Appendix D: Type of Bill
Several different references exist for Type of Bill. Generally, definitions line up but sometimes nuances exist depending on the data source. General data definitions exist below based on the reference links here:
https://www.findacode.com/articles/type-of-bill-table-34325.html
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1840A3.pdf
https://med.noridianmedicare.com/web/jea/topics/claim-submission/bill-types
https://resdac.org/sites/datadocumentation.resdac.org/files/Bill%20Type%20Code.txt
Page Contents
Understanding Bill Types
To determine Type of Bill, use the following:
1st Digit = Type of Facility
2nd Digit = Bill classification (3 different categories) facilities excluding clinics and special facilities clinics only. Special facilities only.
3rd Digit = Frequency
1ST DIGIT | TYPE OF FACILITY | 2ND DIGIT | CLASSIFICATION (IF 1ST DIGIT IS 1-6) | 3RD DIGIT | FREQUENCY (NOT SPECIFIC TO 1ST OR 2ND DIGITS) |
---|---|---|---|---|---|
1 | HOSPITAL | 1 | INPATIENT (INCLUDING MEDICARE PART A) | 0 | NON-PAYMENT/ZERO CLAIM |
2 | SKILLED NURSING | 2 | INPATIENT (MEDICARE PART B ONLY) | 1 | ADMIT THROUGH DISCHARGE CLAIM |
3 | HOME HEALTH | 3 | OUTPATIENT | 2 | INTERIM, FIRST CLAIM |
4 | RELIGIOUS NON-MEDICAL (HOSPITAL) | 4 | OTHER (MEDICARE PART B) | 3 | INTERIM, CONTINUING CLAIMS |
5 | CHRISTIAN SCIENCE (EXTENDED CARE) | 5 | LEVEL I INTERMEDIATE CARE | 4 | INTERIM, LAST CLAIM |
6 | INTERMEDIATE CARE | 6 | LEVEL II INTERMEDIATE CARE | 5 | LATE CHARGE(S) ONLY CLAIM |
7 | LEVEL III INTERMEDIATE CARE | 7 | REPLACEMENT OF PRIOR CLAIM OR CORRECTED CLAIM | ||
8 | SWING BED | 8 | VOID OR CANCEL OF A PRIOR CLAIM | ||
1ST DIGIT | TYPE OF FACILITY | 2ND DIGIT | CLASSIFICATION (IF 1ST DIGIT IS 7) | 9 | FINAL CLAIM FOR A HOME HEALTH PPS EPISODE |
7 | CLINIC OR RENAL DIALYSIS FACILITY (REQUIRES SPECIAL INFORMATION IN 2ND DIGIT) | 1 | RURAL HEALTH CLINIC | A | ADMISSION/ ELECTION NOTICE FOR HOSPICE |
2 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS FACILITY | B | HOSPICE TERMINATION REVOCATION NOTICE | ||
3 | FEDERALLY QUALIFIED HEALTH CENTER (FQHC), FREE STANDING PROVIDER-BASED | C | HOSPICE CHANGE OF PROVIDER NOTICE | ||
4 | OTHER REHABILITATION FACILITY (ORF) | D | HOSPICE ELECTION VOID / CANCEL | ||
5 | COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF) | F | HOSPICE CHANGE OF OWNERSHIP | ||
6 | COMMUNITY MENTAL HEALTH CENTER (CMHC) | G | CWF INITIATED ADJUSTMENT CLAIM | ||
7 | FREE-STANDING PROVIDER-BASED FEDERALLY QUALIFIED HEALTH CENTER (FQHC) | H | CMS INITIATED ADJUSTMENT CLAIM | ||
9 | OTHER | I | FI ADJUSTMENT CLAIM (OTHER THAN QIO OR PROVIDER) | ||
1ST DIGIT | TYPE OF FACILITY | 2ND DIGIT | CLASSIFICATION (IF 1ST DIGIT IS 8) | J | INITIATED ADJUSTMENT CLAIM / OTHER |
8 | SPECIALTY FACILITY (REQUIRES SPECIAL INFORMATION IN 2ND DIGIT) | 1 | HOSPICE (NON-HOSPITAL BASED) | K | OIG INITIATED ADJUSTMENT CLAIM |
2 | HOSPICE (HOSPITAL BASED) | M | MSP INITIATED ADJUSTMENT CLAIM | ||
3 | AMBULATORY SURGICAL CENTER | P | QIO ADJUSTMENT CLAIM | ||
4 | FREE STANDING BIRTHING CENTER | Q | REOPENING / ADJUSTMENT | ||
5 | CRITICAL ACCESS HOSPITAL | ||||
9 | OTHER | ||||
1ST DIGIT | TYPE OF FACILITY | 2ND DIGIT | CLASSIFICATION (IF 1ST DIGIT IS 9) | ||
9 | RESERVED FOR NATIONAL USE | 6 - 8 | RESERVED FOR NATIONAL USE |
