HTA License Conformance Analysis for CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)

The content of this page is being developed with the HTA committee, and is subject to further change. Editors are welcome to use this page to pick up errors in their definitions, but should not regard the analysis as final.

https://www.nubc.org/CodeSystem/TypeOfBill (AHA NUBC Type Of Bill Codes)

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
AHANUBCTypeOfBill NUBC Type of Bill Codes Value Set

Licensing information can be found here.

These codes are listed within the UB-04 Data Specifications Manual. The Official UB-04 Data Specifications Manual, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee. No other publication—governmental or private/commercial—can be considered authoritative. The AHA wants to make you aware that the use of codes, descriptions, or any other content contained in the manual to be used in a software application, publication, or any other derivative work must be properly licensed by the AHA. If your organization uses or intends to use any of the codes or other related content from the manual in this manner, please contact the AHA’s licensing manager, Tim Carlson, at 312.893.6816 or email tcarlson@aha.org

https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set (CMS Place of Service Codes (POS))

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URL Name Copyright Notes
CMSPlaceofServiceCodes CMS Place of Service Codes (POS) Value Set

The Centers for Medicare & Medicaid Services (CMS) maintain Place Of Service (POS) codes used throughout the US health care industry. The CMS POS codes are free to use without restriction.

https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit (AHA NUBC Priority (Type) of Admission or Visit)

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
AHANUBCPriorityTypeOfAdmissionOrVisit NUBC Priority (Type) of Admission or Visit Value Set

Licensing information can be found here.

These codes are listed within the UB-04 Data Specifications Manual. The Official UB-04 Data Specifications Manual, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee. No other publication—governmental or private/commercial—can be considered authoritative. The AHA wants to make you aware that the use of codes, descriptions, or any other content contained in the manual to be used in a software application, publication, or any other derivative work must be properly licensed by the AHA. If your organization uses or intends to use any of the codes or other related content from the manual in this manner, please contact the AHA’s licensing manager, Tim Carlson, at 312.893.6816 or email tcarlson@aha.org

http://www.ama-assn.org/go/cpt (Current Procedural Terminology (CPT®))

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Current Procedural Terminology (CPT) is copyright 2020 American Medical Association. All rights reserved

Approved:To be resolved

URL Name Copyright Notes
C4BBEOBInstitutionalProcedureCodes Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set
AMACPTCMSHCPCSModifiers Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set
AMACPTCMSHCPCSProcedureCodes Procedure Codes - AMA CPT - CMS HCPCS Value Set

https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets (Healthcare Common Procedure Coding System (HCPCS) level II alphanumeric codes)

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
C4BBEOBInstitutionalProcedureCodes Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set

Current Procedural Terminology (CPT) is copyright 2020 American Medical Association. All rights reserved

See information on the use of HCPCS Level I (proprietary and owned by American Medical Association) and Level II codes here

CMS maintains HIPPS. There are no known constraints on the use of HIPPS. See more information about HIPPS codes here

AMACPTCMSHCPCSModifiers Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set

Current Procedural Terminology (CPT) is copyright 2020 American Medical Association. All rights reserved

See information on the use of HCPCS Level I (proprietary and owned by American Medical Association) and Level II codes here

AMACPTCMSHCPCSProcedureCodes Procedure Codes - AMA CPT - CMS HCPCS Value Set

Current Procedural Terminology (CPT) is copyright 2020 American Medical Association. All rights reserved

See information on the use of HCPCS Level I (proprietary and owned by American Medical Association) and Level II codes here

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes (Health Insurance Prospective Payment System (HIPPS))

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
C4BBEOBInstitutionalProcedureCodes Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set

Current Procedural Terminology (CPT) is copyright 2020 American Medical Association. All rights reserved

See information on the use of HCPCS Level I (proprietary and owned by American Medical Association) and Level II codes here

CMS maintains HIPPS. There are no known constraints on the use of HIPPS. See more information about HIPPS codes here

http://www.ada.org/cdt (Code on Dental Procedures and Nomenclature)

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URL Name Copyright Notes
ADADentalProcedureCode ADA Code on Dental Procedures and Nomenclature Value Set

American Dental Association (ADA) developed Current Dental Terminology (CDT®) as a standardized language to help dentists and other members of the healthcare industry communicate effectively. CDT is revised and updated every year.

