NM Human Services

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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

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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

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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

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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

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Field: R-DRAMS-EXTRT-IND R-Reference Number:0859

DRAMS Extract Indicator

Indicates whether the client will have claims extracted to be sent to DRAMS.

Value Short Long Mnemonic

N NO NO NO

Y YES YES YES

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Field: R-DRAMS-TCNCNV-IND R-Reference Number:4696

DRAMS TCN Conversion Ind

Indicates whether the TCNs of claims converted to X2 will be converted back to the original TCN for DRAMS.

Value Short Long Mnemonic

N NO NO NO

Y YES YES YES

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Field: R-DRG-THR-CHAR3-CD R-Reference Number:1804

Ref Drug Thera Class Cd

Indicates the therapeutic classes to which drugs and other prescribed agents may belong.

Value Short Long Mnemonic

A1A Glycosides Digitalis Glycosides GLYCOSIDES

A1B Xanthines Xanthines XANTHINES

A1C Inotropic Inotropic Drugs INOTROPIC

A1D Broncho General Bronchodilator Agents BRONCHO

A2A Arrhythmic Antiarrhythmics ARRHYTHMIC

A4A Hypotensi3 Hypotensives, Vasodilators HYPOTENSI3

A4B Hypotensi2 Hypotensives, Sympatholytic HYPOTENSI2

A4C Hypotensiv Hypotensives, Ganglionic Block HYPOTENSIV

A4D Hypotensi4 Hypotensives,Ace Blocking Type HYPOTENSI4

A4E Hypotensi5 Hypotensives,Veratrum Alkaloid HYPOTENSI5

A4F Hypotensi6 Hypoten, Angio Recptr Antag HYPOTENSI6

A4Y Hypotensi1 Hypotensives, Miscellaneous HYPOTENSI1

A6U Cardiovas Cardiovascular Diag-Radiopaqu CARDIOVAS

A6V Cardiovas1 Cardiovascular Diag Non Radio CARDIOVAS1

A7A Arteriolar Vasoconstrictors, Arteriolar ARTERIOLAR

A7B Coronary Vasodilators, Coronary CORONARY

A7C Peripheral Vasodilators, Peripheral PERIPHERAL

A7D Peripheral Vasodilators, Peripheral (cont PERIPHERAL1

A7E Vasodil Vasodilators, Miscellaneous VASODIL

A7F Veinotoni Veinotonics/Vasculoprotectors VEINOTONI

A7G Inhibit10 C-GMP Phosphodiesterase typ5 INHIBITOR10

A80 Venoscler Venosclerosing Agents VENOSCLER

A9A Calcium Calcium Channel Blocking Agnts CALCIUM

B0A Inhalation General Inhalation Agents INHALATION

B0P Gases Inert Gases GASES

B1A Surfactant Lung Surfactants SURFACTANT

B3A Mucolytics Mucolytics MUCOLYTICS

B3J Expectrnts Expectorants EXPECTRNTS

B3K Cough/Cold Cough and Cold Preparations COUGH-COLD

B3M Respiratry Respiratory Trct Radiopaq Diag RESPIRATRY

B3N Decongesta Decongestant-analygesic-expect DECON-ANALG-EXPECT

B3O Ana-1st-gn 1st Gen Antihistimine-deconges ANTIHST-DECON-ANA1

B3P Non-Narc-A Non-Narc Antituss-1stGen Antih NON-NARC-ANTITUSS1

B3Q NarcoticA Narcotic Antituss-1stGen Antih NARC-ANTITUSS1

B3R Non-Narc-A Non-Narcotic Antituss-1stGen A NON-NARC-ANTITUSS2

B3S Non-Narc-A Non-Narcotic Antituss-1stGen A NON-NARC-ANTITUSS3

B3T Non-Narcot Non-Narcotic Antitussive and E NON-NARC-ANTITUSS4

B3V 1st-Gen-An 1stGen Antihist-decongestant- ANTIHIST-DECONG-1S

B3X 1st-Gen-An 1stGen Antihist-decongestant- ANTHST-DECONG-ANTI

B3Y 1st-Gen-An 1stGen Antihist-decongestant- ANTHST-DECONG-EXP1

B3Z 1st-Gen-An 1stGen Antihist-expectorant ANTIHIST-EXPECTOR1

B4A Non-Narcot Non-Narcotic Antitussive-Analg NON-NARC-ANTITUS1

B4B Non-Narcot Non-Narcotic Antitussive-Analg NON-NARC-ANTITUS2

B4C NarcoticA Narcotic Antitussive-Anticholi NARC-ANTITUS-ANTIC

B4D NarcoticA Narcotic Antitussive-Antihist NARC-ANTITUS-ANTIH

B4E Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS3

B4G Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS4

B4H NarcoticA Narcotic Antitussive-Antihist NARCOTIC-ANTITUS5

B4I Non-NarcA Non-Narcotic Antitussive-Antih NON-NARC-ANTITUS6

B4J NarcoticA Narcotic Antitussive-Antihist NARC-ANTITUSS2

B4K NarcoticA Narcotic Antitussise-Decongest NARC-ANTITUSS3

B4L Non-Narcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS7

B4M Non-Narcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS8

B4N NarcAntit Narcotic Antituss-Antihist NARC-ANTITUSS4

B4P Non-NarcA Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS9

B4Q NarcoticA Narcarcotic-Antituss-Decongest NARC-ANTITUSS5

B4R NonNarcot Non-Narcoric Antitussve-Decon NON-NARC-ANTITUS10

B4S Narcotic A Narc Antituss-Expectorant Comb NARC-ANTITUSS6

B4T Narcotic- Decongest Analgesic non-salica DECONGEST-ANALGESI

B4U Decongesta Decongestant-anticholoiingert1 DECONGEST-ANTICHOL

B4W Decongesta Decongestant-Expectorabt combo DECONGESTS-EXPECTO