Inpatient Hospital
Value | Description |
---|---|
110 | NO PAY CLAIM |
111 | REGULAR INPATIENT |
112 | FIRST PORTION: CONTINUOUS STAY INPATIENT CLAIM |
113 | SUBSEQUENT PORTION: CONTINUOUS STAY INPATIENT CLAIM |
114 | FINAL PORTION: CONTINUOUS STAY INPATIENT CLAIM |
115 | INPATIENT: LATE CHARGE(S) ONLY CLAIM |
116 | INPATIENT: ADJUSTMENT OR PRIOR CLAIM NEEDED |
117 | INPATIENT: REPLACEMENT OF PRIOR CLAIM |
118 | INPATIENT: VOID/CANCEL OF PRIOR CLAIM |
Hospital inpatient (Medicare Part B only)
Value | Description |
---|---|
121 | HOSPITAL INPATIENT (MEDICARE PART B ONLY): ADMIT THROUGH DISCHARGE |
122 | HOSPITAL INPATIENT (MEDICARE PART B ONLY): INTERIM, FIRST CLAIM |
123 | HOSPITAL INPATIENT (MEDICARE PART B ONLY): INTERIM, CONTINUING CLAIM |
124 | HOSPITAL INPATIENT (MEDICARE PART B ONLY): INTERIM, FINAL CLAIM |
125 | HOSPITAL INPATIENT (MEDICARE PART B ONLY): LATE CHARGE(S) ONLY CLAIM |
127 | HOSPITAL INPATIENT (MEDICARE PART B ONLY): REPLACEMENT OF PRIOR CLAIM |
128 | HOSPITAL INPATIENT (MEDICARE PART B ONLY): VOID/CANCEL OF PRIOR CLAIM |
Outpatient Hospital
Value | Description |
---|---|
131 | REGULAR OUTPATIENT |
132 | FIRST INTERIM: CONTINUING OUTPATIENT CLAIM |
133 | SUBSEQUENT INTERIM: CONTINUING OUTPATIENT CLAIM |
134 | FINAL INTERIM: OUTPATIENT CLAIM |
135 | OUTPATIENT: LATE CHARGE(S) ONLY CLAIM |
136 | OUTPATIENT: ADJUSTMENT OF PRIOR CLAIM |
137 | OUTPATIENT: REPLACEMENT OF PRIOR CLAIM |
138 | OUTPATIENT: VOID/CANCEL OF PRIOR CLAIMS |
Outpatient Diagnostic (Non Treatment Plan)
Value | Description |
---|---|
141 | OUTPATIENT DIAGNOSTIC: ADMIT THROUGH DISCHARGE |
142 | OUTPATIENT DIAGNOSTIC: INTERIM, FIRST CLAIM |
143 | OUTPATIENT DIAGNOSTIC: INTERIM, CONTINUING CLAIM |
144 | OUTPATIENT DIAGNOSTIC: INTERIM, FINAL CLAIM |
145 | OUTPATIENT DIAGNOSTIC: LATE CHARGE(S) ONLY CLAIM |
146 | OUTPATIENT DIAGNOSTIC: ADJUSTMENT OF PRIOR CLAIM |
147 | OUTPATIENT DIAGNOSTIC: REPLACEMENT OF PRIOR CLAIM |
148 | OUTPATIENT DIAGNOSTIC: VOID/CANCEL OF PRIOR CLAIM |
Hospital Swing Beds
Value | Description |
---|---|
181 | HOSPITAL SWING BEDS: ADMIT THROUGH DISCHARGE |
182 | HOSPITAL SWING BEDS: INTERIM, FIRST CLAIM |
183 | HOSPITAL SWING BEDS: INTERIM, CONTINUING CLAIM |
184 | HOSPITAL SWING BEDS: INTERIM, FINAL CLAIM |
185 | HOSPITAL SWING BEDS: LATE CHARGE(S) ONLY CLAIM |
187 | HOSPITAL SWING BEDS: REPLACEMENT OF PRIOR CLAIM |
188 | HOSPITAL SWING BEDS: VOID/CANCEL OF PRIOR CLAIM |
Skilled Nursing
Value | Description |
---|---|
211 | SKILLED NURSING: ADMIT THROUGH DISCHARGE |
212 | SKILLED NURSING: INTERIM, FIRST CLAIM |
213 | SKILLED NURSING: INTERIM, CONTINUING CLAIM |
214 | SKILLED NURSING: FINAL CLAIM |
215 | SKILLED NURSING: LATE CHARGE(S) ONLY CLAIM |
217 | SKILLED NURSING: REPLACEMENT OF PRIOR CLAIM |
218 | SKILLED NURSING: VOID/CANCEL OF PRIOR CLAIM |
Skilled Nursing (Medicare Part B Only)
Value | Description |
---|---|
221 | SKILLED NURSING (MEDICARE PART B ONLY): ADMIT THROUGH DISCHARGE |
222 | SKILLED NURSING (MEDICARE PART B ONLY): INTERIM, FIRST CLAIM |
223 | SKILLED NURSING (MEDICARE PART B ONLY): INTERIM, CONTINUING CLAIM |
224 | SKILLED NURSING (MEDICARE PART B ONLY): FINAL CLAIM |
225 | SKILLED NURSING (MEDICARE PART B ONLY): LATE CHARGE(S) ONLY CLAIM |
