Claim Status Code List

Code	Description
0	Cannot provide further status electronically.
1	For more detailed information, see remittance advice.
2	More detailed information in letter.
3	Claim has been adjudicated and is awaiting payment cycle.
4	This is a subsequent request for information from the original request.
5	This is a final request for information.
6	Balance due from the subscriber.
7	Claim may be reconsidered at a future date.
8	No payment due to contract/plan provisions.
9	No payment will be made for this claim.
10	All originally submitted procedure codes have been combined.
11	Some originally submitted procedure codes have been combined.
12	One or more originally submitted procedure codes have been combined.
13	All originally submitted procedure codes have been modified.
14	Some all originally submitted procedure codes have been modified.
15	One or more originally submitted procedure codes have been modified.
16	Claim/encounter has been forwarded to entity.
17	Claim/encounter has been forwarded by third party entity to entity.
18	Entity received claim/encounter, but returned invalid status.
19	Entity acknowledges receipt of claim/encounter.
20	Accepted for processing.
21	Missing or invalid information.
22	... before entering the adjudication system.
23	Returned to entity.
24	Entity not approved as an electronic submitter.
25	Entity not approved.

Code	Description
26	Entity not found.
27	Policy canceled.
28	Claim submitted to wrong payer.
29	Subscriber and policy number/contract number mismatched.
30	Subscriber and subscriber id mismatched.
31	Subscriber and policyholder name mismatched.
32	Subscriber and policy number/contract number not found.
33	Subscriber and subscriber id not found.
34	Subscriber and policyholder name not found.
35	Claim/encounter not found.
37	Predetermination is on file, awaiting completion of services.
38	Awaiting next periodic adjudication cycle.
39	Charges for pregnancy deferred until delivery.
40	Waiting for final approval.
41	Special handling required at payer site.
42	Awaiting related charges.
44	Charges pending provider audit.
45	Awaiting benefit determination.
46	Internal review/audit.
47	Internal review/audit - partial payment made.
48	Referral/authorization.
49	Pending provider accreditation review.
50	Claim waiting for internal provider verification.

Code	Description
51	Investigating occupational illness/accident.
52	Investigating existence of other insurance coverage.
53	Claim being researched for Insured ID/Group Policy Number error.
54	Duplicate of a previously processed claim/line.
55	Claim assigned to an approver/analyst.
56	Awaiting eligibility determination.
57	Pending COBRA information requested.
59	Non-electronic request for information.
60	Electronic request for information.
61	Eligibility for extended benefits.
64	Re-pricing information.
65	Claim/line has been paid.
66	Payment reflects usual and customary charges.
67	Payment made in full.
68	Partial payment made for this claim.
69	Payment reflects plan provisions.
70	Payment reflects contract provisions.
71	Periodic installment released.
72	Claim contains split payment.
73	Payment made to entity, assignment of benefits not on file.

Code	Description
78	Duplicate of an existing claim/line, awaiting processing.
81	Contract/plan does not cover pre-existing conditions.
83	No coverage for newborns.
84	Service not authorized.
85	Entity not primary.
86	Diagnosis and patient gender mismatch.
87	Denied: Entity not found.
88	Entity not eligible for benefits for submitted dates of service.
89	Entity not eligible for dental benefits for submitted dates of service.
90	Entity not eligible for medical benefits for submitted dates of service.
91	Entity not eligible/not approved for dates of service.
92	Entity does not meet dependent or student qualification.
93	Entity is not selected primary care provider.
94	Entity not referred by selected primary care provider.
95	Requested additional information not received.
96	No agreement with entity.
97	Patient eligibility not found with entity.
98	Charges applied to deductible.
99	Pre-treatment review.
100	Pre-certification penalty taken.

Code	Description
101	Claim was processed as adjustment to previous claim.
102	Newborn's charges processed on mother's claim.
103	Claim combined with other claim(s).
104	Processed according to plan provisions.
105	Claim/line is capitated.
106	This amount is not entity's responsibility.
107	Processed according to contract/plan provisions.
108	Coverage has been canceled for this entity.
109	Entity not eligible.
110	Claim requires pricing information.
111	At the policyholder's request these claims cannot be submitted electronically.
112	Policyholder processes their own claims.
113	Cannot process individual insurance policy claims.
114	Should be handled by entity.
115	Cannot process HMO claims.
116	Claim submitted to incorrect payer.
117	Claim requires signature-on-file indicator.
118	TPO rejected claim/line because payer name is missing.
119	TPO rejected claim/line because certification information is missing.
120	TPO rejected claim/line because claim does not contain enough information.
121	Service line number greater than maximum allowable for payer.
122	Missing/invalid data prevents payer from processing claim.
123	Additional information requested from entity.
124	Entity's name, address, phone and id number.
125	Entity's name.