B4X Expectoran Expectorant combinations other EXPECTORANT-COMBIN

B50 NON-NARCOT NON-NARC ANTITUSS-ANALGESIC NON-NARCOTIC-ANTIT

B5D Decongest- Deconestant Analgesic DECONGEST-ANALGES2

B5E Decongest Decongest AnalgesicMixedZanth DECONGEST-ANALGES3

B5F DecongestA Decongest AnalgesicMixedZanth DECONGEST-ANALGES4

B5G DecongestA Decongestant, cookie spo;se DECONGEST-NSAID-CO

B5H 1st-gen-an 1st Gen antihist, decon, nosay ANTIHIST-DECON-NSA

B5I Decongest- Decongestant Analygesic nonsal DECONGEST-ANALGES5

B5J Decon-anal Decon Analgesic non-salicylat DECON-ANALGESIC

B5K DECONGEST- DECON-ANALGESIC,SALICYLATE DECONGEST-ANALGES6

B5L GEN1 ANTIH GEN1ANTIHIST-DECON-ANALGESIC GEN1-ANTIHIST-DECO

B5M 1ST GEN AN GEN1 ANTIHIST-DECONGEST-ANA GEN1-ANTIHIST-ANAL

B5N 1ST GEN AN GEN1 ANTIHIST-DECON-ANALGES GEN1-ANTIHIST-DEC2

B5P DecongestA DECON-ANALGESIC,SALICYL-EXPECT DECON-ANALGESIC2

B5S 1ST GENERA GEN1 ANTIHISTAMINE-ANALGESIC GEN1-ANTIHIST2

B5T 1ST GENERA GEN1 ANTIHISTAMINE-Abalgesic GEN1-ANTIHIST3

BY4 Expectoran Expectorant mixtures EXPECTORANT-MIXTUR

C0B Water Water WATER

C0C Acidosis Drugs Used to Treat Acidosis ACIDOSIS

C0D Alcoholic Antialcoholic Preparations ALCOHOLIC

C0K Bicarbonat Bicabonate Producing/Contain BICARBONATE

C1A Depleters Electrolyte Depleters DEPLETERS

C1B Sodium Sodium/Saline Preparations SODIUM

C1D Potassium Potassium Replacement POTASSIUM

C1F Calcium1 Calcium Replacement CALCIUM1

C1H Magnesium Magnesium Replacement MAGNESIUM

C1P Phosphate Phosphate Replacement PHOSPHATE

C1W Electrolyt Electrolyte Maintenance ELECTROLYT

C1Z Electroly1 Electrolyte Maintenance (cont) ELECTROLY1

C2H Gases1 Respiratory Gases GASES1

C3B Iron Iron Replacement IRON

C3C Zinc Zinc Replacement ZINC

C3H Iodine Iodine Containing Agents IODINE

C3M Mineral Mineral Replacement, Misc. MINERAL

C4G Insulins Insulins INSULINS

C4K Hypoglyce1 Hypoglycem Insul Release Stim HYPOGLYCE1

C4L Hypoglycem Hypoglycem,Biguanid Non-Sulfon HYPOGLYCEM

C4M Hypoglyce2 Hypo, Alpha-Glucosidase(N-S) HYPOGLYCE2

C4N Hypoglyce3 Hypo,Insulin-Respnse Inhans(NS HYPOGLYCE3

C4O Hypoglyce4 Hypo, Absorption Modifie( Unsp HYPOGLYCE4

C4P Hypoglyce5 Hypoglycemics, Unspec. Mech HYPOGLYCE5

C4Q Hypoglyce6 Hypoglycemics, Combination HYPOGLYCE6

C5A Carbo Carbohydrates CARBO

C5B Protein Protein Replacement PROTEIN

C5C Formulas Infant Formulas FORMULAS

C5D Diet Foods Diet Foods DIET-FOODS

C5E Geriatric Geriatric Supplements GERIATRIC

C5F Food Supp Food Supplements, Misc. FOOD-SUPP

C5G Food Oils Food Oils FOOD-OILS

C5H Nucleic Nucleic Acid/Nucleotide Supp NUCLEIC

C5J IV Sol3 IV Solutions: Dextrose/Water IV-SOL3

C5K IV Sol1 IV Solutions: Dextrose Saline IV-SOL1

C5L IV Sol2 IV Solutions: Dextrose/Ringers IV-SOL2

C5M IV Sol IV Sol: Dextrose/Lactact Ring IV-SOL

C5N Protein1 Protein Replacement (Cont 1) PROTEIN1

C5O Solutions Solutions, Miscellaneous SOLUTIONS

C5P Protein2 Protein Replacement (Cont 2) PROTEIN2

C5Q Tonic Tonic TONIC

C5R IV-Sol4 IV Sol:Dextrose-Water (Cont1) IV-SOL4

C5S Protein3 Protein Replacement (Cont 3) PROTEIN3

C5T Food-Supp Food Supplements, Misc (Cont1) FOOD-SUPP1

C6A Vitamin A Vitamin A Preparations VITAMIN-A

C6B Vitamin B Vitamin B Preparations VITAMIN-B

C6C Vitamin C Vitamin C Preparations VITAMIN-C

C6D Vitamin D Vitamin D Preparations VITAMIN-D

C6E Vitamin E Vitamin E Preparations VITAMIN-E

C6F Prenatal Prenatal Vitamin Preparations PRENATAL

C6G Geriatric1 Geriatric Vitamin Preparations GERIATRIC1

C6H Pediatric Pediatric Vitamin Preparations PEDIATRIC

C6J Bioflavon Bioflavonoids BIOFLAVON

C6K Vitamin K Vitamin K Preparations VITAMIN-K

C6L Vit B12 Vitamin B12 Preparations VIT-B12

C6M Folic Acid Folic Acid Preparations FOLIC-ACID

C6N Niacin Niacin Preparations NIACIN

C6P Panthenol Panthenol Preparations PANTHENOL

C6Q Vitamin B6 Vitamin B6 Preparations VITAMIN-B6

C6R Vitamin B2 Vitamin B3 Preparations VITAMIN-B2

C6T Vitamin B1 Vitamin B1 Preparations VITAMIN-B1

C6Z Multi-Vit Multi-Vitamin Preparations MULTI-VIT

C7A Inhibator Purine Inhibitors INHIBATOR

C7B Inhibitor4 Decarboxylase Inhibitors INHIBITOR4

C7C Inhibitor5 Dipeptidase Inhibitors INHIBITOR5

C7D Metabolic1 Metabolic Deficiency Agents METABOLIC1

C7E Appetite Appetite Stimulants APPETITE

C8A Poison2 Metallic Poison Agents POISON2

C8B Poison Acid & Alkali Poison Antidotes POISON

C8D Poision1 Agricultural Poison Antidotes POISION1

C8E Antidotes Antidotes, Miscellaneous ANTIDOTES

D0U Intestinal Gastrointestinal Radiopaq Diag INTESTINAL

D1A Periodont Periodontal Collagenase Inhibi PERIDONTAL

D1D Dental Dental Aids and Preparations DENTAL

D2A Fluoride Fluoride Preparations FLUORIDE

D2D Tooth Ache Tooth Ache Preparations TOOTH-ACHE

D2M Dent Misc Dental Preparations Misc DENT-MISC

D4A Acid Acid Replacement ACID

