Availity type of service code

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The process of submitting benefit preauthorization requests through eviCore healthcare eviCore or other vendors has not changed. Refer to the educational Availity Eligibility and Benefits user guide , Availity Authorizations user guide and Availity Referrals user guide located under the Provider Tools section of our website. Additionally, you can visit our Provider Training section to register for upcoming online training sessions.

Have additional questions or need customized training? Email our Provider Education Consultants for assistance. All rights reserved. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Industry Groups and Caucuses X12 welcomes the assembling of members with common interests as industry groups and caucuses. Awards X12 is pleased to recognize individual members and industry representatives whose contributions and achievements have played a role in the development of cross-industry eCommerce standards.

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Contact Us Contact us through email, mail, or over the phone. All of our contact information is here. Follow x12standards. These codes identify business groupings for health care services or benefits.

This code list is not applicable to the version. Maintenance Request Status The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses: Received The request has been submitted but is not yet under review. Pending Staff has looked at the request to ensure it's a legitimate request not spam , that it is assigned to the correct CMG, and that all required information is present.

CMG Approved The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version. Our plan has a unique benefit for this service and would like to convey this to providers in a codified manner. Current Code Value? Brief description? Business justification? Filter by code: Reset. Anterior teeth include up to five surface classifications - Mesial, Distal, Incisal, Lingual and Labial.

Posterior teeth include up to five surface classifications: Mesial, Distal, Occlusal, Lingual and Buccal. This includes conditions that require movement of the teeth or correction of the malrelationships and malformations of related structures by the adjustment of relationships between and among teeth and facial bones by the application of forces or the stimulation and redirection of functional forces within the craniofacial complex. It has three main branches: removable prosthodontics, fixed prosthodontics and maxillofacial prosthetics.

It is achieved through use of contraceptive methods and the treatment of involuntary infertility. Covered services may include assisted reproductive technology procedures. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. To be used as a prosthodontic abutment, it should remain quiescent and purely secondary to local tissue physiology. Specialty pharmacies are also designed to improve clinical and economic outcomes for patients with complex, often chronic and rare conditions, with close contact and management by clinicians.

This code cannot be submitted with the Inquiry. Back to Top. Extended coverage will be allowed for 24 months or 36 month. Durable Medical Equipment Used Used equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home.

Durable Medical Equipment Purchased Purchased equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home. Renal Supplies Supplies to support treatment of kidneys, or bladder functions. Pre-Admission Testing Services related to the preparation for admission to establish the patients current health status. Durable Medical Equipment Rental Rental equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home.

Pneumonia Vaccine Services provided by a physician or other healthcare provider related to administration of Pneumococcal Pneumonia vaccination. Diagnostic Dental The translation of data gathered by clinical and radiographic examination into an organized, classified definition of conditions present. Periodontics The art and science of examination, diagnosis, and treatment of diseases affecting the periodontium; a study of the supporting structures of the teeth, normal anatomy and physiology and the deviations.

Endodontics The branch of dentistry that is concerned with the morphology, physiology and pathology of the dental pulp and periradicular gum tissues. Maxillofacial Prosthetics The branch of prosthetics is concerned with the restoration of stomatognathic and associated facial structure that have been affected by disease, injury, surgery, or congenital defect.

Adjunctive Dental Services Typically these services involve a drug such as anesthesia or other substances that serve as a supplemental purpose in dental therapy. Plan Coverage and General Benefits Plan coverage and general benefits for the member's policy or contract.

Dental Care The treatment of the teeth and their supporting structures. Dental Crowns An artificial replacement for the natural crown of the tooth covering all five surfaces Anterior teeth surface classifications - Mesial, Distal, Incisal, Lingual and Labial. Orthodontics The area of dentistry concerned with the supervision, guidance, and correction of the growing and mature orofacial structures. Prosthodontics The part of dentistry pertaining to the restoration and maintenance of oral function, comfort, appearance and health of the patient by replacement of missing teeth and contiguous tissues with artificial substitutes.

Preventive Dental The dental procedures in dental practice and health programs that prevent the occurrence of oral diseases. Hospice An integrated set of services and supplies to provide palliative and supportive care to terminally ill patients.