227 | SKILLED NURSING (MEDICARE PART B ONLY): REPLACEMENT OF PRIOR CLAIM |
228 | SKILLED NURSING (MEDICARE PART B ONLY): VOID/CANCEL OF PRIOR CLAIM |
Skilled Nursing Outpatient
Value | Description |
---|---|
231 | SKILLED NURSING OUTPATIENT: ADMIT THROUGH DISCHARGE |
232 | SKILLED NURSING OUTPATIENT: INTERIM, FIRST CLAIM |
233 | SKILLED NURSING OUTPATIENT: INTERIM, CONTINUING CLAIM |
234 | SKILLED NURSING OUTPATIENT: FINAL CLAIM |
235 | SKILLED NURSING OUTPATIENT: LATE CHARGE(S) ONLY CLAIM |
237 | SKILLED NURSING OUTPATIENT: REPLACEMENT OF PRIOR CLAIM |
238 | SKILLED NURSING OUTPATIENT: VOID/CANCEL OF PRIOR CLAIM |
Home Health Inpatient (Not under a Plan of Treatment) - Description Change
Value | Description |
---|---|
321 | HOME HEALTH INPATIENT (NOT UNDER A PLAN OF TREATMENT): ADMIT THROUGH DISCHARGE |
322 | HOME HEALTH INPATIENT (NOT UNDER A PLAN OF TREATMENT): INTERIM, FIRST CLAIM |
323 | HOME HEALTH INPATIENT (NOT UNDER A PLAN OF TREATMENT): INTERIM, CONTINUING CLAIM |
324 | HOME HEALTH INPATIENT (NOT UNDER A PLAN OF TREATMENT): INTERIM, FINAL CLAIM |
325 | HOME HEALTH INPATIENT (NOT UNDER A PLAN OF TREATMENT): LATE CHARGE(S) ONLY CLAIM |
327 | HOME HEALTH INPATIENT (NOT UNDER A PLAN OF TREATMENT): REPLACEMENT OF PRIOR CLAIM |
328 | HOME HEALTH INPATIENT (NOT UNDER A PLAN OF TREATMENT): VOID/CANCEL OR PRIOR CLAIM |
Coordinated Home Care (Medicare A Treatment Plan including DME) - Discontinued as of October 1, 2013
Value | Description |
---|---|
331 | COORDINATED HOME CARE: ADMIT THROUGH DISCHARGE |
332 | COORDINATED HOME CARE: INTERIM, FIRST CLAIM |
333 | COORDINATED HOME CARE: INTERIM, CONTINUING CLAIM |
334 | COORDINATED HOME CARE: INTERIM, FINAL CLAIM |
335 | COORDINATED HOME CARE: LATE CHARGE(S) ONLY CLAIM |
337 | COORDINATED HOME CARE: REPLACEMENT OF PRIOR CLAIM |
338 | COORDINATED HOME CARE: VOID/CANCEL OF PRIOR CLAIM |
Home Health Services (Not Under a Plan of Treatment) - Description Change
Value | Description |
---|---|
341 | HOME HEALTH SERVICES (NOT UNDER A PLAN OF TREATMENT): ADMIT THROUGH DISCHARGE |
342 | HOME HEALTH SERVICES (NOT UNDER A PLAN OF TREATMENT): INTERIM, FIRST CLAIM |
343 | HOME HEALTH SERVICES (NOT UNDER A PLAN OF TREATMENT): INTERIM, CONTINUING CLAIM |
344 | HOME HEALTH SERVICES (NOT UNDER A PLAN OF TREATMENT): INTERIM, FINAL CLAIM |
345 | HOME HEALTH SERVICES (NOT UNDER A PLAN OF TREATMENT): LATE CHARGE(S) ONLY CLAIM |
347 | HOME HEALTH SERVICES (NOT UNDER A PLAN OF TREATMENT): REPLACEMENT OF PRIOR CLAIM |
348 | HOME HEALTH SERVICES (NOT UNDER A PLAN OF TREATMENT): VOID/CANCEL OF PRIOR CLAIM |
Religious Non-Medical Health Care Institution - Hospital Inpatient
Value | Description |
---|---|
411 | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS - HOSPITAL INPATIENT: ADMIT THROUGH DISCHARGE |
412 | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS - HOSPITAL INPATIENT: INTERIM FIRST CLAIM |
413 | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS - HOSPITAL INPATIENT: INTERIM, CONTINUING CLAIM |
414 | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS - HOSPITAL INPATIENT: INTERIM, FINAL CLAIM |
415 | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS - HOSPITAL INPATIENT: LATE CHARGE(S) ONLY CLAIM |
417 | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS - HOSPITAL INPATIENT: REPLACEMENT OF PRIOR CLAIM |
