NM Human Services
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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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 ................
................
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