HL7 v2.5 Vocabulary
0.1.0 - ci-build

HL7 v2.5 Vocabulary, published by HL7/FO. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/frankoemig/hl7.v2.terminology.v25/ and changes regularly. See the Directory of published versions

## : OCE Edit Code (2.5 - 1.0.0) - XML Representation

Active as of 2026-01-27

Raw xml | Download

    <CodeSystem xmlns="http://hl7.org/fhir">
      <id value="cms-OCEEditCode-cs"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><ul><li>Include all codes defined in <a href="CodeSystem-cms-OCEEditCode-cs.html"><code>http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs</code></a></li></ul></div>
      </text>
      <extension
                 url="http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-v2versionCreated">
        <valueString value="2.5"/>
      </extension>
      <extension
                 url="http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-versionHistory">
        <valueString value="generate correct history somehow"/>
      </extension>
      <extension
                 url="http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-tableNo">
        <valueString value="0458"/>
      </extension>
      <url
           value="http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.6.301.9"/>
      </identifier>
      <version value="1.0.0"/>
      <name value="Cms-OCEEditCode-cs"/>
      <title value="OCE Edit Code (2.5 - 1.0.0)"/>
      <status value="active"/>
      <experimental value="true"/>
      <date value="2026-01-27T19:23:43+00:00"/>
      <publisher value="HL7/FO"/>
      <contact>
        <name value="HL7/FO"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org"/>
        </telecom>
      </contact>
      <description
                   value="Code system of concepts specifying the action to be taken during reimbursement calculations.  Used in HL7 Version 2.x messaging in the GP2 segment."/>
      <copyright value="HL7 Inc., 2026"/>
      <caseSensitive value="true"/>
      <compositional value="false"/>
      <content value="complete"/>
      <property>
        <code value="versionIntroduced"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionIntroduced"/>
        <description value="version when was this code introduced"/>
        <type value="string"/>
      </property>
      <property>
        <code value="versionDeprecated"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionDeprecated"/>
        <description value="version when was this code deprecated"/>
        <type value="string"/>
      </property>
      <property>
        <code value="status"/>
        <uri value="http://hl7.org/fhir/concept-properties#status"/>
        <description
                     value="A code that indicates the status of the concept. Typical values are active, experimental, deprecated, and retired"/>
        <type value="code"/>
      </property>
      <property>
        <code value="comment"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#comment"/>
        <description
                     value="A string that provides additional detail pertinent to the use or understanding of the concept"/>
        <type value="string"/>
      </property>
      <property>
        <code value="usage"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#usage"/>
        <description value="usage notes for this code"/>
        <type value="string"/>
      </property>
      <property>
        <code value="modified"/>
        <uri
             value="http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#modified"/>
        <description value="date of last modification"/>
        <type value="dateTime"/>
      </property>
      <concept>
        <code value="1"/>
        <display value="Invalid diagnosis code"/>
        <definition value="Invalid diagnosis code"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="10"/>
        <display
                 value="Non-covered  service submitted for verification of denial (condition code 21 from header information on claim)"/>
        <definition
                    value="Non-covered  service submitted for verification of denial (condition code 21 from header information on claim)"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="11"/>
        <display
                 value="Non-covered service submitted for FI review (condition code 20 from header information on claim)"/>
        <definition
                    value="Non-covered service submitted for FI review (condition code 20 from header information on claim)"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="12"/>
        <display value="Questionable covered service"/>
        <definition value="Questionable covered service"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="13"/>
        <display value="Additional payment for service not provided by Medicare"/>
        <definition
                    value="Additional payment for service not provided by Medicare"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="14"/>
        <display value="Code indicates a site of service not included in OPPS"/>
        <definition
                    value="Code indicates a site of service not included in OPPS"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="15"/>
        <display value="Service unit out of range for procedure"/>
        <definition value="Service unit out of range for procedure"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="16"/>
        <display
                 value="Multiple bilateral procedures without modifier 50 (see Appendix A)"/>
        <definition
                    value="Multiple bilateral procedures without modifier 50 (see Appendix A)"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="17"/>
        <display
                 value="Multiple bilateral procedures with modifier 50 (see Appendix A)"/>
        <definition
                    value="Multiple bilateral procedures with modifier 50 (see Appendix A)"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="18"/>
        <display value="Inpatient procedure"/>
        <definition value="Inpatient procedure"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="19"/>
        <display
                 value="Mutually exclusive procedure that is not allowed even if appropriate modifier present"/>
        <definition
                    value="Mutually exclusive procedure that is not allowed even if appropriate modifier present"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="2"/>
        <display value="Diagnosis and age conflict"/>
        <definition value="Diagnosis and age conflict"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="20"/>
        <display
                 value="Component of a comprehensive procedure that is not allowed even if appropriate modifier present"/>
        <definition