Hospitalization Hospital Inpatient and Outpatient services and supplies for a patient who may or may not have been admitted to a hospital, for the purpose of receiving medical care or other health services.

Plan Coverage Indicates whether a patient has active or inactive coverage for the service date requested. Well Baby Care Medical services and physician visits which are recommended by the American Pediatric Association as appropriate and routine care for a child to a specific age limit.

Transplants Services related to the transfer of living organs or tissue from one body to another. Prosthetics A device that is used to replace a part of the body that is missing.

Chemotherapy The treatment of disease by means of chemicals that have a specific toxic effect upon the disease-producing microorganisms or that selectively destroy cancerous tissue.

Routine Physical A physical examination performed on asymptomatic patients for medical screening purposes. Family Planning Educational services that assists individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births.

Free Standing Prescription Drug Members have separate cost sharing for prescription drugs and medical coverage. Mail Order Pharmacy A mail order pharmacy delivers medications directly to patients through the mail. Generic Prescription Drug Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug.

Podiatry Professional services of a physician or other healthcare provider for the care or treatment of conditions of the foot. Bariatric services - Services that deal with the causes, education, prevention and treatment of obesity. Psychiatric Services related to the diagnosis or treatment of mental health.

Psychotherapy Professional services, including individual or group therapy by providers such as psychiatrists, psychologists, clinical social workers, or psychiatric nurses. Occupational Therapy Professional and facility occupational therapy services performed by an occupational therapist, physician or other healthcare provider at a hospital, office or other covered facility. Speech Therapy Professional and facility speech therapy services performed by a speech therapist, physician or other healthcare provider at a hospital, office or other covered facility.

Skilled Nursing Care Services for a patient in a skilled nursing facility for the purpose of receiving medical care or other health services. Substance Abuse Services provided at a hospital, office or other covered facility as they are related to the diagnosis and treatment of Substance Abuse. Optometry Routine vision services furnished by an optometrist. Lenses A piece of transparent substance having two opposite surfaces either both curved or one curved and one plane, used in an optical device in correcting defects of vision.

Routine Eye Exam A series of tests to evaluate an individual's vision and check for eye diseases. Nonmedically Necessary Physical These physicals are required by other entities e.

Psychiatric Treatment Partial Hospitalization A step-down transition from acute inpatient care or an alternative to inpatient treatment for the practice or science of diagnosing and treating mental disorders. Cognitive Therapy A type of psychotherapy in which negative patterns of thought, are challenged in order to alter unwanted behavior patterns or treat mood disorders.

Pulmonary Rehabilitation Services and instructional guidance administered to an individual suffering from respiratory disease in an attempt to improve the quality of life for the patient. Orthopedic Services related to the correction or prevention of deformities, disorders, or injuries of the skeleton and associated structures. Neurology Services related to the treatment of the nerves or nervous system.

Gynecological Medical care and management of the female reproductive system and associated disorders provided by a physician or other healthcare provider. Obstetrical Medical care and management related to the care of a woman prior, during and after pregnancy, provided by a physician or other healthcare provider. Physician Visit - Sick Professional services rendered by a physician or other healthcare provider during a non-routine visit related to a illness. Physician Visit - Well Professional services rendered by a physician or other healthcare provider during a routine or preventative care visit.

Screening X-ray X-ray services provided by a physician or other healthcare provider for the purpose of preventative care. Screening laboratory Laboratory services provided by a physician or other healthcare provider for the purpose of preventative care.

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Adventist health system regions	168
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Availity type of service code	272
Highmark blue cross blue shield new york	Payment Type Codes. Provider Adjustment Reason Codes. October 31, Transplants Services related to the transfer of living organs or tissue from one body to another. Non-Medical Equipment non DME Durable equipment that can withstand repeated use and serves to augment or replace impaired functionality, environmental control and facilitate a patient's independent living. All X12 work products are copyrighted.
Availity type of service code	Teenage mutant ninja turtles out of the shadows baxter stockman
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On the error message window, click Close. You are returned to the Availity Portal login page. On the login page, click Forgot your password? Once you have logged back in to Availity Portal, enter your code to complete the 2-stepauthentication process to gain full access I have an e-mail address on record with Availity. Why can't I use e-mail self-service to retrieve my user ID or reset my password?