Code	Description
126	Entity's address.
127	Entity's phone number.
128	Entity's tax id.
129	Entity's Blue Cross provider id.
130	Entity's Blue Shield provider id.
131	Entity's Medicare provider id.
132	Entity's Medicaid provider id.
133	Entity's UPIN.
134	Entity's CHAMPUS provider id.
135	Entity's commercial provider id.
136	Entity's health industry id number.
137	Entity's plan network id.
138	Entity's site id .
139	Entity's health maintenance provider id (HMO).
140	Entity's preferred provider organization id (PPO).
141	Entity's administrative services organization id ( ASO).
142	Entity's license/certification number.
143	Entity's state license number.
144	Entity's specialty license number.
145	Entity's specialty code.
146	Entity's anesthesia license number.
147	Entity's qualification degree/designation (e.g. RN, PhD,MD).
148	Entity's social security number.
149	Entity's employer id.
150	Entity's drug enforcement agency ( DEA) number.

Code	Description
152	Pharmacy processor number.
153	Entity's id number.
154	Relationship of surgeon & assistant surgeon.
155	Entity's relationship to patient.
156	Patient relationship to subscriber.
157	Entity's Gender.
158	Entity's date of birth.
159	Entity's date of death.
160	Entity's marital status.
161	Entity's employment status.
162	Entity's health insurance claim number ( HICN).
163	Entity's policy number.
164	Entity's contract/member number.
165	Entity's employer name, address and phone.
166	Entity's employer name.
167	Entity's employer address.
168	Entity's employer phone number.
169	Entity's employer id.
170	Entity's employee id.
171	Other insurance coverage information (health, liability, auto, etc.).
172	Other employer name, address and telephone number.
173	Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber.
174	Entity's student status.
175	Entity's school name.

Code	Description
176	Entity's school address.
177	Transplant recipient's name, date of birth, gender, relationship to insured.
178	Submitted charges.
179	Outside lab charges.
180	Hospital s semi-private room rate.
181	Hospital s room rate.
182	Allowable/paid from primary coverage.
183	Amount entity has paid.
184	Purchase price for the rented durable medical equipment.
185	Rental price for durable medical equipment.
186	Purchase and rental price of durable medical equipment.
187	Date(s) of service.
188	Statement from-through dates.
189	Hospital admission date.
190	Hospital discharge date.
191	Date of Last Menstrual Period ( LMP)
192	Date of first service for current series/symptom/illness.
193	First consultation/evaluation date.
194	Confinement dates.
195	Unable to work dates.
196	Return to work dates.
197	Effective coverage date(s).
198	Medicare effective date.
199	Date of conception and expected date of delivery.
200	Date of equipment return.

Code	Description
201	Date of dental appliance prior placement.
202	Date of dental prior replacement/reason for replacement.
203	Date of dental appliance placed.
204	Date dental canal(s) opened and date service completed.
205	Date(s) dental root canal therapy previously performed.
206	Most recent date of curettage, root planing, or periodontal surgery.
207	Dental impression and seating date.
208	Most recent date pacemaker was implanted.
209	Most recent pacemaker battery change date.
210	Date of the last x-ray.
211	Date(s) of dialysis training provided to patient.
212	Date of last routine dialysis.
213	Date of first routine dialysis.
214	Original date of prescription/orders/referral.
215	Date of tooth extraction/evolution.
216	Drug information.
217	Drug name, strength and dosage form.
218	NDC number.
219	Prescription number.
220	Drug product id number.
221	Drug days supply and dosage.
222	Drug dispensing units and average wholesale price ( AWP).
223	Route of drug/ myelogram administration.
224	Anatomical location for joint injection.
225	Anatomical location.