                    value="Component of a comprehensive procedure that is not allowed even if appropriate modifier present"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="21"/>
        <display
                 value="Medical visit on same day as a type &quot;T&quot; or &quot;S&quot; procedure without modifier 25 (see Appendix B)"/>
        <definition
                    value="Medical visit on same day as a type &quot;T&quot; or &quot;S&quot; procedure without modifier 25 (see Appendix B)"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="22"/>
        <display value="Invalid modifier"/>
        <definition value="Invalid modifier"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="23"/>
        <display value="Invalid date"/>
        <definition value="Invalid date"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="24"/>
        <display value="Date out of OCE range"/>
        <definition value="Date out of OCE range"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="25"/>
        <display value="Invalid age"/>
        <definition value="Invalid age"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="26"/>
        <display value="Invalid sex"/>
        <definition value="Invalid sex"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="27"/>
        <display value="Only incidental services reported"/>
        <definition value="Only incidental services reported"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="28"/>
        <display
                 value="Code not recognized by Medicare; alternate code for same service available"/>
        <definition
                    value="Code not recognized by Medicare; alternate code for same service available"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="29"/>
        <display
                 value="Partial hospitalization service for non-mental health diagnosis"/>
        <definition
                    value="Partial hospitalization service for non-mental health diagnosis"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="3"/>
        <display value="Diagnosis and sex conflict"/>
        <definition value="Diagnosis and sex conflict"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="30"/>
        <display value="Insufficient services on day of partial hospitalization"/>
        <definition
                    value="Insufficient services on day of partial hospitalization"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="31"/>
        <display
                 value="Partial hospitalization on same day as ECT or type &quot;T&quot; procedure"/>
        <definition
                    value="Partial hospitalization on same day as ECT or type &quot;T&quot; procedure"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="32"/>
        <display
                 value="Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days"/>
        <definition
                    value="Partial hospitalization claim spans 3 or less days with in-sufficient services, or ECT or significant procedure on at least one of the days"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="33"/>
        <display
                 value="Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services"/>
        <definition
                    value="Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="34"/>
        <display
                 value="Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria"/>
        <definition
                    value="Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="35"/>
        <display
                 value="Only activity therapy and/or occupational therapy services provided"/>
        <definition
                    value="Only activity therapy and/or occupational therapy services provided"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="36"/>
        <display
                 value="Extensive mental health services provided on day of ECT or significant procedure"/>
        <definition
                    value="Extensive mental health services provided on day of ECT or significant procedure"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="37"/>
        <display
                 value="Terminated bilateral procedure or terminated procedure with units greater than one"/>
        <definition
                    value="Terminated bilateral procedure or terminated procedure with units greater than one"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="38"/>
        <display
                 value="Inconsistency between implanted device and implantation procedure"/>
        <definition
                    value="Inconsistency between implanted device and implantation procedure"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="39"/>
        <display
                 value="Mutually exclusive procedure that would be allowed if appropriate modifier were present"/>
        <definition
                    value="Mutually exclusive procedure that would be allowed if appropriate modifier were present"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="4"/>
        <display value="Medicare secondary payer alert"/>
        <definition value="Medicare secondary payer alert"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="40"/>
        <display
                 value="Component of a comprehensive procedure that would be allowed if appropriate modifier were present"/>
        <definition
                    value="Component of a comprehensive procedure that would be allowed if appropriate modifier were present"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="41"/>
        <display value="Invalid revenue code"/>
        <definition value="Invalid revenue code"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="42"/>
        <display
                 value="Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)"/>
        <definition
                    value="Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="5"/>
        <display value="E-code as reason for visit"/>
        <definition value="E-code as reason for visit"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="6"/>
        <display value="Invalid procedure code"/>
        <definition value="Invalid procedure code"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="7"/>
        <display value="Procedure and age conflict"/>
        <definition value="Procedure and age conflict"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="8"/>
        <display value="Procedure and sex conflict"/>
        <definition value="Procedure and sex conflict"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
      <concept>
        <code value="9"/>
        <display value="Nov-covered service"/>
        <definition value="Nov-covered service"/>
        <property>
          <code value="versionIntroduced"/>
          <valueString value="2.4"/>
        </property>
      </concept>
    </CodeSystem>