D4B Antacids Antacids ANTACIDS

D4C Stomatol Agents for Stomatological Use STOMATOLOGICAL

D4D Antidiarrh Antidiarrheal Microorganisms ANTIDIARRHEAL

D4E Antiulcer Antiulcer Preparations ANTIULCER

D4F Antiulcer1 Anti-Ulcer-H. Pylori Agents ANTIULCER1

D4G Gas Enzyme Gastric Ensymes GAS-ENZYME

D4H Mucositis Oral Mucositis/Stomatitis Agen MUCOSITIS

D4I Mucositis2 Oral Mucositis/Stom Anti-Infla MUCOSITIS2

D4K Gastric Gastric Acid Secretion Reducer GASTRIC

D4L Saliva Saliva Substitute Agents SALIVA

D4N Flatulents Antiflatulents FLATULENTS

D4T Gas Funct1 Gastric Function Diagnostics GAS-FUNCT1

D4U Gas Funct Gastric Funct Radiopaque Diag GAS-FUNCT

D5A Fat-Absorp Fat Absorption Decreasing Agnt FAT-ABSORPTION

D5P Intestina1 Intestinal Absorbnts/Protectnt INTESTINA1

D6A Colon Drgs to TX Chrnic Inflam Colon COLON

D6D Diarrhea Antidiarrheals DIARRHEA

D6H Hemorrhoid Hemorrhoidal Agents HEMORRHOID

D6S Lax/Cath1 Laxatives and Cathartics LAX-CATH1

D6T Lax/Cath Laxatives & Cathartics (cont) LAX-CATH

D7A Bile Salts Bile Salts BILE-SALTS

D7B Choleretic Choleretics CHOLERETIC

D7C Heptc-Diag Hepatic Diagnostics HEPATIC-DIAG

D7J Heptc-Dysf Hepatic Dysftn Preven/Therapy HEPATIC-DYSF

D7L Bile Salt Bile Salt Sequestrants BILE-SALT

D7T Biliary1 Biliary Diagnostics BILIARY1

D7U Biliary Biliary Diagnostic, Radiopaque BILIARY

D8A Enzymes1 Pancreatic Enzymes ENZYMES1

D8B Pancreatic Pancreatic Diagnostics PANCREATIC

D9A Inhibitor2 Ammonia Inhibitors INHIBITOR2

F1A Androgenic Androgenic Agents ANDROGENIC

F2A Impotency Drugs to treat Impotency IMPOTENCY

G0U Uterine Uterine Radiopaque Diag Agnts UTERINE

G1A Estrogenic Estrogenic Agents ESTROGENIC

G1B Estro/Andr Estrogen/Androgen Combinations ESTRO-ANDR

G2A Progest Progestational Agents PROGEST

G2B Progest1 Progestational Agents (Cont 1) PROGEST1

G3A Oxytocics Oxytocics OXYTOCICS

G8A Contracept Contraceptive, Oral CONTRACEPT

G8B Contracep1 Contraceptives, Implantable CONTRACEP1

G8C Contracep3 Conctraceptives, Injectable CONTRACEP3

G9A Contracep2 Contraceptives, Intravaginal CONTRACEP2

H0A Anestheti3 Local Anesthetics ANESTHETI3

H0B Anestheti4 Local Anesthetics (cont1) ANESTHETI4

H0C Anestheti5 Local Anesthetics (cont2) ANESTHETIC5

H0E Mltpl-Scle Agents/ Treat Mltpl Sclerosis MLTPL-SCLEROSIS

H1U Spinal Cerebral Spinal Radio Diag SPINAL

H2A Nerv Syst Central Nervous Syst Stimulant NERV-SYST

H2B Anestheti1 General Anesthetics, Inhalent ANESTHETI1

H2C Anesthetic General Anesthetic, Injectable ANESTHETIC

H2D Barbiturat Barbiturates BARBITURAT

H2E Barbitura1 Sedative-Hypno,Non Barbiturate BARBITURA1

H2F Anxiety Anti-Anxiety Drugs ANXIETY

H2G Psychotic1 Anti-Psychotics,Phenothiazines PSYCHOTIC1

H2H Inhibitor6 Monoamine Oxidase(MAO) Inhibit INHIBITOR6

H2I Psychotic2 Anti-Psychotic,Phenothiaz(cnt1 PSYCHOTIC2

H2J Depressan1 Antidepressants DEPRESSAN1

H2K Depressant Antidepressant Combinations DEPRESSANT

H2L Psychotics Anti-Psychotics,Non-Phenothiaz PSYCHOTICS

H2M Anti-Mania Anti-Mania Drugs ANTI-MANIA

H2N Depressan2 Antidepressants (cont) DEPRESSAN2

H2O Physotics2 Anti-Psych,Nn-Phenothiaz (con1 PSYCHOTICS2

H2P Anxiety1 Anti-Anxiety Drugs (cont) ANXIETY1

H2Q Babitura2 Sed-Hypno,Nn Barbiturate(con1 BARBITURA2

H2R Pruritics Anti-Pruritics PRURITICS

H2T Alcohol Alcohol, Systemic Use ALCOHOL

H2V Narco/Hype Anti-Narcolepsy/Anti-Hyperkin NARCO-HYPE

H2Z Antagonis2 Benzodaizepine Antagonists ANTAGONIS2

H3A Analgesic1 Analgesics, Narcotics ANALGESIC1

H3B Analgesic2 Analgesics, Narcotics (cont) ANALGESIC2

H3C Analgesic3 Analgesics, Non-Narcotics ANALGESIC3

H3D Analgesic4 Analgesics, Salycylates ANALGESIC4

H3E Analgesic Analgesic/Antipyretic, Non-Sal ANALGESIC

H3F Migraine Anit-Migraine Preparations MIGRAINE

H3G Analgesics Analgesics, Miscellaneous ANALGESICS

H3H Analgesic5 Analgesics Narc Anesth Adj ANALGESIC5

H3T Antagonis1 Narcotic Antagonists ANTAGONIS1

H3W Narcotic Narcotic Withdrawal Therpy NARCOTIC

H4B Convulsnts Anti-Convulsants CONVULSNTS

H4C Convulsan1 Anti-Convulsants (cont 1) CONVULSAN1

H4T Hallucingn Hallucinogens HALLUCINGN

H5A Neurotonic Neurontonics/Cerebro Acc Agnt NEUROTONICS

H5B Neuropathi Neuropathic Agents NEUROPATHIC

H6A Anti-Park Anti-Parkinsonism Drugs, Other ANTI-PARK

H6B Anti-Park1 Anti-Parkinsonism/Cholinergic ANTI-PARK1

H6C Antitussiv Antitussives, Non-Narcotic ANTITUSSIV

H6D Antitusiv1 Antitussiv, Nn-Narcotic (con1) ANTITUSIV1

H6E Emetics1 Emetics EMETICS1

H6H Relaxants Skeletal Muscle Relaxants RELAXANTS

H6I Amyotrophi Amyotrophic Lateral Scloerosis AMYOTROPHIC

H6J Emetics Anti-Emetics/AntiVertigo Agent EMETICS

H6L Movement Movement Disorders(Drug Therpy MOVEMENT

H6N Antitussiv Antitussives, Narcotic ANTITUSSIVE

J1A Parasympa Parasympathetic Agents PARASYMPA