Code	Description
226	Joint injection site.
227	Hospital information.
228	Type of bill for UB-04 claim.
229	Hospital admission source.
230	Hospital admission hour.
231	Hospital admission type.
232	Admitting diagnosis.
233	Hospital discharge hour.
234	Patient discharge status.
235	Units of blood furnished.
236	Units of blood replaced.
237	Units of deductible blood.
238	Separate claim for mother/baby charges.
239	Dental information.
240	Tooth surface(s) involved.
241	List of all missing teeth (upper and lower).
242	Tooth numbers, surfaces, and/or quadrants involved.
243	Months of dental treatment remaining.
244	Tooth number or letter.
245	Dental quadrant/arch.
246	Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
247	Line information.
248	Accident date, state, description and cause.
249	Place of service.
250	Type of service.

Code	Description
251	Total anesthesia minutes.
252	Authorization/certification number.
253	Procedure/revenue code for service(s) rendered. Please use codes 454 or 455.
254	Primary diagnosis code.
255	Diagnosis code.
256	DRG code(s).
257	ADSM-III-R code for services rendered.
258	Days/units for procedure/revenue code.
259	Frequency of service.
260	Length of medical necessity, including begin date.
261	Obesity measurements.
262	Type of surgery/service for which anesthesia was administered.
263	Length of time for services rendered.
264	Number of liters/minute & total hours/day for respiratory support.
265	Number of lesions excised.
266	Facility point of origin and destination - ambulance.
267	Number of miles patient was transported.
268	Location of durable medical equipment use.
269	Length/size of laceration/tumor.
270	Subluxation location.
271	Number of spine segments.
272	Oxygen contents for oxygen system rental.
273	Weight.
274	Height.
275	Claim.

Code	Description
276	UB-04/HCFA-1450/HCFA-1500 claim form.
277	Paper claim.
278	Signed claim form.
279	Itemized claim.
280	Itemized claim by provider.
281	Related confinement claim.
282	Copy of prescription.
283	Medicare worksheet.
284	Copy of Medicare ID card.
285	Vouchers/explanation of benefits ( EOB).
286	Other payer's Explanation of Benefits/payment information.
287	Medical necessity for service.
288	Reason for late hospital charges.
289	Reason for late discharge.
290	Pre-existing information.
291	Reason for termination of pregnancy.
292	Purpose of family conference/therapy.
293	Reason for physical therapy.
294	Supporting documentation.
295	Attending physician report.
296	Nurse's notes.
297	Medical notes/report.
298	Operative report.
299	Emergency room notes/report.
300	Lab/test report/notes/results.

Code	Description
301	MRI report.
302	Refer to codes 300 for lab notes and 311 for pathology notes.
303	Physical therapy notes. Please use code 297:6O (6 'OH' - not zero).
304	Reports for service.
305	X-ray reports/interpretation.
306	Detailed description of service.
307	Narrative with pocket depth chart.
308	Discharge summary.
309	Code was a duplicate of code 299.
310	Progress notes for the six months prior to statement date.
311	Pathology notes/report.
312	Dental charting.
313	Bridgework information.
314	Dental records for this service.
315	Past perio treatment history.
316	Complete medical history.
317	Patient's medical records.
318	X-rays.
319	Pre/post-operative x-rays/photographs.
320	Study models.
321	Radiographs or models.
322	Recent fm x-rays.
323	Study models, x-rays, and/or narrative.
324	Recent x-ray of treatment area and/or narrative.
325	Recent fm x-rays and/or narrative.

Code	Description
326	Copy of transplant acquisition invoice.
327	Periodontal case type diagnosis and recent pocket depth chart with narrative.
328	Speech therapy notes. Please use code 297:6R.
329	Exercise notes.
330	Occupational notes.
331	History and physical.
332	Authorization/certification (include period covered).
333	Patient release of information authorization.
334	Oxygen certification.
335	Durable medical equipment certification.
336	Chiropractic certification.
337	Ambulance certification/documentation.
338	Home health certification. Please use code 332:4Y.
339	Enteral/ parenteral certification.
340	Pacemaker certification.
341	Private duty nursing certification.
342	Podiatric certification.
343	Documentation that facility is state licensed and Medicare approved as a surgical facility.
344	Documentation that provider of physical therapy is Medicare Part B approved.
345	Treatment plan for service/diagnosis.
346	Proposed treatment plan for next 6 months.
347	Refer to code 345 for treatment plan and code 282 for prescription.
348	Chiropractic treatment plan.
349	Psychiatric treatment plan. Please use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P.
350	Speech pathology treatment plan. Please use code 345:6R.

