Covered Le for all INDS NC-LTE-ALL 6 NC Off Mkt Non Covered Removed frm Market NC-OFF-MKT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-DIAL-IND R-Reference Number:3870 Drug Dialysis Indicator Drug Dialysis Indicator Value Short Long Mnemonic N No No NO Y Yes Yes YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-FAM-PLN-IND R-Reference Number:3864 Family Plan Indicator FAMILY PLAN INDICATOR Value Short Long Mnemonic N No No NO Y Yes Yes YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-FDB-IND R-Reference Number:9453 DRUG FDB IND DRUG FDB INDICATOR - this field indicate whether or not the drug data came form FDB or not. Value Short Long Mnemonic N No No FDB Data NO SPACE Yes Yes FDB Data YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-FM-CD R-Reference Number:1833 Ref Drug Form Code Indicates the form of the drug agent. Value Short Long Mnemonic 1 Each Each EACH 2 Milliliter Milliliter MILLILITER 3 Gram Gram GRAM ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-GCDF-CD R-Reference Number:2623 GCDF CODE DRUG GCDF CODE Value Short Long Mnemonic 0A UNIDENT. UNIDENTIFIED UNIDENT 1B BLADIRRIG BLADDER IRRIGATION BLADIRRIG 1C CACHET CACHET CACHET 1D CAPHARD CAPSULE, HARD CAPHARD 1E CAPSOFT CAPSULE, SOFT CAPSOFT 1F COATEDTAB COATED TABLET COATEDTAB 1G COLLODION COLLODION COLLODION 1H COMPRLOZ COMPRESSED LOZENGE COMPRLOZ 1I CONCHDSOL CONCENTRATE FOR HAEMODIALYSIS CONCHDSOL 1J CONCRCTSOL CONCENTRATE FOR RECTAL SOLUTIO CONCRCTSOL 1K CONCSOLINF CONCENTRATE FOR SOLUTION FOR I CONCSOLINF 1L CONCSOLINJ CONCENTRATE FOR SOLUTION FOR I CONCSOLINJ 1M CUTANEMUL CUTANEOUS EMULSION CUTANEMUL 1N CUTANFOAM CUTANEOUS FOAM CUTANFOAM 1O CUTANPASTE CUTANEOUS PASTE CUTANPASTE 1P CUTANPWD CUTANEOUS POWDER CUTANPWD 1Q CUTANSOL CUTANEOUS SOLUTION CUTANSOL 1R CUTANSPPWD CUTANEOUS SPRAY, POWDER CUTANSPPWD 1S CUTANSPSOL CUTANEOUS SPRAY, SOLUTION CUTANSPSOL 1T CUTANSPSUS CUTANEOUS SPRAY, SUSPENSION CUTANSPSUS 1U CUTANSTICK CUTANEOUS STICK CUTANSTICK 1V CUTANSUS CUTANEOUS SUSPENSION CUTANSUS 1W DENTALEML DENTAL EMULSION DENTALEML 1X DENTALGEL DENTAL GEL DENTALGEL 1Y DENTALPOWD DENTAL POWDER DENTALPOWD 1Z DENTALSOLN DENTAL SOLUTION DENTALSOLN 2A DENTALSTCK DENTAL STICK DENTALSTCK 2B DENTALSUS DENTAL SUSPENSION DENTALSUS 2C EARCREAM EAR CREAM EARCREAM 2D EARDROPEML EAR DROPS, EMULSION EARDROPEML 2E EARDROPSOL EAR DROPS, SOLUTION EARDROPSOL 2F EARDROPSUS EAR DROPS, SUSPENSION EARDROPSUS 2G EARGEL EAR GEL EARGEL 2H EAROINT EAR OINTMENT EAROINT 2I EARPOWDER EAR POWDER EARPOWDER 2J EARSPYEMUL EAR SPRAY, EMULSION EARSPYEMUL 2K EARSPYSOLN EAR SPRAY, SOLUTION EARSPYSOLN 2L EARSPYSUSP EAR SPRAY, SUSPENSION EARSPYSUSP 2M EARSTICK EAR STICK EARSTICK 2N EARTAMPON EAR TAMPON EARTAMPON 2O EARWSHEMUL EAR WASH, EMULSION EARWSHEMUL 2P EARWSHSOLN EAR WASH, SOLUTION EARWSHSOLN 2Q EFFVAGTAB EFFERVESCENT VAGINAL TABLET EFFVAGTAB 2R EMULINFUS EMULSION FOR INFUSION EMULINFUS 2S EMULINJECT EMULSION FOR INJECTION EMULINJECT 2T ENDOCERGEL ENDOCERVICAL GEL ENDOCERGEL 2U ETPIPSSOL ENDOTRACHEOPULMONARY INSTIL.PW ETPIPSSOL 2V ETPIPWDSOL ENDOTRACHEOPULMONARY INSTIL.PW ETPIPWDSOL 2W ETPISOLN ENDOTRACHEOPULMONARY INSTIL., ETPISOLN 2X ETPISUSP ENDOTRACHEOPULMONARY INSTIL., ETPISUSP 2Y EYECREAM EYE CREAM EYECREAM 2Z EYDRPPSSOL EYE DROPS,POWDER & SOLVENT FOR EYDRPPSSOL 3A EYDRPPSSUS EYE DROPS,POWDER & SOLVENT FOR EYDRPPSSUS 3B EYDROPPR EYE DROPS, PROLONGED RELEASE EYDROPPR 3C EYDROPSOL EYE DROPS, SOLUTION EYDROPSOL 3D EYDROPSREC EYE DROPS, SOLVENT FOR RECONST EYDROPSREC 3E EYDROPSUSP EYE DROPS, SUSPENSION EYDROPSUSP 3F EYEGEL EYE GEL EYEGEL 3G EYELOTION EYE LOTION EYELOTION 3H EYELOTSREC EYE LOTION, SOLVENT FOR RECONS EYELOTSREC 3I EYEOINT EYE OINTMENT EYEOINT 3J FILMCOTTAB FILM COATED TABLET FILMCOTTAB 3K GARGLE GARGLE GARGLE 3L GARGPWDSOL GARGLE, POWDER FOR SOLUTION GARGPWDSOL 3M GARGTABSOL GARGLE, TABLET FOR SOLUTION GARGTABSOL 3N GRCAPHARD GASTRO-RESISTANT CAPSULE, HARD GRCAPHARD 3O GRCAPSOFT GASTRO-RESISTANT CAPSULE, SOFT GRCAPSOFT 3P GRGRANULES GASTRO-RESISTANT GRANULES GRGRANULES 3Q GRTABLET GASTRO-RESISTANT TABLET GRTABLET 3R GASTROEEML GASTROENTERAL EMULSION GASTROEEML 3S GASTROESOL GASTROENTERAL SOLUTION GASTROESOL 3T GASTROESUS GASTROENTERAL SUSPENSION GASTROESUS 3U GINGIVGEL GINGIVAL GEL GINGIVGEL 3V GINGIVPAST GINGIVAL PASTE GINGIVPAST 3W GINGIVSOLN GINGIVAL SOLUTION GINGIVSOLN 3X GRANORSOL GRANULES FOR ORAL SOLUTION GRANORSOL 3Y GRAN SUSP GRANULES FOR ORAL SUSPENSION GRAN-SUSP 3Z GRANSYRUP GRANULES FOR SYRUP GRANSYRUP 4B IMPLCHAIN IMPLANTATION CHAIN IMPLCHAIN 4C IMPLTABLET IMPLANTATION TABLET IMPLTABLET 4D IMPRDRESS IMPREGNATED DRESSING IMPRDRESS 4E INHALEMUL INHALATION EMULSION INHALEMUL 4F INHALGAS INHALATION GAS INHALGAS 4G INHALPWD INHALATION POWDER INHALPWD 4H INHPWDHDCP INHALATION POWDER, HARD CAPSUL INHPWDHDCP 4I INHPWDPDSP INHALATION POWDER, PRE-DISPENS INHPWDPDSP 4J INHALSOLN INHALATION SOLUTION INHALSOLN 4K INHALSUSP INHALATION SUSPENSION INHALSUSP 4L INHVAPLIQ INHALATION VAPOUR, LIQUID INHVAPLIQ 4M INHVAPOINT INHALATION VAPOUR, OINTMENT INHVAPOINT 4N INHVAPSOL INHALATION VAPOUR, SOLUTION INHVAPSOL 4O INHVAPTAB INHALATION VAPOUR, TABLET INHVAPTAB 4Q MRCAPSULE MODIFIED RELEASE CAPSULE MRCAPSULE 4R MRGRANULES MODIFIED RELEASE GRANULES MRGRANULES 4S MRTABLET MODIFIED RELEASE TABLET MRTABLET 4T MWTABSOLN MOUTH WASH, TABLET FOR SOLUTIO MWTABSOLN 4U MABUCTAB MUCO-ADHESIVE BUCCAL TABLET MABUCTAB 4V NASALCREAM NASAL CREAM NASALCREAM 4W NASDRPEML NASAL DROPS, EMULSION NASDRPEML 4X NASDRPSOL NASAL DROPS, SOLUTION NASDRPSOL 4Y NASDRPSUS NASAL DROPS, SUSPENSION NASDRPSUS 4Z NASALGEL NASAL GEL NASALGEL 5A NASOINT NASAL OINTMENT NASOINT 5B NASPWD NASAL POWDER NASPWD 5C NASSPYEML NASAL SPRAY, EMULSION NASSPYEML 5D NASSPYSOL NASAL SPRAY, SOLUTION NASSPYSOL 5E NASSPYSUS NASAL SPRAY, SUSPENSION NASSPYSUS 5F NASALSTICK NASAL STICK NASALSTICK 5G NASALWASH NASAL WASH NASALWASH 5H OPTHINSERT OPHTHALMIC INSERT OPTHINSERT 5I ORALDRPEML ORAL DROPS, EMULSION ORALDRPEML 5J ORALDRPSOL ORAL DROPS, SOLUTION ORALDRPSOL 5K ORALDRPSUS ORAL DROPS, SUSPENSION ORALDRPSUS 5L ORALEMUL ORAL EMULSION ORALEMUL 5M ORALGEL ORAL GEL ORALGEL 5N ORALLYOPH ORAL LYOPHILISATE ORALLYOPH 5O ORALPOWDER ORAL POWDER ORALPOWDER 5P ORMCAPSOFT OROMUCOSAL CAPSULE, SOFT ORMCAPSOFT 5Q OROMUDROPS OROMUCOSAL DROPS OROMUDROPS 5R OROMUGEL OROMUCOSAL GEL OROMUGEL 5S OROMUPASTE OROMUCOSAL PASTE OROMUPASTE 5T OROMUSOLN OROMUCOSAL SOLUTION OROMUSOLN 5U OROMUSPSOL OROMUCOSAL SPRAY, SOLUTION OROMUSPSOL 5V OROMUSUSP OROMUCOSAL SUSPENSION OROMUSUSP 5W PSENDOCGEL POWDER AND SOLVENT FOR ENDOCER PSENDOCGEL 5X PSORALSOLN POWDER AND SOLVENT FOR ORAL SO PSORALSOLN 5Y PSORALSUSP POWDER AND SOLVENT FOR ORAL SU PSORALSUSP 5Z PSSOLINFUS POWDER & SOLVENT FOR SOL. FOR PSSOLINFUS 6A PSSOLINJEC POWDER & SOLVENT FOR SOL. FOR PSSOLINJEC 6B PSSUSPINJ POWDER & SOLVENT FOR SUSP. FOR PSSUSPINJ 6C PBLADIRRIG POWDER FOR BLADDER IRRIGATION PBLADIRRIG 6D POWDORSOLN POWDER FOR ORAL SOLUTION POWDORSOLN 6E POWDORSUSP POWDER FOR ORAL SUSPENSION POWDORSUSP 6F POWDRCTSOL POWDER FOR RECTAL SOLUTION POWDRCTSOL 6G POWDRCTSUS POWDER FOR RECTAL SUSPENSION POWDRCTSUS 6H POWDSOLINF POWDER FOR SOLUTION FOR INFUSI POWDSOLINF 6I POWDSOLINJ POWDER FOR SOLUTION FOR INJECT POWDSOLINJ 6J POWDSUSINJ POWDER FOR SUSPENSION FOR INJE POWDSUSINJ 6K POWDSYRUP POWDER FOR SYRUP POWDSYRUP 6L PRESINHEML PRESSURISED INHALATION, EMULSI PRESINHEML 6M PRESINHSOL PRESSURISED INHALATION, SOLUTI PRESINHSOL 6N PRESINHSUS PRESSURISED INHALATION, SUSPEN PRESINHSUS 6O PRCAPHARD PROLONGED RELEASE CAPSULE, HAR PRCAPHARD 6P PRCAPSOFT PROLONGED RELEASE CAPSULE, SOF PRCAPSOFT 6Q PRGRANULES PROLONGED RELEASE GRANULES PRGRANULES 6S RNGENERAT RADIONUCLIDE GENERATOR RNGENERAT 6T RPPRECURS RADIOPHARMACEUTICAL PRECURSOR RPPRECURS 6U RECTCAPSFT RECTAL CAPSULE, SOFT RECTCAPSFT 6V RECTALCRM RECTAL CREAM RECTALCRM 6W RECTALEMUL RECTAL EMULSION RECTALEMUL 6X RECTALFOAM RECTAL FOAM RECTALFOAM 6Y RECTALGEL RECTAL GEL RECTALGEL 6Z RECTALOINT RECTAL OINTMENT RECTALOINT 7A RECTALSOLN RECTAL SOLUTION RECTALSOLN 7B RECTALSUSP RECTAL SUSPENSION RECTALSUSP 7C RECTALTAMP RECTAL TAMPON RECTALTAMP 7D SEALANT SEALANT SEALANT 7E SOLNHAEMOD SOLUTION FOR HAEMODIALYSIS SOLNHAEMOD 7F SOLNHFILTR SOLUTION FOR HAEMOFILTRATION SOLNHFILTR 7G SOLINFUS SOLUTION FOR INFUSION SOLINFUS 7H SOLINJ SOLUTION FOR INJECTION SOLINJ 7I SOLIOPHSIS SOLUTION FOR IONTOPHORESIS SOLIOPHSIS 7J SOLNORGPRS SOLUTION FOR ORGAN PRESERVATIO SOLNORGPRS 7L SOLVNPARNT SOLVENT FOR PARENTERAL USE SOLVNPARNT 7M STOMIRRIG STOMACH IRRIGATION STOMIRRIG 7N SUSPINJECT SUSPENSION FOR INJECTION SUSPINJECT 7O TABRCTSOLN TABLET FOR RECTAL SOLUTION TABRCTSOLN 7P TABRCTSUSP TABLET FOR RECTAL SUSPENSION TABRCTSUSP 7Q TABVAGSOLN TABLET FOR VAGINAL SOLUTION TABVAGSOLN 7R TDPATCH TRANSDERMAL PATCH TDPATCH 7S URETHGEL URETHRAL GEL URETHGEL 7T URETHSTICK URETHRAL STICK URETHSTICK 7U VAGINCPHRD VAGINAL CAPSULE, HARD VAGINCPHRD 7V VAGINCPSFT VAGINAL CAPSULE, SOFT VAGINCPSFT 7W VAGINCREAM VAGINAL CREAM VAGINCREAM 7X VAGDEVICE VAGINAL DEVICE VAGDEVICE 7Y VAGINEMUL VAGINAL EMULSION VAGINEMUL 7Z VAGINFOAM VAGINAL FOAM VAGINFOAM 8A VAGINGEL VAGINAL GEL VAGINGEL 8B VAGINOINT VAGINAL OINTMENT VAGINOINT 8C VAGINSOLN VAGINAL SOLUTION VAGINSOLN 8D VAGINSUSP VAGINAL SUSPENSION VAGINSUSP 8E VAGINTAB VAGINAL TABLET VAGINTAB 8F VAGINTAMP VAGINAL TAMPON VAGINTAMP 8G WOUNDSTICK WOUND STICK WOUNDSTICK 8H PACKET EA PACKET (EA) PACKET-EA 8I PACKET ML PACKET (ML) PACKET-ML 8J PACKET GM PACKET (GM) PACKET-GM AA AEROSOL AEROSOL (ML) AEROSOL-ML AB AEROSOL AEROSOL (GM) AEROSOL-GM AC AEROSOL AEROSOL (EA) AEROSOL-EA AD AER REFILL AEROSOL REFILL (ML) AER-REFILL-ML AE AER REFILL AEROSOL REFILL (EA) AER-REFILL-EA AF FOAM FOAM (GM) FOAM AG AER REFILL AEROSOL REFILL (GM) AER-REFILL-GM AH AER W/ADAP AEROSOL W/ADAPTER (ML) AER-W-ADAP-ML AI AER W/ADAP AEROSOL W/ADAPTER (EA) AER-W-ADAP-EA AJ AER W/ADAP AEROSOL W/ADAPTER (GM) AER-W-ADAP-GM AK AERO POWD AEROSOL, POWDER (EA) AERO-POWD-EA AL AMPUL-NEB. AMPUL FOR NEBULIZATION (ML) AMPUL-NEB AM MIST AEROSOL, MIST MIST AN VIAL-NEB. VIAL, NEBULIZER VIAL-NEB AO AER BR.ACT AEROSOL, BREATH ACTIVATED AER-BR-ACT AP AERO POWD AEROSOL, POWDER (GM) AERO-POWD-GM AQ SPRAY AEROSOL, SPRAY, (GM) SPRAY-GM AR SPRAY RFL SPRAY, NON-AEROSOL REFILL (ML) SPRAY-RFL AS SPRAY AEROSOL, SPRAY (ML) SPRAY-ML AT SPRAY/PUMP AEROSOL, SPRAY W/PUMP (ML) SPRAY-PUMP AU SPRAY SPRAY, NON-AEROSOL (ML) SPRAY-NA-ML AV FOAM (ML) FOAM (ML) FOAM-ML AW FOAM/APPL. AEROSOL, FOAM WITH APPLICATOR FOAM-APPL AX SPRAY SPRAY, NON-AEROSOL (EA) SPRAY-NA-EA AY AER POW BA AEROSOL POWDER, BREATH ACTIVAT AER-POW-BA AZ AERO POWD AEROSOL, POWDER (ML) AERO-POWD-ML BA BATH (EA) BATH (EA) BATH-EA BB BATH (ML) BATH (ML) BATH-ML BC BATH (GM) BATH (GM) BATH-GM BD SPRAY SPRAY, NON-AEROSOL (GM) SPRAY-NA-GM CA CAPSULE CAPSULE (HARD, SOFT, ETC.) CAPSULE CB CAP.SR 12H CAPSULE, SUSTAINED RELEASE 12 CAP-SR-12H CC CAP.SR 24H CAPSULE, SUSTAINED RELEASE 24 CAP-SR-24H CD CAP W/DEV CAPSULE, WITH INHALATION DEVIC CAP-W-DEV CE CAPSULE DR CAPSULE, DELAYED RELEASE (ENTE CAPSULE-DR-E CF CAPSULE DR CAPSULE, DELAYED RELEASE (OBS CAPSULE-DR CK CAP SPRINK CAPSULE, SPRINKLE CAP-SPRINK CL CAP SPR SA CAPSULE, SPRINKLE SUSTAINED AC CAP-SPR-SA CM CAP MPHASE CAPSULE, MULTIPHASIC RELEASE CAP-MPHASE CO CAP12H PEL CAPSULE, 12HR SUSTAINED RELEAS CAP12H-PEL CP CAP24H PEL CAPSULE, 24HR SUSTAINED RELEAS CAP24H-PEL CQ CAP SEQ CAPSULE, SEQUENTIAL CAP-SEQ CS CAPSULE SA CAPSULE, SUSTAINED ACTION CAPSULE-SA CT CAPSULE CR CAPSULE, DEGRADABLE CONTROLLED CAPSULE-CR DP DROPERETTE DROPPERETTE, SINGLE-USE DROP D DROPERETTE DS SUSPDR REC SUSPENSION,DELAYED RELEASE,REC SUSPDR-REC EA EACH EACH EACH EB BAR BAR BAR EC CAKE CAKE CAKE ED MED. SOAP SOAP, MEDICATED (EA) MED-SOAP-EA EE LIQ. SOAP SOAP, LIQUID LIQ-SOAP EF DENT. CONE DENTAL CONE DENT-CONE EG STICK (GM) STICK (GM) STICK-GM EH STICK (EA) STICK (EA) STICK-EA EI CEMENT CEMENT (GM) CEMENT EJ PLASTER PLASTER PLASTER EK POULTICE POULTICE POULTICE EL MED. SWAB SWAB, MEDICATED MED-SWAB EM MED. CONE CONE, MEDICATED MED-CONE EN MED. TAPE TAPE, MEDICATED MED-TAPE EP MED. SOAP SOAP, MEDICATED (ML) MED-SOAP-ML ER MED. SOAP SOAP, MEDICATED (GM) MED-SOAP-GM ET MED. PAD PADS, MEDICATED (EA) MED-PAD FA FLASK (ML) FLASK FOR LIQUIDS FLASK-ML FB FLASK (GM) FLASK FOR SOLIDS FLASK-GM FI FILM FILM, MEDICATED (EA) FILM FS SHEET SHEET (EA) SHEET GA GAS GAS GAS GH INHALER INHALER (ML) INHALER-ML GI INHALER INHALER (EA) INHALER-EA GJ INHALER INHALER (GM) INHALER-GM GK DISK W/DEV DISK, WITH INHALATION DEVICE DISK-W-DEV GZ INHALERKIT INHALER KIT (EA) INHALERKIT HA INFUS. BTL INFUSION BOTTLE (EA) INFUS-BTL-EA HB INFUS. BTL INFUSION BOTTLE (ML) INFUS-BTL-ML HC PIPETTE PIPETTE (EA) PIPETTE-EA HD PIPETTE PIPETTE (ML) PIPETTE-ML HE ALLERGEN ALLERGEN ALLERGEN HF TINE,SUSP. TINE, SUSPENSION (EA) TINE,SUSP HG AMP W/DEV. AMPUL WITH DEVICE (ML) AMP-W-DEV HH AMPUL AMPUL (ML) AMPUL-ML HI CARTRIDGE CARTRIDGE (EA) CARTRIDGE-EA HJ CARTRIDGE CARTRIDGE (ML) CARTRIDGE-ML HK FROZ.PIGGY IV SOLUTION, PIGGYBACK PREMIX FROZ-PIGGY HL BULKBAGINJ BULK BAG, INJECTION (GM) BULKBAGINJ HM IV SOLN. INTRAVENOUS SOLUTION IV-SOLN HN PIGGYBACK INTRAVENOUS SOLUTION, PIGGYBAC PIGGYBACK-HN HP PIGGYBACK INTRAVENOUS SOLUTION, PIGGYBAC PIGGYBACK-HP HQ DISP SYRIN DISPOSABLE SYRINGE (ML) DISP-SYRIN-ML HR AMPUL AMPUL (EA) AMPUL-EA HS VIAL VIAL (SDV,MDV OR ADDITIVE) (E VIAL-E HT SKIN TEST SKIN TEST SKIN-TEST HU PLAST. BAG PLASTIC BAG, INJECTION (EA) PLAST-BAG-EA HV VIAL VIAL (SDV,MDV OR ADDITIVE) (M VIAL-M HW ADD.SYRIN ADDITIVE SYRINGE (ML) ADD-SYRIN HX DISP SYRIN DISPOSABLE SYRINGE (EA) DISP-SYRIN-EA HY IP SOLN. INTRAPERITONEAL SOLUTION(ML) IP-SOLN HZ PLAST. BAG PLASTIC BAG, INJECTION (ML) PLAST-BAG-ML IA IMPLANT IMPLANT (EA) IMPLANT JA JELLY JELLY (GM) JELLY JB JEL JEL (ML) JEL-ML JC GEL GEL (ML) GEL-ML JD JEL JEL (GM) JEL-GM JE BEADS BEADS (GM) BEADS JF GEL GEL (EA) GEL-EA JG GEL GEL (GM) GEL-GM JH PUDDING PUDDING (EA) PUDDING-EA JI GLOBULE GLOBULE GLOBULE JJ PUDDING PUDDING (GM) PUDDING-GM JP GEL PACKET GEL IN PACKET (GM) GEL-PACKET JS SOL-GEL GEL-FORMING SOLUTION SOL-GEL JT JEL/PF APP JELLY WITH PREFILLED APPLICATO JEL-PF-APP JU GEL/PF APP GEL WITH PREFILLED APPLICATOR GEL-PF-APP JV GEL W/APPL GEL WITH APPLICATOR (GM) GEL-W-APPL-GM JW JELLY/APPL JELLY WITH APPLICATOR (GM) JELLY-APPL JX GEL W/APPL GEL WITH APPLICATOR (ML) GEL-W-APPL-ML JY SOL W/APPL SOLUTION WITH APPLICATOR (EA) SOL-W-APPL JZ LOTION APP LOTION WITH APPLICATOR LOTION-APP KA CREAM(GM) CREAM (GRAMS) CREAM-GM KB CRM SR(GM) CREAM, SUSTAINED RELEASE (GM) CRM-SR-GM KC SUSPENSION SUSPENSION, TOPICAL (GM) SUSPENSION-GM KD GEL SR(ML) GEL, SUSTAINED RELEASE (ML) GEL-SR-ML KL LUBRICANT LUBRICANT LUBRICANT KM CREAM(ML) CREAM (MILLILITERS) CREAM-ML KP PASTE PASTE PASTE KT TOOTHPASTE TOOTHPASTE TOOTHPASTE KV CRM/PF APP CREAM WITH PREFILLED APPLICATO CRM-PF-APP KW CREAM/APPL CREAM WITH APPLICATOR CREAM-APPL OA OINT.(GM) OINTMENT(GM) OINT-GM OB OINT.(ML) OINTMENT(ML) OINT-ML OC OINT.