418 | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS - HOSPITAL INPATIENT: VOID/CANCEL OF PRIOR CLAIM |
Religious Non-Medical Health Care Institution - Outpatient Services
Value | Description |
---|---|
43X | RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTIONS – OUTPATIENT SERVICES |
Intermediate Care - Level I
Value | Description |
---|---|
65X | INPATIENT RESPITE CARE |
Intermediate Care - Level II
Value | Description |
---|---|
66X | GENERAL NONRESPITE INPATIENT CARE |
Clinical Rural Health
Value | Description |
---|---|
711 | CLINIC RURAL HEALTH: ADMIT THROUGH DISCHARGE |
712 | CLINIC RURAL HEALTH: INTERIM, FIRST CLAIM |
713 | CLINIC RURAL HEALTH: INTERIM, CONTINUING CLAIM |
714 | CLINIC RURAL HEALTH: INTERIM, FINAL CLAIM |
715 | CLINIC RURAL HEALTH: LATE CHARGE(S) ONLY CLAIM |
717 | CLINIC RURAL HEALTH: REPLACEMENT OF PRIOR CLAIM |
Hospital Based or Independent Renal Dialysis
Value | Description |
---|---|
721 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS: ADMIT THROUGH DISCHARGE |
722 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS: INTERIM, FIRST CLAIM |
723 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS: INTERIM, CONTINUING CLAIM |
724 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS: INTERIM, FINAL CLAIM |
725 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS: LATE CHARGE(S) ONLY CLAIM |
727 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS: REPLACEMENT OF PRIOR CLAIM |
728 | HOSPITAL BASED OR INDEPENDENT RENAL DIALYSIS: VOID/CANCEL OF PRIOR CLAIM |
Free Standing Clinic
Value | Description |
---|---|
73X | FREE STANDING CLINIC |
Clinic Outpatient Rehabilitation Facility (ORF)
Value | Description |
---|---|
741 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): ADMIT THROUGH DISCHARGE |
742 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): INTERIM, FIRST CLAIM |
743 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): INTERIM, CONTINUING CLAIM |
744 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): INTERIM, FINAL CLAIM |
745 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): LATE CHARGE(S) ONLY CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): REPLACEMENT OF PRIOR CLAIM |
747 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): REPLACEMENT OF PRIOR CLAIM |
748 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): VOID/CANCEL OF PRIOR CLAIM |
Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
Value | Description |
---|---|
751 | CLINIC OUTPATIENT REHABILITATION FACILITY (ORF): VOID/CANCEL OF PRIOR CLAIM |
752 | CLINIC – COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF): INTERIM, FIRST CLAIM |
753 | CLINIC – COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF): INTERIM, CONTINUING CLAIM |
754 | CLINIC – COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF): INTERIM, FINAL CLAIM |
755 | CLINIC – COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF): LATE CHARGE(S) ONLY CLAIM |
757 | CLINIC – COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF): REPLACEMENT OF PRIOR CLAIM |
758 | CLINIC – COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY (CORF): VOID/CANCEL OF PRIOR CLAIM |
Clinic - Community Mental Health Center
Value | Description |
---|---|
76X | CLINIC – COMMUNITY MENTAL HEALTH CENTER |