After you submit an e-mail address—via the My Info section of the My Account page or the pop-up style window that displays when you first log in—Availity sends you an e-mail verification message. You must click the link in this message within 24 hours to verify your e-mail address and enable e-mail self service.

Note: You may see an e-mail address for your account, but still not be able to use e-mail self-service. This can happen if your administrator submitted an e-mail address for you during user set-up, but you did not submit your e-mail address in the pop-up style window that displayed when you first logged in to Availity Portal.

Within 24hours, click the link in the e-mail verification message you receive from Availity. Within 24 hours, click the link in the e-mail verification message you receive from Availity.

Why am I locked out of Availity Portal? Once you have logged back in to Availity Portal, enter your code to complete the 2-stepauthentication process to gain full access.

If you cannot use the on-screen options that are presented to you to unlock your account, contact your administrator. I'm a new Availity user and my temporary password has expired. What should I do? All temporary, system-generated passwords expire after 60 days. If you are a new user who has never logged in, ask your administrator to provide you with a new temporary password.

I received the message, "We recognize your login credentials, but a system error occurred when your administrator was assigning your role s in Availity Portal. Ask your administrator to reassign your roles. I received an SC01 error. The SC01 is a security-related error message used for truly unexpected exceptions such as lost database connections and errors related to problems at our third-party hosting vendor.

Code Maintenance Request. Request for Interpretation. Maintenance Requests. Membership Application. Membership Renewal. Member Representative Request for Workspace Access. Meeting Minutes Browse and download meeting minutes by committee. Transaction Flow X12 defines and maintains transaction sets that establish the data content exchanged for specific business purposes and, in some cases, implementation guides that describe the use of one or more transaction sets related to a single business purpose or use case.

Contact Us Contact us through email, mail, or over the phone. All of our contact information is here. Follow x12standards. These codes identify business groupings for health care services or benefits. This code list is not applicable to the version.

Maintenance Request Status The list below shows the status of change requests which are in process. Each request will be in one of the following statuses: Received The request has been submitted but is not yet under review. Pending Staff has looked at the request to ensure it's a legitimate request not spam , that it is assigned to the correct CMG, and that all required information is present.

CMG Approved The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version. Our plan has a unique benefit for this service and would like to convey this to providers in a codified manner. Current Code Value? Brief description? Business justification? Filter by code: Reset. Anterior teeth include up to five surface classifications - Mesial, Distal, Incisal, Lingual and Labial.

Posterior teeth include up to five surface classifications: Mesial, Distal, Occlusal, Lingual and Buccal. This includes conditions that require movement of the teeth or correction of the malrelationships and malformations of related structures by the adjustment of relationships between and among teeth and facial bones by the application of forces or the stimulation and redirection of functional forces within the craniofacial complex.

It has three main branches: removable prosthodontics, fixed prosthodontics and maxillofacial prosthetics. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. Covered services may include assisted reproductive technology procedures. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts.

To be used as a prosthodontic abutment, it should remain quiescent and purely secondary to local tissue physiology. Specialty pharmacies are also designed to improve clinical and economic outcomes for patients with complex, often chronic and rare conditions, with close contact and management by clinicians. This code cannot be submitted with the Inquiry. Back to Top. Extended coverage will be allowed for 24 months or 36 month.

Durable Medical Equipment Used Used equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home. Durable Medical Equipment Purchased Purchased equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home.

Renal Supplies Supplies to support treatment of kidneys, or bladder functions. Pre-Admission Testing Services related to the preparation for admission to establish the patients current health status. Durable Medical Equipment Rental Rental equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a healthcare provider for use in the home.

Pneumonia Vaccine Services provided by a physician or other healthcare provider related to administration of Pneumococcal Pneumonia vaccination. Diagnostic Dental The translation of data gathered by clinical and radiographic examination into an organized, classified definition of conditions present.

Periodontics The art and science of examination, diagnosis, and treatment of diseases affecting the periodontium; a study of the supporting structures of the teeth, normal anatomy and physiology and the deviations. Endodontics The branch of dentistry that is concerned with the morphology, physiology and pathology of the dental pulp and periradicular gum tissues.