(EA) OINTMENT(EA) OINT-EA OV OIN/PF APP OINTMENT WITH PREFILLED APPLIC OIN-PF-APP OW OINT/APPL. OINTMENT WITH APPLICATOR OINT-APPL PA POWDER POWDER (GM) POWDER-GM PB LEAVES LEAVES (GM) LEAVES PC CRYSTALS CRYSTALS CRYSTALS PD SUSP RECON SUSPENSION, RECONSTITUTED, ORA SUSP-RECON-PD PE POWD EFFER POWDER EFFERVESCENT (GM) POWD-EFFER PF FLAKES FLAKES (GM) FLAKES PG GRANULES GRANULES;POWDER-LIKE,NON-EFERV GRANULES PH DROP RECON DROPS, RECONSTITUTED, ORAL DROP-RECON PI SOLN RECON SOLUTION, RECONSTITUTED, ORAL SOLN-RECON PJ SUS.12H SR SUSPENSION, 12 HR SUSTAINED RE SUS-12H-SR PK PATCH TDWK PATCH, TRANSDERMAL WEEKLY PATCH-TDWK PL CLEANSER CLEANSER (GM) CLEANSER-GM PM LUMP LUMP (GM) LUMP PN CLEANSER CLEANSER (ML) CLEANSER-ML PO EFFPOWDPKT EFFERVESCENT POWDER IN PACKET EFFPOWDPKT PP PACKET PACKET PACKET PQ PATCH TDBW PATCH, TRANSDERMAL BIWEEKLY PATCH-TDBW PR PATCH TD72 PATCH, TRANSDERMAL 72 HOURS PATCH-TD72 PS ADH. PATCH ADHESIVE PATCH, MEDICATED ADH-PATCH PT TOOTH POWD TOOTH POWDER (GM) TOOTH-POWD PU POWDER POWDER (UNITS) POWDER-UNITS PV PATCH TD24 PATCH, TRANSDERMAL 24 HOURS PATCH-TD24 PW TEA (EA) TEA (EA) TEA-EA PX TEA (GM) TEA (GM) TEA-GM PY SUS.24H SR SUSPENSION, 24 HR SUSTAINED RE SUS-24H-SR PZ SUSP PACKT SUSPENSION IN PACKET (EA) SUSP-PACKT QA SUPP.RECT SUPPOSITORY, RECTAL SUPP-RECT QB INSERT INSERT INSERT QC SUPP.VAG SUPPOSITORY, VAGINAL SUPP-VAG QD SUPP.URETH SUPPOSITORY, URETHRAL SUPP-URETH QE SUSP SR SUSPENSION, SUSTAINED RELEASE SUSP-SR QF SUSP RECON SUSPENSION, RECONSTITUTED, ORA SUSP-RECON-QF QG PATCH WKSQ PATCH, TRANSDERMAL WEEKLY, SEQ PATCH-WKSQ QH PATCH DYSQ PATCH, TRANSDERMAL DAILY, SEQU PATCH-DYSQ QV VAG RING RING, VAGINAL VAG-RING RA SOLTN(GM) SOLUTION (GM) SOLTN-GM RB EMULSN(GM) EMULSION (GM) EMULSN-GM RC SHAMPO(GM) SHAMPOO (GM) SHAMPO-GM RD SHAMPO LOT SHAMPOO LOTION (GM) SHAMPO-LOT RE SHAMPO CRM SHAMPOO CREAM (GM) SHAMPO-CRM RF SYRUP(GM) SYRUP (GM) SYRUP-GM RG SUS MC REC SUSPENSION, MICROCAPSULE RECON SUS-MC-REC RL LIQUID LIQUID (GM) LIQUID-GM SA SOLUTION SOLUTION, NON-ORAL SOLUTION-NON-ORAL SB FL EXTRACT FLUID EXTRACT FL-EXTRACT SC ORAL SUSP SUSPENSION, ORAL (FINAL DOSE F ORAL-SUSP SD DOUCHE DOUCHE DOUCHE SE ELIXIR ELIXIR ELIXIR SF ENEMA ENEMA (ML) ENEMA-ML SG ENEMA ENEMA (EA) ENEMA-EA SH EXPECT. EXPECTORANT EXPECT SI LINIMENT LINIMENT LINIMENT SJ SOLUTION SOLUTION, ORAL SOLUTION-ORAL SK LOTION LOTION (ML) LOTION-ML SL LIQUID LIQUID (ML) LIQUID-ML SM MOUTHWASH MOUTHWASH MOUTHWASH SN DROPS SUSP SUSPENSION, DROPS(FINAL DOSAGE DROPS-SUSP SO DROPS DROPS DROPS SP SPIRIT SPIRIT SPIRIT SQ OIL OIL OIL SR SUSPENSION SUSPENSION, TOPICAL (ML) SUSPENSION-ML SS SHAMPOO SHAMPOO SHAMPOO ST SYRUP SYRUP SYRUP SU EMULSION EMULSION EMULSION SV GRAN. EFF. GRANULES, EFFERVESCENT GRAN-EFF SW IRRIG SOLN SOLUTION, IRRIGATION IRRIG-SOLN SX TINCTURE TINCTURE TINCTURE SY ORAL CONC. CONCENTRATE, ORAL ORAL-CONC SZ LOTION LOTION (GM) LOTION-GM TA TABLET TABLET TABLET TB TABLET SOL TABLET, SOLUBLE TABLET-SOL TC TAB CHEW TABLET, CHEWABLE TAB-CHEW TD DISK DISK DISK TE TABLET DR TABLET, DELAYED RELEASE (ENTER TABLET-DR-ENTER TF TABLET EFF TABLET, EFFERVESCENT TABLET-EFF TG GUM GUM GUM TH TABLET HYP TABLET, HYPODERMIC TABLET-HYP TI TAB.SR 24H TABLET, SUSTAINED RELEASE 24HR TAB-SR-24H TJ TAB DISPER TABLET, DISPERSIBLE TAB-DISPER TK GUM(GM) GUM(GM) GUM-GM TL LOZENGE LOZENGE LOZENGE TM TAB.SR 12H TABLET, SUSTAINED RELEASE 12HR TAB-SR-12H TN TAB GRAN TABLET, GRANULE-LIKE OR PACKET TAB-GRAN TO TAB SR SEQ TABLET, SUSTAINED RELEASE 12HR TAB-SR-SEQ TP PELLET PELLET PELLET TQ TAB PRT SR TABLET, SUST.RELEASE,PARTICLES TAB-PRT-SR TR TAB PART TABLET, PARTICLES/CRYSTALS IN TAB-PART TS TABLET SA TABLET, SUSTAINED ACTION TABLET-SA TT TROCHE TROCHE TROCHE TU TAB SUBL TABLET, SUBLINGUAL TAB-SUBL TV TAB BUCCAL TABLET, BUCCAL TAB-BUCCAL TW WAFER WAFER WAFER TX PILL PILL PILL TY TAB BUC SA TABLET, BUCCAL SUSTAINED ACTIO TAB-BUC-SA TZ TAB SA OSM TABLET, OSMOTIC LASER-DRILLED TAB-SA-OSM UA TABLET SEQ TABLET, SEQUENTIAL TABLET-SEQ UB TAB MPHASE TABLET, MULTIPHASIC RELEASE TAB-MPHASE UC TABLET DR TABLET, DELAYED RELEASE (OBS 0 TABLET-DR UD TAB DS PK TABLET, DOSE PACK TAB-DS-PK UE TAB SA SEQ TABLET, SUSTAINED ACTION SEQUE TAB-SA-SEQ UF TAB SR 8HR TABLET, SUSTAINED RELEASE 8HR TAB-SR-8HR UL TAB DIS LN TABLET, DISPERSIBLE LINGUAL TAB-DIS-LN UN UNIT UNIT UNIT WA WAX WAX (GM) WAX WB TAR TAR (GM) TAR WH WHIP WHIP (GM) WHIP YA NEEDLE NEEDLE, REUSABLE NEEDLE YB BULK BULK BULK YC SYRINGE SYRINGE, REUSABLE SYRINGE YD DIAPHRAGM DIAPHRAGM DIAPHRAGM YE BANDAGE BANDAGE BANDAGE YF LENS LENS LENS YG GAUZE GAUZE, NON-MEDICATED GAUZE YH DIS NEEDLE NEEDLE, DISPOSABLE DIS-NEEDLE YI IUD INTRAUTERINE DEVICE IUD YJ CRWL SYRIN SYRINGE, CORNWALL CRWL-SYRIN YK KIT KIT KIT YL DISP SYRIN SYRINGE, EMPTY DISPOSABLE DISP-SYRIN-EMPTY YM PAD PAD PAD YN TAMPON TAMPON TAMPON YO TOWELETTE TOWELETTE (EA) TOWELETTE YP IP SET INTRAPERITONEAL ADMIN.SETS-PAR IP-SET YQ INFUS.SET INFUSION SETS-PARAPHERNALIA INFUS-SET YR STRIP STRIP STRIP YS SUTURE SUTURE SUTURE YT TAPE TAPE, NON-MEDICATED TAPE YU IRRIG SET IRRIGATION SET IRRIG-SET YV SPONGE SPONGE SPONGE YW SWAB SWAB, NON-MEDICATED SWAB YX IV ACCESS. INTRAVENOUS ADMIXTURE ACCESSOR IV-ACCESS YY KIT,REFILL KIT,REFILL KIT,REFILL YZ BLOOD SET BLOOD ADMINISTRATION SET BLOOD-SET ZA MISCELL. MISCELLANEOUS MISCELL ZB BOX BOX BOX ZC BOTTLE BOTTLE BOTTLE ZD COMBO. PKG COMBINATION PACKAGE COMBO-PKG ZE CARTON CARTON CARTON ZP PACKAGE PACKAGE PACKAGE ZT TRAY TRAY TRAY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-GEN-PRD-CD R-Reference Number:1839 Generic Drug Product Code This is the drug's generic product indicator. Indicates whether drug is a brand, generic or other agent. Value Short Long Mnemonic 0 Non-Drug Non Drug Item NON-DRUG-ITEM 1 Generic Generic-Drug GENERIC-DRUG 2 Branded Branded-Drug BRANDED-DRUG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-GENR-IND R-Reference Number:1841 Generic Drug Indicator Indicates whether drug is a multi-source or single source agent. Value Short Long Mnemonic Not-Enter Not-Entered NOT-ENTERED 0 Unspecifed Unspecified UNSPECIFIED 1 Multiple Multiple-Sources MULTIPLE-SOURCES 2 Single-Src Single-Source SINGLE-SOURCE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-ID-CD R-Reference Number:6471 Drug ID Code Drug Identifier Code (indicates what format used for drug id on this row : NDC, GSN, GCN, or TXCL) Value Short Long Mnemonic 1 NDC9 Code Nationa Drug Code 9 Code NDC9-CODE 2 GSN Code Generic Sequence Number Code GSN-CODE 3 GCN Code Generic Code Number Code GCN-CODE 4 TXCL Code Therapeutic Class Code TXCL-CODE 5 NDC11 Code National Drug Code 11 Code NDC11-CODE 6 AHFSTC American Hosp Fmly Svc AHFSTC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-MAC-CD R-Reference Number:2457 Drug Pricing Code Codes describing pricing used for drug. Value Short Long Mnemonic A StHandleDr State Handled Drugs ST-HANDLED-DRUGS C WacCstCnt WAC + 7% unit cost control WAC7CSTCNT D WacCstD WAC + 7% unit cost WAC7CSTD E WacCstE WAC + 7% unit cost WAC7CSTE G GenPrcMan Generic Price Man GENERIC-PRICE M FUL Federal Upper Limit FUL S MaxAllow State Max Allow Cost MAX-ALLOW ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-MAINT-IND R-Reference Number:1849 Maintenance drug indicator Maintenance drug indicator. Value Short Long Mnemonic Not-Maint Non-Maintained-Drug NOT-MAINT-DRUG 1 Maint-Drug Maintained-Drug MAINT-DRUG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-MSMT-CD R-Reference Number:1032 Drug Unit of Measure The unit by which a drug is dispensed and priced. Value Short Long Mnemonic EA Each Each EACH GM Gram Gram GRAM ML Milliliter Milliliter MILLILITER OZ Ounce Ounce OUNCE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-NDC-FMT-CD R-Reference Number:1856 Drug NDC Format Code Drug NDC Format Code. Format of NDC code. Value Short Long Mnemonic 0 Pin11 Pin11 PIN11 1 NDC-4-4-2 NDC-4-4-2 NDC-4-4-2 2 NDC-5-3-2 NDC-5-3-2 NDC-5-3-2 3 NDC-5-4-1 NDC-5-4-1 NDC-5-4-1 4 UPC-5-03-2 UPC-5-03-2 UPC-5-03-2 5 UPC-5-4-01 UPC-5-4-01 UPC-5-4-01 6 UPC-5-4-10 UPC-5-4-10 UPC-5-4-10 7 HRI-4-4-2 HRI-4-4-2 HRI-4-4-2 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-NH-CD R-Reference Number:8872 Drug Code Indicates whether the drug is for Nursing Home. Value Short Long Mnemonic N No No NO Y Yes Yes YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-ORNG-BK-CD R-Reference Number:1858 Orange Book Code Indicates the orange book rating of a drug. Generics must have an "A" rating (and "A" must be in the first position of the code) to be considered therapeutically equivalent to a brand name agent. Value Short Long Mnemonic AA NO PROBLEM NO BIOEQUALIVALENCY PROBLEMS NO-BIOEQUAL-PROBLE AB MEET REQS MEET NECESSARY BIOEQUAL REQS MEET-BIOEQUAL-REQ AN MANY SYST USE MANY DELIVERY SYSTEMS USE-MANY-DEL-SYS AO OILS IDENT INJECTABLE OILS IDENTICAL OILS-IDENT-INGRED AP AQUEOUS IV AQUEOUS SOLUTIONS LABELED SIM INJ-AQUEOUS-SOLN AT TOPICAL EQ TOPICAL PRODUCTS EQUIVALENT TOPICAL-EQUIV BC CTL RELEAS CONTROLLED RELEASE TABLET CTL-RELEAS BD BIO PROBS BIOEQUIVALENCY PROBLEMS BIO-PROBS BE ENT COATED ENENTERIC COATED DOSE EQUIV ENT-COATED BN AERO NEBUL PROD IN AEROSOL NEBULIZER AERO-NEBUL BO FTH INVEST FORMER A OR B FURTHER INVEST FTH-INVEST BP POT PROBS POTENTIAL BIOEQUAL PROBS POT-PROBS BR SUPP ENEM SUPPOSITORIES OR ENEMAS SUPP-ENEM BS STP DEFCNT DRUG STANDARD DEFICIENCIES STD-DEFCNT BT TOPI PROBS TOPICAL PROD BIOEQUAL PROB TOPI-PROBS BX INSUFF DAT INSUFFICIENT DATA INSUFF-DATA ZA LAB NO EVA LABELER NOT EVALUATED LAB-NO-EVA ZB ENT NO EVA PHARM ENTITY NOT EVAL END-NO-EVA ZC NO RATING NO RATING NO-RATING ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-OVERRID-IND R-Reference Number:3307 Drug Override Indicator Drug Override Indicator? Value Short Long Mnemonic N/A NOT ENTERED NOT-ENTERED N NO DRUG OV NO DRUG OVERRIDE NO-DRUG-OVR Y DRUG OVR DRUG OVERRIDE ALLOWED DRUG-OVERRID ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-PA-REQ-CD R-Reference Number:2185 PA required cd MT version only - Drug Coverate - PA required cd Value Short Long Mnemonic N NotRequird PA Not Required N Y Required PA Required Y ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-PRC-TY-CD R-Reference Number:8998 Drug Pricing Type Code DRUG PRICING TYPE CODE Value Short Long Mnemonic ABP AltBPkgPrc Alt Benchmark Pkg Price ALT-BENCHMARK-PKG ABU AltBUntPrc Alt Benchmark Unit Price ALT-BENCHMARK-UNIT AMP AvgManuf Average Manufacturer Price AVG-MANUFACTURER APP AVGWHOLPK Average Wholesale Price Pkg AWP-PKG AWP AvgWhole Average Wholesale Price AVG-WHOLESALE BSL Baseline Baseline Price BASELINE DIR Direct Direct Price DIRECT DOD DeptofDef Department of Defense DEPT-OF-DEF DRP DIRECTPKG Direct Package Price DIR-PKG FMC Fed MAC Fed Max Allowed Cost FED-MAC FUL ACA FUL ACA Federal Upper Limit ACA-FED-UPPER-LMT MAF MDSPACAFUL Medi-Span ACA Fed Upper Limit MDSP-ACA-FUL MAW MdSpanAWP Medispan Avg Wholesale Price MSPN-AVG-WHOLESALE MCD Medicaid Medicaid Avg Wholesale Price MEDICAID-AVG-WHLSL MDP MdSpanDP Medispan Direct Price MSPN-DIRECT MFL MdSpanFUL Medispan CMS Fed Upper Limit MSPN-FED-UP-LMT MWC MdSpanWAC Medispan Wholesale Acq Cost MSPN-WHL-ACQ-COST NDB NADACBrnd NADAC Brand NADAC-BRAND NDG NADACGenr NADAC Generic NADAC-GENERIC SMC StateMac State Maximum Allowed Cost ST-MAX-ALLOW-COST SPP SUGWHLPKG Suggest Wholesale Pkg Price SWP-PKG SWP SUGWHLNIT Suggest Wholesale Unit Price SWP-UNIT WAC WhlAcqCost Wholesale Acquisition Cost WHOLESALE-ACQ-COST WNP WhlNetPkg Wholesale Net Package Price WHOLESALE-NET-PKG WNU WhlNetUnt Wholesale Net Unit Price WHOLESALE-NET-UNIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-RBT-CD R-Reference Number:1867 R_DRUG_RBT_CD Indicates whether the drug has a signed rebate contract affiliated with it. Value Short Long Mnemonic No Entry Not Entered NOT-ENTERED N No Rebate No Rebate NO-REBATE Y Rebate Rebate REBATE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-RNGE-TY-CD R-Reference Number:7469 Drug Range Type Code VV Field: 5927 Qualifier that identifies the values that are entered in the drug range begin and end code fields. Value Short Long Mnemonic AC ALLERGY ALLERGY CODES PA-ALLERGY-CODES AH AHFS AMERICAN HOSPITAL FMLY SVC PA-AMER-HOSP-FMLY CD CHRONIC CHRONIC DIAG PA-CHRONIC-DIAG CL Drug Class FDB DRUG CLASS PA-DRUG-CLASS DC Drug Categ NCPDP DRUG CATEGORY PA-DRUG-CATEGORY DE DEA CLASS DEA CLASS PA-DEA-CLASS DP PA PROG PA DRUG PROGRAM PA-DRUG-PROGRAM-CD DS DEA Sched DEA SCHEDULE CODE PA-DEA-SCHEDULE GC GENERIC GENERIC CODE PA-GENERIC-CODE GS GENRIC SEQ GENERIC SEQ PA-GENERIC-SEQ-NUM HI HICL HICL PA-HICL ND NDC CODE NATIONAL DRUG CODE PA-NDC-NUM NN NDC 1st 9 NINE DIGIT NATIONAL DRUG CODE PA-NINE-DIGIT-NDC RT ROUTE ROUTE OF ADMINISTRATION PA-ROUTE ST Stand ThCL STANDARD THERAPEUTIC CLASS PA-THERA-CLS-STND TC THERA-CLAS THERA CLASS PA-THERA-CLASS WC WRK COMP WORKERS COMP PA-WORKERS-COMP ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-STD-PKG-IND R-Reference Number:1877 Drug Standard Package Ind The drug's standard package indicator. Value Short Long Mnemonic 0 All-Other All-Other-Pkg-Sizes ALL-OTHER-PKG-SIZE 1 Std-Pkg Standard-Package STANDARD-PKG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-UNT-DOSE-CD R-Reference Number:1885 Ref Drug Unit Dose Code Drug unit dose code. Type of unit dose. Value Short Long Mnemonic Not Enter Not Entered NOT-ENTERED 0 All Other All Other Products ALL-OTHER-PRODUCTS 1 Unit Dose Unit Dose UNIT-DOSE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DRUG-X2-IND R-Reference Number:8207 X2 drug usage indicator Indicates if this drug has been reused or if this NDC is currently in use as a Dummy drug. Value Short Long Mnemonic D DUMMY Dummy Drug DUMMY-DRUG R REUSED Reused NDC REUSED-NDC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DUR-ADJUD-IND R-Reference Number:6410 Reference DUR Adjudication Ind Sets the final disposition of the DUR (Reject code 88) exception. The following are rules to the Valid Values: A - Auto deny the claim, regardless of other settings on this DUR Filter Record, D - Deny the claim with a Pro-DUR Advisory, I - Ignore the conflict, do not return an advisory to the pharmacy, P - Pay the claim. Value Short Long Mnemonic A Auto Deny Auto Deny AUTO-DENY D Deny Deny DENY I Ignore Ignore IGNORE M Med Ovrrd Medical Override MEDICAL-OVERRIDE P Pay Pay PAY R Pay Report Pay and Report PAY-REPORT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DUR-CVRG-CD R-Reference Number:8122 Duration Coverage Code Duration Coverage Code Value Short Long Mnemonic F Family Family FAMILY I Individual Individual INDIVIDUAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DUR-SVRTY-CD R-Reference Number:5614 Ref DUR Severity Code Indicates severity level of a given DUR conflict for DUR Filter Value Short Long Mnemonic N/A Not Applicable N-A 1 Major Major MAJOR 2 Moderate Moderate MODERATE 3 Minor Minor MINOR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DUR-UNIT-ACUM-CD R-Reference Number:1066 Duration Units Accumulation Cd Duration Units Accumulation Code Value Short Long Mnemonic A Edit All Edit All Drug Doses EDIT-ALL-DRUGS C Edit Acute Edit Acute Doses Only EDIT-ACUTE-ONLY N No Edit No Edit NO-EDIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DUR-UNIT-SPAN-CD R-Reference Number:7537 Duration Units Span Code Duration Units Span Code Value Short Long Mnemonic D Days Days DAYS M Months Months MONTHS Y Years Years YEARS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-DUR-UNIT-STAT-CD R-Reference Number:9075 Duration Units Status Code Duration Units Status Code Value Short Long Mnemonic D PL Exceed Plan Limits Exceeded PLAN-LIM-EXCEED N No Edit No Edit NO-EDIT P PA Req Prior Auth Required PA-REQUIRED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ELIG-OVERRID-IND R-Reference Number:6456 Eligibility Override Indicator Eligibility Override Indicator Value Short Long Mnemonic NA NOT ENTERED NA 0 NOT SPECIF NOT SPECIFIED NOT-SPECIF 1 NO OVERRID NO OVERRIDE NO-OVERRID 2 OVERRIDE OVERRIDE OVERRIDE 3 FULL STUD FULL TIME STUDENT FULL-STUD 4 DISABLED DISABLED DISABLED 5 DEP PARENT DEPENDENT PARENT DEP-PARENT 6 SIGN OTHER SIFNIFICANT OTHER SIGN-OTHER N NO ELG OVR NO ELIGIBILITY OVERRIDE NO-ELG-OVR Y ELIG OVR ELIGIBILITY OVERRIDE ALLOWED ELIG-OVR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-EXC-FORCE-APP-CD R-Reference Number:1903 Exception Force Approved Claim Exception Control Force Approval Code Value Short Long Mnemonic 0 Can Force Can Be Forced CAN-FORCE 1 Cant Force Can Not Force CANT-FORCE 2 Never Forc Never Force NEVER-FORC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-EXC-RPT-TY-CD R-Reference Number:1906 Ref Exception Report Type Cd VV Field: 2184 Claim Exception Control Report Type Code Value Short Long Mnemonic D Detail Lis Detail List DETAIL-LIST S Short List Short List SHORT-LIST ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-EXT-BENE-IND R-Reference Number:6470 Extension of Benefits Ind EXTENSION OF BENEFITS INDICATOR: default is N. Value Short Long Mnemonic N EXT-NO NO EXT-OF-BENEFITS-NO Y EXT-YES YES EXT-OF-BENEFITS-YE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FAM-PLN-CD R-Reference Number:1911 Family Planning Indicator Code used to specify relationship to Family Planning. Value Short Long Mnemonic 0 NotFamPlng Not Family Planning Related NOTFAMPLNG 1 FamPlng Family Planning Related FAMPLNG 2 SusFamPlng Suspect Family Plng Related SUSFAMPLNG 3 NeverFamPl Never Family Planning Related NEVERFAMPL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FDA-DESI2-IND R-Reference Number:2737 FDA DESI 2 IND Indicator which marks a particular drug as being declared less than effective by the FDA. This field differs from the DESI field because it includes the 1990 HCFA expanded DESI list, which were previously not included in the DESI field. Value Short Long Mnemonic 0 ONE PT TM AT ONE POINT IN TIME AT-ONE-PT-IN-TIME 1 AS SPEC AS SPECIFIED IN HFCA AS-SPEC-IN-HFCA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FDA-DESI-IND R-Reference Number:1832 Drug FDA Designation Indicator Drug FDA Designation Indicator Value Short Long Mnemonic Not Spec Unspecified NOT-SPEC 0 Not Desi No Longer Desi NOT-DESI 1 Desi Desi DESI ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FEE-SEL-TY-CD R-Reference Number:0084 Fee Selection Type Code Fee Selection Type Code. Administrative fees are based on this code. Values: A-All Claims; D-Denied Claims; P-Paid Claims. Value Short Long Mnemonic A All Fee Charge All claims a fee ALL-CLAIMS-FEE D Denied Fee Charge Denied claims a fee DENIED-CLAIMS-FEE P Paid Fee Charge Paid claims a fee PAID-CLAIMS-FEE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FFP-MED-SPLY-IND R-Reference Number:9342 FFP MED SPLY IND The Federal Financing Participation Medical Supply Indicator indicates whether a drug product is a medical supply which may be covered by state programs at the states discretion, but is exempt from OBRA rebate provisions. This value appears in arrays with a