Clinic - Federally Qualified Health Center
Value | Description |
---|---|
77X | CLINIC – FEDERALLY QUALIFIED HEALTH CENTER |
777 | Adjustment or replacement claim |
Licensed Free Standing Emergency Medical Facility
Value | Description |
---|---|
78X | LICENSED FREE STANDING EMERGENCY MEDICAL FACILITY |
Clinic - Other
Value | Description |
---|---|
79X | CLINIC - OTHER |
Specialty Facility Hospice (Non-Hospital Based)
Value | Description |
---|---|
811 | SPECIALTY FACILITY HOSPICE (NON-HOSPITAL BASED): ADMIT THROUGH DISCHARGE |
812 | SPECIALTY FACILITY HOSPICE (NON-HOSPITAL BASED): INTERIM, FIRST CLAIM |
813 | SPECIALTY FACILITY HOSPICE (NON-HOSPITAL BASED): INTERIM, CONTINUING CLAIM |
814 | SPECIALTY FACILITY HOSPICE (NON-HOSPITAL BASED): INTERIM, FINAL CLAIM |
815 | SPECIALTY FACILITY HOSPICE (NON-HOSPITAL BASED): LATE CHARGE(S) ONLY |
817 | SPECIALTY FACILITY HOSPICE (NON-HOSPITAL BASED): REPLACEMENT OF PRIOR CLAIM |
818 | SPECIALTY FACILITY HOSPICE (NON-HOSPITAL BASED): VOID/CANCEL OF PRIOR CLAIM |
Specialty Facility Hospice (Hospital Based)
Value | Description |
---|---|
821 | SPECIALTY FACILITY HOSPICE (HOSPITAL BASED): ADMIT THROUGH DISCHARGE |
822 | SPECIALTY FACILITY HOSPICE (HOSPITAL BASED): INTERIM, FIRST CLAIM |
823 | SPECIALTY FACILITY HOSPICE (HOSPITAL BASED): INTERIM, CONTINUING CLAIM |
824 | SPECIALTY FACILITY HOSPICE (HOSPITAL BASED): INTERIM, FINAL CLAIM |
825 | SPECIALTY FACILITY HOSPICE (HOSPITAL BASED): LATE CHARGE(S) ONLY |
827 | SPECIALTY FACILITY HOSPICE (HOSPITAL BASED): REPLACEMENT OF PRIOR CLAIM |
828 | SPECIALTY FACILITY HOSPICE (HOSPITAL BASED): VOID/CANCEL OF PRIOR CLAIM |
Specialty Facility Ambulatory Surgery
Value | Description |
---|---|
831 | SPECIALTY FACILITY AMBULATORY SURGERY: ADMIT THROUGH DISCHARGE |
832 | SPECIALTY FACILITY AMBULATORY SURGERY: INTERIM, FIRST CLAIM |
833 | SPECIALTY FACILITY AMBULATORY SURGERY: INTERIM, CONTINUING CLAIM |
834 | SPECIALTY FACILITY AMBULATORY SURGERY: INTERIM, FINAL CLAIM |
835 | SPECIALTY FACILITY AMBULATORY SURGERY: LATE CHARGE(S) ONLY CLAIM |
837 | SPECIALTY FACILITY AMBULATORY SURGERY: REPLACEMENT OF PRIOR CLAIM |
838 | SPECIALTY FACILITY AMBULATORY SURGERY: VOID/CANCEL OF PRIOR CLAIM |
Specialty Facility - Free Standing Birthing Center - Reclassified to Outpatient Only
Value | Description |
---|---|
84X | SPECIALTY FACILITY – FREE STANDING BIRTHING CENTER |
Specialty Facility - Critical Access Hospital
Value | Description |
---|---|
851 | SPECIALTY FACILITY – CRITICAL ACCESS HOSPITAL: ADMIT THROUGH DISCHARGE |
852 | SPECIALTY FACILITY – CRITICAL ACCESS HOSPITAL: INTERIM, FIRST CLAIM |
853 | SPECIALTY FACILITY – CRITICAL ACCESS HOSPITAL: INTERIM, CONTINUING CLAIM |
854 | SPECIALTY FACILITY – CRITICAL ACCESS HOSPITAL: INTERIM, FINAL CLAIM |
855 | SPECIALTY FACILITY – CRITICAL ACCESS HOSPITAL: LATE CHARGE(S) ONLY CLAIM |
857 | SPECIALTY FACILITY – CRITICAL ACCESS HOSPITAL: REPLACEMENT OF PRIOR CLAIM |
838 | SPECIALTY FACILITY – CRITICAL ACCESS HOSPITAL: VOID/CANCEL OF PRIOR CLAIM |
Specialty Facility - Residential Facility
Value | Description |
---|---|
86X | SPECIALTY FACILITY – RESIDENTIAL FACILITY |
Specialty Facility - Other - Reclassified to Outpatient Only
Value | Description |
---|---|
89X | SPECIALTY FACILITY – OTHER |