J1B Inhibitor3 Cholinesterase Inhibitors INHIBITOR3

J2A Alkaloids Belladonna Alkaloids ALKALOIDS

J2B Cholinerg2 Anti-Cholinergics, Quaternary CHOLINERG2

J2C Cholinerg1 Anti-Cholinergics, Other CHOLINERG1

J2D Cholinergi Anti-Cholinergics/Antispasmodi CHOLINERGI

J2E Clolinerg3 Anti-Cholingics/Antispas (con1 CLOLINERG3

J3A Stimulants Smoking Deter(Ganglionic Stim STIMULANTS

J4A Block Agnt Ganglionic Blocking Agents BLOCK-AGNT

J5A Adrenergi1 Adrenergic Agnt,Catecholamines ADRENERGI1

J5B Adrenergi2 Adrenergic,Aromat,non-Catechol ADRENERGI2

J5C Adrenergic Adrenergic Agents,Non-Aromatic ADRENERGIC

J5D Adrenergi4 Beta-Adrenergic Agents ADRENERGI4

J5E Sympatho Sympathomimetic Agents SYMPATHO

J5F Anaphylaxi Anaphylaxis Therapy Agents ANAPHYLAXIS

J5G Adrenergi7 Beta-Adrenergics & Glucocortoi ADRENERGI7

J5H Adrenergi8 Adrenergic Vasopressor Agnts ADRENERGI8

J7A Adrenergi6 Alpha/Beta Adrenergic Block ADRENERGI6

J7B Adrenergi3 Alpha-Adrenergic Blocking Agnt ADRENERGI3

J7C Adrenergi5 Beta-Adrenergic Blocking Agnts ADRENERGI5

J7D Adrenergi9 Beta-Adrenergics Block (con1) ADRENERGI9

J8A Anorexic Anorexic Agents ANOREXIC

J9A Intestina2 Intestinal Motility Stimulants INTESTINA2

J9B Spasmodic Antispasmodic Agents SPASMODIC

L0B Enzymes3 Topcl/Muc Membr/Subcut Enzymes ENZYMES3

L0C Diabetic1 Diabetid Ulcer Prep, Topical DIABETIC1

L1A Psoriatic Antipsoriatic Agents, Systemic PSORIATIC

L1B Acne Acne Agents, Systemic ACNE

L1C Hypertrico Hypertricotic Agents, Systemic HYPERTRICHOTIC

L2A Emollients Emollients EMOLLIENTS

L3A Protective Protectives PROTECTIVE

L3B Protectiv1 Protectives (Continued 1) PROTECTIV1

L3C Protectiv2 Protectives (Continued 2) PROTECTIV2

L3E Protectiv4 Protectives (Continued 3) PROTECTIV4

L3P Pruritics1 Anti-Pruritics, Topical PRURITICS1

L4A Astringent Astringents ASTRINGENT

L5A Keratolyti Keratolytics KERATOLYTI

L5B Sunscreens Sunscreens SUNSCREENS

L5C Abrasives Abrasives ABRASIVES

L5D Depilator Depilatories DEPILATOR

L5E Seborrheic Antiseborrheic Agents SEBORRHEIC

L5F Psoriatics Antipsoriatics Agents PSORIATICS

L5H Acne1 Acne Agents, Topical ACNE1

L5I Wound Wound Healing Agents, Local WOUND

L6A Irritants Irritants/Counter-Irritants IRRITANTS

L6B Irritants1 Irritants/Counter-Irrit (cont) IRRITANTS1

L7A Shampoos Shampoos/Lotion SHAMPOOS

L8A Deodorants Deodorants DEODORANTS

L8B Antipersp Antiperspirants ANTIPERSP

L9A Topical Topical Agents, Miscellaneous TOPICAL

L9B Vitamin A1 Vitamin A Derivatives VITAMIN-A1

L9C Pigmentat Hypopigmentation Agents PIGMENTATION

L9D Pigmentat1 Topical Hyperpigmentation Agnt PIGMENTATION1

L9E Topical 1 Topical Agents, Misc (cont 1) TOPICAL1

L9F Cosmetic Cosmetic/Skin Coloring/Dye Top COSMETIC

M0A Blood7 Blood Components BLOOD7

M0B Plasma1 Plasma Proteins PLASMA1

M0C Blood1 Blood Factors, Miscellaneous BLOOD1

M0D Plasma Plasma Expanders PLASMA

M0E Hemophilic Anti-Hemophilic Factors HEMOPHILIC

M0F Factor IX Factor IX Preparations FACTOR-IX

M0G Antiporphy Antiporphyria Factors ANTIPORPHY

M0H Factor II Factor II Preparations FACTOR-II

M0J Factor VII Factor VII Preparations FACTOR-VII

M0K Factor X Factor X Preparations FACTOR-X

M0R Blood Blood Albumin Preparations BLOOD

M0S Blood6 Synthetic Blood Preparations BLOOD6

M0U Blood4 Blood Volume Diagnostics BLOOD4

M3A Blood5 Occult Blood Tests BLOOD5

M3B Blood3 Blood Urea Nitrogen Tests BLOOD3

M4A Blood2 Blood Sugar Diagnostics BLOOD2

M4B IV Fat IV Fat Emulsions IV-FAT

M4E Lipotropic Lipotropics LIPOTROPIC

M4F Leprotics1 Lipotropics, (cont) LEPROTICS1

M4G Hyprglycem Hyperglycemics HYPRGLYCEM

M4H Lipids Agents /affect Cellular Lipids LIPIDS

M93 Inhibtor11 Thrombin Inhibitor,Hirudin Typ INHIBITOR11

M9A Hemostatic Topical Hemostatics HEMOSTATIC

M9D Fibrinolyt Anti-Fibrinolytic Agents FIBRINOLYT

M9F Enzymes2 Thrombolytic Enzymes ENZYMES2

M9J Citrates Citrates as Anticoagulants CITRATES

M9K Heparin Heparin & Related Preparations HEPARIN

M9L Coagulant1 Oral Anticoagulants,Coumarin COAGULANT1

M9M Coagulant2 Oral Anticoagulants,Inandione COAGULANT2

M9P Inhibitor9 Platelet Aggregation Inhibitor INHIBITOR9

M9R Coagulants Coagulants COAGULANTS

M9S Hemorrheol Hemorrheologic Agents HEMORRHEOL

N1A Depressan3 Erythroid Depressants DEPRESSAN3

N1B Hematinics Hematinics, Other HEMATINICS

N1C Stimulant1 Leukocyte (WBC) Stimulants STIMULANT1

N1D Platelet Platelet Reducing Agents PLATELET

N1E Platelet1 Platelet Proliferation Stimula PLATELET1

P0A Fertility Fertility Stim Prep, Non FSH FERTILITY

P0B Hormones2 Follicle Stim/Luteiniz Hormone HORMONES2

P0C Pregnancy Pregnancy Facilitng/Maint Horm PREGNANCY

P1A Hormones3 Growth Hormones HORMONES3

P1B Somatostat Somatostatic Agents SOMATOSTAT

P1C Luteiniz Luteinizing Hormones LUTEINIZ

P1E Hormones Adrenocorticotrophic Hormones HORMONES