current value and five historical values. Value Short Long Mnemonic 0 NMEDSUPPLY NON-MEDICAL SUPPLY NON-MEDICAL-SUPPLY 1 MEDSUPPLY MEDICAL SUPPLY MEDICAL-SUPPLY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FMLY-CVRG-IND R-Reference Number:9366 Formulary Coverage Indicator Formulary Coverage Indicator Value Short Long Mnemonic No Ind No Coverage Indicator NO-IND C Covered Covered COVERED G Genr Sub Generic Substitution GENERIC-SUBSTITUTE H HIVCovered HIV Covered HIV-COVERED N Not Cov Not Covered NOT-COV P Prof Appr Requires Medical Profile Appro PROF-APPR R Pref Drug Preferred Drug (treat as cov) PREF-DRUG X Restrictiv Restrictive Formulary RESTRICTIVE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FMLY-PARM-CD R-Reference Number:1487 Formulary Parameter Code Formulary Parameter Code Value Short Long Mnemonic No Coverag No Coverage NO-COVERAGE C Covered Covered COVERED G Gener Sub Generic Substitution GENERIC-SUB N Not Cover Not Covered NOT-COVERED P Prof Appr Profile Approval PROFILE-APPROVAL R Pref Drug Preferred Drug PREFERRED-DRUG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FORCE-DENY-CD R-Reference Number:1914 Force Deny Code Claim Exception Control Force Deny Code Value Short Long Mnemonic 0 Can Deny Can Be Denied CAN-DENY 1 Cant Deny Can Not Deny CANT-DENY 2 Never Deny Never Deny NEVER-DENY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-FORMULARY-TY-CD R-Reference Number:7972 Formulary Type Code FORMULARY TYPE code is not a required field, but a formulary can be assigned to a plan to supplement covered drug and prior authorization policy (in addition to Plan Benefit settings). Value Short Long Mnemonic C Closed For Closed Formulary CLOSED-FORMULARY N No Formul No Formulary NO-FORMULARY P Pref For Preferred Formulary PREFERRED-FORMULAR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GENR-AVAIL-IND R-Reference Number:1840 Generic Available Ind. Indicates whether the drug has generic availability for substitution. Value Short Long Mnemonic N No Generic No Generic Available NO-GENERIC Y Gen Avail Generic Available GEN-AVAIL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GENR-MAND-IND R-Reference Number:5172 Generic Mandatory Indicator Generic Mandatory indicator is set to 'Y' or 'N' to instruct the system when to post Missing DAW Code edit. Value Short Long Mnemonic N NO GENERIC IS NOT MANDATORY GENERIC-NO Y YES GENERIC IS MANDATORY GENERIC-YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GENR-MFR-IND R-Reference Number:3629 GENERIC MFG IND GENERIC MANUFACTURER INDICATOR Value Short Long Mnemonic 0 N DRUG ITM NON DRUG ITEM NON-DRUG-ITEM 1 GENERIC GENERIC GENERIC 2 BRAND BRAND BRAND 3 ALT PROD ALTERNATIVE PRODUCT ALTERNATIVE-PRODCT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GENR-NAME-IND R-Reference Number:4642 GENERIC NAME IND GENERIC NAME INDICATOR Value Short Long Mnemonic 0 N DRUG ITM NON DRUG ITEM NON-DRUG-ITEM 1 GENERIC GENERIC GENERIC 2 BRAND BRAND BRAND 3 ALT PROD ALTERNATIVE PRODUCT ALT-PRODUCT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GENR-PRC-SPRD-CD R-Reference Number:2692 GENERIC PRICE SPREAD CD GENERIC PRICE SPREAD CODE Value Short Long Mnemonic 0 N DRUG ITM NON DRUG ITEM NON-DRUG-ITEM 1 GENERIC GENERIC GENERIC 2 BRAND BRAND BRAND 3 ALT PROD ALTERNATE PRODUCT ALT-PROD 4 UNKNOWN UNKNOWN SPREAD-UNKOWN 5 MULTIPLE MULTIPLE GSI VALUES MULTIPLE 9 NONE NO VALUE NO-VALUE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GENR-THERA-CD R-Reference Number:5406 GENERIC THERAPEUTIC CD GENERIC THERAPEUTIC CODE Value Short Long Mnemonic 02 ANALYGESIC ANALYGESICS ANALGESICS 05 ANESTHETIC ANESTHETICS ANESTHETICS 08 ANTI OBESI ANTI-OBESITY DRUGS ANTI-OBESITY-DRUGS 11 ANTIARTHRI ANTIARTHRITICS ANTIARTHRITICS 14 ANTIHISTAM ANTIHISTAMINES ANTIHISTAMINES 20 ANTIINFECT ANTIINFECTIVES ANTIINFECTIVES 23 MISCANTIIN MISC-ANTIINFECTIVES MISC-ANTIINFECTIVE 26 ANTINEOPLA ANTINEOPLASTICS ANTINEOPLASTICS 29 ANTIPARKIN ANTIPARKINSON DRUGS ANTIPARKINSON-DRUG 32 AUTONOMIC AUTONOMIC DRUGS AUTONOMIC-DRUGS 35 BLOOD BLOOD BLOOD 38 CARDC DRUG CARDIAC DRUGS CARDIAC-DRUGS 41 CARDIOVASC CARDIOVASCULAR CARDIOVASCULAR 44 CNS DRUGS CNS DRUGS CNS-DRUGS 47 CONTRACEPT CONTRACEPTIVES CONTRACEPTIVES 50 C&C PREP COUGH AND COLD PREPARATIONS COUGH-COLD-PREPS 53 DIAGNOSTIC DIAGNOSTIC DIAGNOSTIC 56 DIURETICS DIURETICS DIURETICS 59 ELE CAL FL ELECTR CALORIC FLUID REPLCMTS ELECTR-CAL-FL-REPL 62 EENT PREPS EENT PREPARATIONS EENT-PREPARATIONS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GENR-THERA-IND R-Reference Number:5609 GENERIC THERAPEUTIC IND The Generic Therapeutic Drug Indicator specifies whether a product is a brand, an Orange Book rated generic, a non-Orange Book generic or a product of unknown equivalence. The GTI also uses the manufacturer table as a starting point, providing therapeutic equivalence information in addition to generic/brand. Drug products (GCN) with A rated alternatives will be flagged as having brand/generic status. Value Short Long Mnemonic 0 NonDrug Med Supplies/Bulk Chemicals NON-DRUG 1 BRated Non-Orange Book Generic NON-ORANGE-BK-GEN 2 BrandDrug Branded Drug BRAND 3 ARated Orange Book Generic ORANGE-BK-GEN 4 EquivUnk Generic Prod - No Orange Equiv GENER-UNKNOWN-EQUI ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GPR-PART-FILL-CD R-Reference Number:5033 Group Partial Refill Code Used by Group to designate whether to add a dispensing fee or copay to a prescription refill. Value Short Long Mnemonic A HalfPay Pay 1/2 Disp Fee on Both PAY-HALF-AND-HALF C CompletPay Pay Disp Fee on Completion Fil PAY-ON-COMPLETION P PartialPay Pay Disp Fee on Partial Fill PAY-ON-PARTIAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GPR-PD-DIFF-IND R-Reference Number:0149 Group Price Paid Differ Ind PATIENT PAID DIFF: In commercial programs, where patient selection of brand products is allowed, this field determines whether the patient is to be charged the difference in price199 Value Short Long Mnemonic N DiffNotPd Difference Not Paid by Patient DIFF-NOT-PAID Y DiffPaid Difference Paid by Patient DIFF-PAID-BY-PAT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GPR-PRICE-CAT-CD R-Reference Number:0128 Group Price Category Code Group price category code indicates which category the reimbursement formula applies to. Value Short Long Mnemonic 1 CUST-SPC-1 CUSTOMER SPECIFIC PRICING CAT1 CUSTOMER-SPEC-1 2 CUST-SPC-2 CUSTOMER SPECIFIC PRICING CAT2 CUSTOMER-SPEC-2 3 CUST-SPC-3 CUSTOMER SPECIFIC PRICING CAT3 CUSTOMER-SPEC-3 4 CUST-SPC-4 CUSTOMER SPECIFIC PRICING CAT4 CUSTOMER-SPEC-4 5 CUST-SPC-5 CUSTOMER SPECIFIC PRICING CAT5 CUSTOMER-SPEC-5 6 CUST-SPC-6 CUSTOMER SPECIFIC PRICING CAT6 CUSTOMER-SPEC-6 7 CUST-SPC-7 CUSTOMER SPECIFIC PRICING CAT7 CUSTOMER-SPEC-7 A ALL ALL ALL B BRAND BRAND BRAND C COMPOUND COMPOUND COMPOUND D NON-DRUG NON-DRUG ITEM NON-DRUG-ITEM E DIAB SUPPL DIABETIC SUPPLIES DIABETIC-SUPPLIES G GENERIC GENERIC GENERIC H DEA SCHED2 DEA SCHEDULE 2 DEA-SCHEDULE-2 I GENERIC IV GENERIC INTRAVENOUS GENERIC-IV J BRAND IV BRAND INTRAVENOUS BRAND-IV K IV NONFMAC INTRAVENOUS NON-FEDMAC IV-NON-FEDMAC L SCH2 NOMAC DEA SCHEDULE 2 NONMAC DEA-SCH2-NONMAC N NON-FEDMAC NON-FEDMAC NON-FEDMAC O OTC OVER THE COUNTER OVER-THE-COUNTER T DIRECT DIRECT DIRECT U WHLSNETUN WHOLESALE NET UNIT WHOLESALE-NET-UNIT W MCAID AWP MEDICAID AWP MEDICAID-AWP X DME-NUTRI DME AND NUTRITIONAL SUPP. DME-MISC Y INSULIN INSULIN INSULIN Z CUST SPEC CUSTOMER-SPECIFIC CUSTOMER-SPECIFIC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GPR-PRICE-DAW-CD R-Reference Number:0131 Group Price DAW Code Dispense as Written (DAW) pricing option. Value Short Long Mnemonic No DAW DAW Not Specified NOT-SPECIFIED-DAW 1 Physician Physician DAW PHYSICIAN-DAW 2 Patient Patient DAW PATIENT-DAW 3 Pharmacist Pharmacist DAW PHARMACIST-DAW 4 No Generic No Generic Available DAW NO-GENERIC-AVAIL 5 Brand DG Brand Dispense as Generic BRAND-DISP-AS-GENR 6 Ovrrd DAW Override DAW OVERRIDE-DAW 7 Brand Mand Brand Drug is Mandatory BRAND-DRUG-MANDATE 8 Gen NA Mar Generic Not Avail in Market GENERIC-NA-MARKET 9 Other DAW Other DAW OTHER-DAW ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GPR-PROV-OVRD-CD R-Reference Number:0136 Group Price Prov Override Cd Provider override allows/disallows payment of a different Ingredient Cost Basis or Dispensing Fee by Pricing Category on a provider-specific basis. Used when particular providers are to receive a different reimbursement rate and/or dispensing fee. Value Short Long Mnemonic B Disc Disp Discount Dispense Override DISCOUNT-DISPENSE D Disc Rate Discount Rate Only Override DISCOUNT-RATE-ONLY F Disp Fee Dispensing Fee Only Override DISPNSING-FEE-ONLY N No Ovrride No Provider Price Override NO-OVERRIDE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GRP-STEPCARE-IND R-Reference Number:0120 Step Care Participant Ind Step Care Participant indicator. Value Short Long Mnemonic N non-partic Doesn't participate in StepCar NON-PARTIC Y participat Participate in StepCare PARTICIPATE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-GRP-TYP-CD R-Reference Number:0093 Group Type Code Group type: M = Mail Order; R = Retail Value Short Long Mnemonic MailRetail Mail Order or Retail Claims MAIL-OR-RETAIL M Mail Order Mail Order Claims Only GRP-TYP-MAIL-ORDER R Retail Retail Claims Only GRP-TYP-RETAIL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-HCFA-DRUG-CAT-CD R-Reference Number:0536 HCFA DRUG CATEGORY CD HEALTH CARE FINANCING ADMINISTRATION DRUG CATEGORY CODE Value Short Long Mnemonic UNSPECIF UNSPECIFIED UNSPECIFIED I INNMULTSRC INNOVATOR MULTI-SOURCE INNOVAT-MULTI-SRC N NINNMULTSR NON-INNOVATOR MULTI-SOURCE N-INNOVAT-MULT-SRC S SINGLESOUR SINGLE SOURCE SINGLE-SOURCE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-HCFA-DRUG-TY-CD R-Reference Number:4376 HCFA DRUG TYPE CODE HCFA DRUG TYPE CODE Value Short Long Mnemonic NPROVHCFA NOT PROVIDED BY HCFA NOT-PROVIDED-HCFA 1 FDA DESGN FDA DESIGNED-PRESCR ONLY FDA-DESIGNED 2 OTC OVER THE COUNTER OVER-THE-COUNTER ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-HM-HLTH-IND R-Reference Number:7123 HOME HEALTH IND HOME HEALTH INDICATOR Value Short Long Mnemonic 0 NOTONHOME NOT ON HOME:SUBSET NOT-ON-HOME 1 HOMEHEALTH ON HOME:SUBSET ON-HOME ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-HOSPITAL-IND R-Reference Number:0188 HOSPITAL IND HOSPITAL INDICATOR Value Short Long Mnemonic 0 NOTONHOSP NOT ON HOSPITAL NOT-ON-HOSPITAL 1 ON HOSPIT ON HOSPITAL ON-HOSPITAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ICD-DESC-SRC-CD R-Reference Number:3088 FDB ICD Desc Source Cd FDB ICD deescription source code Value Short Long Mnemonic 01 CMS CMS CMS 02 FDB FDB FDB 03 NCHS long NCHS Long NCHS-LONG 04 NCHS short NCHS Short NCHS-SHORT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ICD-STAT-CD R-Reference Number:5934 FDB ICD Status Cd FDB ICD status code Value Short Long Mnemonic 1 Live Live LIVE 2 Retired Retired RETIRED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ICD-TY-CD R-Reference Number:4801 FDB ICD Type Code FDB ICD Type Code Value Short Long Mnemonic 01 ICD9CM Dis ICD-9-CM Dis & Inj 001-999 ICD9-CM-DISEASE 02 ICD9CM Prc ICD-9-CM Procedures 01-99 ICD9-CM-PROC 03 ICD9CM V ICD-9-CM V-codes ICD9-CM-V 04 ICD9CM E ICD-9-CM E-codes ICD9-CM-E 05 ICD10CM ICD-10-CM ICD10-CM 06 ICD10PCS ICD-10-PCS ICD10-PCS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-INFER-DIS-CD R-Reference Number:1892 Inferred Disease Code A code that represents an inferred disease. Value Short Long Mnemonic ALCOHOLISM Alcoholism Alcoholism ALCOHOLISM ALZHEIMERS Alzheimers Alzheimers ALZHEIMERS ANGINA PECTO Angina Angine Pectoris ANGINA-PECTORIS CALCIUM RENA Calc Renal Calcium Renal Calcul CALCIUM-RENAL CONGESTIVE H CHF Congestive Heart Failure CONG-HEART-FAIL CUSHINGS SY Cushings Cushings Syndrome CUSHINGS-SYNDROME DIABETES MEL Diabetes Diabetes Mellitus DIABETES-MELLITUS DIARRHEA Diarrhea Diarrhea DIARRHEA EPILEPSY Epilepsy Epilepsy EPILEPSY HYPERKALEMIA Hyperkalem Hyperkalemia HYPERKALEMIA HYPERTENSION Hypertensi Hypertension HYPERTENSION HYPERTHYROID Hyperthyro Hyperthyroidism HYPERTHYROID MENTAL DEPRE Men Depres Mental Depression MENTAL-DEPRESSION MYASTHENIA G Myasthen G Myasthenia Gravis MYASTHENIA-GRAVIS PARKINSONISM Parkinson Parkinsonism PARKINSONISM PERIPHERAL V Perip Vasc Peripheral Vascular Disease PERIPHERAL-VASCUL PHEOCHROMOCY Pheochromo Pheochromocytoma PHEOCHROMOCY PROSTATIC CA Prostat CA Prostatic Cancer PROSTATIC-CANCER PSYCHOTIC DI PsychoticD Psychotic Disorders PSYCHOTIC-DISORDER TUBERCULOSIS Tuberculos Tuberculosis TUBERCULOSIS URINARY TRAC UTI Urinary Tract Infection URINARY-TRACT-INF WILSONS DIS Wilsons DI Wilsons Disease WILSONS-DISEASE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-INFER-TY-CD R-Reference Number:6954 Inferred Disease Type Code A code that indicates whether the r-drug-cd designated infers a defined disease or conflicts with a defined disease. Value Short Long Mnemonic C CNFLCT DIS Conflicts with a Disease CNFLCT-DIS I INFER DIS Infers a Disease INFER-DIS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-INNER-PKG-IND R-Reference Number:3907 R-INNER-PKG-IND INNER PACKAGE INDICATOR Value Short Long Mnemonic 0 ALL OTHERS ALL OTHERS ALL-OTHERS 1 INNER PKG INNER PACKAGE INNER-PKG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-INNOVATOR-LOC-CD R-Reference Number:5699 INNOVATOR LOC CD INNOVATOR LEVEL OF CARE CODE Value Short Long Mnemonic 0 DEFAULT DEFAULT-NON INNOVATOR DRUG DEFAULT-NON-INNOV 1 INNOVATOR INNOVATOR-HELD ORIG PATENT INNOVATOR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-INST-PROD-IND R-Reference Number:1844 Institutional Product Institutional Product Indicator Value Short Long Mnemonic 0 Not Inst Not Institutional NOT-INST 1 Institut Institutional INSTITUT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-LABELED-CD R-Reference Number:2278 Labeled Indication Code Identifies whether a drug indication is Labeled or Unlabeled Value Short Long Mnemonic L Labeled Labeled Indication R-LABELED-INDCTN U Unlabeled Unlabeled Indication R-UNLABELED-INDCTN ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-LABLR-RBT-CD R-Reference Number:3935 Labeler Rebate Code VV Field: 1867 Labeler Rebate Code. Value Short Long Mnemonic No Entry Not Entered NOT-ENTERED N No Rebate No Rebate NO-REBATE Y Rebate Rebate REBATE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-LABLR-SRC-CD R-Reference Number:9726 Source Code CMS Labeler Source Code Value Short Long Mnemonic 1 Manual Manual Entry MAN 2 Systematic System Generated Entry SYS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-LINE25-SRC-IND R-Reference Number:7833 LINE 25 SOURCE IND LINE 25 SOURCE INDICATOR Value Short Long Mnemonic 0 BRAND NAME BRAND NAME ABBREVIATION BRAND-NAME-ABBR 1 GENERIC NM GENERIC NAME ABBREVIATION GENERIC-NAME-ABBR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAIL-ORD-IND R-Reference Number:0039 Mail Order Indicator Identifies client enrollment in the Mail Order Program. Value Short Long Mnemonic N MailOrdN Mail Order Customer = No MAIL-ORDER-CUST-N Y MailOrdY Mail Order Customer = Yes MAIL-ORDER-CUST-Y ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAIL-ORD-RX-CD R-Reference Number:7988 Mail Order Drugs Covered MAIL ORDER DRUGS COVERED: If the Client File indicates a mail order program is applicable for this client, this field should be set to indicate what type of drugs are to be covered. Value Short Long Mnemonic A ALL RXS ALL DRUGS COVERED ALL-DRUGS-COVERED M MAINT ONLY MAIL ORDER MAINT RXS ONLY MAINT-ONLY-COVERED N NO M O PGM NO MAIL ORDER PROGRAM NO-ML-ORD-PGM ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAINT-DOSE-CD R-Reference Number:4517 Maintenance Dose Indicator Maintenance Dose Indicator Value Short Long Mnemonic D Deny-Limit Deny for Exceeding Bene Limits DENY-FOR-LIMITS N No Edit No Edit NO-EDIT P Deny-PA Deny for Requiring PA DENY-FOR-PA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAINT-DRUG-CD R-Reference Number:6656 Maintenance Drug Code Maintenance Drug Code Value Short Long Mnemonic D Use Drug Use Drug Table Maint Code USE-DRUG-TB N Not Maint Not Maintenance Drug NOT-MAINT-DRUG Y Maint Maintenance Drug MAINT-DRUG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-BENE-ACUM-CD R-Reference Number:7822 Max Benefit Accumulation Code Indicates whether the maximum benefit is met monthly, quarterly, or annually. The system tracks all claims paid during the specified time period and uses the total to determine if the member has reached their maximum benefit for the period. At the end of the period, the system resets to zero and begins accumulating claims charges again. Value Short Long Mnemonic A Annually Annually ANNUALLY E PlanEndDt Plan End Date PLAN-END-DATE M Monthly Monthly MONTHLY N None None NONE Q Quarterly Quarterly QUARTERLY S SemiAnnual Semi Annually SEMIANNUALLY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-BENE-CD