Code	Description
351	Physical/occupational therapy treatment plan. Please use codes 345:6O (6 'OH' - not zero), 6N.
352	Duration of treatment plan.
353	Orthodontics treatment plan.
354	Treatment plan for replacement of remaining missing teeth.
355	Has claim been paid?
356	Was blood furnished?
357	Has or will blood be replaced?
358	Does provider accept assignment of benefits?
359	Is there a release of information signature on file?
360	Is there an assignment of benefits signature on file?
361	Is there other insurance?
362	Is the dental patient covered by medical insurance?
363	Will worker's compensation cover submitted charges?
364	Is accident/illness/condition employment related?
365	Is service the result of an accident?
366	Is injury due to auto accident?
367	Is service performed for a recurring condition or new condition?
368	Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility?
369	Does patient condition preclude use of ordinary bed?
370	Can patient operate controls of bed?
371	Is patient confined to room?
372	Is patient confined to bed?
373	Is patient an insulin diabetic?
374	Is prescribed lenses a result of cataract surgery?
375	Was refraction performed?

Code	Description
376	Was charge for ambulance for a round-trip?
377	Was durable medical equipment purchased new or used?
378	Is pacemaker temporary or permanent?
379	Were services performed supervised by a physician?
380	Were services performed by a CRNA under appropriate medical direction?
381	Is drug generic?
382	Did provider authorize generic or brand name dispensing?
383	Was nerve block used for surgical procedure or pain management?
384	Is prosthesis/crown/inlay placement an initial placement or a replacement?
385	Is appliance upper or lower arch & is appliance fixed or removable?
386	Is service for orthodontic purposes?
387	Date patient last examined by entity.
388	Date post-operative care assumed.
389	Date post-operative care relinquished.
390	Date of most recent medical event necessitating service(s).
391	Date(s) dialysis conducted.
392	Date(s) of blood transfusion(s).
393	Date of previous pacemaker check.
394	Date(s) of most recent hospitalization related to service.
395	Date entity signed certification/ recertification.
396	Date home dialysis began.
397	Date of onset/exacerbation of illness/condition.
398	Visual field test results.
399	Report of prior testing related to this service, including dates.
400	Claim is out of balance.

Code	Description
401	Source of payment is not valid.
402	Amount must be greater than zero.
403	Entity referral notes/orders/prescription.
404	Specific findings, complaints, or symptoms necessitating service.
405	Summary of services.
406	Brief medical history as related to service(s).
407	Complications/mitigating circumstances.
408	Initial certification.
409	Medication logs/records (including medication therapy).
410	Explain differences between treatment plan and patient's condition.
411	Medical necessity for non-routine service(s).
412	Medical records to substantiate decision of non-coverage.
413	Explain/justify differences between treatment plan and services rendered.
414	Need for more than one physician to treat patient.
415	Justify services outside composite rate.
416	Verification of patient's ability to retain and use information.
417	Prior testing, including result(s) and date(s) as related to service(s).
418	Indicating why medications cannot be taken orally.
419	Individual test(s) comprising the panel and the charges for each test.
420	Name, dosage and medical justification of contrast material used for radiology procedure.
421	Medical review attachment/information for service(s).
422	Homebound status.
423	Prognosis.
424	Statement of non-coverage including itemized bill.
425	Itemize non-covered services.

Code	Description
426	All current diagnoses.
427	Emergency care provided during transport.
428	Reason for transport by ambulance.
429	Loaded miles and charges for transport to nearest facility with appropriate services.
430	Nearest appropriate facility.
431	Provide condition/functional status at time of service.
432	Date benefits exhausted.
433	Copy of patient revocation of hospice benefits.
434	Reasons for more than one transfer per entitlement period.
435	Notice of Admission.
436	Short term goals.
437	Long term goals.
438	Number of patients attending session.
439	Size, depth, amount, and type of drainage wounds.
440	why non-skilled caregiver has not been taught procedure.
441	Entity professional qualification for service(s).
442	Modalities of service.
443	Initial evaluation report.
444	Method used to obtain test sample.
445	Explain why hearing loss not correctable by hearing aid.
446	Documentation from prior claim(s) related to service(s).
447	Plan of teaching.
448	Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used.
449	Projected date to discontinue service(s).
450	Awaiting spend down determination.