The ADA is the exclusive copyright owner of CDT, the Code on Dental Procedures and Nomenclature (the Code), and the ADA Dental Claim Form. Except as permitted by law, all use, copying or distribution of CDT, or any portion thereof (including the Code on Dental Procedures and Nomenclature) in any product or services (including works prepared for clients by consultants and other professionals), whether in printed, electronic or other format, requires a valid commercial user license from the ADA.

For more information : https://www.ada.org/en/publications/ada-catalog/cdt-products/licensing-for-commercial-users

https://x12.org/codes/claim-adjustment-reason-codes (X12 Claim Adjustment Reason Codes)

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set

Intellectual Property Information

All X12 products are subject to this IP policy, including published and draft works.

X12 is the only organization authorized to grant permission for use of X12 products. Users of all X12 products should make sure that they understand the permissible uses, as well as the limitations on such usage, as outlined below.

Additional IP information can be found here: https://x12.org/products/ip-use

Licensing Information

Send an email to ip@x12.org to request permission to reproduce X12 IP. Include your name, organization, title, address, city, state, zip, email, a detailed description of the Submitted Artifact, including the underlying or cited X12 Product, and a detailed description of the intended audience and planned distribution method for the Artifact.

Additional information on X12 licensing program can be found here:

https://x12.org/products/licensing-program

Purchasing Information:

To purchase code list subscriptions call (425) 562-2245 or email admin@wpc-edi.com

The Centers for Medicare & Medicaid Services (CMS) maintain Remittance Advice Remark Codes (RARC) used throughout the US health care industry.

https://x12.org/codes/remittance-advice-remark-codes (X12 Remittance Advice Remark Codes)

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set

Intellectual Property Information

All X12 products are subject to this IP policy, including published and draft works.

X12 is the only organization authorized to grant permission for use of X12 products. Users of all X12 products should make sure that they understand the permissible uses, as well as the limitations on such usage, as outlined below.

Additional IP information can be found here: https://x12.org/products/ip-use

Licensing Information

Send an email to ip@x12.org to request permission to reproduce X12 IP. Include your name, organization, title, address, city, state, zip, email, a detailed description of the Submitted Artifact, including the underlying or cited X12 Product, and a detailed description of the intended audience and planned distribution method for the Artifact.

Additional information on X12 licensing program can be found here:

https://x12.org/products/licensing-program

Purchasing Information:

To purchase code list subscriptions call (425) 562-2245 or email admin@wpc-edi.com

The Centers for Medicare & Medicaid Services (CMS) maintain Remittance Advice Remark Codes (RARC) used throughout the US health care industry.

http://www.cms.gov/Medicare/Coding/ICD10 (ICD-10 Procedure Codes)

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Approved:To be resolved

URL Name Copyright Notes
CMSICD910PCSProcedureCodes Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set

The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed for the Centers for Medicare and Medicaid Services (CMS) available for public use. CMS is the U.S. governmental agency responsible for overseeing all changes and modifications to the ICD-10-PCS. The International Classification of Diseases, Ninth Revision, Procedure Coding System (ICD-9-PCS) was developed for the Centers for Medicare and Medicaid Services (CMS) available for public use. CMS is the U.S. governmental agency responsible for overseeing all changes and modifications to the ICD-9-PCS.

http://www.cms.gov/Medicare/Coding/ICD9

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
CMSICD910PCSProcedureCodes Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set

The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) was developed for the Centers for Medicare and Medicaid Services (CMS) available for public use. CMS is the U.S. governmental agency responsible for overseeing all changes and modifications to the ICD-10-PCS. The International Classification of Diseases, Ninth Revision, Procedure Coding System (ICD-9-PCS) was developed for the Centers for Medicare and Medicaid Services (CMS) available for public use. CMS is the U.S. governmental agency responsible for overseeing all changes and modifications to the ICD-9-PCS.

https://www.nubc.org/CodeSystem/RevenueCodes (AHA NUBC Revenue Codes)

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
AHANUBCRevenueCodes NUBC Revenue Codes Value Set

Licensing information can be found here.

These codes are listed within the UB-04 Data Specifications Manual. The Official UB-04 Data Specifications Manual, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee. No other publication—governmental or private/commercial—can be considered authoritative. The AHA wants to make you aware that the use of codes, descriptions, or any other content contained in the manual to be used in a software application, publication, or any other derivative work must be properly licensed by the AHA. If your organization uses or intends to use any of the codes or other related content from the manual in this manner, please contact the AHA’s licensing manager, Tim Carlson, at 312.893.6816 or email tcarlson@aha.org

https://www.nubc.org/CodeSystem/PointOfOrigin (AHA NUBC Point of Origin for Non-newborn)

Uses1
Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
AHANUBCPointOfOriginForAdmissionOrVisit NUBC Point Of Origin Value Set

Licensing information can be found here.