R-Reference Number:5857 Maximum benefit code Maximum benefit code can be designated as either Plan or Member. When set to P (plan) this indicates that the amount in the Maximum Benefit fields (FAMILY and INDIVIDUAL) is the maximum amount the plan will pay in the benefit period as indicated by the MAX BEN ACCUML field. Once the plan pays this amount, the member is responsible for 100% of any additional charges for the remainder of the benefit accumulation period. Value Short Long Mnemonic M Member Member MEMBER N None None NONE P Plan Plan PLAN ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-DEP-AGE-CD R-Reference Number:3617 Maximum Dependent Age MAXIMUM DEPENDENT AGE, CODE: 1 TO-BD is the default. Value Short Long Mnemonic 1 TO-BD TO BIRTHDAY TO-BIRTHDAY 2 THRU-BD THRU BIRTHDAY THRU-BIRTHDAY 3 END-MO-BD THRU END OF MONTH OF BIRTHDAY THRU-END-OF-MO-BD 4 END-YE-BD THRU END OF YEAR OF BIRTHDAY THRU-END-OF-YR-BD ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-DLY-FMLY-AMT R-Reference Number:1853 Max Daily Family Amount Maximum Daily Formulary Amount. Value Short Long Mnemonic NOT-ENTER NOT ENTERED NOT-ENTERED AP APPLICATOR APPLICATORFUL FOR CREAMS APPLICATORFUL AY AER POW BA AEROSOL POWDER,BREATH ACTIVAT AEROSOL-POWDER-BA DP DROPERETTE DROPERETTE,DROP DISPENSER DROPERETTE EA EACH EACH TABLET, CAPSULES, SUPPOS EACH EG STICK GM STICK (GM) STICK-GM EH STICK EA STICK (EA) STICK-EA EI CEMENT CEMENT (GM) CEMENT G GRAM GRAM GRAM IN METER-DOSE METERED DOSE AEROSOLS METERED-DOSE JX GEL W/APPL GEL WITH APPLICATOR (ML) GEL-WITH-APPLICATO ML MILLILITER MILLILITER MILLILITER PZ SUSP PACKT SUSPENSION IN PACKET (EA) SUSPENSION-IN-PACK SC SCOOP SCOOP SCOOP WA WAX (GM) WAX (GM) WAX WB TAR (GM) TAR (GM) TAR YO TOWELETTE TOWELETTE (EA) TOWELETTE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-RX-ACUM-CD R-Reference Number:9148 Maximum Drug Accum Code Maximum RX Accumulation Code Value Short Long Mnemonic A Edit All Edit All Drug Doses EDIT-ALL-DRUGS C Edit Acute Edit Acute Drugs Only EDIT-ACUTE-DRUGS N No Edit No Edit NO-EDIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-RX-CVRG-CD R-Reference Number:2722 Maximum Drug Coverage Cd Maximum RX Coverage Code Value Short Long Mnemonic F Family Family FAMILY I Individual Individual INDIVIDUAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-RX-SPN-CD R-Reference Number:9631 Maximum Drug Span Code Maximum RX Span Code Value Short Long Mnemonic D Days Days DAYS M Months Months MONTHS Y Years Years YEARS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-RX-STAT-CD R-Reference Number:6616 Maximum Drug Status Code Maximum RX Status Code Value Short Long Mnemonic D PL Exceed Plan Limits Exceeded PLAN-LIM-EXCEED N No Edit No Edit NO-EDIT P PA Req Prior Authorization Required PRIOR-AUTH-REQ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MAX-UNIT-ACUM-CD R-Reference Number:4061 Maximum Units Accum Code Maximum Units Accumulation Code Value Short Long Mnemonic A Edit All Edit All Drug Doses EDIT-ALL-DRUGS C Edit Acute Edit Acute Drugs Only EDIT-ACUTE-ONLY N No Edit No Edit NO-EDIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MCARE-CVRG-IND R-Reference Number:0670 Medicare Coverage Indicator MEDICARE COVERAGE INDICATOR Value Short Long Mnemonic N No No NO Y Yes Yes YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MGMT-OVERRID-IND R-Reference Number:7182 Management Override Indicator Management Override Indicator? Value Short Long Mnemonic N/A NOT ENTERED NOT-ENTERED 1 SUSP OVR SUSPENSE STATUS OVERRIDE SUSP-OVR 2 NO SUS OVR NO SUSPENSE OVERRIDE - DENY NOS-SUS-OVR L MGMT OV L MANAGE OVERRD ALLOWED (L) MGMT-OV-L N NO MGM OVR NO MANAGEMENT OVERRIDE NO-MGMT-OVR Y MGMT OVR MANAGEMENT OVERRIDE ALLOWE MGMT-OVERRID ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MIN-DLY-FMLY-AMT R-Reference Number:1851 Min Daily Family Amount Minimum Daily Formulary Amount Value Short Long Mnemonic NOT-ENTER NOT ENTERED NOT-ENTERED AP APPLICATOR APPLICATORFUL FOR CREAMS APPLICATORFUL AY AER POW BA AEROSOL POWDER,BREATH ACTIVAT AEROSOL-POWDER-BA DP DROPERETTE DROPERETTE,DROP DISPENSER DROPERETTE EA EACH EACH TABLET, CAPSULES, SUPPOS EACH EG STICK GM STICK (GM) STICK-GM EH STICK EA STICK (EA) STICK-EA EI CEMENT CEMENT (GM) CEMENT G GRAM GRAM GRAM IN METER-DOSE METERED DOSE AEROSOLS METERED-DOSE JX GEL W/APPL GEL WITH APPLICATOR (ML) GEL-WITH-APPLICATO ML MILLILITER MILLILITER MILLILITER PZ SUSP PACKT SUSPENSION IN PACKET (EA) SUSPENSION-IN-PACK SC SCOOP SCOOP SCOOP WA WAX (GM) WAX (GM) WAX WB TAR (GM) TAR (GM) TAR YO TOWELETTE TOWELETTE (EA) TOWELETTE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-MINI-FILE-IND R-Reference Number:8625 MINI FILE IND MINI FILE INDICATOR Value Short Long Mnemonic 0 NOTONMINI NOT ON MINI NOT-ON-MINI 1 ON MINI ON MINI ON-MINI ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-NCPDP-VRSN-NUM R-Reference Number:3512 NCPDP Version Number The NCPDP Version and Release Number of the transaction in which the claim was submitted. Value Short Long Mnemonic 32 Version 32 NCPDP Version Number 3.2 VERSION-32 51 Version 51 NCPDP Version Number 5.1 VERSION-51 D0 Version D0 NCPDP Version D.0 VERSION-D0 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-NDA-IND R-Reference Number:0166 New Drug Application Provided by FDB, New Drug Application to be used in the calculations to replave the GPI field which will no longer be provided. Value Short Long Mnemonic 0 NDA No NDA No NDA-NO 1 NDA Yes NDA Yes NDA-YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-NDC-RBT-CD R-Reference Number:6607 NDC Rebate Code VV Field: 1867 NDC Rebate Code. Value Short Long Mnemonic No Entry Not Entered NOT-ENTERED N No Rebate No Rebate NO-REBATE Y Rebate Rebate REBATE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-NEG-FMLY-IND R-Reference Number:6067 Negative Formulary Indicator Drug negative formulary indicator Value Short Long Mnemonic N No No NO Y Yes Yes YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ORNG-BK-EXPD-CD R-Reference Number:6390 ORANGE BOOK EXPIRATION CD ORANGE BOOK EXPIRATION CODE Value Short Long Mnemonic AA NO BIOEQ NO BIOEQUAL PROBLEM NO-BIOEQUA-PROB AB MEET BIOEQ MEET BIOEQUAL REQUEST MEET-BIOEQUAL-REQ AN MANY DEL USE MANY DEL SYSTEMS USE-MANY-DEL-SYS AO IDENT INGR OILS IDENT INGREDIENTS OILS-IDENT-INGRED AP INJ AQUE INS AQUEOUS SOLUTION INJ-AQUEOUS-SOLN AT TOP EQUIV TOPICAL EQUIVALENT TOPICAL-EQUIV B* FUR INVEST FURTHER INVESTIGATION FURTHER-INVEST BC CNTL REL CONTROL RELEASE CONTROL-REL BD BIOEQ PBMS BIOEQUAL PROBLEMS BIOEQUAL-PROBLEMS BE ENTER COAT ENTERIC COATED ENTERIC-COATED BN AERO NEBLZ AEROSOL NEBULIZER AEROSOL-NEBULIZER BP POTNT PBMS POTENTIAL PROBLEMS POTENTIAL-PROBLEMS BR SUP ENEMA SUPPOSITORY ENEMA SUPPOS-ENEMA BS STD DEFCT DRUG STANDARD DEFICIENT DRUG-STD-DEFICIENT BT TOP B PROC TOPICAL BIOLOGICALPROCESS TOPICAL-BIO-PROCES BX INSUFF DAT INSUFFICIENT DATA INSUFFICIENT-DATA ZA LAB N EVAL LABELER NOT EVALUATED LABELER-NOT-EVAL ZB ENT N EVAL ENTITY NOT EVALUATED ENTITY-NOT-EVAL ZC NO RATING NO RATING NO-RATING ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-OUTER-PKG-IND R-Reference Number:3741 OUTER PACKAGE IND OUTER PACKAGE INDICATOR Value Short Long Mnemonic 0 ALL OTHERS ALL OTHERS ALL-OTHERS 1 OUTER PKG OUTER PACKAGE OUTER-PKG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-OVR-TY-CD R-Reference Number:1056 Override Type code valid values for Disaster Exception Processing Value Short Long Mnemonic E EITHER Recipient and Pharmacy County REC-PHARM-COUNTY P PHARMACY Pharmacy County PHARM-COUNTY R RECIPIENT Recipient County REC-COUNTY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PAT-PKG-INS-CD R-Reference Number:2159 PATIENT PACKAGE INSERT CD PATIENT PACKAGE INSERT CODE Value Short Long Mnemonic NOT REQD PATIENT PKG INSERT NOT REQD PAT-PKG-NOT-REQD 1 PPKGINSREQ PATIENT PACKAGE INSERT REQD PAT-PKG-INS-REQD ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PAY-LESSER-IND R-Reference Number:0141 Pay Lesser Indicator PAY LESSER INDICATOR: This field determines whether the system will pay the lesser of Submitted Total Charge versus the Allowed Total Charge. Value Short Long Mnemonic N CALCULATED PAY CALCULATED PAY-CALCULATED Y SUBMITTED PAY SUBMITTED WHEN LESS PAY-SUBMITTED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-AGE-STAT-CD R-Reference Number:0764 Plan Bene Limit Age Status Cd Plan Benefit Limit Age Edit Status Code Value Short Long Mnemonic D Deny Claim Deny Claim DENY-CLAIM N No Edit No Edit NO-EDIT P PA Req Prior Authorization Required PRIOR-AUTH-REQ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-DAYS-ACUM-CD R-Reference Number:9921 Plan Bene Limit Days Accum Cd Plan Benefit Limit Days Accumulation Code Value Short Long Mnemonic A Edit All Edit All Drugs EDIT-ALL-DRUGS C Edit-Acute Edit Acute Drugs Only EDIT-ACUTE-DRUGS N No Edit No Edit NO-EDIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-DAYS-STAT-CD R-Reference Number:0194 Plan Bene Limit Days Status Cd Plan Benefit Limit Days Status Code Value Short Long Mnemonic D Lim Exceed Plan Limits Exceeded PLAN-LIMIT-EXCEED N No Edit No Edit for Days Supply NO-EDIT P PA Req Prior Authorization Required PRIOR-AUTH-REQ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-LMT-STAT-CD R-Reference Number:1383 Plan Benefit Limit Status Code Plan Benefit Limit Status Code Value Short Long Mnemonic C COVERED BENEFIT LIMIT IS COVERED COVERED N NOT COVER BENEFIT LIMIT IS NOT COVERED NOT-COVERED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-MED-CERT-IND R-Reference Number:2775 Plan Bene Limit Ovrd Med Cert Plan Benefit Limit Override Medical Cert Indicator Value Short Long Mnemonic No Entry No Value Entered NOT-ENTERED N NoOverride Don't Override Med Cert NO-OVERRIDE Y Override Override Med Cert OVERRIDE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-OVRRD-PA-CD R-Reference Number:4451 Plan Bene Limit Override PA Cd Plan Benefit Limit Override PA Code Value Short Long Mnemonic NO OVERRID Not Specified NO-OVERR-DEFAULT I INIT OVERR PA will override 1st rx only OVERRIDE-INIT-RX N NO OVERRID PA will not override NO-OVERRIDE Y OVERRIDE PA will override OVERRIDE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-SEX-CD R-Reference Number:2604 Plan Benefit Limit Sex Code Plan Benefit Limit Sex Code Value Short Long Mnemonic B Both Sexes Both Sexes BOTH-SEXES F Fem Only Females Only FEMALES-ONLY M Males Only Males Only MALES-ONLY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-SUPPLY-CD R-Reference Number:8074 Plan Benefit Limit Supply Code Plan Benefit Limit Supply Code Value Short Long Mnemonic N No Limit No Limit NO-LIMIT R Refill Lim Limits On Refills REFILL-LIMIT T Trial Lim Trial Dosage Limit TRIAL-DOSAGE-LIMIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PBL-TYP-CD R-Reference Number:8471 Plan Benefit Limit Type Code Plan Benefit Limit Type Code Value Short Long Mnemonic A DRUG CAT NCPDP DRUG CATEGORY DRUG-CATGRY C DRUG CLASS NCPDP DRUG CLASS DRUG-CLASS D DEA CODE DEA Schedule CODE DEA-CODE E NDC 11 ELEVEN DIGIT NDC ELEVEN-DIGIT-NDC F AHFS CD AMERICAN HOSPITAL FRMLYRY SRVC AHFS-CD G GENERIC CD GENERIC CODE GENERIC-CD H HICL CD HIERARCHICAL INGRED LIST SK-HICL-CD N NDC 1ST 9 NINE DIGIT NDC NINE-DIGIT-NDC R ROUTE ROUTE OF ADMINISTRATION ROUTE S GEN SEQ NO GENERIC SEQUENCE NUMBER GENERIC-SEQ-NO T THER CLASS SPECIFIC THERAPEUTIC CLASS THERA-CLASS U STNDRD TC STANDARD THERAPEUTIC CLASS STANDARD-TC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PCC-CATEGORY-CD R-Reference Number:7810 Plan Copay Category Code Category Code - identifies how copay is handled for generic, brand, in and out of network, over max benefits for non formulary drugs Value Short Long Mnemonic BG Brand No G Brand No Generic BRAND-NO-GENERIC BR Brand Brand BRAND BX PfrrdBrnd Preferred Brand PFRRD-BRAND GE Generic Generic GENERIC GX PfrrdGnrx preferred Generic PFRRD-GENERIC NB Non NW Br Non Network Brand NON-NETWORK-BRAND NF Non Formul Non Formulary NON-FORMULARY NG Non NW Gen Non Network Generic NON-NETWORK-GENERI NN Non NW BNG Non Network Brand No Generic NON-NETW-BR-NO-GEN NS NonNWSpcl Non Network Special NON-NETWK-SPECIAL NX NNWNF Non Network Non Formulary NON-NETW-NON-FORM OB Overmaxb Over Max Brand OVER-MAX-BRAND OG Overmaxg Over Max Generic OVER-MAX-GENERIC ON OvermaxBNG Over Max Brand No Generic OVER-MAX-BR-NO-GEN SS Special Special SPECIAL XB NonNWPfb Non-Network Preferred Brand NON-NTWK-PFRD-BRND XG NonNWPFG Non Network Preferred Generic N0N-NTWK-PFRD-GNR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PCC-COPAY-CD R-Reference Number:4338 Plan Copay Category Copay Code PCC Copay Code - Code to indicate whether to use copay amount, percent, both, or the lesser or greater of the two. Value Short Long Mnemonic B Both Use Both AMT & PCT BOTH G Greater Use Greater of AMT or PCT GREATER L Lesser Use Lesser of AMT or PCT LESSER N One Use One - AMT or PCT ONE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PCC-PART-FILL-CD R-Reference Number:1292 Plan Copay Partial Refill Code Used by customer to designate whether to add a dispensing fee or copay on a prescription refill. Value Short Long Mnemonic A All Fill All Fill ALL-FILL C Completion Completion Fill COMPLETION-FILL P Partial Partial Fill PARTIAL-FILL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PHL-BUSN-TYP-CD R-Reference Number:6787 Plan Header Limit Bus Type Cd PHL Business Type Code - distinguish between Retail vs. Mail Order type business. Value Short Long Mnemonic M Mail Order Mail Order MAIL-ORDER R Retail Retail RETAIL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PHL-RX-SPAN-CD R-Reference Number:2536 Plan Header Limit RX Span Code RX Span Code Value Short Long Mnemonic D Days Days DAYS M Months Months MONTHS Y Years Years YEARS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PLAN-DAW-CD R-Reference Number:9599 Plan Dispense as Written Code Plan override DAW code lists which Dispense as Written (DAW or Product Selection) codes are allowed if the Generic Mandatory indicator is set to 'Y'. Value Short Long Mnemonic 0 NO DAW NO DAW NO-DAW 1 PHYSICIAN PHYSICIAN DAW PHYSICIAN-DAW 2 PATIENT PATIENT DAW PATIENT-DAW 3 PHARMACIST PHARMICIST DAW PHARMICIST-DAW 4 NO GENERIC NO GENERIC IN STOCK NO-GENERIC-STOCK 5 BRD AS GEN BRAND DISPENSED AS GENERIC BRAND-DISP-AS-GENE 6 OVERRIDE OVERRIDE OVERRIDE 7 BRAND MAND BRAND DRUG MANDATE BY LAW BRAND-DRUG-MANDATE 8 NO GENERIC NO GENERIC AVAILABLE NO-GENERIC-AVAIL 9 OTHER OTHER OTHER ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PLAN-TYPE-CD R-Reference Number:6116 Plan Type Code The Plan Type code is extremely important to the system to determine various factors: person code default, coverage for rebate-able drugs and Closed vs. Open prescriber networks. Value Short Long Mnemonic D Default Default Plan Type DEFAULT-PLAN-TYPE E Grace Edit Grace Do Edit GRACE-DO-EDIT M MC No Edit MediCaid No edit MCAID-NO-EDIT N No Phy Edi No Prescribing Physician Edit NO-PRESC-PHYS-EDIT O MC Do Edit MediCaid Do edit MCAID-DO-EDIT R State MC State Medicaid Reb Edit STATE-MCAID-REB-ED W WC Edit Workers Comp Edit WORKERS-COMP-EDIT Y Phy Edit Prescribing Physician Edit DO-PRESC-PHYS-EDIT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PRIM-THERA-IND R-Reference Number:4147 Primary Therapeutic Class Ind Drug Primary Therapeutic Class Indicator Value Short Long Mnemonic N Not Primar Not Primary Therapeutic Class NOT-PRIMARY Y Primary Primary Therapeutic Class PRIMARY ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PRIOR-AUTH-CD R-Reference Number:1575 Drug Prior Authorization Code Indicates whether the service require Prior Authorization. Value Short Long Mnemonic 2 CopayReq Drug Copay Required COPAY-REQ B NotReq PA not required, 0 Copay NOT-REQ H NonPref Drug non preferred PA req NON-PREF L LTCOnly LTC Only, Else PA req LTCONLY P Powder Powder use in Compound only POWDER R BrandGen If Brand use Gen or Vice Versa BRANDGEN T TherPavil Thereuaptic EQ Available THERPAVAIL V Vaccine Vaccine, LTC only else PA req VACCINE W ClincalPA Clinical PA req X,Drug not cov CLINICAL-PA X TBD Coverage to be determined TBD Y DrugNotCov Drug not covered PA not avail DRUGNOTCOV ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PRIV-NDC-LBLR-CD R-Reference Number:9928 PRIVATE NDC LBLR CD PRIVATE NDC LBLR CODE Value Short Long Mnemonic 0 PRIV LBLR PRIVATE LABELER PRIVATE-LABELER 1 ALL OTHERS ALL OTHERS ALL-OTHERS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PRM-THR-CHAR3-CD R-Reference Number:2780 Ref Primary Therapeutic Cls Cd VV Field: 1804 Indicates the primary therapeutic specific class to which a drug or other prescribed agent may belong. Value Short Long Mnemonic A1A Glycosides Digitalis Glycosides GLYCOSIDES A1B Xanthines Xanthines XANTHINES A1C Inotropic Inotropic Drugs INOTROPIC A1D Broncho General Bronchodilator Agents BRONCHO A2A Arrhythmic Antiarrhythmics ARRHYTHMIC A4A Hypotensi3 