P1F Pituitary Pituitary Suppressive Agents PITUITARY

P1G Inhibitor Adrenal Steroid Inhibitors INHIBITOR

P1U Metabolic Metabolic Function Diagnostics METABOLIC

P2B Hormones1 Antidiuretic/Vasopressor Hormo HORMONES1

P2Z Pituitary1 Posterior Pituitary Prep PITUITARY1

P3A Hormones5 Thyroid Hormones HORMONES5

P3B Thyroid1 Thyroid Function Diagnostic Ag THYROID1

P3L Thyroid Anti-Thyroid Preparations THYROID

P4A Hormones4 Parathyroid Hormones HORMONES4

P4L Bone Resor Bone Resorpr Suppress Agnt BONE-RESORPT

P5A Glucocorti Glucocorticoids GLUCOCORTI

P5B Glucocort1 Glucocorticoids(cont1) GLUCOCORT1

P5C Glucocort2 Glucocorticoids(cont 2) GLUCOCORT2

P5S Mineraloco Mineralocorticoids MINERALOCO

P5T Antagonist Aldosterone Antagonists(Obsol) ANTAGONIST

P6A Hormone Pineal Hormone Agents HORMONE

Q0A Topical 13 Topical Prep,Non-Medicinal TOPICAL-13

Q1A Topical 10 Topical Ear Preparations TOPICAL-10

Q2U Eye Diag Eye Diagnostic Agents EYE-DIAG

Q3A Rectal Rectal Preparations RECTAL

Q3B Rectal1 Rectal/Lower Bowel Glucocort RECTAL1

Q3D Hemorrhoi1 Hemorrhoidal Preparations HEMORRHOI1

Q3H Anestheti2 Hemorrhoid,Local/Rectal Anesth ANESTHETI2

Q3S Laxatives Laxatives, Local/Rectal LAXATIVES

Q4A Vaginal5 Vaginal Preparations VAGINAL5

Q4B Vaginal3 Vaginal Antiseptics VAGINAL3

Q4F Vaginal1 Vaginal Antifungals VAGINAL1

Q4G Vaginal7 Vaginal Antifungals-Antibact VAGINAL7

Q4K Vaginal4 Vaginal Estrogen Preparatioans VAGINAL4

Q4L Vanginal8 Vaginal Lubricants Preparation VAGINAL8

Q4R Vaginal2 Vaginal Antiparasiticts VAGINAL2

Q4S Vaginal6 Vaginal Sulfonamides VAGINAL6

Q4W Vaginal Vaginal Antibiotics VAGINAL

Q5A Topical 14 Topical Preparations, Misc. TOPICAL-14

Q5B Topical 12 Topical Prep, Antibacterials TOPICAL-12

Q5C Topical 16 Topicals, Hypertrichotic Agent TOPICAL-16

Q5D Topical 08 Topical Antipsoriatics(obsol) TOPICAL-08

Q5E Topical 17 Topical Anti-Inflam Nn Steroid TOPICAL-17

Q5F Topical 03 Topical Antifungals TOPICAL-03

Q5G Topical 18 Topical Antifungals- Antibact TOPICAL-18

Q5H Topical 11 Topical Local Anesthetics TOPICAL-11

Q5I Topical 19 Topical Veinotonic/Vasculoprot TOPICAL-19

Q5J Topical 20 Top Hormonal, Otherwise Unspec TOPICAL-20

Q5L Bath Therapeutic Bath/Mineral Salts BATH

Q5N Topical 05 Topical Antineoplastics TOPICAL-05

Q5O Topical-21 Top Antiedema/Anti Inflam Agnt TOPICAL-21

Q5P Topical 04 Top Antiinflammatory Steroidal TOPICAL-04

Q5Q Topical-22 Top Antibio-Antibac-Antifung- TOPICAL-22

Q5R Topical 06 Topical Antiparasitics TOPICAL-06

Q5S Topical 15 Topical Sulfonamides TOPICAL-15

Q5U Topical-23 Topical Cellulite Agents TOPICAL-23

Q5V Topical 09 Topical Antivirals TOPICAL-09

Q5W Topical 01 Topical Antibiotics TOPICAL-01

Q5X Topical-24 Top Antibio/Antiinflam Steroid TOPICAL-24

Q5Y Topical-25 Topical Androgenic Agents TOPICAL-25

Q6A Eye Prep Eye Preparations, Misc. EYE-PREP

Q6B Eye Eye Anti-Infectives (RX Only) EYE

Q6C Eye9 Eye Vasoconstrictors (RX Only) EYE9

Q6D Eye8 Eye Vasoconstrictor (OTC Only) EYE8

Q6E Eye5 Eye Irrigations EYE5

Q6F Cont Lens Contact Lens Preparations CONT-LENS

Q6G Miotics Miotics/Othr Intraoc. Pres Red MIOTICS

Q6H Eye6 Eye Local Anesthetics EYE6

Q6I Eye10 Eye Anitbiotic/Cortoid Combo EYE10

Q6J Mydriatics Mydriatics MYDRIATICS

Q6K Ophthalmic Ophthalmic-Otic Combinations OPHTHALMIC

Q6L Eye11 Eye Antioxidant, Local Agents EYE11

Q6M Ophthalmi1 Ophthalmic-Otic Anti-Infective OPHTHALMIC1

Q6N Ophthalmi2 Ophthalmic-Otic Antibiot-Corti OPHTHALMIC2

Q6O Ophthalmi3 Ophthalmic-Otic Anti-Inflammat OPHTHALMIC3

Q6P Eye3 Eye Antiinflammatory Agents EYE3

Q6Q Ophthalmi4 Ophthalmic-Otic Anitfungal Agn OPHTHALMIC4

Q6R Eye12 Eye Antihistamines EYE12

Q6S Eye7 Eye Sulfonamides EYE7

Q6T Tears Artificial Tears TEARS

Q6V Eye4 Eye Antivirals EYE4

Q6W Eye2 Eye Antibiotics EYE2

Q6Y Eye Prep1 Eye Preparations, Misc. (OTC) EYE-PREP1

Q6Z Eye1 Eye Anti-Infectives,(OTC Only) EYE1

Q7A Nose Prep5 Nose Preparations, Misc. (RX) NOSE-PREP5

Q7B Nose Prep1 Nose Prep, Misc. Anti-Infectiv NOSE-PREP1

Q7C Nose Prep3 Nose Prep,Vasoconstrictor (RX) NOSE-PREP3

Q7D Nose Prep4 Nose Prep,Vasoconstrictor(OTC) NOSE-PREP4

Q7E Nasal Nasal Antihistamine NASAL

Q7F Nasal1 Nasal Prep Anti-Inflamm-Antibi NASAL1

Q7G Nasal2 Nasal Prep Irritnts/Cntr-Irrit NASAL2

Q7H Nasal3 Nasal Mast Cell Stabilizers NASAN3

Q7P Nose Prep2 Nose Prep,Antiinflammatory NOSE-PREP2

Q7W Nose Prep Nose Prep, Antibiotics NOSE-PREP

Q7Y Nose Prep6 Nose Preparations, Misc(OTC) NOSE-PREP6

Q8A Ear Prep4 Ear Preparation,Misc.(RX Only) EAR-PREP4

Q8B Ear Prep3 Ear Prep, Misc. Anti-Infective EAR-PREP3

Q8F Otic Prep Otic Prep, Anti-Inflam Antibio OTIC-PREP

Q8H Ear Prep5 Ear Preparations, Local Anesth EAR-PREP5

Q8P Ear Prep1 Ear Prep, Antiinflammatory EAR-PREP1

