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March 1, 2012

Health Care Provider Taxonomy Codes (HPTC) Update: April 1, 2012

Provider Types Affected
Providers who bill Part A and Part B Medicare Administrative Contractor (MAC), including a Durable Medical Equipment Medicare Administrative Contractor (DME MAC).

Provider Action Needed
Impact to You
The Centers for Medicare & Medicaid Services (CMS) has released the summary of changes reflected in the Health Care Provider Taxonomy Code (HPTC) list. Medicare Part A and Part B MACs as well as DME MACs will update their HPTC tables with this new version effective on January 1, 2012. 

What You Need to Know
The Health Insurance Portability and Accountability Act (HIPAA) requires that submitted data, which is part of a named code set, be valid data from that code set. Claims accepted with invalid data are non-compliant.

What You Need to Do
Please review the information included here and stay current on all HIPAA requirements to insure timely processing of your claims.

Under HIPAA, code sets that characterize a general administrative situation, rather than a medical condition or service, are referred to as non-clinical or non-medical code sets. The Provider Taxonomy code set is an external non-medical data code set designed for use in classifying health care providers according to provider type or practitioner specialty in an electronic environment, specifically within the American National Standards Institute (ANSI) Accredited Standards Committee (ASC) health care transaction.

HIPAA requires that submitted data, which is part of a named code set, must be valid data from that code set. The health care provider taxonomy is a named code set in the 837 professional implementation guides. Carriers must validate the inbound taxonomy codes against their internal HPTC tables.

The HPTCs are updated twice per year in April and October. The summary of changes effective April 1, 2012, is noted in the table below. 

New Codes Modified Codes
No Modified Codes

The HPTC code list is available from the Washington Publishing Company at www.wpc-edi.comExternal Website.

Source: CR 7742

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