Hypotensives, Vasodilators HYPOTENSI3 A4B Hypotensi2 Hypotensives, Sympatholytic HYPOTENSI2 A4C Hypotensiv Hypotensives, Ganglionic Block HYPOTENSIV A4D Hypotensi4 Hypotensives,Ace Blocking Type HYPOTENSI4 A4E Hypotensi5 Hypotensives,Veratrum Alkaloid HYPOTENSI5 A4F Hypotensi6 Hypoten, Angio Recptr Antag HYPOTENSI6 A4Y Hypotensi1 Hypotensives, Miscellaneous HYPOTENSI1 A6U Cardiovas Cardiovascular Diag-Radiopaqu CARDIOVAS A6V Cardiovas1 Cardiovascular Diag Non Radio CARDIOVAS1 A7A Arteriolar Vasoconstrictors, Arteriolar ARTERIOLAR A7B Coronary Vasodilators, Coronary CORONARY A7C Peripheral Vasodilators, Peripheral PERIPHERAL A7D Peripheral Vasodilators, Peripheral (cont PERIPHERAL1 A7E Vasodil Vasodilators, Miscellaneous VASODIL A7F Veinotoni Veinotonics/Vasculoprotectors VEINOTONI A7G Inhibit10 C-GMP Phosphodiesterase typ5 INHIBITOR10 A80 Venoscler Venosclerosing Agents VENOSCLER A9A Calcium Calcium Channel Blocking Agnts CALCIUM B0A Inhalation General Inhalation Agents INHALATION B0P Gases Inert Gases GASES B1A Surfactant Lung Surfactants SURFACTANT B3A Mucolytics Mucolytics MUCOLYTICS B3J Expectrnts Expectorants EXPECTRNTS B3K Cough/Cold Cough and Cold Preparations COUGH-COLD B3M Respiratry Respiratory Trct Radiopaq Diag RESPIRATRY B3N Decongesta Decongestant-analygesic-expect DECON-ANALG-EXPECT B3O Ana-1st-gn 1st Gen Antihistimine-deconges ANTIHST-DECON-ANA1 B3P Non-Narc-A Non-Narc Antituss-1stGen Antih NON-NARC-ANTITUSS1 B3Q NarcoticA Narcotic Antituss-1stGen Antih NARC-ANTITUSS1 B3R Non-Narc-A Non-Narcotic Antituss-1stGen A NON-NARC-ANTITUSS2 B3S Non-Narc-A Non-Narcotic Antituss-1stGen A NON-NARC-ANTITUSS3 B3T Non-Narcot Non-Narcotic Antitussive and E NON-NARC-ANTITUSS4 B3V 1st-Gen-An 1stGen Antihist-decongestant- ANTIHIST-DECONG-1S B3X 1st-Gen-An 1stGen Antihist-decongestant- ANTHST-DECONG-ANTI B3Y 1st-Gen-An 1stGen Antihist-decongestant- ANTHST-DECONG-EXP1 B3Z 1st-Gen-An 1stGen Antihist-expectorant ANTIHIST-EXPECTOR1 B4A Non-Narcot Non-Narcotic Antitussive-Analg NON-NARC-ANTITUS1 B4B Non-Narcot Non-Narcotic Antitussive-Analg NON-NARC-ANTITUS2 B4C NarcoticA Narcotic Antitussive-Anticholi NARC-ANTITUS-ANTIC B4D NarcoticA Narcotic Antitussive-Antihist NARC-ANTITUS-ANTIH B4E Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS3 B4G Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS4 B4H NarcoticA Narcotic Antitussive-Antihist NARCOTIC-ANTITUS5 B4I Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS6 B4J NarcoticA Narcotic Antitussive-Antihist NARC-ANTITUSS2 B4K NarcoticA Narcotic Antitussise-Decongest NARC-ANTITUSS3 B4L Non-Narcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS7 B4M Non-Narcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS8 B4N NarcAntit Narcotic Antituss-Antihist NARC-ANTITUSS4 B4P Non-NarcA Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS9 B4Q NarcoticA Narcarcotic-Antituss-Decongest NARC-ANTITUSS5 B4R NonNarcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS10 B4S Narcotic A Narc Antituss-Expectorant Comb NARC-ANTITUSS6 B4T Narcotic- Decongest Analgesic non-salica DECONGEST-ANALGESI B4U Decongesta Decongestant-anticholoiingert1 DECONGEST-ANTICHOL B4W Decongesta Decongestant-Expectorabt combo DECONGESTS-EXPECTO B4X Expectoran Expectorant combinations other EXPECTORANT-COMBIN B50 NON-NARCOT NON-NARC ANTITUSS-ANALGESIC NON-NARCOTIC-ANTIT B5D Decongest- Deconestant Analgesic DECONGEST-ANALGES2 B5E Decongest Decongest AnalgesicMixedZanth DECONGEST-ANALGES3 B5F DecongestA Decongest AnalgesicMixedZanth DECONGEST-ANALGES4 B5G DecongestA Decongestant, cookie spo;se DECONGEST-NSAID-CO B5H 1st-gen-an 1st Gen antihist, decon, nosay ANTIHIST-DECON-NSA B5I Decongest- Decongestant Analygesic nonsal DECONGEST-ANALGES5 B5J Decon-anal Decon Analgesic non-salicylat DECON-ANALGESIC B5K DECONGEST- DECON-ANALGESIC,SALICYLATE DECONGEST-ANALGES6 B5L GEN1 ANTIH GEN1ANTIHIST-DECON-ANALGESIC GEN1-ANTIHIST-DECO B5M 1ST GEN AN GEN1 ANTIHIST-DECONGEST-ANA GEN1-ANTIHIST-ANAL B5N 1ST GEN AN GEN1 ANTIHIST-DECON-ANALGES GEN1-ANTIHIST-DEC2 B5P DecongestA DECON-ANALGESIC,SALICYL-EXPECT DECON-ANALGESIC2 B5S 1ST GENERA GEN1 ANTIHISTAMINE-ANALGESIC GEN1-ANTIHIST2 B5T 1ST GENERA GEN1 ANTIHISTAMINE-Abalgesic GEN1-ANTIHIST3 BY4 Expectoran Expectorant mixtures EXPECTORANT-MIXTUR C0B Water Water WATER C0C Acidosis Drugs Used to Treat Acidosis ACIDOSIS C0D Alcoholic Antialcoholic Preparations ALCOHOLIC C0K Bicarbonat Bicabonate Producing/Contain BICARBONATE C1A Depleters Electrolyte Depleters DEPLETERS C1B Sodium Sodium/Saline Preparations SODIUM C1D Potassium Potassium Replacement POTASSIUM C1F Calcium1 Calcium Replacement CALCIUM1 C1H Magnesium Magnesium Replacement MAGNESIUM C1P Phosphate Phosphate Replacement PHOSPHATE C1W Electrolyt Electrolyte Maintenance ELECTROLYT C1Z Electroly1 Electrolyte Maintenance (cont) ELECTROLY1 C2H Gases1 Respiratory Gases GASES1 C3B Iron Iron Replacement IRON C3C Zinc Zinc Replacement ZINC C3H Iodine Iodine Containing Agents IODINE C3M Mineral Mineral Replacement, Misc. MINERAL C4G Insulins Insulins INSULINS C4K Hypoglyce1 Hypoglycem Insul Release Stim HYPOGLYCE1 C4L Hypoglycem Hypoglycem,Biguanid Non-Sulfon HYPOGLYCEM C4M Hypoglyce2 Hypo, Alpha-Glucosidase(N-S) HYPOGLYCE2 C4N Hypoglyce3 Hypo,Insulin-Respnse Inhans(NS HYPOGLYCE3 C4O Hypoglyce4 Hypo, Absorption Modifie( Unsp HYPOGLYCE4 C4P Hypoglyce5 Hypoglycemics, Unspec. Mech HYPOGLYCE5 C4Q Hypoglyce6 Hypoglycemics, Combination HYPOGLYCE6 C5A Carbo Carbohydrates CARBO C5B Protein Protein Replacement PROTEIN C5C Formulas Infant Formulas FORMULAS C5D Diet Foods Diet Foods DIET-FOODS C5E Geriatric Geriatric Supplements GERIATRIC C5F Food Supp Food Supplements, Misc. FOOD-SUPP C5G Food Oils Food Oils FOOD-OILS C5H Nucleic Nucleic Acid/Nucleotide Supp NUCLEIC C5J IV Sol3 IV Solutions: Dextrose/Water IV-SOL3 C5K IV Sol1 IV Solutions: Dextrose Saline IV-SOL1 C5L IV Sol2 IV Solutions: Dextrose/Ringers IV-SOL2 C5M IV Sol IV Sol: Dextrose/Lactact Ring IV-SOL C5N Protein1 Protein Replacement (Cont 1) PROTEIN1 C5O Solutions Solutions, Miscellaneous SOLUTIONS C5P Protein2 Protein Replacement (Cont 2) PROTEIN2 C5Q Tonic Tonic TONIC C5R IV-Sol4 IV Sol:Dextrose-Water (Cont1) IV-SOL4 C5S Protein3 Protein Replacement (Cont 3) PROTEIN3 C5T Food-Supp Food Supplements, Misc (Cont1) FOOD-SUPP1 C6A Vitamin A Vitamin A Preparations VITAMIN-A C6B Vitamin B Vitamin B Preparations VITAMIN-B C6C Vitamin C Vitamin C Preparations VITAMIN-C C6D Vitamin D Vitamin D Preparations VITAMIN-D C6E Vitamin E Vitamin E Preparations VITAMIN-E C6F Prenatal Prenatal Vitamin Preparations PRENATAL C6G Geriatric1 Geriatric Vitamin Preparations GERIATRIC1 C6H Pediatric Pediatric Vitamin Preparations PEDIATRIC C6J Bioflavon Bioflavonoids BIOFLAVON C6K Vitamin K Vitamin K Preparations VITAMIN-K C6L Vit B12 Vitamin B12 Preparations VIT-B12 C6M Folic Acid Folic Acid Preparations FOLIC-ACID C6N Niacin Niacin Preparations NIACIN C6P Panthenol Panthenol Preparations PANTHENOL C6Q Vitamin B6 Vitamin B6 Preparations VITAMIN-B6 C6R Vitamin B2 Vitamin B3 Preparations VITAMIN-B2 C6T Vitamin B1 Vitamin B1 Preparations VITAMIN-B1 C6Z Multi-Vit Multi-Vitamin Preparations MULTI-VIT C7A Inhibator Purine Inhibitors INHIBATOR C7B Inhibitor4 Decarboxylase Inhibitors INHIBITOR4 C7C Inhibitor5 Dipeptidase Inhibitors INHIBITOR5 C7D Metabolic1 Metabolic Deficiency Agents METABOLIC1 C7E Appetite Appetite Stimulants APPETITE C8A Poison2 Metallic Poison Agents POISON2 C8B Poison Acid & Alkali Poison Antidotes POISON C8D Poision1 Agricultural Poison Antidotes POISION1 C8E Antidotes Antidotes, Miscellaneous ANTIDOTES D0U Intestinal Gastrointestinal Radiopaq Diag INTESTINAL D1A Periodont Periodontal Collagenase Inhibi PERIDONTAL D1D Dental Dental Aids and Preparations DENTAL D2A Fluoride Fluoride Preparations FLUORIDE D2D Tooth Ache Tooth Ache Preparations TOOTH-ACHE D2M Dent Misc Dental Preparations Misc DENT-MISC D4A Acid Acid Replacement ACID D4B Antacids Antacids ANTACIDS D4C Stomatol Agents for Stomatological Use STOMATOLOGICAL D4D Antidiarrh Antidiarrheal Microorganisms ANTIDIARRHEAL D4E Antiulcer Antiulcer Preparations ANTIULCER D4F Antiulcer1 Anti-Ulcer-H. Pylori Agents ANTIULCER1 D4G Gas Enzyme Gastric Ensymes GAS-ENZYME D4H Mucositis Oral Mucositis/Stomatitis Agen MUCOSITIS D4I Mucositis2 Oral Mucositis/Stom Anti-Infla MUCOSITIS2 D4K Gastric Gastric Acid Secretion Reducer GASTRIC D4L Saliva Saliva Substitute Agents SALIVA D4N Flatulents Antiflatulents FLATULENTS D4T Gas Funct1 Gastric Function Diagnostics GAS-FUNCT1 D4U Gas Funct Gastric Funct Radiopaque Diag GAS-FUNCT D5A Fat-Absorp Fat Absorption Decreasing Agnt FAT-ABSORPTION D5P Intestina1 Intestinal Absorbnts/Protectnt INTESTINA1 D6A Colon Drgs to TX Chrnic Inflam Colon COLON D6D Diarrhea Antidiarrheals DIARRHEA D6H Hemorrhoid Hemorrhoidal Agents HEMORRHOID D6S Lax/Cath1 Laxatives and Cathartics LAX-CATH1 D6T Lax/Cath Laxatives & Cathartics (cont) LAX-CATH D7A Bile Salts Bile Salts BILE-SALTS D7B Choleretic Choleretics CHOLERETIC D7C Heptc-Diag Hepatic Diagnostics HEPATIC-DIAG D7J Heptc-Dysf Hepatic Dysftn Preven/Therapy HEPATIC-DYSF D7L Bile Salt Bile Salt Sequestrants BILE-SALT D7T Biliary1 Biliary Diagnostics BILIARY1 D7U Biliary Biliary Diagnostic, Radiopaque BILIARY D8A Enzymes1 Pancreatic Enzymes ENZYMES1 D8B Pancreatic Pancreatic Diagnostics PANCREATIC D9A Inhibitor2 Ammonia Inhibitors INHIBITOR2 F1A Androgenic Androgenic Agents ANDROGENIC F2A Impotency Drugs to treat Impotency IMPOTENCY G0U Uterine Uterine Radiopaque Diag Agnts UTERINE G1A Estrogenic Estrogenic Agents ESTROGENIC G1B Estro/Andr Estrogen/Androgen Combinations ESTRO-ANDR G2A Progest Progestational Agents PROGEST G2B Progest1 Progestational Agents (Cont 1) PROGEST1 G3A Oxytocics Oxytocics OXYTOCICS G8A Contracept Contraceptive, Oral CONTRACEPT G8B Contracep1 Contraceptives, Implantable CONTRACEP1 G8C Contracep3 Conctraceptives, Injectable CONTRACEP3 G9A Contracep2 Contraceptives, Intravaginal CONTRACEP2 H0A Anestheti3 Local Anesthetics ANESTHETI3 H0B Anestheti4 Local Anesthetics (cont1) ANESTHETI4 H0C Anestheti5 Local Anesthetics (cont2) ANESTHETIC5 H0E Mltpl-Scle Agents/ Treat Mltpl Sclerosis MLTPL-SCLEROSIS H1U Spinal Cerebral Spinal Radio Diag SPINAL H2A Nerv Syst Central Nervous Syst Stimulant NERV-SYST H2B Anestheti1 General Anesthetics, Inhalent ANESTHETI1 H2C Anesthetic General Anesthetic, Injectable ANESTHETIC H2D Barbiturat Barbiturates BARBITURAT H2E Barbitura1 Sedative-Hypno,Non Barbiturate BARBITURA1 H2F Anxiety Anti-Anxiety Drugs ANXIETY H2G Psychotic1 Anti-Psychotics,Phenothiazines PSYCHOTIC1 H2H Inhibitor6 Monoamine Oxidase(MAO) Inhibit INHIBITOR6 H2I Psychotic2 Anti-Psychotic,Phenothiaz(cnt1 PSYCHOTIC2 H2J Depressan1 Antidepressants DEPRESSAN1 H2K Depressant Antidepressant Combinations DEPRESSANT H2L Psychotics Anti-Psychotics,Non-Phenothiaz PSYCHOTICS H2M Anti-Mania Anti-Mania Drugs ANTI-MANIA H2N Depressan2 Antidepressants (cont) DEPRESSAN2 H2O Physotics2 Anti-Psych,Nn-Phenothiaz (con1 PSYCHOTICS2 H2P Anxiety1 Anti-Anxiety Drugs (cont) ANXIETY1 H2Q Babitura2 Sed-Hypno,Nn Barbiturate(con1 BARBITURA2 H2R Pruritics Anti-Pruritics PRURITICS H2T Alcohol Alcohol, Systemic Use ALCOHOL H2V Narco/Hype Anti-Narcolepsy/Anti-Hyperkin NARCO-HYPE H2Z Antagonis2 Benzodaizepine Antagonists ANTAGONIS2 H3A Analgesic1 Analgesics, Narcotics ANALGESIC1 H3B Analgesic2 Analgesics, Narcotics (cont) ANALGESIC2 H3C Analgesic3 Analgesics, Non-Narcotics ANALGESIC3 H3D Analgesic4 Analgesics, Salycylates ANALGESIC4 H3E Analgesic Analgesic/Antipyretic, Non-Sal ANALGESIC H3F Migraine Anit-Migraine Preparations MIGRAINE H3G Analgesics Analgesics, Miscellaneous ANALGESICS H3H Analgesic5 Analgesics Narc Anesth Adj ANALGESIC5 H3T Antagonis1 Narcotic Antagonists ANTAGONIS1 H3W Narcotic Narcotic Withdrawal Therpy NARCOTIC H4B Convulsnts Anti-Convulsants CONVULSNTS H4C Convulsan1 Anti-Convulsants (cont 1) CONVULSAN1 H4T Hallucingn Hallucinogens HALLUCINGN H5A Neurotonic Neurontonics/Cerebro Acc Agnt NEUROTONICS H5B Neuropathi Neuropathic Agents NEUROPATHIC H6A Anti-Park Anti-Parkinsonism Drugs, Other ANTI-PARK H6B Anti-Park1 Anti-Parkinsonism/Cholinergic ANTI-PARK1 H6C Antitussiv Antitussives, Non-Narcotic ANTITUSSIV H6D Antitusiv1 Antitussiv, Nn-Narcotic (con1) ANTITUSIV1 H6E Emetics1 Emetics EMETICS1 H6H Relaxants Skeletal Muscle Relaxants RELAXANTS H6I Amyotrophi Amyotrophic Lateral Scloerosis AMYOTROPHIC H6J Emetics Anti-Emetics/AntiVertigo Agent EMETICS H6L Movement Movement Disorders(Drug Therpy MOVEMENT H6N Antitussiv Antitussives, Narcotic ANTITUSSIVE J1A Parasympa Parasympathetic Agents PARASYMPA J1B Inhibitor3 Cholinesterase Inhibitors INHIBITOR3 J2A Alkaloids Belladonna Alkaloids ALKALOIDS J2B Cholinerg2 Anti-Cholinergics, Quaternary CHOLINERG2 J2C Cholinerg1 Anti-Cholinergics, Other CHOLINERG1 J2D Cholinergi Anti-Cholinergics/Antispasmodi CHOLINERGI J2E Clolinerg3 Anti-Cholingics/Antispas (con1 CLOLINERG3 J3A Stimulants Smoking Deter(Ganglionic Stim STIMULANTS J4A Block Agnt Ganglionic Blocking Agents BLOCK-AGNT J5A Adrenergi1 Adrenergic Agnt,Catecholamines ADRENERGI1 J5B Adrenergi2 Adrenergic,Aromat,non-Catechol ADRENERGI2 J5C Adrenergic Adrenergic Agents,Non-Aromatic ADRENERGIC J5D Adrenergi4 Beta-Adrenergic Agents ADRENERGI4 J5E Sympatho Sympathomimetic Agents SYMPATHO J5F Anaphylaxi Anaphylaxis Therapy Agents ANAPHYLAXIS J5G Adrenergi7 Beta-Adrenergics & Glucocortoi ADRENERGI7 J5H Adrenergi8 Adrenergic Vasopressor Agnts ADRENERGI8 J7A Adrenergi6 Alpha/Beta Adrenergic Block ADRENERGI6 J7B Adrenergi3 Alpha-Adrenergic Blocking Agnt ADRENERGI3 J7C Adrenergi5 Beta-Adrenergic Blocking Agnts ADRENERGI5 J7D Adrenergi9 Beta-Adrenergics Block (con1) ADRENERGI9 J8A Anorexic Anorexic Agents ANOREXIC J9A Intestina2 Intestinal Motility Stimulants INTESTINA2 J9B Spasmodic Antispasmodic Agents SPASMODIC L0B Enzymes3 Topcl/Muc Membr/Subcut Enzymes ENZYMES3 L0C Diabetic1 Diabetid Ulcer Prep, Topical DIABETIC1 L1A Psoriatic Antipsoriatic Agents, Systemic PSORIATIC L1B Acne Acne Agents, Systemic ACNE L1C Hypertrico Hypertricotic Agents, Systemic HYPERTRICHOTIC L2A Emollients Emollients EMOLLIENTS L3A Protective Protectives PROTECTIVE L3B Protectiv1 Protectives (Continued 1) PROTECTIV1 L3C Protectiv2 Protectives (Continued 2) PROTECTIV2 L3E Protectiv4 Protectives (Continued 3) PROTECTIV4 L3P Pruritics1 Anti-Pruritics, Topical PRURITICS1 L4A Astringent Astringents ASTRINGENT L5A Keratolyti Keratolytics KERATOLYTI L5B Sunscreens Sunscreens SUNSCREENS L5C Abrasives Abrasives ABRASIVES L5D Depilator Depilatories DEPILATOR L5E Seborrheic Antiseborrheic Agents SEBORRHEIC L5F Psoriatics Antipsoriatics Agents PSORIATICS L5H Acne1 Acne Agents, Topical ACNE1 L5I Wound Wound Healing Agents, Local WOUND L6A Irritants Irritants/Counter-Irritants IRRITANTS L6B Irritants1 Irritants/Counter-Irrit (cont) IRRITANTS1 L7A Shampoos Shampoos/Lotion SHAMPOOS L8A Deodorants Deodorants DEODORANTS L8B Antipersp Antiperspirants ANTIPERSP L9A Topical Topical Agents, Miscellaneous TOPICAL L9B Vitamin A1 Vitamin A Derivatives VITAMIN-A1 L9C Pigmentat Hypopigmentation Agents PIGMENTATION L9D Pigmentat1 Topical Hyperpigmentation Agnt PIGMENTATION1 L9E Topical 1 Topical Agents, Misc (cont 1) TOPICAL1 L9F Cosmetic Cosmetic/Skin Coloring/Dye Top COSMETIC M0A Blood7 Blood Components BLOOD7 M0B Plasma1 Plasma Proteins PLASMA1 M0C Blood1 Blood Factors, Miscellaneous BLOOD1 M0D Plasma Plasma Expanders PLASMA M0E Hemophilic Anti-Hemophilic Factors HEMOPHILIC M0F Factor IX Factor IX Preparations FACTOR-IX M0G Antiporphy Antiporphyria Factors ANTIPORPHY M0H Factor II Factor II Preparations FACTOR-II M0J Factor VII Factor VII Preparations FACTOR-VII M0K Factor X Factor X Preparations FACTOR-X M0R Blood Blood Albumin Preparations BLOOD M0S Blood6 Synthetic Blood Preparations BLOOD6 M0U Blood4 Blood Volume Diagnostics BLOOD4 M3A Blood5 Occult Blood Tests BLOOD5 M3B Blood3 Blood Urea Nitrogen Tests BLOOD3 M4A Blood2 Blood Sugar Diagnostics BLOOD2 M4B IV Fat IV Fat Emulsions IV-FAT M4E Lipotropic Lipotropics LIPOTROPIC M4F Leprotics1 Lipotropics, (cont) LEPROTICS1 M4G Hyprglycem Hyperglycemics HYPRGLYCEM M4H Lipids Agents /affect Cellular Lipids LIPIDS M93 Inhibtor11 Thrombin Inhibitor,Hirudin Typ INHIBITOR11 M9A Hemostatic Topical Hemostatics HEMOSTATIC M9D Fibrinolyt Anti-Fibrinolytic Agents FIBRINOLYT M9F Enzymes2 Thrombolytic Enzymes ENZYMES2 M9J Citrates Citrates as Anticoagulants CITRATES M9K Heparin Heparin & Related Preparations HEPARIN M9L Coagulant1 Oral Anticoagulants,Coumarin COAGULANT1 M9M Coagulant2 Oral Anticoagulants,Inandione COAGULANT2 M9P Inhibitor9 Platelet Aggregation Inhibitor INHIBITOR9 M9R Coagulants Coagulants COAGULANTS M9S Hemorrheol Hemorrheologic Agents HEMORRHEOL N1A Depressan3 Erythroid Depressants DEPRESSAN3 N1B Hematinics Hematinics, Other HEMATINICS N1C Stimulant1 Leukocyte (WBC) Stimulants STIMULANT1 N1D Platelet Platelet Reducing Agents PLATELET N1E Platelet1 Platelet