Q8R Ear Prep2 Ear Prep, Ear Wax Removers EAR-PREP2

Q8W Ear Prep Ear Prep, Antibiotics EAR-PREP

Q8Y Ear Prep6 Ear Preparations, Misc. (OTC) EAR-PREP6

Q9A Urological Urological Irrigations UROLOGICAL

Q9B Prostate Benign Prostatic Hypetrophy PROSTATE

R1A Urinary1 Urinary Tract Antispasmodic URINARY1

R1B Diuretics4 Osmotic Diuretics DIURETICS4

R1C Diuretics2 Inorganic Salt Diuretics DIURETICS2

R1D Diuretics3 Mercurial Diuretics DIURETICS3

R1E Inhibitor7 Carbonic Anhydrase Inhibitors INHIBITOR7

R1F Diuretics6 Thiazide & Related Diurectics DIURETICS6

R1G Diuretics7 Thiazide & Rltd Diuretics(cont DIURETICS7

R1H Diuretics5 Potassium Sparing Dirutetics DIURETICS5

R1J Diuretics Aminouracil Diuretics DIURETICS

R1K Diuretics1 Diuretics, Miscellaneous DIURETICS1

R1L Diuretics9 Potassium Sparing Diur in Comb DIURETICS9

R1M Diuretic10 Loop Diuretics DIURETICS10

R1R Uricosuric Uricosuric Agents URICOSURIC

R1S Urinary PH Urinary PH Modifiers URINARY-PH

R1T Renal Comp Renal Competers RENAL-COMP

R1U Renal Renal Function Diag Agnts RENAL

R2U Urinary Urinary Tract Radiopaque Diag URINARY

R3U Urine Tes1 Urine Glucose Test Aids URINE-TES1

R3V Urine Tes3 Urine Test Aids, Misc. URINE-TES3

R3W Urine Test Urine Acetone Test Aids URINE-TEST

R3Y Urine Tes2 Urine Multiple Test Aids URINE-TES2

R3Z Urine Tes4 Urine Glucse/Acetone Tst Strip URINE-TES4

R4A Kidney Kidney Stone Agents KIDNEY

R5A Urinary2 Urinary Tract Anest/Analg (Azo URINARY2

R5B Urinary3 Urinary Tract Analgesic Agents URINARY3

S1A Joint Tiss Joint Tissue Replacement JOINT-TISSU

S2A Colchicine Colchicine COLCHICINE

S2B Nsaids NSAids, Cyclooxygenase Inhib NSAIDS

S2C Gold Salts Gold Salts GOLD-SALTS

S2D Nsaids1 NSAids, Cyclooxygenase (cont1) NSAIDS1

S2E Nsaids2 Nsaids,Cyclooxygenase(cont2) NSAIDS2

S2G Bone Disor Drugs Acting on Bone Disorders BONE-DISORDER

S2H AntiInflam Anti-Inflam, Antiarthriti Misc ANTI-INFLAMM

S2I AntiInfla1 Anti-Inflam,Pyrimidine Synt In ANTI-INFLAMM1

S2J AntiInfla2 Anti-Inflam Tumor Necrosis Fct ANTI-INFLAMM2

S2L Nsaids3 Nsaids, Cyclooygenase 2 Inhib NSAIDS3

S7A Neuromusc Neuromuscular Blocking Agents NEUROMUSC

S7B Muscle Skeletal Muscle, Others MUSCLE

U5A Homeopath1 Homeopathic Drugs HOMEOPATH1

U5B Herb Drgs Herbal Drugs HERB-DRGS

U5C Herb Drgs Herbal Drugs (cont 1) HERB-DRGS1

U5D Herb Drgs Herbal Drugs (cont 2) HERB-DRGS2

U5E Herb Drgs Herbal Drugs (cont 3) HERB-DRGS3

U5F Animl-Hmn Animal/Human Derived Agents ANIMAL-HUMAN

U5G Herb Drgs Herbal Drugs (cont 4) HERB-DRGS4

U5H Herb Drgs Herbal Drugs (cont 5) HERB-DRGS5

U5I Herb Drgs Herbal Drugs (cont 6) HERB-DRGS6

U5J Herb Drgs Herbal Drugs (cont 7) HERB-DRGS7

U5X Anthroposo Anthroposophic Drugs ANTHROPOSOPHIC

U6A Adjuvants1 Pharmaceutical Adjuvants, Tab ADJUVANTS1

U6B Adjuvants Pharm Adjuvants, Coating Agnts ADJUVANTS

U6E Ointment1 Ointment/Cream Bases OINTMENT1

U6F Ointment Hydrophilic Cream/Ointment Bas OINTMENT

U6H Solvents1 Solvents SOLVENTS1

U6J Solvents2 Solvents (Continued 1) SOLVENTS2

U6K Solvents3 Solvents (Continued 2) SOLVENTS3

U6L Solvents Solevents (Continued 3) SOLVENTS

U6N Vehicles Vehicles VEHICLES

U6P Vehicles1 Vehicles (Continued) VEHICLES1

U6S Propellant Propellants PROPELLANT

U6T Propellan1 Propellants (Continued) PROPELLAN1

U6W Chemicals Bulk Chemicals CHEMICALS

U7A Susp Agnts Suspending Agents SUSP-AGNTS

U7B Susp Agnt1 Suspending Agents (Cont 1) SUSP-AGNT1

U7C Susp Agnt2 Suspending Agents (Cont 2) SUSP-AGNT2

U7D Surfactan1 Surfactants SURFACTAN1

U7E Surfactan2 Surfactants (Continued) SURFACTAN2

U7H Antioxidan Anticorrosive Agents ANTIOXIDAN

U7J Chelating Chelating Agents CHELATING

U7K Flav Agnts Flavoring Agents FLAV-AGNTS

U7L Flav Agnt1 Flavoring Agents (Cont 1) FLAV-AGNT1

U7M Flav Agnt2 Flavoring Agents (Cont 2) FLAV-AGNT2

U7N Sweeteners Sweeteners SWEETENERS

U7P Perfumes Perfumes PERFUMES

U7Q Color Agnt Coloring Agents COLOR-AGNT

U7R Color Agn1 Coloring Agents (Continued) COLOR-AGN1

U7Z Bondng Agn Bonding/Catalyst Agents BONDING-AGNTS

V1A Alkylating Alkylating Agents ALKYLATING

V1B Metabolite Anti-Metabolites METABOLITE

V1C Alkaloids1 Vinca Alkaloids ALKALOIDS1

V1D Neoplasti1 Antibiotic Anti-Neoplastics NEOPLASTI1

V1E Neoplasti2 Steroid Anti-Neoplastics NEOPLASTI2

V1F Neoplastic Anti-Neoplastics, Misc. NEOPLASTIC

V1G Therapeutc Redioactive Theraputic Agnts THERAPEUTIC

V1H Neoplasti3 Antineoplastic, Misc. (cont 1) NEOPLASTI3

V1I Chemother1 Chemotherapy Antidotes CHEMOTHERA1

V1J Androgeni1 Antiandrogenic Agents ANDROGENIC1

V1K Neoplasti4 Antineoplastic Antibody/Antibd NEOPLASTI4

V2A Neoplasm Neoplasm Monoclonal Diag Agnt NEOPLASM

W1A Penicillin Penicillins PENICILLIN

W1B Cephalospo Cephalosporins CEPHALOSPO

W1C Tetracycli Tetracyclines TETRACYCLI

W1D Macrolides Macrolides MACROLIDES