Maxillofacial Prosthetics The branch of prosthetics is concerned with the restoration of stomatognathic and associated facial structure that have been affected by disease, injury, surgery, or congenital defect.

Adjunctive Dental Services Typically these services involve a drug such as anesthesia or other substances that serve as a supplemental purpose in dental therapy.

Plan Coverage and General Benefits Plan coverage and general benefits for the member's policy or contract.

Dental Care The treatment of the teeth and their supporting structures. Dental Crowns An artificial replacement for the natural crown of the tooth covering all five surfaces Anterior teeth surface classifications - Mesial, Distal, Incisal, Lingual and Labial.

Orthodontics The area of dentistry concerned with the supervision, guidance, and correction of the growing and mature orofacial structures. Prosthodontics The part of dentistry pertaining to the restoration and maintenance of oral function, comfort, appearance and health of the patient by replacement of missing teeth and contiguous tissues with artificial substitutes. Preventive Dental The dental procedures in dental practice and health programs that prevent the occurrence of oral diseases.

Hospice An integrated set of services and supplies to provide palliative and supportive care to terminally ill patients. Hospitalization Hospital Inpatient and Outpatient services and supplies for a patient who may or may not have been admitted to a hospital, for the purpose of receiving medical care or other health services.

Plan Coverage Indicates whether a patient has active or inactive coverage for the service date requested. Well Baby Care Medical services and physician visits which are recommended by the American Pediatric Association as appropriate and routine care for a child to a specific age limit. Transplants Services related to the transfer of living organs or tissue from one body to another. Prosthetics A device that is used to replace a part of the body that is missing.

Chemotherapy The treatment of disease by means of chemicals that have a specific toxic effect upon the disease-producing microorganisms or that selectively destroy cancerous tissue. Routine Physical A physical examination performed on asymptomatic patients for medical screening purposes. Family Planning Educational services that assists individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. Free Standing Prescription Drug Members have separate cost sharing for prescription drugs and medical coverage.

Mail Order Pharmacy A mail order pharmacy delivers medications directly to patients through the mail. Generic Prescription Drug Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. Podiatry Professional services of a physician or other healthcare provider for the care or treatment of conditions of the foot.

Bariatric services - Services that deal with the causes, education, prevention and treatment of obesity. Psychiatric Services related to the diagnosis or treatment of mental health. Psychotherapy Professional services, including individual or group therapy by providers such as psychiatrists, psychologists, clinical social workers, or psychiatric nurses. Occupational Therapy Professional and facility occupational therapy services performed by an occupational therapist, physician or other healthcare provider at a hospital, office or other covered facility.

Speech Therapy Professional and facility speech therapy services performed by a speech therapist, physician or other healthcare provider at a hospital, office or other covered facility. Skilled Nursing Care Services for a patient in a skilled nursing facility for the purpose of receiving medical care or other health services.

Substance Abuse Services provided at a hospital, office or other covered facility as they are related to the diagnosis and treatment of Substance Abuse. Optometry Routine vision services furnished by an optometrist. Lenses A piece of transparent substance having two opposite surfaces either both curved or one curved and one plane, used in an optical device in correcting defects of vision. Routine Eye Exam A series of tests to evaluate an individual's vision and check for eye diseases.

Nonmedically Necessary Physical These physicals are required by other entities e. Psychiatric Treatment Partial Hospitalization A step-down transition from acute inpatient care or an alternative to inpatient treatment for the practice or science of diagnosing and treating mental disorders. Cognitive Therapy A type of psychotherapy in which negative patterns of thought, are challenged in order to alter unwanted behavior patterns or treat mood disorders.

Pulmonary Rehabilitation Services and instructional guidance administered to an individual suffering from respiratory disease in an attempt to improve the quality of life for the patient. Orthopedic Services related to the correction or prevention of deformities, disorders, or injuries of the skeleton and associated structures.

Neurology Services related to the treatment of the nerves or nervous system. Gynecological Medical care and management of the female reproductive system and associated disorders provided by a physician or other healthcare provider.

Obstetrical Medical care and management related to the care of a woman prior, during and after pregnancy, provided by a physician or other healthcare provider. Physician Visit - Sick Professional services rendered by a physician or other healthcare provider during a non-routine visit related to a illness.