Proliferation Stimula PLATELET1 P0A Fertility Fertility Stim Prep, Non FSH FERTILITY P0B Hormones2 Follicle Stim/Luteiniz Hormone HORMONES2 P0C Pregnancy Pregnancy Facilitng/Maint Horm PREGNANCY P1A Hormones3 Growth Hormones HORMONES3 P1B Somatostat Somatostatic Agents SOMATOSTAT P1C Luteiniz Luteinizing Hormones LUTEINIZ P1E Hormones Adrenocorticotrophic Hormones HORMONES P1F Pituitary Pituitary Suppressive Agents PITUITARY P1G Inhibitor Adrenal Steroid Inhibitors INHIBITOR P1U Metabolic Metabolic Function Diagnostics METABOLIC P2B Hormones1 Antidiuretic/Vasopressor Hormo HORMONES1 P2Z Pituitary1 Posterior Pituitary Prep PITUITARY1 P3A Hormones5 Thyroid Hormones HORMONES5 P3B Thyroid1 Thyroid Function Diagnostic Ag THYROID1 P3L Thyroid Anti-Thyroid Preparations THYROID P4A Hormones4 Parathyroid Hormones HORMONES4 P4L Bone Resor Bone Resorpr Suppress Agnt BONE-RESORPT P5A Glucocorti Glucocorticoids GLUCOCORTI P5B Glucocort1 Glucocorticoids(cont1) GLUCOCORT1 P5C Glucocort2 Glucocorticoids(cont 2) GLUCOCORT2 P5S Mineraloco Mineralocorticoids MINERALOCO P5T Antagonist Aldosterone Antagonists(Obsol) ANTAGONIST P6A Hormone Pineal Hormone Agents HORMONE Q0A Topical 13 Topical Prep,Non-Medicinal TOPICAL-13 Q1A Topical 10 Topical Ear Preparations TOPICAL-10 Q2U Eye Diag Eye Diagnostic Agents EYE-DIAG Q3A Rectal Rectal Preparations RECTAL Q3B Rectal1 Rectal/Lower Bowel Glucocort RECTAL1 Q3D Hemorrhoi1 Hemorrhoidal Preparations HEMORRHOI1 Q3H Anestheti2 Hemorrhoid,Local/Rectal Anesth ANESTHETI2 Q3S Laxatives Laxatives, Local/Rectal LAXATIVES Q4A Vaginal5 Vaginal Preparations VAGINAL5 Q4B Vaginal3 Vaginal Antiseptics VAGINAL3 Q4F Vaginal1 Vaginal Antifungals VAGINAL1 Q4G Vaginal7 Vaginal Antifungals-Antibact VAGINAL7 Q4K Vaginal4 Vaginal Estrogen Preparatioans VAGINAL4 Q4L Vanginal8 Vaginal Lubricants Preparation VAGINAL8 Q4R Vaginal2 Vaginal Antiparasiticts VAGINAL2 Q4S Vaginal6 Vaginal Sulfonamides VAGINAL6 Q4W Vaginal Vaginal Antibiotics VAGINAL Q5A Topical 14 Topical Preparations, Misc. TOPICAL-14 Q5B Topical 12 Topical Prep, Antibacterials TOPICAL-12 Q5C Topical 16 Topicals, Hypertrichotic Agent TOPICAL-16 Q5D Topical 08 Topical Antipsoriatics(obsol) TOPICAL-08 Q5E Topical 17 Topical Anti-Inflam Nn Steroid TOPICAL-17 Q5F Topical 03 Topical Antifungals TOPICAL-03 Q5G Topical 18 Topical Antifungals- Antibact TOPICAL-18 Q5H Topical 11 Topical Local Anesthetics TOPICAL-11 Q5I Topical 19 Topical Veinotonic/Vasculoprot TOPICAL-19 Q5J Topical 20 Top Hormonal, Otherwise Unspec TOPICAL-20 Q5L Bath Therapeutic Bath/Mineral Salts BATH Q5N Topical 05 Topical Antineoplastics TOPICAL-05 Q5O Topical-21 Top Antiedema/Anti Inflam Agnt TOPICAL-21 Q5P Topical 04 Top Antiinflammatory Steroidal TOPICAL-04 Q5Q Topical-22 Top Antibio-Antibac-Antifung- TOPICAL-22 Q5R Topical 06 Topical Antiparasitics TOPICAL-06 Q5S Topical 15 Topical Sulfonamides TOPICAL-15 Q5U Topical-23 Topical Cellulite Agents TOPICAL-23 Q5V Topical 09 Topical Antivirals TOPICAL-09 Q5W Topical 01 Topical Antibiotics TOPICAL-01 Q5X Topical-24 Top Antibio/Antiinflam Steroid TOPICAL-24 Q5Y Topical-25 Topical Androgenic Agents TOPICAL-25 Q6A Eye Prep Eye Preparations, Misc. EYE-PREP Q6B Eye Eye Anti-Infectives (RX Only) EYE Q6C Eye9 Eye Vasoconstrictors (RX Only) EYE9 Q6D Eye8 Eye Vasoconstrictor (OTC Only) EYE8 Q6E Eye5 Eye Irrigations EYE5 Q6F Cont Lens Contact Lens Preparations CONT-LENS Q6G Miotics Miotics/Othr Intraoc. Pres Red MIOTICS Q6H Eye6 Eye Local Anesthetics EYE6 Q6I Eye10 Eye Anitbiotic/Cortoid Combo EYE10 Q6J Mydriatics Mydriatics MYDRIATICS Q6K Ophthalmic Ophthalmic-Otic Combinations OPHTHALMIC Q6L Eye11 Eye Antioxidant, Local Agents EYE11 Q6M Ophthalmi1 Ophthalmic-Otic Anti-Infective OPHTHALMIC1 Q6N Ophthalmi2 Ophthalmic-Otic Antibiot-Corti OPHTHALMIC2 Q6O Ophthalmi3 Ophthalmic-Otic Anti-Inflammat OPHTHALMIC3 Q6P Eye3 Eye Antiinflammatory Agents EYE3 Q6Q Ophthalmi4 Ophthalmic-Otic Anitfungal Agn OPHTHALMIC4 Q6R Eye12 Eye Antihistamines EYE12 Q6S Eye7 Eye Sulfonamides EYE7 Q6T Tears Artificial Tears TEARS Q6V Eye4 Eye Antivirals EYE4 Q6W Eye2 Eye Antibiotics EYE2 Q6Y Eye Prep1 Eye Preparations, Misc. (OTC) EYE-PREP1 Q6Z Eye1 Eye Anti-Infectives,(OTC Only) EYE1 Q7A Nose Prep5 Nose Preparations, Misc. (RX) NOSE-PREP5 Q7B Nose Prep1 Nose Prep, Misc. Anti-Infectiv NOSE-PREP1 Q7C Nose Prep3 Nose Prep,Vasoconstrictor (RX) NOSE-PREP3 Q7D Nose Prep4 Nose Prep,Vasoconstrictor(OTC) NOSE-PREP4 Q7E Nasal Nasal Antihistamine NASAL Q7F Nasal1 Nasal Prep Anti-Inflamm-Antibi NASAL1 Q7G Nasal2 Nasal Prep Irritnts/Cntr-Irrit NASAL2 Q7H Nasal3 Nasal Mast Cell Stabilizers NASAN3 Q7P Nose Prep2 Nose Prep,Antiinflammatory NOSE-PREP2 Q7W Nose Prep Nose Prep, Antibiotics NOSE-PREP Q7Y Nose Prep6 Nose Preparations, Misc(OTC) NOSE-PREP6 Q8A Ear Prep4 Ear Preparation,Misc.(RX Only) EAR-PREP4 Q8B Ear Prep3 Ear Prep, Misc. Anti-Infective EAR-PREP3 Q8F Otic Prep Otic Prep, Anti-Inflam Antibio OTIC-PREP Q8H Ear Prep5 Ear Preparations, Local Anesth EAR-PREP5 Q8P Ear Prep1 Ear Prep, Antiinflammatory EAR-PREP1 Q8R Ear Prep2 Ear Prep, Ear Wax Removers EAR-PREP2 Q8W Ear Prep Ear Prep, Antibiotics EAR-PREP Q8Y Ear Prep6 Ear Preparations, Misc. (OTC) EAR-PREP6 Q9A Urological Urological Irrigations UROLOGICAL Q9B Prostate Benign Prostatic Hypetrophy PROSTATE R1A Urinary1 Urinary Tract Antispasmodic URINARY1 R1B Diuretics4 Osmotic Diuretics DIURETICS4 R1C Diuretics2 Inorganic Salt Diuretics DIURETICS2 R1D Diuretics3 Mercurial Diuretics DIURETICS3 R1E Inhibitor7 Carbonic Anhydrase Inhibitors INHIBITOR7 R1F Diuretics6 Thiazide & Related Diurectics DIURETICS6 R1G Diuretics7 Thiazide & Rltd Diuretics(cont DIURETICS7 R1H Diuretics5 Potassium Sparing Dirutetics DIURETICS5 R1J Diuretics Aminouracil Diuretics DIURETICS R1K Diuretics1 Diuretics, Miscellaneous DIURETICS1 R1L Diuretics9 Potassium Sparing Diur in Comb DIURETICS9 R1M Diuretic10 Loop Diuretics DIURETICS10 R1R Uricosuric Uricosuric Agents URICOSURIC R1S Urinary PH Urinary PH Modifiers URINARY-PH R1T Renal Comp Renal Competers RENAL-COMP R1U Renal Renal Function Diag Agnts RENAL R2U Urinary Urinary Tract Radiopaque Diag URINARY R3U Urine Tes1 Urine Glucose Test Aids URINE-TES1 R3V Urine Tes3 Urine Test Aids, Misc. URINE-TES3 R3W Urine Test Urine Acetone Test Aids URINE-TEST R3Y Urine Tes2 Urine Multiple Test Aids URINE-TES2 R3Z Urine Tes4 Urine Glucse/Acetone Tst Strip URINE-TES4 R4A Kidney Kidney Stone Agents KIDNEY R5A Urinary2 Urinary Tract Anest/Analg (Azo URINARY2 R5B Urinary3 Urinary Tract Analgesic Agents URINARY3 S1A Joint Tiss Joint Tissue Replacement JOINT-TISSU S2A Colchicine Colchicine COLCHICINE S2B Nsaids NSAids, Cyclooxygenase Inhib NSAIDS S2C Gold Salts Gold Salts GOLD-SALTS S2D Nsaids1 NSAids, Cyclooxygenase (cont1) NSAIDS1 S2E Nsaids2 Nsaids,Cyclooxygenase(cont2) NSAIDS2 S2G Bone Disor Drugs Acting on Bone Disorders BONE-DISORDER S2H AntiInflam Anti-Inflam, Antiarthriti Misc ANTI-INFLAMM S2I AntiInfla1 Anti-Inflam,Pyrimidine Synt In ANTI-INFLAMM1 S2J AntiInfla2 Anti-Inflam Tumor Necrosis Fct ANTI-INFLAMM2 S2L Nsaids3 Nsaids, Cyclooygenase 2 Inhib NSAIDS3 S7A Neuromusc Neuromuscular Blocking Agents NEUROMUSC S7B Muscle Skeletal Muscle, Others MUSCLE U5A Homeopath1 Homeopathic Drugs HOMEOPATH1 U5B Herb Drgs Herbal Drugs HERB-DRGS U5C Herb Drgs Herbal Drugs (cont 1) HERB-DRGS1 U5D Herb Drgs Herbal Drugs (cont 2) HERB-DRGS2 U5E Herb Drgs Herbal Drugs (cont 3) HERB-DRGS3 U5F Animl-Hmn Animal/Human Derived Agents ANIMAL-HUMAN U5G Herb Drgs Herbal Drugs (cont 4) HERB-DRGS4 U5H Herb Drgs Herbal Drugs (cont 5) HERB-DRGS5 U5I Herb Drgs Herbal Drugs (cont 6) HERB-DRGS6 U5J Herb Drgs Herbal Drugs (cont 7) HERB-DRGS7 U5X Anthroposo Anthroposophic Drugs ANTHROPOSOPHIC U6A Adjuvants1 Pharmaceutical Adjuvants, Tab ADJUVANTS1 U6B Adjuvants Pharm Adjuvants, Coating Agnts ADJUVANTS U6E Ointment1 Ointment/Cream Bases OINTMENT1 U6F Ointment Hydrophilic Cream/Ointment Bas OINTMENT U6H Solvents1 Solvents SOLVENTS1 U6J Solvents2 Solvents (Continued 1) SOLVENTS2 U6K Solvents3 Solvents (Continued 2) SOLVENTS3 U6L Solvents Solevents (Continued 3) SOLVENTS U6N Vehicles Vehicles VEHICLES U6P Vehicles1 Vehicles (Continued) VEHICLES1 U6S Propellant Propellants PROPELLANT U6T Propellan1 Propellants (Continued) PROPELLAN1 U6W Chemicals Bulk Chemicals CHEMICALS U7A Susp Agnts Suspending Agents SUSP-AGNTS U7B Susp Agnt1 Suspending Agents (Cont 1) SUSP-AGNT1 U7C Susp Agnt2 Suspending Agents (Cont 2) SUSP-AGNT2 U7D Surfactan1 Surfactants SURFACTAN1 U7E Surfactan2 Surfactants (Continued) SURFACTAN2 U7H Antioxidan Anticorrosive Agents ANTIOXIDAN U7J Chelating Chelating Agents CHELATING U7K Flav Agnts Flavoring Agents FLAV-AGNTS U7L Flav Agnt1 Flavoring Agents (Cont 1) FLAV-AGNT1 U7M Flav Agnt2 Flavoring Agents (Cont 2) FLAV-AGNT2 U7N Sweeteners Sweeteners SWEETENERS U7P Perfumes Perfumes PERFUMES U7Q Color Agnt Coloring Agents COLOR-AGNT U7R Color Agn1 Coloring Agents (Continued) COLOR-AGN1 U7Z Bondng Agn Bonding/Catalyst Agents BONDING-AGNTS V1A Alkylating Alkylating Agents ALKYLATING V1B Metabolite Anti-Metabolites METABOLITE V1C Alkaloids1 Vinca Alkaloids ALKALOIDS1 V1D Neoplasti1 Antibiotic Anti-Neoplastics NEOPLASTI1 V1E Neoplasti2 Steroid Anti-Neoplastics NEOPLASTI2 V1F Neoplastic Anti-Neoplastics, Misc. NEOPLASTIC V1G Therapeutc Redioactive Theraputic Agnts THERAPEUTIC V1H Neoplasti3 Antineoplastic, Misc. (cont 1) NEOPLASTI3 V1I Chemother1 Chemotherapy Antidotes CHEMOTHERA1 V1J Androgeni1 Antiandrogenic Agents ANDROGENIC1 V1K Neoplasti4 Antineoplastic Antibody/Antibd NEOPLASTI4 V2A Neoplasm Neoplasm Monoclonal Diag Agnt NEOPLASM W1A Penicillin Penicillins PENICILLIN W1B Cephalospo Cephalosporins CEPHALOSPO W1C Tetracycli Tetracyclines TETRACYCLI W1D Macrolides Macrolides MACROLIDES W1E Chloramph Chloramphenicol & Derivatives CHLORAMPH W1F Aminoglyco Aminoglycosides AMINOGLYCO W1G Antibioti1 Antitubercular Antibiotics ANTIBIOTI1 W1H Aminocycli Aminocyclitols AMINOCYCLI W1I Penicilli1 Penicillins (Continued) PENICILLI1 W1J Vancomycin Vancomycin and Derivatives VANCOMYCIN W1K Lincosamid Lincosamides LINCOSAMID W1L Topical 02 Antibiotics TOPICAL-02 W1N Polymyxin Polymyxin & Derivatives POLYMYXIN W1P Betalactam Betalactams BETALACTAM W1Q Quinolones Quinolones QUINOLONES W1R Inhibitors Beta-Lactamase Inhibitors INHIBITORS W1S Thienamyci Thienamycins THIENAMYCI W1T Cephalosp1 Cephalosporins (Continued) CEPHALOSP1 W1V Antibioti2 Steroidal Antibiotics ANTIBIOTI2 W2A Sulfonamid Absorbable Sulfonamides SULFONAMID W2B Sulfonami1 Non-Absorbable Sulfonamides SULFONAMI1 W2C Sulfonami2 Absorbable Sulfonamides (con 1 SULFONAMI2 W2E Mycobatrm Anti-Mycobaterium Agents MYCOBATRM W2F Nitrofuran Nitrofuran Derivatives NITROFURAN W2G Chemothera Chemotherapeutic,Antibact,Misc CHEMOTHERA W2Y Infective1 Anti-Infectives,Misc(Antibact) INFECTIVE1 W3A Antibiotic Antifungal Antibiotics ANTIBIOTIC W3B Antifungal Antifungal Agents ANTIFUNGAL W3C Antifunga1 Antifungal Agents (Continued) ANTIFUNGA1 W3D Antifunga2 Antifungal Agents (cont 2) ANTIFUNGA2 W4A Malarial Anti-Malarial Drugs MALARIAL W4C Amebacides Amebacides AMEBACIDES W4E Trichomon Trichomonacides TRICHOMON W4F Infectives Anti-Infect,Misc(Antiparasit) INFECTIVES W4K Protozoal Anti-Protozoal Drugs, Misc PROTOZOAL W4L Anthelmin Anthelmintics ANTHELMIN W4M Topical 07 Topical Antiparasitics (Cont) TOPICAL-07 W4N Repellants Insect Repellants REPELLANTS W4O Antihelmi1 Anthelmintics (cont 1) ANTHELMIN1 W4P Leprotics Anti-Leprotics LEPROTICS W4Q Inscticide Insecticides INSCTICIDE W5A Antivirals Antivirals, General ANTIVIRALS W5B Antiviral1 Antivirals, HIV-Specific ANTIVIRAL1 W5C Antiviral2 Antivirals, HIV-Spec Protease ANTIVIRAL2 W5D Antiviral3 Antiviral Monoclonal Antibodie ANTIVIRAL3 W5E HepatitisA Hepatitis A Treatment Agents HEPATITISA W5F HepatitisB Hepatitis B Treatment Agents HEPATITISB W5G HepatitisC Hepatitis C Treatment Agents HEPATITISC W70 Vaccine10 Gram Postve Rod/Bacillus Vacci VACCINES10 W7B Vaccines9 Viral/Tumorigenic Vaccines VACCINES9 W7C Vaccines4 Influenza Virus Vaccines VACCINES4 W7F Vaccines5 Mumps/Related Virus Vaccines VACCINES5 W7H Vaccines Enteric Virus Vaccines VACCINES W7I Immunosti Immunostimulants, Bacterial IMMUNOSTIMULANTS W7J Vaccines6 Neurotoxic Virus Vaccines VACCINES6 W7K Antisera Antisera ANTISERA W7L Vaccines2 Gram Positive Cocci Vaccines VACCINES2 W7M Vaccines3 Gram(-)Bacilli(Non-Enteric)Vac VACCINES3 W7N Vaccines8 Toxin-Prod Bacilli Vac/Toxoids VACCINES8 W7P Vaccines7 Rickettsial Vaccines VACCINES7 W7Q Vaccines1 Gram Negative Cocci Vaccines VACCINES1 W7R Vaccine11 Spirochete Vaccines VACCINES11 W7S Antivenins Antivenins ANTIVENINS W7T Skin Test Antigenic Skin Tests SKIN-TEST W7U Extracts1 Hymenoptera Extracts EXTRACTS1 W7V Extracts2 Rhus Extracts(Psn Oak,Psn Ivy) EXTRACTS2 W7W Extracts Allerginc Extracts,Therapeutic EXTRACTS W7X Bacteria Bacteria, Aerobic/Anaerobic Ag BACTERIA W7Y Fungi Fungi/Yeast Preparations FUNGI W7Z Vaccine Vaccine/Toxoid Prep,Combinatns VACCINE W8A Antisepti2 Heavy Metal Antiseptics ANTISEPTI2 W8B Actv Agnts Surface Active Agents ACTV-AGNTS W8C Antisepti3 Iodine Antiseptics ANTISEPTI3 W8D Oxidizing Oxidizing Agents OXIDIZING W8E Antiseptic Antiseptics, General ANTISEPTIC W8F Irrigants Irrigants IRRIGANTS W8G Antisepti1 Antiseptics, Miscellaneous ANTISEPTI1 W8H Mouthwash Mouthwashes MOUTHWASH W8I Antisepti4 Anticeptics, Misc (cont 1) ANTISEPTI4 W8J Antibctrl Antibacterial Agents, Misc. ANTIBCTRL W8K Antisepti5 Anticeptics, Misc (cont 2) ANTISEPTI5 W8T Preserv Preservatives PRESERV X0A Blood Test Blood Testing Prep, In-Vitro BLOOD-TEST X1A Condoms Condoms CONDOMS X1B Diaphragms Diaphragms/Cervical Cap DIAPHRAGMS X1C IUD IUD's IUD X1D Preg-test1 Pregnancy/Ovulation Tests (Obs PREG-TESTS1 X1F Preg-test2 Pregnancy Tests PREG-TESTS2 X1G Ovulation Ovulation Tests OVULATION X2A Needles Needles/Needleless Devices NEEDLES X2B Syringes Syringes & Accessories SYRINGES X3A Ostomy Ostomy Supplies OSTOMY X4B Incontinen Incontinence Supplies INCONTINEN X5A Med Supp Medical Supplies, Misc. MED-SUPP X5B Bandages Bandages,Gauze,Tape/Rel Supp BANDAGES X5C Med Supp1 Medical Supplies, Misc(Cont 1) MED-SUPP1 X5D Gloves Gloves GLOVES X5E Bandages1 Bandages & Reltd Supp (cont 1) BANDAGES1 X5F Aseptic Aseptic Tests & Accessories ASEPTIC X5G Gowns Gowns/Smocks GOWNS X6A Med Supp4 Medical Supplies,Misc(Cont 2) MED-SUPP4 X6D Dental1 Dental Supplies DENTAL1 X7A Contact Ln Contact Lens Prep.Gas,Hard Sft CONTACT-LNS X8A Admin Set1 Parenteral Admin Sets ADMIN-SET1 X8B Admin Sets Blood Administration Sets ADMIN-SETS X8C Admin Set2 Irrigation Administration Sets ADMIN-SET2 X8P Med Supp2 Medical Supplies, Misc(Cont 3) MED-SUPP2 X8V Med Supp3 Medical Supplies, Misc(Cont 4) MED-SUPP3 Y0A Med Equip2 Durable Medical Equip., Misc MED-EQUIP2 Y0B Crutches Crutches CRUTCHES Y0D Bed Boards Bed Boards BED-BOARDS Y0E Impotency1 Impotency Devices IMPOTENCY1 Y1A Feed Devic Feeding Devices FEED-DEVIC Y1B Thermomtr Thermometers THERMOMTR Y2G Clean Air Clean Air Centers CLEAN-AIR Y3A Med Equip Durable Med Equip,Misc(Grp 1) MED-EQUIP Y3C Med Equip1 Durable Med Equip,Misc(Grp 2) MED-EQUIP1 Y4A Cntraceptv Diaphragms CNTRACEPTV Y4B Catheters Catheters and Related Devices CATHETERS Y5A Braces Braces and Related Devices BRACES Y5C Wtr Bottle Hot Water Bottle&Reltd Devices WTR-BOTTLE Y7A Inhalers Respiratory Aids,Devices, Eqp INHALERS Y7B Procedural Medical Procedural Aids PROCEDURAL Y8A Hearng Aid Hearing Aids and Related Devic HEARNG-AID Y8B Rub Syring Rubber Syringes RUB-SYRING Y9A Diabetic Diabetic Supplies DIABETIC Z1A Histamine Histamine Preparations HISTAMINE Z1C Serotonin1 Serotonin and Derivatives SEROTONIN1 Z1D Enzymes Enzyme Replcmnt(Ubiquit Enzym) ENZYMES Z1E Antioxidan Antioxidant Agents ANTIOXIDANT Z1F Immune Immune System Cell Groups IMMUNE Z2A AntiHistam Anti-Histamines HISTAMINES Z2B AntiHista1 Anti-Histamines (Continued) HISTAMINE1 Z2C Serotonin Anti-Serotonin Drugs SEROTONIN Z2D Inhibitor8 Histamine H2 Inhibitors INHIBITOR8 Z2E Immunosupp Immunosuppresives IMMUNOSUPP Z2F Stabilizer Mast Cell Stabilizers STABILIZER Z2G Immunomod Immunomodulators IMMUNOMOD Z2H Inhibitor0 Systemic Enzyme Inhibitors INHIBITOR0 Z2I AntiHista2 AntiHistamines (cont 2) HISTAMINE2 Z2O 2ST GEN AM 2ND GEN ANTIHISTAMINE & DECONG GEN2-ANTIHISTAMINE Z2P ANTIHISTAM ANTIHISTAMINES - 1ST GENERATIO ANTIHISTAMINES-1GE Z2Q ANTIHISTAM ANTIHISTAMINES - 2ST GENERATIO ANTIHISTAMINES-2G1 Z3G Misc Agnts Miscellaneous Agents MISC-AGNTS Z4A Prostaglan Prostaglandins PROSTAGLANDINS Z4B Antagonis3 Leukotriene Receptor Antagonis ANTAGONIS3 Z4C Inhibtor10 Thromboxane A2 Inhibitors INHIBITORS10 Z9A Drugs Unclassified Drugs DRUGS Z9D Diag Prep Diagnostic Preparations, Misc. DIAG-PREP ZZN 1ST GEN AM 1ST GEN ANTIHISTAMINE & DECONG GEN1-ANTIHIST ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PROC-MOD-CD R-Reference Number:0139 Procedure Modifier Modifiers are used in conjunction with procedure codes to more clearly