Code	Description
451	Preoperative and post-operative diagnosis.
452	Total visits in total number of hours/day and total number of hours/week.
453	Procedure Code Modifier(s) for Service(s) Rendered.
454	Procedure code for services rendered.
455	Revenue code for services rendered.
456	Covered Day(s).
457	Non-Covered Day(s).
458	Coinsurance Day(s).
459	Lifetime Reserve Day(s).
460	NUBC Condition Code(s).
461	NUBC Occurrence Code(s) and Date(s).
462	NUBC Occurrence Span Code(s) and Date(s).
463	NUBC Value Code(s) and/or Amount(s).
464	Payer Assigned Control Number.
465	Principal Procedure Code for Service(s) Rendered.
466	Entities Original Signature.
467	Entity Signature Date.
468	Patient Signature Source.
469	Purchase Service Charge.
470	Was service purchased from another entity?
471	Were services related to an emergency?
472	Ambulance Run Sheet.
473	Missing or invalid lab indicator.
474	Procedure code and patient gender mismatch.
475	Procedure code not valid for patient age.

Code	Description
476	Missing or invalid units of service.
477	Diagnosis code pointer is missing or invalid.
478	Claim submitter's identifier (patient account number) is missing.
479	Other Carrier payer ID is missing or invalid.
480	Other Carrier Claim filing indicator is missing or invalid.
481	Claim/submission format is invalid.
482	Date Error, Century Missing.
483	Maximum coverage amount met or exceeded for benefit period.
484	Business Application Currently Not Available.
485	More information available than can be returned in real time mode. Narrow your current search criteria.
486	Principle Procedure Date.
487	Claim not found, claim should have been submitted to/through 'entity'.
488	Diagnosis code(s) for the services rendered.
489	Attachment Control Number.
490	Other Procedure Code for Service(s) rendered.
491	Entity not eligible for encounter submission.
492	Other Procedure date.
493	Version/Release/Industry ID code not currently supported by information holder.
494	Real-Time requests not supported by the information holder, resubmit as batch request.
495	Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit.
496	Submitter not approved for electronic claim submissions on behalf of this entity.
497	Sales tax not paid.
498	Maximum leave days exhausted.
499	No rate on file with the payer for this service for this entity.
500	Entity's Postal/Zip Code.
501	Entity's State/Province.
502	Entity's City.
503	Entity's Street Address.
504	Entity's Last Name.
505	Entity's First Name.
506	Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse.
507	HCPCS
508	ICD9
509	E-Code
510	Future date
511	Invalid character
512	Length invalid for receiver's application system.
513	HIPPS Rate Code for services Rendered.
514	Entities Middle Name.
515	Managed Care review.
516	Adjudication or Payment Date.
517	Adjusted Repriced Claim Reference Number.
518	Adjusted Repriced Line item Reference Number .
519	Adjustment Amount.
520	Adjustment Quantity.
521	Adjustment Reason Code.
522	Anesthesia Modifying Units.
523	Anesthesia Unit Count.
524	Arterial Blood Gas Quantity.
525	Begin Therapy Date.
526	Bundled or Unbundled Line Number.
527	Certification Condition Indicator.
528	Certification Period Projected Visit Count.
529	Certification Revision Date.
530	Claim Adjustment Indicator.
531	Claim Disproportionate Share Amount.
532	Claim DRG Amount.
533	Claim DRG Outlier Amount.
534	Claim ESRD Payment Amount.
535	Claim Frequency Code.
536	Claim Indirect Teaching Amount.
537	Claim MSP Pass-through Amount.
538	Claim or Encounter Identifier.
539	Claim PPS Capital Amount.
540	Claim PPS Capital Outlier Amount.
541	Claim Submission Reason Code .
542	Claim Total Denied Charge Amount.
543	Clearinghouse or Value Added Network Trace.
544	Clinical Laboratory Improvement Amendment.
545	Contract Amount.
546	Contract Code.
