HL7 v2.5.1 Vocabulary
0.1.0 - ci-build

HL7 v2.5.1 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.v251/ and changes regularly. See the Directory of published versions

## : OCE Edit Code (2.5.1 - 1.0.0) - JSON Representation

Active as of 2026-01-27

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    {
      "resourceType" : "CodeSystem",
      "id" : "cms-OCEEditCode-cs",
      "text" : {
        "status" : "generated",
        "div" : "<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>"
      },
      "extension" : [
        {
          "url" : "http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-v2versionCreated",
          "valueString" : "2.5.1"
        },
        {
          "url" : "http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-versionHistory",
          "valueString" : "generate correct history somehow"
        },
        {
          "url" : "http://terminology.hl7.org/v2plusvocab/StructureDefinition/codesystem-tableNo",
          "valueString" : "0458"
        }
      ],
      "url" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/cms-OCEEditCode-cs",
      "identifier" : [
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:oid:2.16.840.1.113883.6.301.9"
        }
      ],
      "version" : "1.0.0",
      "name" : "Cms-OCEEditCode-cs",
      "title" : "OCE Edit Code (2.5.1 - 1.0.0)",
      "status" : "active",
      "experimental" : true,
      "date" : "2026-01-27T19:29:18+00:00",
      "publisher" : "HL7/FO",
      "contact" : [
        {
          "name" : "HL7/FO",
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org"
            }
          ]
        }
      ],
      "description" : "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" : "HL7 Inc., 2026",
      "caseSensitive" : true,
      "compositional" : false,
      "content" : "complete",
      "property" : [
        {
          "code" : "versionIntroduced",
          "uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionIntroduced",
          "description" : "version when was this code introduced",
          "type" : "string"
        },
        {
          "code" : "versionDeprecated",
          "uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#versionDeprecated",
          "description" : "version when was this code deprecated",
          "type" : "string"
        },
        {
          "code" : "status",
          "uri" : "http://hl7.org/fhir/concept-properties#status",
          "description" : "A code that indicates the status of the concept. Typical values are active, experimental, deprecated, and retired",
          "type" : "code"
        },
        {
          "code" : "comment",
          "uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#comment",
          "description" : "A string that provides additional detail pertinent to the use or understanding of the concept",
          "type" : "string"
        },
        {
          "code" : "usage",
          "uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#usage",
          "description" : "usage notes for this code",
          "type" : "string"
        },
        {
          "code" : "modified",
          "uri" : "http://terminology.hl7.org/v2plusvocab/CodeSystem/Property#modified",
          "description" : "date of last modification",
          "type" : "dateTime"
        }
      ],
      "concept" : [
        {
          "code" : "1",
          "display" : "Invalid diagnosis code",
          "definition" : "Invalid diagnosis code",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "10",
          "display" : "Non-covered  service submitted for verification of denial (condition code 21 from header information on claim)",
          "definition" : "Non-covered  service submitted for verification of denial (condition code 21 from header information on claim)",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "11",
          "display" : "Non-covered service submitted for FI review (condition code 20 from header information on claim)",
          "definition" : "Non-covered service submitted for FI review (condition code 20 from header information on claim)",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "12",
          "display" : "Questionable covered service",
          "definition" : "Questionable covered service",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "13",
          "display" : "Additional payment for service not provided by Medicare",
          "definition" : "Additional payment for service not provided by Medicare",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "14",
          "display" : "Code indicates a site of service not included in OPPS",
          "definition" : "Code indicates a site of service not included in OPPS",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "15",
          "display" : "Service unit out of range for procedure",
          "definition" : "Service unit out of range for procedure",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "16",
          "display" : "Multiple bilateral procedures without modifier 50 (see Appendix A)",
          "definition" : "Multiple bilateral procedures without modifier 50 (see Appendix A)",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "17",
          "display" : "Multiple bilateral procedures with modifier 50 (see Appendix A)",
          "definition" : "Multiple bilateral procedures with modifier 50 (see Appendix A)",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "18",
          "display" : "Inpatient procedure",
          "definition" : "Inpatient procedure",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "19",
          "display" : "Mutually exclusive procedure that is not allowed even if appropriate modifier present",
          "definition" : "Mutually exclusive procedure that is not allowed even if appropriate modifier present",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "2",
          "display" : "Diagnosis and age conflict",
          "definition" : "Diagnosis and age conflict",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "20",
          "display" : "Component of a comprehensive procedure that is not allowed even if appropriate modifier present",
          "definition" : "Component of a comprehensive procedure that is not allowed even if appropriate modifier present",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "21",