define how the procedure code was used. Value Short Long Mnemonic 0 MOD-00 Initial Billing MOD-00 1 MOD-01 First Additional Billing MOD-01 2 MOD-02 Second Additional Billing MOD-02 20 MOD-20 Microsurgery MOD-20 21 MOD-21 Prolonged E/M Service MOD-21 22 MOD-22 Unusual Procedural Svc MOD-22 23 MOD-23 Unusual Anesthesia MOD-23 24 MOD-24 Unrelated E/M Svc Post-op MOD-24 25 MOD-25 Identifiable E/M Svc Same Day MOD-25 26 MOD-26 Professional Component MOD-26 27 MOD-27 Mlt OP Hosp E/M enctr same/day MOD-27 3 MOD-03 Third Additional Billing MOD-03 32 MOD-32 Mandated Services MOD-32 4 MOD-04 Fourth Additional Billing MOD-04 47 MOD-47 Anesthesia by Surgeon MOD-47 5 MOD-05 Fifth Additional Billing MOD-05 50 MOD-50 Bilateral Procedures MOD-50 51 MOD-51 Multiple Procedures MOD-51 52 MOD-52 Reduced Services MOD-52 53 MOD-53 Discontinued Procedure MOD-53 54 MOD-54 Surgical Care Only MOD-54 55 MOD-55 Postoperative Management Only MOD-55 56 MOD-56 Pre-operative Mngt Only MOD-56 57 MOD-57 Decision for Sugery MOD-57 58 MOD-58 Staged/related Proc Post-op MOD-58 59 MOD-59 Distinct Procedural Service MOD-59 6 MOD-06 Sixth Additional Billing MOD-06 62 MOD-62 Two Surgeons MOD-62 66 MOD-66 Surgical Team MOD-66 7 MOD-07 Seventh Additional Billing MOD-07 73 MOD-73 Discontin OP proc prior to Ane MOD-73 74 MOD-74 Dscontinued oP proc after Ane MOD-74 76 MOD-76 Repeat Proc by Same Phys MOD-76 77 MOD-77 Repeat Proc by Another Phys MOD-77 78 MOD-78 Return to or for Related Surg MOD-78 79 MOD-79 Unrelated Surg Post-op SamePhy MOD-79 8 MOD-08 Eighth Additional Billing MOD-08 80 MOD-80 Assistant Surgeon MOD-80 81 MOD-81 Minimum Assistant Surgeon MOD-81 82 MOD-82 Asst Surgeon Qual Resident Not MOD-82 9 MOD-09 Ninth Additional Billing MOD-09 90 MOD-90 Reference (outside) laboratory MOD-90 91 MOD-91 Repeat Clinical diag lab test MOD-91 92 MOD-92 Transport Two Patients MOD-92 93 MOD-93 Transport Three Plus Patients MOD-93 99 MOD-99 Multiple Modifiers MOD-99 AA MOD-AA Physician Personally Performed MOD-AA AB MOD-AB Reimbursement Employee <5 Empl MOD-AB AC MOD-AC Reimburse Non-Empl <5 Individu MOD-AC AD MOD-AD Reimburement More 4 Procedures MOD-AD AE MOD-AE Reimbursement Residents <=2 Pr MOD-AE AF MOD-AF Anesthesia Complicated By Hypo MOD-AF AG MOD-AG Emergency Anesthesia MOD-AG AH MOD-AH Clinical Psychologist MOD-AH AJ MOD-AJ Clinical Social Worker MOD-AJ AK MOD-AK Nurse Practitioner/team Rural MOD-AK AL MOD-AL Nurse Prac/Team Non-rural MOD-AL AM MOD-AM Physician, Team Member MOD-AM AN MOD-AN PA Svc,Not Asst,Not-team Membe MOD-AN AS MOD-AS Assistant Surgery By PA MOD-AS AT MOD-AT Acute Treatment MOD-AT AU MOD-AU PA Svc Other Than Asst, Team MOD-AU AV MOD-AV Nurse Prac, Non-team Member MOD-AV AW MOD-AW Clinical Nurse Spec Non-team MOD-AW AY MOD-AY Clinical Nurse Spclst, Team MOD-AY BP MOD-BP Purchase Option Benificiary De MOD-BP BR MOD-BR Purchase Option Ben to Rent MOD-BR BU MOD-BU Purchase Option Did Not Respon MOD-BU CC MOD-CC Procedure Code Change MOD-CC DD MOD-DD Diag Site - Diagnostic Site MOD-DD DE MOD-DE Diag Site - Custodial Facility MOD-DE DG MOD-DG Diag Site - Hosp-based Dialysi MOD-DG DH MOD-DH Diag Site - Hospital MOD-DH DI MOD-DI Diag Site - Transfer Site MOD-DI DJ MOD-DJ Diag Site - Non-hosp-base Dial MOD-DJ DN MOD-DN Diag Site - Skilled Nursing Fa MOD-DN DP MOD-DP Diag Site - Physician Office MOD-DP DR MOD-DR Diag Site - Residence MOD-DR DX MOD-DX Diag Site - Phys Off Then Hosp MOD-DX E1 MOD-E1 Upper Left, Eyelid MOD-E1 E2 MOD-E2 Lower Left, Eyelid MOD-E2 E3 MOD-E3 Upper Right, Eyelid MOD-E3 E4 MOD-E4 Lower Right, Eyelid MOD-E4 ED MOD-ED Custod Facil - Diagnostic Site MOD-ED EE MOD-EE Custod Facil - Custodial Facil MOD-EE EG MOD-EG Custod Facil - Hosp-based Dial MOD-EG EH MOD-EH Custod Facil - Hospital MOD-EH EI MOD-EI Custod Facil - Transfer Site MOD-EI EJ MOD-EJ Subsequent Clm. Injection Only MOD-EJ EM MOD-EM ER Supply, ESRD only MOD-EM EN MOD-EN Custod Facil - Skilled Nursing MOD-EN EP MOD-EP ECF-Phys/EPSDT Svc MOD-EP ER MOD-ER Custod Facil - Residence MOD-ER ET MOD-ET Emergency Treatment MOD-ET EX MOD-EX Custod Facil - PhysO Then Hosp MOD-EX F1 MOD-F1 Left Hand, Second Digit MOD-F1 F2 MOD-F2 Left Hand, Third Digit MOD-F2 F3 MOD-F3 Left Hand, Fourth Digit MOD-F3 F4 MOD-F4 Left Hand, Fifth Digit MOD-F4 F5 MOD-F5 Right Hand, Thumb MOD-F5 F6 MOD-F6 Right Hand, Second Digit MOD-F6 F7 MOD-F7 Right Hand, Third Digit MOD-F7 F8 MOD-F8 Right Hand, Fourth Digit MOD-F8 F9 MOD-F9 Right Hand, Fifth Digit MOD-F9 FA MOD-FA Left Hand, Thumb MOD-FA FP MOD-FP Service Part of Fam Plng Prog MOD-FP G1 MOD-G1 Most Recent URR Read < 60 MOD-G1 G2 MOD-G2 Most Recent URR Read 60-64.9 MOD-G2 G3 MOD-G3 Most Recent URR Read 65-69.9 MOD-G3 G4 MOD-G4 Most Recent URR Read 70-74.9 MOD-G4 G5 MOD-G5 Most Recent URR Read =>75 MOD-G5 G6 MOD-G6 ESRD Pat w/less 6 dialy in mon MOD-G6 G7 MOD-G7 Preg res from rape/incest MOD-G7 G8 MOD-G8 MAC (Ane)for complex surg proc MOD-G8 G9 MOD-G9 Monitored Anes/Cardio-Pulm Cnd MOD-G9 GA MOD-GA Waiver of Liabil Stmt on File MOD-GA GC MOD-GC Svc Perf by Resident Under Phy MOD-GC GD MOD-GD Hosp-based Dialysis -Diag Site MOD-GD GE MOD-GE Svc Perf by Resident W/o Phys MOD-GE GG MOD-GG Hosp-based Dialysis Fac -Hosp MOD-GG GH MOD-GH Hosp dial-hosp/diag mam conv MOD-GH GI MOD-GI Hosp-based Dialysis--Transfer MOD-GI GJ MOD-GJ Hosp dial-non-hosp/opt out emg MOD-GJ GN MOD-GN Hosp dial-SNF/svc by speech pa MOD-GN GO MOD-GO Service delivered by Occ Thera MOD-GO GP MOD-GP Hosp dial-phys off/svc by PT MOD-GP GR MOD-GR Hosp-based Dialysis--Residence MOD-GR GT MOD-GT Via Interact Audio&Video Telec MOD-GT GU MOD-GU Proc perf in non-fee sched POS MOD-GU GV MOD-GV Svc prov as routine in McareQC MOD-GV GX MOD-GX Hosp dial-phy stop/svc not cov MOD-GX HD MOD-HD Hosp - Diagnostic Site MOD-HD HE MOD-HE Hosp - Custodial Facility MOD-HE HG MOD-HG Hosp - Hosp-based Dialysis Fac MOD-HG HH MOD-HH Hospital to Hospital MOD-HH HI MOD-HI Hosp - Transfer Site MOD-HI HJ MOD-HJ Hosp - Non-Hosp-based Dialysis MOD-HJ HN MOD-HN Hosp - Skilled Nursing Facilit MOD-HN HP MOD-HP Hosp - Physician Office MOD-HP HR MOD-HR Hospital to Resident MOD-HR HX MOD-HX Hosp - Phys Office Then Hosp MOD-HX ID MOD-ID Transfer Site--Diagnostic Site MOD-ID IE MOD-IE Transfer Site--Custodial Facil MOD-IE IG MOD-IG Transfer Site--Hosp-based Dial MOD-IG IH MOD-IH Transfer Site--Hospital MOD-IH II MOD-II Transfer Site--Transfer Site MOD-II IJ MOD-IJ Transfer Site--N/Hosp-base Dia MOD-IJ IN MOD-IN Transfer Site--Skilled Nursing MOD-IN IP MOD-IP Transfer Site--Phys Office MOD-IP IR MOD-IR Transfer Site--Residence MOD-IR IX MOD-IX Transfer Site--PhysO Then Hosp MOD-IX JD MOD-JD N/Hosp-based Dialys--Diag Site MOD-JD JE MOD-JE N/Hosp-based Dialys--Custodial MOD-JE JG MOD-JG N/Hosp-based Dialys--Hosp Dial MOD-JG JH MOD-JH N/Hosp-based Dialys--Hospital MOD-JH JI MOD-JI N/Hosp-based Dialys--TransSite MOD-JI JJ MOD-JJ N/Hosp-based Dialys--N/HospDia MOD-JJ JN MOD-JN N/Hosp-based Dialys--SNF MOD-JN JP MOD-JP N/Hosp-based Dialys--PhysOffic MOD-JP JR MOD-JR N/Hosp-based Dialys--Residence MOD-JR JX MOD-JX N/Hosp-based Dialys--PhysO/Hos MOD-JX K0 MOD-K0 LowerExtrem Prosthesis LVL 0 MOD-K0 K1 MOD-K1 LowerExtrem Prosthesis LVL 1 MOD-K1 K2 MOD-K2 LowerExtrem Prosthesis LVL 2 MOD-K2 K3 MOD-K3 LowerExtrem Prosthesis LVL 3 MOD-K3 K4 MOD-K4 LowerExtrem Prosthesis LVL 4 MOD-K4 KA MOD-KA Add on Options for Wheelchair MOD-KA KH MOD-KH 1st Month Rent DME,Prosth,Orth MOD-KH KI MOD-KI 2nd/3rd Month Rent--DMEPOS MOD-KI KJ MOD-KJ Months 4-15 Rent Pen Pump MOD-KJ KK MOD-KK Inhalation SOL Cmpnd--FDA Aprv MOD-KK KL MOD-KL Prod Char Defined Meet Med Pol MOD-KL KM MOD-KM ReplcFacial Prosthesis-NewImpr MOD-KM KN MOD-KN ReplcFacial Prosthesis-PrevMst MOD-KN KO MOD-KO Single Drug Unit Dose Formulat MOD-KO KP MOD-KP First Drug of Mult Drug Unit D MOD-KP KQ MOD-KQ Second or Subsq Drug Of MultUD MOD-KQ LC MOD-LC Left Circumflex Coronary Arter MOD-LC LD MOD-LD Left Anterior Desc Coronary Ar MOD-LD LL MOD-LL Lease/Rental--apply to Purchas MOD-LL LR MOD-LR Laboratory Round Trip MOD-LR LS MOD-LS FDA Monitor Intra Lens Implant MOD-LS LT MOD-LT Left Side MOD-LT MS MOD-MS 6 Mos Maint/Svc Fee (Non-Warr) MOD-MS ND MOD-ND SNF - Diagnostic Site MOD-ND NE MOD-NE SNF - Custodial Facility MOD-NE NG MOD-NG SNF - Hosp-based Dialysis Fac MOD-NG NH MOD-NH SNF - Hospital MOD-NH NI MOD-NI SNF - Transfer Site MOD-NI NJ MOD-NJ SNF - Non-Hosp-based Dialysis MOD-NJ NN MOD-NN SNF - Skilled Nursing Facility MOD-NN NP MOD-NP SNF - Physician Office MOD-NP NR MOD-NR SNF - res/new when rented MOD-NR NU MOD-NU New Equipment MOD-NU NX MOD-NX SNF - Phys Office Then Hosp MOD-NX P1 MOD-P1 A Normal, Healthy Patient MOD-P1 P2 MOD-P2 Pt With Mild Systemic Disease MOD-P2 P3 MOD-P3 Pt Has Severe Systemic Disease MOD-P3 P4 MOD-P4 Life Threatening Syst Disease MOD-P4 P5 MOD-P5 No Survival Without Surgery MOD-P5 P6 MOD-P6 Brain Dead, Organ Donor MOD-P6 PD MOD-PD Phys Office--Diagnositic Site MOD-PD PE MOD-PE Phys Office--Custodial Facilit MOD-PE PG MOD-PG Phys Office--Hosp-based Dialys MOD-PG PH MOD-PH Phys Office--Hospital MOD-PH PI MOD-PI Phys Office--Transfer Site MOD-PI PJ MOD-PJ Phys Office--N/Hosp-based Dial MOD-PJ PL MOD-PL Progressive Addition Lenses MOD-PL PN MOD-PN Phys Office--SNF MOD-PN PP MOD-PP Phys Office--Physician Office MOD-PP PR MOD-PR Phys Office--Residence MOD-PR PX MOD-PX Phys Office--PhysO Then Hosp MOD-PX Q2 MOD-Q2 HCFA/ORD Demo Proj Proc/Svc MOD-Q2 Q3 MOD-Q3 Live Kidney Donor Post Op MOD-Q3 Q4 MOD-Q4 Service for Refrng Phys Quals MOD-Q4 Q5 MOD-Q5 Service for Ref Phys Qual for MOD-Q5 Q6 MOD-Q6 Svc Finished by Locum Tenens MOD-Q6 Q7 MOD-Q7 One Class -A- Finding MOD-Q7 Q8 MOD-Q8 Two Class -B- Findings MOD-Q8 Q9 MOD-Q9 One Class -B- and 2 -C- Findng MOD-Q9 QA MOD-QA FDA Investigational Device Exm MOD-QA QB MOD-QB Physician Svc Rural HPSA MOD-QB QC MOD-QC Single Channel Monitoring MOD-QC QD MOD-QD Digital Recording/Storage MOD-QD QE MOD-QE Oxygen Prescribed < 1 Liter/Mi MOD-QE QF MOD-QF Oxygen GT 4 Lit/Min Portable R MOD-QF QG MOD-QG Oxygen GT 4 Liters/Minute MOD-QG QH MOD-QH Oxygen System Conserving Devic MOD-QH QK MOD-QK Med Dir of 2,3,4 Concur Anesth MOD-QK QL MOD-QL Pat proun dead after amb call MOD-QL QM MOD-QM Hosp Arrng AMB Svc Provided MOD-QM QN MOD-QN Hosp Provided Ambulance Svc MOD-QN QP MOD-QP Documentation Exists Phys Orde MOD-QP QQ MOD-QQ Claim subm w/writ stmt intent MOD-QQ QR MOD-QR Repeat Lab Test on Same Day MOD-QR QS MOD-QS Monitored Anesthesia Care Svc MOD-QS QT MOD-QT Tape Recording Device MOD-QT QU MOD-QU Phys Service in Urban HPSA MOD-QU QV MOD-QV Svc prov in Mcare qual trial MOD-QV QW MOD-QW CLIA Waived Test MOD-QW QX MOD-QX CRNA with medical direction MOD-QX QY MOD-QY Medical direction of one CRNA MOD-QY QZ MOD-QZ CRNA with no medical direction MOD-QZ RC MOD-RC Right Coronary Artery MOD-RC RD MOD-RD Residence--Diagnostic Site MOD-RD RE MOD-RE Residence--Custodial Facility MOD-RE RG MOD-RG Residence--Hosp-based Dialysis MOD-RG RH MOD-RH Residence--Hospital MOD-RH RI MOD-RI Residence--Transfer Site MOD-RI RJ MOD-RJ Residence--N/Hosp-based Dialys MOD-RJ RN MOD-RN Residence--Skilled Nursing Fac MOD-RN RP MOD-RP Res-phys off/replac-repair DME MOD-RP RR MOD-RR Rental MOD-RR RT MOD-RT Right Side Body Surg/Pros/Orth MOD-RT RX MOD-RX Residence--PhysOffice Then Hos MOD-RX SD MOD-SD Accident Scene--DiagnosticSite MOD-SD SE MOD-SE Accident Scene--Custodial Faci MOD-SE SF MOD-SF 2nd Opinion Orderd by a Pro MOD-SF SG MOD-SG Ambulatory Surgery Center MOD-SG SH MOD-SH Accident Scene--Hospital MOD-SH SI MOD-SI Accident Scene--Transfer Site MOD-SI SJ MOD-SJ Accident Scene--N/Hosp Dialys MOD-SJ SN MOD-SN Accident Scene--SNF MOD-SN SP MOD-SP Accident Scene--Phys Office MOD-SP SR MOD-SR Accident Scene--Residence MOD-SR SX MOD-SX Accident Scene--PhysO Then Hos MOD-SX T1 MOD-T1 Left Foot, Second Digit MOD-T1 T2 MOD-T2 Left Foot, Third Digit MOD-T2 T3 MOD-T3 Left Foot, Fourth Digit MOD-T3 T4 MOD-T4 Left Foot, Fifth Digit MOD-T4 T5 MOD-T5 Right Foot, Great Toe MOD-T5 T6 MOD-T6 Right Foot, Second Digit MOD-T6 T7 MOD-T7 Right Foot, Third Digit MOD-T7 T8 MOD-T8 Right Foot, Fourth Digit MOD-T8 T9 MOD-T9 Right Foot, Fifth Digit MOD-T9 TA MOD-TA Left Foot, Great Toe MOD-TA TC MOD-TC Technical Component MOD-TC UE MOD-UE Used DME MOD-UE VP MOD-VP Aphakic Patient MOD-VP ZZ MOD-ZZ Third Surgical Opinion MOD-ZZ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-PYMT-CYCL-CD R-Reference Number:0042 Payment Cycle Code A1 indicates weekly checks, B1 indicates ACS produces pharmacy checks for the customer every 2 weeks and C1 indicates checks are produced by the customer. Value Short Long Mnemonic A1 STD PMT Standard Weekly STD-PAYMENT-CYCLE B1 GEN PMT Generic GENERIC-PMT-CYCLE BY BiWeekly Bi-Weekly Payment BIWEEKLY-PMT C1 NEW CL PMT Gen-New Client NEW-CLIENT-PMT-CYC CY Custom Custom Payment Days CUSTOM-PMT DY Daily Daily Payment DAILY-PMT MY Monthly Monthly Payment MONTHLY-PMT NP NO PYMNT No Payment NO-PAYMENT SY SemiMonth Seni-Monthly Payment SMONTHLY-PMT WY Weekly Weekly Payment WEEKLY-PMT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RATED-GSN-CD R-Reference Number:8619 Rated GSN Code Two A Rated General Sequence Number Code Value Short Long Mnemonic Not Specif Not Specified NOT-SPECIFIED 2 2AGenAvail 2-A-Rated Generic Available TWO-A-RATED-GEN-AV N GenNotAvai No A-Rated Generic Available A-RATED-GEN-NAVAIL Y Gen Avail A-Rated Generic Available A-RATED-GEN-AVAIL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-REFLL-EXMT-IND R-Reference Number:5616 Refill Too Soon Exempt Ind Refill-Too-Soon Exempt Indicator Value Short Long Mnemonic N No No NO Y Yes Yes YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-REPKG-IND R-Reference Number:8006 REPACKAGE IND REPACKAGE INDICATOR Value Short Long Mnemonic 0 NOT REPKG NON REPACKAGED NOT-REPACKAGED 1 REPACKAGED REPACKAGED REPACKAGED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RNGE-HIER-CD R-Reference Number:8873 drug hierarchy code Indicates the hierarchy of drug range type codes. Value Short Long Mnemonic 05 NDC National Drug Code NDC 10 GSN Generic Sequence Number GSN 15 GCN Generic Code GCN 20 TXCL Therapeutic Class TXCL 25 DrugCat NCPDP Drug Category DRUG-CAT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-ROUTE-DESC R-Reference Number:9025 ROUTE DESCRIPTION ROUTE DESCRIPTION Value Short Long Mnemonic NOT ENTER NOT ENTERED NOT-ENTERED BUCCAL BUCCAL BUCCAL BUCCAL DENTAL DENTAL DENTAL DENTAL EPIDURAL EPIDURAL EPIDURAL EPIDURAL IMPLANT IMPLANT IMPLANTATION IMPLANTATION INHALATION INHALATION INHALATION INHALATION INJECTION INJECTION INJECTION NOT COVERED-RT CD INJECTION-NCOVERED INTRAARTER INTRAARTER INTRAARTERIAL INTRAARTERIAL INTRAARTIC INTRAARTIC INTRAARTICULAR INTRAARTICULAR INTRACAVER INTRACAVER INTRACAVERNOSAL INTRACAVERNOSAL INTRADERM INTRADERM INTRADERMAL INTRADERMAL INTRAMUSC INTRAMUSC INTRAMUSCULAR ONLY INTRAMUSCULAR-ONLY INTRAPERIT INTRAPERIT INTRAPERITONEAL INTRAPERITONEAL INTRATHECA INTRATHECA INTRATHECAL INTRATHECAL INTRAVEN INTRAVEN INTRAVENOUS ONLY INTRAVENOUS-ONLY IRRIGATION IRRIGATION IRRIGATION IRRIGATION MISCELL MISCELL MISCELLANEOUS MEDICAL SUPPLY MISCELL-MED-SUPPLY MUCOUS MEM MUCOUS MEM MUCOUS MEMBRANE MUCOUS-MEM NASAL NASAL NASAL NASAL OPTHALMIC OPTHALMIC OPTHALMIC OPTHALMIC ORAL ORAL ORAL ORAL OTIC OTIC OTIC OTIC PERFUSION PERFUSION PERFUSION PERFUSION RECTAL RECTAL RECTAL RECTAL SUBCUTAN SUBCUTAN SUBCUTANEOUS SUBCUTANEOUS SUBLINGUAL SUBLINGUAL SUBLINGUAL SUBLINGUAL TOPICAL TOPICAL TOPICAL (HAIR, NAILS, & SKIN) TOPICAL TRANSDERM TRANSDERM TRANSDERMAL TRANSDERMAL TRANSLING TRASLING TRANSLINGUAL TRANSLINGUAL URETHRAL URETHRAL URETHRAL URETHRAL VAGINAL VAGINAL VAGINAL VAGINAL ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RPT-PRINT-IND R-Reference Number:8928 REPORT PRINT IND REPORT PRINT INDICATOR Value Short Long Mnemonic N No No Print Report NO-PRINT-REPORT Y Yes Yes Print Report YES-PRINT-REPORT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RPT-RUN-FREQ-CD R-Reference Number:9806 REPORT RUN FREQUENCY CD REPORT RUN FREQUENCY CODE Value Short Long Mnemonic M Monthly Monthly Report MONTHLY-REPORT N No No Run Report NO-RUN-REPORT P Payment Payment Report PAYMENT-REPORT Q Qrtly Quarterly Report QUARTERLY-REPORT R Request Request Report REQUEST-REPORT T YTD Year To Date Report YEAR-TO-DT-REPORT W Weekly Weekly Report WEEKLY-REPORT Y Yearly Yearly Report YEARLY-REPORT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RPT-TY-CD R-Reference Number:7492 REPORT TYPE CODE REPORT TYPE CODE Value Short Long Mnemonic 1 TXCL Therapeutic Class Code Spec TXCL 2 GCN Generic Code Number GCN 3 GSN Generic Sequence Number GSN 4 Drug Cat Drug Category Code DRUG-CAT-CD 5 DEA Drug Enforcement Agency Code DEA 6 Drug Class Drug Class DRUG-CLASS 7 NABP Num Natl Assoc Boards Pharm Number NABP-NUM 8 Sel Phys Selected Physician Code PHYS-CD ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RSN-FOR-SVC-CD R-Reference Number:8605 DUR Conflict / Reason for Svc