547	Contract Percentage.
548	Contract Type Code.
549	Contract Version Identifier.
550	Coordination of Benefits Code.
551	Coordination of Benefits Total Submitted Charge.
552	Cost Report Day Count.
553	Covered Amount.
554	Date Claim Paid.
555	Delay Reason Code.
556	Demonstration Project Identifier.
557	Diagnosis Date.
558	Discount Amount.
559	Document Control Identifier.
560	Entity's Additional/Secondary Identifier.
561	Entity's Contact Name.
562	Entity's National Provider Identifier (NPI).
563	Entity's Tax Amount.
564	EPSDT Indicator.
565	Estimated Claim Due Amount.
566	Exception Code.
567	Facility Code Qualifier.
568	Family Planning Indicator.
569	Fixed Format Information.
570	Free Form Message Text.
571	Frequency Count.
572	Frequency Period.
573	Functional Limitation Code.
574	HCPCS Payable Amount Home Health.
575	Homebound Indicator.
576	Immunization Batch Number.
577	Industry Code.
578	Insurance Type Code.
579	Investigational Device Exemption Identifier.
580	Last Certification Date.
581	Last Worked Date.
582	Lifetime Psychiatric Days Count.
583	Line Item Charge Amount.
584	Line Item Control Number.
585	Line Item Denied Charge or Non-covered Charge.
586	Line Note Text.
587	Measurement Reference Identification Code.
588	Medical Record Number.
589	Medicare Assignment Code.
590	Medicare Coverage Indicator.
591	Medicare Paid at 100% Amount.
592	Medicare Paid at 80% Amount
593	Medicare Section 4081 Indicator.
594	Mental Status Code.
595	Monthly Treatment Count.
596	Non-covered Charge Amount.
597	Non-payable Professional Component Amount.
598	Non-payable Professional Component Billed Amount.
599	Note Reference Code.
600	Oxygen Saturation Qty.
601	Oxygen Test Condition Code.
602	Oxygen Test Date.
603	Old Capital Amount.
604	Originator Application Transaction Identifier.
605	Orthodontic Treatment Months Count.
606	Paid From Part A Medicare Trust Fund Amount.
607	Paid From Part B Medicare Trust Fund Amount.
608	Paid Service Unit Count.
609	Participation Agreement.
610	Patient Discharge Facility Type Code.
611	Peer Review Authorization Number.
612	Per Day Limit Amount.
613	Physician Contact Date.
614	Physician Order Date.
615	Policy Compliance Code.
616	Policy Name.
617	Postage Claimed Amount.
618	PPS-Capital DSH DRG Amount.
619	PPS-Capital Exception Amount.
620	PPS-Capital FSP DRG Amount.
621	PPS-Capital HSP DRG Amount.
622	PPS-Capital IME Amount.
623	PPS-Operating Federal Specific DRG Amount.
624	PPS-Operating Hospital Specific DRG Amount.
625	Predetermination of Benefits Identifier.
626	Pregnancy Indicator.
627	Pre-Tax Claim Amount.
628	Pricing Methodology.
629	Property Casualty Claim Number.
630	Referring CLIA Number.
631	Reimbursement Rate.
632	Reject Reason Code.
633	Related Causes Code.
634	Remark Code.
635	Repriced Approved Ambulatory Patient Group.
636	Repriced Line Item Reference Number.
637	Repriced Saving Amount.
638	Repricing Per Diem or Flat Rate Amount.
639	Responsibility Amount.
640	Sales Tax Amount.
641	Service Adjudication or Payment Date.
642	Service Authorization Exception Code.
643	Service Line Paid Amount.
644	Service Line Rate.
645	Service Tax Amount.
646	Ship, Delivery or Calendar Pattern Code.
647	Shipped Date.
648	Similar Illness or Symptom Date.
649	Skilled Nursing Facility Indicator.
650	Special Program Indicator.
651	State Industrial Accident Provider Number.
652	Terms Discount Percentage.
653	Test Performed Date.
654	Total Denied Charge Amount.
655	Total Medicare Paid Amount.
656	Total Visits Projected This Certification Count.
657	Total Visits Rendered Count.
658	Treatment Code.
659	Unit or Basis for Measurement Code.
660	Universal Product Number .
661	Visits Prior to Recertification Date Count CR702.
662	X-ray Availability Indicator.
663	Entity's Group Name.
664	Orthodontic Banding Date.
665	Surgery Date.
666	Surgical Procedure Code.