W1E Chloramph Chloramphenicol & Derivatives CHLORAMPH

W1F Aminoglyco Aminoglycosides AMINOGLYCO

W1G Antibioti1 Antitubercular Antibiotics ANTIBIOTI1

W1H Aminocycli Aminocyclitols AMINOCYCLI

W1I Penicilli1 Penicillins (Continued) PENICILLI1

W1J Vancomycin Vancomycin and Derivatives VANCOMYCIN

W1K Lincosamid Lincosamides LINCOSAMID

W1L Topical 02 Antibiotics TOPICAL-02

W1N Polymyxin Polymyxin & Derivatives POLYMYXIN

W1P Betalactam Betalactams BETALACTAM

W1Q Quinolones Quinolones QUINOLONES

W1R Inhibitors Beta-Lactamase Inhibitors INHIBITORS

W1S Thienamyci Thienamycins THIENAMYCI

W1T Cephalosp1 Cephalosporins (Continued) CEPHALOSP1

W1V Antibioti2 Steroidal Antibiotics ANTIBIOTI2

W2A Sulfonamid Absorbable Sulfonamides SULFONAMID

W2B Sulfonami1 Non-Absorbable Sulfonamides SULFONAMI1

W2C Sulfonami2 Absorbable Sulfonamides (con 1 SULFONAMI2

W2E Mycobatrm Anti-Mycobaterium Agents MYCOBATRM

W2F Nitrofuran Nitrofuran Derivatives NITROFURAN

W2G Chemothera Chemotherapeutic,Antibact,Misc CHEMOTHERA

W2Y Infective1 Anti-Infectives,Misc(Antibact) INFECTIVE1

W3A Antibiotic Antifungal Antibiotics ANTIBIOTIC

W3B Antifungal Antifungal Agents ANTIFUNGAL

W3C Antifunga1 Antifungal Agents (Continued) ANTIFUNGA1

W3D Antifunga2 Antifungal Agents (cont 2) ANTIFUNGA2

W4A Malarial Anti-Malarial Drugs MALARIAL

W4C Amebacides Amebacides AMEBACIDES

W4E Trichomon Trichomonacides TRICHOMON

W4F Infectives Anti-Infect,Misc(Antiparasit) INFECTIVES

W4K Protozoal Anti-Protozoal Drugs, Misc PROTOZOAL

W4L Anthelmin Anthelmintics ANTHELMIN

W4M Topical 07 Topical Antiparasitics (Cont) TOPICAL-07

W4N Repellants Insect Repellants REPELLANTS

W4O Antihelmi1 Anthelmintics (cont 1) ANTHELMIN1

W4P Leprotics Anti-Leprotics LEPROTICS

W4Q Inscticide Insecticides INSCTICIDE

W5A Antivirals Antivirals, General ANTIVIRALS

W5B Antiviral1 Antivirals, HIV-Specific ANTIVIRAL1

W5C Antiviral2 Antivirals, HIV-Spec Protease ANTIVIRAL2

W5D Antiviral3 Antiviral Monoclonal Antibodie ANTIVIRAL3

W5E HepatitisA Hepatitis A Treatment Agents HEPATITISA

W5F HepatitisB Hepatitis B Treatment Agents HEPATITISB

W5G HepatitisC Hepatitis C Treatment Agents HEPATITISC

W70 Vaccine10 Gram Postve Rod/Bacillus Vacci VACCINES10

W7B Vaccines9 Viral/Tumorigenic Vaccines VACCINES9

W7C Vaccines4 Influenza Virus Vaccines VACCINES4

W7F Vaccines5 Mumps/Related Virus Vaccines VACCINES5

W7H Vaccines Enteric Virus Vaccines VACCINES

W7I Immunosti Immunostimulants, Bacterial IMMUNOSTIMULANTS

W7J Vaccines6 Neurotoxic Virus Vaccines VACCINES6

W7K Antisera Antisera ANTISERA

W7L Vaccines2 Gram Positive Cocci Vaccines VACCINES2

W7M Vaccines3 Gram(-)Bacilli(Non-Enteric)Vac VACCINES3

W7N Vaccines8 Toxin-Prod Bacilli Vac/Toxoids VACCINES8

W7P Vaccines7 Rickettsial Vaccines VACCINES7

W7Q Vaccines1 Gram Negative Cocci Vaccines VACCINES1

W7R Vaccine11 Spirochete Vaccines VACCINES11

W7S Antivenins Antivenins ANTIVENINS

W7T Skin Test Antigenic Skin Tests SKIN-TEST

W7U Extracts1 Hymenoptera Extracts EXTRACTS1

W7V Extracts2 Rhus Extracts(Psn Oak,Psn Ivy) EXTRACTS2

W7W Extracts Allerginc Extracts,Therapeutic EXTRACTS

W7X Bacteria Bacteria, Aerobic/Anaerobic Ag BACTERIA

W7Y Fungi Fungi/Yeast Preparations FUNGI

W7Z Vaccine Vaccine/Toxoid Prep,Combinatns VACCINE

W8A Antisepti2 Heavy Metal Antiseptics ANTISEPTI2

W8B Actv Agnts Surface Active Agents ACTV-AGNTS

W8C Antisepti3 Iodine Antiseptics ANTISEPTI3

W8D Oxidizing Oxidizing Agents OXIDIZING

W8E Antiseptic Antiseptics, General ANTISEPTIC

W8F Irrigants Irrigants IRRIGANTS

W8G Antisepti1 Antiseptics, Miscellaneous ANTISEPTI1

W8H Mouthwash Mouthwashes MOUTHWASH

W8I Antisepti4 Anticeptics, Misc (cont 1) ANTISEPTI4

W8J Antibctrl Antibacterial Agents, Misc. ANTIBCTRL

W8K Antisepti5 Anticeptics, Misc (cont 2) ANTISEPTI5

W8T Preserv Preservatives PRESERV

X0A Blood Test Blood Testing Prep, In-Vitro BLOOD-TEST

X1A Condoms Condoms CONDOMS

X1B Diaphragms Diaphragms/Cervical Cap DIAPHRAGMS

X1C IUD IUD's IUD

X1D Preg-test1 Pregnancy/Ovulation Tests (Obs PREG-TESTS1

X1F Preg-test2 Pregnancy Tests PREG-TESTS2

X1G Ovulation Ovulation Tests OVULATION

X2A Needles Needles/Needleless Devices NEEDLES

X2B Syringes Syringes & Accessories SYRINGES

X3A Ostomy Ostomy Supplies OSTOMY

X4B Incontinen Incontinence Supplies INCONTINEN

X5A Med Supp Medical Supplies, Misc. MED-SUPP

X5B Bandages Bandages,Gauze,Tape/Rel Supp BANDAGES

X5C Med Supp1 Medical Supplies, Misc(Cont 1) MED-SUPP1

X5D Gloves Gloves GLOVES

X5E Bandages1 Bandages & Reltd Supp (cont 1) BANDAGES1

X5F Aseptic Aseptic Tests & Accessories ASEPTIC

X5G Gowns Gowns/Smocks GOWNS

X6A Med Supp4 Medical Supplies,Misc(Cont 2) MED-SUPP4

X6D Dental1 Dental Supplies DENTAL1

X7A Contact Ln Contact Lens Prep.Gas,Hard Sft CONTACT-LNS