Code identifying the type of utilization conflict detected or the reason for the pharmacist's professional service. This field used to be called R-CONFLICT-CD. (NCPDP field E4) Value Short Long Mnemonic AD Add Drug Additional Drug Needed ADDITIONAL-DRUG AN RX Auth Prescription Authentication PRESCRIPTION-AUTH AR Adv React Adverse Drug Reaction ADVERSE-DRUG-REACT AT Add Toxic Additive Toxicity ADDITIVE-TOXICITY CD Chron Dise Chronic Disease Management CHRONIC-DISEASE CH Call Help Call Help Desk CALL-HELP-DESK CS Compl/Sym Patient Complaint/Symptom COMPLAINT-SYMPTOM D1 Drug2Drug Drug to Drug for Reporting DRUG-TO-DRUG DA Drug-Aller Drug-Allergy DRUG-ALLERGY DC Disease In Drug-Disease (Inferred) DRUG-DISEASE-INFER DD Drug-Drug Drug-Drug Interaction DRUG-DRUG-INTERACT DF Drug-Food Drug-Food interaction DRUG-FOOD-INTERACT DI Drug Incom Drug Incompatibility DRUG-INCOMPATIBLE DL Drug-Lab Drug-Lab Conflict DRUG-LAB-CONFLICT DM Drug Misus Apparent Drug Misuse DRUG-MISUSE DR DoseRange Dose Range Conflict DOSE-RNGE-CONFLICT DS Tobacco Tobacco Use TOBACCO-USE ED Patient Ed Patient Education/Instruction PATIENT-EDUCATION ER Overuse Overuse OVERUSE EX Excess Qty Excessive Quantity EXCESSIVE-QUANTITY HD High Dose High Dose HIGH-DOSE IC Iatrogenic Iatrogenic Condition IATROGENIC-COND ID Ingred Dup Ingredient Duplication INGREDIENT-DUPLIC LD Low Dose Low Dose LOW-DOSE LK Lock In Lock In Recipient LOCK-IN-RECIPIENT LR Underuse Underuse UNDERUSE MC Disea Rpt Drug-Disease (Reported) DRUG-DISEASE-RPT MN Insuff Dur Insufficient Duration INSUFFICEINT-DURAT MS Missg Info Missing Information/Clarificat MISSING-INFO MX Excess Dur Excessive Duration EXCESSIVE-DURATION NA Not Avail Drug Not Available DRUG-NOT-AVAILABLE NC Non-cover Non-covered Drug Purchase NON-COVERED-DRUG ND New Diseas New Disease/Diagnosis NEW-DISEASE-DIAG NF Non-Formul Non-Formulary Drug NON-FORMULARY-DRUG NN Unnecessar Unnecessary Drug UNNECESSARY-DRUG NP New Patien New Patient Processing NEW-PATIENT NR Lactation Lactation/Nursing Interaction LACTATION-NURSING NS Insuff Qty Insufficient Quantity INSUFFICIENT-QTY OH Alcohol Alcohol Conflict ALCOHOL-CONFLICT PA Drug-Age Drug-Age DRUG-AGE PC Pat Conser Pat Question/Concern PATIENT-CONCERN PG Pregnancy Drug-Pregnancy DRUG-PREGNANCY PH Preventive Preventive Health Care PREVENTIVE-HEALTH PN Prescriber Prescriber Consultation PRESCRIBER-CONSULT PP Plan Proto Plan Protocol PLAN-PROTOCOL PR Prior Adv Prior Adverse Reaction PRIOR-ADVERSE-REAC PS Prod Sel Product Selection Opportunity PRODUCT-SELECTION RE Envir Risk Suspected Environmental Risk ENVIRONMENTAL-RISK RF Prov Ref Health Provider Referral PROVIDER-REFERRAL SC Subopt Cmp Suboptimal Compliance SUBOPTIMAL-COMPL SD Subopt Dru Suboptimal Drug/Indication\ SUBOPTIMAL-DRUG SE Side Eff Side Effect SIDE-EFFECT SF Subopt D F Subopt Dose Form SUBOPT-DOSAGE-FORM SR Subopt Reg Subopt Regimen SUBOPTIMAL-REGIMEN SX Drug-Gend Drug-Gender DRUG-GENDER TD Thera Dup Therapeutic Dup THERAPEUTIC-DUPLIC TN Test Need Lab Test Needed LAB-TEST-NEEDED TP Payer Ques Payer/Processor Qustn PAYER-PROC-QUEST ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RX-LMT-EXMT-CD R-Reference Number:7201 RX Limit Exempt Code RX Limit Exempt Code Value Short Long Mnemonic LmtNotExmp Limit Not Exempt LIMIT-NOT-EXMT C LmtExmtCus Limit Exempt Per Custom LIMIT-EXMT-CUSTOM D LmtExmpDrg Limit Exempt Per Drug LIMIT-EXEMPT-DRUG M LmtExmpPA Limit Exempt Per PA LIMIT-EXEMPT-PA N LmtNotExmp Limit Not Exempt LIMIT-NOT-EXEMPT S RefTooSoon Refill Too Soon REFILL-TOO-SOON ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-RX-LMT-EXMT-IND R-Reference Number:1634 RX Limit Exempt Ind RX Limit Exempt Indicator Value Short Long Mnemonic Lmt Nt Exm Limit Not Exempt LIMIT-NOTEXEMPT N Lmt Nt Exm Limit Not Exempt LIMIT-NOT-EXEMPT Y Lmt Exempt Limit Exempt LIMIT-EXEMPT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-SALES-TAX-IND R-Reference Number:0148 Sales Tax Indicator Sales tax indicator determines whether the system will add sales tax. Value Short Long Mnemonic N Not Req Sales Tax Not Required S-TAX-NOT-REQUIRED Y Required Sales Tax Required S-TAX-REQUIRED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-S-D-PHARM-IND R-Reference Number:3977 Ref Same Dif Pharmacy Ind Same/different pharmacy. Indicates whether the conflict will post if prescribed by the same pharmacy or different pharmacy when editing for DUR filter. Value Short Long Mnemonic D Different Different DIFFERENT N N/A Not Applicable N-A S Same Same SAME ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-S-D-PRESCR-IND R-Reference Number:6510 Ref Same Dif Prescriber Ind Same/different prescriber. Indicates whether the conflict will post if prescribed by the same or different prescriber when editing for DUR filter. Value Short Long Mnemonic D Different Different DIFFERENT N N/A Not Applicable N-A S Same Same SAME ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-SEX-CD R-Reference Number:0104 Ref Sex Code Indicates sex that the procedure applies to. Value Short Long Mnemonic B M/F Male or Female BOTH F Female Female FEMALE M Male Male MALE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-STEPCARE-IND R-Reference Number:0077 Stepcare Indicator Y or N Value Short Long Mnemonic N Non-Partic Does not Participate in Stepca NON-PARTIC Y Participat Participate in Stepcare PARTICIPATE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-STND-THERA-CD R-Reference Number:1878 Therapeutic class code Indicates the drug's therapeutic class code. Value Short Long Mnemonic 00 MED SUPPLI MED SUPPLIES,AND OTH NON-DRUG MEDICAL-SUPPLIES 01 ANTI ULCER ANTI-ULCER PREPARATIONS ANTI-ULCER 02 EMETICS EMETICS EMETICS 03 ANTIDIARRH ANTIDIARRHEALS ANTIDIARRHEALS 04 ANTISPASMO ANTISPASMODICS,ANTICHOLINERGIC ANTISPASMODICS 05 BILE THERA BILE THERAPY BILE-THERAPY 06 LAXATIVES LAXATIVES LAXATIVES 07 ATAR TRANQ ATARACTICS-TRANQUILIZERS ATARACTICS 08 MUSCL RELA MUSCLE RELAXANTS MUSCLE-RELAXANTS 09 ANTIPARKIN ANTIPARKINSON ANTIPARKINSON 10 CNS STIMUL CNS STIMULANTS CNS-STIMULANTS 11 PSYCH ANTI PSYCHOSTIMULANTS-ANTIDEPRESSAN PSYCHOSTIMULANTS 12 AMPHETAMIN AMPHETAMINE PREPARATIONS AMPHETAMINE 13 ANTIOBESIT ANTIOBESITY PREPARATIONS ANTIOBESITY-PREP 14 ANTIHISTAM ANTIHISTAMINES ANTIHISTAMINES 15 BRONCH DIL BRONCHIAL-DILATORS BRONCHIAL-DILATORS 16 BNTITUSSIV ANTITUSSIVES-EXPECTORANTS ANTITUSSIV-EXPECT 17 COUGH COLD COUGH AND COLD PREPARATIONS COUGH-COLD-PREP 18 ADRENERGIC ADRENERGICS ANRENERGICS 19 NASAL PREP NASAL & OTIC PREPARATIONS,TOPI NASAL-PREP 20 OPHTHALMIC OPHTHALMIC PREPARATIONS OPHTALMIC-PREP 21 TETRACYCLI TETRACYCLINES TETRACYCLINES 22 PENICILLIN PENICILLINS PENICILLINS 23 STREPTOMYC STREPTOMYCICS STREPTOMYCINS 24 SULFONAMID SULFONAMIDES SULFONAMIDES 25 ERYTHROMYC ERYTHROMYC ERYTHROMYCINS 26 CEPHALOSPO CEPHALOSPORINS CEPHALOSPORINS 27 ANTIBIOTIC ANTIBIOTICS, OTHER ANTIBIOTIC-OTHER 28 ANTIBACTER ANTIBACTERIALS, URINARY ANTIBACTERIALS-URI 29 CHLORAMPHE CHLORAMPHENICOL CHLORAMPHENICOL 30 ANTINEOPLA ANTINEOPLASTICS ANTINEOPLASTICS 31 ANTIPARASI ANTIPARASITICS ANTIPARASITICS 32 ANTIMALARI ANTIMALARIALS ANTIMALARIALS 33 ANTIVARALS ANTIVARIALS ANTIVIRALS 34 TB PREPARA TB PREPARATIONS TB-PREPARATIONS 35 TRIMETHOPR THIMETHOPRIM TRIMETHOPRIM 36 CONTRACEPT CONTRACEPTIVES, TOPICAL CONTRACEPTIVES 37 VAGINAL CL VAGINAL CLEANSERS VAGINAL-CLEANSERS 38 ANTIBACTER ANTIBACTERIALS AND ANTISEPTICS ANTIBACTERIALS 39 DIAGNOSTIC DIAGNOSTICS DIAGNOSTICS 40 ANAL NARC ANALGESICS, NARCOTIC ANALGES-NARCOTIC 41 ANAL NNARC ANALGESICS, NON NARCOTIC ANALGES-NON-NARCOT 42 ANTIARTHRI ANTIARTHRITICS ANTIARTHRITICS 43 ANES G INH ANESTHETICS GEN INHALANT ANESTH-GEN-INHALEN 44 ANES G INJ ANESTHETICS GEN INJECT ANESTH-GEN-INJECT 45 ANES LOCAL ANESTHETICS LOCAL ANESTH-LOCAL 46 SEDAT-BARB SEDATIVE, BARBITURATE SEDATIVE-BARBIT 47 SEDAT-NBAR SEDATIVE, NON-BARBITURATE SEDATIVE-NON-BARB 48 ANTICONVUL ANTICONVULSANTS ANTICONVULSANTS 49 ANTINAUSEA ANTINAUSEANTS ANTINAUSEANTS 50 CORTICOTRO CORTICOTROPINS CORTICOTROPINS 51 GLUCOCORTI GLUCOCORTICOIDS GLUCOCORTICOIDS 52 MINERALOCO MINERALOCORTICOIDS MINERALOCORTICOIDS 53 ALDOSTERON ALDOSTERONE ANTAGONISTS ALDOSTERONE 54 ANTIDOTES ANTIDOTES ANTIDOTES 55 THYROID PR THYROID PREPARATIONS THYROID-PREPS 56 ANTITHYROI ANTITHROID PREPARATIONS ANTITHYROID-PREPS 57 IODINE THE IODINE THERAPY IODINE-THERAPY 58 DIABETIC T DIABETIC THERAPY DIABETIC-THERAPY 59 ANABOLICS ANABOLICS ANABOLICS 60 ANDROGENS ANDROGENS ANDROGENS 61 ESTROGENS ESTROGENS ESTROGENS 62 PROGESTERO PROGESTERONE PROGESTERONE 63 CONTRACEPT CONTRACEPTIVES, ORAL CONTRACEPTIVE-ORAL 64 OTH HORMON OTHER HORMONES OTHER-HORMONES 65 PROTEIN LY LIPOTROPICS LIPOTROPICS 66 CholReduce CHOLESTEROL REDUCERS CHOLESTEROL-REDUCE 67 DIGESTANTS DIGESTANTS DIGESTANTS 68 PROTEIN LY PROTEIN LYSATES PROTEIN-LYSATE 69 ENZYMES ENZYMES ENZYMES 70 RAUWOLFIAS RAUWOLFIAS RAUWOLFIAS 71 HYPOTENSIV HYPOTENSIVES, OTHER HYPOTENSIVES-OTHER 72 VASOD-COR VASODILATORS, CORONARY VASODIL-CORONARY 73 VASOD-PERI VASODILATORS, PERIPHERAL VASODIL-PERIPHERAL 74 DIGITALIS DIGITALIS PREPARATIONS DIGITALIS-PREP 75 XANTHINE XANTHINE DERIVATIVES XANTHINE 76 CARDIOVASC CARDIOVASCULAR PREPARATIONS CARDIOVASCULAR 77 ANTICOAGUL ANTICOAGULANTS ANTICOAGULANTS 78 HEMOSTATIC HEMOSTATICS HEMOSTATICS 79 DIURETICS DIURETICS DIURETICS 80 VIT-FATSOL VITAMINS, FAT SOLUBLE VITAMINS-FAT-SOL 81 VIT-WATSOL VITAMINS, WATER SOLUBLE VITAMINS-WATER-SOL 82 MULTIVITAM MULTIVITAMINS MULTIVITAMINS 83 FOLIC ACID FOLIC ACID PREPARATIONS FOLIC-ACID-PREP 84 COMPLEX B COMPLEX WITH VITAMIN C PREPA B-COMPLEX-W-VIT-C 85 VITAMIN K VITAMIN K PREPARATIONS VITAMIN-K-PREP 86 INFANT FOR INFANT FORMULAS INFANT-FORMULAS 87 ELECTROLYT ELECTROLYTES AND MISC NUTRIENT ELECTROLYTES 88 HEMATINICS HEMANTINICS HEMATINICS 89 ALLERGENS ALLERGENS ALLERGENS 90 BIOLOGICAL BIOLOGICAL BIOLOGICALS 91 ANTIPURIT ANTIPURITICS ANTIPURITICS 92 COAL TAR P COAL TAR PREPARATIONS COAL-TAR-PREP 93 EMOLLIENTS EMOLLIENTS PROTECTIVES EMOLLIENTS-PROTECT 94 FUNGICIDES FUNGICIDES FUNGICIDES 95 DERMATOLOG DERMATOLOGICALS, ALL OTHER DERMATOLOGICALS 96 HEMORRHOID HEMORRHOIDAL PREPARATIONS HEMORRHOIDAL-PREP 97 OXYTOCICS OXYTOCICS OXYTOCICS 98 PARASYMPAT PARASYMPATHETIC AGENTS PARASYMPATHETIC-AG 99 UNCLASSIFI UNCLASSIFIED DRUG PRODUCTS UNCLASSIFIED-DRUG ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-SVC-CVRD-CD R-Reference Number:0074 Ref Covered Code Identifier indicating if the service is covered. Value Short Long Mnemonic C Covered Covered Code COVERED D Deny Deny Code DENY N Not Applic Not Applicable NOT-APPLIC S Suspend Suspend SUSPEND Z None No Coverage NONE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-SVC-EMRGCY-IND R-Reference Number:1761 Emergency Service Indicator Indicates (Y/N) if service is emergency related. Value Short Long Mnemonic N NON EMERG NON EMERGENCY SERVICE NON-EMERGENCY-SVC Y EMERG SVC EMERGENCY SERVICE EMERGENCY-SERVICE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-SVRTY-LVL-CD R-Reference Number:8612 Severity Level Code SEVERITY LEVEL CODE Value Short Long Mnemonic 1 Mst Severe Most Severe MOST-SEVERE 2 Severe Severe SEVERE 3 Pos Severe Possibly Severe POSSIBLY-SEVERE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-THERA-GENR-CD R-Reference Number:9654 Reference Thera Class GCN Code Indicates whether contents of R_DRUG_ENTY_CD is a Therapeutic Class Code or a Generic Code Number Value Short Long Mnemonic G GCN Generic Code Number GENR-CD-NUM N NDC National Drug Code NDC S GSN Generic Sequence Number GENR-SEQ-NUM T TXCL Therapeutic Class Code Spec THERA-CLS-CD-SPEC ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-UNITS-STAT-CD R-Reference Number:5123 Units Status Code Units Status Code Value Short Long Mnemonic D PL Exceed Plan Limit Exceeded PLAN-LIM-EXCEEDED N No Edit No Edit NO-EDIT P PA Req Prior Auth Required PA-REQUIRED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-UNIT-USE-CD R-Reference Number:5047 UNIT USE CD UNIT USE CODE Value Short Long Mnemonic 0 ALL OTHER ALL OTHER PRODUCTS ALL-OTHER-PRODUCTS 1 UNITOFUSE UNIT OF USE UNIT-OF-USE ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-UNT-TYPE-CD R-Reference Number:0742 CMS Unit Type Code CMS-defined Unit Type Code describes form of drug Value Short Long Mnemonic AHF AHF Anti-Hemophilic Factor Units ANTI-HEMOPHILIC CAP CAP Capsule CAPSULE EA EACH Each EACH GM GRAM Gram GRAM ML ML Milliliter MILLILITER SUP SUP Suppository SUPPOSITORY TAB TABLET Tablet TABLET TDP PATCH Trans-Dermal Patch PATCH ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-VOID-IND R-Reference Number:4608 Void Indicator Setting the void indicator serves as a soft delete, that is the row in the table still exists but will be ignored in all processing. Value Short Long Mnemonic N VoidRowN No Row is Not Void VOID-ROW-NO Y VoidRowY Yes Row is Void VOID-ROW-YES ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: R-WC-IND R-Reference Number:4420 Worker's COMP Indicator Worker's COMP Indicator Value Short Long Mnemonic N Non-WC Non Workers Comp Customer NON-WC Y Wrkrs Comp Workers Compensation Customer WRKRS-COMP ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: T-CARR-BILL-MED-CD T-TPL Number:2455 TPL Carrier Billing Med Cd The medium used for submitting TPL carrier billing. Value Short Long Mnemonic B Both Both Electronic and Paper BOTH E Electronic Electronic Billing Submission ELECTRONIC P Paper Paper Billing PAPER ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: T-CARR-HCPCS-IND T-TPL Number:4310 Carrier HCPCS Indicator TPL Carrier HCPCS Indicator Value Short Long Mnemonic P TPL Primar TPL Primary Carrier TPL-PRIMARY-CARR S TPL Second TPL Secondary Carrier TPL-SECOND-CARR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: T-CARR-TY-CD T-TPL Number:0019 TPL Carrier Type Code This field describes the persons or organizations for TPL billing. Value Short Long Mnemonic A Attorney Attorney ATTORNEY B Both (H&N) Both (Health & Non-Health) BOTH-H-N D Dist Atty District Attorney DISTRICT H Health Health HEALTH N Non-Health Non-Health NON-HEALTH P Plain Atty Plaintiff Attorney PLAINTIFF R Participan Participant PARTICIPANT S Absnt Par Absent Parent ABSENT-PAR ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: T-CVRG-PART-REL-CD T-TPL Number:9168 Coverage Part Release Code VV Field: 2676 Coverage Part Release Code Value Short Long Mnemonic 0 Not Spec Not Specified NOT-SPECIFIED 1 Self Self/specified Relative SELF-SPEC-RELATIVE 2 Spouse Spouse SPOUSE 3 Child Child CHILD 4 Other Other OTHER ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: T-CVRG-PLCY-CD T-TPL Number:2558 TPL Coverage Policy Code This field describes policy coverage. Value Short Long Mnemonic 01 Inpat Med Inpatient Medical INPAT-MED 02 Inpat Surg Inpatient Surgery INPAT-SURG 03 Inpat Psyc Inpatient Psych INPAT-PSYCH 04 Inpat Hosp Inpatient Hospital INPAT-HOSP 05 Outpat III Outpatient Illness OUTPAT-III 06 Outpat Sur Outpatient Surgery OUTPAT-SURG 07 Outpat Psy Outpatient Psych OUTPAT-PSYCH 08 Outpat Acc Outpatient Accident OUTPAT-ACC 09 Phys Med Physician Medical PHYS-MED 10 Phys Off Physician Office PHYS-OFF 11 Phys Psych Physician Psych PHYS-PSYCH 12 Phys Acc Physician Accident PHYS-ACC 13 Pharmacy Pharmacy PHARMACY 14 Dental Dental DENTAL 15 Oral Surg Oral Surgery ORAL-SURG 16 Psych Res Psych Res PSYCH-RES 17 Ph Cost Av Pharmacy Cost Avoidance PHARMACY-COSTAVOID 18 Ph Pay Ch Pharmacy Pay Chase PHARMACY-PAYCHASE 19 MC HMO Ph MC HMO with Pharmacy MC-HMO-W-PHARMACY 20 Lab/X-ray Lab/X-ray LAB-XRAY 21 Spec w Ph Special Pop with Pharmacy SPEC-POP-W-PHAR 22 Accident Accident ACCIDENT 23 MC HMO SR MC HMO Senior with Pharmacy MC-HMO-SENIOR-W-PH 24 Home Hlth Home Health HOME-HEALTH 25 Nurs HM SN Nurs HM SNF NURS-HM-SNF 26 Nurs HM IC Nurs Hm ICF NURS-HM-ICF 27 Med Supp A Medicare Supplement A MED-SUPP-A 28 Med Supp B Medicare Supplement B MED-SUPP-B 29 Inpat Matr Inpatient Maternity INPAT-MATRN 30 Outpt Matr Outpatient Maternity OUTPAT-MATRN 31 Phys Matr Physician Maternity PHYS-MATRN 32 EPSDT Well EPSDT Wellness EPSDT-WELL 33 Perinatal Perinatal PERINATAL 34 ICU Intensive Care Unit ICU 35 Blood Blood BLOOD 36 IP MAT CP Inpatient MAT CP IP-MAT-CP 37 OP MAT CP Outpatient MAT CP OP-MAT-CP 38 Phys MATCP Physician MAT CP PHYS-MAT-CP 39 Transport Transportation TRANSPORT 40 Eyeglasses Eyeglasses EYEGLASSES 41 Ment Hlth Mental Health MENT-HEALTH 42 Anesthesia Anesthesia ANESTHESIA 43 Cancer Cancer CANCER 44 MedicareC Medicare C MED-SUPP-C 45 MedicareD Medicare D MED-SUPP-D ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: T-PART-VOID-IND T-TPL Number:4721 Part Void Indicator TPL Participating Void Indicator Value Short Long Mnemonic N Active Not Voided NOT-VOIDED Y Voided Voided VOIDED ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Field: T-PLCY-RESRC-CD T-TPL Number:2587 TPL Policy Resource Code This field describes the type of resource records that a policyholder may have. 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