          "display" : "Medical visit on same day as a type \"T\" or \"S\" procedure without modifier 25 (see Appendix B)",
          "definition" : "Medical visit on same day as a type \"T\" or \"S\" procedure without modifier 25 (see Appendix B)",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "22",
          "display" : "Invalid modifier",
          "definition" : "Invalid modifier",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "23",
          "display" : "Invalid date",
          "definition" : "Invalid date",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "24",
          "display" : "Date out of OCE range",
          "definition" : "Date out of OCE range",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "25",
          "display" : "Invalid age",
          "definition" : "Invalid age",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "26",
          "display" : "Invalid sex",
          "definition" : "Invalid sex",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "27",
          "display" : "Only incidental services reported",
          "definition" : "Only incidental services reported",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "28",
          "display" : "Code not recognized by Medicare; alternate code for same service available",
          "definition" : "Code not recognized by Medicare; alternate code for same service available",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "29",
          "display" : "Partial hospitalization service for non-mental health diagnosis",
          "definition" : "Partial hospitalization service for non-mental health diagnosis",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "3",
          "display" : "Diagnosis and sex conflict",
          "definition" : "Diagnosis and sex conflict",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "30",
          "display" : "Insufficient services on day of partial hospitalization",
          "definition" : "Insufficient services on day of partial hospitalization",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "31",
          "display" : "Partial hospitalization on same day as ECT or type \"T\" procedure",
          "definition" : "Partial hospitalization on same day as ECT or type \"T\" procedure",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "32",
          "display" : "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" : "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" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "33",
          "display" : "Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services",
          "definition" : "Partial hospitalization claim spans more than 3 days with insufficient number of days having mental health services",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "34",
          "display" : "Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria",
          "definition" : "Partial hospitalization claim spans more than 3 days with insufficient number of days meeting partial hospitalization criteria",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "35",
          "display" : "Only activity therapy and/or occupational therapy services provided",
          "definition" : "Only activity therapy and/or occupational therapy services provided",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "36",
          "display" : "Extensive mental health services provided on day of ECT or significant procedure",
          "definition" : "Extensive mental health services provided on day of ECT or significant procedure",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "37",
          "display" : "Terminated bilateral procedure or terminated procedure with units greater than one",
          "definition" : "Terminated bilateral procedure or terminated procedure with units greater than one",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "38",
          "display" : "Inconsistency between implanted device and implantation procedure",
          "definition" : "Inconsistency between implanted device and implantation procedure",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "39",
          "display" : "Mutually exclusive procedure that would be allowed if appropriate modifier were present",
          "definition" : "Mutually exclusive procedure that would be allowed if appropriate modifier were present",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "4",
          "display" : "Medicare secondary payer alert",
          "definition" : "Medicare secondary payer alert",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "40",
          "display" : "Component of a comprehensive procedure that would be allowed if appropriate modifier were present",
          "definition" : "Component of a comprehensive procedure that would be allowed if appropriate modifier were present",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "41",
          "display" : "Invalid revenue code",
          "definition" : "Invalid revenue code",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "42",
          "display" : "Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)",
          "definition" : "Multiple medical visits on same day with same revenue code without condition code G0 (see Appendix B)",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "5",
          "display" : "E-code as reason for visit",
          "definition" : "E-code as reason for visit",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "6",
          "display" : "Invalid procedure code",
          "definition" : "Invalid procedure code",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "7",
          "display" : "Procedure and age conflict",
          "definition" : "Procedure and age conflict",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "8",
          "display" : "Procedure and sex conflict",
          "definition" : "Procedure and sex conflict",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        },
        {
          "code" : "9",
          "display" : "Nov-covered service",
          "definition" : "Nov-covered service",
          "property" : [
            {
              "code" : "versionIntroduced",
              "valueString" : "2.4"
            }
          ]
        }
      ]
    }