Physician Visit - Well Professional services rendered by a physician or other healthcare provider during a routine or preventative care visit. Screening X-ray X-ray services provided by a physician or other healthcare provider for the purpose of preventative care. Screening laboratory Laboratory services provided by a physician or other healthcare provider for the purpose of preventative care.

Mammogram, High Risk Patient Mammography services for patients that have been identified with a greater than normal risk for breast cancers and related diseases. Mammogram, Low Risk Patient Mammography services for patients that have been identified with a normal risk for breast cancers and related diseases. Flu Vaccination Services provided by a physician or other healthcare provider related to the administration of influenza virus vaccination.

Dermatology Services provided by a physician or other healthcare provider involving the skin and its diseases. Durable Medical Equipment Durable medical equipment that can withstand repeated use and is primarily and customarily used to serve a medical purpose and generally is not useful to a person in the absence of an illness or injury.

Diabetic Supplies Blood sugar glucose test strips, monitors, insulin, lancet devices and lancets, glucose control solutions used to monitor and assist in the treatment of diabetes. Non-Medical Equipment non DME Durable equipment that can withstand repeated use and serves to augment or replace impaired functionality, environmental control and facilitate a patient's independent living.

Psychiatric Emergency Emergency services related to the diagnosis or treatment of mental disease. Step Down Unit A hospital unit providing a level of care between intensive and routine.

Skilled Nursing Facility Head Level of Care Services directly related to care associated with severe brain injuries requiring a skilled level of care. Skilled Nursing Facility Ventilator Level of Care Services directly related to care associated with ventilator dependent respiratory conditions requiring a skilled level of care.

Diagnostic Imaging The use of radiographic, sonographic, and other technologies to create a graphic depiction of the body parts in question. Fixed Prosthodontics The branch of prosthodontics concerned with the replacement or restoration of teeth by artificial substitutes that are not readily removable such as fixed partial dentures, pontics and abutments.

Removable Prosthodontics The branch of prosthodontics concerned with the replacement or restoration of teeth by artificial substitutes that are readily removable such as a denture, partial denture and interim prosthesis. Intraoral Images - Complete Series Complete set of images using radiographic, sonographic, and other technologies representing an image or set of images within the oral cavity.

Oral Evaluation The art and science of evaluation to make a clinical judgment or appraisal of a patient's dental health or condition. Dental Prophylaxis A series of procedures where plaque, calculus, and stain are removed from the teeth often referred to as "prophy" or teeth cleaning.

Panoramic Images A tomogram of the jaws, taken with a specialized machine designed to present a panoramic view of the full circumferential length of the jaws on a single film. Sealants A resinous material designed for application to the occlusal surfaces of posterior teeth to seal the surface irregularities and prevent the carious process.

Fluoride Treatments A separate process from dental prophylaxis of applying prescription strength fluoride product designed to prevent caries. Dental Implants A device, usually alloplastic, that is surgically inserted into or onto the oral tissue.

Temporomandibular Joint Dysfunction Services related to the Impaired function of the temporomandibular articulation of the jaw. Retail Pharmacy Prescription Drug Dispenses prescription drugs and provides professional pharmacy services, such as clinical pharmacy consulting respective to the dispensing function. Long Term Care Pharmacy Long term care pharmacy serve the residents of nursing homes, assisted care facilities, extended care facilities, retirement homes, or post acute care.

Diabetic Education Patient educational program designed to bring awareness of diabetes, what it takes to treat it, and the necessary changes that should be made to improve their lifestyle. Early Intervention Services related to treatment for babies or toddlers with developmental delays or disabilities. Preventive Services Preventive services such as check-ups, patient counseling and screenings to prevent illness, disease and other health-related problems.

Specialty Pharmacy Specialty pharmacies are designed to efficiently deliver medications with specialized handling, storage, and distribution requirements. Durable Medical Equipment New New equipment needed for medical reasons to be used by a person that is ill or injured and is ordered by a health care provider for use in the home. Ophthalmology Services related to diagnosis and treatment of the eye and related structures including surgical services.

Contact Lenses A thin lens placed directly on the surface of the eye.