These codes are listed within the UB-04 Data Specifications Manual. The Official UB-04 Data Specifications Manual, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee. No other publication—governmental or private/commercial—can be considered authoritative. The AHA wants to make you aware that the use of codes, descriptions, or any other content contained in the manual to be used in a software application, publication, or any other derivative work must be properly licensed by the AHA. If your organization uses or intends to use any of the codes or other related content from the manual in this manner, please contact the AHA’s licensing manager, Tim Carlson, at 312.893.6816 or email tcarlson@aha.org

https://www.nubc.org/CodeSystem/PointOfOriginNewborn (AHA NUBC Point of Origin for Newborn)

Uses1
Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
AHANUBCPointOfOriginForAdmissionOrVisit NUBC Point Of Origin Value Set

Licensing information can be found here.

These codes are listed within the UB-04 Data Specifications Manual. The Official UB-04 Data Specifications Manual, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee. No other publication—governmental or private/commercial—can be considered authoritative. The AHA wants to make you aware that the use of codes, descriptions, or any other content contained in the manual to be used in a software application, publication, or any other derivative work must be properly licensed by the AHA. If your organization uses or intends to use any of the codes or other related content from the manual in this manner, please contact the AHA’s licensing manager, Tim Carlson, at 312.893.6816 or email tcarlson@aha.org

https://www.nubc.org/CodeSystem/PatDischargeStatus (AHA NUBC Patient Discharge Status Codes)

Uses1
Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
AHANUBCPatientDischargeStatus NUBC Patient Discharge Status Codes Value Set

Licensing information can be found here.

These codes are listed within the UB-04 Data Specifications Manual. The Official UB-04 Data Specifications Manual, copyrighted by the American Hospital Association, is the only official source of UB-04 billing information adopted by the National Uniform Billing Committee. No other publication—governmental or private/commercial—can be considered authoritative. The AHA wants to make you aware that the use of codes, descriptions, or any other content contained in the manual to be used in a software application, publication, or any other derivative work must be properly licensed by the AHA. If your organization uses or intends to use any of the codes or other related content from the manual in this manner, please contact the AHA’s licensing manager, Tim Carlson, at 312.893.6816 or email tcarlson@aha.org

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software (Medicare Severity Diagnosis Related Groups (MS-DRGs))

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Approved:To be resolved

URL Name Copyright Notes
CMSMS3MAPAPRDRG MS-DRGs - AP-DRGs - APR-DRGs Value Set

The Centers for Medicare & Medicaid Services (CMS) maintain MS-DRGs used throughout the US health care industry. The CMS MS-DRGs are free to use without restriction.

The clinical logic is maintained by a team of 3M clinicians, data analysts, nosologists, programmers and economists. The logic is proprietary to 3M but is available for licensees to view in an online definitions manual.

To license APR DRG from 3M, see request form here

http://uri.hddaccess.com/cs/apdrg (All Patient Diagnosis Related Groups (AP DRGs))

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Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
CMSMS3MAPAPRDRG MS-DRGs - AP-DRGs - APR-DRGs Value Set

The Centers for Medicare & Medicaid Services (CMS) maintain MS-DRGs used throughout the US health care industry. The CMS MS-DRGs are free to use without restriction.

The clinical logic is maintained by a team of 3M clinicians, data analysts, nosologists, programmers and economists. The logic is proprietary to 3M but is available for licensees to view in an online definitions manual.

To license APR DRG from 3M, see request form here

http://uri.hddaccess.com/cs/aprdrg (All Patient Refined Diagnosis Related Groups (APR DRGs))

Uses1
Expected Copyright(copyright expectations unknown)
Approved:To be resolved

URL Name Copyright Notes
CMSMS3MAPAPRDRG MS-DRGs - AP-DRGs - APR-DRGs Value Set

The Centers for Medicare & Medicaid Services (CMS) maintain MS-DRGs used throughout the US health care industry. The CMS MS-DRGs are free to use without restriction.

The clinical logic is maintained by a team of 3M clinicians, data analysts, nosologists, programmers and economists. The logic is proprietary to 3M but is available for licensees to view in an online definitions manual.

To license APR DRG from 3M, see request form here