X8A Admin Set1 Parenteral Admin Sets ADMIN-SET1

X8B Admin Sets Blood Administration Sets ADMIN-SETS

X8C Admin Set2 Irrigation Administration Sets ADMIN-SET2

X8P Med Supp2 Medical Supplies, Misc(Cont 3) MED-SUPP2

X8V Med Supp3 Medical Supplies, Misc(Cont 4) MED-SUPP3

Y0A Med Equip2 Durable Medical Equip., Misc MED-EQUIP2

Y0B Crutches Crutches CRUTCHES

Y0D Bed Boards Bed Boards BED-BOARDS

Y0E Impotency1 Impotency Devices IMPOTENCY1

Y1A Feed Devic Feeding Devices FEED-DEVIC

Y1B Thermomtr Thermometers THERMOMTR

Y2G Clean Air Clean Air Centers CLEAN-AIR

Y3A Med Equip Durable Med Equip,Misc(Grp 1) MED-EQUIP

Y3C Med Equip1 Durable Med Equip,Misc(Grp 2) MED-EQUIP1

Y4A Cntraceptv Diaphragms CNTRACEPTV

Y4B Catheters Catheters and Related Devices CATHETERS

Y5A Braces Braces and Related Devices BRACES

Y5C Wtr Bottle Hot Water Bottle&Reltd Devices WTR-BOTTLE

Y7A Inhalers Respiratory Aids,Devices, Eqp INHALERS

Y7B Procedural Medical Procedural Aids PROCEDURAL

Y8A Hearng Aid Hearing Aids and Related Devic HEARNG-AID

Y8B Rub Syring Rubber Syringes RUB-SYRING

Y9A Diabetic Diabetic Supplies DIABETIC

Z1A Histamine Histamine Preparations HISTAMINE

Z1C Serotonin1 Serotonin and Derivatives SEROTONIN1

Z1D Enzymes Enzyme Replcmnt(Ubiquit Enzym) ENZYMES

Z1E Antioxidan Antioxidant Agents ANTIOXIDANT

Z1F Immune Immune System Cell Groups IMMUNE

Z2A AntiHistam Anti-Histamines HISTAMINES

Z2B AntiHista1 Anti-Histamines (Continued) HISTAMINE1

Z2C Serotonin Anti-Serotonin Drugs SEROTONIN

Z2D Inhibitor8 Histamine H2 Inhibitors INHIBITOR8

Z2E Immunosupp Immunosuppresives IMMUNOSUPP

Z2F Stabilizer Mast Cell Stabilizers STABILIZER

Z2G Immunomod Immunomodulators IMMUNOMOD

Z2H Inhibitor0 Systemic Enzyme Inhibitors INHIBITOR0

Z2I AntiHista2 AntiHistamines (cont 2) HISTAMINE2

Z2O 2ST GEN AM 2ND GEN ANTIHISTAMINE & DECONG GEN2-ANTIHISTAMINE

Z2P ANTIHISTAM ANTIHISTAMINES - 1ST GENERATIO ANTIHISTAMINES-1GE

Z2Q ANTIHISTAM ANTIHISTAMINES - 2ST GENERATIO ANTIHISTAMINES-2G1

Z3G Misc Agnts Miscellaneous Agents MISC-AGNTS

Z4A Prostaglan Prostaglandins PROSTAGLANDINS

Z4B Antagonis3 Leukotriene Receptor Antagonis ANTAGONIS3

Z4C Inhibtor10 Thromboxane A2 Inhibitors INHIBITORS10

Z9A Drugs Unclassified Drugs DRUGS

Z9D Diag Prep Diagnostic Preparations, Misc. DIAG-PREP

ZZN 1ST GEN AM 1ST GEN ANTIHISTAMINE & DECONG GEN1-ANTIHIST

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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

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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

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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

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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

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Field: R-DRUG-MAC-CD R-Reference Number:2457

Drug Pricing Code

Codes describing pricing used for drug.

Value Short Long Mnemonic

A StHandleDr State Handled Drugs ST-HANDLED-DRUGS

C WacCstCnt WAC + 7% unit cost control WAC7CSTCNT

D WacCstD WAC + 7% unit cost WAC7CSTD

E WacCstE WAC + 7% unit cost WAC7CSTE

G GenPrcMan Generic Price Man GENERIC-PRICE

M FUL Federal Upper Limit FUL

S MaxAllow State Max Allow Cost MAX-ALLOW

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Field: R-DRUG-MAINT-IND R-Reference Number:1849

Maintenance drug indicator

Maintenance drug indicator.

Value Short Long Mnemonic

Not-Maint Non-Maintained-Drug NOT-MAINT-DRUG

1 Maint-Drug Maintained-Drug MAINT-DRUG

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Field: R-DRUG-MSMT-CD R-Reference Number:1032

Drug Unit of Measure

The unit by which a drug is dispensed and priced.

Value Short Long Mnemonic

EA Each Each EACH

GM Gram Gram GRAM

ML Milliliter Milliliter MILLILITER

OZ Ounce Ounce OUNCE

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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

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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

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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

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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

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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

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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

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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

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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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